Beruflich Dokumente
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IMAGE OF HOSPITAL
structure
2.0
2.1
22
2.3
2.4
2.5
2.6
2.7
28
Objectives
Introduction
Concept of Public Relation
Principles of Public Relation in Hospitals
Public Relation Department
Patient's Expectationand Satisfaction
Conflicts
Let Us Sum Up
Answers to Check Your Progress
OBJECTIVES
After studying this unit, you would be able to:
describe the concept of public relation;
identify 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 mteract with people whom you do not know, but you would like to impress
them and help t h e n This activity is public relation.
Very often when we discuss about some successful persons, we say that Wis unpressive
and has good public relations. As a person has his own public relation, so 1s true of an
organisation which has its own public relation. In today's world of globalization and the
paradigm shift of people's opmion and expectation, with the rise in competition, tfie role of
public relation has become all the more important. In this unit you will learn 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.
The teim is often used iilterchailgeably with information, communication, public affairs,
propaganda, adversity. It is used as noun e.g. how is your public relations; and as a verb the situation was public relation or as a modification, it was public relation's
accomplishment.
Prof. E.J. Robinson of Boston University has described public relation as an applied social
and behavioural science. It is that function, which measures, evaluates and interprets the
attitudes of various relevant publics. The fundamental purpose of public relations' practice
is to establish a two-way flow of communication for mutual understanding, based on truth,
knowledge and full information.
Public Relation as per dictionary means presenting a good image of an organisation to the
public especially by distributing information.
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Public Relation is a combination of science and art. It uses various scientific principles and
methods to deal with the public, to use statistical and other methods to conduct survey and
to assess the opinion of individual or groups and then arrive at a particular decision. Public
relation has a close association with anthropology, psychology, sociology and economics.
Anthropology helps in studying mankind, taking into consideration their origins, beliefs,
customs, etc. For a good public relation, one must have a thorough knowledge of
psychology so that he could deal successfully while dealing with mass, as people's
behaviour is closely related to hisher psycho. If one could not feel or measure this process
of mind, particularly of a group, the situation would become chaotic and of utter confusion.
Even for motivation, one needs to understand the basic psychology. By now you are aware
that hospital is a social organisation. You will also appreciate that institutions like hospital
exists only because of society and is judged ohly by its contribution to society as viewed
by the society. Sociology the study of human interaction and interrelations, their conditions
and consequences, helps to understand the view and needs of the society and therefore
modify its policies and services in accordance to social needs. There are several factors,
which affect public relations and are being described here for your understanding.
1) Attitude
Education
The education of the public is a very important factor. The more educated a person is,
the more self-respect he would have, and he would like to be treated more as an
individual rather than a group. He would never tolerate authoritarianism. The mode of
tools to be adopted would depend veiy much upon the education of the public.
Challenges in Hospital
Management
who decide and affects the choice of hospital. Even when the patient has arrived in the
hospital, the satisfaction of patient as well as of attendants are important for good public
relation. Thus, you would appreciate that successful PR is based on scientific theory
followeL artfully.
2) The hospital services should adapt its services according to the needs of the
population it is serving. The needs of the patients could be determined by periodically
surveying patients' opinion, expectations and analysin'g them through scientific means
and accordingly tailoring the services.
3) The members of the governing body or top decision-makers should be alert, sensitive
and responsive to the needs of their clients.
4) AU hospital works should be interpreted in such a way that it appeals to the public and
are informed on logical and rational grounds.
5) These rational appeals should be given a thrust accommodating the emotional and
personal needs of the people involved.
6) The attitude should be such that criticism and rational resistance are not suppressed
nor attempts are made to overpower them. Rather they should be welcomed and
answered honestly.
9) Public relation programmes should keep in mind the vision or aim of the hospital and
also realising that it is the public who are paying the bills of the hospital and therefore
their interests should always be protected.
10) Hospital functions .should always be updated of the recent trends in public and adopt
or publish accordingly. For example if the talk of the town is about health insurance,
then the public relation department should publicize more about their policy towards
insurance rather than speak about national programmes.
