Medical education and autonomy in teaching hospitals

Introduction. Despite the implementation of hospital autonomy in many developed (France, Denmark) and developing countries(Ghana, Zimbabwe, Kenya and Indonesia) since the early 1980s , relatively little research has been directed towards evaluating the experiences of these hospitals .Efficiency, equity, accountability and quality of care can be considered as four main evaluative criteria in assessing hospital autonomy while achieving these goals are not easy for autonomous public sector hospitals ,it is even more difficult to obtain for teaching ones. Methods. We present the views obtained by two separate studies 1- Hospital autonomy experiences in other countries 2- Interview with Deans and faculty members of medical schools in our country during 2001. Hospital autonomy in teaching hospitals in Ghana and Zimbabwe have been evaluated by a group of investigators of Harvard University and published in 1997. These studies have addressed the four pre-mentioned goals and evaluated the role of governments, General and financial managing systems and human resource managing systems .The research methodology employed in undertaking the studies included data collection and analysis direct observation by the study teams and field trials. Results. These case-studies suggest that success with autonomy in public sector hospitals and specially teaching hospitals in developing countries have been limited. Having not a clearly defined mission, inefficient decision making and management system insufficient motivation for changes in view and performances of personnel under-optimal level of bed occupancy rates were the main negative results of such management system. Even planning and budgeting processes have not changed much and governmental allocations have increased every year. Interviews with Deans and faculty members throughout the Islamic Republic of Iran have also revealed much more negative impacts of autonomization in teaching hospitals as follows: Medical education should not be considered as a way for making profit, so it is intrinsically in contrary with autonomization. It has reduced the contribution of Medical schools in management of teaching hospitals Faculty members are involved mainly in therapeutic and profit –making tasks and this has led to untoward effects on education quality and Medical ethics. It has adversely affected the spectrum of diseases (admitted in teaching hospitals) and limitation in educational facilities. Conclusion. Goals of autonomy in teaching hospitals of studied countries have not been achieved and there is a general consensus regarding the exclusion of teaching hospitals from autonomization, otherwise some sort of subsidies should be allocated for educational expenses in these hospitals.