Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.
BACKGROUND
Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality.


METHODS
We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic).


RESULTS
The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001).


CONCLUSIONS
It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.
Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA, lmfunk@wisc.edu.
Luke M
LM
Funk
Dante M
DM
Conley
William R
WR
Berry
Atul A
AA
Gawande
D017954:Africa South of the Sahara; D013502:General Surgery / Q000458:organization & administration*; D006297:Health Services Accessibility; D006739:Hospital Administration; D006801:Humans; D007407:Interviews as Topic; D010865:Pilot Projects