The health services of Australia and in particular, Queensland, concentrate their expenditure and their workforce in hospitals. Community health services are expanding and more effort and finance are being devoted to the development of community health care. New health trends are emerging which emphasise the community health service or individual lifestyle. These trends should shift resources away from the hospitals at a time when already financial constraints are being imposed on hospitals throughout Australia. Australians through their political system need to formulate National health plans so that resources can be strategically allocated.
All organizations must have clear objectives. The incorporated Hospital Boards within the Queensland Public Hospital System need to develop clear objectives and the Hospitals' objectives should incorporate the strategic plans necessary to effect Stated National plans. The major 1'-1etropolitan and Provincial Hospital Boards will require to be closely involved and apprised of plans which are developed and adopted by the Queensland Government.
The Management of Queensland is Hospitals by the Board and the tripartite Executive team could adapt to a role which would include the planning function. The Managers' decision making process and role need to be understood in the complexity of the Hospitals' environment. The nature of Hospital Management differs significantly from the management of commercial organisations. These differences must be appreciated if Budgets provide the main mechanism used by the Queensland Government to effect plans and constrain costs in its Public Hospitals.
Basic initiatives are presented which will give Hospital Boards and managers greater autonomy in attaining the Boards' objectives. The Hospital Board and manager should be allowed managerial flexibility within the setting of a global budget.
Departmental budgeting will allow departmental heads to be involved in the financial allocation and control processes. The participation of staff in the general management functions will reduce the level of conflict within the Hospital as the constraints will be understood.
The Paper highlights a few megatrends which are evident in society generally. These are (a) Representative Democracy to Participatory Democracy, (b) Institutional Help to Self Help and (c) Centralization to Decentralization. The initiatives described in this paper are not intended to be major dislocations within a large system but instead are basic initiatives which could be undertaken without major turbulence. These changes should make the Queensland Health System more adaptive within a rapidly changing environment.