Public Hospitals are facing imperative challenges offered by the fast growth of communication, as well as biomedical technology; the necessity for cost-control; as well as the spotlight on efficiency and competence; the augment of populations' strains for services and transformations in demographic and epidemiological factors (Counte, 1995; Walid, 2003; Henry, 1997; Patricia, 2001). The diverse strategies for restructuring should include devolution and centralization, changeover guidelines, redefinition of the purposes of hospitals and primary care, formation of novel positions for experts, enhanced administration, cost-control and marketplace direction. No matter the strategy assumed, the aspirations of restructuring are to give health care that is oriented towards result, footed on proof and centered on usefulness and competence, to augment the accessibility of services, patient happiness and the superiority of care (Counte, 1995).

Therefore, reforms of public hospitals should focus on how to develop value and decrease expenditure devoid of restraining access and evenhandedness. Majority of the countries are tormenting from economic downturn, generating difficulties of assistance of the health care system; with public hospitals tormenting the most from lack of capital for continuation, staff and even essential drugs and apparatus. Therefore in the fast changing world, it is imperative that public hospitals learn to be flexible to adapt transformation. Bearing this in mind, the paper provides strategies to make public hospitals function effectively in this quickly changing economy (Henry, 1997).

Hospital investment in infrastructure

Hospital investment in infrastructure should be focused on the growth and completion of best customs' policies concerning properties for the stipulation of health care. The major reason should be to expand evidence-based strategy to support stakeholders in the reformation of health care facilities, when making decisions in the field of architecture or investment in infrastructure (Covin, Prescott & Slevin, 1990).

The following issues should be addressed

Results of changing technological, clinical and social models of care for health care structures;

Classification of structures, which mirror paramount value design and functionality at the same time as also representing most excellent value;

Investment programming and completion;

Measures for the management, procurement and removal of buildings, making the most of competence and helpfulness (Covin, Prescott & Slevin, 1990).

Emergency Medical Services

Emergency medical services pretense one of the major difficulties of the public health care system. They are required to create quick and proper reactions to life-threatening state of affairs.

Out-of-hospital medical emergency services (OHEMS) and hospital emergency departments form the two foundations of emergency medical services. Generally, coordination between them is not very good.

Strategies should be developed on emergency services that should produce devices to augment emergency medical services in public hospitals, to cut down death and morbidity intensities. It in addition, should record the association amid hospital formation and clinical performance and monetary competence. Furthermore, the strategy should address numerous aspects, which connect to the hospitals' concerns (Vogel, Langland & Gapenski, 1993).

What are the most excellent organizational structures for emergency services to reduce death, as well as morbidity?

How does hospital formation persuade services' and clinical performance and monetary competence?

How to recognize emergency medical services?

What functions might the diverse specialist play to make the most of resources?

How should medical emergency professionals be educated?

What kind of executive organization develops results?

How can the unsuitable utilization of emergency departments be cut down?

How to support the utilization of interdepartmental procedures?

Integrated Care/Linking Levels of Care

The functions of public health care hospitals are becoming more and more complicated: medical technologies permit the stipulation of services at diverse levels of care; chronic patients need care, health promotion, as well as treatment services in manifold locations over a period of time; as well as economic issues compels for well-organized stipulation of services. These events appeal for a cautious management of services, teamwork of service providers and participation of patients (Fottler, Blair, Whithead, Laus & Savage, 1989).

Badly integrated delivery systems augment the danger of contradicting proposals and medication regimes, repetition of diagnostic events, holdups in the detection of obstacles, deprived change from one level of care to another and inadequate training of chronic patients to manage with their state after release. Therefore public hospitals should create better-integrated health care delivery systems as a plan to manage with present and predictable health care services requirement (Fottler, Blair, Whithead, Laus & Savage, 1989).

The strategy should aim to assist an improved connection of the diverse levels of care all the way through the progress of novel information, design of appropriate strategies to maintain transformation and...

