UNIT 1 PRESENT HOSPITAL SCENARIO:

MANAGEMENT ORIENTATION
Structure
10

Objectives

11

lntroduct~on
Present Hosp~talScenarlo
I 21
Resources Ava~lable

12

1.2.2
1.3

Prcsent Status of Medical Care

The Maladies: Cause and Effect Relatibnsh~p

The Malad~es
C'au:e and Effect Reldtlonshlp
1 32
P~oblcnisand Constra~nts
1 33
Managenlent of Hosp~tals:Challenges and Strategies
1 4 1
Management D~mens~ons

17 1

1.4

1.4.2

Challenges and Strategies

1.5
1.6

Remedial Measures
Let Us Sum Up

1.7

Answers to Check Your Progress

1.0 OBJECTIVES
After golng thoug11 t h ~ unlt,
s
you should be able to:
make an assessment of the overall status of hospitals in India;
8

~ d e n t ~ the
f y problem aleas In hospitals;
l ~ sthe
t cause and effect relat~onshipof tbe problem; and
~dentifythe r e ~ n e d ~measures
al
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 r d e e 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~ngto provide nledical care at optimum cost and how best the challenges could be
niet to provide opt~murnclilality 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 i n 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:

. .

Ownership
Number

Beds

Government

4473

375987

Local Bodies

335

19677

10289

228 155

15097

6238 19*

Voluntary and Private

Total

-*

Hospitals

As on 1 . I .96 informat~oncollected 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.

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.
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.

,'

'

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.

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.

......................................................................................................................

......................................................................................................................

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
emphasis on primary health as opposed to
medical system of funds, p 1 a c e . h ~
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
cornrnltteereport 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
-morethan 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 illequipped-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 ei sn H o s p i t a l
klanagrment

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 1010 blood banks then existing in the country 616 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~talsystem 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 Orientation

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
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~nethe 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
D
there is no uniformity in policies and programmes.

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 Expenditureand 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~dof even minimum required health facilities, because of this negative approach
towards health.

Lackof IntersectoralApproach
Good health of community depends upon vanous factors like basic sanitation, safe drinking
water, balanced d ~ eand
t 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 ~ lnf
. Norms and Standards

Countrywide public and private sector medical establishmentsare organised without proper

Challenges i n Hospital
Management

planning considerations as there are no nationally accepted norms and standards. There is
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.

Philosophyof 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 facilitiesprovided 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.

Sharing of power, unionism, conflict between administrativeand 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~elledas "Shrine to Mammon"?

Present H o s p i t a l Scenario
Management Orientatior

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.

<'hallenges i n Hospital
Management

The above activities in turn will improve and maintain public image of the hospital.

1.4.2 Challenges and Strategies

Some areas in which hospital effectiveness is being questioned and the role of administrator
is under stress, include:
a)

Organisation structure

b) Technology management
c) Manpower utilisation
d) Sharing of power in decision-makmg
e) Patient care--quality management
f)

Cost and financing of operations

g). Leadership and motivation

h) Information technology
i)

Marketing of hospital services

Hospital Organisation

No two hospitals are alike-this will be reflected in the organisational structure. The ideas
and outlook of management, the type of services, and the relative skill of personnel, will all
have a bearing on the structure of the organisation.
Due to various factors in a government department the organisation structure tends to
become unrelated to the goals of the organisation and the administrators freedom to
organise is seriously curtailed. Organisation structure is expected to provide a sound
framework for management, however, the present structure is identified as a stumbling block
and it has become necessary to reorganise to achieve clarity of responsibility, and
accountability.
There is centralisation of authority, generally remote from the point where tasks are
performed. Authority is vested to a position without clear accountability. For example, the
administrators have little control over staffing, and in the selection of people who constitute
their work group.
Due to increased specialisation, changing technology, and increased expectations of
consumers and employees the hospitals require better co-ordination and organisational
adaptability. The administrator's expertise is that of an integrator structuring the
perceptions among producers, and between producers and consumers, so that change can
be effected without destroying organisational integration.
Therefore, there is a need for an organisational structure and a system for performance of
various activities, which can be regulated through process control methods.
Technology Management

Technology management is posing a great challenge to hospital management. The

continuous process of technological advancement, particularly in the field of diagnostic and
therapeutic services, often lead to conflicting situations between the health care providers
and the expectations of the community. The cost benefit analysis of technology by the
hospital management in terms of hospital size, location, morbidity status of population,
budget, mission and management of the technology in terms of quality improvement 1s
critical to the hospital's success. Hospitals desire to update technology to be competitive
among the health care organisations should always be weighed with the benefit to the
organisation and the improvement of quality of care for the community.
Manpower Utilisation

Hospital is a labour-intensive organisation. Human resources with adequate level of

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

1I

Sharing of Power
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~entof 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 i n 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?

Present Hospital Scenario:

Management Orientatio~i

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

management.

.....................................................................................................
3) What are the factors respo~isiblefor 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-esare mentioned below:
Reduce overcrowding in district/city/refei~alhospitals 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~itroducenorms 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~deinceiitives 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
-people
-aging

and semi-urban population health needs

covered under insurance schemes
population

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

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~umsand also
the maladies are all pervading from PHC level to the tert~arycity 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~cialand 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~onof existing resources

c) Poor budgetary planlilng

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

1i
I
1

Check Your Progress 3

1) a) Organisational planning and development
b) Efficient operation
c) Cost containment
d) Increase productivity
e) Information technology

I
I

f) Marketing

2) a) Organisation structure
b) Technology management
c) Pahent care quality of care

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.

Present Hospital Scenario:

Management Orientation

UNIT 2 PUBLIC RELATION AND

IMAGE OF HOSPITAL
Structure
2.0
2.1
2.2
23
2.4
2.5
26
2.7
2.8

Objectives
Introduction
Concept of Public Relation
Principles of Public Relation in Hospitals
Public Relation Department
Patient's Expectation and Satisfaction
Conflicts
Let Us Sum Up
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
influencingpublic 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.