1. Illustrate the Meaning and significance of Healthcare Administration and the factors influencing it.
2. Healthcare Administration is a Science and an Art. Comment.
3. Describe the various principles and objectives of a Healthcare Administration.
4. Healthy Environment is an important aspect as a concern for the Healthcare. How would you address this issue effectively?
Case No 1
Implementing an Integrated Human Resources System: Recognizing that the manager/employee relationship is key in creating a great place to work, the group XYZ has devoted a great deal of time and energy to redefining managers’ roles in the organization in an effort to improve that relationship. It has stressed the importance of an integrated Human Resources System, where the key human resources functions of selection, appraisal, reward, development, organizational development, communication, and employee relations must be closely inter-related and mutually supportive and where the manager must play a key role. This has been a driving force in the implementation of several key initiatives.
In addition, XYZ conducted a workplace culture assessment and integrated the results from that survey into those same initiatives. The survey used was the Competing Values Model survey. The results of that survey yielded four imperatives: they are – increase the level of accountability to get things done; continue to enhance collaboration throughout the organization; decrease the amount of bureaucracy; and increase the amount of innovation and risk-taking.
Several initiatives were launched to accomplish the above objectives. The first was re-designing the performance management process. XYZ transitioned from a once-a-year performance review document to a year-round, two-way communication process that emphasizes performance improvement and individual development. To begin the process, managers met with their employees to collaboratively set performance expectations, the aim being to be as specific and measurable as possible. Managers now meet at least twice each year to discuss performance. Ratings were removed from the performance review document to facilitate discussions that were more qualitative in nature and that focused on feedback and coaching. In addition, considerable time is devoted to creating and discussing individual development plans that emphasize professional and personal growth. These changes in the performance management process allow for more interaction between an employee and his/her manager to discuss issues that are most important to the employee. Communication and trust are enhanced as a result.
Because organization improvement is based on the quality of the managers and their relationships with their employees, the second initiative was created: to develop a robust management development curriculum. This curriculum was closely linked to the culture survey so that the culture imperatives are reinforced throughout the year. New managers to the organization attend monthly development sessions that range from half days to full days in order to become acculturated to XYZ’s way of managing. Experienced managers are able to choose from a menu of learning opportunities that best fit their development needs and their learning styles.
Finally, efforts to lessen the amount of control and bureaucracy have begun which ultimately transitions more decision-making ability to the managers and further reinforces their ability to make decisions that are in the best interest of their own employees. Human Resources recognized that to give managers the level of control necessary to affect the changes desired, a close examination of the policies and procedures needed to take place with the goal of eliminating unnecessary controls or increasing manager discretion/input wherever possible. For example, managers are now collaborating with Human Resources to a much greater extent to decide pay issues as opposed to relying on decisions based, in large part, on system-wide HR policies/guidelines.
Workforce Problem the Program/Initiative Was Designed to Address
- How to best engage the workforce to achieve the mission and vision
- How to recruit and retain the best employees
- How to create a great place to work
- Implement an Integrated HR System approach
- Redefine the managers’ role in the organization to devote increased time and energy to managing their Human Resources
- Develop managers so that they can fulfill their critical role in creating a great place to work
- Transition to a true Performance Management process to engage the workforce so that it can achieve its strategic vision
- Executives and managers are clear about the organizational culture and in agreement with where it is headed.
- An entirely new performance management process was created, and all managers were trained in the process.
- Employee opinion survey results have improved, and in some areas the organization is approaching world-class benchmarks.
Limitations or Problems Encountered
- The program takes time. It is difficult in complex organizations with multiple sub-entities, and it takes a lot of time to see results.
- The health system has limited resources and had to do much of the work itself.
- It is difficult for some to understand that this is a long-term effort, and when people already have projects on their plate, it is important to work to prevent them from burning out.
Issues to be discussed
- Facts of the case
- Discuss the various initiatives as enumerated in the case based on your analysis.
- Establish whether the integrated Human Resource system for the Health care is effective or not. Justify your view.
Case No 2 Referral System in Health Services: A Case Study of Punjab
Punjab is one of the vital states of Indian Union consisting of 17 districts. Punjab has a vast network of public health care facilities comprising of 217 hospitals excluding three tertiary level hospitals, 104 community health centres, 484 primary health centres and 1462 subsidiary health centres, dispensaries. The teritary care facilities in Punjab consists of three Govt. Medical Colleges, two private medical colleges and a prestigious Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh under the Ministry of Health and Family Welfare, Government of India.
Punjab Health Systems Corporation established under the world bank project aims to develop secondary health care. It has taken up 151 health institutions including all district hospitals. 42 Sub-divisional hospitals and 87 Community, Health Centre, 6 Area hospitals. Under the World Bank project, Punjab Health Systems Corporations is responsible for:
- Renovation of hospital buildings to provide appropriate space for services.
- Upgrading and updating of clinical skills of Medical Officers and staff nurses through an effective training programme.
Provision of ambulances for transporting critical patients.
4. Installations of phone, fax in hospitals.
5. Strengthening of Secondary level health care shall support the primary health care and thus there is need to formulate and implement an ideal and effective referral system. This is the right time and situation for Referral System to work and is the rationale for this system to develop.
THE REFERRAL SYSTEM IN PUNJAB
The Punjab Health Systems Corporation has initiated to strengthen the functioning of the hospitals for referral system through the following measures:
- Renovating and upgrading hospital buildings to provide appropriate space for services.
