Hospital Organization (EDL 339)
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MODULE I : HEALTHCARE ORGANIZATIONS IN INDIA
While tourism is a major source of income for any country, medical tourism is a comparatively new trend. In recent times, medical tourism has become a way for several third-world countries with high-end medical facilities to provide medical services to patients from across the world. These services are usually made available at a less than 60% cost than at developed countries like the USA. India, with its huge pool of medical graduates, and the availability of world-class medical facilities in several hospitals in its important cities, is fast emerging as the destination of choice for medical tourism. The Indian Government has made several policies to encourage medical tourism, bringing in special processing of medical visas and providing hospital with incentives for taking in international patients. Taking advantage of this situation, several corporate hospitals in India have set up entire departments to deal with international patients, and provide the not only with the required treatment, but also pre and post medical care support services including visa processing, pickup from the airport, providing accommodation support, and end-to-end medical care including counseling and rehabilitation support. Several reputed hospitals have acquired in international Joint Commission International (JCI) certification which assures foreign patients of quality of the medical services. The Apollo Group of Hospitals is one of the pioneers in the area of medical tourism. The first hospital in India to receive the JCI accreditation, the Apollo Group now has six branches that have the JCI accreditation. The group has a special International Wing that takes care of medical tourists. The services provided by the Apollo hospitals to patients coming in from other nations include tele-consultation with experts for diagnosis and possible cures, video-conferences with patients where required, help in providing visa, pick up from the airport, support in providing suitable accommodation to the patient and their attendants, medical facilities and services, nursing, and counseling and rehabilitation services. They also have translators available, who can help them communicate with the doctors and attendants in the hospital. A counselor is made available, who can provide orientation to the patients and guide and help them whenever required. The Apollo group of hospitals treats more than 50000 foreign patients from 55 countries annually. Apollo Chennai also runs a Wellness Center on its premises, which offers holistic healing services such as Ayurveda, yoga, aromatherapy, meditation, pranic healing and music therapy to its international patients, as part of a special recovery package. Medical tourism in India is estimated to grow to USD 9 billion by 2020. With the high-end services provided to its international patients, Apollo is set to play a very important role in cornering a sizeable portion of the business.
Question 1: “When a person travels to a different country for medical treatment, it is called:”
Select one:
a. Tourism
b. Sight-seeing
c. Medical tourism
d. Insurance planning
Question 2
Popular treatments opted by medical tourists include:
Select one:
a. “Heart, bone and hip replacement”
b. Cosmetic surgeries
c. Skin grafting and oncology
d. All of the above
Question 3
The advantages of coming to India for medical treatment include:
Select one:
a. “Healthcare personnel well-versed in English, leading to reduced language barriers”
b. Growing compliance with international quality standards
c. Both of the above
d. None of the above
Question 4
The Apollo group is a pioneer in the area of medical tourism. Which of the following statements supports the given statement?
Select one:
a. The Apollo group of hospitals treats several international patients regularly.
b. Apollo group was the first in India to receive JCI accreditation
c. Apollo group provdes teleconsultation to patients
d. All of the above
Question 5
What aspects of treatment are covered under medical tourism packages?
Select one:
a. Pre-screening of the patients medical condition
b. Teleconference and/or video conference for consultation between patient and the specialist doctor
c. “Actual medical treatment, nursing, counselling and rehabilitation”
d. All of the above
Question 6
What steps is the Indian government taking to promote medical tourism?
Select one:
a. Providing easy ways to process visas under the category of medical tourism
b. Providing incentives to hospitals treating international patients
c. Both of the above
d. None of the above
Question 7
Why do people prefer to travel to other countries for medical treatment?
Select one:
a. The required treatment is not available in their home country
b. The available treatment is very expensive in their own coountry
c. There is a long waiting time for the start of the medical procedure required
d. All of the above
Question 8
Why does the government encourage medical tourism?
Select one:
a. It promotes the doctors and health facilities of the country throuoghout the world
b. Medical tourism brings in lots of revenues for the country
c. It helps the country improve its infrastructure
d. For the goodwill it creates
Question 9
Why is India a preferred destination for medical tourists?
Select one:
a. India has high-end medical equipment and skilled doctors available
b. The cost of medical treatments in India is much cheaper compared to the USA or UK
c. “India also provides for alternate medical treatments like Yoga, Ayurveda and pranic healing”
d. All of the above
Question 10
Why is JCI accreditation important?
