In quest of a perfect administrator

With medicos, MBAs, CAs, military personnel and professionally qualified hospital administrators vying to wear the administrative mantle, Rita Dutta explores what the future holds for them

With the changing face of hospital administration, the men running the show have also changed. Present hospital administrators are a potpourri of medical and non-medical people. So who are these new age administrator sand what qualities define them?

He should be a leader, one who knows to bring the best in each of his team members and a personification of promptness, alertness and one who can take quick decisions, says Dr R R Singh director, Tata Institute of Social Sciences.

With the healthcare customers being the most demanding ones, the administrator should devise tricks to handle the wide gamut of people crowding the hospital. Experts say the ransacking of Singhania hospital of the J K Group in 2002 by an unruly mob is an instance of an administrator who failed himself, by letting a tensed situation go out of hand. Experts say a person with sound knowledge of healthcare should be appointed as the administrator, preferably with a degree with hospital administration.”He should be able to understand the requirements of the hospital and be a liaison between the management and the staff. He should understand their problems and try to solve them in discussion with the management”, says Dr Vijai Kumar, medical director, Jaslok hospital, Mumbai. To which Dr S Ramamoorthy, MD, Malar hospital, adds,”An administrator is a person who understands the sector he is working for, whether it is medical or any other industry. Hence whatever be the qualifications, a hospital administrator should be strict, straightforward, and transparent.”

With corporatisation of healthcare sector, experts say an administrator should have entrepreneurial skills too, to cut down on costs. According to Dr D Prema Chandra Sagar, Executive Vice Chairman and CEO, Sagar Apollo Hospital, “A business manager complements the services extended to the customer by adding value to it. He has the effective role of a communicator between the medical personnel and the customers. Ultimately it is essential to know the dynamics of the hospital business.”

Realising the importance of having proper management principles for hospitals, recently an association of nine non-government hospitals in the eastern region was formed under the banner of the Association of Hospitals of Eastern India (AHEI). The heads of these nine hospitals is working towards promoting better standard of services for healthcare in hospitals, for promoting nursing services education, training of nursing and para medical staff and creating facilities for further study in healthcare services. Says A M Mallick, Chairman, Association of Hospitals of Eastern India (AHEI), and also Vice President-Finance and Administration, Woodlands Hospital and Medical Research Center, Kolkata, “In West Bengal where most of the patients rely on government run hospitals for their healthcare needs, the private players have a crucial role to play in this juncture. Hence, we have asked the member hospitals to try and standardize the system of working in the hospitals. We are also looking at patient welfare, care, cost and treatment.” In West Bengal, where hospitals have to deal with labour unrest and trade unions, the administrator should have knowledge of HR and Personnel Management, says director of super-specialty hospital in Kolkata.

With hospital administrators being the most sought-after vocation, the debate on who deserves to sit at the helm of affairs has gained momentum. While government hospitals still follow the doctor-centic model, trust hospitals are witnessing a trend of military people wearing the executive mantle, while the corporate show an affinity towards recruiting MBAs and CAs. Administrators hailing from the medical background grumble that non-medical people are infringing on their territory, without understanding the intricacies of the profession. Says an administrator from a medical background, “How can a non-medical person decide policy matters on hospitals, when most of them do not even understand the difference between cardiac surgery and cardiac intervention.” Medical administrators insist that doctors feel at ease, feel that their grievances are heard properly, when the administrator is a medical person.” Experts say that the kind of egos that doctors have, they only like to take orders from the fraternity only. A non-medical administrator of a corporate hospital reveals that whenever he wants to implement any new discipline, it is always the doctors who are resistant to the idea. Non-medical administrators point out that doctors are not good businessmen and they should be confined to clinical work. Doctors contradict this argument by saying,”Health is not just about business.”

Padmashree and Padmabhushan winner, chief cardiologist Dr B K Goyal, dean, Bombay Hospital, who refused to get involved in the administration of the hospital and restricted his work only to administration of the college gives another perspective. “A top line doctor would not chuck off his clinical career for administration. It is only the not-so-successful doctors who settle for administration.”

The non-medicos defend themselves saying that with 70 per cent of administrative work being non-medical, knowledge of medicine is not obligatory. An administrator with a non-medical background says, “A doctor should not hassle himself with administrative work. He should concentrate on clinical work and leave general administration to non-medicos.” Non-medicos also insist that a doctor heading administration would always have a soft corner for his specialty, which might lead to neglect of other departments. Says Rubin Shah, CEO, Sterling Hospital, Ahmedabad, “We always see that a cardiac surgeon opens cardiac care hospital, endorsing the fact that a medical person always have an affinity towards his own department. It is only a non-medical person who can be unbiased and work towards the holistic growth of the hospital.” Within the non-medicos, who is the best choice-MBA, CA or military personnel? Advocating the trend of military personnel becoming hospital administrators, Brigadier Joe Curian, CEO, P G Hinduja Hospital says, “There is not much of a difference between handling material and men in the army and in a hospital atmosphere.” Experts says that terms like protocol, SOS, material and men management, which have become the vocabulary of civil hospital, are high-jacked from the military, proving that military management is the best.

