Opportunities in Hospital and Health Care Administration Pradeep Bhardwaj
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Hospital administration is one of the most competitive and challenging career you can embark on and one of the most rewarding. Doctors as consultant, write prescriptions, diagnostic tests and perform surgery, right ? Well, who take care of Doctors, Nurses, technicians, Para medicals, Administrative staff, the patient and countless other things that go into running a successful management and administration of the hospital and providing effective health care of superior quality at low cost ?
These important tasks are responsibility of a Hospital Administrator or Health Administrator.
The Indian hospital and health care industry has the potential to become a global hub for health care services. An increasing number of global players in health care are focusing on the Indian market. The health care industry is expected to grow rapidly over the next decade to reach Rs. 4.9 trillion by 2012. The size of the Indian hospital industry is presently estimated at Rs. 2.7 trillion. This industry is growing at an annual rate of 13%. According to WHO report, India needs to add 80,000 hospital beds each year for the next five years to meet the demands of its growing population.
The private sector accounts for nearly 86% of the health care market while the public sector accounts for the rest. With over a 350 million strong middle class demanding quality health care, the Indian hospital industry is poised to grow at an even faster pace. The number of medical tourists visiting India is also increasing every year.
Corporate hospitals, which came into existence with Apollo Hospitals in the 1980s, are now being set up in almost every Indian city. Corporate groups such as Max, Fortis, Escorts, and Wockhardt 2have aggressive expansion plans. Furthermore, corporate such as the Tata Group, Birla Group, Larsen and Toubro, and Reliance have established hospitals. With the entry of corporate players into the Indian hospital industry, there has been an improvement in the infrastructure and the quality of services. Increasing life-style diseases and the rising demand for quality health care services have led to the emergence of speciality clinics.
Hospital Administrators and Managers in the Hospital and Health care industry would have to be well-versed in developing the appropriate pricing, branding, operations and promotional strategies. They would be required to understand the quality of health care delivery process and suggest improvements. They would have to have a thorough knowledge of all costs and work towards improving profitability of the health care sector.
Hospital administration is concerned with planning, organizing, staffing, coordinating, controlling and evaluating health services for the community to provide maximum patient care of superior quality at low cost. Hospital administrator is responsible for overall management of the hospital and health care services. Hospital Administrator act as a liaisons between doctors, patients, staff and health insurance companies. Administrators see that hospital operate efficiently and provide adequate medical care to patient with a human touch. Hospital administrator run the hospital on a day to day basis to render better patient care, with a prime objective of patient satisfaction.
Health management is now an area for professional managers. Health care is a sunrise sector in Indian. It is a Rs. 73,000 crore industry with great growth potentials within a decade. India's health care industry is wroth Rs. 73,000 crore i.e., roughly 4 per cent of the Gross Domestic Product (GDP). The industry is expected to grow by around 13 per cent per year by the next four year. The health care service growth involves the entire gamut of operations like health care delivery, health insurance, third party administrators, health care software, medical equipment and health education.3
According to a detailed study done by Asian Health Services, the size of the health care industry in 1999–2000 was at Rs 92,400 crore, which includes pharmaceuticals, hospitals, nursing homes, doctors, unattached labs, diagnostic centres and alternative medicine. The medical services sector lacks basic infrastructure and standardization in quality of services. Delivery of effective health care services requires training of professionals in core and specific aspects of health care management. Health services have a very elaborate and effective infrastructure in most developed countries and there is need for streamlining health facilities in India. Primary health care services include community child health care, family doctor service, essential hospital services etc. are provided essentially to the masses through State and Central Government Health Services. Through health care status of the people in India has been improving, the country has to go a long way for a establishing an optimally functional system in the wake of the growing population. Hospital Management education is expected to assume tremendous value for achieving these standards. Professional services of trained manpower is currently being used increasingly in privately run hospitals.
Hospital and health care managers or administrators have a wide range of responsibilities cover strategic planning, financial and human resource planning, maintenance of buildings, purchase and control of supplies, personnel management, etc. A few institutes offer the course only to medical graduates with experience in medicine while there are other institutions offering a postgraduate programme open to all graduates.