Select one:
a. It is an international accreditation that assures the quality of services provided by the hospital
b. It looks good for the hospital to show international accreditation
c. It is not important. It is just an additional certificate
d. All of the above
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MODULE II : HOSPITALS AS ORGANIZATIONS
Key performance indicator (KPI) is defined as a quantifiable measure used to evaluate the success of an organization, employee, etc. in meeting objectives for performance.
The standards for any industry do not remain the same over time. As times change and demands rise, there is a subsequent rise in the healthcare needs. Due to this, the standards of patient care are pushed to a new high. KPIs in a hospital help track operational effectiveness and help understand how the hospital is performing. KPIs aid in assessing operations and setting goals within a hospital.
Some key performance indicators for a hospital are:
Staff-to-Patient Ratio: A deficit in staff directly affects the quality of patient care. A good ratio could help in better handling of patients.
Patient Wait Time: Longer wait times mean lower patient satisfaction scores. Minimizing the wait time makes patients feel well-attended to.
Average Length of Stay: Lengthy hospital stays could be due to administrative oversight or post-operative complications. A hospital should ensure that the stay of the patient is minimum besides making sure that they are not being prematurely discharged.
Occupancy: This shows the average number of patient rooms in use at one time, giving an idea of how small or how big the facility is compared to its actual demand.
Claim Processing: The time and amount being spent on processing a claim and the rate of claim denial should be considered and kept as low as possible.
Medication Errors: The number of errors in treatment, medication, dosage, etc. is to be well documented to measure the flaws in treatment procedures and their incidence.
Patient Follow-Up: This measures the follow-up done to know the patient’s improvements after his/her visit to the facility.
Trainings: This helps track the amount of training provided in each department.
Patient Satisfaction: Various tools like surveys, feedbacks, etc. are used to understand the overall patient satisfaction as it can serve as a great marketing tool for a hospital.
Media Mentions: Keeps track of how often the hospital is mentioned in the media and also whether the mention is positive or negative.
While these are the mainstream KPIs that could be used by hospitals, there are other KPIs which can be considered trying. These include – number of educational programs, number of preterm births, number of educational programs, patient confidentiality, number of partnerships with advocacy groups, childhood immunizations, etc.
All KPIs should be subject to the SMART criteria, i.e., the KPIs should have a Specific purpose, have a Measurable value, be Assignable, Realistic and have outcomes seen within a predefined Time period.
KPIs should be aimed at improving efficiency of the hospital and maintaining quality of patient care and operations. They play an important role in the performance measurement process by helping to identify and appropriately measure levels of service performance. The National Standards for Safer Better Healthcare recognizes the use of KPIs as part of the process to systematically monitor, evaluate and continuously improve the quality of care.
Question 1: KPIs should to subject to _______ criteria.
Select one:
a. SMART
b. NSSBH
c. NABI
d. HIMT
Question 2
Longer patient-wait time results in _______.
Select one:
a. Improved hospital performance
b. Reduced patient satisfaction
c. Better marketing
d. Better patient care
Question 3
Media mentions should be evaluated for what reason?
Select one:
a. To publicize on social media
b. To increase the count of mentions
c. To add them to the hospital bulletin for everyone to see
d. To keep track of what positives and negatives are being mentioned
Question 4
The KPI for claim processing should help in
Select one:
a. Increasing rate of claim denial
b. Reduce time and amount spent on claim processing
c. Not giving the discharge summary on patient s exit
d. Increase the bill amount of the patient
Question 5
What does a deficit in patient care result in?
Select one:
a. Increased hospital performance
b. Decreased pressure on staff on board
c. Increased patient care
d. Decreased patient care
Question 6
What does KPI stand for?
Select one:
a. Knowledge Process Interface
b. Key Performance Indicators
c. Knowledge Protocol Indicators
d. Knowledge Process Investigation
Question 7
What is to be done to the medication errors that take place within the hospital?
Select one:
a. Document them all
b. Oversee them
c. Repeat them
d. Blame the patient
Question 8
What should ideally be done to know the patient s improvements after his/her visit to the facility?
