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Hospital Operation

Healthcare Management Consulting Services Firm
Paskal Hypersquare B-28, Bandung
Functions involved
Why difficult
The challenge
What you need
Healthcare industry
Healthcare is the most changing and most regulated industry
Hospital operations covers large function compare to other
Hospital are getting smaller and specialised.
Shortage of skilled employees.
Technology is advancing rapidly.
Information systems infrastructure is a growing focus.
The difference of operations and strategic

Operational Management Strategic Management

Day-to-day or short-term Medium to long-term

Task or departmental level Organizational level

Complete task or project Provide direction of organization

Concerned with detailed actions Concerned with broad actions

For supervisor and junior managers For directors and senior managers
Operational management
Applying managerial functions (POAC) to day to day activities.
The management of the efficient transformation of inputs into
outputs to effectively satisfy customers.
Input Process Output

Doctors Examination Healthy

Nurses patient

Management of any activities/process that create good and or

provide services.
Issues in Hospital Management
Masterplan strategic
Renovasi dan ekspansi strategic & operation
Program fungsi strategic & operation

Medical Equipment
Alat canggih faktor competitiveness strategic & operation

Interior & Furniture:

Seperti hotel strategic & operation
Issues in Hospital Management
Visi Misi Nilai-nilai - Strategi strategic
Human Resource management strategic & operation
Hospital Culture strategic & operation
Quality Management strategic & operation
Financial Management strategic & operation
Leadership strategic & operation
Hospital marketing strategic & operation
Reorganisation strategic
Networking National/ International strategic & operation
Hospital Information System strategic & operation
Issues in hospital operations.
Revenue cost
P4P (pay for performance) incentives for better outcome.
EBM (evidence based medicine) scientific validation of procedures.
Bundling packages, insurance
Never events will not be reimburse for unnecessary procedures or avoidable error.
Shortage of doctors and nurses how to manage
Managing decentralized facilities COEs.
Resource tracking and management consumables inventory and amount, capital equipment
location and utilization.
Improve operational efficiencies flow, processes, scheduling, wait time.
Cost of advancing technologies expensive technology becoming expectation of patient,
physician and employee.
Government regulation and policies JSN.
Objectives in operational
Enhancement for effectiveness and efficiencies.
Effective doing the right things the results.
Efficient doing things right the process.
Productivity improvement.
Quality control.
Operations management in services
are more difficult.
How to match supply with
Supply wait for demand under utilize.
Demand wait for supply unsatisfied customer.
Emergency room (supply: medical service, demand: urgent need
for medical services).
Demand > supply crowding and delay, potential lost of patient.
Supply > demand doctors, nurses, infrastructure under utilized.
Mastering POAC framework is the foundation
of day to day management.
POAC is basic managerial functions

Planning create detail action

plan to complete a task or a
Organizing allocate the
necessary resources to complete
the outlined actions.
Controlling Organizing
Actuating influence people to
complete the detail action plan
with the allocated resources.

Actuating Controlling Measure the

accomplishment against the
target and correct deviation.
Planning is the foundation of management.
First element of POAC Planning process
1. Set goals and see clearly what you
Planning want to accomplish.

2. Turn the goals into key stages, or

broad actions.
Controlling Organizing
3. Specify the time to complete each

4. Break the key stages into smaller
more managements steps.

Planning can be simple or 5. Specify the time to complete each

complex step.

Prepare dinner Host Olympic game

Have a clear vision of the goal or outcome you
want to achieve.
Goal is a purpose which you
want to pursuit.

Goal is different to dream:

Dream is a fantasy, something you
only think about.

Goal is something that you take

steps in obtaining.

For example:
Dream saya ingin punya jaringan
RS di seluruh Asia Tenggara

Goal saya ingin dirikan 1 RS tiap

2 tahun sampai jadi 10 RS di Jabar
Your goal needs to be SMART for you to achieve it.
Practical Management Tool Goal: To become the next president
of Indonesia.

S Specific Is this goal SMART?

M Measurable

A Achievable

R Realistic

T Time-bound
Think of the key stages of getting from where
you are to where you want to be.
Your current position is the starting
point of the journey.
Your SMART goal is the destination of
the journey.
Key stages are major points joining
the two ends.
Use experience and/or logic to
identify the key stages.
Think in broad terms; focusing on
details now may confuse you.
Simple goal has few key stages,
complex goal has many.
Better to have some stages than
none; you can adjust later.
Estimate how long it would take to complete
each key stage.
Use experience and/or logic to create
the time estimates for each stage.
It is better to have rough estimates
than none at all.
Sum of estimates is the expected
time required to achieve the goal.
Compare the estimated time to
completion with your goal.
Make appropriate adjustments if
Organizing is making available the resources
required to undertake each step of the plan.
Second element of POAC Three components to consider


