1

Table 7.1: Time distribution on administrative

functions
Activity Percentage of time

Planning 25

Directing and coordinating 48

Personal meeting people 11

Controlling 12

Organizing 4

2
This precludes appointing senior practicing
doctors as chief executives. Medical doctors
trained in health and hospital administration,
who are alive to the medical care needs of the
patients also understand the needs of the
hospital and professionals working in them,
and are thus more suitable to head hospitals.

3
Health administrators face challenges in their
professional inputs. Administrators trained in
general programmes of hospitals
administration without a good grounding in
such subjects as economics, information
systems, accounting, finance, marketing,
regional planning and law will need to
broaden their preparation for corporate roles.

4
Such preparation would provide a definite
competitive edge for individuals who have a
formal training in health administration and
some corporate preparation.

5
 Leadership in the Hospitals
Most of the administrators in the hospitals
are professional physicians who waste 60 to
70 per cent of their time in routine
administrative activities. Management of
hospitals requires knowledge and
competency in managerial and
administrative sciences.

6
Therefore, most of the present leaders in
hospitals have no training in management
sciences, and yet are made responsible for
the management of health institutions.

7
 Lack of Dedicated Professional Staff

Due to ineffective manpower planning,

recruitment, compensation and development
systems, there is high degree of job
dissatisfaction among health professionals.

8
 Controls

There are stringent financial and managerial

controls exercised on the hospital
administrative staff either by the department
of health services in the case of public
hospitals, or managing trustees in the case of
other hospitals.

9
Ineffective Organization and Allocation of
Work

Hospitals have experienced difficulties in

clear cut division of work, clear job
description, consequently there is ineffective
utilization of manpower.

10
Problems of Motivation and Job Satisfaction
of Employees

Most of the hospitals report problems of

identifying motivated personnel and
motivating the employees to provide
adequate services.

11
ROLES AND FUNCTIONS OF HOSPITAL
ADMINISTRATION

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The following is a description of the various
roles and functions of the hospitals
administrator, and activities associated with
them. Description of each function and role
leads to a key element under that role. At the
end of each such description, the key element
is highlighted.

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1. Working with People.
The administrator has no direct clinical
responsibility for any patients, that rests
firmly on the members of the medical staff
who have the clinical freedom to decide who
shall be treated for what, by what means and
for how long.

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Because doctors are responsible in this way,
they are in a unique position to influence the
work and development of the hospital. The
physician’s “management” of a case has an
effect far beyond the clinic or ward situation,
on the work of the other staff, and in the
functioning of other departments remote
from his sphere of action.

15
Therefore, the clinicians to a very great
extent call the tune for all the services which
contribute to patient care—not only for
nursing, pathology, radiology, and pharmacy,
physiotherapy and the rest of the professions
supplementary to medicine, but also for the
cook who makes the salt-free diet, or the
technician who maintains the dialysis
machine.
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Dictum: Balance the goals of the hospitals by
working with patient care teams where
physician is the kingpin (who in turn works
with others in rendering patient care).
Understand workers, their motivations and
aspirations, and knit them together as a
team.

17
2. The Enabling Role.
One of the prime roles of the administrator is
to enable the doctors, nurses and patient-
care team to do their job efficiently. He
“enables”, “sees” to and “ensures”.

18
All this is part of his enabling job, but not the
whole of it. He must concern himself also
with creating and maintaining the
nonmaterial conditions in which the
professional staff can do their work best—
morale, atmosphere, the sprit of the place are
as much of his business as the water supply
and electricity.

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Dictum: Ensure the provision of necessary
physical facilities and ensure that the
supportive services are available in the right
amount, of the right quality, and at the right
time and place.

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3. Hospital Administration and Staff.
Running any hospital calls for a great deal of
judgment and skill. This is because there are
many types of staff who are specialists in
their own area and departments, which
function more or less as independent units.

21
Workers at the operational level, e.g. nursing
personnel, feel that more than one authority
controls them—firstly the head of the clinical
service, secondly the head of the nursing
department and thirdly the administration.
This multiplicity of reporting and regulating
authority is a source of constant trouble.

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Dictum: Understand the staff and understand
variations in styles of administration.

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4. Staff Motivation.
Expensive facilities and equipment do not
necessarily make for a good hospital, it is the
people who operate them that make the
hospital go. This function is one of the most
challenging functions of a hospital
administrator.

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The staff needs to be motivated to give their
best at all times even in trying situations.
Many discouraging factors and stress
situations, in which hospitals abound, tend
easily to lead to erosion in motivation.

25
Dictum: Develop measures to keep up
motivation of all categories of staff, and be
constantly on the look-out for cases of
dissatisfaction and conflict.

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5. Facilitating Decision Making.
A great part of the job of a hospital
administrator concerns decision making.
There are several kinds of decision making in
a hospital. The most characteristic are the
technical decisions about the treatment of
patients, with which he is not directly
associated, but which influence overall
decision making, with which he is concerned.
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Whether he recognizes it or not, the clinician,
no less than his colleagues who run the X-ray
or pathology departments, is also a manager.
The most common decision about which
patient to admit and for how long should he
be kept in hospital can be taken only by
individual physicians.

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To them these may seem to be purely clinical
decisions, but these are also management
decisions. To admit Mr. A rather than Mr. B or
to keep Mrs. C in hospital a few days longer,
or to send Ms. D home early to free a bed for
someone else, all these are decisions which
influence use of resources.

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Within a particular specialty the chief of that
specialty exercises a sort of coordinating
function. However, between specialties, there
is some element of confusion. Various
department heads may find themselves in a
competitive relationship.

30
Although each chief is entitled for help from
the common services, and has a right to get
it, this does not happen automatically.

31
Dictum: Provide appropriate inputs to
decision making at the clinical departmental
level, and coordinate decision making at the
interdepartmental level.

32