Role of Hospital Administrators

welcome viewers good morning today we have two distinguished speakers with us and their faces are familiar to you on my left is dr. bananas who is a senior hospital administrator and consultant and on my right is Professor a Kossuth you're familiar with Professor sue he has been helping us in the teleconferencing sessions for a long time and today we have discussions on to three important topics first we will discuss course three and in that I have requested up to madonna's to discuss with you or to present about the role of hospital administrators and also a bit about the problems and issues in hospital management then we will have a break at well at 11:45 and then from 1 o clock I have requested dr. Sood to take the to three important topics like you know the course - we have block one which is about the financial management and that deals with budgeting and cost containment and also there is a blocked second block is dealing with marketing and health economics or he will discuss a little bit about marketing as well so we will have three sessions and each session will be of 45 minutes and let me tell you that we just finished an international workshop in ignore on healthcare waste management and we had you know a Sigma has launched a certificate program in healthcare waste management in the Southeast Asian countries and this program is already on offer in India as well as in Bangladesh and Nepal and we also propose to launch it in a few more countries and in this workshop we had delegates from Nepal Bhutan Indonesia Maldives and India and healthcare waste management is assuming very great importance as you remember some time back there was a United Nations Basel convention and this bus'll convention had described that was about the trans boundary movement of the hazardous waste and this bus'll convention in switzerland dissolved that healthcare waste with the second most hazardous waste after the radioactive waste and the w-h-o in various studies it has described that annually there are so many million of hepatitis B hepatitis C and HIV infections which are caused and on account of needlestick injuries and on account of the hazardous waste irresponsible disposal or irresponsible collection I mean segregation collection transportation and treatment of the biomedical waste so this was just for your information and now without taking any more time I will request dr. bass dr. Bahamas to please present to make his presentation about the topics that we discussed thank you sir morning good morning we start with straight with the hospital Aegean organization and as you all know that typically any kind of hospital whether it is a public or private we have three levels of three lines of authority I think we can yeah that's better one is the governing body the governing body looks after the moral and legal aspects of the organization so any organization obviously it is to have some licenses to conform with the regulations and legislations of the state of jinsol to the state subject model means moral as well as ethical issues that are really governed by the governing board well there are other divisions of the governing board which could be created and one of them could be ethics committee which could look at the ethics ethical issues of the organization I mean in this case it's the hospital second we have the administrative staff or who are responsible for the resources resource mobilization or gather start functioning the staff for and they're not the typical line functionaries and in that case we have the finance department we have the financial account which is reducing today we have the HR department we have the housekeeping department and so and so forth and of course now it is headed by a typical position which is either a director for the hospital or a medical support at the hospital or a CEO of the hospital and so and so forth there are very many nomenclature that could be given to this kind of four person who is heading this services and third of course it's the professional services which is a usually clinical and non-clinical therefore when you talk of clinical and non-clinical we have a typical divide of clinical supportive and utility somewhere we also divide our clinical is the clinical services like medicine surgery or that is binary ratings and so and so forth support services are the lab imaging and the support services utility is of course the other services that we are talking of like housekeeping pharmacy manifold Nehring maintenance and so and so forth these are the typical divisions in a hospital organization now what what are the factors that influence the typical hospital care now we are all used to this diagram which is called the structure process and output or input processing output and this is how the governance of the hospital usually takes place and this is typically used to establish a quality system in a hospital so therefore what is the input what is the process in the output I'll deliver first on the input input means what are the structural components of the organization or a hospital in this case now a hospital has typical structural connotation one is the physical facility the layout the land the building the the electricity the water supply the backup sources for electricity the backup sources for water and then we have the staff we have the equipment's we have the drugs we have the licenses so these all together and compare that we can in put in an organization well in the process when how the activities are carried out in the organization so what are the processes that take place we have typically admission process the service the registration process the admission process and you know then the patient undergo the surgery is or treatment and so forth in March of course we have the discharge process now in between we have the transferring process we have the intramural transfer the extramural transfer the waste management the infection control activities the myriad of activities all