Health care managers and administrators oversee and direct the running of hospitals, nursing homes, and health care facilities. They are incharge for facilities, services, programmes, staff, budgets, and relations with other organization. For all these years it was the medical practitioner who handled this extra responsibility along with paramedical staff almost with out any formal training. Today the management of hospitals and health services has assumed a professional status.4
Hospital management is among the top ten millennium professions according to a recent US survey. As health care management is increasingly privatised there is a greater need for not only skillful doctors but also efficient hospital administrators. The hospital administrator plays a vital a role in saving lives, without having to take scalpel in hand. Hospital administrators manage hospitals, outpatient clinics, hospices, and drug-abuse treatment centres. Hospitals are open round the clock – 24/7 – and administrators may be called in at any hour to make decisions and resolve disputes. In large hospitals, there may be several administrators, one for each department. In smaller facilities, they oversee the day-to-day operations of all departments.
Administrators make sure hospitals operate efficiently and provide adequate medical care to patients. Their responsibilities are numerous and sometimes require the assistance of the medical and support staff. They act as liaisons between governing boards, medical staff, and department heads and integrate the activities of all departments so they function as a whole. Following policies set by a governing board of trustees, administrators plan, organize, direct, control and coordinate medical and health services. Administrators recruit, hire, and sometimes train doctors, nurses, interns, and assistant administrators. Administrators plan budgets and set rates for health services. In research hospitals, administrators develop and expand programs and services for scientific research and preventive medicine. In teaching hospitals, they aid in the education of new doctors. Administrators plan departmental activities, evaluate doctors and other hospital employees, create and maintain policies, help develop procedures for medical treatments, quality assurance, patient services, and public relations activities such as active participation in fund-raising and community health planning.
Administrators also attend staff meetings, participate in health planning councils, go to fund-raising events, and travel to professional association conventions. A hospital administrator's job is difficult and demanding. They need to keep up with advances in medicine, computerized diagnostic and treatment equipment, data processing technology, government regulations, health insurance changes, and 5financing options. While doctors strive to keep the blood flowing and the heart beating, the hospital administrator is doing his job in keeping the hospital alive and healthy.
With the medical sector becoming increasingly competitive and growing rapidly, the need for managing the health care field professionally has become even more acute. Hospital administration comprises a number of complex operations with a considerable scope for ambiguity. A through understanding of these complex operations is essential for effective and efficient policy making and optimal resource utilisation.
Hospital administrators are responsible for facilities, management of staff, equipments, and auxiliary services. They are responsible for recruitment of staff, supervision of the day to day work, maintenance and upkeep, replacement of equipment, handling budgets and making schedule for fee payments. They are involved in space allocation, preparation of roasters for duty, maintenance and repair of building and equipments, providing work facilities to employees, turnover of laundry etc.
In matters pertaining to expansion, restructuring, policy planning they work with the board of governors. They execute the decisions of the Board often undertaking the entire responsibility of large projects. The Administrator's responsibilities include financial and human resource planning, controlling the purchase and distribution of supplies, building and equipment maintenance, managing investments in infrastructure, personnel management, disposal of hospital waste, evaluating competition, organizing support services such as laundry, catering etc.
In service training schedules, community programmes and in house meetings are other important activities of hospital managers.
Health care administration is aimed at providing management skills to professionals responsible for delivery of health care services in the country. Managing primary health centres and government hospitals is the task assigned largely to doctors who may not essentially have managerial training. Nevertheless, the trends are likely to show changes in favour of professionals trained for managing health services.6
Most large and medium sized hospitals have a hospital administrator. The hospital administrator is incharge of various aspects of health care administration: Hospital organization, Planning and control, Medical Staff management, Demography and Biostatistics, Management of Research in Health care, Epidemiology and Community Health and Strategic Management in health care system.
Currently there are two kind of professionals who opt for the programme – medical professionals and other graduates. In very large hospitals generally the administrative set up has both medical and non-medical administrators. While the technical aspects such as procurement of equipments and medical expendables, recruitment and training of staff, management of professional and assignment of duties of other staff, maintenance and services, security, are looked after by graduates trained in health services management.
Administration means getting things done and Management means the purposeful and effective use of resources-manpower, materials and finance for fulfilling a pre-determined objective. Management is ultimately the art of making people more effective by using the intellectual tools of planning, organizing, directing and monitoring.
