Fellow Since 1995
Servicio de Ortopedia y Traumatologia
This profile was prepared when Marcelo Viale was elected to the Ashoka Fellowship in 1995.
The New Idea
Marcelo Viale's new model of hospital organization and management is based on principles of decentralization, self-governance and community control. Although those principles have been effectively employed in other settings, they are dramatic departures from prevailing norms in Argentina and elsewhere in Latin America. Key elements of Marcelo's model include a shared management structure that teams doctors with enlightened community leaders; a redesigned management and service delivery system that includes modern technology and computer-based controls; and a compensation structure that allows hospital employees to benefit from savings generated by cost-cutting measures. In the hospital that he directs in Tigre, he is pioneering a new structure in which a volunteer community board, rather than a centralized government agency, is responsible for the institution's governance. Thus "liberated" from obsolete rules imposed by long-entrenched political interests, he is demonstrating that public institutions can provide health care in a humane, cost-effective and efficient manner. With the endorsement of the hospital's community board, a portion of the savings achieved from cost-cutting measures and administrative reforms is earmarked for bonuses for hospital professionals and staff members. This scheme, which is a major departure from the usual compensation practices in public institutions, is providing a much-needed and quick-acting stimulus for improved performance. Marcelo is taking special care to ensure that the principle of universal accessibility to high-quality and humanely provided care is uniformly reflected in the hospital's practices. Indeed, Marcelo views community-based governance and up-to-date and efficient management practices not as ends, in and of themselves, but as vehicles for achieving his true goal-a new ethic in providing sensitive, efficient and high-quality health care to all citizens of Argentina.