Industry Voice

Symptoms of a Sick Hospital

Some 'management diagnostic tests' can help one identify the symptoms of a hospital turning sick

Increase in income, a growing middle class with increased spending power, ageing population, rising importance of preventive healthcare, urbanisation, a burgeoning medical tourism and penetration of healthcare insurance have driven the growth of healthcare industry in India.

In spite of all these positive factors, many hospitals strive hard to break even and are not able to survive in the competitive market. Why so? Some 'management diagnostic tests' can help one identify the symptoms of a hospital turning sick such as leadership, structure, hierarchy, manpower, systems and processes.

Leadership

Peter Drucker said, 'No institution can possibly survive if it needs geniuses or supermen to manage it. It must be organised in such a way as to be able to get along under a leadership composed of average human beings'. No institution can survive if it is under a 'one-man rule'. Unrealistic programme objectives, lack of early results, faulty phasing of work, inflexible implementation, inefficient project management, and lack of a specified system for people management are the major reasons for management failure.

Leaders should possess the following six traits especially in the healthcare industry—generosity, ethical discipline, justified patience, enthusiastic effort, concentration on minute details and focusing on goals. As Dalai Lama said — 'A leader who wants to take all the credit destroys other people's motivation. A good chief executive must be generous in giving credit where it is due'.

Structure

As organisations grow and develop, they should modify their structures to align with their strategies. According to Isaac Asimov, 'the only constant is change, continuous change, inevitable change'.

A control-based structure emphasises lower-level needs such as basic pay and does not allow for the fulfillment of higher-level needs like independence, empowerment, permission to fail, achievement, self-confidence and recognition. Employee turnover will be high and morale low in such organisations. The control-based environment translates into medical errors and destroys employee motivation, satisfaction and morale.

A commitment-based approach believes that people are capable of self-discipline and can work autonomously. They take the initiative, trust each other, and overcome communication barriers, enhancing teamwork. This results in low attrition rate. However, when the autonomy is curbed, there will be a high level of dissatisfaction among good employees.

Hierarchies

While hierarchy is closely related to leadership, it differs in that it identifies leaders down various levels right up to the grass roots. While young talent should be cultivated, it is vital not to ignore older workers. In many organisations, it is seen that older loyal employees are given positions of importance where they can be used as tools of change. To a certain extent, they are used as management representatives who implement vital changes as younger employees are willing to learn from them. When such employees are ignored and demoralised, it reflects on the entire workforce, since other employees conclude that hard work and loyalty will never be rewarded in the institution.

Manpower

More than salary, good infrastructure, hierarchal structure, defined roles, recognition, training, career growth plays a major role in retaining an employee. A successful hospital not only has to have top talent in place; the management has to rightly identify a high-potential team, cultivate and retain them. As healthcare continues to grow in complexity, a good employee will become even more critical as the hospital tries to keep pace with change and evolve into the future. To retain and keep them satisfied, management has to build the will for change, cultivate promising improvement ideas, put those ideas into actions through effective leadership and execution. It is necessary to have a skilled inventory and compensate with the market. They should also promote and embrace mentoring at both the individual and organisational levels. The increase in attrition rate clearly symbolises the sickness of the hospital.

Recruitment Failures

Most human resource personnel in the health sector are concerned about hiring right, but at times they cut short the process due to lack of time. As is often quoted, 'Hire in haste; repent at leisure' - it is not good idea to hire too quickly. If the CEO has no time for the hiring process, it is better to appoint a hiring committee.

Keeping the Right People

There are four types of people in any organisation:

Star Performers (10 per cent): Are important players and high achievers often exceeding expectations. They leave very quickly if they are not given recognition and respect.

High Performers (20-30 per cent): Consistently perform high-quality work and are optimally fit for their assignments. They are easily recruited by your competitors.

Steady Performers (40-60 per cent): Are usually competent, reliable, loyal and excellent followers. They are essential to keep the organisation in business.

Poor Performers (15-20 per cent): Functionally ineffective, either mis-hired or misaligned into jobs. Invariably they are appointed through strong references.

The ratio of the various performers constituting the organisation is an indication of the health of the hospital.

Systems and Processes

Apart from the above perspectives, overloading of information to patients, time stress, complex process of admission and discharge, increase in debtors, lack of human interface and lack of caring staff also play a vital role in making a hospital sick. Differences between medical and non-medical employees lead to lack of patient-centric values.

Non-acceptance of newer processes and refusal to change with the times surely heralds death for an organisation. Many changes are taking place in healthcare towards the implementation of quality. By not capitalising on changing trends, the hospital will lose out in the long run.

Conclusion

Healthcare is an industry where there is neither recession nor a slump in demand. Quality care, commitment, change, creativity and innovation are the mantras of today's healthcare management.

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