these and comprise the processes now what is the output now output is typically what we say as a what are the rates let us say what are the there are two kinds of output one is the manager and output the other is a clinical output and therefore we call them as managerial indicators or clicking indicate doesn't typically follicular indicator we can have seed injection rate which talks about the quality of the hospital the service is provided by the hospital we can have re-entry into the operating room we have we can have a ADR adverture of the reaction we can have transfusion reactions we can have you know needlestick number of noodle stick injuries as was spoken by a forever one then we have the managerial indicators as a manager a lot but what is a bed occupancy rate what is the OPD attendant what are the infection rate what is the bed turnover rate you know what is the utilisation is what is the patient satisfaction did what is the employees address actually so these are the output indicator so we have a clear divider was to what it an input or a structural component what is a process component I'm going to the output component now what are the variables now we talked of the variables in the variables we have number one we have when we talked of the physical factors that is the land building and so and so whether we talked of the staff as well so what are the staff the staff are the we have to divide the staff into doctors nurses technicians initiative staff you know in support staff so and and everything the staff is usually based on a workload earlier on we had norms norms for the primary health center staffing now so the primary health center a disability or a community health center but now did the modern management we have spoken of for utilization what is the load of the hospital and therefore what how much would be the staffing and the staff should be utilized optimally so it doesn't make sense that there is a good amount of staff the hospital full of software but there are no patients so it depends on the load of the hospital and therefore the apportionment of the staffing whether it is a private sector or a public sector should be according to the load now how a load is calculated when you forecast the business plan of the hospital which will be spoken by a process or later we forecast 25 percent occupancy 50 percent occupancy hundred percent occupancy so so the staffing how much talking are you requiring or would you be requiring a 25 percent occupancy at 50 percent occupancy so therefore it is a clearly forecasted what how much would be staffing and what bare which is based on the workload so it is on the page or else we can have a doctor you know how many doctors per patient so we have some norms we have the norms are 4 is to 1 5 is to 1 1 is to 1 and so and so forth the nursing norms by mention the Nursing Council of India and some by the Medical Council of India now thus since the human capital is very important and it is almost equivalent to our capital assets of a hospital or organization we must develop them so we must develop them that is the one is recruitment then we also do the courier development their education they are training further physical figure yeah these things will discuss clinical and services effective use of bread and resources effective usage of parent resources which is a manager in indicator which I have told you we must always make use not only for the manpower but also of the resources we have a CT scan so the CT scan is operational 24 hours or per day it can be it can be used an ultrasound machine and MRI machine which can be used 24 hours a day so how much are utilizing are utilizing 25 percent 50 percent or max in capacity of the CT scanner so their how do you calculate so there is a method that how you calculate what is the process time what is the end time what is the out time and divided by 24r so you can in a day let's say a CT scan the procedure time is fifteen minutes in and out time you supplement together it becomes half an hour so in a day 24 hours so we have maximum capacity of working and doing let's say 48 cities this is scans per day so supposing we are doing 7 we are doing 8 we are doing 10 we are doing 12 so we were therefore we can calculate how many cities can and what are the percent of the neutralization of the city scanner that is of the equipment the same can be utilized as a utilization ratio for the space supposing it's a converted ICU so can be read I assume we have certain into 30 it is 300 eyes your bad days how many bad days are occupied and if the I see bad days are occupied at the rate of 1 is a person what intervention shall you take or intervene so that the utilization rates are increased because ICU or the operating room of a hospital are the highest resourceful area of the hospital and therefore they should be utilized more and more now these are you know the concerns or these are the role this is the typical role of the hospital manager or a hospital administrator quantum of load or quantity of work the workload and of course leadership and motivation leadership and motivation we have discussed again and again and that is something which is a typical art of how you are oh you did a sub skills you possess how are you motivating the total staff of your hospital keeping their morals high and thereby improving the productivity now let us see what is the typical role of the hospital administrator o governing body it is a provider so provider does provide what does the provoke what will they provide doctors nurses paramedical staff equipments and so and so forth what are the recipients the recipients are recipients of services or recipients of healthcare and mostly the recipients are the patients for locally or community at large and the interface as you can see the interface is the admission of style all the reader here is the CEO or the director of the hospital or maybe the medical super the medical super nor the CEO acts as an interface within the provider and the recipient