Comparative study between Public and Private sector hospitals

Comparative Study of Human Resource practices in

Private and public sector hospitals

Final presentation

Members This is our team

Comparative Study Of Public And Private Sector Hospitals

Farah Agha

Hassan Javed

Hyder Nawaz

Shahid Nadeem

PRELUDE One of the most ancient foundations of world Significant role in every societal placement Changing role of a hospital Complexity in modern needs

Diagnostic paradigm Treatment facilities Interconnecting support services

Change in clients’ profile In response to which:

New needs and wants

In service industry importance of human efforts are patent


RESEARCH STATEMENT

“A comparative study of human resource practices used in both public and

private hospitals”


INTRODUCTION

Hospital industry in Pakistan is in its developmental phase

It has become an imperative that human side of the system also be calibrated

Reason is the introduction of new techniques, technologies and medical procedures

Study of Hospitals Management on Human Resource grounds become more necessary

It is the human resource which is responsible for running all the new systems and procedures we are deploying


TYPES OF HOSPITALS There hospital industry can be divided in four main segregations


Hospitals

Objective

Teaching-cum

research

General

Special

Ownership

Government

Semi-Govt.

Voluntary Agencies/

Charitables

Private

Path

Allopath

Ayurveda

Homeo

Unani

Others

Size

Teaching-Research

District Headquart

er

Tehsil Headquart

er

Basic Health Center

Primary Health Center

RESEARCH OBJECTIVES This research thesis would help in determining the various

constitute of the service cultures in public and private hospitals.

This research will infer the implication of the human resource concerning’ policies over the organization

This would enable us to discover the reasons that are contributing in strengthening or weakening of the hospital service structure.

It will advance public understanding of the role of the Human resource management and its vitality for efficient running of a hospital

Improve literature on Human Resource practices and it’s scope for healthcare industry.


Our research will cover the

following aspects while

exploring the human

resource department of the

hospitals in public and

private sector of Pakistan:

1. Structure/ Hierarchy

2. Management selection

process and criterion

3. Organization’s Culture,

Norms, values

4. Communication Lines

5. Policy Making


Hospitals Selected:

SCOPE OF STUDY

Government

Hospitals

General Hospital

Jinnah Hospital

Meo Hospital

Private Hospital

s

National Hospital

Doctors’ Hospital

Shaukat Khanum cancer

Hospital

LIMITATIONS A very complex system involving wide variety of variables. It is very

difficult to look into each of the variable that affects its HRMS. Due to the lack of doctors’ and staff participation we found it very

hard to convince them to fill the questionnaire, they were not ready to give much time.

Many Public hospitals were undergoing a physical structural change, because of which most of the concerned people were not available.

We cannot cover all the Hospitals of Pakistan. The research will therefore be restricted to geographic of Lahore.

All the Hospitals from Lahore also cannot be visited. So, we take three public and three private hospitals within the metropolitan boundaries of Lahore.


FINDINGS OF LITERATURE REVIEW

In subcontinent human resource effectiveness is achieved by using control HR theory rather than commitment model (Walton 1985, Arthur 1994)

Walton’s (1985) conceptual model hypothesizes that commitment work system’s outperform traditional work systems in organization

Effect of HRM is lower in highly institutionalized sectors than in a less institutionalized sector

Quantitative approaches like operations research can be used to estimate the demand for doctors, nurses and other staff in the outpatient and in-patient sections of hospital

❶Employee turn over index(ETI) ❷Employee stability index (ESI) ❸Absenteeism index(AI) ❹Accident index for frequency (AIF)


FINDINGS OF LITERATURE REVIEW (…..)

If employees are effective, their contribution to the hospital will be effective, consequently the hospital will also be effective in accomplishing its goals

Hackman & Oldham (1976) claims that if all the core dimensions exist in the job, carried out by people, they are well motivated to perform. The core dimensions of a job are:

Skill variety

Autonomy

Task identity

Feedback

Task Significance

It is understood if the first three are in the job, the person will feel their job important, valuable and worthwhile


RESEARCH METHODOLOGY

Research Type Applied form of research has been used to develop the thesis

focusing on comparing the human resource practices of public and private hospitals in Pakistan.

Data Type Primary data is used in this study. Questionnaire was designed for the

collection of primary data.

