Indian Healthcare System - Pure view of Customer Act - Health Care Case Study Assessment Answer

 Health Care Case Study Assessment Answer

TASK:

Case I - HOSPITAL ADMINISTRATION – ROOT OF THE PROBLEM.

Introduction of professionally qualified hospital administrators into hospitals is a need of the hour. It is now accepted that all hospitals including government hospitals need a fully qualified, experienced hospital administrator. Taking advantage of this rising requirement, ma

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ny (actually too many) institutions are today offering hospital administration courses.

With a few exceptions, most of them have neither the hospital infrastructure nor a proper faculty. Moreover they are not hospital-based, though it is inconceivable how proper hospital administration can be taught, except in hospitals. What such institutions do, is to send their students for so called “project work” to hospitals for a short period. From my own experience, this project work is a farce, and actually waste of time. What is worse, the students get a totally warped and wrong idea of hospital functioning, problems and solutions.

Moreover the chief instructor and faculty, consist of general administrators and not qualified hospital administrators. While many aspects of administration pertaining to hospitals can be dealt with by those who are not doctors, ‘Hospital’ administration can only be taught by doctors, who have a recognised post graduate qualification in hospital administration, and who have considerable experience in working and administering hospitals.

The practice of appointing senior doctors, without hospital administration qualification or experience, as hospital administrators, is bad, and is the root cause of many of the ills of the hospitals. Asking non-doctors with even a qualification in hospital administration to ‘teach’ hospital administration is worse. While a non medical microbiologist, can participate in teaching of medical graduates, he/she cannot be a professor of pathology, as the scope is wider.

So also for hospital administration, a doctor alone, can have a comprehensive insight into hospital functioning. In this connection the concept that experts in community health are automatically hospital administrators, is absurd.

We have nursing schools that are not hospital-based, which churn out nurses and grant them registration. Our experience is that, while they can mouth the theory of nursing, they are ineffective nurses, and have to be retrained in nursing. The same situation is what happens to ‘hospital’ administration. This means that many institutions, who claim to impart training in hospital administration, are misrepresenting facts, if not cheating.

Questions:

1. Outline the reasons as to why hospital administration can only be taught by doctors. Present a counter analysis to oppose this point of view.

2. On what fronts do various institutions compromise while designing hospital administration courses? What are the steps you may take to ensure wholesome teaching for the hospital administration course?

3. What do you mean by Hospital? Focus on the significance of the role played by a Hospital Administrator in a Hospital.

CASE II

INDIAN HEALTHCARE SYSTEM

India has both private health care system and a public, universal health care system. The universal health care system run by the local (state or territorial) governments. The "government hospitals", some of which are among the best hospitals in India, provide treatment at taxpayer cost. Most drugs are offered free of charge in these hospitals.

Most government hospitals do not require payment from people below poverty line, proof of citizenship or residency. Government hospitals in some parts of the country and some private non-profit (including teaching) hospitals charge a nominal fee to prevent abuse of the system. Most hospitals are operated on an annual budget allocated by the government, and do not rely on individual billing. These hospitals also provide better amenities (such as private air-conditioned rooms) if the patient can afford to pay. However, they charge less than comparable private hospitals.

The private clinics and hospitals are owned and operated by private individuals, small corporations and large hospital chain corporations. The private health care in many modernised hospitals in Indian cities are comparable to their counterparts in developed countries. However, the public health care system, except for the teaching hospitals, is often not as good or fast as the private hospitals.

Questions:

1. Discuss in detail the difference in Private Hospital and Government Hospital from the aspects of

a. Functioning

b. MIS Maintenance

c. Purview of Consumer Act

d. Speed of Service

e. Accountability towards the patient.

2. What are the types of hospitals? Critically examine the present National Health Policy and its impact on the private healthcare industry in India.

CASE III

LIFE SAVING A PRIORITY OR SECONDARY?

A day after a man bled to death from his gunshot wounds in a city hospital after being turned away from two others, hospital managements claimed Tuesday that saving lives was their top priority. Tarun Gupta, a 47-year-old retail goods trader, died Monday after being shot by three unidentified men near his home in south Delhi’s Cannought area. His son rushed him from one hospital to another but both refused to admit him, evidently for fear of being embroiled in a medico-legal case.