Activity 1
You had been assigned to visit public sector company say NTPC and had been assigned to
make a presentation to the various categories of employees in their auditorium. Describe
what would be the information that you would like to have and how would you make the
presentation. Again your hospital is asked to make a presentation at a primary school. In
what way your presentation would be different from that you had earlier made at the said
PSU.
Working with other departmental heads -both clinical'and support, to maintain good
relation between the hospital and public and contribute to mutual understanding.
3) To conduct opinion surveys among present and former patients and thus be aware of
the current state of opinion and theifexperiences of the hospital and constantly alerting
the administrator of the outcome of such sllrveys.
4) Attending to the complaints and comments from the patients, visitors and relatives,
trying to sort out the problems, and whenever their wish cannot be met or are
unjustified, explaining the complainant the reasons thereof.
Challhnges in Hospital
\lanagement
5)
Maintaining close contact with various prominent community members who have
interest in hospital and have the capacity to alter public view.
6)
Maintaining close liaison with other hospitals particularly those who are referring the
patients. To inform them about the patients as soon as they are admitted, and keeping
good contact with community welfare organisations like Lions Club, Rotary Club, Blood
Bank etc.
7)
Maintaining close contact with peoples concerned with mass media like press, radio.
television etc. To prepare press release or announcements for the adminiseatdr or ..
spokesperson. To assist reporters by providing relevant and accurate infonhation.
8)
To make sure that all suggestions and complaints sent by post are duly acknowledged
and to send an acknowledgement letter or action taken, signed by Chief PRO or hospital
administrator.
9)
10) To supervise all the departments which are important from PR point of view, like that of
reception and enquiry, registration, OPDs during peak hours, OT waiting area, ICU
waiting area etc.
11) To arrange various meetings, conferences or workshops. To attend to visiting
dignitaries, team visits to hospital and preparing'materials to be delivered by eminent
physician or surgeon for some important public presentation.
To arrange exhibition where the main objective is to educate the public of the progress
in medical care and diagnostic methods and to motivate the people to use the updated
facilities available in the hospital. These exhibitions are tailored keeping in view the
people to whom they are addressed. For example, exhibition in an industry would stress
more on screening workers for early diagnosis of silicosis, cancer etc. and availability of
health check up facility whereas for a low socio-economic group, the stress would be
more on communicable diseases and dietary advises.
13) To arrange for pamphlets, booklets, manuals etc. for the patients. These booklets are in
general of two types:
a) Booklets to be distributed among the patients which welcomes new visitors to the
hospital preferably having an introduction by the administrator. It contains all the
relevant information, regulations specialties and diagnostic or screening facilities
available, the charges of various facilities e.g. room rents, package deals etc. and
rules/regulations of the hospital like visiting hours, meal timings etc.
b) Booklets or manuals for the in-house staff about the various procedures, job
description of staff, facilities to staff, do's and don'ts, whom to contact in particular
situations etc.
14) To publish house journals which address to all sections of staff and help create
common identity among staff members from senior most to down the line staff. It
normally includes:
a) News which are national, regional and local.
b) Feature articles by the staff member and includes medical as we'll as non-medical
articles like case studies and essays etc.
c) News related to personnel e.g on newcomers, retirements, promotions, awardees
etc.
d) Information fiommanagement to staff.
e)
f)
The house journals serve a very important role to augment coordination, and offer an
excellent opportunity to clear any doubts or stop grapevine communication. It also
serves to let off steam before it explodes.
The PRO has to make arrangements so that each and every staff members receive a
eopy of the magazineljournal. It may also be sent by post to various organisations on
panel, to patients who are frequently visiting the hospital so that they also feel a sense
of belongingness to the hospital.
1)
2)
'
You are going to publish a house journal. The introduction of the journal should start
~
:
with which one o f t l following
a) Fuh~replans of hospitals
b) Existing facilities available and staff distribution
C)
Vision/mission of the hospital
d) Recent accomplishment of the hospital
3)
You have received a suggestion by post from one of your valued patient. What would
be your immediate reaction?
