Introduction to Hospital Adminstration

A brief description on Hospital Administration for introduction level

1. Introduction to Hospital Administration Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics ), MBBS Armed Forces Medical Institute (AFMI)

2. WHO expert committee, 1956: ‘ The hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete healthcare, both curative and preventive, and whose out- patient services reach out to the family in its home environment; the hospital is also a centre for the training of health workers and for bio- social research’

3. WHO Expert Committee, 1963: ‘ A hospital is a residential establishment which provides short-term and long-term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury and for parturients . It may or may not also provide services for ambulatory patients on an out-patient basis’.

4. Administration Administration is the art and science of guidance, leadership, and control of the efforts of a group of individuals towards some common goal . Management Management is an art of getting things done through and with the people in formally organized groups. It is an art of creating an environment in which people can perform and individuals and can co-operate towards attainment of group goals .‘ Management is the operational part of administration.

5. Broadly speaking, management takes into account the directing and controlling functions of the organization, whereas administration is related to planning and organizing function . Administration has to do with the setting up of objectives and crucial policies of every organization. What is understood by management, however, is the act or function of putting into practice the policies and plans decided upon by the administration .

6. ADMINISTRATIVE ELEMENTS  Planning  Organization  Staffing  Directing  Coordinating  Reporting  Budgeting  Supervising  Evaluation Hospital administration is keeping the hospital running efficiently, leading the doctors, nurses, and other professionals who work there, and managing the resources.

7. Planning is decision making for future events. The process of organization implies to the arrangement of human and non-human resources in an orderly fashion to accomplish organizational objectives . Staffing is the process of “ personnelizing ” the organization, by hiring the right type and adequate number of workers to each unit for the time required. Directing means giving instructions, guiding, counselling , motivating and leading the staff in an organization in doing work to achieve organizational goals .

8. Coordination brings different elements of a complex activity or organization into relationship that will ensure efficiency and/or harmony. The reporting to management is a process of providing information to enable in judging the effectiveness of their responsibility centres , for taking corrective measures, and to facilitate future decision making. Budgeting is the process of forecasting the amount of money required to accomplish a task, and creating a plan to spend the money efficiently .

9. Supervision Supervision refers to the day-to-day relationship between an executive and his immediate subordinates . Supervision aims at satisfying both: -Work -Workers Factors affecting style of supervision: -Condition present -Type of work -Subordinates characteristics -Personal characteristic of manager One of the basic function of supervision is ‘motivation’ of the employees. Evaluation Evaluation is analysis of completed or ongoing activities that determine or support accountability, effectiveness, and efficiency .

10. Role of H ospital A dministrators General roles Canadian management expert Henry Mintzberg distinguishes ten key managerial roles that managers and executives need to fulfill. T he managerial roles as described by Mitzberg is grouped into three categories, which are equally relevant for hospital administrator also . Decision role Entrepreneur role Disturbance handler role Resource allocator role Negotiator role Interpersonal roles Figure head Leader role Liaison role Informational roles Recipient role Disseminator role Spokesperson role

11. Interpersonal contact concerns the contact between the manager and the people in his environment. 1 . Figurehead As head of an organization , a manager is expected to carry out ceremonial duties . A manager represents the company both internally and externally in all matters of formality. He is the one who addresses people celebrating their anniversaries, attends business dinners and receptions. 2. Leader In his leading role, the manager motivates and develops staff and fosters a positive work environment. He coaches and supports staff, enters into (official) conversations with them, assesses them and offers education and training courses. 3. Liason A manager serves as an intermediary and a linking pin between the high and low levels. In addition, he develops and maintains an external network . Interpersonal contact

12. According to Henry Mintzberg , the managerial role involves the processing of information which means that they send, pass on and analyze information . 4. Monitor As a monitor the manager gathers all internal and external information that is relevant to the organization . He is also responsible for arranging, analyzing and assessing this information so that he can easily identify problems and opportunities and identify changes. 5. Disseminator As a disseminator the manager transmits factual information to his subordinates and to other people within the organization. 6 . Spokesman As a spokesman the manager represents the company and he communicates to the outside world. Information processing

13. Managers are responsible for decision-making. The following Mintzberg Managerial Roles fall under decision-making: 7. Entrepreneur As an entrepreneur, the manager designs and initiates changes and strategies. 8. Disturbance handler In his managerial role as disturbance handler, the manager will always immediately respond to unexpected events and operational breakdowns. 9 . Resource allocator In his resource allocator role, the manager controls and authorizes the use of organizational resources . He allocates finance, assigns employees, positions of power, machines, materials and other resources so that all activities can be well-executed within the organization. 10. Negotiator As a negotiator, the manager participates in negotiations with other organizations and individuals and he represents the interests of the organization. Decision-making

14. Specific roles By virtue of serving a healthcare organization the hospital administrator performs some specific roles which are described below. The hospital administrator ensures that hospital runs effectively and efficiently. The role of hospital administrator varies, depending upon the nature and complexity of hospital. Various roles can be grouped as role towards patients, towards hospital organization, towards community.

15. Motivation: Maslow's H ierarchy of Needs Maslow's hierarchy of needs is a theory in psychology proposed by Abraham Maslow in 1943. Maslow's hierarchy of needs is often portrayed in the shape of a pyramid with the largest, most fundamental needs at the bottom and the need for self-actualization and self-transcendence at the top . Maslow's theory suggests that the lower level needs must be met before the individual will strongly desire the secondary or higher level needs . Motivation is the process of arousing and sustaining goal-directed behavior.

