Organizational change in public hospitals: From the bureaucratic to the participatory model of management

OBJECTIVE Investigation of the ways of changing from the bureaucratic model to the participatory model of management in public hospitals, based on modern techniques and methods of organization and administration. METHOD The study was conducted using the Delphi qualitative research method with a team of 10 experts specializing in health services management, in two cycles of questions. The degree of consensus among the participants reached 90%. RESULTS Change from the bureaucratic to the participatory model of management is possible if organizational changes can be brought about in the philosophy (values and attitudes) of both the leadership and the employees and the emotional involvement of the employees in their work, and if there is effective implementation of cycles of quality, creation and development of a culture of quality and responsibility, adoption of a global budget, introduction of modern hospital technology and elimination of bureaucracy, with the support of the Ministry of Health for all these efforts. The experts consider the assignment to leadership positions based on merit in public hospitals to be equally important for a successful transition to the participative model of management. Leaders should possess formal qualifications and a thorough knowledge of the health sector, with a scientific perspective favoring the systemic approach. CONCLUSIONS The steps that the team of experts has suggested will be expected to enhance the establishment of a quality hospital culture focusing on both patient safety and satisfaction and employee satisfaction, and to transform the public hospital into a learning organization that promotes public values. Such a learning organization would be a modern organization that inspires innovative and growth-oriented organizational behavior, characterized by respect in every action of both leadership and its members.