The reference period of this study is from 21st December 2009 – 02th January2010.

Complete literature review, development of study objectives, designing of questionnaire, survey and Analysis was done within this period.


RESEARCH METHODOLOGY(……..)

Sampling Technique Stratified random sampling is used.

Sample Population From all the hospitals which were selected for purpose of data

collection, a sample of 60 personnel has been taken.

10people from each hospital were asked to fill in the questionnaire.

To ensure that right information is being collected we have selected personnel having 2 – 3 years of work experience.

Among these 10 people 5 are from low line management staffs 3 people are from admin area like finance or general administration. And the remaining 2 are doctors.

Specifically, responses were collected from the doctors at administrative positions in public and private hospitalsComparative Study Of Public And Private Sector Hospitals

RESEARCH METHODOLOGY (……..)

Data Collection Tools Different tools are used for data collection as to minimize potential bias

caused by collecting data from single source. Questionnaire

Interview

Direct Observation

Questionnaire Formation The questionnaire used structured questions

Consisting of 32 questions divided into two sections ‘A’ and ‘B’

Section ‘A’ consists of two questions seeking to calculate the exact personnel knowledge about human resource functions.

Section ‘B’ will consist of 30 questions segregated into 6 parts with 5 questions in each part.


RESEARCH METHODOLOGY (……..)

Research Hypothesis If HR policy or system implementation is because of top management’s

decision then this system can be implemented any ware without discrimination

If huge Financials investment make HR implementations more easy and trouble free then HR practices shouldn’t be successful in small scale hospital management

If Patient portfolio is a very important characteristic and facilitates human resource polices implementation then no public hospital be able to implement human resources policies in its culture

If Government rules and laws are a great hurdle in implementing human resource polices then other governmental sectors would also be effected by this

If successful HR system implementation is due to qualification of doctors and related staff then in private hospitals HR policies must be implemented.


Theoretical Framework

Effective HRS is a result of the involvement of all four possible levels in hospital system

Hospital management is a teamwork effort

HRM functions effectiveness is dependent upon some particular variables

Positivity or negativity of these variables influence the HR management system to act as positive or negative i.e. efficient or In-efficient

From the top are intervening variable

Beneath the diagram are some moderating variable which support the system and facilitates the most likely positive situation to occur


Effectiveness of Human Resource System

Involvement of Top

Management/ Owners

Involvement of Doctors and Nurses

Involvement of

Administrative Staff

Involvement of Low Level Employees (sweepers)

Health Policie

s

Ethnicity

Political

Culture

Recruitment and Selection System

Work environment

Compensation and benefits

Structure and hierarchy

Appraisal System

Medicare culture sense

Collaboration

Cultural Openness

MotivationReward & Recognitio

n

ANALYSIS OF QUESTIONNAIRE

Part A


Question# 1&2

I know what is a human resource

department and what are its key

functionalities?


97%

3%

Knowledge about human Resource Department

YesNo

47%

53%

Effiency of Huam Resource Department

YesNo

Human resource department is

working efficiently in my hospital?

Question#2 detailed analysis


67%

33%

Doctors from Public Hospitals

Yes

No

100%

Doctors from Private Hospi-

tals

Yes

No

22%78%

Managers from Pub-lic Hospitals

Yes

No

67%

33%

Managers from Private Hospitals

Yes

No

100%

Low-Level Employees from Public Hospitals

Yes

No

67%

33%

Low-Level Em-ployees from Pri-

vate Hospitals

Yes

No

ANALYSIS OF QUESTIONNAIRE

Part B


Analysis

Employees from Private hospitals agreed to this notion

Whereas people from public hospital most disagreed with the statement

Lower level employees in both hospital has not been properly taken care off


17%

50%

33%

Doctors from Private Hospitals

Strongly Disagree

Disagree

Agree

Strongly Agree

67%

22%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%

LLE from Private Hos-pitals

Strongly Disagree

Disagree

Agree

Strongly Agree

100%

LLE from Public Hos-pital

Strongly Disagree

Disagree

Agree

Strongly Agree

22%

78%

Managers from Public Hospitals

Strongly Disagree

Disagree

Agree

Strongly Agree

17%

33%50%


Strongly Disagree

Disagree

Agree

Strongly Agree

Management recognizes individual efforts?