16. Physiological needs Physiological needs are the physical requirements for human survival . Air, water, and food are basic requirements for survival in all animals, including humans. Clothing and shelter provide necessary protection. If these requirements are not met, the human body cannot function properly and will ultimately fail.

17. Safety needs Once a person's physiological needs are relatively satisfied , their safety needs take precedence and dominate behavior. Safety and Security needs include: -Personal security -Financial security -Health and well-being -Safety needs against accidents/illness and their adverse impacts

18. Social belonging After physiological and safety needs are fulfilled, the third level of human needs is interpersonal and involves feelings of belongingness . According to Maslow, humans need to feel a sense of belonging and acceptance among their social groups. It is based on the concept that, ‘ Humans need to love and be loved ’.

19. Esteem Esteem presents the typical human desire to be valued by others . Maslow noted two versions of esteem needs : a "lower" version and a "higher" version. The "lower" version of esteem is the need for respect from others . This may include a need for status, recognition, fame, prestige, and attention . The "higher" version manifests itself as the need for self-respect . For example, the person may have a need for strength, competence, mastery, self-confidence, independence, and freedom .

20. Self-actualization " What a man can be, he must be ." This quotation forms the basis of the perceived need for self-actualization. This level of need refers to what a person's full potential is and the realization of that potential. For example, one individual may have the strong desire to become the best doctor in the locality with highest qualification, or a praise-worthy administrator, or a Member of Parliament (MP) . In another, the desire may be expressed athletically. For others, it may be expressed in paintings, pictures, or inventions.

21. Self-transcendence In his later years , Abraham Maslow explored a further dimension of needs. The self only finds its actualization in giving itself to some higher goal outside oneself, in altruism and spirituality. "Transcendence refers to the very highest and most inclusive or holistic levels of human consciousness, behaving and relating, as ends rather than means, to oneself, to significant others, to human beings in general, to other species, to nature, and to the cosmos".

22. The Kano Model of Customer satisfaction conceptualizes that satisfaction of clients depend on functionality of three attributes of products or services: - Threshold , - Performance, - and excitement. These classifications are useful for guiding design decisions in that they indicate when good is good enough, and when more is better. KANO MODEL OF SERVICE SATISFACTION ( 198 4 by Professor Noriaka Kano)

23. The Kano Model addresses three types of requirements : - Satisfying basic needs (Threshold attributes): Allows a company to get into the market . - Satisfying performance needs (Performance attributes): Allows a company to remain in the market . - Satisfying excitement needs (Excitement/delight attributes): Allows a company to excel , to be world class.

24. Threshold attributes (Dis-satisfiers or Basic Needs): Expected features or characteristics of a product or service ( b asic functionality). These needs are typically “ unspoken .” This includes a clean bathroom, clean linens and a pleasant, fresh aroma in the air. If these needs are not fulfilled, the customer will be extremely dissatisfied. Example: Cleanliness of a hotel . When a person books a reservation at a hotel, they do not request a clean room. They expect it. If this basic need is not met, they will be extremely dissatisfied . Improving the performance of these attributes do not guarantee increased customer satisfaction and may only add to the cost of product.

25. Performance Attributes ( Satisfiers or Performance Needs): Standard characteristics that increase or decrease satisfaction by their degree (Successful surgery, cost/price , ease of use, speed). These needs are typically “ spoken .” Using the hotel example again, “spoken” needs could be Internet access , a room away from the elevators, a non-smoking room, the corporate rate etc. The better fulfillment leads to linear increment of customer satisfaction and absence or poor performance of these attributes will diminish the customer satisfaction.

26. Delighters or Excitement Needs: Unexpected features or characteristics that impress customers and earn the company “extra credit.” These needs also are typically “unspoken.” Example: Those who stay in a hotel, are delighted by a free wi-fi , internet access in TV, HD TV etc ; which are not expected normally. The presence of these attributes delights the customer and results in high satisfaction. The absence of these attributes however does not cause dissatisfaction .  A point to be noted here is that today’s excitement attribute would evolve into performance attribute in near future and finally could end up as a threshold attribute. An example could be power steering in a car.

27. Examples for the Kano Model Excitement attributes:   Robotic surgery, Online access via TV,  paying via smartphone. Performance attributes:   Union of fractured bones with minimal surgery, Display resolution, battery life of smart phones. Threshold attributes:   Union of fractured bones, Customizable ring tones, TV channel search. Indifferent qualities:   Fixing fractured bones by internal or external fixation,adding emoticons to instant messaging apps, capacity of more than 1000 stations in TVs. Reverse qualities:   Union of fractured bone with HAI, Displaying apps when changing channels, rust on motorcycle wheel rims.

28. Kano Requirements Type Definitions: A Summary Requirements Type Definition Must Be (Expected Quality/ Threshold attributes ) Requirement that can dissatisfy (expected, but cannot increase satisfaction) One-Dimensional (Desired Quality/ Performance attributes ) The more of these requirements that are met, the more a client is satisfied Delighters (Excited Quality/ Excitement attributes ) If the requirement is absent, it does not cause dissatisfaction, but it will delight clients if present Indifferent Client is indifferent to whether the feature is present or not Reverse Feature actually causes dissatisfaction A competitive product meets basic attributes , maximizes performances attributes , and includes as many “excitement” attributes as possible at a cost that the patient can conveniently bear .

29. Hospital Administration is a specialty, as like as having specialization in Orthopedics, Cardiology, Urology etc. When there is a group of people, endeavoring to serve a common goal; there is always a need for management. Like any other organization, where management is a must to smoothly run the entity; hospital which is a more complex organization; the requirement for Hospital Manager/ Administrator is an undeniable reality.