- Upgrading and updating clinical skills of medical officers and staff nurses through an effective training programme.
- Providing ambulances for transporting critical patients.
- Installing phone, fax and paging systems in hospitals.
- Financial powers to Senior Medical Officers in charge of the hospitals to accord necessary single sanction up to Rs. 5,000 (Rs. Five thousand only) and Deputy Medical Commissioners, Civil Surgeon, Medical Superintendent up to Rs, 10,000 (Rs. Ten thousand only) to meet the emergency.
- The user’s charges are to he retained at the site of collection. These are to be used by the Senior Medical Officer In charge of the hospital. Norms of services have been designed for each level of faculty.
FEATURES OF REFERRAL SYSTEM
- Referral Network and Zoning
To identify the various referral levels, the whole district is divided into several zones and the referral levels are indicated for each zone. To facilitate and for convenience of patients, certain number of Primary Health Centres are grouped and linked to community health centre (C.H C.) /Tehsil Hospital/Area Hospita ls / District Hospitals depending upon the distance, availability of services, facilities of transportation, etc. But adopting a grouping system, uniform referral pattern has been developed. In this system the patient will know the course of further treatment, in case one is referred for some special procedure at appropriate level of care. Similarly, a good rapport and faith in the referral system will be developed. This is called zoning.
It helps in evolving a chain for the health units beginning at the primary level moving up through the middle tier and finally reaching the tertiary hospitals. Let us explain it with the help of Kiratpur Sahib.
After dividing the district into zones, the same is to be depicted on the map. The map should reflect all the health institutions, roads, river, bridges, Bus Stand, Railway route, Railway station, Police station, Post offices, etc.
These maps will have to be displayed at the reception counter in each of the health institutions.
- Transportation Facilities
lo build up an effective Referral System, a dependable transportation arrangement has been provided where the health personnel shall be able to send the patients to the next appropriate level of care at the earliest, as the flow of patients is expected to be from primary health centres to the tertiary level.
- Referral-cum-Feed-back Card
Referral system is a two way process. The patient referred will be given the referral-cum-feed card. The colour coding has been done. The patient referred from CHC shall get blue cards. The patients referred from Tehsil hospital/Area hospital shall get green card. The patients referred from Distt. hospital shall get white card. The patient referred from P.H.C. or Subsidiary Health Centres shall have pink card.
The referral card contains—General information about the patients such as name, age, gender, address, Chief complaints, clinical findings, vital signs. Investigations done, Treatment given, procedure done where referred, and purpose of referral, i.e. for admission, Investigation or expert opinion.
At the referred hospital, patients could report directly to the unit or department to which he or she has been referred through a special counter for referred patients.
- Referral Procedure
In the referral procedure, there are two types of referral— (i) Emergency, (ii) Routine referral. In routine referral the patient will have to make his own transportation arrangement, however proper counseling needs to be done. The patient shall be given referral card. The regular hospital hours 8.00 a.m. to 2.00 p.m. In summer and 9.00 am to 3.00 p.m. in winter with half an hour break L30 p.m. to 2.00 p.m. For investigations, the best suitable time 9.00 AM. to 11.30 A.M. However emergency patients who are to be attended round the clock.
- Receiving of Referred Patients
Referral units should receive the patients directly at a place identified in each hospital without waiting in general outdoor patient department (OPD).
The receiving hospital must ensure that a referred patient enjoys the following privileges.
(i) Queue Jump: The referred patient will not stand in queue for general out-patients. He/She directly goes to the doctor referred on priority through a special counter of referred patients on routine.
(ii) No need of new OPD ticket. The referral card itself to he used as OPD ticket. The entry is to be made in the referral registers at the reception counter.
(iii) No purchee fee for referred patient with referral card.
(iv) Feed-back——After dealing with patient and at the time of discharge in case of admission, the doctor should fill up referral-cum-feed-back card. This will help the referring doctor to know whether the patient that he had referred, had got the relief. The specialist may send the feed back on slip (from slip pad) through S.M.O. 1/C of the health institution.
(v) Provision of low cost transportation—in emergency patients, it is clear that the actual fuel charges are to he paid by the patient. In poor patients (unknown, yellow card holders, natural Calamities, Disaster), this can be exempted.
(vi) From jail Hospitals, the patients are referred through the Police guard.
- Norms of Service
Norms of Services have been worked out for institutions at various levels in terms of facilities, staffing, equipment, services, etc.
- Maintenance of Registers
Two registers both by referring institutions and referred institutions are to be maintained to keep a proper records. Besides, there are large number of details which have been drawn to make the system functional. However, the systems has not taken roots and is still in its infancy.
For making referral system successful, Punjab Health System Corporation has taken the following steps:
- Intensive Training ro all personnel from top to bottom to make them aware of the potentialities and limitations of referral systems.
- Equipping the health institutions with the prescribed norms of services.
- Making the people aware through maps of zoning and also through a video cassette “Know your Hospital”.
- Arranging transport facilities.
- Delegation and decentralisation of administrative and financial powers.
- Overseeing the implementation.
- Conducting research to diagnose the problems which stand in the way of efficient functioning of referral system.
By now, referral system has been introduced in all districts of Punjab. It is hoped that this would bring a revolution in health services in Punjab.
Issues to be discussed
- Facts of the case.
- Analyse the Referral System based on the case and taking out of case examples as well.
- Based on the analysis do you perceive increased effectiveness in the health services? Justify your view.