Select one:
a. Follow-up by hospital staff
b. Wait for patient s re-visit
c. Estimate the well-being
d. None of the above
Question 9
What should KPIs be aimed at?
Select one:
a. Reducing quality of healthcare
b. Having a deficit in staff
c. Improving efficiency
d. Increasing patient stay at the hospital
Question 10
Which one of the following recognizes KPI use to improve the quality of care?
Select one:
a. National Standards for KPI in Hospitals
b. National Performance Monitor Board
c. National Standards for Safer Better Healthcare
d. Quality Control Board
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MODULE III: ORGANIZATIONAL DESIGN
A network organization is best defined as an organization formed by intersecting and cross-cutting linkages between several separate organizations, usually connected on a project basis. One of the organizational design is networks, and it can be found in many areas of healthcare. In a study by A. Willem and P. Gemmel, they focused on two governance aspects of health care networks, i.e., governance structure (structures for collaboration) and governance mechanisms (coordination in networks), and attempt was made to search answers to questions such as:
• Which kinds of governance exist in health care networks?
• Which kind of governance is assumed to be preferable for health care networks?
To study if the three kinds of governance mechanisms can be found together or independently, a case study was done. It also focused on whether a governance structure is associated with a particular governance mechanism, and lastly whether there are effective configurations of governance structure, governance mechanisms, and network attributes. Three types of governance mechanisms are markets, hierarchy, and relational governance, and the relational model is typically associated with networks.
Relational governance refers to synchronization based on trust, reciprocity, and universal norms and values that are rooted in the relationships between the network partners. The sample consisted of 22 healthcare networks in Flanders. Most networks were of psychiatric care, disabled, the elderly or those in palliative care.
Based on the data, six out of the 22 cases were classified as effective. Qualitative data revealed that goals differ, even within a similar category of care. For instance, “Psychiatric care networks 1 and 2” were both perceived as effective, but the first network’s main objective was improving care while the second network’s was developing additional care. “Psychiatric care network 2” did not adequately reach its goals, although it was still perceived as effective. Objectives in the networks ranged from cooperation and patient referral to integrated care and establishing new services.
A balance in governance mechanisms might be preferable. Hierarchical governance mechanisms may be important for the success of healthcare networks if combined with relational and contractual governance mechanisms.
Networks can be perceived as competent despite lack of trust, or inflexibility; but some characteristics, such as low levels of legitimacy or relational governance, seem to be occurring more often among the less effective networks
In the most effective networks balanced combination of relational, contractual, and hierarchical governance was observed, but such balance was absent in seven out of 16 cases of less effective networks. It was concluded that in a complex healthcare environment, network effectiveness could be increased by a balanced combination of governance mechanisms.
Question 1: “In a complex healthcare environment, network effectiveness could be increased by: “
Select one:
a. Markets
b. Balanced combination of governance mechanisms
c. Hierarchy
d. Relational governance
Question 2
“In hospitals, which type of departmentation is common?”
Select one:
a. By Function
b. By Committee
c. By Geographical location
d. All of the above
Question 3
“Which organizational structure ensures improved coordination between the departments, flexibility and responsiveness to customer requirements?”
Select one:
a. Matrix structure
b. Functional structure
c. Divisional structure
d. None of the Above
Question 4
Relational governance refers to synchronization based on:
Select one:
a. Trust
b. Reciprocity
c. Universal norms and values
d. All of the above
Question 5
What are the basic organization designs?
Select one:
a. Bureaucratic model
b. Team model
c. Matrix model
d. All of the above
Question 6
What are the disadvantages of bureaucracy?
Select one:
a. Maladaptive
b. Rule-bound
c. Overly cautious and unproductive
d. All of the above
Question 7
What are the governance aspects of health care networks?
Select one:
a. Governance structure (structures for collaboration)
b. Governance mechanisms (coordination in networks)
c. Both of the Above
d. None of the Above
Question 8
What are the types of governance mechanisms?
Select one:
a. Markets
b. Hierarchy
c. Relational governance
d. All of the above
Question 9
What variables should be taken into consideration when planning organizational design?
Select one:
a. Degree of Environmental Stability
b. Control
c. Nature of work
d. All of the above
Question 10
Which structure minimizes or eliminates organizational boundaries?
