UNIT 1 PRESENT HOSPITAL SCENARIO: MANAGEMENT ORIENTATION

Structure 10 Objectives 1 1 lntroduct~on 1 2 Present Hosp~tal Scenarlo

I 2 1 Resources Ava~lable 1.2.2 Prcsent Status of Medical Care

1.3 The Maladies: Cause and Effect Relatibnsh~p 1 7 1 The Malad~es 1 3 2 C'au:e and Effect Reldtlonshlp 1 3 3 P~oblcnis and Constra~nts

1.4 Managenlent of Hosp~tals: Challenges and Strategies 1 4 1 Management D~mens~ons 1.4.2 Challenges and Strategies

1.5 Remedial Measures 1.6 Let Us Sum Up 1.7 Answers to Check Your Progress

1.0 OBJECTIVES

After golng thoug11 t h ~ s unlt, you should be able to:

make an assessment of the overall status of hospitals in India; 8

~den t~fy the problem aleas In hospitals;

l~s t the cause and effect relat~onship of tbe problem; and

~dentify the re~ned~al measures as a manager.

1.1 INTRODUCTION

In Block 1 of this course you have been acquainted with the overview of hospital system which dealt with evolution of hospitals, hospital organisation and its role, and the role of hospital adpinistration.

During the course of your studies you must have learnt about. the classification of hospitals, the roles of present day hospitals and the rdee played by the administration. You must have also observed that the hospitals are a higw complex social, economic and scientific

.

organisations whose main firnction is to provide comprehensive health care to the society and to act as a refenal system within the infrastructure of the hospital system in the locality or regloll.

With the increase in the awareness in the technological advancement pertaining to diagnostic and therapeutic aspects of medical care there is an increasing demand and expectation of the people for better, comprehensive and quality medical care. The question arises as to how the different types of hospitals are functioning and to what extent they are able to meet the expectations of the people? What problems and challenges the hospitals are fac~ng to provide nledical care at optimum cost and how best the challenges could be niet to provide opt~murn clilality care at optimum cost to the maximum number of people?

In 11115 unlt you a 111 ]calm about Ihe present hospital scenal.io as perceived by the

Challenges in Hospital hlanmgement

consumers of medical care. Further you will learn about the challenges perceived by the administrators. and the factors responsible for the present status of various health establishments. You will also learn about the steps required to be taken to improve the quality of care at optimum cost to the best satisfaction of people.

PRESENT HOSPITAL SCENARIO

1.2.1 Resources Available

. . While studying the evolution of nospitals in our country you have learnt that after independence in 195 1 there were 2014 hospitals with 106,478 beds in the country. The bed: population ratio was 0.30 per 1000. Subsequently more and more hospitals were created and present bed:population ratio is about 0.7 per 1000. But majority of the facilities were created in urban areas. Presently there are 15037 hospitals with almost 6.24 lakh beds, out of which 462 1 hospitals are in rural areas and 10,4 16 in urban areas (CBHI, 1996). It is clear from abo.ve that 70 per cent of the hospitals are available for 30 per cent of urban population while 70 per cent of rural population has to manage with 30 per cent of hospital facilities. The ownership status of medical institutions as on 1. I . 1996 is given below:

-* As on 1 . I .96 informat~on collected from states.

It will be seen that government owns 29.6% of the hospitals with 60.4 per cent beds. The local bodies have 3.1 per cent beds, the voluntary.and private bodies constitute 68.1 per cent of the hospital but the number of beds is 36.5 per cent only.

Ownership

Government

Local Bodies

Voluntary and Private

Total

1.2.2 Present Status of Medical Care *

Even after 50 years of independence, we find that our social sector has miserably failed to meet the peoples growing expectations for 'the services. Although there has been substantial manifold increase in the number of primary health centres, community health centres, hospitals and the hospital beds during the successive plan periods of 50 years. one still finds that all these achievements have been neutralised due to population explosion on the one hand and the increase in awareness and demand for quality care by the population on the other.

