I believe it is unsustainable to compensate some physicians for being on call and others not. Since there is increasing pressure on all physicians and since, in my eyes, it is unethical to put the biggest burden of calls mostly on young shoulders (like resident’s shoulders), I think we have to recognise that being on call is work that should be compensated. Probably better than compensating only those specialties that are required by the trauma system, I think it is better to differentiate using other parameters, like the gravity of the calls for the different specialties. Of course there will be discussions, but I think it is possible to find objective criteria.
I think a good way might be using lean methodology to analyse clinical processes in multidiscplinary teams and to incorporate people with all different backgrounds in the analysis. Using the techniques of value stream mapping, can help you optimise the efforts of people with different backgrounds and make physicians perform at the top of their license.
Working in Belgium too, I do agree with previous comments stating it is very tough to work in this environment.
I think one of the causes of the problem is the fact that historically there are too many hospitals in Belgium, especially in Brussels. Besides that, as you state all hospitals are general hospitals; and the law requires them to be general and to treat all kinds of pathologies.
We have a federal government and regional governments, with no clear distinction between the jurisdiction of these different governments. And we see a large difference between vision of politicians of the different regions of the country. There is also too much influence of interest groups on the government. For all these reasons political decisions are made too slowly. And none of the governments wants to share savings with providers.
In this context, I think it is quite impossible to focus on growth in a seperate hospital. Since in this constrained situation, ethically acceptable growth can only come from taking patients and activities from other hospitals, I think it is better to focus on stronger and faster cooperation with the other hospitals in the region and to use upcoming legislation (following the network legislation), to reorganise the hospital landscape in Brussels (and Flanders) to create real economies of scale.
Although I’m bare-handed, I agree with personal gloves. Since you cannot change the compensation model and since it is impossible to create a sense of urgency with a CEO who wants to avoid conflicts, chances are low you can change things. You could hope for some sudden external financial or regulatory pressure to help you, but without this help I think it’s an impossible task.
If you start from the specialisations where patients are used to paying out of their pockets: the three you mention: plastic surgery, phleboloby and orthopaedics; and you add ENT and ophtalmology. For all surgeries, except for cataract (which is usually done under local anesthesia), select children or adult patients with low ASA score. Then I think you can create value for the patients and for the company.