2. Hospital Management HHSM 304 SEMS.3-2016 COLLEGE OF BUSINESS. RABIGH King Abdul Aziz univ. 1

3. Introduction: Hospitals المستشفى are the focal points الجهة الرئيسية of education for the health professionals and clinical research necessary for advancement of Medicine. Thus the hospital is one of the most complex من اكثر المنظمات تعقيدا of all administrative organizations. Therefore, it requires a thorough knowledge not only of the hospital set-up but also of its meaning, history, classification تصنيف, peculiar conditions لحالات محددة prevailing in hospital administration etc. 2

4. Definition of hospital: Let us examine a few definitions of the term ‘hospital’. The word ‘hospital’ is derived from the Latin word which comes from hospes, meaning a host. The English word ‘hospital’ comes from the French word hospitale, as do the words ‘hostel’ and ‘hotel’, all originally derived from Latin. The three words, hospital, hostel and hotel, although derived from the same source, are used with different meanings. The term ‘hospital’ means an establishment for temporary occupation by the sick and the injured. Today hospital means “an institution in which sick or injured persons are treated”. 3

5. A hospital is different from a dispensary-a hospital being primarily an institution where in-patients are received and treated. While the main purpose of a dispensary مستوصف is distribution توزيع of medicine العلاجات and administration of outdoor relief للمرضى المراجعين. 4

6. Blackiston’s New Gould Medical Dictionary (McGraw-Hill, New York, 1959, p. 560) describes A hospital as: “ Institution for medical treatment facility primarily intended, appropriately staffed and equipped to provide diagnostic and therapeutic services in general medicine and surgery or in some circumscribed field or fields of restorative medical care, together with bed care, nursing care and dietetic service to patients requiring such care and treatment.” 5

7. Nature and scope of hospital: طبيعة ونطاق المستشفى Human beings make a society المجتمعات. Healthy human beings make a healthy society However, every society has its share of unhealthy human beings. They are as much a part of society as the healthiest of individuals. 6

8. 1.In the past, an individual afflicted by a wound or disease was condemned to suffer and fend for himself. 2. In those primitive days, the healthy never assisted or looked after the afflicted. 3.The belief, then, was that illness was caused either by evil spirits or was a punishment for one’s misdeeds. Later, the ‘tribe’ assumed the responsibility of looking after the sick who were considered. 7

9. Changes in Hospital Organization: As far as voluntary hospitals are concerned, many religious groups ran family-style, mission-oriented establish service centers for the sick. As these grew in to larger and larger modern health institutions, the outward ا and inward pressures to adapt to the changes in society became evident. 8

10. With the increasing complexity of medical care and acceptance of the hospital as a service, adjunct services to supplement the usual medical and nursing care are to be developed. These involve medical social work, linen and laundry management, nutrition housekeeping, medical record technology, medical laboratory technology, hospital accounting. 9

11. Types of Health Care Organizations King Abdul Aziz university College of business CHAPTER Two : 10

12. Types of Health Care Organizations An understanding of the various health care agencies and their services could help the manager to perform and assume his/her role effectively. Health care agency is considered as a setting for providing health care services (e.g. curative, preventive, and/or educational) to the society Whether in clinics; homes; ambulatory care settings; and hospitals. 11

13. Types of Health Care Organizations Classification of health care agencies: Agencies providing health care can be classified in one of three ways: Classifications by length of stay Classification by type of services: Classification by type of ownership: ● Short stay ● Traditional acute care ● Long –term care ● General vs. specialty ● Community vs. tertiary ● Sub-acute(transitional) care ● In-home care ● Ambulatory care ● Governmental ● Non-Governmental * For-profit * Non-for-profit 12

14. Types of Health Care Organizations Classification according to length of stay: Classification according to length of stay: 1) Short-stay facilities: ● Which provide services to patients/clients who are suffering from acute conditions that require less than 24 hrs of care. ● Short stay may take place in separate units in a hospital, or in short –stay centers. 13