Analysis

Mixed response

Penalty system is unfair at all levels in public hospital as reported by respondents

Level of confidence will be high in private hospital doctors

Strongly disagreement from managers show that there has been some active case


Penalty system is fair and unbiased to everyone?

33%50%

17%Doctors from Private

HospitalsStrongly Disagree

Disagree

Agree

Strongly Agree

56%44%


Strongly Disagree

Disagree

Agree

Strongly Agree

29%

59%12%


Strongly Disagree

Disagree

Agree

Strongly Agree20%

60% 20%


Strongly Disagree

Disagree

Agree

Strongly Agree

78%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

50%

17% 17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

As we go along the hierarchical levels, we can see that the ratio of disagreement is increasing and it is highest when we come to lower levels of management. It means that top management is only concentration on upper levels and providing equal services to all levels


Reward system is unbiased?

67%

33%

Doctors from Private HospitalsStrongl

y Dis-agreeDis-agreeAgreeStrongly Agree

67%11%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

40%

47%13%

LLE from Private Hos-pitalsStrongly

Disagree

Disagree

Agree

Strongly Agree

27%

53% 20%


Strongly Disagree

Disagree

Agree

Strongly Agree

56%44%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

33%33%

17%

Doctors from Public HospitalsStrongly

Dis-agreeDis-agreeAgreeStrongly Agree

Analysis

As we can see, ratio of agreement towards the statement is more in doctors and managers than it is in low level employees. And if we see cross functionally it is more in the personnel working in private hospitals rather than public hospital.


Selection system is just and unbiased?

17%

50%

33%


Strongly Dis-agreeDis-agreeAgreeStrongly Agree

22%

56%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

27%

67%7%


Disagree

Disagree

Agree

Strongly Agree

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

45%

22%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

50%

17%



Analysis

In public hospitals collectively 83% of the sample population disagreed to this statement whereas in private hospitals 0% doctors said that handwork is not rewarded, on the other hand 33% of them agreed and 67% strongly agreed that hard work is rewarded

But situation is more complex when we ago along the managerial levels in private hospitals. In managerial level 22% of the sample population disagrees to the fact that their hard work is not rewarded. It means there still are loop holes on private side as well and management is not focusing on 360 degree channels.


Commitment to work is rewarded?

33%

67%



22%

56%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

7%

53%

40%


Disagree

Disagree

Agree

Strongly Agree

33%

53% 13%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

78%

11%Managers from Public


Disagree

Agree

Strongly Agree

33%

50%

17%



Analysis

Clearly private hospital is taking lead

But only doctors are fully satisfied. Lower level employees still have some proportion in disagreement

Public hospitals need to work a lot on changing its physical work environment


Freshness in work environment?

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

56%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

13%53%

33%

LLE from Private Hos-pitalsStrongly Disagree

Disagree

Agree

Strongly Agree20%

67%13%


Strongly Disagree

Disagree

Agree

Strongly Agree

89%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

50%

33%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Hosting services are only for upper managerial levels

Lower levels in both hospitals are deprived of them

A unique answer is from administration staff in public hospitals where 100% of them disagreed to the notion that they are provided with any hosting services


Availability of hosting services?

17%

50%

33%

Doctors from Private HospitalsStrongly

Disagree

Disagree

Agree

Strongly Agree

22%

33%33%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

13%

53%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

40%

60%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%

Managers from Public HospitalsStrongly

Disagree

Disagree

Agree

Strongly Agree

67%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Public hospitals have more workplace complaints than private hospitals

In lower managerial levels private hospitals’ employees also facing problems.


Work place complaints?

17%

33%50%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

22%45%

11%

Managers from Private HospitalsStrongly

Disagree

Disagree

Agree

Strongly Agree

33%40%

27%


Strongly Disagree

Disagree

Agree

Strongly Agree33%

53% 13%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

78%


Disagree

Disagree

Agree

Strongly Agree

17%

67%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Goodwill could be at stake

Public hospitals are performing badly

Complaints are also from managerial level and lower level managers from private hospitals

It implies that there could be some fish under the carpet


Policies and procedures are aligned with core values?

17%

33%

50%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

22%

56%

11%Managers from Private


Disagree

Agree

Strongly Agree

13%

27%

40%20%


Strongly Disagree

Disagree

Agree

Strongly Agree

19%25%

37% 19%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

78%

11%


Disagree

Disagree

Agree

Strongly Agree

33%

50%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Minimal in private

At peak in public

Dangerous level

Very bad for overall efficiency


Level of Ethnicity?