Challenges in Hospital
iManagement
hospital among the patients, it was found that more than half of the patients selected that
particular hospital as per the advise of their peer groups who themselves or their relatives at
some point of time in the past, had the good experience of the hospital. Therefore, it is the
patient who creates the image of the hospital, both good and bad. It is said that a satisfied
patient would bring in ten more patients but a dissatisfied one would prevent double the
number from visiting a hospital.
Therefore, the responsibility of building up the image of the hospital falls on the satisfied
patient, which is turn, depends on their experiences when they are availing some of the
services of the hospital. The quality of experience would depend upon all the staff
members with whom hetshe had an interaction and the procedural system through which
they had to undergo while receiving medical care. However the Public Relation Department
organises and facilitates the process so as to deviate the impression in favour of the
hospital. However, the aim of everyone in the hospital is a satisfied patient. The role of
various staff members in the context of public relation and the image of the hospital are as
under:
Doctor
It is the doctor who matters the most to the patient. If the patient is satisfied w ~ t hthe
doctor, he tends to forget and forgive all the bad experiences. Traditionally medical
profession has had the image of active medical personnel and passive patient. Med~cal
professionals prefer to deal impersonally with problems rather than people because of the
prestige of the medical profession and its high esteem. In general, the role behaviour of
doctors in ward settings is divided into four types-the humanitarian, the professionals, the
bureaucrats and misfits. In an American Hospital Study, it was found that inost patients
expect kindness, understanding, sympathy, interest and encouragement from the doctors
rather than intelligence, knowledge, skill and training of the doctor.
There are three basic models of the doctor-patient relationship:
a)
Active-passive: In h s model, the doctor is active and the patient is passive, as seen in
an emergency situation, serious injuries, coma etc. The patient behaves like an infant
who is helpless and the doctor behaves like a parent. The patient cannot ask any
question and he has to abide by the doctor's wishes.
Mutual Participation: In this case the doctor helps the patient to help himself as in
chronic disorders or an ambulatory patient. The understanding and judgement of the
patient is as important as of the doctor.
Nurse
Nursing care is probably the second most important factor, if not the first for which a patient
comes to the hospital, particularly for the inpatients, and thus contributes in a major way for
better public relations in hospital. However, as against earlier days, when nurses were seen
as an angel of mercy, the image is being replaced by less angelic and considerably more
mercyfil. As in the case of doctors, with increasing technical skill and more demands, they
also have become more supervising and less sensitive to the suffering with more mechanical
approach. This shift of attitude can be demonstrated by the fact that still today, most
students enter nursing profession because of traditional concept of tender loving care to
individual patients, but over the course of their nursing education in the present system
their attitude changes. Even unionism, which was never thought of to affect the nursing
services, are nowadays very common in this profession also. A patient most often expects
affection and caring from the nurses. As discussed earlier, a person when he becomes ill,
behaves like a child and for him the nurse is like a mother or own sister. However, it is not
uncommon for the attendants of patients more often, the young males passing indecent
comments on the nurses, this may be one of the reason for the change of attitude. In a
study it was revealed that nurse patient interaction was the highest (about 60%) of total
staff patient interaction. However, about half of thepatients reported that nurses were
unkind to them. Even nurses confessed that whenever the patients or attendants annoyed
them, they used to snub them. They find disciplining patients is more easier and less time
consuming than calm discussion.
In spite of the constraints and recent trends, in a study conducted at a premier institute
revealed that more than three-fourth of patients were satisfied with the performance of the
nurses. The PR department can arrange crash courses or workshops to help the nurses
develop their interpersonal and communication skills and help them to understand how
their behaviour can affect the impression of the hospital on a patient. They should be made
to understand that it is the nurses with whom the patients most often interacts and therefore
whatever inlpresslon they gather by the nurses' response are carried away with them and
dissipated to the public.