Management is a ‘SCIENCE’ because it proves, predicts, define, measure and utilizes knowledge. At the same time it is an ‘ART’ because it feels, guesses, describe, express, communicates and practices. It is also a ‘PROFESSION’ because it requires skills, knowledge and the development of a positive mental attitude.
Six M's are
  • Men
  • Money
  • Materials
  • Machinery
  • Method
  • Market
In the end, all management can be reduced to three words: People, Product and Profit, People come first.7
Management is an executive function involving the direction of human effort towards the realization of the basic objectives of the organizations.
Administration is a determinative function concerned with laying down of basic objectives and broad policies of an organizations.
Management is more popular to business enterprises where economic performance is of prime importance
It is preferred in Government departments, Hospitals and other non business organizations.
Management is a doing function concerned with of implementation policies largely done and is influenced by the objectives of organizations and is done usually at middle level management.
Administration is a thinking process concerned with determination of policies done mainly at Top Level management and is influenced by outside forces and public opinion.
Management - You order others
Administration - You order yourself
In practice both the terms are used interchangeably because both involves the same principles and functions.
Hospital Administration is a serious business since it covers a large number of activities. The profession of hospital and health care administration is unique because hospitals involve highly Qualified professionals dealing with the question of life and death. Hospital administration is more complex than administration of any other business institute/organization because:
  • Hospital involve 24 hrs., 365 day, years after years works.
  • Hospital services involve high risk and quick services.
  • Hospital deal with human beings.
  • Hospital is a medical and social institution.
  • Hospital services is of emergency nature.
  • Hospital work within the framework of Ethical and Legal issues.
  • Hospital employs different categories of people with widely varying technical and highly qualified educational background.
  • Hospital work is highly stressful since it deal with a ‘Question of life and death’.
In India, Administration and management is thousands of years old. Five thousand year ago, Lord Shri Krishna proved his decision making ability, cool approach to problems, public relation skills, intelligence, determination, dedication and counseling skills as a ‘Administrator and a Leader. The scientific management started in Late 1950 in India, when Department of Management were established in Indian Universities. This followed the establishment of Indian Institute of Management (IIM's) beginning in 1960. First time, in 1939 American College of Hospital Administration designed a code of ethics for hospitals.
Administration or Management is a science and an art like medical sciences. Professional hospital and health care administrators have proven how hospitals can be managed effectively, economically and effectively in targeted time period.
After independence, India is a rich heritage of administration. Hospital administration opened up a hoard of career opportunities, never seen before. Indian health professionals in demand not only in India but also in countries like the US, UK, Germany and Japan. About 90 per cent of the work which the medical administrator do in administration does not require medical knowledge on the other hand, people with medical background have no training in Hospital Management. This results in misutilisation of the technical manpower and inefficiency in Administration.
Today's organizations are facing their toughest competition in Decades. The answer lies in doing a better job of meeting and satisfying patient needs. Every organization wanting to win. Only patient centreed organization will win, those that can deliver superior value to their target patients.
The health care services, which are good yesterday, barely meet the requirement of today and will be inadequate tomorrow. In the age of technological revolution, customer needs are continuously 9increasing, customer expect a speedy response of their queries, there is greater competition, which demands improvement in health services.
The health care sector in India is in the middle of a high growth phase both in terms of volume and sophistication with corporatisation acting as one of the major drivers of this sector. The health care field also has growing participation by new stake holders such as the IT and Insurance sector who in themselves are rapidly growing and expanding thereby generating higher demands for trained health care administrator at all levels. In the last couple of years has fuelled the demand for young graduates and postgraduates specializing in health care administration.
Hospital administrator are in great demand, In fact, they are the most sought professionals in health care sector today. Hospitals are becoming a highly scientific and complex medical centre and are becoming hub of whole system of health care. Medical sector becoming increasingly competitive and capital intensive the need for managing hospitals has become even more acute.
In today's, world of advancing technology health care delivery represents an extremely complex collection of diagnostic, operational and administrative processes. Management skills in Planning, Operation, Marketing, Materials, Telemedicine, HIS and Human Resource Management are the need of the hour. Today, we have about 3.5 lakh health institution in India (Large, medium, small). Our health system is unique as compared to other countries - there are Government, Private, Religious, Industrials, MNC's, Allopathic, Aurveda, Homeopathy, Para medicals and Nature cure hospitals and institutions. There are newer diseases, newer diagnostic technology etc. All these factors will required trained hospital administrators. So, we are on the road to professionalise health care services.
