HOSPITAL MANAGEMENT  by  Mr. Adeyinka Antwi, Director of Administration,Federal Neuro-Psychiatric Hospital, Yaba Lagos, Fellow Institute of Health Service Administrators of Nigeria, B.A ( Hist), M.B.A (HRM), Pgd (Hosp. Mgt) MMP(Managerial Psychology)FIHSA, FICA,

                                                                

     The art and science of hospital management is one that is not static, its always evolving and responding to the dynamic needs of its socio-political and economic environment. It is important to however mention, that the focus of hospital management, is the delivery of an effective and efficient service delivery to the client.

For a better insight into the subject of hospital management, we will concern how ourselves with the following:

What is a hospital? A hospital defined.

Characteristics and features of a hospital.

The different tiers or types of hospital?

The issue of patients’ expectations.

Hospital management defined?

Hospital structure and funding.

Human Resources Management.

What’s a hospital Management?

 Hospital Defined

  The word” hospital” have been severally defined by various authorities and practitioners. Let’s examine a few definitions of the term “hospital”. The word “hospital” is derived from the Latin word “hospitalis” which comes from “hospes” meaning, “a host”.

The English word “hospital “comes from the French words “hostel” and “hotel”, although derived from the same source are used with different meanings. This connote that the term hospital means an establishment for temporary occupation by the sick and the injured.

Dorland’s illustrated Medical Dictionary defines a hospital as

“ an institution located, constructed, organized, staffed to supply scientifically, economically, efficiently and unhindered, all or any recognized part of the complex requirements for the prevention, diagnosis and treatment of physical, mental and the medical aspect of social ills; with functioning facilities for training new workers in many special professional, technical and economical fields, essentials to the discharge of its proper functions and with adequate contacts with physicians, other hospitals , medical schools and accredited health agencies engaged in the better- health programme.

 

Steadman’s Medical Dictionary defined hospital as

“ as an institution for the care, cure, and treatment for the sick and wounded, for the study of diseases and for the training of doctors and nurses”

 

Blackiston’s New Gould Medical Dictionary defined hospital

“ an institution for medical treatment facility primarily intended, appropriately staffed and equipped to provide diagnostic and therapeutic services in general medicine and surgery or in some circumscribed fields of restorative medical care , together with bedcare , nursing care and dietetic service to patients requiring such care and treatment.

 

  From the above it is possible to say that there is no one single definition that best describe the word hospital. The hospital to the average lay man is simply a place to seek cure for sickness or an ailment.

  It is however important to state that a hospital is unique and easily identifiable facility building designed specifically to meet its purpose. It defer from any other major buildings in major towns, cities and commitments in terms of its structure, purpose, staffing, machines and tools. Hospitals’ operations and activities are determined by the law establishing them. Regulatory bodies such as government agencies and professional bodies also ensure that their operations meet with the best standards of practice, in the delivery of good and affordable health care.

The general consensus among policy makers, practitioners and authors in health care service delivery industry however remains that the hospital should be:

• A purposeful building: It should be a suitably constructed infrastructure.
• It must be established by law, adequately licensed and registered by appropriate authority to carry out its activities.
• Essentially staffed by professionals that are trained and knowledgeable in the treatment of patients or those who can operate machines and equipment in adequate quantity and of good quality.
• The users of hospital infrastructure and services are those who come on their own or brought in by relations to seek treatment for an ailment.
• The hospital also provides training services for care providers and trainees.
• The care providers or the hospital is obliged to charge fees and is not forbidden from doing so.

  Generally, there are three major types of hospitals. The categorization relates to the nature of their services and other            factors. They are:

Primary. Basically, these are primary health care centres. They offer basic health care services mainly of preventive nature and are often located in the rural communities. These are mainly under the jurisdiction of the local government.

Secondary. These are states General hospitals which provide wide range of medical care in almost all specialist care they offer.

The privately owned hospitals or clinics, and rehabilitation centres can easily be classified under these categories.

Tertiary. The Tertiary hospitals include the teaching and specialist hospitals. They are     at the apex of a nation’s health care system. They offer specialist care to patients whose case cannot be treated at any levels previously listed above.

PATIENTS’ EXPECTATIONS

   Patients’ expectations refer to the anticipation or the belief about what is to be encountered in a consultation or in a health    care facility. It is the mental picture that patients or the public will have of the process of interaction with the system. Patients come to a consultation with expectations which they may or may not be overtly aware of. These expectations may be openly presented or the physician may have to attempt to elicit them. Reactions to unmet expectations can range from disappointment to anger. Thus, knowing the expectations of our patients can help avoid these reactions, enhance their healthcare experience, and reduce our exposure to liability. Studies have shown that as much as 70% of litigation relates to real or perceived problems involving physician communications, which influences patients’ expectations. Not meeting expectations can also result in non-compliance or suboptimal compliance and affect physicians’ reputation in a community.