of healthcare and and of course the governing body so he has to be the middle and be an interface amongst astride of the well he has to report to the governing body hey Steve unstable to the patient and to the community needs and here is also to be answerable to the doctors the nurses and the phenomenon staff of the hospital when you stride he fits into the middle and therefore he has to and typically we call in as an interface between all of them what is the internal operation internal operation of an organization is organizational planning and development we have talked of planning and right from the inception stage and how we need more the person the leader or the hospital administrator or the manager of the hospital as planned and then how he is developing the and implementing the same plan which is n massaged efficient operation typical efficient operation means operation management of the organization so how is he encompassing this activity of operation one day to day day and it is not firefighting is no troubleshooting alone it has to be a planned activity and then it is seen that all the treatment plant has been implemented in the same way relevant of course there are issues and concerns sometimes off and on that as in when there is some medication there is some firefighting there is some troubleshooting which are I mean routine affairs but in case the systems are there in our organization typically the process management is taking place and there which will reduce all these firefighting I mean no one would say that then whenever in a days where there is no firefighting there is no indication there is no you know so there will be but then if the systems are well planned and well design I think I'm sure this issues will not crop up cost containment cost containment is another ratio which will again crop up in the second part of the discussion today and so should we look after this and we all participate and how do we achieve this cause containment and increase the revenue from alternative sources of revenue cost containment and that aspect will talk increasing productivity now productivity is something that either and property is by the manpower productivity the equipment's are there if they are used they will be productive but what the here the here issue is the manpower the manpower has to be productive so in that much time in that many eight hours of that person is producing maximum output a surgeon a city where surgeons can do for surgery let's say bye-bye surgeries or open-heart surgeries here is achieved maximum productivity but we do not have the resources and we do not have the input we don't have the patient Road if the man is there the equipments are there so his productivity is r3 we come down now while motivation important exhibition is again increasing of products we have manpower but they are not really motivated once they are not motivated they will not be productive and then it comes to an organizational loss in terms of output profitability or you know profitability is both in public sector and private sector private sector it is in monetary terms and in public sector it is in development meant in terms in terms of number of people who have who have utilized the hospital who have taken the services of the hospital so productivity is make a quantifiable it is measurable now other activities is you know community participation load of patients and of course marketing marketing will be discussing again in the second session so but here if I may just interrupt for a moment it is a very useful discuss and viewers which is going on and dr. bananas is saying that in the hospital we have the different resources the the human resources there then we have the equipment's machinery and he gave example of the CT scan etc and then we have got the financial resources and as well as the finally is talking about about the leadership and motivation so you see the utilization of these resources is something very very crucial and particularly in the public hospitals if we see that's where the indecision that he mentioned you know the restructure process output or input process output in the output of certain things are measurable certain are not measurable so easily but he we can measure certainly the bed occupancy rate average length of stay the death rate the better than over rate you know in the bad days all those kind of things but when it comes to the the quality of services the patient satisfaction the hospital acquired infection some of it is measurable but some of it is becomes very difficult to measure so so the role of the leadership plays a very vital I mean role of the leadership plays a very important role and then also the the motivation of the people and here I would like to invite comments from both the experts that are sitting on the Dyess is that you see we take example of a typical state health care whether it is state health care at the state level provincial level or at the central level at the central level we have got the central Health Service and in the states we have the provincial medical services and for example because the doctor is the leader of the team in any situation whether it is a primary health center or it is the director-general of health services or it is a big hospital or a Medical College Hospital so this leadership role played by our colleagues in different positions of the hierarchy is something that has to be scrutinized and that has to be looked into why I am saying so that be the leadership over this since the time of independence is being questioned by the community has been questioned by the policymakers and when we put a doctor immediately after his or her graduation or the post graduation they come from the ivory towers of pop you know affects medical institutions in the country whatever whichever place they are and they are suddenly put into the health system whether it is the primary health center level or community health center the district hospital or the Medical College Hospital