Therefore, this is the right and exciting time to ensure an international future in the world's largest and fastest growing hospital and health care industry. Be a health care professional with a sharp Managerial and Administrative prospective.10
Business Development and Strategic Planning is responsible for leading, enhancing directing, organizing and monitoring all business development, strategic planning, marketing, public relations and business communications for Hospitals and Clinics to ensure its competitive presence in local, regional and national market places.
In collaboration with Hospital Leadership, develop, execute and evaluate strategies and tactics to ensure organization health and continued growth by identifying comprehensive, cost effective, legally compliant customer services. Activities include but are not limited to:
  • Develop Hospitals and Clinics strategic plan to include, business, marketing and communications plans with annual strategic updates.
  • Provide leadership on new technologies and clinical services to maintain competitive edge, including recommending cost-effective capital plan expenditures and developing new clinical enhancements in collaboration with physicians.
  • Provides leadership for strategic cost management and clinical pathway development including, decreased length of stay, charges, utilization and inventory management.
  • Provides matrix leadership to Service Line Directors to ensure business unit goals are aligned with strategic directions of the organization, considering legal compliance and operations issues, promote research activities that gain recognition; compile and analyze clinical and operations outcomes data; develop and execute performance improvement plans, and actively participate in the development and monitoring on quality indicators.
Contribute to the overall financial strength of the organization by participating in the development of budget plans for internal customers as required to support endeavors related to personnel, equipment and supply needs including capital, operating, marketing, planning, communications and new services. Provide leadership for pricing, responding to payers requests for proposals, and strategic cost containment concepts.
Establish and maintain effective working relationships with physician leaders to promote practice enhancement and participation in the planning, implementation and evaluation of critical services as 11defined through the strategic planning process; actively participate in physician recruitment and retention strategies; and, enhance referral to physicians through growth strategies.
Develop and execute marketing and promotional strategies that facilitate business growth, increased awareness of available services and recognition as a premier health care provider. Collaborate with Hospital Community and Public Relations to ensure synergy of service delivery and consistency in organizational messaging, when appropriate.
Attract, develop, retain and motivate a skilled, engaged, workforce focused on timely, accurate work results that are delivered in a manner reflecting service excellence. Manage budget for assigned areas of responsibility.
In collaboration with Administrative Team peers, employ system-wide thinking to establishing priorities and addressing mission critical issues, including promoting a multidisciplinary approach to achieving strategic objectives, ensuring patient and family needs are addressed, promoting excellence in customer service and satisfaction through development and implementation of information sharing mechanisms and timely communication with stakeholders.
Represents Hospital to peers in the health care industry and to the community at large as an active participant in professional associations and community activities. Actively partner with external representatives to assure Hospital's standing as a good community citizen in a manner that ensures alignment with organization interests.
  • The beggst challenge for the health care industry today is an acute shortage of trained personnel, ranging from Hospital Administrators, doctors, nurses, technicians and even health care administrators. There will be shortfall of over 350,000 Hospital Administrators by the year 2012.
  • Such challenges present an opportunity for both domestic and foreign players in the form of ‘training and education’.
  • Our analysis shows the foreign players can enter the market to take a two-fold advantage. One, they also get a piece of the booming 12education sector and two, they can source some of the talent for their own countries as human resources shortage in health care will be a global phenomenon.
  • Medical equipment forms another promising opportunity within health care. Our analysis pegs the medical equipment industry at US$ 2.17 billion (Rs 9,790 Cr) in 2006 growing at 15% per year and will reach US$ 4.97 billion (Rs 22,396 Cr) by 2012 currently over 65% of the medical equipments are imported and thus is a key area for forging partnerships across borders. Engineering excellence, cost-effective labor, increasing emphasis on intellectual property rights and most importantly a fast growing domestic market makes India an ideal manufacturing base.