15. Types of Health Care Organizations 2) Traditional acute care: 2) Traditional acute care: ● It takes place in the hospital. ● It includes patients staying more than 24 hrs but fewer than 30 days. 3) Long term care : 3) Long term care : ● Which include those agencies that offering services to patients with major rehabilitation needs, chronic diseases, functional losses, or mental illness. ● The average length of stay extends from several months to years. 14

16. Types of Health Care Organizations Classification by type of service: Classification by type of service: 1) General hospital: ● Which offers medical, surgical. Obstetric, emergency, and diagnostic as well as laboratory services. 15

17. Types of Health Care Organizations 2) Specialty hospital: ● Which offers only a particular type of care such as: - Psychiatric hospitals - Women's hospitals - Children's hospitals ● Specialty hospitals tend to be less common than general hospitals 16

18. Types of Health Care Organizations 3) Community hospital: 3) Community hospital: ● Which provides those services provided in the general hospital but for specific community. 17

19. Types of Health Care Organizations 4) Tertiary hospital: ●Which are serving as referral centers for clients with complex or unusual problems. ●They have the facilities for specialized types of care such as burn centers, bone marrow transplant centers, as well as resources for general care. ●They serve a wide geographic area in addition to their own community. ●Usually associated with a university or are a part of a large medical center. 18

20. Types of Health Care Organizations 5) Sub-acute care (transitional care): ● It is a growing type of services that may be offered in a special unit of a hospital or may be provided in long – term care setting. The unit (medical services +discharge rapid) Hospitals The unit ( rehabilitative services ) Long-term facilities 19

21. Types of Health Care Organizations 6) In-home services: ●Which are provided in the community health care agencies, by health care professional including nurses, physical therapists, social workers, and home health care aid. ● this care may be: Short–term: teaching and monitoring after hospitalization 1) Short–term: teaching and monitoring after hospitalization 2) Intermediate-term: to assist an individual until self-care is possible 2) Intermediate-term: to assist an individual until self-care is possible 3) Long-term: for those 3) Long-term: for those with ongoing health problems 20

22. Types of Health Care Organizations 7) Ambulatory care: ● Which refers to care services provided to persons who are not hospitalized ● The ambulatory settings include: The outpatient surgery centers Minor emergency clinics Outpatient dialysis units Outpatient birthing centers 21

23. Types of Health Care Organizations Classification by ownership Governmental Organizations:  Owned, administered, and controlled by government  Provide free care for patients  May offer private accommodation for free-paying patient 22

24. Types of Health Care Organizations The governmental hospital are owned by: a- The Ministry of Health. b- The University. c- Military personnel. d- Health insurance organization. e- Health care organization. 23

25. Types of Health Care Organizations 2) Non-Governmental Organizations: For-profit agencies (PRIVATE): owned, operated, and controlled by individuals, groups, or private organizations. 24

26. Types of Health Care Organizations Non-for-profit agencies (Voluntary health agencies): ● Owned and operated by non-profit groups or organizations (e.g. religious bodies & community boards) ● The original capital costs are obtained in a variety of ways (e.g. through donation) 25

27. Chapter three: HEALTH HOSPITAL MANAGMAE NT: 26

28. Hospital administration should be entrusted on those who have the necessary training and the right kind of attitude to perform this vital task. 27

29. Definition of Management: Is an art with a scientific base a science can be learned through the study of basic rules, principles and formulas acquired through trial-and-error & years of experience 28

30. Definition of Management: It is a process, with both interpersonal and technical aspects, through which the objectives of the health services organization are specified and accomplished by utilizing human and physical resources and technology. 29

31. Management Process Inputs Human & physical resources. Technology. Transformation Influenced by management. Outputs Accomplishment of the objectives of the organization or part of it. 30

