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Hospital Management

Prof. Kyawt Sann LwinProfessor/HeadHealth Policy and Management

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Sakharkar BM (2009) Principles of Hospital Administration and Planning, 2nd Edit, Chapter 7. Jaypee brother Publishing.

Joshi DC and Joshi Mamta (2009) Hospital Administration, Chapter 2, Jaypee brother Publishing.

Robbins SP, Coulter M (2005) Management, 8th Edit., Pearson Education Limited.

Laurie JM (2010) Management and Organizational Behavior, 9th edit., Pearson Education Limited.

References:

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“Making things happen through people” Coordinating work activities so that they are

completed efficiently and effectively with and through other people

Efficiency – getting the most output from the least amount of inputs – (low waste)

Effectiveness – completing activities so that organizational goals are attained – (high attainment)

Management

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Dictionary definitions tend to see the two words as synonymous

Mgt. as “administration of business concerns”Admin. As “Management of public affairs”

Administration – taken place in accordance with some form of rules or procedure, part of management process

Mgt. implies a greater degree of discretion

Management and Administration

5Central focus of management

Organizational performance and effectiveness

Achieving the goals and objectives of the organization

Satisfying the needs and expectations of people at work

Creating an organisational climate in which people work willingly and effectively

The focus of management

Improving the people-organization relationship

Welding a coherent pattern of work activities

System of motivation, job satisfaction and rewards

Harnessing the efforts of staff

Organizational process and the execution of work

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Someone who works with and through other people by coordinating their work activities in order to accomplish organizational goals

Helping others do their work and achieve May have other work duties not related to

coordinating and integrating the work of others Classification – first-line, middle, top manager

Manager

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Top manager

Middle manager

First-line manager

Non-managerial employees

Managerial levels

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First-line managers – mangers at the lowest level of the organization who manage the work of non-managerial employees who are directly involved with the production – often called supervisors

Middle managers – managers between the first level and the top level of organization who manage the work of first-line managers

Top managers – managers at or near the top level of organization who are responsible for making organization-wide decisions and establishing the goals and plans that affect the entire organization

Managerial levels

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Three specific categorization schemes to describe what managers do

Functions, roles and skills Management functions: Planning, organizing,

leading/directing and controlling Roles: Interpersonal, informational, and decisional Skills: conceptual, human, and technical skills

What do managers do?

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1. Planning – involves defining goals, establishing strategies for achieving those goals, and developing plans to integrate and coordinate activities

2. Organizing – involves for arranging work to accomplish the organization’s goals - involves determining

1. what tasks are to be done, 2. who is to do them, 3. how the tasks are to be grouped, 4. who report to whom, and 5. where decisions are to be made

Management functions

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3. Leading /Directing– involves motivating subordinates, influencing individuals or teams as they work, selecting the most effective communication channels, or dealing in any way with employee behaviour issues

4. Controlling – involves monitoring actual performance, comparing actual to standard, and taking action, if necessary

Management functions

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Role Organized set of behavior associated with a position Managers have formal authority over the unit they

command and this leads to a special position of status in the organization

1. Interpersonal roles2. Informational roles3. Decisional roles

(Henry Mintzberg)

General roles of managers /Hospital administrators

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Figurehead role Most basic and simple role, as a symbolic head,

obliged to perform certain duties, like attending ceremonies, etc.

Leader Responsible for motivating employees, responsible

for staffing and training Liaison

Maintain contacts (horizontal relationship) with outside organizations and develop rapport with other organizations

Interpersonal roles

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Recipient/monitor Seeks and receives information (formal or informal)

from inside the hospital or outside organizations, govt. / private hospitals, National /State Govt.

Disseminator Transmits the information, after processing it to the

people who need it, inside or outside the organization Spokesperson

Represents the hospital and calls press conferences, conduct board meetings

Informational roles

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Entrepreneur Searches for, is visionary and can arrange

resources for improvement Disturbance handler

Responsible for corrective action and crisis mgt. during disaster, strikes etc.

Resource allocator Responsible for allocation of resource to various

areas of hospital, budgeting and scheduling activities opportunities

Decisional roles

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Negotiator Responsible for representing the hospital for

negotiation, in respect of public private partnership, merger or joint ventures etc.

