Leadership in Challenging Times: Managing Hospitals in the Transitional Countries of Southeast Europe.

Managing healthcare, especially in transitional countries, is challenging. The firstnamed author was Managing Director of a leading Clinical Center in Sarajevo, facing the need for institutional and structural reform after the 1992-1995 war. Economic and sociopolitical transition has to also take into account major changes in the health of the population, linked to war, migration and overall demographic change. A different kind of leadership was needed in the context of falling industrial production, lack of investment, exclusion from global business, unemployment, poverty, corruption, dislocation of the infrastructure and catastrophic ecological conditions. Although the adjustment procedure has started, especially for the planned accession to European Union membership, the countries in the Balkans are lagging behind. In the context of hospitals, leaders and managers face a long-term uncontrolled increase in health protection expenditure, which has resulted in an increase of overall healthcare costs, with new pressures from the market economy. Accordingly, these countries have started comprehensive and deep reforms of health financing, which are now being implemented. Leaders in this area are struggling with a lack of practical experience and searching for benchmarks and comparisons with other countries which have already experienced these challenges and have now reached a higher level of stability. [ABSTRACT FROM AUTHOR]