THE ROLE OF RESEARCH IN HOSPITAL MANAGEMENT

Dr. Nihal de Silva MD,MPH, ACOG (USA)

Hospital • What is a hospital? Fr. For guest. Hospitality.– A building for the reception and treatment of the old, sick,

hurt (trauma)• Hospice – a house of entertainment for strangers esp. one kept by

monks, a home of refuge. L. hospitium…a stranger, a guest.

• The earliest concept of hospital– …a place to go for medical help but usually terminal and so

associated with death. Negative image. Time of death invokes spirituality… associated with religious rituals and managed by religious people. (monks, priests, nuns)

• The early western hospitals were mostly managed by churches and even to this day carry religious names. Gives it a cozy feeling, but maybe in fact, a business devoid of any religious affiliation.

• Before politics (communication) got centralized…local autonomy, culture, religion (usually single), small scale operations, church/temple centered. Operators acted with religious conviction, no charge or minimum charge. Charity.

• Population increase…centralized politics…government..standardization..control…registration

• In parallel…new cures and medicines…. Quacks, medicine men, doctors, nurses, dedicated staff.

• Concepts of contagiousness, quality, hygiene, comfort, privacy, choice

• Changes in meaning with time.• In the present day…..building, organization…related to

practice of medicine and education• Defined by size…#of beds, level of technology,

education affiliation, medical and social research, conveniences (nursing, parking, family accommodation, comforts/luxury, access, parking, curb appeal, fashion, etc).

Research

• Research = Re ( again) + search…L. circaare. Fr. Chercher…to go about…..circus…a circle.

• Look AGAIN for NEW information.

Hospitals

1. Government/state…2. Private…religion/charity/business oriented

/Foundations3. Trusts (PPP) 4. other

1. GOVERNMENT…Public

• social policy like education , defense etc…. for the masses… aims for the basic standards and services. Cost sensitive……money from central budget. No frills service…Serious responsibility.

• Central management and planning.…..disparate distribution of services…slow introduction of new services.…chronic manpower shortages…..underfunded…...lacks curb appeal……political influences that may not be in line with the vision/mission.

• To serve the largest amount of people at the least cost with the barest (least) of essential services at an acceptable level of quality. Mostly free service or with minimal co-payment.

• Non profit…operating in the red…..no surplus to invest on improvements.

• Progress and improvement depends on budget allocation.

• Will welcome cash donations but few people will donate cash…corruption

• Most donations are in services and kind managed by “friends of the hospital etc”

• No incentives for performance or inventiveness…Good performance may be non/under appreciated…….central command. Follow commands. Job security.

• Seemingly logical ideas may not be accepted. Might be misinterpreted as pushy, bossy, curry favoring, better than thou, politically incorrect.

• In “advanced” countries, management (bureaucracy) is mostly by non physicians (MPHs, nurses, MBAs, political appointees)

• In older systems, management in mostly by physicians….poorly trained for the job. More power play and political loyalties/allegiances. Control of domain/empire/kindom.

• Changes come slow, late, usually below what is required. In the long run….always behind.

• This is called government mentality. Universal syndrome. Better in some countries mostly due to faster communication systems.

• We are forced to tolerate this…..

2. PRIVATE

a) Charity model.• Depends on donations and endowments.

Philanthropy. Loose business structure but conservatively managed. Outdated model.

• Occasional government help. But do not have to follow government rules/regulations.

• He who pays the Piper calls the tune.

• b) Community model…(municipal, city) business model tempered with some non business (humane?) principals. Religion/foundation based. Minimal profit or break even. Corporate structure. Conservatively managed but open to market conditions and shifts/trends with caution.

• c) Purely a business model. For profit……With ethical standards….. Newer, faster, better, bigger image. Corporate structure. Shareholder sensitive.

• 3. PPP – TRUST• A combination of government and private

enterprise……new rules….UK

(PRIVATE) HOSPITAL STRUCTURE …….

• Community hospital also run on similar patterns (models)

Eg. A Women’s and Children’s Hospital…..specialty hospital as opposed to a general Hospital

• CEO…Manager/President….most likely not a physician

• Administration…..Human resources…Accounting….Customer service….

• Legal department…..Privileges/Risk management….By-laws….Anti Trust legislation

• Fund raising/PR/events management…Space management/expansion…..Parking

• Accounting/Financial……Interface with insurance companies/State/Federal programs

• Quality assurance….Length of stay…….Critical pathways

• Nursing staff….. …..Quality assurance (QA)…..Length of stay….Critical pathways

• Medical staff…..various departments as shown below

• Library….Continuing Medical Education (CME)• Medical records/Statistics…Computer

systems….Health indicator stats• Dept. of Ob….Dept of Gyn….Dept of

Pediatrics/Neonatology….OPD….respective subcommittees….Tumour board

• Delivery suite…Operating theaters…..ICU …….Wards

• CPR team…code…..CME and certification• Infection control…. Surveillance within

different areas….local patterns….State/national figures

• Laboratory services….stat/routine…..blood bank/milk bank….coordination with other labs/hospitals

• Radiology/Imaging services• Pharmacy…shared purchasing…..coordination

with other pharmacies/hospitals

• Medical support services….physiotherapy, inhalation therapy, occupational therapy

• Emergency services (ER)….Patient transport services…..ambulance (subcontract)

• Central supply• Maintenance….Gardening (subcontracts)

….Waste disposal (legislated/city, municipal codes) ….Security (subcontracts)

• Housekeeping…janitorial….laundry• Dietary/Kitchen….nutritionist……dining

facilities/public interface• Credit Union• Labour union…benefits package• Volunteer

services…..Clergy/chapel….counseling….Hospice unit.

Thank You !