and this person who has come either as a specialist or as a professor assistant professor or as a general duty medical officer is that loss in the organization he doesn't know the system she doesn't know the government functioning he doesn't know how the hospital is working and that person is really not giving or is not able to give so I feel that the systems in which he has been put he has not been given any orientation to this system of the hospital or to be health care delivery system wherever he is posted or she's either she is posted as a result of which we are not able to extract the maximum of this human resource which is so competent which has been trained for about seven to ten years in medical colleges so what do you feel not to be done that how can we overcome this and whether this is the problem or not a problem so both of you I mean both you and Kossuth both of you are now exposed to public shelter now with our experience there we are very clear that this kind of induction program or induction training program or socializing program doesn't exist there however the hospitals are do have some kind of training program on account of national health schemes or let us say first polio rch you know I put these kind of training programs are there but peculiarly we have no idea as to I think you can be order process who can comment as to why this kind of induction training program doesn't take place when a doctor is inducted into the services a young doctor we have seen sir graduation is posted at the primary health center the community health center C has no or he has no idea coer s and they say oh we have just been put here and we start working without knowing you know then and all that they are no interested is you know is documentation filling up the immunization how many people have come to the OPD and so in support I think I would process who do commit on that thank you doctor hit on that as professors a girl will directly said management is a very important I think job which is expected from a doctor whether he is placed in a primary health center setting or in the hospital setting but unfortunately during our MBBS training or maybe specialization as well except for hospital administration there hardly any efforts for management because whether the doctor is placed in a primary health center where you have to have lot of other functionaries like you have health assistant your health worker you have to deal with community you have to plan for resources other than your clinical skills and sometimes as a doctor at the primary health center you have to play more of a leadership role and more of a management managerial competencies are required other than your clinical competencies so that the efficiency is definitely there but it is good that the institution like in the Gandhi National Open University has come up with this program which I think gives a personally to all the doctors were either in private service or government so they say opportunity at least required these competences many a time we acquire these management and leadership competencies by trial and error method based upon over experience because still knowing the government set up your administrative positions are usually given by your experience or seniority dr. padarthas mentioned about medical super Dennett in most of the government set up the medical superintendent usually is the senior most professor he may be from basic sciences he may be from clinical sciences but very few I think especially in the government sector institution have this post reserved for people with many GL backgrounds and administrative background but gradually the changes are coming of course in the corporate sector Hospital which are coming up the posts have been exclusively kept for the administrators with administrative and managerial background and government set up of course will also gradually take over this because the resources again have been a big constraint in the government sector as well and now the thinking is going on how to sort of utilize these resources because the funds which are being allocated to the government sector whether it's medical college or hospital they are greatly decreasing in fact in some of the states and the government is not able to provide even the plans which we have the policies the moment we say that the investment of the government in health sector is not as but the even if you look at the per capita investment on health is very less as compared to the other countries so this thinking is greatly coming up and over the period I think the administrative positions will be created as a caterer in the hospital as well and therefore till that time I think the supplementary program like this management program by new another institution I think they're very very very important role in fact once you acquire some additional because management concept our principles are universal most of times we think that these are applicable only to the business sector but these concepts and principles are universally applicable in all sector including the health sectors so basically we are dealing with human beings we are dealing with that professor with on the side that we are dealing with resources in terms of money in terms of material in terms of equipment and human beings so wherever you are placed as a primary center or district hospital you are interacting with these resources and your performance as a leader is determined how efficient you are or how effective you are so unknowingly we are using those concepts of management and principle in whichever capacity we are working with a head of department or head of the unit or a primary health center in charge and these concepts and principles as I said are universal and yes they if we use some of these things in our day-to-day practice that will increase our efficiency and I think these are some of my observation that over the period of time the change will come in the government sector as well right now it is a private sector