Consultant -Hospital Care & Management

Contract

This is a No grade contract. More about No grade contracts.

1. Purpose of the consultancy:

This consultancy aims to develop synthesized evidence to understand how single-specialty hospitals perform compared with general hospitals and provide policy and technical recommendations.

2. Background

Hospitals are complex institutions that are key components of healthcare systems, receiving between 50% and 80% of government health expenditure in many countries. Hospital care is under pressure to increase quality and decrease cost. As a result, hospitals look into the opportunities offered by concepts from the business. One of these concepts is the so-called “focused factory concept”. Implementing "focused factories", aimed at specific treatments or diseases, is proposed as a way to increase the efficiency of hospital care, promoting the establishment of “specialty hospitals”. Focus on healthcare operations is a concept often employed in the debate about how the hospital industry can cut costs and concurrently meet the pressures of increased demand for health services. Specialty hospitals are not a new phenomenon. From psychiatric and tuberculosis hospitals to children's and eye hospitals, they have long existed. Specialty hospitals offer focused services to treat medical conditions that require a particular subset of skills and technology. The current interest lies in developing single-specialty hospitals for specific conditions or illnesses such as cardiology or orthopedics for which such hospitals were previously uncommon or non-existent. The concept of specialty hospitals was first introduced in the USA beginning in the 1990s. During the last decades, there was a rapid increase in the number of small hospitals specializing in cardiac, orthopedic, and surgical services, taking advantage of new forms of technology, available capital, and daycare-oriented services. Furthermore, most of these hospitals were physician-owned, for-profit, and specialty-specific.

Due to the recent growth in specialty hospitals, there has been growing attention about the role and position of these hospitals and how they may impact neighboring general hospitals. Multiple studies, particularly in the United States, have reported the pros and cons of specialty hospitals while examining the effect of specialty hospitals on the quality of care, costs, and well-being of neighboring hospitals as well. Some have claimed that these specialty hospitals efficiently produce services by concentrating them in one institution. They argue that specialty hospitals avoid inefficiencies of scheduling and use of facilities not expressly designed for the illness or condition. The aggregate volume that results from a given focus could lead specialty hospitals to achieve better outcomes, and the experience accumulated in a specialty could be an asset with which to maximize efficiency. They believe that these organizations can set a new competitive benchmark for hospital services by taking advantage of the associated economies of scale and scope, potentially lowering the cost of health care and possibly enhancing the quality of care by concentrating the expertise associated with increased specialization augmenting patient choices. Critics argue that specialty hospitals as a whole have not demonstrated high cost and quality benefits over general hospitals. In addition, their competitive presence in the industry threatens general hospitals’ ability to provide care. Opponents claim that specialty hospitals create financial incentives for physicians to overutilize clinical services and engender unfair competition by selectively treating the most profitable patients, thereby limiting the ability of full-service community hospitals to cross-subsidize unprofitable services. Opponents asserted that specialty hospitals might reduce quality and increase costs, since specialty hospitals provide only the more profitable types of services, select relatively healthier and more profitable patients with conditions of lower severity, and induce demand for services in their specialty (6).To date, several studies have compared the performance of specialty hospitals versus general hospitals. The impact of specialty hospitals on different performance measures such as inpatient charges, length of stay, efficiency, costs, consumer satisfaction, community benefits, their quality and relationship with neighboring hospitals has been researched.

This growing specialization in the hospital sector is not limited to the USA. Many developing and middle-income countries, including countries in the Eastern Mediterranean Region (EMR), have witnessed an increase in the number of private hospitals, including single-specialty hospitals. At WHO, for several reasons, historically, our attention has been going to general hospitals, especially community ones (e.g., district hospitals). We lack a good understanding of the ongoing transformation of the hospital as an industry. Yet, in order to provide the best guidance to our member states, it is important that we have the best knowledge of the state of the evidence and of the policy debate on specialty hospitals: are they a path to discourage, to regulate, to accompany? Within which general guidelines? Are specialty hospitals really a positive step towards a better distribution and use of healthcare resources (optimum planning) and top-quality services to the population? What factors are affecting their performance as providers and as a component of a larger health system? What are the relative merits of specialty hospitals versus general hospitals?

