The first trial of Health Impact Assessment on the management reform of a public hospital

1. The first trial of Health Impact Assessment on the management reform of a public hospital Michiko Hoshiko, Kunio Hara, Tatsuya Ishitake Kurume University School of Medicine, Japan HIA2011Ⅺ HIA International Conference, Granada (Spain)

2. The changes of Japanese hospital number Public Others Private

3. Financial difficulties！ Public hospitals Finance ( 2006) Finance (2009) About 40% About 30% About60% About70% Public Hospital Transformation Guidelines(2007) 《The difference of Public and Private》 Public hospitals are in red rather than Private hospitals！

4. Blue ; demerit red; merit

5. Classification of management transformation of public hospital Applied all of the provisions of the Local Public Enterprise Law (all application) complete privatization High Local incorporated administrative system (non-civic servant ) Local incorporated administrative system (civic servant ) Independent position Management transformation Applied all of the provisions of the Local Public Enterprise Law ( a part application) Designated administrator system Low Public position High Low

6. Aim The aim of our study was to clarify the impact of Hospital A’s management transformation on the health of residents, patients, and hospital employees and to determine the priority order of health impact before management transformation. Hospital A ～2009 2010～ Local incorporated administrative system (non-civic servant ) Public Hospital

7. Methods ・Concurrent and comprehensive HIA ・Period ; April 2009 – March 2010 (before management transformation) ・Steering group ; 17 members 4 hospital staff ( clerk, nurse, radiologist, examiner ) 2 administrative officials 2 healthcare specialists 2 labour union members 2 residents, 1 paramedic 1 physical therapist , 3 academic researchers

8. Conduct assessment • Government policy analysis (specific information, from publicly available comments related to hospital management publications issued by hospitals ) • Community profiling (profiling of A city and B city) • Compilation of qualitative and quantitative data (questionnaires to hospital employees. Interview executives and leader of the labour union in Hospital Aand Hospital B) • Health impact assessment positive and negative aspects separated certainty of evidence (high,medium,low) the degree of impact(large,medium,small) Hospital B

9. Priority order of health impact Y Highest priority large Degree of impact medium small X low medium high Certainty of impact (frequency)

10. Result The employees developed feelings of distrust toward hospital executives The employees agree with hospital executives

11. Result ≪The number of HIA for target groups≫

12. Result

16. Priority order of HIA ≪positive impact ≫ ≪negative impact≫ B Y C Y A B A 3 1 4 19 9 2 large large degree of impact E degree of impact D C B G F E D 16 11 8 10 12 7 5 6 17 13 18 15 14 medium medium H small small 20 X X low medium high low medium high Certainly of impact (frequency) Certainly of impact (frequency)

17. Conclusions Our study showed that the management transformation of public hospitals would affect residents and employees both positively and negatively. The notable achievement of this study was that it encouraged the hospital to organise a series of labour-management discussion based on mutual trust in a democratic method rather than a top-down method. The approach eventually intensified the bonds of the labour-management relationship and helped the hospital management maintain its credibility with its employees. Thank you

21. 《Specialists(nurses and technologists）》Negative effects

22. Priority order of HIA ≪positive impact ≫ ≪negative impact≫ Y Y B A C B A 3 1 2 4 19 9 large large R R R R F S degree of impact degree of impact E D C B G F E D 16 11 8 10 12 7 5 6 17 13 18 15 14 medium medium C D S D E S R R C E C E E H 20 small small X X low medium high low medium high Certainly of the impact (frequency) F Certainly of the impact (frequency) R：residents/patients，S：specialists, D：doctors, M：hospital executives, C：hospital clerk staff，F：fire department

23. 5. Health Impact assessment 《Residents , Patients》 Positive effects

24. Conclusions Our study showed that the management transformation of public hospitals would affect residents and employees both positively and negatively. The notable achievement of this study was that it encouraged the hospital to organise a series of labour-management discussion based on mutual trust in a democratic manner rather than a top-down manner. The approach eventually intensified the bonds of the labour-management relationship and helped the hospital management maintain its credibility with its employees. Thank you

25. 《Fire department staff》 Negative effects

26. 《Hospital Executives》 Negative effects

27. 5. Health Impact assessment 《Residents , Patients》 Positive effects

28. 5. Health Impact assessment 《Residents , Patients》 Positive effects

29. 《Residents , Patients》 Negative effects

30. 《Specialists(nurses and technologists) 》 Positive effects

31. 《Doctors》 Positive effects

32. 《Hospital Executives》 Positive effects

33. 《Hospital Clerks》 Positive effects

34. 《Hospital Clerks》 Negative effects