Productivity and quality of public hospital medical staff: A dominican case study

Medical care personnel constitute a major portion of health‐care costs and are an important determinant of quality. Personnel policy, especially regarding physicians and nurses, is central to the level and type of care provided, and ultimately to the resources expended. There is increasing evidence that state health systems in many Latin American countries face the apparently paradoxical situation of oversupply of physicians coupled with the undersupply of physician services. Yet, productivity of medical staff in public facilities in Latin America is a relatively unexplored area. Further, little is known about the relationship between productivity of medical staff and quality of services provided in developing countries. Taking the case of a large public hospital in the Dominican Republic, this study examines the quality of hospital structure and process as it relates to the functions and performance of physicians, and to a lesser extent, nurses. Based on a patient‐based survey, data were collected on physician and nurse time allocations in outpatient, emergency, surgery and inpatient wards, the types of services provided, and the time costs of providing them. The analysis focuses on medical staff performance according to the professional levels of physicians and nurses providing care, and the time spent attending to patients and conducting supervisory tasks. The gap between contracted and expended physician hours is examined. The paper concludes with a discussion of the policy implications for hospital management, particularly as they relate to incentives for medical personnel.