The Indian healthcare scenario presents a spectrum of contrasting landscapes. At one end of the spectrum are the glitzy steel and glass structures delivering high tech medicare to the well-heeled, mostly urban Indian. At the other end are the ramshackle outposts in the remote reaches of the “other India” trying desperately to live up to their identity as health subcenters, waiting to be transformed to shrines of health and wellness, a story which we will wait to see unfold. With the rapid pace of change currently being witnessed, this spectrum is likely to widen further, presenting even more complexity in the future.

1. ISSUES IN HEALTHCARE
MANAGEMENT

2. • Healthcare management essentially describes the
leadership and general management and administration
of hospitals, hospital networks, public health systems
and/or health care systems.
• It is also referred to as "Medical and health services
management", "Health systems management“,
"Healthcare systems management" or
"Health Administration".
Healthcare Management

3. HEALTH CARE SPECTRUM

4. • The Domain of Healthcare
is distinct because of the
uniqueness of their –
 product,
 people,
 Processes,
 Structure,
 Technology &
 Quality
Do we require Healthcare Managers?

5.  The variety and range of products
may include laboratory, radiology,
cardiology , surgical services. The
services must be mixed and
matched according to the specific
need
 The process seldom occurs in
standardised manner.
 Consumption of one product often
leads to another.
Products

6.  Hospital environment brings both
problems and opportunities, as it
deals with knowledge workers in
many fields (doctors, technicians,
nurses, hospital executives,
financing, marketing and material
personnel.)
 Decision made in hospital are
critical to a degree incomparable
with any other business as it deals
routinely with problems that result
in life and death.
People

7.  The healthcare process
begins with consulting the
doctor about the ailment and
can sometimes end in
invasive surgery and
intensive care in hospitals.
 Can never have a
standardized process
Process

8.  The organisational structure of a hospital is neither
pyramidal, steep, nor flat like a matrix. But is rather like a
galaxy where small spheres and clusters comprise a
whole system.
 The locus of control within the galaxy is continually
changing.
 Each time, unique teams are assembled from a different
combination of specialists, doctors, technologists and
expert nurses.
Structure

9.  The greatest medical and
technological advancements in
the history of hospital care
have happened in the past two
decades
 50% cost goes into technology
while setting up a new hospital.
 80% have a very short life
span.
 New diseases and solutions
emerge almost daily.
Technology

10.  Quality is the crux of the hospital industry.
 Providing Quality care at an affordable price for the
steady stream of customers seeking preventive health
care check ups or diagnostics or curative is a major
challenge.
Quality

11. Contemporary Issues
 The ultimate Objective of Health management is to
mold numerous departments with unique person
power, unique equipment, unique problems and
unique yet differing view points and a general lack of
finances into a smooth running machine.
 Like any other Organization, Healthcare Industry has
its own share of Management problems which can be
classified under the following heads -

12. Issues in
Health
Management
strategic
Financial
Human
Resource
Operations
Healthcare
reform
Quality
Maintenance

13. • Rapidly Changing Environment
• Data Availability
• Competition with other healthcare providers
• Problems and challenges of increasing complexity, and
decisions taken can have a profound effect on the
providers and receivers of care.
• Find a balance between providing outstanding care,
Quality expectations and reducing operating costs.
Strategic Management

15.  Concentration on core services that can be provided
well and with more efficiency
 Plans can be redundant if considered for long term
objectives
 Evaluation at regular intervals is a must
 Set realistic goals
 Provide Direction to the entire Organization
 Support and concurrence of the Board are essential
for almost every major activity

16.  It is the corner stone for successful hospital management.
Financial Management
 Although hospitals and
outpatient centers hope
to reduce illness and
improve client well-being,
these institutions are also
places of business that
must continue turning a
profit to stay open.

17.  Preparation of departmental budgets
 Consolidation
 Negotiation, Prioritization
 Decision making on essential and non essentials
 Precise statement of requirements and their utility -
essential to avoid “drifting in a sea of ambiguity”
 Make a detailed presentation to the Board and indicate a
monitoring process
BUDGETING

18.  Standard equipment surveillance
can pick up minor problems early
and easily
 A continuous process of training
in maintenance and repair
procedures is absolutely essential
 Every hospital should have a
maintenance organization
 Records of equipment and the
repair status
 Annual maintenance contracts
COST CUTTING THROUGH
MAINTENANCE

19.  Helps in cost reduction
 Assures equal quality
 Effective purchase
planning
 Good communication
among participating
hospitals
 A pre-established central
clearinghouse to facilitate
receipt and dispensing
GROUP BUYING

20.  Use of computers
 Equipment and drugs lying
un-utilized
 Fixing responsibilities
 Cost recoveries
 Forward planning
 Basis of calculations
 Storage
 Maintenance mechanisms
INVENTORY CONTROL