This group encompasses all those except doctor and nurses working in the hospital. Thus,
it includes technicians, administrative personnel, ambulance drivers, nursing aides, sanitary
and engineering workers etc. Most of them, except nursing aide and sanitary workers, are
not required frequently to interact with patients.
1
However. one study found that more than half of this category of employees used harsh
urords whenever patients or his relatives did anything knowingly or unknowingly against
their wishes. Their influence usually are more on rural illiterate patients who are from
adjoining areas and who consider this group of employees to be superior to them. On the
other hand, inspite of these people's more closeness to illiterate rural people; they pay more
attention and attend to services more frequently to such patients who tipped them and
those who are urban and literate.
Sensitive Areas of a Hospital in the Perspective of Public Relations and Image of the
Hospital
i)
Reception and Enquiry Office: The central reception area is the first point of contact of
the patient with the hospital. The reputation of the hospitaI could be made or marred by
response of this important department. Persons working here should be courteous,
showing concern for the visitors and should have full knowledge of the routine
procedures of the hospital. They are to be trained to remain cool and tactfully answer
all the queries of the patient. During the peak hours additional staff may be posted and
are to be supervised personally by the Chief PRO. Every effort to be made to attend to
waiting patients and no patients should be allowed to wait for want of someone's help,
as a waiting sick patient who is confused at the central lobby of the hospital creates a
bad impression to other patients. The areas to be equipped with adequate number of
telephones sets, on line computer and have an attractive and appealing environment.
ii) Registration and Billing Counter: These are basically located in the central lobby
adjacent to Reception and Enquiry Office. The staff shol~ldbe prompt, $ourteous,
cheerful and efficient wearing the official uniform. As with other staff, they should
display their identity cards or name plates. It has been observed that the practice of
displaying the identity of the staff makes them alert of their behaviour to avoid any
complaints specific to them. It is the first point of contact for such patients who have
determined to avoid the services of the hospital and therefore to be treated in a more
cautious way?
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iii) Emergency Service Department: Public relation is very important in this department as
the patients visiting here are serious or consider themselves serious and demands
prompt attention. Other attendants, who are emotionally charged, usually accompany
them. Even a minor incidence of delay or misbehaviour could flare up the situation.
Therefore, persons manning the station should be mature enough with good organising
capability so as to initiate prompt, courteous treatment as well as explaining the
accompanying persons,
iv) Out Patient Department: OPDs are also known as the shop windows of the hospital.
More than two-third of all patients attending the hospital avail the OPD services.
About three-fourth of all admissions and investigations are through OPD. Therefore
the manner is which the services are provided goes a long way in creating the image of
the hospital. The staff posted at OPD should be courteous, prompt and disciplined and
more so punctual. Waiting in the OPD for consultation is very frequent and most hated,
but is unavoidable. Therefore mechanisms to distract them and make the waiting period
comfortable should be made like provision of good sitting arrangements, tea or coffee
vendor near the area, closed circuit TV showing interested but educating film or soft
music background. If feasible, appointment system may be incorporated. Adequate
Challenges in Hospital
Management
number of trolleys and wheelchairs with attendants are to be provided. The major
source of revenue collection depends on the OPD services, from consultation,
investigat~odor even admission. Therefore, in addition to image of hospital from the
economics point of view too, this area is very important for the hospital.
v) Other areas like lift, staircase, ICU waiting areas and the nursing couilter are also very
important from the point of view of public relation.
Activity 2
1)
You would like to start an orientation programme for the staff for better PR of hospital.
Which category of staff would you choose to begin with'?
a) Doctors
b) Nurses
c) Para medical staff
2)
What are the issues you would like to stress more upon while preparing a protocol for
patients in emergency, which would be different from ambulatory patients. ( Please
include protocols to be followed by doctors, nurses, reception and billing department
with emphasis on zero waiting time.)