Gupta was finally taken to the Holy Family hospital some distance away. But it was too late and doctors declared him dead.

As newspapers readers and others reacted with shock, hospital managements said human life was paramount.

“Life saving is the foremost duty of a doctor and a hospital. In accident or medico-legal cases (MLC), all that the doctor has to do is to fill the injury sheet, which in any case is a part of the assessment of the patient,” said S. K. Sharma, chairperson of the board of management and head of the critical care unit of Sri Gangaramji hospital.

“Doctors should not be afraid of getting involved in such cases. Their priority should be to save the person’s life,” Sharma told IANS.

According to officials, the hospital gets about 125 patients a day in its casualty department. Of these, five percent are MLC cases.

Added Harpreet Singh, chief administrator of Maxima Health: “I don’t want to comment about other hospitals, but if we get a patient who needs emergency life saving treatment, we will give it to him.

“Medico-legal cases keep happening. That doesn’t stop us from saving a person’s life first and then looking into the MLC side by side.”

Authorities at the LifeCare hospital agreed and said if it was a matter of saving a life, the hospital never refused an emergency case.

According to the hospital authorities, some hospitals hesitate in taking in MLC cases immediately because of financial implications. If a patient is not accompanied by a relative, the hospital administration might hold the medical staff responsible for unpaid bills, they fear.

Questions:

1. What are the issues that influence a Doctor’s decision in accepting/rejecting any MLC and treating the patient?

2. “The psychological variables considerably influence the behavioral profile.” Discuss this statement in the context of above article.

3. Departmental relationships influence patient care. Outline the departmental relationship issues and discuss related dimensions such as conflict, insensitiveness, support of management, fear etc.

4. Discuss the process of selection and post-selection processes to be followed by a hospital manager in selecting quality people.

CASE IV

Essential for Success - Training in Hospitals

Hospitals, today, have realised the need to shed their image of a cluttered and chaotic place. More health and quality-conscious Indian customers and international patients are on the lookout for cheaper yet superior healthcare facilities, which in turn have given a new dimension to the concept of care and indirectly to the training and development scenario. "Hospitals are being compared to hotels and airlines, and the customer is more demanding and expects nothing but warm and hospitable staff," No more do patients just flock to hospitals for treatment. "To fulfill this demand, training and development has gained crucial importance,

Learning is a key to competitive advantage and training is seen as the means to achieve it. Training enables to continually work at improving services. "No organisation can choose whether or not to train, the only choice is the method. Our educational system provides us with technical knowledge and therefore it becomes imperative to provide soft skill training,"

Soft Skills: Soft skills play a vital role in hospitals to assuage emotionally distraught people who come to the hospital and expect empathy and attention. If the staff is not well trained to handle the customer tactfully, it can backfire on the image of the hospital. Some of the soft skills training programmes include self-awareness, confidence-building, inter-personnel skills, team spirit, corporate communication, behavioral management and leadership.

Leadership programmes: To hone the behavioral skills of its employees, hospitals have initiated leadership programmes for its attendants. An attendant meant to transfer patients from the OT to the ward needs to understand the importance of the process. Through training on process leadership this importance can be instilled. For a manager it is important that he achieves team work, resolve personal issues and extract performance out of his team.

"Also the in-house customer should get prompt response from various departments. All this is possible when you train your employees with regards to what to do, at what time, and how to resolve the issues, if problems arise

Internal Team-building: Training programmes are also effective platforms for internal team building. When employees from different departments of a hospital come together by dint of a training initiative, it gives them an opportunity to understand each other better. An activity-based leadership programme conducted at Mumbai’s Hinduja Hospital had executives and managers from 20 different departments come together for a quiz contest. This initiative proved instrumental for forming a bond and increasing the efficiency of the hospital.

Technical training: The technical workfront of training and development in a hospital includes aspects like evaluation of patients by technicians from ECG, Echo, TMT, X-Ray, and also anaesthesia technicians, physician assistants, cath lab technicians and nursing care professionals. In Frontier Lifeline Hospital (FLH), Chennai, all these aspects of training are provided to the newly-joined technicians and nurses by the already trained staff members.

