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The Hospitality Promise

Sitting in my Nanjing inn on a blustery day, amid my third visit to China, I’m struck again by the acknowledgment that accommodation isn’t only the domain of “the friendliness business” – informal lodging, inns, resorts, event congregations, or eateries. It’s likewise not socially needy, however culture assumes a job in making others feel welcome, great and at home. This is the third inn in which I’ve remained in the same number of months, and I have had a wide scope of accommodation encounters.

One lodging was so dull, even with every one of the lights on, I couldn’t peruse the numbers on my bag bolt to get it open, so I depended on utilizing the spotlight application on my telephone for the required light; poor cordiality. In another lodging, each worker I experienced demonstrated their gratefulness for my essence with grins, benefit, and some of the time even a major thank you; first class cordiality. Baggage deferred from the air terminal was conveyed directly to our stay with a grin; immaculate friendliness.

Possibly those don’t appear enormous signals of cordiality, or “un-accommodation”, yet that is a piece of the point. What appears as though nothing to one individual will appear to be a unimaginably expansive signal by another.

As a B&B landlord your day by day activities seem to be (or ought to be) the exemplification of cordiality; that is a ton of what brings your visitors back and makes them prescribe to loved ones your hotel as the place to go. Neatness and great sustenance help, in any case it’s the administration, the neighborliness, that influences your business to sing and sparkle. Would you be able to accomplish more than you are doing?

Lodgings can here and there endeavor to copy that B&B accommodation, and some even succeed, yet they regularly come up short. Insufficient appointment of capacity to the general population on the cutting edge, and principle loaded and accountant controlled arrangements meddle with the common stream of accommodation. It frequently appears to me that inns simply couldn’t care sufficiently less to consider offering the support of their visitors that carries them back with euphoria.

Cordiality Outside the Lodging Industry

In a more extensive center, I believe that any business which interfaces with individuals is in the accommodation business. Get much social insurance? Specialists, attendants, and front work area individuals would profit by giving careful consideration to politeness, and regarding their patients as though they matter! They could offer neighborliness alongside their medicinal services and be well in front of the challenge.

Travel any? Aircrafts, train and transport organizations, and cabs could pick up something about client administration and thinking about individuals. Eateries can miss the mark regarding the check too. Accommodation is a simple method to separate yourself and take clients back to you.

Similar remains constant for event congregations, greens and fitness centers, amble yards and building supply yards, shoe fix shops, supermarkets and drug stores, gems stores, telephone and service organizations, book shops, and even cinemas; they would all be able to profit by applying fundamental accommodation to their plan of action to keep their clients cheerful and returning. McGuckin Hardware, a long-term Boulder, Colorado, handyman shop, used to have awesome client benefit; any representative of the store knew where anything you were getting some information about was found. They have developed so enormous that I find that is not the case any longer, but rather they in any event realize who to request to enable you to discover what you are searching for, and afterward stroll to you where it is to enable you to find it. That is friendliness in my book.

I have since a long time ago utilized the West Point Grocery store in Akron, Ohio, as a prime case of market specialty definition and finish – they reliably follow up on what they’ve characterized. It’s jumped out at me that they additionally show breathtaking cordiality – they are consistent with themselves and approach their customers with deference. When you go to that store, which doesn’t look like much from the road, or even the parking area, and venture inside, you are transported into a supernatural land. Not exclusively is the quality first class, yet the staff welcomes you and offers to help. The store is spread out so as to enable you to discover what you need effectively, and on the off chance that you can’t discover it there are various individuals working there who are happy to help. You are guaranteed perfection, and you get it. Accommodation overflows from each side of that store, and from each worker. For what reason can’t different business do that?

Greatness doesn’t need to mean highbrow and costly. Perfection implies the best of what you guarantee to offer. In the event that that implies you guarantee the best scratch and dent section items and costs, that is what is given. In the event that it implies you guarantee the best 7-star understanding, that is the thing that it is. Hell, Durgin Park in Boston guarantees surly servers, and that is the thing that you get – and cherish it when it occurs! Cordiality is thinking about your clients, and the administration of giving to the dimension of that guarantee. In the event that you need to be known as the Surly B&B, and individuals need that, take the plunge and do it well.

