Hospital management17

1. Hospital Management
Prof. Kyawt Sann Lwin
Professor/Head
Health Policy and Management
1

2.  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:2

3.  “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)
Management3

4.  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 Administration4

5. 5
Central 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

6.  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
6 Manager

7. Top manager
Middle manager
First-line manager
Non-managerial
employees
7 Managerial levels

8.  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
8 Managerial levels

9.  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
9 What do managers do?

10. 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
10 Management functions

11. 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
11 Management functions

12.  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 roles
2. Informational roles
3. Decisional roles
(Henry Mintzberg)
General roles of managers /Hospital
administrators
12

13.  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 roles13

14.  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 roles14

15.  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 roles15

16.  Negotiator
Responsible for representing the hospital for negotiation, in
respect of public private partnership, merger or joint
ventures etc.
Decision role16

17. 17
Roles 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 team
2. 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. 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. 19 Roles and Functions of Hospital Administrators
4. 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. 20 Roles and Functions of Hospital Administrators
7. 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 care
9. 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 quality
10. Dealing with new technology

21. 21 Roles and Functions of Hospital Administrators
11. 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 hospital
14. Fact-finding and investigation
15. Social commitment
 Serve the society through the hospital

22.  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 managers22

23.  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 managers23

24. Level of mgt. Skills
Higher level mgt.
Middle level mgt.
Lower level mgt.
Management skills
Human
Conceptual
Technical
24

25. 1. Technical skill
2. Analytical skill
3. Decision making skill
4. Computer skill
5. Human relation skill
6. Communication skill
7. Conceptual skill
Skills of Hospital Administrator25

26.  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 skill26

27.  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 skill27

28.  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 skill28

29.  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 skill29

30.  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-ordination30

31.  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)31

32. 1. Division of work
2. Authority and responsibility
3. Discipline
4. Unity of command
5. Unity of direction
6. Centralization of Authority
7. Scalar chain
8. Order
Principles of Mgt. (Fayol’s)32

33. 9. Remuneration
10. Stability of tenure
11. Esprit de corps
12. Initiative
13. Subordination of individual interest to organizational
interest
14. Equity
Principles of Mgt.33

34.  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 work34

35.  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 responsibility35

36.  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. Discipline36

37.  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 command37

38.  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 direction38

39.  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 authority39

40.  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 chain40

41.  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. Order41

42.  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. Remuneration42

43.  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 tenure43

44.  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 corps44

45.  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. Initiative45

46.  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
46

47.  Subordinate must be treated without any bias for race,
religion, sex, and class
 Manager should be Impartial, kind, and fair to their
subordinates
14. Equity47

48. 1. Determination of goals and objectives
2. Facility and program planning
3. Financial management
4. Personal management
5. Co-ordinating departmental operation
6. Program review and evaluation
7. Public and community activities
8. Health industry activities
9. Government related activities
10. Educational development
Managerial activities of a Hospital48

49.  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 board49

50.  Job of the administrator is to plan, to organise, to direct 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 administrator50

51. 1. Leadership in the hospital
2. lack of funds for hospital services
3. 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 system
5. Stringent financial and managerial controls on administrative
staff
6. Ineffective organization and allocation of work
7. Problems of motivation and job satisfaction of employees
Problems faced by hospital
51

52.  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 hospital52

53. 1. Horizontal contact
2. Vertical contact
3. Motivation
4. Participation
5. Communication
How is coordination facilitated53

54. 54