Depending on the need and vision, Indian hospitals have moulded their training structure. At Hinduja Hospital, the HR department identifies the training needs of its employees for the calendar year, comes up with a calendar and sticks to it. Depending upon the type of programme, a decision is taken to conduct the training programme internally or to outsource it. The main parameters are the category of people who are to be trained, the subjects on which they need training and the kind of output the hospital is looking at in the end.

Max Healthcare has a full-fledged centralised training cell in the form of Max Institute of Medical Education (MIME), which takes care of all its technical training requirements. On the other hand, soft-skills and service training is handled by the HR department. "It is not the question of benefits, but what works best for an organisation. If we have resources within the company, why not utilise them? So, MIME outsources service training to its HR department vis-à-vis HR department outsources medical training to MIME, and it works for us," opines Dr Puri.

Manipal Hospital widely used the concept of 'Training the Trainer', where an internal resource is identified for this programme, who then assists the training department to conduct various training programmes.

Every employee needs training related to his aspect of the job. "We also conduct programmes in Marathi for our attendant category and try to ensure that all categories of employees undergo training," states Ankush Gupta, Manager-HR, PD Hinduja Hospital, Mumbai.

Even HoDs need behavioral training. "I should know how to deal with my customers and my first customer is my staff. Am I only limited to my technical skill or I should know the supervisory or managerial skills? All the doubts and uncertainties are addressed in training," Gupta explains.

Newer methods: However, all training programmes need not be boardroom-oriented. Hospitals have discovered that e-learning is equivalent to a virtual classroom where a professional from his own centre learns the curriculum. "We have installed Edusat for DNB candidates and tele-lectures are regularly conducted from Southampton General Hospital, UK, and also from eminent professors in the field of cardiology, cardiac surgery and anaesthesia, using tele-medicine facility," says Dr Padmanabhan. For the training purpose and awarding the qualification, the hospital has tied up with IIT (Chennai) for medical biotechnology and BITS-Pilani for physician assistant courses. Under the Management Development Programme (MDP), hospitals even send their employees to hospitals abroad for training.

Questions:

1. Training and development is a marriage between medical training and service training. Comment on this statement and critically analyze it.

2. Identify the challenges faced in running a hospital while maintaining the motivation level and competitiveness of the staff.

3. What are the different training methods employed by different hospitals. How does performance audit contribute to assessment of a training programme?

CASE V

A Day of a Patient in Hospital: Case study

Let me introduce myself. I am Mr. Sridhar, a resident of Amrita Colony; working as a class-one officer in one of the Nationalized Bank in Kerala. Last night, I have to face severe chest pain with high vomiting. Since the pain has on the left part of the chest, I decided to visit one of the hospitals near by with one of my relative. I have chosen this hospital for treatment because of the personal advice of few of my relatives. This hospital is 500-bedded multi specialty. 

The structure of the hospital is so huge and beautiful that it inspires every one who sees it from outside. Imported cars of Doctors and Staffs surrounded the hospital. Though, we feel that it is so congested and created difficulty to the patients to enter into the hospital. The front area of the hospital is crowed with patients and their relatives. The waiting area of the hospital is so small that the patients have to wait here and there, wherever they find comfortable place.  The building ventilation is not good enough to stay for long period there in the premises. More over, we observed inadequate security and attenders to control and help patient and their relatives to get avail of the service of the hospital.

I have seen one information counter in front of the hospital. But the person inside the information centre is sitting idle and no one approaches the cabin for information seeking. Since we are new to the hospital we decided to get some assistance from the information centre. We approached the information counter and enquired about consultation. The information officer asked us to go right and stay there in the queue. He didn't tell us for what purpose we have to be in queue. We have seen two rows near be the counter. When we reached the queue almost 60-70 people are standing in each row. We saw the board Registration Department in front of the counter.  Since we don't know the purpose of it, I asked one of the patient's relatives, who stayed in the queue, 'the purpose of this queue'. Instead of giving us a reply he asked a few questions. " Are you 'old cardholder' or 'new one'?" We didn't get what he meant. By understanding our face of expression he further asked us "are you the first time in hospital." Now we are clear about what he meant and replied immediately that 'yes, this is the first time.' He directed us to another queue where new cardholders are standing and asked us to register as new patient in the hospital. By giving thanks to the person we lined our self as 70-75th person in the new cardholders queue. We came to understand that this 500- bedded hospital has only a centralized registration counter and both new and old cardholders have to get the registration from the one counter. Since it is a single window process, the patient's relatives and patients have to stay in the long hours in the queue to get their name registered as new patient and get the medical record of the old patients.