32. It must be designed to meet all the needs of people it is to serve. It must be a size which the people can afford to build and operate. It must be well-staffed with a sufficient number of physicians, nurses and other trained personnel to give adequate and efficient service. 31

33. Reasons for inadequate hospital service: Lack of planning. Lack of locally available funds. Principles of Planning Hospital Facilities & Services 1.Patient care of a high quality. 2.Effective community orientation. 3.Economic viability. 4.Sound architectural plan. 32

34. 1- Patient Care of High Quality: 1.Provision of competent professional and technical staff and of the equipment and facilities necessary to support the hospital's patient care. 2.An organizational structure that assigns responsibility appropriately and requires accountability for the various functions within the institution, 3.Interaction of members of the medical staff with each other and with other members of the health team. 4.Continuous review by appropriate persons of the adequacy of care provided by physicians, nursing staff and paramedical technicians. 33

35. 2- Effective Community Orientation: 1.A governing board made up primary of persons who have demonstrated concern for the community as well as leadership ability. 2.Policies that assure availability of services as needed to all of the people in the hospital service area. 3.Participation of the hospital in community programs to provide preventive, emergency and casualty care and to teach good health and health care practices to community residents. 34

36. 3-Economic Viability : 1.A corporate organization that accepts responsibility for sound financial management with optimum quality of care and the hospital's responsibility for community services and that raises funds, when necessary, to supplement the hospital's earned income. 2.Patient care objectives that are consistent with projected services demands and the availability of operating financing for adequate personnel and equipment required to maintain patient care of a high quality. 35

37. 3-Economic Viability: 3- Community participation in the hospital's programs through sponsors, contributions, auxiliaries and volunteers. 4- An annual budget plan for maintaining: –Services at a high level of quality. –Appropriate standby equipment and services. –Competitive salary and wage scales and employee benefits. –Interest and payments on mortgage and other indebtedness. 36

38. 4- Sound Architectural Plan: 1.Retention of an architect experienced in hospital design and construction. 2.Selection of a site large enough to provide for parking and future expansion and readily accessible to water and sewage lines and to population concentrations through highway, rail, rapid transit or bus lines. 3.Determination of facility size appropriate to the demands of the hospital's service area and of departmental areas large enough to provide the diagnostic and treatment services required by the hospital's medical staff on an emergency and day- to-day basis. 37

39. Sound Architectural Plan: 4- Adequate attention to important hospital concepts such as: Infection control. Disaster planning. Use of hospital services by ambulatory inpatients as well as outpatients. Intensive and extended care units. Psychiatric care programs. 38

40. CHAPTER foure: Leader ship in hospital management: 39

41. What is leadership? Leading people Influencing people Commanding people Guiding people 40

42. Types of Leaders Leader by the position achieved Leader by personality, charisma Leader by moral example Leader by power held Intellectual leader Leader because of ability to accomplish things 41

43. Managers vs. Leaders Managers Focus on things Do things right Plan Organize Direct Control Follows the rules Leaders Focus on people Do the right things Inspire Influence Motivate Build Shape entities 42

44. Common Activities Planning Organizing Directing Controlling 43

45. Planning Manager Planning Budgeting Sets targets Establishes detailed steps Allocates resources Leader Devises strategy Sets direction Creates vision 44

46. Organizing Manager Creates structure Job descriptions Staffing Hierarchy Delegates Training Leader Gets people on board for strategy Communication Networks 45

47. Directing Work Manager Solves problems Negotiates Brings to consensus Leader Empowers people Cheerleader 46

48. Controlling Manager Implements control systems Performance measures Identifies variances Fixes variances Leader Motivate Inspire Gives sense of accomplishment 47

49. Leadership Traits Intelligence – More intelligent than non-leaders – Scholarship – Knowledge – Being able to get things done Physical – Doesn’t see to be correlated Personality – Verbal facility – Honesty – Initiative – Aggressive – Self-confident – Ambitious – Originality – Sociability – Adaptability 48

