ROLE OF A HEALTH MANAGER AND TRENDS IN PAKISTAN

BY

DR.MUHAMMAD KASHIF
MBA Batch: SA-003, CP-2008 Enrolment No. DUHS/HM/0052/2008

SUPERVISOR

DR.SIRAJ UL SALKEEN
Assistant Professor, Medical Unit iii Civil Hospital, Karachi

A Research Project submitted to the Faculty of Health/Hospital/Pharmaceutical Management Of The Dow University of Health Sciences Institute of Health Management In partial fulfillment of the requirements For the degree of Master of Business Administration 21January / 2012

Acknowledgements 2 Abstract / Executive Summary3 MBA Batch: SA-003, CP-2008.........................................................................................1 Enrolment No. DUHS/HM/0052/2008...............................................................................1 DR.SIRAJ UL SALKEEN..........................................................................................1 ABSTRACT:...................................................................................................................5 1 Project Introduction.........................................................................................................6 0.1 Background of the study:...........................................................................................6 0.2 Purpose:......................................................................................................................7 0.3 Objectives of the study...............................................................................................7 0.4 Justification:...............................................................................................................7 0.5 Hypothesis..................................................................................................................8 0.6 Definition of key terms..............................................................................................8 LITERATURE REVIEW...................................................................................................9 0.7 Introduction................................................................................................................9 0.8 History of health management & role of managers ..................................................9 0.9 Recent practices and policies.....................................................................................9 1.10 Effective Concepts:...............................................................................................13 1 RESEARCH METHODOLGY......................................................................................13 1.1 Research Strategy.....................................................................................................13 1.2 Population:...............................................................................................................14 1.3 Research Instruments...............................................................................................14 1.4 Research setting:......................................................................................................14 1.5 Drafting Questionnaire:...........................................................................................14 1.5.1 Sampling:..........................................................................................................14 1.5.2 Sampling universe:............................................................................................15 1.5.3 Sampling technique:..........................................................................................15 2 DATA PRESENTATION AND ANALYSIS:...............................................................15 2.1 Data Collection and Procedure:...............................................................................15 2.2 Limitation of Study..................................................................................................15 2.3 Data Analysis Procedure..........................................................................................15 2.4 Survey findings & statistical analysis....................................................................16 2.5 Graphic illustration & conclusions of results:.........................................................16 2.5.1 Do you understand the need of separate manger at hospital ward?..................16 2.5.2 The poor outcome in health sector is mainly due to the ineffective delivery of services in hospital?...................................................................................................17 2.5.3 Do you think the person who has administrative degree is better manger for govt. Hospital? ..........................................................................................................18 2.5.4 Delay of patient care due to involvement of administration person?...............19 2.5.5 Working efficiency is increased after inducting of Health Manager?..............20 2.5.6 Delay of patient care due to involvement of clinical staff in administration?. .21 2.5.7 The poor outcome in health sector is mainly due to low spending on the health sector in Pakistan?......................................................................................................23 2.5.8 Ineffective delivery of health services at govt. hospital ward due to low capacity of occupancy?..............................................................................................24