Select one:
a. Boundaryless Organisations
b. Network Organisations
c. Both A and B
d. None of the Above
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MODULE IV : HOSPITALS AND ORGANIZATIONAL STRUCTURE
Horizontal Integration: Apollo Health had acquired Nova Specialty Hospitals and relaunched it as Apollo Spectra in 2015. Nova Specialty had a chain of 11 short-stay surgery centers spread across eight cities, and post-acquisition it added 45 modular OTs, 350 patient beds were providing inpatient and outpatient facilities. The combined turnover was estimated to be around INR 115 – 125 crore for the year ending March 2015. Apollo also introduced preventive health checks and sugar clinics in the new centers. The exclusive surgery center model minimizes hospital-acquired infections resulting in the elimination of unnecessary hospitalization and thereby leading to remarkable medical outcomes.Vertical Integration:According to Mckinsey and Company, Vertical integration is a risky strategy and is complex, expensive, and hard to reverse. It can be profitable and fruitful only if done after a careful and detailed analysis. Example of a transformative merger is the USD 69 billion deal between pharmacy giant CVS Health and insurer Aetna. CVS has 9,700 retail pharmacies and 1,100 walk-in clinics, and generated USD 177.5 billion in net revenue in 2016, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise which is a middleman between pharmaceutical manufacturers and dispensers like pharmacies. After its purchase of Aetna, the third largest health plan in the US, aims to reduce medicine prices and push for the most effective treatment choices, to achieve more competitive insurance premiums. By joining forces with CVS, Aetna can take advantage of its roughly 10,000 clinics to have a greater reach to people, while the gain of Aetna’s 22 million members would be a significant boon to CVS’ Minute Clinics. CVS/Aetna merger will also discourage new ventures coming from Amazon or other players. About 97 percent of Aetna’s shareholders and 98 percent of CVS shareholders are in favor of the merger, but the final approval is still on hold as U.S. Department of Justice wants CVS Health and Aetna to each provide detailed information.Apollo Hospitals entered in a retail pharmacy business that caters to the wellness market, along with the therapeutic medicine supplies to the patient population, also including skin care, cosmetics, beauty and other healthcare related products. Presently 2400 plus Apollo pharmacies function and Apollo is aiming at 2,000-plus pharmacy outlets in the next three to four years.
Question 1: A horizontal service-line leadership after a horizontal Integration
Select one:
a. help to avoid capital and other resource duplication
b. Improves market capture
c. promote performance improvements and achieve efficiencies
d. All of the above
Question 2
A hospital merging with a retail pharmacy is the example of:
Select one:
a. Horizontal Integration
b. Vertical Integration
c. Neither of A or B
d. Both A and B
Question 3
Hospital tie up with an Insurance company is an example of:
Select one:
a. Horizontal Integration
b. Vertical Integration
c. Neither of A or B
d. Both A and B
Question 4
Merger between CVS and Aetna is an example of
Select one:
a. Horizontal Integration
b. Vertical Integration
c. Neither of A or B
d. Both A and B
Question 5
Top companies in Health Care and Market Research — Navicure and ZirMed are merging. What type of integration is this?
Select one:
a. Horizontal Integration
b. Vertical Integration
c. Neither of A or B
d. Both A and B
Question 6
Vertical integration
Select one:
a. is easy to implement
b. is always profitable
c. Can be done without risk analysis
d. “is a risky strategy which is complex, expensive, and hard to reverse”
Question 7
What is important aspect to look into during a horizontal integration plan?
Select one:
a. Staff availability
b. Governance Structure
c. Revenue Generation
d. Location
Question 8
What is required before any merger or acquisition?
Select one:
a. Revenue Generation
b. Adequate analysis of risks
c. Personnnel
d. Stakeholders Interest
Question 9
What is the most valuable tool for achieving coordination in hospitals
Select one:
a. Structure
b. Planning
c. Personnel
d. Expertise
Question 10
Which of these is an example of horizontal Integration?
