Introduction

An organisation is an entity comprising multiple people such as an institution or an association that has a particular purpose. What makes an organisation an organisation is not the paper work that makes it official but to be an organisation there must be four things:

1. A goal in mind

2. A leader or committee making the decision

3. Action involved

4. Communication and members present

Organisation is the anatomy, and management is the physiology of the process. Organisation is the systemic bringing together of interdependent parts to form a unified whole through which authority, control and coordination may be exercised to achieve a given purpose. Organisational structure is represented by a basic organisational chart forming the skeleton of the organisation. Organisational functions are carried out by formalisation and supervision which serves as the muscles and nerves. 

A hospital as a health care organisation has been defined in varied terms as an institution involved in preventive, curative/ameliorative, palliative or rehabilitative services.

Definition of Hospital according to WHO: “A Hospital is an integral part of a Social and Medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whose outpatient services reach out to the family and its home environment; the hospital is also a centre for the training of health workers and biosocial research.”

The word “hospital” originates from the Latin ‘hospice.’ In fact, the word hospital, hostel and hotel all derive from the common Latin root hospice. The place or establishment where a guest is received was called the hospitium or hospitale.

A hospital is unique and highly complex organizational entity. To the community it is an important social and economic asset, to patients it is a place to receive care; to physicians it is a place to treat patients; to employees it is a place to work and to its managers, it is a multi – faceted organization embracing clinical, financial, ancillary and supportive activities.

It is a place where sophisticated equipment, technology and personnel are organized to provide health services. Advances in technology and medical science have caused the hospitals to become the central and primary provider organizations in health services delivery. Thus, a hospital is an inseparable entity of our lives, meaning many things to different people.

Management science applies to all organization like hospitals. Hospitals employ huge resources which require professional management of finance personal, equipment and material. With the increasing complexity of medical sciences and growing number and size of hospitals, the application of management principles to the hospitals needs the same care and consideration which is essential for running a business or industrial enterprise.

Today with the growing population of India and demand for medical services, hospitals are facing acute problems of utilizing the available resources. Private hospitals are on profit base but public hospitals are on service base. So, the picture of public hospital is totally different than private hospital. This is not because of the lack of professional knowledge or competence but due to poor management of health services.

That the modern hospital is an extremely complex organization is evident from the fact that it provides essential services which must be available 24 hours a day. Obviously, the hospitals differ from other organizations in that, they deal continuously with the problems of life and death. The hospital has unique characteristics as compared to other organisations. These characteristics in the Indian context can be summed up thus:

1. Hospitals are operated continuously. This leads to high cost and causes personnel and scheduling problems. 

2. There is wide diversity of objectives and goals among the individuals, professional groups and various sub-systems. Hospital components are responsible for/or participate inpatient care, education, research, prevention of prospective ailments, accommodation and intricate medical and surgical procedures. These activities are generally conflicting. Effective co-ordination is becoming difficult in minimizing this conflict and obtaining the maximum support in achieving hospital mission. 

3. Hospital personnel range from highly skilled and educated to unskilled and uneducated employees. The major responsibility of the hospital manager is to get work from these diversified groups. Unionization among personnel complicates human resource management in hospitals. 

4. Many components of hospital operation have dual lines of authority. 

5. Physicians are responsible for patient care, education and research. This necessitates unique skills and special working relationships. 

6. Hospitals deal with the problems of life and death. This puts significant psychological and physical stress on all the personnel. The setting and outcome may cause consumers and their families to be hypercritical. 

7. It is difficult to determine and measure the quality of patient care. There has been progress in determining what quality is, but many questions were unanswered and there is disagreement among experts as to how and what should be measured. 

8. One major characteristic of hospital management is the over emphasis on medical care and the overriding of financial aspects of hospital operations. This results in distortion of management principles and their application to hospitals as compared with other undertakings 

Hospital organisation and management models

Figure: hospital organisation and management model

A Management Model is simply the set of choices made by executives about how the work of management gets done—about how they define objectives, motivate effort, coordinate activities, and allocate resources.

Notice two key features. First defining your Management Model is about making choices. In the airline industry there are several coexisting business models, and every firm knows it has to make an explicit choice about which one to adopt. Similarly, some industries already feature competing Management Models. 

Second, we can put some structure around the concept by suggesting that the discipline of management has four specific dimensions. Managers have to decide where their organization—or their department or unit—is going (define objectives), and they have to get people to agree to go in that direction (motivate effort). The means by which they do this is to manage across (coordinate activities) and to manage down (making decisions). 