Hospitals

Voluntary and private bodies have been encouraged by the goveinment to augment the facilities. In addition, industries provide health care services to their employees individually and through employees state insurance scheme. However, 70 per cent of hospital beds provided by Government, Voluntary Organisation and Private bodies are located in urban areas. It has created regional imbalance not only in the setting of hospital services but also in the distribution and availability of trained medical manpower in the rural as well as urban areas.

Number

4473

335

10289

15097

In spite of appreciatingthe gap in demand and supply of medical care facilities the government and medical fraternity have hardly made any attempt to consolidate the gains in resources, over the years, by judicial use of existing facilities; as a result the people are disillusioned and giscontented leading to numerous complaints through press and

,' ' consumers forums of the country. .

Beds

375987

19677

228 155

6238 19*

Check Your Progress 1

1) Fill in the blanks:

a) Present bed population ratio is ................................................................... ................................................... b) 70 per cent of hospitals are available for and 30 per cent

hospital facilities are available for ................................................

2) What is the ownership status of hospital beds for government, voluntary and private bodies.

F ...................................................................................................................... i ......................................................................................................................

ci 3) What are the causes of discontentment of people in respect of medical care?

1.3 THE MALADIES: CAUSE AND EFFECT RELATIONSHIP

1.3.1 The Maladies Over the last decade there has been increasing number of press reports highlighting the deplorable state of public and private hospitals and nursing homes. Extracts of some of those are mentioqed below:

Public hospitals turn into illness factories. For millions of Indians, going to a hospital remains a nightmarish experience; big crowds, long queues, confusing maze-like layout, incomprehensible instructions, tedious procedures, casual diagnosis, rough handling by sullen staff, rude physicians, bribe-taking by touts, complete absence of accountability and unjustified delays. Such a state of affairs personify just one aspect-negligence, callousness, incompetence and lack of care-a state of crisis prevailing in the health care system of tke country. It further states that the public hospitals are themselves victims of p6licies whch give low priority to health, starve the medical system of funds, p 1 a c e . h ~ emphasis on primary health as opposed to specialized care, keep the system grossly understaffed by poorly paid junior doctors and nurses, neglect maintenance, create extreme overcrowding and ensure that the whole system goes to seed.

As regards the private hospitals and nursing homes another press report mentions in the headline, "Shrine to Mammon Private Hospitals offer no Solution". Referring to a cornrnlttee report of health experts (1992) appointed by Municipal Corporation of Gleater Bombay on city's nursing homes, the survey found the following deficiencies:

As per survey reports on nursing homes in other cities like Delhi, Calcutta, Patna, Lucknow, Bangalore the findings were generally the same with some variations. In Delhi for instance it has been reported that out of estimated 2000 private nursing homes, over 1500 are unlicensed.

The rural health infrastructure consistmg of about 2622 community health centres and -more than 22000 primary health centres (1997-98 report) also suffer from various

- maladies like, lack of suitable accommodation, inadequate staff, insufficient diagnostic and therapeutic facilities llke equipment, drug etc. In some cases laboratory, X-ray and OT facilities although available are not utilised due to lack of manpower. As a result there is constant flow of patients from periphery towards district and city hospitals.

Even in city llke Delhi the peripheral zonal hospitals are either understaffed or ill- equipped-resulting in flow of patients towards larger hospitals leaving the small hospital under utilised.

Present Hospital Scenario: Management Orientation

C ' h a l l r ~ ~ g e s i n Hospital k l a n a g r m e n t

In recent times the blood bank services came under scrutiny. A.F. Ferguson and Co.. a management consultancy firm made startling revelations in its report (1995). -Out of 101 0 blood banks then existing in the country 61 6 were unlicensed.

-One-foi-th of the blood used in various hospitals was drawn from the licensed commercial blood banks.

