HOSPITAL MANAGEMENT AND DECISION MAKING

Most of us plan many things in our lives. We plan to go as a holiday trip, plan or

careers, plan our investments and so on. Hospitals are no exception and managers

at all levels do lot of planning. Lot of information has to be gathered and

processed before a plan is formulated. In other words, a plan is like a jigsaw

puzzle. Planning is necessarily forward looking. It is looking into the future. It

bridges the gap between where we are and where we want to go.

INTRODUCTION OF HOSPITAL MANAGEMENT

The WHO has adopted the following definition of Hospital:

It is an integral part of a social and medical organization, the function of which is:

a. to provide for the population complete health care both promotive and

preventive care and

b. whose outpatient services reach out to the family in its home

environment.

The hospital is also a center for

c. training of health worker and

d. biosocial research

The emphasis is on preventative and promotive aspects of health and on

education and research.

Hospital Management becomes complex

Hospital Management becomes much more complex because of its complex

operations and the peculiar circumstances under which it operates.

1. As provider of good patient care it has to run highly specialized medical and

surgical procedures and provide standard type of hotel accommodation.

2. Round the clock services: Many of the staff members have to be on call.

3. Deal continuously with problems of life and death. Therefore a sense of

urgency always prevails.

4. Pattern of dual authority – There are two main authority lines in operation –

professional and executive. When any conflict occurs, the employee is

caught in between resulting in low moral and affects their performance.

5. Usage of Newer and costly equipment due to discoveries and innovations in

medical science. Problem of maintenance and servicing becomes acute.

6. Hospitals are compared to industry or a factory. But it differs widely. The

product of the hospital – service and medical care- is rather intangible and

cannot be measured in terms of quality.

7. The facilities needed in hospitals are innumerable from pin to equipment

costing lakhs of rupees. The hospital is self-contained town. It has to have its

own electricity, water supply, laundry, kitchen, drainage system, garbage

clearance, workshop, transport, stores etc.

8. It is basically a human organisation. People are involved at every stage-the

workers and the patients. Therefore, humility, devotion to patients,

compassion and consideration for the sick and wounded have to be the

hallmark qualities of all those who work there.

9. Management with human touch is a must in hospital management. It is a

human organisation run on business lines but not for business ends.

10. Community expectations are higher as they become aware of their right to

better health.

11. Expanding specialities, rising costs and limited resources.

12. Necessity of a team approach (Cooperation – Coordination)

The main purpose of the hospital is to restore health to the human body. To

this can be added preventive, promotive & rehabilitation. To increase skills and

efficiency in the health care delivery, Education and Research play a vital role.

To provide these, hospital has to avail services of skilled professional medical

staff, trained nurse and other technical personnel necessary in diagnosis and

treatment. A well-defined hospital management has to be worked out taking into

consideration of the following points:

1.Project understanding

This requires that

a. All concerned with the hospital have full knowledge of the functions of the

hospital.

b. The hospital is only a component of the health scheme designed for the

community must be understood:

c. The current advances in the fields of medical science and technology be

appreciated:

d. The scope of human possibilities, as skilled labour of different types, can be

utilized for the patients’ benefit is considered.

2. Forecasting:

Attempt only after knowing all facts that will help towards making a

correct guess.

1. Planning

a. Never start without a plan:

b. Always work out a detailed plan, irrespective of whether it is for (a) a new

building b) a new department or c) a new procedure.

c. Utilize all relevant people in planning procedures:

d. Place of committees in such procedures be realized and utilized.

2. Resources Assembling

a. Men

b. Material

c. Money

d. Method and

e. Space

3. Departmentation

Organise area or group activities using certain principles and factors.

Principles

a. Define units of primary concern and others which are auxiliary units:

b. Consider applicability of centralized / decentralized concept.

c. Span of control

d. Formal and informal organization.

Factors

a. the availability of specialists and thus taking advantage of such

specialization

b. as a means of aiding effective control

c. as a method for facilitating proper co-ordination

d. as a procedure for giving special attention

e. its suitability to the local condition, and

f. as a mode of expenditure reduction.

4. Co- Ordination

a. Communitation: i) formal

ii) grape - vine

b. Use of Committess.