  Patients with unmet expectations may never complain to the physician directly but instead they just will not return for ongoing and follow-up care. [1,2] The days of absolute trust and blind obedience to doctors are over.

  Understanding and managing patients’ expectations can improve patient satisfaction, which refers to the fulfillment or gratification of a desire or need. When we can “read” our patients, they are grateful. They will sense we understand them better because our responses are accurate and appropriate to what they expect and feel deep inside.

  Patients’ expectations of the health facility are varied, they can however be classified in the following ways:

• Humane Treatment: They want personal services. Patients want to be treated as human being not as a number or object.
• Prompt Services: Patients’ expectation includes being attended to quickly, and at the right time with little or no delay.
• Efficient Services. Patients’ expects that hospitals are designed to provide effective and efficient services to patients.
• Affordable Services. The expectations of patients are that the services provided in hospital will not be out of reach. It will be affordable. The concept of affordability stems from the belief that it is the duty of government to provide health care services for ( the welfare of) her citizens. They maintain that whatever the individual pays should just be enough to sustain the health care system. Provision of health care service delivery should therefore be highly subsidized.
• Courteous Services. Patients expect care givers in hospitals to be polite to them. They expect them to show respect and be empathetic to their condition.
• Accessibility: the expectation of patients is that there must be unhindered access to the health care facilities. They should be able to work in and out without any form of hindrances. They also want free access to health professionals that will attend to their complaints.

 HOSPITAL MAMAGEMENT WHAT IS IT?

  Hospital Management defined.

  The term hospital management is broad in scope and has varied definitions depending on the perspectives of individuals on the    subject. It mainly relates to all aspects of management of all aspects of a hospital; a coordination of all elements of a       hospital.  The whole range of activities includes that of the security guards that ensures the protection of lives and properties   to the   Medical Health Record, to inventory and auditing of medicines, to human resource and financial management, to   facility   management and to environmental health and also to the activities of cleaners in the hospital as other various   activities that   may have any significant impacts on the lives of the patients while in the vicinity of a health facility.

 It can also be defined as the whole process where healthcare providers effectively and efficiently administer everything from   patient registration to appointment scheduling, document management, consultation management, lab management, drug safety,   report generation, staff management, outpatient management, and so much more.

  In my own opinion, Hospital management can simply be defined as all well-coordinated efforts to ensure effective and   effective service delivery to the patients. It entails all aspects of harnessing all human and material resources towards   meeting the needs and expectations of patients.

  Health facility managers or Hospital Administrators are therefore charged with the responsibility of taking of each element   of the hospital.

 Some attributes of Hospital Management include the followings:

 CO-ORDINATION: Whether in a health care centre, clinics, rehabilitation centres, Co-ordination is the soul of hospital management. There is need for coordination of activities among the different professionals involved in the treatment and care of the patients.

 To further enhanced coordination in a hospital setting, there is a need for advanced technology. This will help to integrate and synchronize all activities in the hospital and promote prompt and effective service delivery to the patients. It will also help to ensure that there are no leakages in the system. Advanced technology such as Electronic Medical Record system is an important factor in the hospital facility and function.

ORGANIZATIONAL STRUCTURE

  One other major concern in hospital management is the structure. The organizational structure is an important element in the   survival and success of any organization. It outlines how certain activities are directed in order to achieve the goals of an         organization and in this instance the health facility or hospital. These activities rules, roles, responsibilities of each individual     and departments within the hospital.

  The Organizational structure also determines how information flows between levels within the hospital. It is devoid of   individual preferences; it is defined and not subjective. It is either centralized or decentralized. When centralized, decisions   from top down, while in a decentralized decision-making is distributed among various levels of the organization. Whatever form   the designed, it is important that it is clear to all.

  The organizational structure of the hospital or a health facility defines in specific term the hierarchy within an organization.   A successful organizational structure defines each employee's job and how it fits within the overall system. Put simply, the   organizational structure lays out who does what so the company can meet its objectives.

TEAM AND TEAM COLLABORATION STRTEGY.

  Another attribute of hospital management is the promotion of team and collaborative strategy among specialists and sub-   specialists. Team works and team collaboration are two distinct elements in the hospital set up. The specialist and sub-   specialists see themselves as a team, but as a team they cannot work in isolation of the other teams, hence the need for   collaboration. Effective teamwork between healthcare providers reduces extra work. Collaboration, along with perceived       patient outcomes, accounts for up to 60% of the variance of job satisfaction for health professionals.

  In order to promote team and team collaboration strategy, there is a need to build or put in place a culture of Co-operation   among the Specialists and sub-specialist. A collaborative corporate culture places central value on collaborative teamwork. This  is accomplished by setting up office space, team structure, support systems, and other organizational elements in a way that is supportive of effective teamwork.