However, the brickbat for military personnel are galore. Whines a medical director of a hospital, “It is sad that retired military people use the hospital as their rehabilitative home. Waging a war is different from hospital management.” MBAs and CAs are vying for the post, saying that they are best suited to handle business and finance management, an area which is increasingly being accorded importance in healthcare.

While all the medicos grapple to learn management strategies, and non-medicos take time to get acquainted with medical jargons, the market seems to be opening up for professionally qualified administrators with a medical background. “It is need of the time to have professionally qualified hospital administrators with medical background,” says Dr Kumar. Even the responses from the HR section of different hospitals reveal that the candidates with medical background with hospital management background is always given preference. A non-medical person, even if he has done professional management course would only be restricted to doing middle order or front office level, says an administrator of a Mumbai-based hospital. Perhaps, one has to wait for a few more years to see in which direction the tide turns.

(With inputs from Vijaya K and Joy Roy Choudhury)

“A hospital admnistrator must have fire in his belly”

Dr Vijay Kumar, Manager, Hospital Administration, Image Hospital, Hyderabad

Dr Vijay Kumar firmly believes that professional administrators have been taking over the traditional administrators. “Hospital administration has become a very dynamic area just as any other administrative job in any other sector. It is a very sensitive job as we deal with emotionally beaten people. Lately we are aiming at removing unpredictability in the final bill, as our market is a price sensitive one.” He says historically, hospital or healthcare managers have evolved from apprenticeships within technical areas.

According to him, some management skills can be acquired while in job. “Organisational skills can be learned over time if the work environment allows. Other management skills, however, are highly technical in nature and do not lend themselves to an on-the-job-training approach. Among these are financial and medical management skills,” says he.

Hospital management, like most scientific disciplines, has a language- a jargon- all its own, according to him, “In order to function effectively, one must understand that language. So a person with a Masters in Hospital Administration from a good institute is always preferred.” You need to have some who can apply him into the situation and come out with solutions. You need to have someone with “fire in his belly”.

(P Ram Kumar )

“An administrator’s job is to motivate”

Dr A Malathi, Director-Administration, Manipal Hospital, Bangalore

Dr A Malathi, a perfect blend of qualified medical doctor and business manager, shoulders the responsible position of Director-Administration of Manipal Hospital for the past two years. A Medical graduate from Bangalore Medical College, she completed her MD in Human Physiology from Bombay University and became a professor much early in her career and rose to become the head of the Human Physiology department in Bombay. About the changing concept of healthcare industry she says, “Over the years hospitals have become very focussed in providing customer care. Hospitals aim to provide everything under one roof without compromising the quality of services provided.” She advocates professional hospital administrators, as it ensure personalised care. She says that the management of Manipal Hospital offers the team with freedom of action, material and moral support in order to produce responsibility, accountability, and maturity. “We believe in value based management,” adding, “At Manipal Hospital we believe in empowerment of every individual heading each department who has the liberty to go ahead with his decision if he thinks it is right.” According to her an administrator believes in motivating every employee towards identifying his own capabilities and committing to give his optimum best to the organisation.

(Vijaya K )

“Professionals bring accountability”

Dr Yogi Mehrotra, MD, Apollo Hospitals, Delhi

Dr Yogi Mehrotra, the man behind the success of Apollo Hospital, Delhi, believes professionals enhances functionality of the hospital. “In Apollo‘s case, professionals were hired for the to improve the services and bring an accountability in the services rendered. These professionals are from the various specialized areas like housekeeping, food and beverages, materials and others.” The professionals have helped in running the hospital smoothly and in optimizing the services and also seeing that the costly equipment are better utilized and the cost are reduced by eliminating the wasteful expenditure. He partly conforms to the idea that doctors are terrible businessmen. “Doctors are neither good or bad businessmen. As they are neither trained to be businessmen nor in administration, they have not developed the skills of managing big hospitals. Further, being professionals in their subject they would like the ultimate without going into cost aspects.” However, he is quick to add, “There are exceptions to the rule and there are many outstanding doctor administrators.” According to him, the basic concept in running a corporate hospital is to provide patient’s satisfaction and good clinical outcomes comparable to the best in a world at a cost which is reasonable.

(Nidhi Srivastava )

“A qualified administrator is equivalent to an unqualified one with 15 years of experience”

Major General Vijay Krishna, CEO, Breach Candy, Mumbai

Elegant and suave Major General Vijay Krishna is the first CEO that Breach Candy has appointed in November, 2001 in its history of hospital administration. A BE from Secunderabad, Krishna has worked in the army before joining Breach Candy, a hospital which boasts of treating the who’s who of India, whether it is prime minister Atal Bihari Vajpayee or Amitabh Bachchan, and having the best doctors.

He feels that his becoming a hospital administrator in not by default. “Anybody who is capable of handling crisis, expenses, procedures systems, and implementation is a good administrator. I was not aware of the technical know-how much and not conversant with many medical terms when I joined, but I am learning,” he admits. Perhaps, his management skills in the army are coming handy, as he is trying to overcome the difficulty of space constraint in his attempt to have a full-fledged casualty ward. However, he believes, “A qualified administrator is equivalent to an unqualified one with 15 years of experience.” Though most non-medical administrators grumble that doctors have big egos and do not want to conform to discipline, he says, “Not for Breach Candy. Here medicos and non-medicos work in tandem”.

(Rita Dutta )