Marchal et al. BMC Public Health 2010, 10:787 http://www.biomedcentral.com/1471-2458/10/787 the need for change. Subsequently, a workshop on “Effective Communication in Customer Care Service” was organised for all staff members. Ward conferences were organised to enhance the capacity of operational staff to analyse their problems and find their own solu- tions. The health information officer was actively involved in preparing ward-specific performance ana- lyses and the patient and staff satisfaction surveys. The resulting information was fed back to the units to sti- mulate improvement. A second priority was the rehabilitation of prime resource generating service points. Repairs were carried out at the operation theatre in 2006, and major opera- tions started again. In July 2006, the National Health Insurance Scheme (NHIS) temporarily accredited the hospital. The M/Supt. initiated a registration drive in the district, together with the district NHIS office. At the end of the year, the proportion of patients registered with the NHIS had risen to 13,1%. Subsequently, the hospital began the rehabilitation of the mortuary, for which the hospital staff agreed to lend funds from their Staff Welfare Funds. The mortuary commenced opera- tions in 2007. Successful efforts were also made to keep up the stock of drugs. Third, the CMT revived the regular communication channels with the aim to involve the mid-level managers and to better stream information up and down the orga- nisation. The regular committees, which are supposed to operate in all GHS institutions, were a key element. The monthly Heads of Unit Meeting, uniting the heads of all units and departments of the hospital, was reinstated, as well as the procurement committee and the staff dur- bars. The Hospital Management Committee, more restricted in membership than the Heads of Unit meet- ing and providing strategic guidance to the CMT, was revived. For strategic reasons, all doctors as well as some external actors like the Ho Municipal District Director and the Regional Public Health Nurse were included in the Hospital Management Committee. This committee subsequently met monthly. Also, contact with key external stakeholders was re-established, including the district National Health Insurance Scheme office, the Regional Health Directorate and the Munici- pal District Health Director. Relations with the local chief and with the press were taken care of. A ‘Hospital Open Day’ was organised to enhance involvement of the community and other stakeholders and to start dissemi- nating the message of change. Finally, measures were taken to improve core adminis- trative functions needed to ensure improved revenue collection. NHIS claim processing was streamlined and additional accountants were hired. Page 7 of 16 Phase 4 - Development and consolidation of the 5 year strategic plan In 2007, the CMT felt that the dynamics of change would be better sustained by a strategic plan for the hospital. Its development was initiated with the hiring of two lecturers of the Unit of Change Management, Ho Polytechnic. A staff member of the Regional Health Directorate assisted this team. The initial process con- sisted of a participative SWOT analysis and environ- mental scanning, followed by a cycle of focus group discussions with staff from all cadres. On this basis, the Polytechnic team drafted a preliminary plan. The CMT revised the mission statement and the action plan at the end of 2007. The resulting Strategic Plan 2008-2013 “Rising [sic] internal strength” [39] was consolidated through extensive consultation with the staff and exter- nal stakeholders, including representatives of NGOs, the Municipal Health Directorate and the District Assembly. The first part of the plan presents a synthesis of the SWOT analysis, the basic assumptions and forecasts on which the plan is based, and the vision, mission, core values and objectives of the hospital (see Table 1). The second part presents the main strategies and detailed action plans [39]. The plan was launched officially in January 2008, in the presence of a number of MOH and GHS senior staff. T-shirts, pamphlets, flyers, copies of the strategic plan and meeting calendars were widely distributed: a deliberate strategy to create visible signs of change. More importantly perhaps, a new information channel was created: the monthly hospital information bulletin targets staff and external actors and dissemi- nates information on management interventions and on the performance of the departments. Table 1 Key elements from the Strategic Plan 2008-2014 “Rising internal strength” The core values The main strategies Patient/client at the centre, irrespective of status Fair treatment to all Team spirit and harmony at all levels to enhance synergy Efficient utilisation of resources to improve accountability Rationalisation through dissemination of best practices To be sensitive to the environment To improve the quality of care To strengthen the hospital’s health workforce To ensure adequate infrastructure To increase revenue To improve the management systems