While distinctive societies have diverse methods for appearing and administration, despite everything you know it when you have been treated as though you matter. Maybe the Chinese don’t make enormous outward appearances or utilize huge hand signals to convey, yet regardless you perceive a warm welcome when you see it.

You likewise know when you have been dealt with like soil, or that you don’t make a difference, or that you are just a feast ticket to the individual giving administration (or not). It doesn’t make a difference where you are the point at which you encounter that sort of poor administration, you don’t care for it and won’t be back on the off chance that you have any control in the issue. Your visitors feel a similar way.

How To Select The Right Hospital For Your Treatment

In a crisis, your life relies upon getting to the closest emergency clinic. Be that as it may, when you have a choice to prepare, choosing the correct clinic for your treatment has a significant effect. It not just gives you the certainty that you are in great hands, yet additionally makes your stay at the emergency clinic justified, despite all the trouble. The best medical clinics have the best of everything. They have the correct specialists ready, the best care staff, the stand out therapeutic hardware and foundation. On the off chance that you are choosing a clinic for your treatment, here are a couple of tips on the most proficient method to choose the best medical clinic:

Look at clinic appraisals

Appraisals are a decent place to begin your examination. All things considered, regardless of whether there aren’t such a large number of emergency clinics in your general vicinity to think about, evaluations give you a reasonable thought regarding the administrations you can hope to get. Clinics are by and large evaluated utilizing the accompanying variables:

· Patient encounters – quiet encounters with the specialist, the care staff and other emergency clinic individuals does make a difference. Patient’s sentiment about the tidiness of the emergency clinic and its upkeep likewise influences medical clinic evaluations.

· Patient results – tolerant results are an essential factor in rating clinics. The occasions a patient must be re-conceded for a similar illness and so forth has any kind of effect in medical clinic evaluations.

· Hospital practices and Safety scores assume a noteworthy job in affecting the rating of a medical clinic.

Along these lines, evaluations are not simply some arbitrary numbers, they could be of incredible help when you wish to choose an emergency clinic for your treatment.

Converse with past patients

It is a smart thought to get input from patients in regards to the emergency clinic. They will have the capacity to give you precise data of how the rooms were kept and how cordial or hostile the attendants were and how expertly the specialist finished the treatment. Converse with somebody who has encountered it direct and you will show signs of improvement thought of which emergency clinic to choose.

Look at specialist’s profiles

Truth be told check this before you check whatever else. It is essential to look at the specialists locally available before you conclude a medical clinic. On the off chance that you are searching for a heart medical procedure, look at the heart specialists working at that emergency clinic either fulltime or on a for every visit premise. It is a smart thought to get to know the specialists treating you.

Medical clinic strength

At last, choose whether you wish to choose a strength emergency clinic or a multispecialty medical clinic. Claim to fame medical clinics give administrations to only one kind of treatment, for example, ‘Heart Hospital’. Multispecialty emergency clinics can treat a fluctuated sort of diseases.

At long last, ensure that you waitlist a couple of emergency clinics in your general vicinity and really visit them. Converse with the staff and look at the rooms. You can likewise look at their sites or web-based social networking pages to get more data. The tributes composed by the patients are critical as well. Look at them before you choose! Think about every one of the focuses and after that select the best emergency clinic for your treatment.

Using Psychology When You Take a Child to the Hospital

Likely the most vital thing to remember when you take a youngster to medical clinic is your consistent confirmation that he/she isn’t the only one in the experience. What’s more, I signify “steady”. You ought to never, not notwithstanding for a minute, permit any trace of the youngster being separated from everyone else to crawl into your discussions.

Kid brain science is a significant subject, and you may not understand that even an evidently guiltless utilization of things to come tense when you converse with the youngster may offer ascent to some sub-cognizant shock in his/her psyche. In this way, for instance, say “The attendants are continually looking out for you, even while you’re snoozing.”, as opposed to “The medical caretakers will dependably be looking out for you, even while you’re sleeping.” If you can’t see the subtlety in the impact of these two different ways of saying a similar thing, it would be ideal if you simply trust me: they are extraordinary.