  • Growth in medical infrastructure will be accompained by demand for associated products and services. One such important industry is medical textiles, which shall almost double to a US$ 753 million (Rs 1822 Cr). Medical value travel has finally come of age and is poised to grow at 22% annually.
  • With hospitals moving in for quality accreditations like JCI, NABH and ISO and tie-ups between insurance players and hospitals, this sector has the potential to be a latent growth driver. A percentage of high end beds will provide treatment to medical tourists and the estimated value of the industry will reach US$ 1.48 billion (Rs 6,678 Cr) by 2012 from its current size of US$ 450 million (Rs 2025 Cr).
As Per Analysis
  • As per analysis health insurance has the potential to show fantastic top line growth. Premiums grew 133% for private players and for the overall industry premiums grew at 47% in Q1 of 2006. The Health insurance sector will grow to US$ 3.8 billion (Rs 17,100 Cr) in collected premiums by 2012 as compared to US$ 711 millions (Rs 3,199 Cr) in 2006.
  • Clinical trials has the potential of becoming a US$ 1 billion (Rs 4,500 Cr) industry by 2010, even though the advantages of trials in India is well known, the industry needs a boost in terms of effective government policies and active interest by the government including effective utilization of established government infrastructure.
  • The Health services outsourcing sector has real potential as most of the key components needed for success are present in India. Plus India has demonstrated potential in outsourcing. As per analysis the total size of the industry in set to grow to US$ 7.4 billion (Rs 33,300 Cr) by 2012 gowing at 11% per year.
  • Analysis points towards the need for stronger partnerships in health care, between the government and private sector. Even a realistic targets of 1.85 beds per thousand population by 2012 needs an investment of US$ 77.9 billion, the government and private players neeed to focus on their core competencies/responsibilities and work together to reduce inefficiencies and complement each others effort.
Increasing private sector participation in health care services is stimulating change in India health care industry. According to an ICRA industry report on Health care India spends 5.1 per cent of its GDP on health.
The health market is estimate at Rs. 1,408 billion ($30 billion) and includes retail pharmaceutical, health care services, medical and diagnostic equipment and supplies.
While India's overall expenditure on health is comparable to most developing countries, India's per capita health care expenditure is low due its large billion-plus population and low per capita income. This scenario is not likely to improve because of rising health care costs and India's growing population (estimated to increase from 1 billion to 1.2 billion by 2012).
The government's share in the health care delivery market is 20 per cent while 80 per cent is with the private sector.
Primary Care (in rural areas):
  • 22,271 Primary health care centres
  • 137,271 Sub-centres
Secondary Care (health care centres in smaller towns and cities):
  • 1,200 PSU (Public sector units) hospitals,
  • 4,400 District hospitals,
  • 2,935 Community health care centres.
Tertiary care (hospitals):
  • 117 Medical colleges and hospitals.
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Source: Frost and Sullivan
Hospital administration is a challenging profession. The Qualities of head and heart that hospital administrator seeks:
Keen Observer
360 Degree of vision, should be able to step back and look at the bigger picture and then devise solution. Should possess ability to have both macro and micro perspective on any issue before him.
Effective Communicator
Good administrator should be able to convey the things with clarity and as simply as possible without patronizing or scaring other with the command of his vast knowledge or intellect.
Good Listener
Hospital requires a lot of patience and sympathy. At times people only need a good listener, e.g though their problems can not be solved - at times they may also realize this - but all that they need is to know that people in authority are aware of their frustrations and anxieties. He should be able to understand this.
Respect for Fact and Intellectual Honest
Administrator should not speak without facts and should have patience to find the whole truth.
Should Behave Gracefully
Administrator should never loose temper even under stress.
Transparently Honest
He should not be bluff. Truth is always more convenient in today's busy world. He should know how to say no if that is what situation demands, without hurting people as far as possible.16
Good Leader
A hospital administrator must have leadership skill. Nowadays almost all corporate are realizing the importance of leadership in the management. He should be able to influence people to act with zeal and enthusiasm to achieve the target goal. He should be able to lead people and not seek directions from them in difficulty. He should inspire confidence-encourage them to give suggestions. Take responsibility for the mistakes of your juniors if committed without motive, i.e. you should be able to know your men.