2.5.9 Govt. Hospital Working Environment is Pleasant after Inducting of Ward Manager?....................................................................................................................25 2.5.10 Clinical Staff has a Responsibility for Assuring the Quality all Services of all Work Undertaken within the Hospital?.....................................................................26 2.5.11 Ineffective delivery of health services at govt. hospital ward due to high duty hours?.........................................................................................................................28 2.5.12 Ineffective delivery of health services due to involvement of non administrative person?...............................................................................................29 2.5.13 Ineffective delivery of health services due absenteeism of all type of staff is very high?...................................................................................................................30 Good Service relations ship between management & employees is very important for effective delivery of health...................................................................................31 2.5.15 Think if thing that by managing thing properly at wards, we can reduce cost of hospitalization?......................................................................................................32 2.5.16 Health manager effectively designed to meet the specific needs within the context of health promotion as well as treatment, prevention, and control of diseases?.....................................................................................................................33 2.5.17 Do you think health manager is a real person for communication with internal audiences of the hospital?..........................................................................................34 2.5.18 Do you think health manager is a real person for communication with external audiences of hospital?..................................................................................35 2.5.19 Do you understand introduction of health manager make more accountability at hospital or ward?....................................................................................................36 2.5.20 Are you a non-smoker?...................................................................................37 2.5.21 Do you think after inducting of health manager faster treatment and care from specialist staff is early?..............................................................................................38 2.5.22 Do you understand ineffective delivery of health facility due to shortage of staff at govt. hospital?................................................................................................39 2.5.23 Do you think hospital culture is very important for effective delivery of health services?..........................................................................................................40 2.5.24 Do you think ineffective delivery of health facility at govt. hospital due to involvement of physician, surgeon, nurse and professor in administrative matter?..41 2.5.25 Do you think involvement of the hospital physician, surgeon, nurse and professor is necessary for administrative matter?......................................................42 3 Summary & Recommendation.......................................................................................44 3.1 Findings....................................................................................................................44 3.2 Scope of a Manager.................................................................................................45 3.3 Conclusion...............................................................................................................45 3.4 Recommendations....................................................................................................46 3.5 Future research recommendations:..........................................................................46 4 Bibliography / References..............................................................................................47 4.1 Review of questionniare ........................................................................................51 4.2 DR. AQUIL AHMED KHAN ...........................................................................51 4.3 Enrolment No. DUHS/HM/0033/2008...................................................................51 4.4 MBA Batch: SA-003, CP-2008 .........................................................51 4.5 MR. Siraj Salekeen ..............................................................................................51

(SUPERVISOR) ...........................................................................................51 5 Structure of Research Report..........................................................................................54

Acknowledgement: The most valuable part of this project experience has been my contacts from health care department, and its related field staff. They shared their experiences and contributed with open mind and heart and without expectations that their participation would not necessarily benefit them in any ways. I feel very privileged to have been acquainted with these people and was able to share their views and reviews. My heartfelt regards to all those involved with me in this project and contributed a lot. My supervisor Dr. Siraj ul- Salkain deserve an extreme gratitude for his patience and showing confidence in my ability to complete what has been a long task. I would like to thank him for sharing his knowledge and taking such active interest in my work. I would also like to thank Mr.Siddique (director IHM), my kind teacher, Mr.Riaz Hussain Somro and Mr.sohail Pasha and specially my colleagues Dr.Aqeel Ahmed Khan for this support and encouragement and my family specially my nephew Engineer Waseem Akhter and Amen Akhter; without their support I wouldnt be able to complete this project. Above all I offer my thanks to my soul mate. Thank you for listening to my ideas and concerns and being there for me, always!

ABSTRACT:
Hospitals deal with the health of their patients. High-quality medical care relies on welltrained doctors and nurses and on high-class facilities and services. It also relies on a good Medical Manager in a hospital. However, it can be hard to access and present this information in an actionable format. Without Manager, the data collection and transformation processes are slow and it increase the time required to progress performance. To counter this, a Manager specializes in collecting data quickly, scrubbing it for accuracy, and produce levels that one can act upon. This relaxes employees from benchmark data compilation, and allows them to achieve more valuable tasks. The importance of a Health Manager cannot be ignored because health policies and planning in a country mostly depends on the correct and timely decisions to overcome various health issues. The fundamental goal of this research is to ensure that all health services meet the needs of our growing and ageing population through inducting a Health manager. There had been a need to develop and establish a health manager who is able to collect, process, analyze and provide feedback on all health related data. This also includes information on input, process and output indicators. Managers are emphasizing more to understand the culture and climate of their organization to enhance the effectiveness and productivity. This research is conducted particularly for those already working in hospital managers posts carrying managerial responsibility in different sectors of a hospital. The research was conducted in all stakeholder of the health sector through discussions, questionnaires and interviews with the experts in the relevant fields. These include Professors, Consultants, General physicians of government and non government hospitals, pharmaceutical industries, donor agencies and private sector specialists. The studies show that hospitals have their own specific indoor culture and the social responsibility stands as the salient characteristic. An extensive review of the literature on different subjects of health sector was conducted. They were based on the assessment of different reports and more than 100 performance indicators were scrutinized and then a survey was carried out in different areas of health sector. After assessing the role of a health manger in government hospitals, I have only focused on three dimensions which are as follows: clinical effectiveness, staff orientation and responsiveness & patient focus. Science of management applies not only to industry and commerce but to all fields of employment. Management fundamentals and principles are universal. They apply to all areas of human activities, though the techniques and procedures of their application may differ, depending on the nature of work to be performed. Thus, professional management is essential for all fields of human activity and hospitals are no exception.