While standing in the queue, we have seen lot of heated arguments between registration staff and the patient's relatives. Especially in the old cardholders queue, we heard 'Medical Record Missing' is the major issue. Though the department has installed computers it has been seen that the nursing assistants are undertaking half of the work manually. The computer entry and manual work are going together in the service area. It has created a lot of confusion among staffs of the department and they find it difficulty to search the old medical records.  We heard some of the comments of the staff members that the nursing sisters of the concerned departments might not have returned the medical charts to the registration department and because of which it is creating difficulty to find as and when it needs. We saw that the medical records are placed in haphazard manner. The medical record shelves are dusted and unclean. Proper lighting facilities are not there to identify the medical records. The nursing assistants and staff members' majority time has taken majority of their time in finding the old medical records of patients. Medical-Chart missing caused delay-in getting service from doctors.

We reached in front of the counter at about 9.30am, clearing one hour in the queue. Our relative advised us to consult only with Dr. Rajasekharan (cardiac specialist) of the same hospital, whose medical expertness is famous in the locality. We asked the registration staff to get the consultation of Dr. Rajasekharan. The staff immediately replies that Dr. Rajasekharan is overloaded with patients so that they have to consult with Dr. Radhamani (Chest Specialist). While our request continues, ignoring us, the registration staff asked the other person, who stayed back to us, to avail of the service. We embarrassed with the situation. The registration department staff asked us 'either to get the consultation of Dr. Radhamnai or leave from the queue'. Finally we compelled to take the consultation of Dr. Radhamnai, without our willingness and consent. I thought here patients don't have the right to choose any doctor they want to consult.  Though we are insulted by the incident, without making any further request or resistance, we left the queue to avail of medical service from the doctor.  We thought the service of information counter and the registration department is not patient friendly. The management is not taking care of major patient management services, which inculcate better impression feeling among them.

We don't know the exact location of the Out Patient Department (OPD) of Dr. Radhamani, Chest Specialist. There is no signboard indicating the locations for different medical services. Since we got a bitter experience from the registration department and information counter we are feared to ask any clarification from the staffs of the hospital. Looking and searching the Out Patient Department (OPD) of Dr. Radhamani, we lost around 15 minutes. Finally, one of the patients relative directed us towards the chest department, which is in the second floor of the hospital. When we reached the second floor we saw a queue of 60-70 people already waiting there to consult with Dr. Radhamani. Only a few chairs are arranged to the patients in front of the consulting room. We feel that the comforts of the patients are not in the hospitals prime agenda. Patients with severe stress also have to wait there without getting resting facilities.  One of the patient's relative, by directing us, helped to give the registration slip to the consulting room for patient's name-calling.  Here also we got very little information about the procedure to get consultation from the doctors. There is no one to assist the patients and give direction to them who are so tired. Twice I felt giddiness and suffocation while waiting for consultation.  I sent my relative outside to get some drinking water since there is no arrangement for drinking water to the patients. We waited in front of the consultation room till around 11.45am. Finally, at around 11.50 am our turn came.  Doctor made the initial enquiry to me. After hearing the case the doctor asked us to meet Dr. Rajashekharan to continue the consultation with, since he has better expertise in the area of illness. By hearing this we felt so bad about the registration department of the hospital from where we directed to a wrong consultation. We already lost half a day to get medical service.  The doctor apologizes and asked the attender to show Dr. Rajashekharan's cabin to continue the consultation. Cursing the system of the hospital we followed the attender to get the service of Dr. Rajashekharan. The consultation corridor of Dr. Rajashekharan is much crowed than Dr. Radhamani. There also we have to wait till 12.15pm to get the consultation. We detailed all the physical difficulties to the doctor. Hearing patiently, he asked us to go for an X ray of the chest. Further, he asked us to meet at 1 o clock with X ray.