The hospital is an organisation that mobilises the skills of number of divergent groups of people namely professionals, semi-professionals, and non-professionals to provide a highly personalised service to the individual patients. A hospital faces so many challenges so this is where the management models come in handy. There are many management models and here are few of them:

1. Kurt Lewin’s Change Management Model

 

a. Maslow’s Hierarchy of Needs

Maslow said that we all start from the bottom and once the need at the bottom gets fulfilled, we can go ahead to gradually fulfil our all other needs.

i. Physiological: You need to fulfil these basic needs first before you think about other needs. Air, water, food, shelter, sex, sleep and warmth are the basic needs as Maslow pointed out. They are also called your biological needs.

ii. Safety: Once you can fulfil the physical needs, you will go ahead and think about your safety, maintaining law and order, ensuring security and getting free from fear.

iii. Love & Belongingness: Later you need to have family, friends and love and affection and a place where you feel that you’re included.

iv. Esteem: After physiological, safety and love & belongingness needs, you can think about achievement, mastery, self-respect, autonomy.

v. Self-actualization: This is the top most need you have and that is to achieve your full potential, extracting the best out of you and leaving a legacy which Steve Jobs called “making a dent in the universe.”

 

b. Lencioni’s 5 Dysfunctions of a Team

Why are teams so dysfunctional? They are made up of individuals with varied interests, strengths and weaknesses. You know the saying, “The road to hell is paved with good intentions” — the same is true for human behaviour. Even the most well-intentioned people slip into unproductive and unhealthy behaviour. Combine that with a manager who isn’t skilled in team building and guiding in this area, and bam — dysfunctional team. But Lencioni says with knowledge, courage and discipline, teams can just as quickly become not only cohesive, but high performing.

i. The GRPI model

ii. Tuckman’s model of team development

iii. ADDIE’s model

iv. The GROW model

v. Herzberg’s motivators and hygiene factors

vi. The Johari Window

vii. ADKAR change model

viii. Kotter’s Change Management Model

ix. PDCA model

IPO model: Input-Process-Output

Much of the work in organizations is accomplished through teams. It is therefore crucial to determine the factors that lead to effective as well as ineffective team processes and to better specify how, why, and when they contribute. Substantial research has been conducted on the variables that influence team effectiveness, yielding several models of team functioning. Although these models differ in a number of aspects, they share the commonality of being grounded in an input-process-output (IPO) framework. Inputs are the conditions that exist prior to group activity, whereas processes are the interactions among group members. Outputs are the results of group activity that are valued by the team or the organization.

The input-process-output model has historically been the dominant approach to understanding and explaining team performance and continues to exert a strong influence on group research today. The framework is based on classic systems theory, which states that the general structure of a system is as important in determining how effectively it will function as its individual components. Similarly, the IPO model has a causal structure, in that outputs are a function of various group processes, which are in turn influenced by numerous input variables. In a hospital scenario the model is almost similar to an IPO model of other organisations but differ in the output section where its main focus is related to human lives. In its simplest form, the model is depicted as the following:

Input —> Process —> Output

 

Inputs

Inputs reflect the resources that groups have at their disposal and are generally divided into three categories: individual-level factors, group-level factors, and environmental factors. Individual-level factors are what group members bring to the group, such as motivation, personality, abilities, experiences, and demographic attributes. Examples of group-level factors are work structure, team norms, and group size. Environmental factors capture the broader context in which groups operate, such as reward structure, stress level, task characteristics, and organizational culture. In an IPO model of hospital, the inputs will include in broad terms: man power, materials, money, machines, methods, minutes and information.

 

Processes

Processes are the mediating mechanisms that convert inputs to outputs. A key aspect of the definition is that processes represent interactions that take place among team members. Many different taxonomies of teamwork behaviours have been proposed, but common examples include coordination, communication, conflict management, and motivation.

In comparison with inputs and outputs, group processes are often more difficult to measure, because a thorough understanding of what groups are doing and how they complete their work may require observing members while they actually perform a task. This may lead to a more accurate reflection of the true group processes, as opposed to relying on members to self-report their processes retrospectively. In addition, group processes evolve over time, which means that they cannot be adequately represented through a single observation. These difficult methodological issues have caused many studies to ignore processes and focus only on inputs and outputs. Empirical group research has therefore been criticized as treating processes as a “black box” (loosely specified and unmeasured), despite how prominently featured they are in the IPO model. Recently, however, a number of researchers have given renewed emphasis to the importance of capturing team member interactions, emphasizing the need to measure processes longitudinally and with more sophisticated measures.

 

Outputs

Indicators of team effectiveness have generally been clustered into two general categories: group performance and member reactions. Group performance refers to the degree to which the group achieves the standard set by the users of its output. Examples include quality, quantity, timeliness, efficiency, and costs. In contrast, member reactions involve perceptions of satisfaction with group functioning, team viability, and personal development. For example, although the group may have been able to produce a high-quality product, mutual antagonism may be so high that members would prefer not to work with one another on future projects. In addition, some groups contribute to member well-being and growth, whereas others block individual development and hinder personal needs from being met.

Both categories of outcomes are clearly important, but performance outcomes are especially valued in the team’s literature. This is because they can be measured more objectively (because they do not rely on team member self-reports) and make a strong case that inputs and processes affect the bottom line of group effectiveness.

This is the IPO model for a hospital: