Case I – HOSPITAL ADMINISTRATION – ROOT OF THE PROBLEM.
Introduction of professionally qualified hospital administrators into hospitals is a need of the hour. It is now accepted that all hospitals including government hospitals need a fully qualified, experienced hospital administrator. Taking advantage of this rising requirement, many (actually too many) institutions are today offering hospital administration courses.
With a few exceptions, most of them have neither the hospital infrastructure nor a proper faculty. Moreover they are not hospital-based, though it is inconceivable how proper hospital administration can be taught, except in hospitals. What such institutions do, is to send their students for so called “project work” to hospitals for a short period. From my own experience, this project work is a farce, and actually waste of time. What is worse, the students get a totally warped and wrong idea of hospital functioning, problems and solutions.
Moreover the chief instructor and faculty, consist of general administrators and not qualified hospital administrators. While many aspects of administration pertaining to hospitals can be dealt with by those who are not doctors, ‘Hospital’ administration can only be taught by doctors, who have a recognised post graduate qualification in hospital administration, and who have considerable experience in working and administering hospitals.
The practice of appointing senior doctors, without hospital administration qualification or experience, as hospital administrators, is bad, and is the root cause of many of the ills of the hospitals. Asking non-doctors with even a qualification in hospital administration to ‘teach’ hospital administration is worse. While a non medical microbiologist, can participate in teaching of medical graduates, he/she cannot be a professor of pathology, as the scope is wider.
So also for hospital administration, a doctor alone, can have a comprehensive insight into hospital functioning. In this connection the concept that experts in community health are automatically hospital administrators, is absurd.
We have nursing schools that are not hospital-based, which churn out nurses and grant them registration. Our experience is that, while they can mouth the theory of nursing, they are ineffective nurses, and have to be retrained in nursing. The same situation is what happens to ‘hospital’ administration. This means that many institutions, who claim to impart training in hospital administration, are misrepresenting facts, if not cheating.
1. Outline the reasons as to why hospital administration can only be taught by doctors. Present a counter analysis to oppose this point of view.
2. On what fronts do various institutions compromise while designing hospital administration courses? What are the steps you may take to ensure a wholesome teaching for the hospital administration course?
3. What do you mean by Hospital? Focus on the significance of the role played by a Hospital Administrator in a Hospital.
CASE II – INDIAN HEALTHCARE SYSTEM
India has both private health care system and a public, universal health care system. The universal health care system run by the local (state or territorial) governments. The “government hospitals”, some of which are among the best hospitals in India, provide treatment at taxpayer cost. Most drugs are offered free of charge in these hospitals.
Most government hospitals do not require payment from people below poverty line, proof of citizenship or residency. Government hospitals in some parts of the country and some private non-profit (including teaching) hospitals charge a nominal fee to prevent abuse of the system. Most hospitals are operated on an annual budget allocated by the government, and do not rely on individual billing. These hospitals also provide better amenities (such as private air-conditioned rooms) if the patient can afford to pay. However, they charge less than comparable private hospitals.
The private clinics and hospitals are owned and operated by private individuals, small corporations and large hospital chain corporations. The private health care in many modernised hospitals in Indian cities are comparable to their counterparts in developed countries. However, the public health care system, except for the teaching hospitals, is often not as good or fast as the private hospitals.
1. Discuss in detail the difference in Private Hospital and Government Hospital from the aspects of
b. MIS Maintenance
c. Purview of Consumer Act
d. Speed of Service
e. Accountability towards the patient.
2. What are the types of hospitals? Critically examine the present National Health Policy and its impact on the private healthcare industry in India.
CASE III – LIFE SAVING A PRIORITY OR SECONDARY?
A day after a man bled to death from his gunshot wounds in a city hospital after being turned away from two others, hospital managements claimed Tuesday that saving lives was their top priority. Tarun Gupta, a 47-year-old retail goods trader, died Monday after being shot by three unidentified men near his home in south Delhi’s Cannought area. His son rushed him from one hospital to another but both refused to admit him, evidently for fear of being embroiled in a medico-legal case.
Gupta was finally taken to the Holy Family hospital some distance away. But it was too late and doctors declared him dead.
As newspapers readers and others reacted with shock, hospital managements said human life was paramount.
“Life saving is the foremost duty of a doctor and a hospital. In accident or medico-legal cases (MLC), all that the doctor has to do is to fill the injury sheet, which in any case is a part of the assessment of the patient,” said S. K. Sharma, chairperson of the board of management and head of the critical care unit of Sri Gangaramji hospital.
“Doctors should not be afraid of getting involved in such cases. Their priority should be to save the person’s life,” Sharma told IANS.
According to officials, the hospital gets about 125 patients a day in its casualty department. Of these, five percent are MLC cases.
Added Harpreet Singh, chief administrator of Maxima Health: “I don’t want to comment about other hospitals, but if we get a patient who needs emergency life saving treatment, we will give it to him.
“Medico-legal cases keep happening. That doesn’t stop us from saving a person’s life first and then looking into the MLC side by side.”
Authorities at the LifeCare hospital agreed and said if it was a matter of saving a life, the hospital never refused an emergency case.
According to the hospital authorities, some hospitals hesitate in taking in MLC cases immediately because of financial implications. If a patient is not accompanied by a relative, the hospital administration might hold the medical staff responsible for unpaid bills, they fear.