big Hospital corporate Hospital which are taking care for selecting positions as a medical administrators thank you thank you I think that was a good discussion and I deliberately wanted this to happen and the reason is that you see unless we have and very rightly both the the experts have nailed the issue is that the induction training before we put or just after the recruitment of the doctors or the nurses you know all these stuff some induction training should be carried out in the organization wherever they are posted for example if the doctor is posted in the district health system whether is his hospital at the district level or CSV or PSE I think there should be a one weeks at least induction training at the district hospital followed by the place where is visually posted so that he comes to know what is the district health organization similarly in the hospital if he is posted he or she is posted as a gynecologist or a general duty medical officer or a casualty medical officer I think we need about two weeks orientation training induction training so that the person knows about the objectives of the organization and this not true of only the public hospitals even in the private or corporate hospitals induction training programs are absolutely necessary it may not be necessary for a visiting consultant I can understand but for a regular doctor who is there as a regular employee of any Hospital some sort of induction training is very important motivation leadership qualities have to be inculcated management training courses as dr. Sood as highlighted they need not be a two-year or three-year or a one-year program but we can have short capsules wherever it is not possible for the state government or the doctors to undergo long courses I think a four week three week two week courses on the National Institute of Health there are courses where people are nominated that is a three week hospital administration course then this top College course I think these are the things which are very very important which probably our health plan or sadness traitor's at the state and central level as well as any other place they have to take note of thank you please thank you sir I couldn't agree more just a few no infection some of the states before the doctors are inducted in the service we are given exposure as Professor Agarwal said about the induction training I remember in punjab haryana there is a provision for induction training of placing them at various level so that they actually get what is happening in reality and as you said that we have institution at the state level non-state Institutes of Health and Family Welfare has come up in almost all the state then district level training centers are also available in most of the states so we have a fairly good networking beside medical colleges so I think there is a perhaps more person sensitization is needed planners a planning stage whereby we should plan for not only induction training but also for a regular in-service training pool because once a person joins a set of whether in government sector private sector and over the period of time as he get promoted or given new responsibilities and trained he need to be given an orientation program maybe one week to week or three week as he says but this should be as a part of their human resources development strategy for the hospital or for the father yes thank you all right thank you sir I think I couldn't agree more than what would you have said now I like to draw your attention to this slide some managerial skills which the manager should possess or and as process food said it the manager principle management principles are the same whether it is a business organization and hospital is also a business apparently so so the problem is what we can feel a face right now is most of us complain that in the private sector the corporate hospitals are managed by people who are not doctors and their business manner can we have the slide please yeah that's better so the issue is the person should be good in general management and why so there this slide is very familiar at all of you one is that conceptual skills the human skills and also the technical skills people at the level or when the person is inducted he should have a lot of technical skills lot of technical skills and and he should be very good in his whatever he's a nurse if she's a nurse if he's a doctor him - goodness he must know the principles of Nursing he must have good bedside manner himseif he's a doctor so technically they must be very very sound the top man should be very good very lot of it should be conceptual and then he would have very little of technical and significant amount of human skills now conceptual skills here is the difference now if the manager of the organization which is a hospital is a medical or a doctor he should he would have naturally a lot of conceptual skills of all the clinical services or support services a manager services which do services the finance is insurance over then that is the differentiator now a person who is not a doctor will not be able to appreciate the clinical concepts so here you will lack the conceptual skills on on account of medical practices well arrest everything is probably the same the middle level persons would have good amount of human skills I mean you should have good interpersonal communication you should have good human relationship with each other this slides must be when all of you must be conversant with conceptual skills human skills and technical skills now what are the reasons so we did discuss aquick Li for the changes in the healthcare sector now in terms of a lot of it was now discussed for the finance and process would the address the idea is the deficit in the per capita expenditure on on account of healthcare it for the moment of India this is a deficit which is you know worldwide I mean no one is as rich or be the private sector in the private sector we have to spend the money and so as to earn the money within a certain