Hospital Management

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 Hospital Management

A Vital Aspect of Healthcare Management

Dr. Minhaj A. Qidwai

Treat the guests in the shelter as you wish to be treated

The word hospital comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, hospitable reception.!Thus a relationship of a guest to be sheltered with hospitality. Institutions created specifically to care for the ill  appeared early in India. Fa Xian, a Chinese Buddhist monk who travelled across India in 400 CE, recorded in his travelogue that: The heads of the Vaisya [merchant] families in them establish in the cities houses for dispensing charity and medicine.2

The Romans constructed buildings called valetudinaria for the care of sick slaves, gladiators, and soldiers around 100 B.C. However, with the declaration of Christianity as accepted religion construction of a hospital in every cathedral began. Thus in-patient medical care in the sense of what we today consider a hospital, was initiated under the Byzantine empire.3

The first prominent Islamic hospital was founded in Damascus in around 707 AD. However most agree that the establishment at Baghdad was the most influential; it opened during the Abbasid Caliphate of Harun-al-Rashid in the 8th century. However, the first ever psychiatric hospital was built in Baghdad in 705 AD.4

The hospitals continued to develop in Europe and other parts of the world. By the late 19th century, two sets of hospitals emerged-Public and Private and later hospitals began to take shape as general, specialized, teaching, in different settings.

Hospitals have played a vital role in healthcare management. Usually, they are a part of an integrated health system on a secondary and tertiary level. Hospitals are unique in terms of healthcare delivery. Their doors are always open. No matter what time of day, hospital physicians and staff are prepared for anything – from treating life-threatening diseases or the common cold, to aiding in emergency situations and disaster relief. With several departments all providing life-saving care, catering to patients of all ages round the clock, hospitals become a back bone of any healthcare system. Thus, their management is vital for managing the healthcare for the catchment population. More professional is the management better managed will be the healthcare. Therefore, a management position in Hospital Management is important, not only for the patients, but also for the healthcare system as a whole.

Managing hospital is a complex issue. There are several factors and players which need to be considered. However, the three biggest issues facing the hospital management are ensuring the sustainability, financial viability and customer satisfaction.

Sustainability comes from the vision and mission of the hospital. The board of governors or the top management sets a road map for their cause of establishing the setup. However, the main issues hospitals usually face is the financial instability, due to Mismanagement, Increased competition; and significant receivables.The factors to assess whether or not a hospital can survive independently can be gauged from responding the following questions5:

  • Does it have geographic barriers?
  • What does its payor mix look like — is it positive or negative?
  • Does it have a substantial physician alignment strategy?
  • What does its asset base look like? Capital investments? Renovations?
  • What is its cost structure? Long-term lease rates?
  • Quality of care? Alternatively, is it the type of hospital that a board member would take his or her family to?

Sustainability of any hospital is also linked with the patient’s opinion and satisfaction. Following were opined by patients according to a study6:

  • Nearly half (48%) patients felt they had to wait too long to get a bed in the hospital after presenting to the ER.
  • Most of the patients (68.6%) said that they were never asked for views on the quality of care provided.
  • Some of the patients (20% ) did not find anyone in the staff to talk to about their worries and fears
  • More than a quarter (27.6%) felt that they were given emotional support to only some extent.
  • Up to one third (32%) of the patients said they were not provided enough information regarding their operative procedures beforehand.

So, it is important to take appropriate measures to satisfy the needs of the patients. From the staff and service delivery perspective, there are three key areas which need to be addressed. Role of nurses, the physicians and surgeons and the diagnostic services. This triad needs to be handled professionally and a hospital manager who knows the clinical setup is well equipped to render this responsibility. Thus, the backbone of management of a hospital are the trained professionals esp. with a healthcare or clinical background.

Good hospital management can often be the difference between a well-maintained and operated hospital and a chaotic environment where the staff is unsatisfied and quality of patient care suffers. Good hospital management practices do correlate with the clinical outcomes it achieves, including mortality rates, as well as with patients’ satisfaction with care. In both UK and US hospitals, each one-point increase in management scores was associated with a 6 to 7 percent decrease in 30-day mortality following myocardial infarction. In France, the hospitals with the best management scores were more likely than other facilities to have low cesarean section rates and shorter case-mix adjusted lengths of stay.7 Suffice to say that, Management practices predict a hospital’s financial performance.

The business side of the hospital is vital to the lifeline of the system. Hospitals are multifaceted systems, where there are hundreds of operations going on at one time.Hospital managers need to have business sense to run the hospital efficiently. They need to focus much of their time and attention on improving the books of the hospital and therefore, issues such as budgeting, hospital public relations and marketing, and billing and collections should be their top most priority.

However, the concerns of hospital managers go beyond business and directly into the delivery of care. Managers must maintain their ethical responsibilities while ensuring that all operations throughout the hospital are running smoothly, from surgery schedules, patient flow, record updates and confidentiality, waste management, and equipment maintenance and set up.

There is no doubt that hospital managers have their hands full when it comes to their day-to-day operations, but they play a crucial role in ensuring patient care and in the success of the hospital as a whole. To summarize, hospital managers have to provide special care to the guests sheltered within their institution and devise strategies to sustain the set up for the visionaries of the hospital.

REFERENCES

  1. http://en.wikipedia.org/wiki/Hospital
  2. Legge, James (1965). A Record of Buddhistic Kingdoms: Being an Account by the Chinese Monk Fâ-Hien of his Travels in India and Ceylon (A.D. 399–414) in Search of the Buddhist Books of Discipline.[publisher missing][page needed]
  3. James Edward McClellan and Harold Dorn, Science and Technology in World History: An Introduction (Baltimore: The Johns Hopkins University Press, 2006), p.99,101.
  4. Sir Glubb, John Bagot (1969), A Short History of the Arab Peoples, retrieved 2008-01-25.
  5. http://www.beckershospitalreview.com/hospital-management-administration/8-key-issues-for-hospitals-and-health-systems-2013.html
  6. This article is available from: http://www.biomedcentral.com/1472-6963/7/161
  7. http://www.mckinsey.com/search.aspx?q=hospital+management.
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