Decision role

17Roles and Functions of Hospital Administrators

1. Working with people Has no direct clinical responsibility Balance the goals of the hospital by working with

patient care teams understand workers, their motivations and aspirations,

and knit them together as a team2. Enabling role

Ensure the provision of necessary physical facilities, supportive services are available in the right amount, of right quality, and at right time at right place

18 Roles and Functions of Hospital Administrators

3. Hospital administration and staff There are many types of staff who are specialist in

their own sphere and department which function more or less as autonomous unit

Need to understand the staff and understand the variations in the style of administration

19 Roles and Functions of Hospital Administrators4. Staff motivation

Develop measures to keep up motivation of all categories of staff

5. Facilitating decision making Provide appropriate inputs to decision making at

clinical departmental level, and coordinate decision making at interdepartmental

level 6. Management of resources

To decide between competing claims for manpower and financial resources

20 Roles and Functions of Hospital Administrators7. Negotiating

With agencies outside the hospital and staff members within, especially regarding working arrangement and conflict resolution

8. Containing costs To make medical staff cost-conscious, to reduce

expenditure without jeopardizing patient care9. Understanding efficiency and effectiveness

To secure maximum output from minimum input To achieve goals of hospital i.e., to meet customer

needs and delivering service quality10.Dealing with new technology

21 Roles and Functions of Hospital Administrators11.Establishing managerial climate

Administrative personnel must be compatible with each other and with the organization

12.Management development Plan leadership development at different levels

13.Evaluation The ability to evaluate people, programs and overall

effectiveness of the hospital14.Fact-finding and investigation15.Social commitment

Serve the society through the hospital

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Technical skill – understanding of and proficiency in specific type of activities involving methods, process or techniques

without this skill – will find it difficult to supervise and train juniors

Human skill – skill in dealing with people, as mgt. is science as well as art of getting things done through people

it involves effective team work, the direction and leadership of staff to achieve coordinated effort

Skills of effective managers

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Conceptual skill ability to understand complexity of the whole

organization and how changes in any one part of organization affect others, to see the big picture, to look into the future of the organization (strategic planning)

Also involve decision making skills

Skills of effective managers

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Level of mgt.Skills

Higher level mgt.

Middle level mgt.

Lower level mgt.

Management skills

Human

Conceptual

Technical

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1. Technical skill2. Analytical skill3. Decision making skill4. Computer skill5. Human relation skill6. Communication skill7. Conceptual skill

Skills of Hospital Administrator

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Ability to diagnose and evaluate Required to understand the problem and develop an

action plan Is used in scientific approach and techniques for

problem solving

2. Analytical skill

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To choose from among the alternatives, and ability to choose most appropriate alternative for effectiveness and efficiency

This ability differentiate one administrator to other Administrators are paid to make decisions

3. Decision making skill

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Using computer significantly increase administrator’s productivity

Important for handling information and management of Hospital Information System (HIS)

Conceptual understanding of computers and how particular software performs various tasks

4. Computer skill

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Effective communication is a key to success: what you speak and how you speak is important – the contents, the tone, the pitch, body language, the medium etc.

Ability to communicate in a way that other people understand and seek and use feedback from hospital staff to ensure they understood

6. Communication skill

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Facilitating different groups in an organization and orchestrate their effort to achieve the common goal

Central problem: Human – diverse groups of people - forced to achieve a cohesive goal

Active activity, deliberately planned and executed Easier to coordinate in organization characterized by

clear lines of authority, well-understood allocation of functions and delegation of authority

Cooperation – passive activity, may arise spontaneously

Co-ordination

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One of the general administrative theories of what managers do and what constitute good management practice

Fundamental rules of management that could be applied in all organizational situations – flexible and adaptable to changing circumstances

Principles of Mgt. (Fayol)

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1. Division of work2. Authority and responsibility3. Discipline4. Unity of command5. Unity of direction6. Centralization of Authority7. Scalar chain8. Order

Principles of Mgt. (Fayol’s)

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9. Remuneration10. Stability of tenure11. Esprit de corps12. Initiative13. Subordination of individual interest to

organizational interest14. Equity

Principles of Mgt.