33%

67%


Disagree

Disagree

Agree

Strongly Agree

22%

44%

22%



Disagree

Agree

Strongly Agree

20%80%


Strongly Disagree

Disagree

Agree

Strongly Agree13%

27%

60%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%


Disagree

Disagree

Agree

Strongly Agree

17%

50%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

From both public and private sector only doctors got a chance for new knowledge

Other levels are completely ignored

Knowledge gap

Performance gap


Training and refresher courses are provided?

33%

67%


Disagree

Disagree

Agree

Strongly Agree

100%

Managers from Private HospitalsStrongly

Disagree

Disagree

Agree

Strongly Agree

20%80%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%


Disagree

Disagree

Agree

Strongly Agree

67%

33%


Disagree

Disagree

Agree

Strongly Agree

Analysis

Private hospitals’ motivate their employees at nearly all levels

Public hospitals lack that soul in their structure

Specially lower level employees in public hospitals are totally neglected


Employees are motivated by management to excel in their field?

33%

67%


Disagree

Disagree

Agree

Strongly Agree

56%11%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

40%

33%

27%


Strongly Disagree

Disagree

Agree

Strongly Agree

13%80%

7%

LLE from Public Hos-pitalStrongly Disagree

Disagree

Agree

Strongly Agree

11%

78%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

17%33%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

After doctors from both the private and public hospitals managers from both hospitals are somewhat let to get their hands on new practices and procedures

But a very minimal percentage

Could be because of their job nature


New practices and procedures are introduced?

83%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

67%

22%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

60%7%


Strongly Disagree

Disagree

Agree

Strongly Agree20%

80%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

44%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

67%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Show the monotony in employees work life

Responses from private hospitals are positive than from public


All hospitals have same culture no matter what?

100%


Disagree

Disagree

Agree

Strongly Agree

67%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

7%

27%

53%

13%LLE from Private Hos-

pitalsStrongly Disagree

Disagree

Agree

Strongly Agree

7%87%7%


Disagree

Agree

Strongly Agree

33%

56%

11%


Disagree

Disagree

Agree

Strongly Agree

50%

33%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Knowledge and experience gap can be seen

Only doctors agreed to the notion from both sides

Private hospitals’ employee response was more positive than publics’

Reason could be the knowledge environment they work in


Innovation is possible in hospitals?

67%

33%


Disagree

Disagree

Agree

Strongly Agree

78%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

27%

7%

47%

20%


Strongly Disagree

Disagree

Agree

Strongly Agree

40%

27% 33%

LLE from Public Hos-pitalStrongly

Disagree

Disagree

Agree

Strongly Agree

11%

44%

22%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

83%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Mixed response shows that favoritism is in the culture

For some policies are consistent for some not

But public hospitals are behaving poorly

Especially at lower managerial level


Management Policies are consistent?

33%

50%

17%


Disagree

Disagree

Agree

Strongly Agree

11%

22%

56%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

20%

40%20%


Strongly Disagree

Disagree

Agree

Strongly Agree27%

53%13%

7%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

33%33%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

67%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Only doctors responded positively to this notion

It means that level of autonomy is very low overall in hospital culture

Less self confidence

Delayed system response

Repeated error s could be some outcomes


Employees are involved in decision making that directly affect them?

17%

50%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

33%

44%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

47%

27%7%


Strongly Disagree

Disagree

Agree

Strongly Agree

40%

47% 13%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

67%

22%


Disagree

Disagree

Agree

Strongly Agree

17%

33%

50%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

An overall heavy disagreement

Less efficient work system

Political structure

Employee rivalry


Cross functional communication is encouraged?

33%

50%

17%


Disagree

Disagree

Agree

Strongly Agree

11%

56%

22%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

27%33%

40%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

60%

20%


Disagree

Agree

Strongly Agree

11%

78%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

67%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

For amusement part disagreement to this notion is mostly from private hospitals and specifically from managerial or lower level employees

May take long to orient with system


Job description is properly communicated?

