overnance of TeaGching Hospitals in Ethiopia: Achieving Alignment in Academic Health Science Centers, 2015

Abstract

ackground: Academic health science centers (AHSCs), today represent a unique fusion of traditional academia, hospital functions, several levels of education, and, above all, patients. They are complex organizations trying to discharge an often conflicting mélange of responsibilities. This complexity has grown in recent years with the increasingly rapid rate of change, stressing both faculty and leadership. There is a paucity of information on how this complex relationships works in Academic Health Science Centers in Ethiopia. Objective: To explore the governance status and alignment across governance, strategy, economics and management of academic health science centers in Ethiopia. Method and materials: Case study was conducted on four selected teaching hospitals in Ethiopia from April 20/2015 to May 10/2015. Interviewer administered structured questionnaires; focus group discussion and in-depth interview guides were used for data collection. Descriptive statistics like frequency tables, graphs descriptive summaries and narrative texts were used to describe the results. Result: Out of the 17 respondents, more than three fourth were male. Only less than half of the respondents perceived that there is fully integrated strategy across all mission and entities. All of the selected teaching hospitals have governing board with defined term of reference. But, only one among the AHSCs under study was governed by a single unified board, while the three remaining AHSCs have two separate governing boards, hospital governing board and university board. Regarding economic alignment, more than half of the respondent reported that their centers use structured methodologies plus explicit funding for strategic priorities across their centers. Concerning the extent to which management structures for clinical activities are integrated, nearly one third of participants responded that there is separate management structure for physicians. The overall alignment is 3.4 and 2.25 for AHSCs with high alignment and AHSCs with low alignment respectively on 1 to 5 scales. Overall AHSCs alignment corresponds with higher levels of alignment in all of the four key dimensions. Conclusion: Though the need for alignment is high among the AHSCs, the overall alignment is low. Therefore, the AHSCs should have to assess the current state of alignment in their institution and develop a definition of success in alignment that is consistent with its unique mission and strategic vision, and then routinely monitor performance against these metrics