Except if the conditions are uncommon, it is far-fetched that the two guardians can remain with a kid in emergency clinic for the term of the treatment. On the off chance that it’s unrealistic for somewhere around one parent to be there whenever, do attempt to orchestrate a grandparent, sibling, sister, auntie, uncle, cousin, companion, and so forth to cover for you. On the off chance that there are any holes, do set up your tyke ahead of time for them by saying that he/she can make new companions in the clinic ward. “It’s energizing to make new companions, and you can keep on observing each other when you return home!”

Keeping a Child Occupied in Hospital

Fatigue isn’t an Option!

It is fundamental for a youngster in clinic to have natural articles close within reach, be they toys, books, a most loved cover, and so forth. (Guarantee that each such thing is perfectly spotless before you take the kid to the medical clinic.) Such things comfort the youngster in new environment. Mentally, well-known things alone once in a while accomplish a 100% impact to stay away from weariness, in light of their very commonality. In a perfect world, there should be some new thing or things which are given to the tyke extraordinarily in light of the fact that he/she is going to medical clinic. This is to animate the tyke’s brain, as particular from bringing solace. This additionally gives a motivation to the youngster to go to clinic, instead of a hesitance.

The “Along these lines, You’re Going to Hospital” booklet is perfect for this reason. In the event that the tyke winds up exhausted in emergency clinic, his/her mind will meander to the genuine motivation behind why he/she is there. You absolutely don’t need that to occur!

A Hospital Adventure

The Difference among Positive and Negative

For a youngster, going to medical clinic ought not be an occasion to fear, but rather one to anticipate. How your youngster sees the visit is in your grasp, as a parent. Stress the positive things, and play down or dodge the negative viewpoints. Discussion about the consequences of the treatment, instead of the purposes behind the treatment. For example, “When you get back home, you can participate in games/eat dessert/(whatever).”, instead of “The specialists will remove the agony no doubt about it.” “You won’t have to take those pills any more.” Are you getting the thought?

The Distraction Ruse

Make the looming visit to the emergency clinic sound fascinating; like an experience. Most youngsters have a focused nature. On the off chance that you can occupy your tyke’s brain from the genuine purpose behind the medical clinic visit, it’ll all be over before you know it. The “In this way, You’re Going to Hospital” booklet can accomplish both of these points; Your youngster’s visit to the medical clinic can appear both an experience and a challenge. Either print out numerous duplicates of it from the downloadable form, or request a few printed duplicates of it, and hand them out to alternate children in a similar ward, and guide them with it. Obviously, you’ll murmur “mystery” counsel to your tyke, with the goal that he/she can win. That’ll make him/her significantly increasingly energized!

The Importance of Information about the Hospital

Children are not Fools

There’s no point attempting to trick a kid about the motivation behind why medical clinics exist. They are for relieving ills, patching bones, and so forth. They are not play areas or fun spots for “rest overs”. In the event that you deceive your tyke in that way, it might have an unfavorable impact when he/she finds reality from other kids in the emergency clinic whose guardians have not perused this page. The impact may even be horrendous. In case you’re enticed to pursue that way, reconsider.

Clearly, advising an offspring of the subtleties of the approaching activity or the drug is probably going to have a similarly horrendous impact. Endeavor to strike a harmony between the two boundaries. Preferably, the measure of data to provide for a kid going to medical clinic ought to be sufficiently only to pre-empt him/her from making clumsy inquiries. On the off chance that a kid asks a first inquiry, you can anticipate more inquiries. This you would prefer not to occur. It is a dangerous slant to either stressing the tyke with such a large number of terrible subtleties or to deluding him/her. You can fathom this potential predicament by utilizing the “Thus, You’re Going to Hospital” booklet, extraordinarily intended for the reason.