Searching a lot places here and there; at last we found the X ray department. This time we didn't get annoyed, while seeing long queue of patients in front of X ray room. We waited there expecting the call. When our turn came the attender asked us the payment bill of X ray. Since we don't know the procedures, we asked the help of attender, what to do. He directed us to the cash counter, where we have to make the payment of the X ray.  Once again cursing the system, we went to pay the X ray bill. When we come back it is around 12.40pm. We waited further to take the X-ray. Around 12.50am our second chance came. After taking the X ray, the X ray technician asked us to wait another 15 minutes to get the film. We waited till 1.15 to get the X ray film. We saw empty cabin of Dr. Rajasekharan when we reached there with the X-ray film. The consultation finished at 1. O'clock. The attender asked us to come at 3.30pm for second OPD time.  We become so tired and helpless to strike back or tell anything. Thinking about the money spent and too much concerned about the illness, we decided to wait till 3.30pm the hospital premises.

We continued our stay at hospital consultation corridor. When the doctor came once again, we though our lot will be coming in the first place. But contradictory to that we came to know that there are patients who have already taken the consultation ticket in the evening hours.  We have to wait till 4.30pm to see the doctor once again. Doctor by looking at the case record and the X ray asked me to go for blood and urine test. He asked us to get the result before 7.00pm. Though, we have strong aggression towards the doctor by hearing another test, we obeyed his direction. 

Since we have a hard experience from the information counter, registration department and the X ray department we decided to pay the bill first and search the lab. We paid the bill and with the help of one of the hospital attender we found out the lab area. The area is empty when we reached there. We have given the slip and waited outside. Though there is no patient, the lab staff didn't call us for test. Curiously, we asked the lab staffs 'how long we have to wait here.' One of the staff replied that the lab staffs have gone for their coffee break and will be returning only after one hour. We thought, for a patient service institution, 'coffee break is more important that patient comfort.' Here also we have to wait till 6.00pm. When the staffs returned they took the sample of blood and urine and asked me to wait 45 minutes.  Though we informed them about the urgency in getting the result the staffs showed their helplessness by citing scientific reasons. We waited till 6.45pm to get the result.

With the result we once again come to the consultation area of Dr. Rajasekharan. There we have to wait another half an hour, even though we have consultation timing at 7.00pm. When our lot came, with tension and anxiety we have shown the test result to the doctor. By going through all the details and further physical tests he informed me that there is nothing to worry, it is not related to heart but because of 'gas formation inside stomach'. By hearing this I become so relieved from the frustration and tension of the whole day about knowing results of the disease. 

Since there is no patient out side waiting for consultation, I thought I should share with him our hard experience that we faced from different department of this hospital.  Doctor patiently heard all my complaints. After hearing all our difficulties Dr. Rajasekharan gives his personal visiting card to us and directed to come to his home clinic for private consultation in future. He told us that this hospital is not good in getting better services. For better treatment and special consideration private consultation is better. Here in this hospital, you have to face the same experience in every consultation. Hearing this remarks we become so annoyed. As an employee of the hospital the doctor is using his office premises for getting personal advantages. Instead of promoting the hospital he is thinking about personal gains from the difficulties of the patients. We paved 'good night' to the doctor and the 'hospital' and left the consultation room.

When we reached the hospital gate, a few of our relatives are waiting all along there.  With anxiety they asked us entire details. We told them that nothing to worry it only due to 'gas formation' inside the stomach.

Curiously with satire they asked us that big question, 'one day diagnose to identify the gas formation?!!!!!!! It's strange'…

Questions 1. Do you feel that the patients have the right to consult doctors in accordance with their choice? 2. How the information system affects the customer relationship? 3. What is the importance of keeping the medical records system intact in the delivery of service? 4. How the hospital management system affects effective patient management in this case? Discuss? 5. Design a hospital management system, which help in effective patient comfort and satisfaction. 6. How the business scenario of this 500-bedded hospital, can be improved with management expertness? 7. How the employees in this organisation can be motivated?

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