83%

17%


Disagree

Disagree

Agree

Strongly Agree

22%

22%33%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

53%

13%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

44%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

33%

33%


Disagree

Disagree

Agree

Strongly Agree

Analysis

Negative responses from public hospital

Even from doctors side


Proper orientation is given to employees?

13%

27%

40%20%


Strongly Disagree

Disagree

Agree

Strongly Agree

27%

40%33%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

20%60%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

33%22%

22%


Disagree

Disagree

Agree

Strongly Agree

11%

78%



Disagree

Agree

Strongly Agree

33%

33%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Ideas are only accepted by doctors

Managers and low level employees are left over

Stagnant environment

Low morale


New Ideas are welcome and accepted?

17%

83%


Strongly Disagree

Disagree

Agree

Strongly Agree

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

47%

53%


Strongly Disagree

Disagree

Agree

Strongly Agree

53%

47%


Disagree

Disagree

Agree

Strongly Agree

100%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

33%

50%


Disagree

Disagree

Agree

Strongly Agree

Analysis

Only at lower levels in public hospitals

Upper two levels are let go off

Private hospitals response is overall positive

In doctors area 17% of them strongly agreed which means that there could be a separate policy for doctors in one of private hospitals regarding work assignment


Work is properly assigned and checked?

17%

67%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

78%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

7%

53%

40%


Strongly Disagree

Disagree

Agree

Strongly Agree

7%20%

40%33%


Disagree

Disagree

Agree

Strongly Agree

67%

22%

11%


Disagree

Disagree

Agree

Strongly Agree

17%

50%

33%


Disagree

Disagree

Agree

Strongly Agree

Analysis

Doctors from private hospitals mostly denied this fact but other two level responded positively to the notion

It means that there is a loop hole in audit done by hospital

It could be because doctors them self are administrators


Internal Audit is done on Full scope?

17%

67%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

56%

22%



Disagree

Agree

Strongly Agree

24%

6%

59%

12%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

53%27%


Disagree

Disagree

Agree

Strongly Agree

22%

67%

11%


Disagree

Disagree

Agree

Strongly Agree

33%

50%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

Analysis

Employee affiliation

More in private less in public

More in doctors than in other levels of public hospitals


I am a part of this hospital and they care about what I say?

67%

33%



33%

22%33%



Disagree

Agree

Strongly Agree

13%

20%40%

27%


Disagree

Disagree

Agree

Strongly Agree

13%

73%13%


Disagree

Disagree

Agree

Strongly Agree

11%

78%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

17%

50%

17%



Analysis

Doctors from both the sectors work in a some what autonomous environment

An overall positive response is from private hospital where we can see people are responding positively at every level about autonomy


17%

50%

33%

Doctors from Private HospitalsStrongly Disagree

Disagree

Agree

Strongly Agree

56%22%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

13%

20%40%

27%


Strongly Disagree

Disagree

Agree

Strongly Agree

20%

60% 20%


Disagree

Disagree

Agree

Strongly Agree

89%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

17%

33%33%

17%


Disagree

Disagree

Agree

Strongly Agree

What is the level of Autonomy given to employees?

Analysis

Another place where both the hospital came together in black spot

Hospitals from Neither of the sector having a fully functional feedback system

A little percentage of doctors said they agree. It means in one of the private hospital it could be running


84%

16%


Disagree

Disagree

Agree

Strongly Agree

13%

38%50%


Strongly Disagree

Disagree

Agree

Strongly Agree

24%35%

35%6%


Strongly Disagree

Disagree

Agree

Strongly Agree

47%

53%


Disagree

Disagree

Agree

Strongly Agree

22%

33%

44%


Disagree

Disagree

Agree

Strongly Agree

33%

67%


Strongly Disagree

Disagree

Agree

Strongly Agree

Feedback System is properly working?

Analysis

Positive response from doctors and managers from private hospitals

Whereas lower level employees showed disagreement

In public hospitals overall grievance handling is poor


17%

50%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%

56%

33%

Managers from Private HospitalsStrongly Disagree

Disagree

Agree

Strongly Agree

19%

44%

31%6%


Strongly Disagree

Disagree

Agree

Strongly Agree13%

80%

7%


Strongly Disagree

Disagree

Agree

Strongly Agree

78%

11% 11%


Disagree

Disagree

Agree

Strongly Agree

17%

50%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Grievances are heard and properly heard after?