-The ddnors, mostly undernourished poor people, were not medically examined before bleeding. Around 4000 to 5000 regular professional donors were accepted for donation in as many as 20 cities.

-Existence of middlemen and the nexus between doctors and the blood banks was established.

-The statutory AID Surveillance centres were got in operation and up to 85% of blood collected was not screened for the HIV virus.

-Lack of storage facilities and the blood banks were in most unhygienic environment.

Majority substandard, most of them being housed in tiny flat lets (e.g. 200 sq. feet). A seventh of them in sheds or lofts in sluxhs.

77 per cent do not have scrubbing rooms.

Less than third has qualified nurses.

Some have operation theatres as small as 48 sq.feet.

Some do not disinfect the OT more than once a week, some once in 3 days.

Non incinerate infectious waste material, instead dump it in municipal bins, from where scavenger pick out needles, syringes for recycling.

Some claim to be maternity homes but only a third have labour room.

37.5 per cent of all wards and 50 per cent of beds are dirty, most are poorly lit. The heaviest costs are incurred in unneg?ssary investigations.

Large number of high priced private hospitals and nursing homes do not have intensive care units or facilities for critical care in emergencies

These press reports will give you a fair idea of the prevailing maladies in the existing system.

1.3.2 Cause and Effect Relationship

Hospital is a composite medical and social organisation providing medical care servlces while acting and interacting with several variables like task, technology, structure, people and power. These five variables are interdependent and any change in one of these variables will cause or effect change in the other variables. The 'People' is considered as the most important and vital variable in the organisation. l 3 e hosp~tal system constantly interacts with'people m the process of delivery of medical care, such as, patrents and community, medical staff, para medical and nursing staff, and the higher authorities. To appreciate the problem it is necessary to examine the roles played by the 'people' in the hospital system.

Patients

While medical care services and technology are advancing the public awareness is also increasing to generate demands for benefits of new technologies. Patient is vitally interested not only in the availability of care but in its quality and low cost as well. He demands personalised care, and free access to information concerning their illness and likely progress, and emotional support. He assumes the hospital authority is responsible for providing quality medical and nursing care, safety and comfort to the patients.

Providers of Care Present Hospital Scenario: Management Orientat ion

The hospital administration has to dreate a working environment providing suitable stmctural facilities, like building space, staff, beds, equipment, services within the reach of all categories of staff in time and space. Staff should be suitably motivated and trained, and adequate policy, rules and procedures should be available for conflict resolution, industrial harmony and well do-ordinated activities.

Organisers of Care

The owner has moral and legal responsibility to ensure that the interest of each patient is I protected and appropriate measures are taken to monitor and improve quality of care and

patlent safety. In the process he is also interested to maintain productivity by optimizing cost of care. 3 .:

1.3.3 Problems and Constraints *

After highlighting the above roles of the people in hospital system an attempt is being made to exam~ne the cause and effect relationship of the maladies prevailing at macro-level and micro-level.

Health is a State Subject

Health being a state subject, every state has its own pattern of delivery of medical care and there is no uniformity in policies and programmes. D

Hierarchy of Need

Healh has always been allotted a low priority. It occupies sixth place in the order of priority for budgetary allocation. Thus the monetary resources are and have always been a constraint in the health sector.

Health is Treated as Expenditure and Not an Investment

Unlike the Railways, Commerce or Industry where the allocation of funds is regarded as an investment because they are revenue generating sectors, the medical services are considered to be an expenditure, since no profit motive is involved. However, it should be realised that healthy people means a healthy nation. Fifty per cent of the population is devo~d of even minimum required health facilities, because of this negative approach towards health.

Lackof Intersectoral Approach

Good health of community depends upon vanous factors like basic sanitation, safe drinking water, balanced d ~ e t and health education. These require a well co-ordinated and integrated approach amongst the vasous sectors. Lack of co-ordination at various levels h q resulted in high mortality and morbidity rates in the country leading to uncontrolled situation prevailing in hospitals.