period of time and therefore will now quickly discuss in the second session break-even analysis when do you want to break even and what are the types of break-even analysis although that we'll be discussing now sorting in terms of Finance with the government's to make the increased demands with the end exploitation of the citizens so there is a deficit well it is a national issue and we can do very little about it unless the economy of the country whatever but then some states are quite rich there is a differentiator some states are wealthier we're in the perfect income is more and then that those states are you know health budget is more and some states are not all that but increased awareness to quality resulting increase demand for faretta now this is something a growing development now which is I don't think it will be issue is a development and now the country most of the states are exposed to what is quality the concepts of quality and some of the state and with an election coming in there is a lot of imputation accreditation there for a couple of states in the country are also now interested for accreditation for the national system of accreditation lack of friendly customer services and government facilities so this is now increasingly is seeming to be some of those states which are now exposed to quality they are now making a certain interventions as to how to be more customer friendly they're having city and charter they're having sign leaders they are having a nice facade they're having a welcoming attitude that pitchin tries to a patient feels invited I mean not that earlier the facilities were not that earlier it wasn't more of a high ec but then nowadays it is now changed into more of for this kind of things now the patient feels invited waiting time will waiting time is an issue everywhere whether it is the OPD the operating room the war you know so it will be a good idea for the hospital manager to assess and monitor the waiting time and intervene if the waiting time is long or even if it is not long of intervene to make it shorter and thereby increasing the patient satisfaction month after month or year after year lack of modern and appropriate equipment in public hospitals well this is an issue and such this is I think I need your comment because public hospitals they have one differ differentiator and that is they don't have a post of a biomedical engineer they do have equipment which is by all means how they're prepared we have an idea some of the equipments are excessive we need access in nature a lot of radiant wants to be found a lot of CDs canister found within the absence of a radiologist in the absence of a pediatrician there are areas warmers there are ventilators they are NICU well there is a skewed approach of equipment procuring then the absence of biomedical engineer this is a concern and no one has an idea of an AMC no one has an idea of the calibration which is a which ends very soon the equipment is getting defunct I think this is a very very important issue and I couldn't agree less with dr. Madan thus you see there was a study which was carried out by Department of Electronics Government of India way back in 1991 and this hospital was surprisingly carried out by Department of Electronics not by Ministry of Health and all over the country selecting a sample of about ten states including Delhi and then in South Tamilnadu and then West Bengal Assam and then Punjab etcetera so cutting across the whole country and this study was being conducted when mr. and Whittle was the secretary of the Department of Electronics who became the chief Vigilance Commission of later on and this study revealed that as I mentioned in the last teleconferencing also if you remember that as much as 40 to 50 percent of the hospital equipments in the public hospitals across the country are lying non-functional for want of simple maintenance repair spare parts etc so this is a very callous wastage which has been probably ignored and our hospital administrators particularly in public hospitals are not seized with this they have very little idea they are not there so little sometimes indifferent to the whole issue of the equipment management because they say they are not knowing anything about the equipments I don't say that the medical administrators should know the ins and outs of the equipment but then certainly there are processes there are ways that how the equipment has to be selected how the specifications have to be decided how the tenders have to be floated the technical bits the commercial bits I think all those things as a manager of the hospital you are supposed to know and therefore the annual maintenance contract about the biomedical engineer this is a crucial issue in the hospital manager men can be hospitals and I are very happy to share with you that biomedical engineers have been recruited I know of at least a state Tamil Nadu Tamil Nadu has got a Tamil Nadu Health System project which I happened to visit a number of districts as on the invitation of that government and a five biomedical engineer CL biomedical engineers have been recruited only to look after this equipment management and I think this should be followed by the all the states also thank you sir the second issue is again of the aging population that need more efforts and services we all know that the quality of law of the dahle of which are the indices worldwide and the senile population on our country is increasing so there is a captive audience of general population which visit the hospitals and there ukalaka lee we call them as vulnerable patients whether there are semi citizens or elderly people or children so particular attention to have to be given to the meat of their needs not simple things like you know a separate counter when the government of India is giving them facilities in terms of discounts in the railway fare the airfare why can't the hospital keep their I separate the counter these are some which will go a long way in operative the government