Select one:
a. A hospital merging with another hospital providing similar or more services
b. A hospital merging with a retail pharmacy
c. A Hospital opening branches in different cities
d. A hospital opening centers in different countries
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MODULE V : ORGANIZATIONAL STRUCTURE AND HOSPITAL PERFORMANCE
Various models of organizational structure exist. A matrix model is one where employees are answerable to two management structures: one, the project manager, and other, the functional manager controlling specific activities like manufacturing, finance, or marketing. Some advantages of this model are:
• Reduction in management layers
• Break down of traditional department barriers
• Clarity in tasks and goals
• Improved coordination between the departments
• Efficient use of resources
• Flexibility and responsiveness to customer requirements
• Quick decision making
However, this model is not easy to implement and can generate conflicts.
John Hunter Hospital was commissioned in January 1991 in Newcastle. Stimulated by competition and changing health environment, the hospital was planned on the model of decentralization of allied health services, mainly physiotherapy department. To cope with the external pressures and fulfill external demand, Matrix Management Model (MMM) was implemented from the inception. Rather than being employed by a physiotherapy department, physiotherapists were assigned to one of six patient care divisions (PCDs):
1. pediatrics
2. obstetrics and gynecology
3. medicine
4. surgery
5. anesthesia and intensive care, and
6. emergency medicine
Physiotherapists and other allied health staff had dual lines of reporting, one to the chairperson of the respective PCDs and other to the director of physiotherapy.
Initial benefits were enhanced team approach to patient care, increased staff satisfaction in clinical matters and improved continuity of care. But the hospital started facing issues, especially in its recruitment process. Recruitment to a position spanning two PCDs required permission from the chairman, the business managers in both PCDs and the general manager. This was a complex and time-consuming procedure, leading to recruitment delays. The problem intensified due to lack of interest by the involved administrators, and lack of recognition of the importance of the position. Missing clarity on role definition among managers of PCDs and physiotherapy and a lack of recruitment experience added to the issues.
Another concern was staff development, especially for the physiotherapists rotating between PCDs. PCDs were not ready to bear the cost of courses or conferences, especially if it was considered irrelevant to that PCD. If the physiotherapist was permanently to the particular PCD, it would take up the costs, but this was creating jealousy among staff as all PCDs were not able to afford training costs.
The complexity of service planning, quality improvement, and human resource management, the lack of authority over the budget for both salaries and wages and goods and services were some of the problems faced by the hospital. The lack of authority over the goods and services budget resulted in inefficiencies in ordering, inability to obtain required goods and didn’t allow the hospital to benefit from economies of scale. The hospital was also finding it difficult to hire a permanent Head of the Department.
In February 1995, John Hunter Hospital undertook a strategic planning process. A new division – Clinical Support Services was setup, with centralization various services into clinical departments based on professional lines of responsibility. Post restructuring, the hospital saw:
• Improved efficiency in its recruitment process
• Savings and efficient purchases due to budgetary control
• Resourceful use of time as less time was consumed by cumbersome administrative processes
• More time was spent on professional issues and clinical care
Question 1: A manager s perspective on change concentrates on
Select one:
a. Quality
b. Return on Investements
c. Employee Satisfaction
d. None of the Above
Question 2
After how many years of inception the hospital decided to restructure
Select one:
a. 4
b. 3
c. 10
d. 5
Question 3
Individual change management focuses on
Select one:
a. Employee Satisfaction
b. Return on Investements
c. Quality
d. None of the Above
Question 4
John Hunter Hospital was following which organizatinal structre at inception?
Select one:
a. Decentralized
b. Matrix
c. Both of the Above
d. Centralized
Question 5
Possible outcomes of change could be
Select one:
a. Employees resist the change
b. Valued personnel leave the organization
c. Productivity declines
d. All of the Above
Question 6
Restructuring may be done to
Select one:
a. Improve care quality
b. Increase patient turnover
c. Expand services
d. All of the Above
Question 7
The healthcare industry is currently undergoing mass-scale changes everywhere primarily because of:
Select one:
a. Rising costs of healthcare
b. Disparity in healthcare access
c. Both of the Above
d. None of the Above
Question 8
The success of the change depends on
Select one:
a. Employee Satisfaction
b. Improved Quality
c. Increased Rvenues
d. All of the Above
Question 9
This structure was in favour of physiotherapists
Select one:
a. Agree
b. Disagree
c. Partially
d. Mostly
Question 10
What were the challenges faced by the hospital
Select one:
a. Recruitment Delay
b. Ambiguity in Roles
c. Dissatisfied physiotherapists
d. All of the Above
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ASSIGNMENT 2
The North East Ambulance Service (NEAS), a Foundation Trust of the UK’s National Health Service (NHS), received NHS Foundation Trust status in 2011. Foundation Trusts were created to allow decisions to be made by local organizations and communities, free from central government control and able to decide how best to spend the Trust’s income, based on the needs of the local community. The NEAS delivers front-line services from 61 stations across 3,230 square miles. The NEAS serves a population of over 2.7 million people offering emergency response services and a patient transport service, which provides pre-planned non-emergency transport for patients travelling for outpatient appointments in the region. A hazardous area response team is trained to deal with major incidents and delivers specialist response services. The NEAS responds to over 360,000 emergency and urgent incidents each year. With over 2,000 staff, 500 vehicles, and nearly 10 million miles travelled per year, the NEAS is an essential service in UK’s North East.
