the hospitals

One of the basic rules of change management is "explain". Everything at every stage of the process to all parties concerned. And make double-sided conversation. The only more important than that is sure to change in steps.
Well, the new Health Minister Professor Anna-Maria Borissova managed to break both rules at once. And throw in a panic not only heads of state hospitals, but few private investors in this sector.
Two letters
Soon after Borisova said in an interview that in Bulgaria must remain only 130 hospitals (also absolutely adequate to the size and population number), from her office sent a questionnaire to hospitals with which they must samokategorizirat and do not cover certain criteria, will be closed. The strange thing here is the choice of criteria, comment from industry, even more strange is that the letter was released and clinics that do not work with the health insurance scheme is not financed with public funds and to fight its competitors rely solely on the quality of their service.
And since none of the health ministry has not bothered to explain why it wants this information - only a statement of national health insurance card or you will be used as an argument to close the clinic or wards, hospital directors in the last week of any heated phones health institutions with a request for comment.
Against this background, they received a second letter. This time the request of national consultants (professors or associate professors who set the standards for the treatment of certain diseases and consult the health ministry and health fund) emergency clinics to obtain information about doctors, the number of operations, patients and equipment and in general all of the commercial information hospital. The important detail here is that these represented national consultants and doctors in hospitals. So in practice, most hospitals in the country are forced to share information which should be company secrets with competitors.
All these lead to three paradoxes
Paradox number one
  Until now, most industry fair assumption is that if you do not quite meet the requirements at issue, the hospital will be allowed to work with the Health Insurance Fund. Strangely, however, why such letters are received and hospitals, which are entirely private and not work with the NHIF.
In the private Gynecological Hospital Aesculapius 97 in Rousse as all births are paid by the patient number and it will contract with cash. According to the categorization, however, it must have 300 births to continue working. However, the hospital has fewer than 300 births in 2009
"Fears of colleagues from private hospitals, that information may be used to see where they are most vulnerable to small hospitals and to put such requirements and criteria to automatically close them. The request for a certain number of births as a untenable, particularly in crisis and where labor is paid - you should have just 300 or 500, "says Dr. Alexander Rudnitski, manager of Aesculapius 97. According to him the requirements of new standards in obstetrics and gynecology, which are also enshrined in avtokategorizatsiyata "are so high that only five out of 10 district hospitals will have the necessary specialists and equipment to enable them to work.
  Paradox No. 2
  In the new requirements of the Ministry are set pieces for more specialists in the clinics. And despite three facts which Prof. Borisova could not know. The first - that in recent years had several years of zero specialization of doctors. Moreover, rare specialties such as anesthesiology, is granted annually 10 units of specialization. And last but not least - every day a doctor leaves Bulgaria.
"These are criteria that can respond immediately only five or six most prestigious hospitals. To achieve them, other hospitals have to offer higher wages. This in turn can not do because the health fund payments delayed," said Prof . Vladislav Ivanov, director of the General Hospital in Smolyan.
Ministry of Health responded that the information will underpin development in the updated national health card. It will present the real picture in every area on 19 different criteria - population in the area, incidence, specific nuisances, professionals, equipment, beds and more. Based on this we'll lay down the guidelines for restructuring the hospital system. "This is not about closing hospitals, and for the inventory of the entire health system. We all know that there are now hospitals for active treatment, which not long function and patients do not attend. A hospital is not just building a content . This requires a sufficient number of qualified specialists, modern equipment, daily practice, "stated the health ministry.
According to Prof. Krassimir Ivanov, director of University Hospital "St. Marina" Varna, requests for categorization are not dressed in law and this is not a document which to derive some consequences. "Rather, accept it as a pre-drilling looks at how health system," he says. Professor Ivanov from Smolyan, however, is of the opinion that instead of writing different criteria should require hospitals to categorize the ISO for medical services and not have self.
  Paradox # 3
  National consultants are doctors, usually professors, who work in large university clinics. So they sent a letter requesting specific information to make hospital directors hospitals to provide information to familiar with their business competitor, which in turn can write a standard to which its competitors do not comply.
  The role of national consultants to participate actively in the development of medical standards and to observe compliance. Hospitals do not share standards of state, municipal and private, but are equally valid for all, as the Ministry of Health regulations concerning the operation of all hospitals, health department explained. In the area hard to comment on what steps are the first team of the ministry.
The opinion of most doctors is that what is the criteria that hospitals are not only the Ministry but that the industry should participate in their determination. Then you have to deal with the necessary doctors - specialists in rare specialties. "It should be thought about not managing to state hospitals and to the owner who is not law anywhere in the world, but to make competition for professional management of the largest and most hospitals," said Andrei Markov, director of Private Health Fund .
If these steps do not explain, however, the silence of the institutions will become doctors in opposition to everything that happens. Even if it is good.