50. Leadership Styles Delegating – Low relationship/ low task – Responsibility – Willing employees Participating – High relationship/ low task – Facilitate decisions – Able but unwilling Selling – High task/high relationship – Explain decisions – Willing but unable Telling – High Task/Low relationship – Provide instruction – Closely supervise 49

51. New Leaders Take Note General Advice – Take advantage of the transition period – Get advice and counsel – Show empathy to predecessor – Learn leadership Challenges – Need knowledge quickly – Establish new relationships – Expectations – Personal equilibrium 50

52. New Leader Traps Not learning quickly Isolation Know-it-all Keeping existing team Taking on too much Captured by wrong people Successor syndrome 51

53. Seven Basic Principles Have two to three years to make measurable financial and cultural progress Come in knowing current strategy, goals, and challenges. Form hypothesis on operating priorities Balance intense focus on priorities with flexibility on implementation…. 52

54. Seven Basic Principles, con’t Decide about new organization architecture Build personal credibility and momentum Earn right to transform entity Remember there is no “one” way to manage a transition 53

55. Core Tasks Create Momentum Master technologies of learning, visioning, and coalition building Manage oneself 54

56. Create Momentum Learn and know about company Securing early wins – First set short term goals – When achieved make a big deal – Should fit long term strategy Foundation for change – Vision of how the organization will look – Build political base to support change – Modify culture to fit vision 55

57. Create Momentum Build credibility – Demanding but can be satisfied – Accessible but not too familiar – Focused but flexible – Active – Can make tough calls but humane 56

58. Master Technologies Learn from internal and external sources Visioning - develop strategy – Push vs. pull tools – What values does the strategy embrace? – What behaviors are needed? Communicate the vision – Simple text- Best channels – Clear meaning- Do it yourself! 57

59. Enabling Technologies, con’t Coalition building – Don’t ignore politics – Technical change not enough – Political management isn’t same as being political – Prevent blocking coalitions – Build political capital 58

60. Manage Oneself Be self-aware Define your leadership style Get advice and counsel – Advice is from expert to leader – Counsel is insight Types of help – Technical – Political – Personal Advisor traits – Competent – Trustworthy – Enhance your status 59

61. How Far Can You Go? 60

62. Top 10 Skills of High-Performing Healthcare Leaders

63. Top 10 Skills of High-Performing Healthcare Leaders As healthcare reform continues to drive a rapid pace of change and uncertainty throughout the industry, healthcare leaders are evolving and adapting new skill sets to successfully lead their organizations. Today’s executives face a dizzying array of challenges, from meeting reform mandates to filling positions despite the looming shortages of experienced healthcare professionals. To navigate these complexities, effective senior healthcare leaders must possess a wide variety of leadership skills. Never before have healthcare leaders faced so many challenges. Healthcare reform aside, they continue to battle a variety of complex issues that demand specific skills, personality traits and leadership qualities. Here are ten of the most important leadership skills you need to keep your organization at the forefront of success.

64. 1. Have a Vision... and Stick to It Effective leaders have a clear vision of what success will look like in a specific time period. They know how to plan for it, how to communicate and direct it, and how to implement it. They dream big and look forward to overcoming the challenges their vision will face. They also know that their vision has to be actionable and measurable. And, perhaps most importantly, they understand that they are ultimately accountable for it. As the public face of the organization, they must own the vision and nurture its continuing success.

65. 2. View Change as Opportunity In times of uncertainly, good healthcare leaders display an innate agility in adapting to constantly changing conditions. They are flexible enough to recognize and maximize the opportunities that are inherent in times of change, without losing sight of their vision. This will be increasingly important as healthcare reform continues to reshape traditional models of care. The best leaders understand that change doesn’t have to compromise their vision. In fact, it can be an opportunity to propel their vision forward.

