Diagnostic Analysis and Effectiveness in the Management of Bulgarian Hospitals

Introduction

Corporate diagnostic analysis developed as an approach for linking organisational results to predefined objectives. In hospital management, this logic is particularly important because effectiveness cannot be evaluated solely by reporting activity; results must be assessed against business plans, management priorities and strategy.

The study therefore examines the gap between the theoretical role of diagnostic analysis and its actual use in Bulgarian hospitals.

Aim

To investigate current diagnostic-analysis practice in Bulgarian hospitals and identify its purposes, scope, characteristics and most frequently used performance domains and indicators.

Material and methods

The opinions of 412 professionals working in 109 Bulgarian hospitals of different types were studied during 2006–2008.

A 25-item questionnaire was used, combining open, closed and semi-closed questions with items designed to determine weighting coefficients. The design therefore captured both practice patterns and the relative importance attributed to different analytical domains.

Primary purpose: assessment of current status

In 88% of cases, diagnostic analysis was performed to establish the hospital's current state. This demonstrates a strong diagnostic and planning function but not necessarily systematic measurement of progress against predefined strategic objectives.

What triggers analysis

The most common trigger was a requirement from higher-level authorities — 70% of responses. A substantial share of hospital analysis was therefore externally stimulated through reporting, control or administrative requirements rather than being fully embedded as a continuous internal management process.

Dominant domains: clinical activity and finance

The two leading domains in the analysis of internal organisational potential were medical activity — 21% and financial activity — 17%. These are essential dimensions, but alone they do not provide a sufficiently multidimensional picture of management quality, patient perspective, workforce, processes and strategic development.

The patient perspective: theory-practice gap

One of the study's most important findings is the gap between theoretical frameworks and practice regarding the role of the patient. Modern performance frameworks treat the customer/patient perspective as a core dimension, whereas it was less fully integrated into diagnostic analysis in the surveyed hospitals.

This represents an early empirical indication of a deficit that later became central to patient-centred care and hospital performance assessment.

The central management deficit

Diagnostic analysis was used to plan future actions, but it was not sufficiently linked to verification of whether objectives stated in business plans and management strategies had actually been achieved.

This creates a separation between measurement and strategy: hospitals assess their condition but do not always use the same indicators to monitor strategic execution.

Management implications

• indicators should be selected according to objectives, not only data availability;
• analysis should track both current status and progress toward strategic goals;
• the patient perspective should be integrated alongside clinical and financial dimensions;
• analytical findings should lead to concrete management actions;
• diagnostic analysis should function as a continuous internal management process, not merely a response to external requirements.

Main contributions

• provides empirical evidence from 109 hospitals and 412 professionals on actual diagnostic-analysis practice;
• quantifies its principal purposes and domains;
• identifies the dominance of medical and financial measures;
• highlights the limited integration of the patient perspective;
• identifies the missing link between analysis, business plans and strategic execution;
• supports a more balanced and strategy-oriented performance measurement system.

Conclusions

Bulgarian hospitals used diagnostic analysis widely, but mainly to establish current status and support future planning. To become a mature performance-management instrument, analysis must be directly linked to organisational objectives, business plans and management strategy.

The key shift is from asking “What is our current state?” to asking “To what extent are we achieving our objectives, and why?”. That connection transforms indicators from reporting data into management tools.

Scientific Key Terms