The General Regulations for Hospitals, published in 1968, is perhaps one of the most outstanding diplomas in the organization of hospitals in Portugal. Even today, as we read this pioneering document, we see its influence on the internal regulations of most hospitals and on successive hospital management laws. Insofar as it was such an innovative document for the time, perhaps all the following successive attempts to legislate hospital management were unable to present themselves as the vanguard of the times.

The last example is Decree-Law 18/2017, of October 2nd. This diploma approves the most recent Legal Regime and the Statutes applicable to hospitals and local health units. In many respects, rather than keeping up with international progress, it covers the status quo of the hospital organization. Even at the level of boards of directors, contrary to qualifying hospital managers, it is based on prejudices.

On the one hand, it keeps the composition limited to a maximum of five elements, preferring to ignore the current dimension and complexity of a large part of hospital centers. On the other hand, it demands that one of the members be proposed by the member of the Government responsible for the area of finance.

Something sui generis, when, by definition, the entire council is appointed by the Council of Ministers, under the proposal of the members of the Government responsible for the areas of Finance and Health. In other words, at least one of the elements is not a common choice. If one of the biggest challenges for boards of directors is to work as a team, here is the first barb.

In the same diploma: the members of the board of directors of the Public Hospital, integrated in the business sector of the State, are appointed from among individuals who preferably have curricular evidence of specific training in health management and adequate professional experience – preferably. In other words, no specific training or adequate professional experience is required. At the very least, the clinical director is expected to be a doctor and the nurse director is expected to be a nurse!

Since 2015, the Global Consortium for Healthcare Management Professionalization, developed within the framework of the International Federation of Hospitals, which integrates various governmental, private and academic organizations, urgently calls on governments and the international community to recognize that health performance and improvement depend on the existence and quality of professional management of health organizations, having presented five concrete measures to be implemented at the level of each country:

1) Adoption of the Health Management Competencies Directory to inform and align health services management development programs at all undergraduate and graduate levels of education, continuing education and professional development;

2) Adaptation and incorporation of skills into formal credit systems, which should be based on independent assessment and evidence of demonstrated skills;

3) Formal recognition of health service management as a profession;

4) Implementation of a merit-based health care management career;

5) Recognition of professional associations of health service managers as key stakeholders for policy dialogue related to leadership and management in health and the promotion of the profession.

It is important to remember that the Public Manager Statute (EGP), updated in 2012, requires the signing of a management contract with any public company within 3 months from the appointment of the public manager. Failure to comply with the established deadline will result in the nullity of the act of appointment. In these contracts, the dismissal of the public manager must be obligatorily provided for in the event that the respective performance evaluation is negative. Furthermore, the remuneration of public managers takes into account the fixed remuneration and management bonuses.

However, these premiums may not apply if the hospital: does not regularly and scrupulously comply with its tax obligations; do not reduce your current indebtedness level; do not make regular and timely payments to your workers, suppliers and service providers; does not reduce the level of expenses that are not necessary for the accomplishment of its corporate purpose and, therefore, subject to autonomous taxation; record losses for two consecutive years.

We are now running through the year 2019, and the delay in the application of a 2012 law is not understood. We are well aware that the priority of the Finance team was to question the quality of management, disclaiming the lower investment in the NHS as a percentage of GDP and operational management blockade, due to the superb level of centralization and minimum degree of autonomy.

But more is expected from Health and Public Administration. Applying the statute of public manager will be to fulfill the basics. It is imperative to review the qualification framework for the management of health services, including specialized education and training, career updating, a transparent recruitment process, performance assessment, accountability and continuous training.

Better management, more SNS.

The article can be read at the Public Hospital in January 2019