Governance in Moroccan public hospitals: critical analysis and perspectives for action

Abstract

PurposeThe purpose of this paper is to analyse the framework of hospital governance in order to understanding the persistence of dysfunctions that have caused the deterioration of the image and quality of Moroccan public hospital services.Design/methodology/approachThe analysis of the hospital governance model has used a conceptual framework examining four dimensions: institutional, financial, accountability and decision-making dimensions. This framework operationalization was highlighted through a documentary review of the main regulatory and legal texts as well as multiple case studies, using semi-structured interviews with the key stakeholders, considering their expertise and implication in the governance process.FindingsThe study was able to highlight that the governance structure of Moroccan public hospitals has been subject to numerous legislative provisions and modern management instruments. However, the limited autonomy, the resources shortage, dilapidated equipment, the chronic budget deficit, staff demotivation, the lack of accountability mechanisms have led to the deterioration of the quality of care and, hence, to patient's dissatisfaction.Practical implicationsThe analysis formed the basis for a series of recommendations. These were mainly aimed at rethinking the current governance model by setting up an institutional policy to improve the current governance structures and monitoring mechanisms of hospitals, as well as revising the instruments for planning and evaluating the provision of care and services according to the real needs of the population, taking into account the financial limits.Social implicationsThe hospital governance framework is proving to be a powerful tool for identifying the problems contributing to sub-optimal hospital performance, and calls for policy interventions to improve the organisation organization and delivery of hospital services with greater patient involvement.Originality/valueThis study was the first to analyse the Moroccan hospital governance model, using a comprehensive and structured evaluation methodology designed for public hospitals and supported by extensive data collection which made it possible to offer a broad and in-depth view of the actual functioning of these institutions.