Controlling Organizing


Organizing is based on the work that

you did in planning.
It is relatively straight forward if you
have detailed steps in your plan.
Manpower is the software required to
complete the steps in a plan.
For each step outlined in your plan,
you need to:
1. Identify duties and authorities
of the people required to
complete the step.
2. Determine the required skill and
experience of these people.
3. Decide on the number of
people needed to complete a
4. Ascertain the availability of such
people within your organization.
5. Identify method to acquire such
people externally.
6. Specify the person(s)
responsible for the step.
Tools are the hardware required to
complete the steps in a plan.
For each step outlined in your plan,
you need to:
1. Identify the hardware required
for each step, such as tools,
equipment and place.
2. Check the availability of the
identified hardware within your
3. Determine how to obtain the
identified hardware externally if
4. Consider the skills needed to
operate or utilize the identified
Budget is the amount of money required to
complete the steps in a plan.
For each step outlined in your plan,
you need to:
1. Determine the availability of
funds to realize the goal.
2. Estimate the cost required to
complete each step such as:
Hiring and training of staff
Purchasing of equipment
Payment for services rendered

3. Calculate the expected cost to

complete all steps.
4. Compare the expected cost
with the allocation.
5. Make adjustments where
Tips for organizing the resources.
Delegate each step to one person.
Select the right person for the step.
Delegate responsibility and authority.
Actuating is influencing the people to
complete the steps of the plan.
Third element of POAC Components of actuating


Controlling Organizing

Actuating is the implementation
of your plan.
It is very hands-on requiring lots
of interaction with people.
Take a communication quiz.

Think of an important conversation that you had recently:

1. Did I prepare ahead for the conversation?
2. Did I think about the best way to approach the person?
3. Was I take note and mirror the persons communication style?
4. Did I pay full attention, without multitasking, to the other person?
5. Was my intention to discuss rather than to be right?
6. Did I listen without interruption, even if I did not agree?
7. If I asked the person to take action, was my request clear and concise?
8. Did I summarize what I thought I heard before expressing my view?
9. Did I follow-up to see if the conversation was successful?
10. If the outcome did not meet my expectation, did I think how to improve?
Communication is active interaction between
two people.

Role switches throughout the


Sender Receiver
Preparation is very important for good

Practical management tool

1. Know yourself
What is the intention?
What are the role and relationship?
What are our feelings and attitude?
2. Know the other person
Expectation from communication
Knowledge and capacity
Vocabulary, interest and personality
3. Tailor your communication
Use appropriate vocabulary
Mirror the other person
4. Communicate assertively
Fully express your ideas and interest
Have energy and be firm
Balance sending and receiving
We have two ears and one mouth; listen twice
as much as you speak.

To give something to the other person.

Give Example: respect, interest, care or consideration

To receive something from the other person.

Receive Example: information or guidance

To create an outcome
Outcome Example: change attitude or solve a dispute
You need good listening skills to achieve the
listening purposes.
Listening blocks can prevent you Example of listening blocks:
from achieving listening purposes. Jumping to conclusion
Thinking of solution prematurely
Making judgment about the person
Stereotyping the person
Worrying about your interest
Filtering what is important to you

Listening blocks categories:

1. Evaluation premature evaluation of
the other persons communication.
2. Attribution limited or skewed
perception of the other person.
3. Defensiveness feeling threatened
by the other person.
There are many ways to unblock you listening.

Practical management tool

1. Determine if it is your priority
to listen.
2. Make the commitment to
listen to the other person.
3. Identify the outcome you want
to achieve from listening.
4. Understand from the other
persons mindset.
5. Manage behavior to support
6. Be aware of listening blocks
and unblock your listening.
As a manager, you should spend most of your
time supervising your subordinates.
Supervising is observe and direct the
work of your subordinates.
Communicating 1. Give overview of the plan:
Key stages
2. Explain responsibilities:
Supervising Tasks to be done
Time to complete
Expected result
3. Conduct progress meetings:
Motivating Daily catch-up
Weekly formal meetings
4. Overcome obstacles:
Leading Time
Tips for becoming a good supervisor

Be fair to everyone
Know your subordinates
Give simple direction
Confirm subordinates understanding
Provide regular feedback
Do not take over assigned task
Maintain open line of communication
Reward good performance
Defend your subordinates
Managers can use motivation to bring the
loss souls back on track.

Motivating is stimulating interest or

Communicating enthusiasm to doing something.



Performance of a motivated staff is better
than an unmotivated one.

Performance Equity Effort

Intrinsic Value of reward



Which one is more powerful, intrinsic or extrinsic motivation?

As a manager, which one should you use to motivate your subordinates?
Doing something for the external reward.
A person will do a task even he has no interest in because he wants the external
motivation reward.

Intrinsic Doing something because it is inherently interesting or enjoyable.

motivation A person will do a task even if he does not receive any external reward.
There are many ways to motivate people.

Practical management tool

Hire the right person.
Be a good supervisor.
Show appreciation with:
Employee recognition awards
Bonus system

Know what motivate your

subordinates, their buttons.
Press their buttons at the
appropriate times.
Transfer people to right job
Managers can use motivation to bring the
loss souls back on track.
Leading is influence a group of
people or an organization.



Different researchers have coined different
terms to different leadership styles.
Examples of leadership style
Task oriented
People oriented

There is no best leadership style,

only appropriate.
Appropriateness depends on the
need of the organization.
We use the Myer Briggs Test to determine
your leadership style.