The use of modern management techniques for the most favorable operation of resources is extensively accepted in our industry, but its use in the area of public health, especially hospital administration, has not had the same reception. The hospital managers files and correspondence will reflect the accomplishment of policy and also the hospitals day-today activities in so far as they need his or her direction.

Chapter # 01 1 Project Introduction

0.1 Background of the study:

Government run hospital services follow a wide variety of form, arising partly from the specialist temperament of their work and partly from the numbers of separate hospitals and other health care facilities that may exist within a country and their geographical distance both from each other and from the government. While all hospitals are subject to the health legislation in power in the country concerned, it is typical to find some decentralization of management responsibility. The model followed in a particular country or region will determine the specific legislative framework within which each hospital operates, the degree to which it match to civil service practice and the freedom enjoyed by hospital administrators to determine their own policies and measures. To efficiently deal with the health problems in Pakistan, numerous Policies emphasize on providing better health care services. Few of these include: Health related Millennium Development Goals, Medium Term Development Framework, Poverty Reduction Strategy Papers, National Health Policy and Vision 2030. In Spite of these policies, the health related problems in Pakistan are catastrophic and distrustful. The main reason is avoidance in focusing the root of problems and their solutions. Hospitals are considered as an extremely important and major unit of the health sector. A hospital is a complex organization that needs to deal with a large number of inpatients and outpatients on daily basis. It also has an important role in managing the burden of diseases (BOD) but unfortunately, hospitals are not playing this task effectively and the main reason is our failure to run hospitals in an organization like format. We have been unsuccessful in evaluating the role of a Health Manager among the managing, teaching and clinical cadre. In various countries there are also hospitals run by charitable or commercial organizations. Such hospitals are not subject to managerial control by a central government, although they are certainly subject to any overarching health legislation within the country. Some charitable hospitals may receive funding in one form or another and may agree to some form of accountability to the government in return. The

guidance provided in this research is primarily planned for government hospitals, but much of the information incorporated here will also be appropriate in other sectors. Minutes and records of major committees and of the governing body, if there is one, serve as the central record of the hospitals dealings. The hospital administrators files and correspondence will mirror the implementation of policy and also the hospitals dayto-day activities in so far as they need his direction.

0.2 Purpose: This research has three primary aims. These are 1. To launch the concept of hospital management and the framework within which hospital management programs operate 2. To elucidate the management of patients casenotes, including discussion of filing and numbering systems, arrangement of records and management of indexes 3. To outline the management of a range of other hospital records, including X-rays, specimens, patient registers, administrative and policy files, nursing records, pharmacy records and financial records. 0.3 Objectives of the study The objectives of the study are to: To identify the need of a health manager, its role in government hospitals and to highlight the strengths and weaknesses in the current system To review the present status of the Government hospitals as a management prospective in Karachi, Pakistan

0.4 Justification: The current study is, therefore, helpful in highlighting the: Assessing the role of a health manager in government hospitals Its role in developing and preparing the profile of a health manager Requirement of qualified health managers in government health organizations in Karachi, Pakistan. The study was thoughtful for understanding the need of a health manager at government hospitals in Karachi. These guidelines will create an understanding of different positions and will help people

to implement the strategic plans and bring desired changes. Along with that, it will also motivate employees; enhance the effectiveness and productivity without wasting much effort, time and resources.