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The work assigned to each worker – should be clearly defined

Activities of organization – precisely clarified Thus work performed efficiently with gradual

development of competence and skills – the advantage of specialization

1. Division of work

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Managers must be able to give orders and authority should be commensurate with responsibility

without authority one cannot discharge responsibility Responsibility – is assumed and arises out of

assignment of activity Authority – official / personal authority Official authority – by virtue of official position Personal authority – as a result of personal qualities

like competence, intelligence, experience, moral worth and past service

2. Authority and responsibility

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Essential for efficient operation of the organization Respect/obey the rules that govern the organization Require good supervisors at all levels Managers must decide on the most appropriate form

of sanction in case of offences against discipline Manager should set the good example through their

actions and behavior

3. Discipline

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In any action an employees should receive orders from one supervisor only

Must know who is his “immediate boss” and be responsible to him for his work

Dural command is a perpetual source of conflicts

4. Unity of command

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Each group of activities with the same objective must have one head and one plan

Relate to “organization” as a whole – should have team work and unity – without this there will be wastage of organizational resources

5. Unity of direction

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The degree to which subordinates are involved in decision making

The extent to which authority is concentrated or dispersed – depend upon type of organization, size of organization and manager’s ability to control

should be clear in the organization – who is to issue orders and the areas of authority

Conflicting orders – will create confusion

6. Centralization of authority

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The line of authority or chain of supervisors from the top management to the lowest ranks in the organization

Could be short-circuited in crisis situation or emergency

7. Scalar chain

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People and materials should be in the right place at the right time

There should be appointed place for every thing/each employee, and each thing/employee in its appointed place

Will result in optimization of the resources

8. Order

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Equal pay for equal work Each person should be paid according to his

contribution Payment method can influence organizational

performance and should be fair and afford maximum possible satisfaction to employees and employer

9. Remuneration

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Unnecessary turnover of employees is both the cause and the effect of bad management

Permanent nature of the job, resulting in a feeling of security and involvement in work

Management should provide orderly personnel planning and ensure that replacements are available to fill vacancies

10. Stability of tenure

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Harmony and unity among members of the organization is a greatest strength

To avoid the dangers of divide and rule of one’s own team, and whenever possible verbal contacts should be used

11. Esprit de corps

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Employees who are allowed to originate and carry out plans will exert high level of effort

Employee should be given opportunities for use of creative ideas in their work

It is a means to job involvement and commitment to organizational goals

12. Initiative

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Organization is set up to meet the needs of society Individual / group must sacrifice some selfish interests

in the overall interest of the organization and society

13. Subordination of individual interest to organizational interest

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Subordinate must be treated without any bias for race, religion, sex, and class

Manager should be Impartial, kind, and fair to their subordinates

14. Equity

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1. Determination of goals and objectives2. Facility and program planning3. Financial management4. Personal management5. Co-ordinating departmental operation6. Program review and evaluation7. Public and community activities8. Health industry activities9. Government related activities10.Educational development

Managerial activities of a Hospital

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A body of persons statutorily responsible for running the hospital

can make and guide policy but cannot “run” a hospital’s day to day affairs

Also called board of directors/ trustees, governing body, management board

Governing board

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and to control Represents the organization to higher authorities and to

outside world Responsible for

policies and procedures, the overall administrative structure, financial mgt., personnel mgt., reporting to the board, relations with medical staff, overseeing medical care, maintaining the physical facilities, legal matters and maintaining good public relations

Hospital administrator

511. Leadership in the hospital2. lack of funds for hospital services3. Adaptation to external pressures

– government policies, trade unions, other political bodies

4. Lack of dedicated professional staff- Due to ineffective manpower planning, recruitment,

compensation and development system5. Stringent financial and managerial controls on

administrative staff6. Ineffective organization and allocation of work7. Problems of motivation and job satisfaction of

employees

Problems faced by hospital

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Heterogeneous groups of workers Specialization Complex interrelationship Group work: individual merit is not noted Crisis orientation Round the clock functioning Objective is not clear, results not quentifiable Exhibit both authoritative and participative pattern of

leadership Patients cannot express their needs

Characteristics of work of the hospital

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1. Horizontal contact2. Vertical contact3. Motivation4. Participation5. Communication

How is coordination facilitated

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Thank You