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.

7. 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.

8. 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.

9. 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.

10. 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.

11. Role of Hospital Administrators
General roles
Canadian management expert Henry Mintzberg distinguishes ten key
managerial roles that managers and executives need to fulfill.
The 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

12. 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

13. 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

14. 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

15. 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.

16. Motivation:
Maslow's Hierarchy 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.

17. 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.

18. 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

19. 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’.

20. 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.

21. 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.

22. 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".

24. 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
(1984 by Professor Noriaka Kano)

26. 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.

28. Threshold attributes (Dis-satisfiers or Basic Needs):
Expected features or characteristics of a product or service (basic
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.

29. 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.

30. 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.

31. 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.

32. 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.

33. 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.