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Charlotte Amalie
Tuesday, August 16, 2022
HomeNewsArchivesHOSPITAL AUTONOMY? WHAT'S TO LOSE?

HOSPITAL AUTONOMY? WHAT'S TO LOSE?

For almost thirty years I have argued for placing all health related programs within the Department of Health. My justification was efficiency. It appeared to me a single bureaucracy was preferable to multiple bureaucracies. A single personnel office, business office, collections office, clinical laboratory, pharmacy, etc. should be manpower, space and equipment efficient. I have been wrong.
The fact is our government does not work! It is loaded with featherbedding employees who do not work, do not want to work, do not know how to work, and is rapidly running out of those increasingly rare employees willing to get the work done – regardless.
Why does the governor go outside to find people to run important programs? Because those inside political appointees don't cut the mustard. Too many supervisors, directors, executive directors, deputy directors, and assistant commissioners are given fancy titles and healthy salaries, to feed their egos and maximize their ultimate retirement.
Look at the precedent. We must have electricity and water; therefore, the Water and Power Authority is semi-autonomous. We are totally dependent upon our sea and airports; therefore, the Port Authority is semi-autonomous. Magen's Bay is the largest single draw for the tourist industry next to shopping; therefore, the Magen's Bay Authority is semi-autonomous. The message is simple: "If it must work, it must be removed from government influence!"
Why don't government and the Department of Health work? Because there are too many possible scapegoats, too many possibilities for malfunction, too many dead end employees. Government doesn't work because the unions deny promotions for merit and reward tenure rather than productivity. The Department of Health doesn't work because it is possible for a handful of individuals to control the functioning of the organization for reasons other than patient care.
With autonomous hospitals it will be easier to cut through the smoke and identify the fire. When your loved one needs medication, the list of responsible persons is short. When your loved one dies from inadequate care, it is easier to pin point who is restricting care. When someone complains about his or her bill, it will be easier to show what the cost is and explain hospital charges. And when people refuse to pay their bills, it will be easier to show they are exposing the community to suffering and death.
Why not Autonomy! The sooner we get it on, the sooner we can get on with it.

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For almost thirty years I have argued for placing all health related programs within the Department of Health. My justification was efficiency. It appeared to me a single bureaucracy was preferable to multiple bureaucracies. A single personnel office, business office, collections office, clinical laboratory, pharmacy, etc. should be manpower, space and equipment efficient. I have been wrong.
The fact is our government does not work! It is loaded with featherbedding employees who do not work, do not want to work, do not know how to work, and is rapidly running out of those increasingly rare employees willing to get the work done - regardless.
Why does the governor go outside to find people to run important programs? Because those inside political appointees don't cut the mustard. Too many supervisors, directors, executive directors, deputy directors, and assistant commissioners are given fancy titles and healthy salaries, to feed their egos and maximize their ultimate retirement.
Look at the precedent. We must have electricity and water; therefore, the Water and Power Authority is semi-autonomous. We are totally dependent upon our sea and airports; therefore, the Port Authority is semi-autonomous. Magen's Bay is the largest single draw for the tourist industry next to shopping; therefore, the Magen's Bay Authority is semi-autonomous. The message is simple: "If it must work, it must be removed from government influence!"
Why don't government and the Department of Health work? Because there are too many possible scapegoats, too many possibilities for malfunction, too many dead end employees. Government doesn't work because the unions deny promotions for merit and reward tenure rather than productivity. The Department of Health doesn't work because it is possible for a handful of individuals to control the functioning of the organization for reasons other than patient care.
With autonomous hospitals it will be easier to cut through the smoke and identify the fire. When your loved one needs medication, the list of responsible persons is short. When your loved one dies from inadequate care, it is easier to pin point who is restricting care. When someone complains about his or her bill, it will be easier to show what the cost is and explain hospital charges. And when people refuse to pay their bills, it will be easier to show they are exposing the community to suffering and death.
Why not Autonomy! The sooner we get it on, the sooner we can get on with it.