This will enhance sense of appreciation and belonging by the various teams to the organization, as it will help to dissolve conflict in the workplace among the health tams. It will also improve commitment and enhance productivity.

 To ensure team work and team collaboration, it requires management setting goals and defining roles. Having a clear sense of purpose is the defining features of a successful team and building collaboration among the teams. Each team feels a sense of accomplishment for contributing to a worthwhile goal. The mental image gives an intrinsic motivation to achieve more as a team, and with other teams in a collaborative and supportive way.

HUMAN RESOURCE MANAGEMENT

  Of great importance to hospital management is the issue of human resource management (HRM). It is key to the success of any organization. The Human resources management, is an organizational function that focuses on the strategic management of its employees. The HR managers are responsible for the people within an organization, which tend to be the most valuable assets that the organization has.

  In today world, the roles of Human Resources department are changing, it is more strategic than just administrative. It’s more  focus on the objectives of the organization. In hospital the human resources activities include recruitment and selection of best and capable hands to work in the hospital, onboarding new hires, deployment to department or where their services are needed, managing training and development, creating and updating employee records, communicating policies and decisions to all employees, dismissing employees and enforcing disciplinary actions, ensuring that organization is meeting employment laws, Addressing and investigating all form of complaints and grievances, design and implementation of rewards system, the design of an exit plan. It is also the duty of the HR to ensure the retainership of talent employees in the hospital.

In a hospital setting the human resource management focuses attention on maximizing employee productivity and taking pre-emptive measures to protect them on the job either from physical assault or infectious disease. In a general sense, the human resources department helps to uphold the hospital’s culture and core values.

FINANCIAL MANAGEMENT.

 One other aspect of hospital management is financial management. It is so important to give attention to this element of hospital management because, resources available to all human organization are never enough. Both public and private hospital have this issue to deal with. The Federal government this year allocated the total sum of N724 billion (4.2 percent of the total budget) for the healthcare sector across the 36 states of the federation and the Federal Capital Territory.

The term financial management also has lots of definitions. Out of all the definitions most popular and widely accepted definition of financial management is delivered by S.C. Kuchhal. According to him, “Financial Management deals with procurement of funds and their effective utilization in the business.” It behoves on hospital managers to therefore manage their allocations towards ensuring that there are no leakages in the utilization in the fund allocated by the government as well as funds internally generated. Utilization of funds should give priority to patients care and staff welfare. Patients care and staff welfare should of paramount in the utilization.

The use of automation in the collection of revenues from various payment points for services made available should be exploited to check leakages and quality of services rendered to the patients. It is also for the purpose of system auditing.

 FACILITY MANAGEMENT

Hospital management also involves facility management. Facility management is simply defined as the maintenance of an organization’s building and equipment. The issue of facility management is very critical to health care service delivery if the goal is to offer safe and qualitative healthcare service to the people. Facility Management touches on the safety of lives and properties. It involves appointment of an individual and a department charged with that responsibility. Management must also be committed to the ideal of facility management in the most cost saving manner without compromising standard.

 In a hospital environment, facility management involves Health and safety management. Hospital management under this element of facility management will means that the hospital is obliged to comply with all laws that seeks to protect the staff and visitors to the hospital from personal injuries arising from the use of the hospital facilities and equipment.  

  The issue of facility management also involves insuring the hospital properties, machines and equipment, against damage, theft etc. It is to cushion the effects of replacing them when the unfortunate occurs.

ENVIRONMENTAL SAFETY IN HOSPITAL

   Hospital management also involves Environmental Safety because the environment is a complex environment in which different  aspects including patents, staff, equipment, services, and information are interfaced. Environment safety is critical for life support. The hospital management must be committed to adequate labelling of building, waste management, noise control, Radiation safety, prevention of infectious diseases, General building safety, safe water quality, Heating Ventilation and air-conditioning.

TRAINING AND DEVELOPMENT.  

Hospital management also involves training and development of employees. This is done to bring them up to date with current practice and knowledge in their various fields. It is also designed to prepare them for leadership roles in the hospital. Training and development refer to educational activities within a company created to enhance the knowledge and skills of employees while providing information and instruction on how to better perform specific tasks.

EXTERNAL OR PUBLIC RELATION

Public or external relation is an integral part of hospital management. External PR communication is directed outside the organization or to the environment. The aim of the external public relations is to create a good image of the hospital. The external environment includes the immediate or closest community, government, its agencies, other hospitals, Media Houses, Corporate organization etc.

Pubic or External Relation are used for many crisis called PR Crisis Management. Prediction and detection of potential crisis are the main task of PR crisis management, and the way in which the media interpreted the crisis can significantly affect the course, dismissal or wider effects of the crisis.

Adeyinka Antwi