21.  Avoid under utilization of staff
 promoting services that are
more cost-effective, yet offer
the opportunity to provide more
and better-paying outpatient
procedures
 Plan the methods of marketing
– entry points, camps,
exhibitions, AV aids, mass
media approaches
 Using satisfied customers as
resources
 Hospital image is the most
important guiding factor
EXPANDING REVENUES

22.  Ear marking individuals to
search for assistance
program
 Staff inputs
 International, Governmental
and NGO based aid
 Running special programs to
generate revenues

23. • Access to affordable, high-quality healthcare is far from a
given for millions of people
Healthcare Reform

24. • Changes in culture of staff and their
expectations
• Shortage of qualified skilled personnel
• It is easy to get attached to facts and
figures and we eventually lose sight of
the human aspects.
• We some times place too much
emphasis on the end result no matter
how it is achieved and we inadvertently
create a human relations nightmare
Human Resource

26.  In medical facilities, there's usually one leadership
position in each specialty. Most of the time, the person
promoted into management has technical skills, but not
leadership skills.
 Because of shortage of staff, scheduling issues and
monetary considerations, leadership training isn't a
high priority. Therefore, there's a lack of true leadership
and good management, which means staff have to rely
on learned skills rather than good direction.
Leadership

27.  Finding the right people for the right job
 Effective communication techniques
 Formulation of personnel policies
 Employee involvement and empowerment
 Your motivation and enthusiasm will determine their
performance
 The “closed mind – open mouth” syndrome can have
disastrous effects on the working relationships.
 Communicate directly with your staff and make them feel
that you care for them.
 Consider innovative ideas from them - Staff, out of their
experiences, have some good ideas and adopting them
may enhance efficiency besides improving the self image
of employees and ensures their cooperation
 Gaining staff approval and support is an important
administrative action. Make efforts to sell any changes you
wish to propose.

28.  Weekly meetings
 CMEs
 Deputations for special
training
 Acquisition of new
qualifications
 Ensuring equal opportunities
to all
 Providing feed back at staff
meetings based on inputs
from various sources
IN SERVICE TRAINING

29.  Vital element is creation of a good
atmosphere in employer and
employee relations.
 Taking care of minimal needs will
avoid a crisis
 Dealing efficiently with the
intangibles of human feeling and
emotion
 Molding a system that is not
based on pay cheques.
 Loyalty is a bond, which holds an
employee to the hospital, is to be
nurtured and is an art.
HANDLING COLLECTIVE BARGAINING
AND UNION PROBLEMS

30.  Serve as an extended arm
 Acts as a field practice area
for trainees
 Aid in research
 Facilitates early diagnosis
and prompt referrals
 Enables follow up in the
community
 Linkages and liaison with the
base hospital essential
 Boosts the confidence of
patients
 May result in increase in
clientele at the hospital
COMMUNITY OUTREACH
SERVICES

31. New facilities are getting smaller,
specialized, and dispersed.
Managing limited Human
resources
Financial Constraints
Patient Satisfaction
Process flow and improvement -
reduce wait times particularly in
the emergency department
Operations

32.  improve operational efficiency –
scheduling
 employee education of cost / revenue
and process improvement
 resource tracking and management
 capital equipment location and
utilization
 consumable inventory location and
amount
 supply chain management
 de-bottlenecking
What can we do?

34.  collaborative planning, forecasting and
replenishment
 S&OP
 Reduced product variety for price
leveraging – stents

35.  Dilemma of maintaining high quality
of service while holding the cost line.
 Demanding Patients
 With an abundance of medical plan
and health care facility choices,
patients do not have to settle for
"second-best" treatment. Health care
managers must ensure they meet
patient expectations if they wish to
stay competitive in their profession.
Quality Management

36.  Litigations / Legal disputes
between patients,
insurance providers and
healthcare providers take
time and money away from
medical research and
treating patients.
 Patient safety concerns
include medical errors and
new diseases that are not
only dangerous, but can
spread easily. One of the
biggest worries is the
spread of hospital-acquired
infections among patients.

39.  standardization of processes and supply items, instead
of allowing physicians to pick and choose based on
their preferences.
 The broad shortage of nurses means that many duties
fall to untrained or inexperienced assistants, thereby
driving up the likelihood of error.
 Discrepancies in pay draw
medical students away
from certain fields and into
others, resulting in a
lopsided distribution of
doctors and a lack, or
surplus, of options for
patients.

40. Maintain Key Ethical Principles like:
Veracity – truth telling, informed
consent, respect for autonomy.
Privacy – a persons right to remain
private, to not disclose information.
Confidentiality – only sharing private
information on a ‘need to know basis’.
Fidelity – loyalty, maintaining the duty
to care for all no matter who they are
or what they may have done.
Non – maleficence – to do no harm.

41. THANK YOU!