to attract and retain the best of doctors and other stuff it is a phenomena which is across the country fan India no state government can is able to retain the doctors they are not able to fill the vacant post and in spite of the best of efforts by and consorted effort by the secretary the principal second and the minister they are unable to fill up the vacant post thereby this is a concern and it will probably remain I've been cement about it I think it will remain I don't we don't see that a we filled up very soon inability of the government to attract and retain the best managerial talent but the same and the same principles also apply now methods of financing some innovation on accounts of methods of financing because ultimately it is money that is going to matter and irrespective of the fact whether it is a pub whether it is a ruby color and symmetry the user fee I mean whichever hospital has a little bit of financing in it is always better management consulting and contracting not all the many Harrell abilities are available with the hospital management to end their necessarily or not to be there so in case you need some support or help we can certainly and there are means and ways as to how to avail these kind of services either by contracting in terms of PPP or in other modes of Bo T or you know Bo R and so and so forth new treatment protocols yes the hospital chief for the medical servants would be oriented to the treatment protocols or clinical pathways we should hear to some of them Nash minimum nationally if not international treatment protocol at least in the national treatment protocols which are available I mean foxy has Indian epidemic Pediatrics also has different protocols you know all these professional bodies have written protocols so we should adhere to some of the treatment protocols clinical and that will aid and ascertain the standards of quality of the clinical services outsourcing of certain service functions I will not deliberate on the houses in Jordan it take a lot of time what will happen you know ultimately we must get a ship to the outpatient treatment or the daycare be very the bed turnover it becomes more the bed occupancy rates becomes more the average length of stay becomes lesser so these are the industries that we should monitor and gradually seen the improving and there were a certain in a principle of continuous quality improvement these are technology acquisition move did get our attention cause and accountability accountability in terms of services increasing patient involvement in decision making so then for consumerism we must be first exposed to what is consumer protection act ourselves the hospital manager and also treat the patient as a potential consumer whether he pays for the user fee or not irrespective of that with the reliving availing of our services and we are for sale we are really marketability our market value increases only by the number of patients that you see or we service greater utilization of more sophisticated equipment which we have discussed earlier what is the result of these kind of changes that we involvement of professional management companies between higher you can take the help of different managers higher standards of patient care more accountability better quality of services greater efficiencies lower treatment cycle cost greater access to the public health facility or the private health facility either I mean both are equally striving for this kind of access the private sector is wanting patients only for the profit and the public sector is wanting more patients to show that these many patients are also available so it is not only it doesn't only means that is to give means everybody's have gone up Nora it has across the hospital instituting derivative proper are a very small component of the health care facility additional investment in healthcare facilities in technology improvements making made in existing public health facilities compete with the private so now we are upgrading some of the public health facilities and mostly they're just costumes across some of the states and they can probably compete with the private entities some problems in terms of her hospital facility planning and operational performance planning standards impact of technological advances on facility planning safety patient safety and staff safety future expansion human resources from schools had discussed the end of all process of ever disassociation selection recruitment manpower training and development planning and staffing issues attrition and retention staff motivation and staff satisfaction HR policies employ HR policies that you know there is a manual there is a manual but then there are no defined HR policies job specification rotation and job enrichment labor unions and strides financial manager deliberately leave because financial management will discuss data I see I I think again we can leave because IT is Toby but then yes we can go into hospital information systems we can talk about vegetation we can talk with packs and simple maintenance maintenance we have discussed in terms of biomedical engineer but then other issues all also their fire and safety power backup you know store management and some regulations regulations are the licenses it is irrespective of they can private hospitals all the hospitals should have the licenses which are required for economic managers lighting housekeeping waste management I think we can continue with the same discussion little later and I would remind the regional centers and the viewers at work across the country that they should try to let us know that if they are listening to us and raise any questions if they have because we have the experts to answer to your queries on these two three important areas we will again come back to you at 1200 hours thank you very much

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Keywords: Role, Hospital, Administrators

Id: s0yJd3P5NgU

Length: 45min 11sec (2711 seconds)

Published: Tue Oct 07 2008