66. 3. Be Courageous in the Face of Risk Creating opportunity out of change usually necessitates taking some risks. However, as famed U.S. General George S. Patton once said, “Take calculated risks. That is much different from being rash.” Good leaders understand this. They have the courage to try new things, many of which won’t be easy. But they also understand that capitalizing on risks requires careful study and a disciplined plan of action. Not only does this improve their chances of success, it breeds confidence within the organizational ranks that their leader knows how to generate opportunities without carelessly jeopardizing the vision.

67. 4. Know How to Influence People Today’s successful healthcare leaders know how to push past resistance. They realize the influence they can wield and they know how to use it to advance their vision. Good leaders aren’t passive. Instead, they are active, persistent advocates for both their vision and their organization. This isn’t limited to C-suite leaders, either. Leaders at every level must understand how their influence can be critical in sustaining collective intensity, passion and determination in achieving the organization’s goals.

68. 5. Stay Engaged Healthcare is a relationship industry, and good healthcare leaders are constantly engaged at every level of their organization. They know how to connect and work with key internal stakeholders – employees and physicians – and external consumers, including patients, families and the community they serve. More importantly, they understand how to integrate these relationships and unite them under a single vision. This will be increasingly critical as healthcare reform continues to redefine traditional reimbursement structures, physician and hospital alignment and the advancement of more patient-centered models of care.

69. 6. Know Talent When You See It The best leaders are always surrounded by a high- performing team. They trust their staff to effectively take action and achieve the desired outcomes. An effective leader must know how to recruit talent who will act on the organization’s vision. This includes everyone, not just the C-suite. Every person must understand the vision, have faith in your ability to execute that vision and possess the skills and attitudes to help achieve it. It’s an ongoing process that takes time and diligence.

70. 7. Stay Positive... and Energetic It always seems that the top performers in any industry have a relentlessly positive attitude towards the future and an inexhaustible reservoir of energy in sharing their vision. Think of the leaders you’ve admired most. Their drive, determination, optimism and passion are contagious. Where does it come from? Inevitably, it springs from a firm belief in what they are doing and a passion for moving it forward. Not that they didn’t experience periods of frustration or complications. But good leaders know how to cultivate a positive, energetic atmosphere, and they understand that it starts with them – every single day.

71. 8. Understand that Healthcare is a Business Inspiring leaders realize that healthcare is – and should be – a calling. But they also understand that it’s a business, too, and like any other successful business, it is consumer driven. In fact, healthcare reform has actually intensified the consumer focus. Good leaders understand this and they know how to leverage consumer- centric experiences that haven’t been traditionally associated with the healthcare industry.

72. 9. Appreciate the Importance of Mentoring As successful as the healthcare industry as been in developing cutting-edge, life-saving technologies, it has been woefully lacking in creating quality mentoring programs. Good leaders understand the importance of mentoring. They create environments in which current and future leaders can gain valuable experiences early in their careers. This is invaluable to future leaders, because they get to see firsthand how top performers react and respond to different situations. This exposure is critical in developing the competencies they’ll need as their careers advance.

73. 10. Continuously Learn and Improve Today’s high performers recognize that leadership skills aren’t exclusively intuitive. Rather, they are constantly honed. That’s why top leaders make it a habit to seek out leadership development opportunities. For some, this might include reading books or attending seminars. For others, it might include visiting with other leaders whom they admire. Just be sure you can define the methods by which you best learn, thus you’ll be more apt to stay engaged in ongoing development. Also, don’t be hesitant to look for development opportunities outside healthcare. Other industries face similar challenges and you can learn valuable lessons from networking with leaders in those particular fields.

74. There’s no denying that healthcare will continue to change. As it does, the industry will continue to reward the healthcare leaders who can adapt to those changes and leverage their leadership skills in creating opportunity in a time of uncertainty. The good news is that all of these leadership traits can be learned and honed. Better yet, they can be shared and passed down to the next generation of healthcare leaders.

75. ALL THE BEST,,,,,,, DR.HASAN ALQUDAH 74