The purpose of this study is to gather and synthesize current evidence relating to the performance of specialty hospitals compared to general hospitals in terms of different performance domains (i.e., effectiveness, efficiency, responsive governance, staff orientation, safety, and patient-centeredness). It will explore the available evidence on the advantages and disadvantages of specialty hospitals over general hospitals and provides policy/technical recommendations for countries based on the literature review, interview with key informants and an expert consultation meeting.

This consultancy belongs to a forthcoming broader WHO program of work on reforming the hospital sector in the post-COVID era.

3. Planned dates:

Start date: 10 November 2021

End date: 20 February 2022

4. Task and responsibilities

The consultant will work with EMRO Hospital Care and Management unit/UHS to perform a comprehensive desk review supported by key informant interviews to interpret findings in the light of what was already known about the subject, followed by a virtual expert consultation meeting.

Outputs:

The objectives of the comprehensive desk review are:

1. To identify the scope and focus of the research findings on the performance of specialty hospitals vs. general hospitals,
2. To create a short overview of aspects of hospital performance that have been examined from scientific and grey literature in different countries,
3. To investigate areas where evidence is sufficient to support decisions regarding specialty hospitals and identify areas that need to be further explored.

The goals of the key informant interviews are:

• • • To discuss/validate review findings,
  • To understand factors influencing the performance of specialty hospitals,
  • To propose suggestions to the countries for how they could benefit from specialty hospitals,
  • To identify topics for further research

Deliverables:

The main tasks that are to be accomplished by the consultant are:

• Conduct a comprehensive desk review on the performance of single-specialty hospitals vs. general hospitals
• Interview a limited number of key informants/experts on the performance of single-specialty hospitals vs. general hospitals
• Draft the report and conduct a virtual expert consultation meeting to present and discuss the findings of the study. Participants will be policy makers, hospital managers and academics/experts from countries inside and outside the region
• Draft a paper for submitting to a peer-review journal, summarizing (synthesizing) study findings
• Finalize the report based on the feedback from the expert consultation meeting
• Draft a policy brief

5. Technical Supervision

The selected Consultant will work under the supervision of:

Responsible Officer:

DR Hamid Ravaghi, Regional advisor, HCM/UHS

Manager

Dr Awad Mataria, Director, UHS

6. Specific requirements

- Qualifications required:

Advanced degree (Master’s or above) in health services management for hospitals. PhD is desirable

- Experience required:

At least -7 years of experience in research/ academia in health (hospital) service management.

- Skills / Technical skills and knowledge:

• Excellent knowledge of health systems, health (hospital) services delivery and management,
• Experienced in conducting the scoping review and qualitative studies
• Good experience with project management
• Good communication / PR skills

- Language requirements:

Fluent (Read - Write - Speak) in English

7. Place of assignment

The consultant will work remotely.

8. Medical clearance

The consultant will provide a medical certificate of fitness for work.

9. Travel

Not applicable

Additional Information

• This vacancy notice may be used to identify candidates for other similar consultancies at the same level.
• Only candidates under serious consideration will be contacted.
• A written test may be used as a form of screening.
• If your candidature is retained for interview, you will be required to provide, in advance, a scanned copy of the degree(s)/diploma(s)/certificate(s) required for this position. WHO only considers higher educational qualifications obtained from an institution accredited/recognized in the World Higher Education Database (WHED), a list updated by the International Association of Universities (IAU)/United Nations Educational, Scientific and Cultural Organization (UNESCO). The list can be accessed through the link: http://www.whed.net/. Some professional certificates may not appear in the WHED and will require individual review.
• For information on WHO's operations please visit: http://www.who.int.
• WHO is committed to workforce diversity.
• WHO has a smoke-free environment and does not recruit smokers or users of any form of tobacco.
• Applications from women and from nationals of non and underrepresented Member States are particularly encouraged.
• WHO's workforce adheres to the WHO Values Charter and is committed to put the WHO Values into practice - https://www.who.int/about/who-we-are/our-values
• Consultants shall perform the work as independent contractors in a personal capacity, and not as a representative of any entity or authority. The execution of the work under a consultant contract does not create an employer/employee relationship between WHO and the Consultant.
• WHO shall have no responsibility whatsoever for any taxes, duties, social security contributions or other contributions payable by the Consultant. The Consultant shall be solely responsible for withholding and paying any taxes, duties, social security contributions and any other contributions which are applicable to the Consultant in in each location/jurisdiction in which the work hereunder is performed, and the Consultant shall not be entitled to any reimbursement thereof by WHO.