Myer Briggs test classify people The 16 personality types are

into 16 personality types. grouped into 8 leadership styles.
Q1: Do you prefer outward interactions or
inward thoughts?
Extraverted (E) Introverted (I)
Act first, think/reflect later. Think/reflect first, then act.
Feel deprived when cutoff from Regularly require "private time"
the outside world. to recharge batteries.
Usually motivated by outside Mind is sometimes so active it is
world of people and things. "closed" to outside world.
Enjoy wide variety and change in Prefer one-to-one talks and
people relationships. relationships.
Q2: Do you notice in detail or in patterns?

Sensing (S) Intuitive (N)

Mentally live in now, attend to Mentally live in the future,
present opportunities. attending to future possibilities.
Use common sense and create Use imagination and create new
practical solutions. possibilities.
Remember fact and past events Remember patterns, context and
in rich detail. connections.
Like clear and concrete Like ambiguous, fuzzy data and
information. guessing meaning.
Q3: Are you decisions more based on facts
or likes/dislikes?
Thinking (T) Feeling (F)
Search for facts and logic in a Search for personal feelings in a
decision situation. decision situation.
Naturally notices tasks and work Naturally sensitive to people
to be done. needs and reaction.
Provide objective and critical Seek consensus and popular
analysis. opinions.
See conflict as a natural part of So conflict as something to be
relationship with people. avoided.
Q4: Do you prefer a planned or an adapting
approach when dealing people?
Judging (J) Perceiving (P)
Plan before taking action. Take action without a plan.
Focus on completing one task Focus on doing many things at
before moving on. the same time.
Able to keep ahead of deadlines. Work best close to deadlines.
Prefer routines, targets and dates Prefer flexibility, freedom and
to manage life. variety in life.
Myer Briggs leadership styles.
Leadership style Personality types Description

Participative ESFJ/ENFJ People-oriented, motivator, builds personal relationships, likeable,

interpersonal skills, cares for others

Ideological ISFP/INFP Value-driven, has passion for key issues, focuses on important themes,
champions the cause

Change oriented ENTP/ENFP Tries things that are new, prototypes, introduces change, looks for
unexpected outcomes, creates new opportunities, experiments

Visionary INTJ/INFJ Develops long term vision, produces radical ideas, foresees the future,
anticipates what is outside current knowledge

Action oriented ESTP/ESFP Takes action, produces results, leads from the front, sets an example,
does what is asked of others

Goal oriented ISTJ/ISFJ Observes, listens, clarifies goals, establishes realistic expectations, makes
aims crystal clear

Executive ESTJ/ENTJ Organises, makes plans, sets measurable goals, coordinates work of
different people, manages resources

Theorist ISTP/INTP Analyses, uses models, produces explanations, compares other

situations, engages in intellectual debate
When to use and when not to use each
leadership style.
Leadership style When to use When not to use

Participative Commitment from others is critical, or Decisions need to be forced through, conflict is
sensitive situations being avoided

Ideological The group has lost its identity, or doing too There is a problem that needs to be solved with
many unimportant things dispassionate objectivity

Change oriented The group is 'stuck in a rut', or the status There are already too many initiatives under way
quo needs to be challenged and some stability is needed

Visionary Radical change is needed, change is a long There are immediate dangers, the group may not
term activity survive in the short term

Action oriented The lack of achievement has destroyed The group is being too expedient, current success
motivation may ebb in the future

Goal oriented The direction is vague or expectations have There are already too many goals or too much
not been articulated information

Executive There is lack of organization, or there are no There are so many processes that creativity has
measures of achievement been stifled

Theorist The situation is complex or driven by People's feelings are paramount, or the group go
technical solutions round in circular arguments
Controlling is measuring the accomplishment
against the standard and correct deviation.
Forth element of POAC Controlling process

1. Set expected performance

2. Determine actual performance
Planning 3. Compare expected with actual
4. Take corrective action if needed

The first three tasks are is actually

Controlling Organizing part of actuating.
Set expectations and monitor
progress are done at meetings
To take corrective actions, you need
Actuating Identify the cause of problems
Create solution to solve the problems
A manager can use 5 why to find the root
course of a problem by himself.

Practical management tool


Why? Why?

Why? Why?
A manager can use the 6 thinking hats to
problem solving in a group.
Developed by Dr. Edward De Bono in 1985.
Group decision making tool that is fast, smart and efficient.

Process Benefits
Blue What is our agenda?
What is our decision?
Yellow What are the benefits?
What makes idea attractive?

Facts and information

What information is
White available? Black What could be the problem?
What could be difficult?
What information we need?

Creativity Feeling
Green What are the alternatives?
How to make it better?
Red What are my feelings?
What does my gut tell me?
A manager can use the 6 thinking hats to
problem solving in a group.

Practical management tool

Everyone must wear the same
hat at the same time.
Everyone must participate,
irrespective of personal
No right order to use the hats;
our suggestion is:
1. White
2. Green
3. Red
4. Yellow
5. Black
6. Blue
Cyclethrough the hats until
satisfactory outcome is reached.