The Hospital Through the Eyes of a Child

By their temperament, emergency clinics are typically obvious, approaching, overwhelming structures which can impart fear into a susceptible youngster. Indeed, even joyously shaded illustrations on the inside dividers can’t mask the perpetuation and slenderness of the passageways. A portion of the machines on view, which grown-ups see as innocuous, may appear to a kid to be like a weapon utilized by an insidious warlord in a sci-fi animation.

It’s not just the medical clinic building and the machines which can make a youngster apprehensive; emergency clinics likewise contain interesting looking individuals: specialists, attendants, doormen pushing trolleys and wheelchairs, old and youthful patients in their night wear. You and I barely bat an eyelash at the prospect of such sights, however envision them through the eyes of a tyke, particularly if it’s the tyke’s first visit to a clinic!

Sadly, there’s nothing one can do to keep away from these sights. The main arrangement is satisfactory planning by telling, or even better, by demonstrating the youngster what he/she will find in clinic. This is the place the “Along these lines, You’re Going to Hospital” booklet can help. To be sure, it is significant in this regard, since it takes all the diligent work and thought off your hands for you.

The Most Important Person in the Hospital

At the point when a kid goes to medical clinic, he/she is contemplating guardians, companions, school. Highest in a tyke’s psyche is ME. What’s going on to ME? That is the reason the “In this way, You’re Going to Hospital” booklet puts forth an admirable attempt to make “ME” the most vital and uncommon individual in the clinic; the fundamental character in the experience; the hot most loved in the challenge.

Whatever the purpose behind your visit, when you take a kid to emergency clinic, you should have the capacity to utilize every one of your faculties and think in the manner in which your kid does. It is no simple undertaking, in any case, in the event that you succeed, it very well may be a less upsetting background for both you and your youngster.

How to Find the Best Hospitals Abroad

When you need to travel abroad, you have to comprehend what sort of things, individuals or surroundings that you will be managing. To be sheltered and to figure out how to anchor you in an obscure nation stands essential. Do inquire about, before you’re restorative travel will assume an essential job in the accomplishment of your outing. Research should be done on the quantity of medical clinics, medications that they offer, area and other fundamental perspectives, for example, settlement, transport medium, and so forth. In any case, finding the correct medical clinic, specialist and treatment is important as you can’t give your wellbeing a chance to be in question. As Medical Tourism has become prominent, there are numerous emergency clinics that you may discover, however you have to limit on them as you need to choose the best clinic for the Medical Treatment.

Rundown down the quantity of emergency clinics that you find online at the place that you intend to visit.

When you have done this, go for research to think about the accompanying focuses for every single medical clinic in your rundown.

Cost:

Keep yourself adaptable with numerous alternatives and think about the costs of flights, clinic medicines, convenience, and so forth. On the off chance that you discover a place where the flight tickets are expensive, yet the medications are reasonable at that point pick that put in light of the fact that the ulterior rationale is to get great quality treatment that gives a decent reaction to the wellbeing and fulfills you. Looking at the Prices will likewise give you a harsh thought of how much cash you will need and enable you to do the planning as needs be. This will additionally enable you to have a peaceful outing where all you have to focus on simply the treatment. A few medications must be exorbitant and different things will be moderate, here on the off chance that you get a decent quality treatment with guaranteed enhancement, don’t reconsider this.

Area:

The area of your emergency clinic is an imperative angle to take a gander at. While going for medicinal medications, one must choose a quiet, beautiful scene for it loosens up the psyche and body and would satisfy the therapeutic traveler or patient. There are numerous medical clinics that are situated at excellent places and have a tranquil domain with numerous exercises for the two grown-ups and kids to take a break like playing in the garden, and so on. Henceforth, area of the emergency clinic matters a great deal. The patient ought to be in a cheerful situation, the recuperation winds up successful and rapidly. Likewise, ensure you have different offices encompassing the medical clinic like Pharmacy, Hotels, ATM, and so on. Along these lines, you have a simple access to everything at whatever point you require it.