Analysis

Private hospitals management is more efficient in conflict resolution than public hospitals

It shows the devotion with which management of hospital take their work


17%

17%50%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

44%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

50%

17%


Strongly Disagree

Disagree

Agree

Strongly Agree

13%

47%

33%7%


Strongly Disagree

Disagree

Agree

Strongly Agree

33%

53% 13%


Strongly Disagree

Disagree

Agree

Strongly Agree

11%56%

22%11%


Strongly Disagree

Disagree

Agree

Strongly Agree

Management is efficient in conflict resolution?

Analysis

Only managers from both sectors and doctors from private hospitals are giving a positive response to the question

It could be because they are able to pull strings from within

Doctors from public and LLE from both sectors are negating the notion by disagreeing


83%17%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

67%

11%


Strongly Disagree

Disagree

Agree

Strongly Agree

7%

47%

40%7%


Disagree

Disagree

Agree

Strongly Agree

13%

67%20%


Strongly Disagree

Disagree

Agree

Strongly Agree

22%

33%22%

22%


Strongly Disagree

Disagree

Agree

Strongly Agree

67%

33%


Strongly Disagree

Disagree

Agree

Strongly Agree

Compensations are timely claimed?

CONCLUSION All the facilities are currently available only for upper

managerial levels, like doctors, health care supervisors and administration staff

Current hierarchical structures are not letting hospitals work efficiently

Huge gap in service provided by private and pu8blic hospitals Private hospitals are more responsive than public hospitals

for providing solutions to their personnel Low level employees face same situation in both public and

private hospital, whereas situation in public hospital is worse than in private


CONCLUSION (……)

Gray Area One: Hierarchical Discriminations Certain managerial levels are bestowed with all the facilities

which an HR system can offer, but at the same time a lower manger is deprived of all those facilities E.g.. Workplace facilities are every employees right but they are only

offered to doctors.

IMPACT: Concept of discrimination will evolve and disturb teamwork relation. Hospitals are run on the basis of collective teamwork efforts. If one element is un-cooperative to another it will simply effect the

customer to the system which is a common patient. If a hospital is not serving its patient it means it is not doing one thing it

was made for.Comparative Study Of Public And Private Sector Hospitals

CONCLUSION (……)

Gray Area Two: Hospital Management is a non-issue To the owners or guardians of the hospitals, management of

hospital is a non issue. Its just a business of diagnosing a problem and curing it to the

extent possible. Hiding themselves from the fact that now hospitals are more

hybrid in nature and cater a more complex market need IMPACT:

In coming years the hospital industry is going to blank on the grounds, simply of the reason it will unable to cater the modern demands as a health care associate.

All the managerial functions are now attached with hospitals like financing in shape of medical insurance, medical loans in which hospital plays the most important role.


CONCLUSION (……)

Gray Area Three: Un-audited area There is no formal auditing or rigorous auditing protocol identified

for hospital industry. In public sector, people do what they want to, and there is no one to

ask them that how and why they are doing what they are. Auditing help people to restrain themselves from illegal activities Although auditing is done by government but its scope and strength

is limited IMPACT:

This factor is weakening the hospital industry both financially and morally. Many cases by expired medicine or by the bad treatment from doctor’s side. If this factor is not taken care of the hospital industry will lose the interest of its

stakeholdersComparative Study Of Public And Private Sector Hospitals

CONCLUSION (……)

Gray Area Four: Lack of awareness about patient rights and hospital’s responsibilities Not every one coming to hospital is educated about the ethics

of being in hospital Both hospital staff and patients don’t know about their rights

and usually cross the line and refuse other party to give due rights

No Campaign is designed by the hospital to educate its employees as well as patients.

IMPACT: Chances of Clash between attendants and employees of hospital. Patient’s and hospitals’ repute can be affected.