To overcome these challenges, emphasis on human resource should be given. However, in this regard the political system has a different view point; as pointed out by Henry R. Desmarais in his article "Financing graduate medical education: The search for new sources of support. He asserts," Funding the "Congressional leaders and educators seem to be in agreement in their opposition to expanded federal regulation of medical education, including federal allocation of training slots and approval of programs. However, the use of public funds generally requires a policy rationale and some means of holding recipients accountable for policy goals. In the current political climate, it has proved exceedingly difficult to reconcile these conflicting views (Henry, 1997)."
This is a highly threatening preposition. The government should base their actions of the human resources for health program aspiring to assist health care systems and professionals to become accustomed to encounter the confrontations of the 21st century, instead of cutting down the funding assistance program (Patricia, 2001; Liedtka, 1992). Furthermore, while deriving a strategy to assist graduates the government should look for answers to the following questions.

How can the government form strategies to assist human resources in a constructive manner?

How can the roles be constructively dispersed amid health care professionals?

Which are the most excellent systems for education and training for the graduates?

The system should work to transform the education of health care professionals and the combinations of professionals employed to offer services that give superior care for the population and augmented level of health. The professionals should be able to cope with the continuous modifications in health services ensuing from the fast growth of technology and science and the rising stress of the population. Furthermore, they should be able to cope with the redefinition of professionals' purposes and the transformation in health care systems (Patricia, 2001; Liedtka, 1992).

The role of Stake Holders

The 1990s lead in an era of momentous control by stakeholders in the manner trade functioned. The areas concerned ran the gamut from commercial social accountability to interior domination. The media vigorously underscored the eminence of stakeholders and finished that "the days when CEOs could neglect their... owners and other corporate stakeholders are coming to an end... now managers will have to listen to - and learn from - other groups who are demanding a voice in the running of the corporation (Fottler, Blair, Whithead, Laus & Savage, 1989)." As stakeholders are developing into a key power, executives must deem ways to supervise stakeholders.

While there are numerous stakeholders for infirmaries, a current analysis of hospital administrative recognized the five most significant and influential. These are: medical personnel, patients, hospital supervisions, professional personnel, and panels of trustees. The medical staff's prospects are principally related to high medical superiority and sufficient maintenance services. Patients, like surgeons, care about medical quality, but they are also apprehensive about service value and low expenses (Fottler, Blair, Whithead, Laus & Savage, 1989).

The hopes of hospital supervision comprise cost suppression, productivity, and organizational control. The primary apprehensions of the specialized staff are also medical superiority and accessibility of ample services and amenities. The panel of trustees, which holds formal management of the infirmaries, is concerned in prosperity, preserving a stable stream of profits and cash stream, and efficient exploitation of resources (Fottler, Blair, Whithead, Laus & Savage, 1989).

Furthermore, a study was lately conducted on views of the stakeholders on five sets of anticipated outcomes: health professions education impact, curricula and services, students, community and policy, and sustainability and structural change outcomes. Walid El Ansari (2003) concludes, "If partnerships are to contribute to improved health status, then we must evaluate the degree of impact they have on improving the social and health aspects that they set out to attain. To this end, this study examined stakeholders' views of five sets of anticipated outcomes. There was a reasonable degree of certainty that the partnerships would achieve their intended outcomes. Using tightly defined specific stakeholder groups for the analyses is recommended in order to offset the lack of homogeneity among partnership groups and volunteer participants (Walid, 2003)."

In winding up, whilst the stress placed by health care supervisory on managerial efficacy, efficiency, and spiritedness is creditable and would keep happy the apprehensions and requirements of diverse stakeholders, superior concentration needs to be alerted on providing the requirements of patients (Walid, 2003; Fottler, Blair, Whithead, Laus & Savage, 1989).

The politics of Public Hospitals

In a complex and fast changing market economy. Public sector hospitals should work together and resolve their vested interests in order to provide most excellent…