Quality:

Whatever administration or item it might be, we generally take a gander at how quality compelling it is. It is essential to benefit a decent quality treatment, regardless of on the off chance that you need to pay more for that. Quality accompanies positive outcomes. Take the assistance of a Medical Tourism Consultant or any individual who has been to that emergency clinic to discover which medical clinic offers top notch medications and gives square with consideration regarding each patient who is there? There are high odds of hazard to wellbeing or life in the event that you get low quality treatment and one must be extremely watchful while choosing a medical clinic as it ought to be veritable. Along these lines, converse with the greatest number of individuals as you can or employ an advisor to have somebody close by who will bolster you all through the medicinal treatment.

Notoriety:

We as a whole go to all around presumed puts as their administrations, mood and medications are among the best that fulfills us. While choosing an emergency clinic, ensure that it has great name and notoriety among the neighborhood individuals and individuals who have been visited and treated at the medical clinic. You can search for tributes if there are any on the medical clinic’s site or request to be associated with a couple of patients who have visited the emergency clinic. When you are there, you can converse with individual individuals or patients at the emergency clinic and find about its notoriety. You can locate a decent enhancement in the condition just at rumored emergency clinics as they have confirmed and experienced specialists.

Offices:

Aside from the world class treatment that you get from the emergency clinic, it is constantly valuable to perceive what different offices they have. For example, the clinic ought to have all advanced gear and should offer a wide range of testing, determination, and so forth. You can visit their site to know the offices that they give. They ought to have a progressed and present day gear for your treatment procedure. Concentrate these at different emergency clinics identifying with your treatment procedure and pick the best one. Having every one of the methods under one rooftop will be less tiring and less tedious. Think about this while choosing your emergency clinic so you don’t need to move around much and the treatment is sans bother. The medical clinics ought to have very much prepared rooms and space to oblige every one of the patients and ought to be distributed with crisis rooms and different necessities.

Claims to fame:

Each best medical clinic will be generally known for something specifically. For instance, a malignant growth understanding should be dealt with and the emergency clinic chose is had some expertise in treating disease then you are at the ideal place. Similarly there will be medical clinics that have practical experience in a specific field, for example, nervous system science, dermatology, and so forth. The best medical clinics have confirmed staff, experts and best specialists who can serve you are the best and enhance your wellbeing. So search for these claims to fame at various medical clinics and go to the one that suits your wellbeing condition well. Ensure that you are given decisions and meet the specialists by and by, talk about the wellbeing condition and afterward proceed with the treatment.

Security:

You should avoid potential risk and require some additional push to find that the administrations are certified and safe. Any treatment or testing ought not cause any issues or damage your wellbeing. Ensure that you are dependably in numbers while the treatment happens. The medical clinics ought to have Safety starts things out arrangement and give you a protected situation, treatment, confided in specialist and staff. The instruments utilized for testing ought to be new or sanitized completely. So select the best and authentic emergency clinic where they really care for you and not play around with your wellbeing.

Voyaging Distance:

In spite of the fact that you may feel that voyaging use isn’t critical, yet it counts as you do put in some measure of cash to travel starting with one place then onto the next. The expense of voyaging may be less, however toward the finish of your trek you will see that you spent very some measure of cash only to travel. You should keep yourself refreshed with the sort of transport that is accessible in the city you are in and ought to have little learning about the expense for nobody tricks you. It is prudent to take settlement at a lodging adjacent the clinic so you probably won’t need to spend much and if there should arise an occurrence of a crisis, you can get to all the more rapidly keeping away from the long separation travel that takes up a great deal of time.

The travel industry Opportunities:

When you are at an emergency clinic, it doesn’t imply that you will just focus on the treatment, you will be strained reasoning and agonizing over everything times. A patient isn’t encouraged to invest all the energy in the treatment yet in addition occupy the brain as it is imperative for them to be upbeat and keep their mind quiet. So imagine a scenario where you are on a Medical Travel. You can generally take some time out have a fabulous time and investigate the place as once in a while do individuals motivate an opportunity to fly abroad and it’s few out of every odd day that you inspire the chance to invest some quality energy with family. Select a city where there are many touring places and where you could learn and investigate about the place.

Analyze the best medical clinics among one another as contrasting from an all around rumored with a facility that has no equivalent guidelines isn’t doing equity or being implausible. The above parameters may be tedious, however you will be happy to have done it when you are on your visit as it will just help you at each stage and execute the arrangement in a very much planned way.