Permn to Person Contact: In this case, the Chief PRO or Hospital Adrninlstrator is
acquainted to a particular reporter or person from press. Because of their long
association or they may be the patient of a renowned doctor who is also an
administrator, the press gets the information from the person at a one to one meeting
and publishes their regular columns in newspaper.
b)
Press Conference: Press conference is organised by the PR depaitment like any other
meeting. Journalists fiom different agencies are called and made comfortable to receive
some announcements followed by handouts in the form of news release. Due
preparations are needed before calling press conference. The presence of director and
concerned physician and patients is required. As journalists are very busy people, it
is always wise to give precise information and be ready for any probing question from
the journalists.
c)
Press Reception: This is very similar to social parties where after the reception and
initial refreshments, there is a brief meeting followed by final refresbents.
d) Meet the Press: As against press conference and press briefings where all the
arrangements are made by the hospital in meet the press programmes the arrangement
are made by associations like Press Clubs, and the distinguished guest from the
organisation is called on. This is usually done for some dignitary who happens to
represent the hospital for some renowned or breakthrough works.
The following is advisable for the PR person who is maintaining the relation with press:
1)
The matters, which are more of public interest and not the organisation, should be
given due regard and to be more stressed.
2)
3)
If the PRO does not want something to be quoted, helshe should avoid talking off the
record or in personal terms to the journalists. Otherwise the unwanted information may
be published without revealing the source and thus causing more damage to the image
of the hospital.
4)
Selecting the best option, taking into consideration the cost involved and the
magnitude of return.
2)
3)
4)
However, the patient is the best judge and evaluator of the service and would provide the
actual infomnlation, and about the image of the hospital as is seen by them. To obtain their
C'balleages i n Hospital
Hanagement
2.6 CONFLICTS
You will agree to that the most difficult task for a public relation department or any person in
.
the managerial capacity is to face conflict and to resolve it. However newcomers in the
managerial positions fear it most. Therefore, it is imperative for you to have $brief idea of
conflict
You will agree to that conflict is an inevitablepart of life, be it in personal life or
organisational life. At times the manager or administrator has to take decisions which may
not be favourable to all people, and the people within the organisation may stand against
the decision and create a conflict like situation. In a hospital like organisation which are
engaged with public dealings, conflicts are not infrequent.
Nature of Conflict
It is very difficult to classlfj conflict, as depending on the situation, they differ from each
other, whereas to some extent, they have certain things is common. However, there are two
extremes of the spectrum of conflict:
Now you will learn about various types of conflicts and how to resolve them.
1) Intra Personal Conflict: It is a conflict that a person has to face with himself. The
situation 1s common with everyone and one has to face it at different situations in day to
day life, e.g. when one has to make a choice between different goals or means to achieve
. the goal -ugh
different ways. Even when one has to do certain-jobs against his will,
but under some compulsion, one is in conflict with self. As the conflict is arising h m
within, the person has to solve it himself. However the best way is to discuss with
someone who is a close friend or individual with whom one can confide and trust and
then take a decision.
2) Interpersonal Conflict: It is the conflict between two individuals. When a person does
not like the other one. due to reason whatsoever may be, they are in conflict with each
other.
To resolve such conflicts, one has to identify the reason or source and has to deal with
it. There may be various sources of such conflict, some of which are as under:
a)
Different attitude, nature and style of individuals which are mismatch to each other.
b)
There may be a competition among the individuals that may be obvious or virtual.
c)
Members sharing the same goal thus prompting unhealthy competition among the
members.
An example of such type of conflict is when a Chief Medical Officer (CMO) retired
and there is a scope that one of the four Deputy CMOSwould be promoted. This
situation would lead to competition among the Dy. CMOS, and one may try to
supress other or start complaining against another to the Director.
d).
e)
Interpersonal conflicts as mentioned above are very common in any organisation and
the managers should not be too bothered about them, as they do not lead to any tense
situation and are controllable.
