Abstract
Autonomize Process of Banphaew Hospital The autonomization process of Banphaew hospital is a long continuous evolution process. Initiated by community participated in hospital administration in the past to organization reform recently. The objective of this study is to observe and analyze the interaction between each stakeholders with system transformation process. The data was obtained by literature review, questionnaire, focus group interview and in depth interview. The study revealed that there was the delay of the autonomization process and there are many important episode occurred between the process. Six issues were taken into consideration in the following aspects:Decrease administration complexity new national gazette that would establish new organization structure that is more efficient. The inventory process is to be kept easy and the organization can initiate new innovative according to the need of the population. Ex: the join venture with pharmaceutical company to manage the drug procurement and delivery process, the join venture with Banphaew municipal to construct public swimming pool.Improve resource allocation As an autonomous hospital, Banphaew hospital has freedom to manage its own human resource according to need. There was a sharply increase in accountants, public relation. There was a sharply decrease in cook, and low skill labors. The hospital is financed with capitation budget 782 baht per registered person. This excludes civil servant and people who are in social security scheme. The hospital is the main contractor of the budget; therefor the hospital allocates the budget to health centers.Increase effectiveness and efficiency As an autonomous hospital, Banphaew has freedom to design the remuneration processes that relates with performance. This maximizes organization effectiveness. Before being autonomous, the hospital was in depth, compared to after being autonomous which the profit from four month operation was around 4 to 6.4 million baht. However, after investigation we found that there was some revenue from special ex-province project; such as physical examination of the immigrant, which brought 6.7 million baht to the hospital.Increase accountability the autonomization process included the commitment to service with continuous quality improvement. The public acknowledgement about the new autonomous hospital commitment was due to universal coverage policy of the government that emphasizes the evaluation process. Because of the delay of the whole process, the executive board accountability cannot be evaluated as intended. The accountability that the other supported government agency should commit to the autonomization process of Banphaew was related to political agenda.Political compliance before the gazette was approved there was a split between the pro and the con, which create the day of the whole process. However, the hospital was autonomized by the support from several public agencies. At district level, there formed controversial groups and there was a demonstration at district level due to autonomous process. The chaos period within the hospital during the transformation was also related to the ex-hospital controversial. However, after the 6th of January election, the government that was led by Tasking Chinawatra announced health policy that highly supported autonomous hospital and the other stakeholder pay more attention as well as being more supportive to Banphaew hospital.Increase community participation Banphaew community was participated a hospital administration board even before autonomization process and there was a good relation between the hospital and the Rotarian. Four months after autonomization, the executive board from community is still under searching and appointing process. The uncertainty of the other stakeholder prohibited Banphaew hospital from running the public campaign about the change. The change of the government to government that won landslide vote by universal health coverage campaign created public health concern in the country, which was the best propaganda for Banphaew hospital.The autonomization process Banphaew hospital should be investigate more to follow the change systematically to answer the question whether the change to autonomous hospital was really good for the organization, policy, and the health of the whole population.
