Abstract

In this paper we will address issues of organizational changes in public sector where the relevance of management has not diminished during the last two decades of the neo‐liberal market philosophy. Public sector organizations are susceptible to greater and more open accountability with politicians, pressure groups, taxpayers and voters all having an interest in the performance of it. In late 1990s Estonian government initiated reforms of health care system in the country. Estonian Hospital Master Plan (EHMP) 2015 was launched in 2000 which, within the others, was initiating the merge of seven Tallinn hospitals into North Estonian Regional Hospital (NERH). To evaluate efficacy of organizational changes during implementation of EHMP‐model into health care system in Estonia we utilized personal interviews of top and middle managers and annual reports of merged hospitals to benchmark these measures to earlier merged Univerity Hopsital and other EU hospitals. We conclude that even NERH was established and the reform‐initiated changes were mostly introduced by the deviation from first‐line governmental plans and introduction of new political directions in 2003 lead to new organizational changes and managerial efforts to gain the goals with, unfortunately, prolonged change process.

Highlights

  • Transformed from being an authoritarian, centralized, totalitarian socialist state to a democratic country with a free market economy has made the management of change a major issue in Estonia

  • Public sector organizations are susceptible to greater and more open accountability with politicians, pressure groups, taxpayers and voters all having an interest in the performance of it

  • The author alleges that the application of Estonian Hospital Master Plan (EHMP) was limited because: a) the plan focuses on final aims instead of transition processes assuming that Estonian state can manage needed changes; b) the plan focuses only on acute medical care with no attention to the care of mental disorders, tuberculosis and long-term and rehabilitation care; c) the plan did not take into consideration traditional regional centers and logistics between them; d) this proposal is based on medical quality and economic efficiency only with no attention to regional interests to restore previous hospitals

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Summary

Introduction

Transformed from being an authoritarian, centralized, totalitarian socialist state to a democratic country with a free market economy has made the management of change a major issue in Estonia. In order to fulfil the vision NERH three high-level strategic objectives: have been brought out a) to achieve steady improvement in treatment quality and growth of patients’ satisfaction, b) to increase a market share in special health care and to offer a wider range of specialities, c) to reach a state of an efficiently managed organization, and in 2005, more objectives were added, d) together with medical service delivery research, medical training are the main goals of NERH. In order to make changes in that direction a new structure (principal and support processes), personnel policy, clients’ service re-arrangement, renovations were planned as the managerial tools for these changes For this purpose, an appropriate change management program was introduced covering critical areas like communicating the change rationally, achieving employees’ participation and motivating them to act. This guaranteed a comprehensive understanding and implementation of the rationalization plans

Methods and data
Analysis of benchmarked data
Findings
Conclusions
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