Lack of Leadership in Health Field

With the introduction of newer medical technologies in diagnostic and therapeutic services the cost of medical care has become very expensive, and has created an imbalance in demand and supply. In order to meet this challenge there is a need for dynamic leadership. ' One of the causes of malfunctioning of hospital services is the lack of appropriate leadership not only at the apex levels but also at the middle levels.

1 g ~ l . nf Norms and Standards

Countrywide public and private sector medical establishments are organised without proper

Challenges in Hospital planning considerations as there are no nationally accepted norms and standards. There is Management no uniform guidelines for construction of buildings, organisation structure, staffing,

equipping or standards for performance. Except certain hospitals in organised sectors like Railways, Defence and some newly construct corporate sector, none of the hospitals meet the modem management needs for medical care.

Philosophy of Mammon

Certain industrialists and rich people have found hospital as a profitable industry, and therefore there is mushroom growth of private hospitals, nursing homes, polyclinics in all urban and semi-urban areas. These establishment are purely profit oriented, and are not guided by any statelnational norms and standards for performance and they are thri\ ing in spite of glaring inadequacies in facilities provided by them.

Consumer Awareness

The patients and the community are generally aware that the health care is a basic human need and right. They have right to good medical care. The enlightened urban and semi urban population are also aware that medical practitioners, like other professionals, were liable under the Consumer Protection Act (CPA) 1986. This will definitely solve glaring cases of neglect and callousness. However, sirnu!taneously the community should be aware of the genuine limitations of the medical care facilities available, to avoid frivolous and vexatious complaints.

At microlevel there are many extra-mural and intra-mural factors which are directly or indirectly responsible for the maladies in the hospital system.

Extra-mural Factors

Inadequate and irrational allocation of funds

Failure of the policy of regionalisation system of medical care forcing patients to crowd in larger hospitals leaving smaller hospitals underutilised.

Political and bureaucratic apithy and at times interference in hospital management.

Absence of norms and standards and regulatory mechanism for establishment and functioning of all types of hospitals/nursing homes.

Lack of professimal training as no system of ccihpulsory training for upgradinglupdate for medical, technical and administrative staff exists.

Intra-mural Factors

Inadequate manpower, material and financial resources, leading to gap in demand and supply. Poor utilisation of resources available due to inefficient professional and administrative staff - Lack of motivation, misuse and pilferage of materials. .

Costs and financing of operation: Poor budgebry planning and control. 4 Sharing of power, unionism, conflict between administrative and medical staff. - Inefficient machinery for handling grievances, patient complains and staff conflicts.

Inadequate inservicelon the job training for technical and paramedical staff causing inefficiency and lack of involvement. Inadequate policy, rules, standing procedures; for activities, and non-existence of rewlatory mechanism

Check Your Progress 2 1) Why private hospitals and nursing homes are lab~elled as "Shrine to Mammon"?

2) Enumerate five main reasons at macro-level for poor performance of health system.

3) Enumerate five intra-mural factors for deterioration of standards of medical care.

1.4 MANAGEMENT OF HOSPITALS: CHALLENGES AND STRATEGIES

1.4.1 Management Dimensions While studying the role of administrator in the previous block you must have noted that hospital administrator is the executive leader required to manage an organised group of people from different educational background. engaged in a specific task of providing medical care in a hospital. His function demands interaction with the:

patients

medical staff

paramedical and other personnel

higher authorities

community, i.e., the dependent population who utilise the hospital, other hospitals and medical institutions in the area. the political leaders and so on.

Today the modem hospital administrator has to strike a balance between internal operational activities and outside activities. Administrators are always under pressure to keep up with changing times. They must develop new skills and apply old skills to new situations. In present situation an administrator has to give more emphasis on organisaticnal planning and development, efficient operation, cost containment, increase in productivity and marketing. To discharge these functions efficiently and effectively he needs the following :

Well motivated adequately trained manpower in a suitably structured organisation, with empowerment. Hospital system design specifications and procedures for efficient delivery of medical care services.