Should Not Panic
In the face of problems or difficulties, he should be able to keep cool even in scary situations. When chips are down he should be able to stand i.e. hold his ground and be counted. Should be able to cope with change effortlessly in today's ever changing environment and should not feel rattled by change. Should react proportionately to the degree of change. Change is the currency of times we are living in.
Good Judge
This is the most essential quality for any administrator, you would need it all the time.
Should be Sensitive
He should be sensitive to other's suffering and problems even if they are self inflicted or you are not able to help much.
Should be Habitually Objective
He should be habitually objective with a deep sense of fair play and justice. You should not be hesitant to give credit where it is due and share honour if the situation rightfully demands so.
Time Management
Time and tide waits for none. Once the time is lost it is lost forever. So a particular task should be completed in the allotted time frame.17
In Final Analysis
He is a nice guy who does not mind even if he finishes second and lets somebody else win if that could bring cheer to someone's life. At times a gesture is all that you can do. But remember sometimes even a gesture goes a long way.
Some other Attributes and Qualities of a Good Hospital Administrator
Ability to deal with people from diverse background is an essential quality of hospital administrators. They should hence be sympathetic, tactful and patient listeners. Problem solving is required at all times hence the ability to be a team leader with a positive approach is essential. Hospital administrators must understand organizational development, financial budgeting, material management, medical purchasing and maintenances, building regulations and above all must have good public relations skills. Interest in service, in health care and in welfare are at the core of this profession. Hospital administrators convene meetings at various levels and hence need good communication skills.
  • Hospital administrator must be diplomatic, tactful and infinitely patient.
  • He must have strong analytical and decision making abilities.
  • He must have excellent interpersonal and communication skills
  • Administrator must have good organizing capacity and must be firm but considerate while handling people.
  • He must have a sense of responsibility and take his job seriously.
  • He must be an intelligent judge of human nature which quality is essential while selecting personnel.
  • He must be expert at educating and providing direction to his subordinates.
  • He must be a man with a fine business sense so that he can secure value for money for the hospital.
  • He must be capable of working with everyone cordially, regardless of their position of status in the hospital.
  • He must have strong time management skill (Beat The Clock).
  • He must review performance and speak with power.
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Lord Ganesha
LORD GANESHA SYMBOLISM (Portrait of an administrator)
Big head
Think big and think profitable
Big ears
To listen patiently to new ideas and suggestions
Small mouth
To speak less and listen more
Small eyes
To cut off all bounds of attachment.
To pull you nearer to the highest goal.
Blessing hand
Protect spiritual path to supremacy.
Trunk high
High efficiency and adaptability.
Reward of Sadhana.
Large stomach
Pace fully digests all good and bad in life.
Desire unless under control, can cause havoc. Keep your desires under control and do not allow them to take you for a ride.
The whole world is at your feet and for your asking.
Time Bound
Remember their names
Eye contact is the key
Talk less and listen more
Write follow-up notes on a consistent basis
Be open and ask open-ended questions
Become a resource to others
Knowledge is know people and know their work
  1. Focus on the positives
  2. Discover challenges and discuss your ideas
  3. Work more flexibly
  4. Stimulate yourself by training
  5. Meet people and involve them, help them
  6. Laugh with people, not at people
  7. Prioritise your work
  8. Work towards common goals
  9. Walk and talk
  10. Think strategically
  11. Speak with power
  12. Information is the best prescription
  13. Set a road map, time line and action plan
Hospital Management Mantras: Five Vital Tips
  1. See things not as they are but how they can be:
    Inspire your people to look beyond their limitations, as these are just a figment of our imagination. We set ourselves within boundaries, based on our experiences.
  2. Work towards common goals:
    This process helps extract the best from all teams and nurture it to accomplish common missions.
  3. Walk and talk:
    People do not like to be managed, but they like to be led, the best leaders are those who create leaders rather than followers.
  4. Team spirit—A Catalyst:
    An effective leader injects his associates with a team spirit that works towards the betterment of the organisation as a whole.
  5. Freedom with responsibilities
    A responsible organization motivates its associates to be able to learn from their mistakes.
Headstart: How to stay happy at work
  • Focus on positives
  • Discover challenges
  • Work more flexibly
  • Training may help
  • Network more people
  • Inject a bit of fun
  • Gear up and socialise
  • Prioritise your work load.