Developments in hospital management: a proposal for a new hospital management model for Malta

The management of hospitals has changed considerably over the last two decades. The business processes and patient treatment regimes are unrecognisable from those of ten years ago. Health care in general faces unprecedented challenges internationally as the demand for more medical treatment and services increases together with a parallel emphasis on quality and cost containment1. Furthermore external factors such as the 'greying' population and growing patients' expectations increase the burden upon hospital management and staff to provide a quality hospital service. Hospitals are expensive enterprises. Huge investments go into the construction and equipping of hospitals. In the UK the cost of building a hospital is £1000 /square metre2, whilst in Malta new construction costs around Lm430 /square metre. Medical equipment accounts for an additional 20%. Furthermore hospitals invariably take the lion's share of health care expenditure, averaging around 8% of GDP in Western Europe3 . It is therefore incumbent upon the authorities to ensure that the populace gets an appropriate return on its investment. This paper reviews developments in hospital care and management, including the increasing importance of focusing care and management decisions around the patient. It will explore the role clinicians should play in management, itself still a topic of controversy. The role of information technology and its indissoluble link with the proper administration of resources will also be critically appraised. These will be reviewed in the local context where a model for the future management of Malta's hospitals is proposed.peer-reviewe