The European process for integration continues. In Ireland, the vote in favour of the new constitution was clear. Further ratifications have been completed in national parliaments and the remaining final signatures to the Treaty on the new constitution are considered safe. Democracy is laborious but there is no better form of governmental organisation. In particular, the federalist design of decisions is an essential prerequisite for the distribution of legitimate con sti tutional power of governments and institutions.
However, we must be sure that this inherently complex process is transparent and controllable and that the principle of subsidiarity is maintained. This means that all things are governed more successfully “in house”. Parent institutions have the task of building the framework of possibilities for action. Certainly a heavy demand, which requires a permanent balance of counterbalances but it is worthwhile.
The ongoing financial and economic crisis and the concerted cooperation between international management have clearly demonstrated the importance of common cooperation and how joining forces can mitigate crisis. Hospitals are also affected by these crises in various ways including the financing of investments. Furthermore, the very basis of financing health systems is affected by decreasing gross domestic product and increasing unemployment.
This dangerous development is further aggravated by the profound structural problems in European societies, which arise from the demographic change. Hospitals have to provide increasing medical and nursing care for older citizens. This is, however, only one side of the challenge. The structural problem is becoming clearer with the lack of qualified young people in medicine and nursing. Strong management and collaborative action is needed at both national and European level.
All the more significant is the fact that it is the responsibility of the hospital management to address these issues on an entrepreneurial level. However, it is just as important that hospital directors focus on improving the structures and processes of healthcare provision at both national and European levels. The national associations of hospital directors as well as the European Association of Hospital Managers serve as a platform for this activity.
We need to constantly review the basic organisation of our organisations both in terms of objectives and activities as well as in relation to structures. So all of us are asked to make the things for which we are responsible the best they can be every day instead of simply forecasting bad scenarios.
The next opportunity to discuss an important question regarding the structural development of our hospitals is the EAHM seminar during MEDICA in Düsseldorf on German Hospital day. The topic of choice is "Towards a Balanced Co - operation of Public and Private Actors". We look forward to a lively discussion.