You merit the best so select the best and have an effective and brilliant Medical Travel. Doing as such much research may be troublesome in the event that you have not a solitary thought regarding it so enlist a Medical Tourism Consultant for yourself who will make things less demanding for your Medical travel.

The Sickly State of Public Hospitals

There are many types of hospitals but the most well known are the Public Hospitals. What sets them apart is that they provide services to the indigent (people without means) and to minorities.

Historically, public hospitals started as correction and welfare centres. They were poorhouses run by the church and attached to medical schools. A full cycle ensued: communities established their own hospitals which were later taken over by regional authorities and governments – only to be returned to the management of communities nowadays. Between 1978 and 1995 a 25% decline ensued in the number of public hospitals and those remaining were transformed to small, rural facilities.

In the USA, less than one third of the hospitals are in cities and only 15% had more than 200 beds. The 100 largest hospitals averaged 581 beds.

A debate rages in the West: should healthcare be completely privatized – or should a segment of it be left in public hands?

Public hospitals are in dire financial straits. 65% of the patients do not pay for medical services received by them. The public hospitals have a legal obligation to treat all. Some patients are insured by national medical insurance plans (such as Medicare/Medicaid in the USA, NHS in Britain). Others are insured by community plans.

The other problem is that this kind of patients consumes less or non profitable services. The service mix is flawed: trauma care, drugs, HIV and obstetrics treatments are prevalent – long, patently loss making services.

The more lucrative ones are tackled by private healthcare providers: hi tech and specialized services (cardiac surgery, diagnostic imagery).

Public hospitals are forced to provide “culturally competent care”: social services, child welfare. These are money losing operations from which private facilities can abstain. Based on research, we can safely say that private, for profit hospitals, discriminate against publicly insured patients. They prefer young, growing, families and healthier patients. The latter gravitate out of the public system, leaving it to become an enclave of poor, chronically sick patients.

This, in turn, makes it difficult for the public system to attract human and financial resources. It is becoming more and more destitute.

Poor people are poor voters and they make for very little political power.

Public hospitals operate in an hostile environment: budget reductions, the rapid proliferation of competing healthcare alternatives with a much better image and the fashion of privatization (even of safety net institutions).

Public hospitals are heavily dependent on state funding. Governments foot the bulk of the healthcare bill. Public and private healthcare providers pursue this money. In the USA, potential consumers organized themselves in Healthcare Maintenance Organizations (HMOs). The HMO negotiates with providers (=hospitals, clinics, pharmacies) to obtain volume discounts and the best rates through negotiations. Public hospitals – underfunded as they are – are not in the position to offer them what they want. So, they lose patients to private hospitals.

But public hospitals are also to blame for their situation.

They have not implemented standards of accountability. They make no routine statistical measurements of their effectiveness and productivity: wait times, financial reporting and the extent of network development. As even governments are transformed from “dumb providers” to “smart purchasers”, public hospitals must reconfigure, change ownership (privatize, lease their facilities long term), or perish. Currently, these institutions are (often unjustly) charged with faulty financial management (the fees charged for their services are unrealistically low), substandard, inefficient care, heavy labour unionization, bloated bureaucracy and no incentives to improve performance and productivity. No wonder there is talk about abolishing the “brick and mortar” infrastructure (=closing the public hospitals) and replacing it with a virtual one (=geographically portable medical insurance).

To be sure, there are counterarguments:

The private sector is unwilling and unable to absorb the load of patients of the public sector. It is not legally obligated to do so and the marketing arms of the various HMOs are interested mainly in the healthiest patients.

These discriminatory practices wreaked havoc and chaos (not to mention corruption and irregularities) on the communities that phased out the public hospitals – and phased in the private ones.

True enough, governments perform poorly as cost conscious purchasers of medical services. It is also true that they lack the resources to reach a substantial segment of the uninsured (through subsidized expansions of insurance plans).

