Health Sector Governance Better Governance for Better Health Principles & Guidelines for Governance in Hospitals Egypt 2014 Center for International Private Enterprise Health Sector Governance Better Governance for Better Health Principles & Guidelines for Governance in Hospitals Egypt 2014 Center for International Private Enterprise 4 Principles & Guidelines for Governance in Hospitals The Healthcare Governance & Transparency Association (HeGTA) is an Egyptian non-governmental, non-profit organization founded in 2012 with the vision of promoting governance and transparency in the healthcare sector in order to enable healthcare reform and to create investment opportunities. HeGTA aims to contribute to a healthcare system which is based on accountability, equality, fairness, efficiency and quality by the creation, pooling and dissemination of knowledge in the realm of healthcare governance and transparency. HeGTA is exclusively dedicated to the topics of governance and transparency in healthcare. Having a unique calibre of experts in these realms as (founding) members, HeGTA is an active player in the governance arena of Egypt and involved in different initiatives. The Center for International Private Enterprise (CIPE), a non- for-profit affiliate of the US Chamber of Commerce, Washington D.C., builds institutions of private enterprise and market-oriented reform. CIPE’s key program areas include anticorruption, advocacy, business associations, corporate governance, democratic governance, access to information, the informal sector and property rights, and women and youth. The U.S. Agency for International Development (USAID) is an independent federal government agency that receives overall foreign policy guidance from the Secretary of State. Its work supports long- term and equitable economic growth and advances U.S. foreign policy objectives by supporting economic growth, agriculture and trade, global health, democracy, conflict prevention, and humanitarian assistance. It works in close partnership with private voluntary organizations, indigenous organizations, universities, American businesses, international agencies, other governments, and other U.S. government agencies. Principles & Guidelines for Governance in Hospitals 5 Reader Guidance: What This Guide Is About What Does This Guide Offer? This Guide offers Principles and Guidelines to facilitate the incorporation of corporate governance practices in hospitals in Egypt. The application of these Principles would lead to thriving and sustainable organizations, showing high levels of integrity and transparency. What Is Corporate Governance? Corporate governance refers to the “procedures and processes according to which an organization is directed and controlled. The corporate governance structure specifies the distribution of rights and responsibilities among the different participants in the organization – such as the board, managers, shareholders and other stakeholders – and lays down the rules and procedures for decision-making.” (OECD). Advancing the view that hospitals in many dimensions do not differ from other types of organizations, incorporating corporate governance practices would be highly beneficial for them. Why Does This Guide Matter? This Guide supports individual hospitals in responsibly and sustainably increasing their performance through the incorporation of corporate governance practices. Health is a fundamental component needed to ensure the well-being of society. To promote health, a sound and fair healthcare system is needed. Having corporate governance principles as advanced in this Guide implemented by a critical mass of hospitals would upgrade the whole sector. Thereby, the Guide bridges the gap between the social and humanitarian mission of the hospital on one side and its organizational nature on the other side. This should achieve high levels of performance that can meet the demands of today’s patients while containing costs. Ultimately, this should lead to accessible, affordable and equal high quality services for patients and would prevent corruption as well as other unethical behavior. How Was This Guide Developed? The Guide was developed based on a complex methodology. Initially, a framework based on intensive desk research and best practices was developed. Accordingly, the Guide’s five Principles and their Guidelines were developed by core experts. 6 Principles & Guidelines for Governance in Hospitals This was followed by 34 one-on-one stakeholder interviews and six stakeholder opinion and feedback roundtables in Cairo, Alexandria, Mansoura, Tanta, Port Said and Aswan. Subsequently, the content was informed and enriched by the inputs gathered during these stakeholder engagement activities. Finally, the Guide was reviewed by a diversity of distinguished experts and stakeholders. For What Should This Guide be Used? This Guide is designed to lead through the process of becoming a well-governed and transparent hospital. Thereby, it aims to offer fundamental guidance to hospital owners, board members and managers, irrespective of the hospital being public or private, governmental or non-governmental, for profit or not-for-profit. For policy makers, the Guide can function as a national reference for well-governed hospitals. On the community level, the Guide shall help to determine the expectations the civil society can have towards the hospital and should facilitate checking on them. How Is This Guide Structured? The Guide bases on five Principles and respective Guidelines. These Principles have intersections and theoretical and/or practical overlaps. However, the Guide addresses them separately to facilitate using them in a way that helps in tackling one issue at a time. Yet, they need to be understood and implemented as a whole in order to achieve high levels of governance. In order to facilitate understanding of how practical application could look like, the Guide entails some samples for every principle. For implementation, though, the hospital needs to develop its own sets of policies and procedures that fit its particular situation and stance. It should be taken into consideration that the implementation process is expected to be a long term undertaking. Principles & Guidelines for Governance in Hospitals 7 Acknowledgement The Center for International Private Enterprise, an affiliate of the US Chamber of Commerce, is pleased to present governance principles for the health sector. We would like to thank Dr. Mostafa Hunter for initiating and leading the process of developing this Guide. Special thanks also go to all stakeholders, especially members of the Health Governance and Transparency Association, who were engaged in the process guaranteeing professionalism and practicality. Those principles and guidelines were developed by the collective effort of Dr. Mostafa Hunter, who developed the project and led its content, and to the project management team, Tamara Kohl, Yasmine Badr, Pamina Karl; as well as the team of consultants, Hany Abou El Fotouh, Yasmine Hassaan, Abdallah Al Karaimy, and Emad Aziz. Biographies of the core team as well as lists of reviewers, contributors to expert and stakeholder insights and participants of the roundtables are in the Annex at the end of this Guide. Randa Al Zoghbi Country Director, Egypt Office The Center for International Private Enterprise (CIPE) 8 Principles & Guidelines for Governance in Hospitals Word of the Author In alignment with the structural reform attempts in Egyptian hospitals, this Guide proposes a corporate governance approach towards healthcare in which it attempts to materialize concepts of justice, accountability, sustainability and affordability to better serve humanity. It endeavors to bring the best of all worlds to create a bridge between theory and practice in Egyptian hospitals and to set a pattern for excellence. It articulates working at the roots of problems by proposing an institutional structural approach towards hospital reform that offers more than conventional quick fixes. I am delighted to launch the Guide with Principles and Guidelines for Governance in Hospitals, which I believe, is a step to realize our vision for creating autonomous, accountable and well-governed hospitals capable of taking decisions independently and competent enough to operate in a rapidly changing sector, while positively interacting with the complex stakeholder environment they are working in. It is the starting point for stimulating ambition in expanding the notion of governance in the entire healthcare sector aiming at reaching more effectiveness and efficiency in serving the needs of the patients in Egypt. The Guide lays a credible and hard-edged foundation to be a pivotal point of reference for further activities and potential publications and research. Hopefully, the Guide creates a constructive debate around its content to further advance it over time. As you read the Guide, it inspires you by giving broader perspectives through interlinking between the hospital’s humanitarian dimension and its organizational construct. It demonstrates the collective outcome of expert inputs combined with intensive stakeholder engagement activities, which enriched the content and resulted in the creation of a big community of stakeholders believing in the topic and willing to take it further. Besides, adopting a participatory approach in developing the Guide with practitioners, policy makers and hospital top managers assured its practicality and applicability in Egyptian context. Generally, the Guide walks