1. What are the issues that influence a Doctor’s decision in accepting/rejecting any MLC and treating the patient?
2. “The psychological variables considerably influence the behavioral profile.” Discuss this statement in the context of above article.
3. Departmental relationships influence patient care. Outline the departmental relationship issues and discuss related dimensions such as conflict, insensitiveness, support of management, fear etc.
4. Discuss the process of selection and post selection processes to be followed by a hospital manager in selecting quality people.
CASE IV – Essential for Success – Training in Hospitals
Hospitals, today, have realised the need to shed their image of a cluttered and chaotic place. More health and quality-conscious Indian customers and international patients are on the lookout for cheaper yet superior healthcare facilities, which in turn have given a new dimension to the concept of care and indirectly to the training and development scenario. “Hospitals are being compared to hotels and airlines, and the customer is more demanding and expects nothing but warm and hospitable staff,” No more do patients just flock to hospitals for treatment. “To fulfill this demand, training and development has gained crucial importance,
Learning is a key to competitive advantage and training is seen as the means to achieve it. Training enables to continually work at improving services. “No organisation can choose whether or not to train, the only choice is the method. Our educational system provides us with technical knowledge and therefore it becomes imperative to provide soft skill training,”
Soft Skills: Soft skills play a vital role in hospitals to assuage emotionally distraught people who come to the hospital and expect empathy and attention. If the staff is not well trained to handle the customer tactfully, it can backfire on the image of the hospital. Some of the soft skills training programmes include self-awareness, confidence-building, inter-personnel skills, team spirit, corporate communication, behavioral management and leadership.
Leadership programmes: To hone the behavioral skills of its employees, hospitals have initiated leadership programmes for its attendants. An attendant meant to transfer patients from the OT to the ward needs to understand the importance of the process. Through training on process leadership this importance can be instilled. For a manager it is important that he achieves team work, resolve personal issues and extract performance out of his team.
“Also the in-house customer should get prompt response from various departments. All this is possible when you train your employees with regards to what to do, at what time, and how to resolve the issues, if problems arise
Internal Team-building: Training programmes are also effective platforms for internal team building. When employees from different departments of a hospital come together by dint of a training initiative, it gives them an opportunity to understand each other better. An activity-based leadership programme conducted at Mumbai’s Hinduja Hospital had executives and managers from 20 different departments come together for a quiz contest. This initiative proved instrumental for forming a bond and increasing the efficiency of the hospital.
Technical training: The technical workfront of training and development in a hospital includes aspects like evaluation of patients by technicians from ECG, Echo, TMT, X-Ray, and also anaesthesia technicians, physician assistants, cath lab technicians and nursing care professionals. In Frontier Lifeline Hospital (FLH), Chennai, all these aspects of training are provided to the newly-joined technicians and nurses by the already trained staff members.
Depending on the need and vision, Indian hospitals have moulded their training structure. At Hinduja Hospital, the HR department identifies the training needs of its employees for the calendar year, comes up with a calendar and sticks to it. Depending upon the type of programme, a decision is taken to conduct the training programme internally or to outsource it. The main parameters are the category of people who are to be trained, the subjects on which they need training and the kind of output the hospital is looking at in the end.
Max Healthcare has a full-fledged centralised training cell in the form of Max Institute of Medical Education (MIME), which takes care of all its technical training requirements. On the other hand, soft-skills and service training is handled by the HR department. “It is not the question of benefits, but what works best for an organisation. If we have resources within the company, why not utilise them? So, MIME outsources service training to its HR department vis-à-vis HR department outsources medical training to MIME, and it works for us,” opines Dr Puri.
Manipal Hospital widely used the concept of ‘Training the Trainer’, where an internal resource is identified for this programme, who then assists the training department to conduct various training programmes.
Every employee needs training related to his aspect of the job. “We also conduct programmes in Marathi for our attendant category and try to ensure that all categories of employees undergo training,” states Ankush Gupta, Manager-HR, PD Hinduja Hospital, Mumbai.
Even HoDs need behavioral training. “I should know how to deal with my customers and my first customer is my staff. Am I only limited to my technical skill or I should know the supervisory or managerial skills? All the doubts and uncertainties are addressed in training,” Gupta explains.
Newer methods: However, all training programmes need not be boardroom-oriented. Hospitals have discovered that e-learning is equivalent to a virtual classroom where a professional from his own centre learns the curriculum. “We have installed Edusat for DNB candidates and tele-lectures are regularly conducted from Southampton General Hospital, UK, and also from eminent professors in the field of cardiology, cardiac surgery and anaesthesia, using tele-medicine facility,” says Dr Padmanabhan. For the training purpose and awarding the qualification, the hospital has tied up with IIT (Chennai) for medical biotechnology and BITS-Pilani for physician assistant courses. Under the Management Development Programme (MDP), hospitals even send their employees to hospitals abroad for training.
1. Training and development is a marriage between medical training and service training. Comment on this statement and critically analyze it.
2. Identify the challenges faced in running a hospital while maintaining the motivation level and competitiveness of the staff.
3. What are the different training methods employed by different hospitals. How does performance audit contribute to assessment of a training programme?
1. What do you mean by Hospital Financing? What do you mean by break – even analysis?
2. Explain the meaning of Project Planning.
3. Discuss the different considerations to be given due weightage while preparing feasibility report of a project.