Budget planning. monitoi-~ng and control, towards cost containment.

Optimum utilisativn of resources to increase productivity.

Con~~nunity education on hospltal matters affecting them.

Present Hospital Scenario Management Orientat ior

education and skill when properly motivated to work with zeal and confidence can only achieve good results. The reasons for poor capacity utilisation are:

Outdated recruitment rules, specifying education and experience standards not commensurate with present day requirement.

Lack of organised on the job training and inservice training for growth and development.

Departmental policy. rules and procedures, and the duties and responsibilities for each grade are not specified resulting in overlapping of functions.

. Poor motivation due to poor managerial leadership.

Unsuitable organisation climate conflicts, no grievance procedure, lack of facilities, reward or pun~shrnent. w

C)

Therefore, there is a need for a good executive leadership to attend to personnel management for optimum capacity utilisation and to prevent frequent turnover of trained manpower.

I

1 Sharing of Power I

There are multiple line of authorities in the complex, modem hospital. A delicate balance of power exists which is frequently shifting. Authority lines can be considered as checks and balances within the organisation. Power is synonymous with exercising influence and control over a situation; it is that force when used causes a change.

Hospital governing body is responsible for monitoring the quality of care rendered in the hospital by the medical staff. The medical staff has the overall responsibility for the quality of medical care provided to patients. The hospital administrator has to ensure availability of resources required for medical care and efficient operation of different departments directly or indirectly providing medical care services. Hospital is, therefore a functional organisation with three lines of authority. The administrator should empower his subordinates through the following methods: a) Delegation of authority to take decisions b) Involven~ent of enlployees at all levels of decision making process c ) Provide resources m e n , materials, finance, system design, rules and procedures d) Provide developmental opportunities e) Trust employees

Sharing information g) Recognition and rewards h) Empowerment of teams. The need for empowerment for willing co-operation and performance of tasks cannot be over emphasized. This will help in process control and in determining causes of success or failure.

Patient Care

The quality of care refers to the degree of excellence of the medical care delivered-whether it meets or exceeds the accepted standards. However, the criteria necessarily changes with improved efficiency related to technological advancement. It is a moral as well as legal responsibility of the owner of the hospital to ensure that the interest of the patient is safeguarded and appropriate measures are taken to monitor and improve quality and patient safety at reasonable cost to the satisfaction of the patient.

The measurement of quality of service poses many problems, as it is not possible to establish accurate standards of judgement. Yet we need to have some means of evaluating the service. for, only then the efficiency of performance and in turn the community benefit, can be assessed.

The medical care service quality evaluation programme should be so designed that the adequacy of the structure, the process of medical care delivery and the impact on the beneficiaries can be assessed in quantitative and qualitative terms and correlated with cost nf carp

Present Hospital Scenario: Management Orientatio~b

C'hallenges in Hospital Xlanagemcnt

Cost and Financing Operations

In our hospitals there is a perpetual problem of scarcity of resources. The cost of manpower and material resources, and the cost of operation of facilities have increased manifold. Therefore, it is essential that all those who are engaged in hospital activities and not only in hospital management must be made responsible for reducing/controlling cost of operation of activities. Responsibility of such nature cannot be imposed, but it has to be introduced in a manner acceptable to the people.

Therefore, working out an acceptable cost containment strategy for hospitals is a problem requiring urgent attention.

Leadership and Motivation

The administration of modem hospital has become a demanding profession because of increasing complexity. There is an urgent need for high quality management of our hospitals as in any other industry. A fhlly trained hospital administrator can only ensure optimum and economic utilisation of resources, prevent underuse/overuse of facilities, standardise hospital rules and procedures, collect data for evaluation of performance. The hospital administrator should pursue the twin aims of efficiency and effectiveness.

