Autonomy at Zammit Clapp Hospital

Abstract

This study was motivated by the fact that although Zammit Clapp Hospital was opened in 1991, as a 'pilot project' upon which the structure of future hospitals would be based if outcomes were successful, the implementation of autonomy in the piloted hospital has not been followed up by any research. The study utilized qualitative, historical and quantitative research in a time-series framework and involved both management and patients' input with the aim of investigating the nature and extent of autonomy given to the hospital in terms of strategic, administrative, financial and human resource management and procurement. It also sought to establish whether the degree of accountability, efficiency and quality of care is dependent on the nature and extent of autonomy given and whether these achievements are at the expense of equity. What are the pitfalls of giving autonomy to hospitals and are there any lessons to be learnt from this experience? Many perceive the experiment as successful. However, studies on hospital autonomy in other countries show conflicting outcomes. Findings indicate that quality of care and patients' outcomes are high as can be seen by the patient satisfaction questionnaire findings and the improvements in the Barthel Index Scale. Findings also imply that changes in Governments accompanied by changes to hospital policies to reflect the new Government's approach have a negative impact on autonomy. The complete turnover of Hospital Management Committee members for the third time in 1998 may have given hospital management the initial impetus to motivate the teams as is evident by the achievements of 1999. Yet to many of them, the extent of managerial responsibility for the hospital's operations on a day-to-day basis remains unclear. In times of instability, managerial activity inevitably slows down and professional managers tend to revert to their role of technical specialists as is evident by the sustained level of quality of care. So while initially the autonomy status served as an incentive for the management team, the changes due to politics have resulted in management being cautious in decision-making. Furthermore, while autonomy has not been at the expense of equity, the lack of devolvement of decision powers at departmental management levels has served as a deterrent to the achievement of the full benefits of autonomy in terms of efficiency and accountability.