The role of a good administrator

Dr Anurag Saxena, Fellow Programme in Management, IIM-Ahmedabad Assistant Professor, Indian Institute of Public Health Gandhinagar, gives an insight on what roles hospitals and its administrators are supposed to play

The recent unfortunate incidence at Baba Raghav Das Medical College in Gorakhpur, Uttar Pradesh highlight multiple aspects that are plaguing the hospital and public health management in India. Amongst the multi-dimensional problems highlighted by the incidence, it gets bit obscure to notice why a principle of such a large and over-crowded hospital should be acting as its administrator and have signing authority for a multitude of administrative document. Making the senior most practicing doctor of a hospital its administrator is a common practice across private and public hospitals in India. However, in light of the recent incidence, there is a need to understand the role of hospital administrator and the unique value that a professionally trained hospital administrator can add to the working of a hospital. There is also a need to ask questions related to the pitfalls of asking the senior practicing doctors to take on the additional role of managing a hospital. There are no easy answers to these issues, however, these issues need to be looked at in the context of what roles hospitals and its administrators are supposed to play.

Hospitals are a very important component of the healthcare system. They account for more than 60 – 70 per cent of the expenditure incurred in a healthcare system and are viewed by public as one of the most important manifestation of strength of a healthcare system. In general, for hospitals, it can be argued that doctors make key decisions about patient care, availability of capital determine the equipment that hospital has for providing care, and there is not much value that good management practices in hospital can offer. However, a study published in 2011 by McKinsey & Company, London School of Economics, Harvard University, and Stanford University covering 1,200 hospitals across multiple countries found that better managed hospitals in France had shorter case-mix adjusted length of stay. In the US, higher score in hospital management practices correlated with the likelihood of patient recommending the hospital to others, and in UK, better managed hospitals had better financial performance. Similar other research- based evidence also suggest that better managed hospitals generally have superior clinical outcomes, higher degree of patient satisfaction, higher likelihood of patients recommending the hospital to others, and better financial performance.

Administrator – The key person

In a hospital, hospital administrator is the key person who is responsible for its day-to-day working. The administrator ensures that all the departments in a hospital are working in coordination with each other, systems and processes adhere to the envisaged quality of healthcare service provision, appropriate policies to recruit and train workforce are in place, plan budget and set rates for services, develop and implement a blueprint for advancing research and community outreach activities. The administrator is also expected to undertake strategic planning for the hospital, analyse and improve systems and processes for efficient and effective delivery of services, review financial reports, and establish policies to ensure that all departments are following the best management practices. Hence, the presence of an appropriately trained administrator can help a hospital in achieving superior clinical outcomes, higher degree of patient satisfaction, higher likelihood of patients recommending the hospital to others, and better financial performance.

In India, there is still a high prevalence of communicable diseases, and indicators of maternal and child health are still poor. As per the estimates, India accounts for approximately 25 per cent of total maternal deaths in the world, and for more than 20 per cent of child deaths across the globe. Rapid increase in prevalence of non-communicable diseases such as cardiovascular diseases, diabetes, cancer, and other life-style diseases are further making the situation much more complex. In such a situation, there is a need for hospital administrators who are sensitive to the broader issues of public health and at the same time are capable of steering hospitals towards organisational excellence. For fulfilling this role, hospital administrators are required to have skills to manage hospital activities, monitor quality of care, assess healthcare needs of the targeted population segment, gear-up hospital to meet those needs, educate target population about hospital’s offerings, and overall coordinate resources to fulfill hospital’s objective in an effective and efficient way.

Moreover, there is a significant under-investment in the production of professionally trained hospital administrators. In western India comprising states of Gujarat, Madhya Pradesh, Maharashtra, and Rajasthan there are only three to four notable institutes that are offering a full-time course on hospital administration and management. There are no reasons to believe that similar situation will not there in region consisting of Uttar Pradesh, Bihar, Jharkhand, Chhattisgarh, and Northeastern states. Hence, resulting in a geographic and institutional imbalance in the availability of trained hospital administrators. It is, thus, leading to a situation where senior doctors, along with their regular clinical practice, are also performing the role of an administrator in the hospitals. However, such a situation places a significant demand on the time of these doctors, and makes it difficult for them to manage both clinical and administrative work. As a result, either clinical or administrative work or both gets neglected, causing poor quality of care, higher cost of service delivery, and lower patient satisfaction. Lack of trained administrators also results in a lack of second line of leadership and pose a serious challenge to the sustainability of initiatives taken by the hospitals. Thus, to strengthen the hospital sector and improve the healthcare situation, there is an urgent need to undertake initiatives aimed at increasing the availability of professionally trained hospital administrators who can tackle the challenges faced by hospitals and healthcare sector in India.

Regional centres of excellence

In strengthening the hospital sector, central and state governments can play a very important role by enabling the formation of autonomous body/council to coordinate the production and actions of public health and hospital management professionals across geographical regions in India. Such a council can assess the quality and quantity of professionally trained administrators required in each region and recommend policies aimed at encouraging the development of regional centres of excellence. These regional centres of excellence would contribute towards strengthening hospital administration practices through practice-oriented research, teaching, and by providing continuous education opportunities for middle and senior level executives in hospitals. Institutions like AIIMS, IIMs, Public Health Foundation of India (PHFI) and Indian Institute of Public Health (IIPH) that are involved in teaching and research in the domain of health and management can contribute by hosting and nurturing regional centres of excellence responsive to the issues faced by hospital sector in each region. Corporates and public hospitals can contribute by undertaking initiatives aimed at extending the support for applied research and in highlighting the challenges faced by the sector. Government, corporates, and academic institutes should also coordinate their efforts and aim for creating a platform for practitioners, researchers and policy makers to interact. Hospital and broadly healthcare sector will benefit enormously from such a platform and will make significant contribution by preparing the sector for the current and future challenges faced by it.

(Disclaimer: The views and opinions expressed in the article are those of the author and do not necessarily reflect the official policy or position of the organisation with which the author is associated.)