The deficiency of trained administrators particularly for larger hospital is posing a problem in management of hospital.

Information Technology

Scientific management is recognised as the key to the success of an enterprise. By now you know that the management is the effective use of human, financial and material resources to achieve the organisational objective through the managerial functions of planning, organising, staffing, leading and controlling. Information system is the most vital for performing all managerial functions as it provides required information to each level of management, at the right time, in the rightform and the right place, so that decisions are made efficiently and effectively.

The framework of hospital information system should be so organised that there is a ;apid and regular feedback of information. A vast amount of information is available in the hospital to enable an objective assessment of the hospital service and to compare the performance of one hospital with that of another. The main problem is the collection, compilation and presentation of the basic statistical facts in a more acceptable and digestible form.

Therefore, the system of collection and presentation of "Hospital Operational Statistics" and "Hospital Morbidity Statistics" should be standardised.

Marketing of Hospital Services

Marketing has since been recognised as one of the core activities m the hospital management, particularly in private hospitals. Hospitals which concentrate on treatment of diseases are gradually under going a change to health management. Marketing should not only stop at bringing in patients but also be extended to develop a permanent image within the minds of people by building lasting relationship.

With the health insurance gaining importance and the recent proposal by the government to privatise health insurance a new challenge is faced in marketing hospital servlce.

The hospital administrator should now be familiar with health insurance policies, diseases covered, cost of adopting the scheme, reimbursement policies and attracting potential customers, and also to take care of a patient within the stipulated period and cost.

Check Your Progress 3

1) In hospital management what are the main thrust areas? .

2) Enumerate six areas where challenges are faced by administrators in effective management.

..................................................................................................... I 3) What are the factors respo~isible for poor manpower utilisation?

1.5 REMEDIAL MEASURES

The causes of malady as enumerated above are multidimensional and therefore, remedy depends on situational analysis and problem identification followed by appropriate steps for selection of best solutions out of the altemtives. However, broadly the general remedial measul-es are mentioned below:

Reduce overcrowding in district/city/refei~al hospitals by enforcing regionalisation system. Siniultaneously improve the functioning e.g. PHCs, CHCs and other small and medium size hospitals by providing adequate staff and facilities, and adequate supervision and control.

I~itroduce norms and standards for provision of resources, and for performance through strict quality control procedures to ensure accountability.

Development of all categories of staff through organised training and motivation, and provide suitable organisational structure and climate for efficient hnctioning, and prov~de inceiitives to highly skilled and efficient staff to prevent turnover.

lntroduction of information technology for hospital performance statistics which can benefit nlanagement of hospitals in periodical evaluation of activities, both professional and administrative, to ensure optimum quality and quantity of care provided at reasonable cost. Information technology can be used for cost containment programmes and comparing performance of similar hospitals.

Government should lay more emphasis on:

-people below poverty line

-rural and semi-urban population health needs

-people covered under insurance schemes

-aging population

--emegenc y care

---comprehensive therapeutic system of medicine by integrating allopathic and Indian systems of medicine at all levels.

Present Hospital Scenario: Management Or ientat io~ i

Challenges in Hospital Management Encourage private sector to establish hospitals and function under suitable regulat~on

to provide optimum care at low cost.

Appointment of trained hospital administrators, particularly for medium or large size hospitals, to act as an executive leader in management of complex modem hospitals of today.

Check Your Progress 4

How information technology can benefit management of hospitals?

1.6 LET US SUM UP

In this unit you have learnt that our hospitals all over the country present a dismal pichlse as reflected in various press reports and complaints received by consumer fo~ums and also the maladies are all pervading from PHC level to the tert~ary city hospitals. The gap between demand and supply is increasing with introduction of new technology and rising cost of medical care.

You have also learnt about the cause and effect relationship of the prevailing maladies at macro-level, micro-level and some general remedial measures.