An opportunity to work together helps to reduce such interpersonal conflicts. Forthis it
is the responsibility of the top management with the help of public relation department to
create a team spirit among the staff members and a closely-knit environment. One of the
common source of such interpersonal conflict is the stereotyping, when people who had
been working in the organisation for a long time are resistant to the entry of a new
manager, more so, when the newcomer has some additional qualification. In such
circumstances, both the parties would try to maintain a distance from each other and
would try to evabte each other. This would prevent meaningful interaction among
them. However,' to solve such a situation an environment is created by the superior, e.g.,
giving them a task, where there is no option, but everyone has to interact with each
other, a bridge is created, and after some time it would be noticed that all are in
harmonious relation with each other. Therefore, the reader would comprehend that both
the parties who were eye to eye with each cther and were in conflict, but after they have
worked with each other and shared their view points has become friends.
3) Intergroup Conflict :These conflicts are between different groups or different
departments of the same organisation. In any organisation there are many departments
or subunits, and all of them has to work with each other in order to achieve the
organisational goal. For example in a hospital, the administrator is dependant on
clinicians and nursing staff who are a directly related for patient care. On the other hand
he has to depend on other departments also like on materials department fc# purchase of
Challenges in Hospital
Management
members of some department may be totally unaware of the job of other department,
more so, if they are distantly related. Therefore one department may have the feeling that
the other department has no work and are a parasite on the organisation. For example in
a hospital, the medical residents could never digest the fact that the accounts
department, which comprise of 8- 10 staff members are overworked. For them, the job of
account department is only to make salary statements that too once in a month.
However, they would never realize the other jobs that accounts section has to do like
preparing balance sheet, auditing etc. To combat such a situation interdepartmental
contact or exposure programmes like financial management for non-financial department
helps in promoting mutuality and collaboration. These programmes would help in
appreciating functioning of other departments.
1) Avoidance: To use all mechanisms not to face conflict by avoiding the situation or
showing indifference to the situation till the parties who were emotionally charged, cools
down, and it helps as a good escape strategy. The problem is investigated after some
time, when the strong emotion has settled down and then taking a decision. But this
avoidance strategy also sends out a wrong signal, particularly when leadership
positions are involved as they would be seen as lacking courage or not having decision
taking capability and in turn would provide an opportunity to subordinates by
perpetually creating such conflict like situation in order to weaken the leader. Moreover,
any such issue, which once is avoided, may resurface again with a more complicated
face.
2) Diffusion: The strategy involves listening to the problem, but not taking any concerete
decision, instead aims to diffuse the situation, by taking some ad hoc decision or giving
assurances, e.g., immediately comprising an expert committee or negotiation committee
to probe the matter and wait for the committee's recommendations. This strategy does
helps in avoiding the acute problem, but in turn would leave anxiety and dissatisfaction
among the staff member. Moreover the recommendations as suggested by the committee
may in future put the administratlon in a more difficult situation, particularly when the
recommendatlon could not be implemented or new issues may crop up with the
recommendation.
3) Confrontation: Confrontation involves negotiation and use of authority. The
administration develops a one-point programmes till a decision is taken and all other
issues of lesser importance are ignored or are sidelined. This strategy is applied when
the conflict has taken a large dimension and there is a likelihood of disruption of the
functioning of the organisation. The authority has to take a policy decision, or he may
have to decide in favour' of one party or even have to reprimand somebody and punish
him other party. For this the authority has to take a bold decision and no ambiguity is left
in order to solve the conflict for once and for all.
Activity 3
1) One fine morning just after you have entered your CMO office you face many of your
old staff who are agitated and are complaining of their new boss whom they are yet to
meet face to face, but has received a strict guideline from him about the guidelines to be
followed while in the department. How would you tackle the issue as a CMO?
2) There is a sudden notice of intimation of strlke from next day following an incident
when a sanitary supervisor has slapped a sanitary worker. What would be your action?
3)
b)
c)
Wait for the Chief Administrator who is out of town and is expected to arrive in the
evening, and then start negotiation.
Would carry on negotiation till evening, and let the Chief Administrator to take
decision.
Challenges i n Hospital
Management