In 2015, NEAS found itself facing several challenges that were impacting staff engagement.
The key challenges were 1) a 24/7 working pattern, resulting in a 168-hour week which conflicted with the day time working hours of managers, 2) less time given to team meetings as staff were not based at a dedicated site, 3) communicating with staff was challenging because they were constantly mobile, and 4) the high demand for services left staff with little time for becoming involved in staff engagement activities.
To address these issues the trust initiated several improvement measures to bring about a positive change. The range of initiatives included restructuring, changes to the management, new strategic partnerships, and a review of their values and internal culture.
To begin with, the NEAS redefined its vision and values. The mission and vision of the NEAS were articulated based on interviews with stakeholders and on staff feedback.
The NEAS also took an active decision to make improvements to staff engagement in other ways too, one of which was by restructuring its operational management teams. The trust introduced frontline managers to support ambulance crews. When ambulance crews are exposed to distressing and stressful situations, the frontline manager is available to provide guidance and relevant support services, and to offer counselling. The crew does no longer have to process and deal with difficult experiences independently.
Alongside the restructuring, the NEAS also reviewed its organizational culture. The findings identified several issues that needed to be addressed. These included a greater focus on employee welfare, improvements in policy and procedures to embed quality care and safety deeper into the culture. The staff was involved in helping to shape the new vision, mission and values. Team-building activities were improved and a leadership program focusing on building a compassionate culture was initiated. Thanks to the numerous engagement interventions, scores yielded by the annual staff survey and the staff friends and family test (FFT) improved.
Question 1: “As seen in the NEAS case, restructuring may affect:”
Select one:
a. Staff engagement
b. Staff recruitment
c. Working patterns
d. None of the above
Question 2
“Before the restructuring, the challenges facing the ambulance crew included: “
Select one:
a. Frequent team meetings
b. Less demand for services
c. A 24/7 working pattern
d. All the above
Question 3
“In a restructuring, articulating or redefining the mission and vision is the exclusive responsibility of:”
Select one:
a. Senior Manager
b. Staff
c. Operational Management Team
d. None of the above
Question 4
“In the NEAS context, which of the following can be considered a change management initiative?”
Select one:
a. Introduction of a leadership program
b. Team-building activities
c. Annual staff surveys
d. All the above
Question 5
Frontline managers have the ultimate responsibility for ensuring:
Select one:
a. The right number of ambulances are available
b. Investigating and dealing with complaints
c. The well-being of ambulance crew
d. None of the above
Question 6
The clinical care manager (CCM) role was created to:
Select one:
a. Offer counselling in distressing situations
b. To go on duty with the staff and have conversations about work
c. Offer support and guidance in stressful situation
d. None of the above
Question 7
The objective of the NEAS restructuring was:
Select one:
a. To add resources
b. To improve front-line services
c. To reduce the time spent by staff on the road
d. To enhance staff engagement
Question 8
The operational management team was restructured by:
Select one:
a. Adding new resources
b. Downsizing
c. Adding new station officers
d. Creating a new role
Question 9
Which of the following activities may be used for an effective restructuring?
Select one:
a. Proactive change management measures
b. Strategic partnerships
c. Changes in the management structure
d. Articulating a mission and vision statement
Question 10
Which of the following statements is true? Restructuring is:
Select one:
a. A strategy for dealing with organizational troubles in a real-life environment.
b. The obvious impact of troubles in an organization.
c. A reaction to increased workloads.
d. A strategy to enhance management s decision-making skills.
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