It has been however, emphasised that the challenge has to be met by jud~cial and econon~ic use of resources, by training and motivation of staff, cost containment progranlrnes. introduction of norms and standards for resources and performance, and above all. enforcing a regulatory mechanism through conculrent performance evaluation, to ensure that failures or success is made accountable.

Present day hospital is a very complex organisation. The quality of service provided to the patient by hospital employees is the foundation of good hospital community relations. There are many constraints and challenges in the management of hospitals and in today's scenario the adrmnistrator is under tremendous pressure.

Check Your Progress 1

1) a) 0.7per 1000. b) urban areas, rural areas.

2) Government 60.4% Voluntary +Private bodies 36.5%

3) a) Growing awareness and expectations b) In equity in distribution of medical facilities c) In accessibility and rising cost of medical care

Check Your Progress 2

1) "Mammon" is known as God of reaches. Private hospitals and nursing homes are purely profit oriented.

2) a) Low priority for health

b) Consumer awareness C) Lack of inter-sectoral approach

d) Lack of leadership in health field e) Lack of norms and standards

3) a) Inadequate manpower, material and financial resources b) Poor utilisat~on of existing resources c) Poor budgetary planlilng

? d) Inadequate training e) Inadequate policy, rules, procedures.

Check Your Progress 3 1 i 1) a) Organisational planning and development I 1 b) Efficient operation

c) Cost containment d) Increase productivity

Present Hospital Scenario: Management Orientation

e) Information technology f) Marketing

I I 2) a) Organisation structure

b) Technology management c) Pahent care quality of care

I I d) Cost and financing operations.

e) Manpower utilisation f) -Marketing of hospital services

3) a) Outdated Recruitment Rules b) Lack of organised training for growth and development c) Inadequate policy, rules and procedures for efficient functioning d) Poor managerial leadership and motivation e) Unsuitable organisational climate for functioning.

Check Your Progress 4

Periodical evaluation of activities-both professional and administrative to ensure optimum quantity and quality of medical care.

Cost containment programme.

Compare performance of similar hospitals.

UNIT 2 PUBLIC RELATION AND IMAGE OF HOSPITAL

Structure 2.0 Objectives 2.1 Introduction 2.2 Concept of Public Relation 23 Principles of Public Relation in Hospitals 2.4 Public Relation Department 2.5 Patient's Expectation and Satisfaction 26 Conflicts 2.7 Let Us Sum Up 2.8 Answers to Check Your Progress

After studying this unit, you would be able to: describe the concept of public relation;

identi@ the factors affecting public relati6n;

able to set up a Public Relation Department; and

recognise the different types of conflict and describe how decisions are made or prescribe how the conflicts should be resolved in the capacity of a manager.

2.1 INTRODUCTION

You will agree that public relation is a part of every day life. The fact that you have taken up the course of hospital management or have opted for medical graduation indicates that you are going to interact with people whom you do not know, but you would like to impress them and help them. This activity is public relation.

Very often when we discuss about some successful persons, we say that Q@ is impressive and has good public relations. As a person has his own public relation, so 1s h e of an organisation which has its own public relation. In today's world of globalization and the paradigm shift of people's opinion and expectation, with the rise in competition, the role of public relation has become all the more important. In this unit you will leam the factors influencing public relations and the principles of PR in hospitals. You will also learn about the factors responsible for patient satisfaction, courses of conflict in hospitals and how to resolve them.

2.2 CONCEPT OF PUBLIC RELATION

Think about your family and try to make out who in your family is doing the job of public relation (though unconsciously) for your family. You will agree to that the best example of public relation in a family is mother who alone can maintain the mutual understanding between the father and children. It is she who maintains or conveys each other's requirements or feelings and thus helps to keep the family united. She has the full and detailed knowledge about the neighbours, their family members, from where they belong and even their likes or dislikes. Whenever a guest is to visit the family, shelonly decorates the home and serves the guest so as to create a good impression of the family. In a similar way the public relation department projects the hospital or organisation and maintains good relation with the society.