5. Staffing and Equipment:

a. Develop a definite pattern before planning.

b. Consider all factors that influence evolving such patterns.

c. Knowledge of such existing patterns is important.

6. Directing

a. Proper communication necessary

b. Concept of employing the whole man

c. Proper orientation

d. In-service / on the job training

e. Delegation

f. Use of committees

7. Controlling

This is a must. It is four fold, such as

a. Qualitative

b. Quantitative

c. Cost

d. Consumer satisfaction

Broadly hospital activities can be classified into 5 groups.

1. Clinical Service:

2. Nursing Service:

3. Medico – administration: Medical records, Lab,

(Para medical) X’ ray, Pharmacy

Physical therapy

Dietary

4. Supportive Service: Housekeeping, Laundry,

Sanitation, Steam

supply, Maintenance.

5. Business Service: Personnel, store

purchase, finance,

security, transport.

An organizational chart is to be drawn in order to maintain discipline and

coordination, defining responsibilities and functions, channel of communication,

lines of authority and relationships.

GOVERNING BOARD

EXECUTIVE COMMITTEE

FOREMAN

By this every individual would know definite duties, will avoid overlapping

and duplication, will bring in efficiency and economy in the organisation.

Components of good Hospital Management:

1. Span of control – technically feasible and defined.

2. Line of authority – clearly defined.

3. Delegation of authority with responsibility.

4. Built in flexibility.

5. Balanced organisation.

6. Objectives – clearly defined & notified to all staff.

Signs of bad Hospital Management

1. High turnover

2. Friction among heads (Groupism)

3. Slowness in decision process.

4. Lopsided aged structure.

GENERAL SUPERINTENDENT

NURSING SUPERINTENDENT

MEDICAL SUPERINTENDENT

ADMINISTRATION NURSING MEDICAL

5. Too many rumours

6. Too many disciplinary actions.

1:3 EVOLUTION OF MANAGEMENT

Historic Background

1300 B.C – Early Egyptian papyri interpretive importance if organisation and

administration in a bureaucratic way.

Parables of Confucius gave practical suggestions for adequate public

administration and advice the selection of unselfish honest and capable officers.

Western Civilization: Roman catholic church had a most formal organisation.

Taj Mahal and Egyptian Pyramids demonstrate the practice of management in

older days.

16th to 18th century ; Cameralists were the group of German and Austrian Public

Administrators.

Scientific Management Stage:

Scientific Management was started with Taylor in U.S.

Robert Owen - Father of Modern Personnel Management.

Charles Babbage (the father of computer) – Wrote “On the Economy of

Machinery and Manufacturers” on 1832.

Henry Vernum Poor – Editor of American Railroad Journal saw the need of

managerial system.

Frederick W.Taylor and his work “The Principles of Scientific Management”

published on 1911.

Henry Fayol – Father of Modern Operation Management Theory published his

principles on his books ‘Administration industrielle et Generale’ in French.

Contribution of F.W.Taylor (Father of Scientific Management)

1.Replacing rule of thumb with science.

2.Obtaining harmony in group action rather than discord.

3. Achieving co-operation of human beings rather than chaotic individualism

4.Working for maximum output rather than restricted output.

5.Developing all workers to the fullest extent possible for their own and their

company’s highest prosperity.

Contribution of Henry Fayol (Father of Modern Management)

The Principles of Henry Fayol are as follows:

1.Division of Work

2.Authority and Responsibility

3.Descipline

4.Unit of Command

5.Unity of Direction

6.Subordination of individual interest onto general interest

7.Remuneration of personnel

8.Centralization

9.Scalar Chain

10.Order

11.Equity

12.Stability of tenure of personnel

13.Initiative

14.Esprit de corps (Union is Strength)

Contribution of Peter F. Drucker (Management Guru)

Drucker Views on management may be summarized as follows

1. Management as a Practice

2. Three basic functions of management is the achievement of pupose

and mission of the institution, make the work productive and

worker achieving and effective management on social

responsibility.

3. Objective setting (M.B.O)

4. Orientation towards justice

5. Federalism – Centralised control in a decentralised structure.

MATERIAL PREPARED BY

PROF T.JEYARAJASEKAR M.H.M., MPHIL., P.G.D.O.R., P.G.D.M.M.