40,000,000 people in the USA have no medical insurance – and a million more are added annually. But, there is no data to support the contention that public hospitals provide inferior care at a higher cost – and, indisputably, they possess unique experience in caring for low income populations (both medically and socially).

So, in the absence of facts, the arguments really boil down to philosophy. Is healthcare a fundamental human right – or is it a commodity to be subjected to the invisible hand of the marketplace? Should prices serve as the mechanism of optimal allocation of healthcare resources – or are there other, less quantifiable, parameters to consider?

Whatever the philosophical predilection, a reform is a must. It should include the following elements:

Public hospitals should be governed by healthcare management experts who will emphasize clinical and fiscal considerations over political ones. This should be coupled with the vesting of authority with hospitals, taking it back from local government. Hospitals could be organized as (public benefit) corporations with enhanced autonomy to avoid today’s debilitating dual effects: politics and bureaucracy. They could organize themselves as Not for Profit Organizations with independent, self perpetuating boards of directors.

But all this can come about only with increased public accountability and with clear measuring, using clear quantitative criteria, of the use of funds dedicated to the public missions of public hospitals. Hospitals could start by revamping their compensation structures to increase both pay and financial incentives to the staff.

Current one-fits-all compensation systems deter talented people. Pay must be linked to objectively measured criteria. The Hospital’s top management should receive a bonus when the hospital is accredited by the state, when wait times are improved, when disrollment rates go down and when more services are provided.

To implement this (mainly mental) revolution, the management of public hospitals should be trained to use rigorous financial controls, to improve customer service, to re-engineer processes and to negotiate agreements and commercial transactions.

The staff must be employed through written employment contracts with clear severance provisions that will allow the management to take commercial risks.

Clear goals must be defined and met. Public hospitals must improve continuity of care, expand primary care capacity, reduce lengths of stay (=increase turnaround) and meet budgetary constraints imposed both by the state and by patient groups or their insurance companies.

All this cannot be achieved without the full collaboration of the physicians employed by the hospitals. Hospitals in the USA form business joint ventures with their own physicians (PHO – Physicians Hospital Organizations). They benefit together from the implementation of reforms and by the increase of productivity. It is estimated that productivity today is 40% less in the public sector than in the private one. This is a dubious estimate: the patient populations are different (sicker people in the public sector). But even if the figure is incorrect – the essence is: public hospitals are less efficient.

They are less efficient because of archaic scheduling of patient-doctor appointments, laboratory tests and surgeries, because of obsolete or non-existent information systems, because of long turnaround times and because of redundant lab tests and medical procedures. The support – which exists in private hospitals – from other (clinical and nonclinical) personnel is absent because of impossibly complex labour rules and job descriptions imposed by the unions. Most of the doctors have split loyalties between the medical schools in which they teach and the various hospital affiliates. They would tend to neglect the voluntary affiliates and contribute more to the prestigious ones. Public hospitals would, therefore, be well advised to hire new staff, not from medical schools, share risks with its physicians through joint ventures, sign contracts with pay based on productivity and put physicians in the governing boards. In general, the hospitals must shrink and re-engineer the workforce. About half the budget is normally spent on labour costs in private hospitals – and more than 70% in public ones. It is no good to reduce the workforce through natural attrition, mass layoffs, or severance incentives. These are “blind”, nondiscriminating measures which affect the quality of the care provided by the hospital. When compounded by work rules, seniority systems, job title structures and skewed grievance procedures – the situation can get completely out of hand.

The government must contribute its part. Public hospitals cannot comply or compete with the demands of national, publicly traded HMOs with political clout and the capacity to raise capital to finance hyper-sophisticated marketing. Public policy must be written to support “safety net” institutions. They must be allowed to organize their own MCOs (Managed Care Organizations of patients), to insure patients and to market their services directly to groups of potential consumers. This way they will save the 20% commission that they are paying HMOs currently. If they become more efficient and reduce utilization, they will absorb the full benefits, instead of ceding them to contracting groups of patients and insurance companies or even to the government’s medical insurance plans. The hospitals will thus be able to construct their own networks of suppliers and share their risks with their physicians or with the insurance companies as best suits their objectives.

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