RECOMMENDATIONS


Recommendations

AdministrativeGeneral

Recommended Model: Hospital

Autonomy

RECOMMENDATIONS (……)

Administrative recommendations Training should be provided whoever runs the administration of a

hospital Administration should be separated from the general medical

functions Administrators must be provided with proper technical knowledge of

management as to control a hospital systems in particular Like B-Tech +MBA (techno management) MBBS course could be

changed to have some topic regarding regarding health care management or certification could be introduced specially for health care professionals

65% of total personnel in a hospital does not require advance medical knowledge however 35% of them have to stay with medical matters and necessary training can be imparted for the same



General recommendations

Cultural change is required Competency planning/management Appraisal system Control on ethnicity Training /refresher workshops for all levels Team based work structure should be promoted Physical workplace enhancements


Recommended Model: Partial Hospital Autonomy for Public Sector Hospitals




Public hospitals are generally responsible for 80% of recurrent government health sector expenditure

Government therefore face the task not only of finding new resources to fund the high cost activities of hospitals, but also of utilizing existing resources more efficiently.

Autonomy can both help in reducing financial burden of hospitals on governments and strengthening the efficiency and effectiveness of public hospitals

The process of leading hospitals to an autonomous architecture has five basic steps

Identification of hospitals Decision Making Process Design Dealing with Key Interventions




Identification of

Hospitals

Performance evaluation

Present Structure of

decision making

Decision Making

Process

Design

Nature & Extent of Autonomy

Autonomy and The health Sector

Organizational Models

Models of Autonomy

Internal Organization

Performance evaluation criterion

Consensus Building

Key Interventions

Administration

Finance

Human Resource

Management

Procurement

Hospital Information

system

IDENTIFICATION Process of identification involves seven steps

1) Make a list of al public hospitals, and classify them according to the level of services they provide

2) Estimate the sum total of government resources each hospital consume, both in absolute numbers as well as a percentage of total government expenditure in the health sector

3) Identify hospitals believed to be performing poorly, according to criteria currently being used by ministry of health or finance, general or medical community

4) If there are many hospitals performing poorly, rate the hospital according to criteria such as consumption of government funds so as to chose a manageable number of hospitals that can be targeted for reform.

5) Describe the present structure of decision making and administration in this list of selected hospitals

6) Evaluate performance of the selected hospitals in accordance with how they meet the criteria of efficiency, equity, accountability, quality of care and revenue mobilization.

7) Revise, if necessary, the priorities in the list of hospitals targeted for reform.Comparative Study Of Public And Private Sector Hospitals

DECISION MAKING If the previous analysis indicates that:

Some government hospitals are generally failing in their bid to maximize public welfare, or are doing so at high cost

These hospitals consume a large share of government health budget in the form of capital infusions, subsidies and operational expense

Then it can be concluded that: Public production of health in govt. owned and managed hospitals, at

least in the present form, is not the most efficient way of using government resources, and an improvement in the present position is likely to have a major positive impact.

Decision is to be made that should we go for autonomy or not


PROCESS After deciding to give autonomy the next step is to create enabling

conditions to facilitate implementation There is a six step procedure for describing the issues, key players, resources

and networks involved in a specific health policy decision.

1. Expected effect of the health policy along the dimensions of identity, size, timing,

and intensity of the effects.

2. Opponents and proponents of the health policy.

3. Identification of major organizations and individuals in the decision-making

processing, and assessment of the impact of the policy on these organizations and

individuals.

4. Identification of the formal and informal linkages between organizations and

individuals involved in the policy.

5. Assessment of the major changes in the responsible organization, and covers the

general organizational and the political environment.

6. The sixth and final step analyzes the strategies for influencing the decision.Comparative Study Of Public And Private Sector Hospitals

DESIGN


Design

Nature and extent of autonomy

Health domain Overall or Hospital specific

Hospital domain AdminProcurementHRM ….

Autonomy and health reforms

Resource mobilization

Decentralization & devolutionIncrease private sector involvement

Models of Autonomy

Autonomous hospital with independent board

Setting up organization of hospital as quasi-government and make it autonomous

Internal Organization

Performance evaluation criteria

Consensus Building


KEY INTERVENTIONS

Key Intervention

s

Administration Finance

Human Resource

Management

ProcurementHospital

Information system


LAST WORDS

We suggest that an important starting point is abroad agreement between the key stakeholders on the overall

mission of autonomy, and on the specific mandate of the public hospital. Just as important is a focus on results and

outcomes, rather than on rules and procedures. And finally, it is critically important to lay out clear and unambiguous

guidelines on the roles, responsibilities, and power of each player, as well as the sanctions to be imposed for failure to

fulfill these responsibilities.


Thank You

Comparative study between Public and Private sector hospitals

Documents

Transcript of Comparative study between Public and Private sector hospitals