0.5

Hypothesis

This paper explores a question regarding the role of a Health manager in Government Hospitals; whether a health manager incorporates for improvement in Government Hospitals or restricts it otherwise without wasting much efforts, time and resources? 0.6 Definition of key terms . Health: the condition of the body and the degree to which it is free from illness, or the state of being well. (Definition of health noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Hospital: a place where people who are ill or injured are treated and taken care of by doctors and nurses (Definition of hospital noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Disease: (an) illness of people, animals, plants, etc., caused by infection or a failure of health rather than by an accident (Definition of disease noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Ward: one of the parts or large rooms into which a hospital is divided, usually with beds for patients (Definition of ward noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Administration: the arrangements and tasks needed to control the operation of a plan or organization (Definition of Administration noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Manager: the person who is responsible for managing an organization (Definition of Manager noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press) Government: the group of people who officially control a country (Definition of Government noun from the Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press)

CHAPTER 2

LITERATURE REVIEW
0.7 Introduction A comprehensive review of literature, research materials, articles and evaluation reports are done to assess the existing situation and the policy debates. This include documents and reports available from better hospital services like Leeds, World Health Organization (WHO), United Nations Childrens Fund (UNICEF), Asian Development Bank (ADB), Centre for Poverty Reduction and Income Distribution (CRPRID), Poverty Reduction Strategy Papers (PRSP), Ministry of Health (Islamabad) and Mehbub ul Haq Human Development Centre. 0.8 History of health management & role of managers

Healthcare administration is an often overlooked, but extremely important, field in healthcare. The first thing that comes to mind when you think hospital is MD or Surgeon or Nurse, right? Well, the Healthcare Administrators are the ones who work behind the scenes, controlling your patient records, the inner politics of the hospital, the hospital finances, the administrative work, and more. They are like the Big Brothers of the healthcare industry, watching over the welfare of entire hospitals and healthcare facilities. You may have come across several various, interchangeable terms for this field, such as Healthcare Services, Healthcare Management, Health Services Administration and so forth. To clarify, they are interchangeable and synonymous. They all fall under the umbrella of Healthcare Administration. There are different titles because the job description and exact title of a Healthcare Administrator will differ based on the type of institution they run. For example, the healthcare manager of a hospital is called a Hospital Executive, whereas the manager of hospital information would be called a Health Information Manager. Up until the late 1800s, hospitals offered little to no real patient support for the sick, because there was simply not enough money nor knowledge of professional medical treatment. This all changed, however, with the innovations in medicine, anesthesia, modern surgery and medical tools in the earlier 20th century. Hospitals began to open their doors to the sick, prepped with the tools and knowledge to assist the ailing. Just between 1875 and 1925, the number of US hospitals grew from about 170 to over 7,000! As the number of hospitals grew, it became more and more apparent that there had to be some type of training program to prepare the individuals who were to manage and assume administrative responsibilities. Thus, the first modern day health systems management program was born in 1934 at the University of Chicago. 0.9 Recent practices and policies

Pakistan is in the middle of epidemiological transition where almost 40 percent of the total burden of disease (BOD) is accounted by infectious/communicable diseases. These

include diarrheal diseases, acute respiratory infections, malaria, tuberculosis, hepatitis B&C, and immedicable childhood diseases. Another 12 percent is due to reproductive health problems. Nutritional deficiencies particularly iron deficiency anemia, Vitamin-A deficiency, iodine deficiency disorders account for further 6 percent of the total BOD. Non-communicable diseases (NCD) caused by sedentary life styles, environmental pollution, unhealthy dietary habits, smoking etc include cardiovascular diseases, cerebrovascular accidents (hemiplegic), diabetes and cancers and they account for almost 10 percent of the BOD in Pakistan. With the increase in life expectancy, diseases/disabilities of the old age are also on a rise. These include eye problems, paralysis and bone diseases. The drug addiction problem is growing especially in the youth. There are approximately 5 million addicts out of which 50 percent are heroin addicts. The growing threat of injecting drug abusers poses a great challenge when one considers the hidden cases of HIV/AIDS and Hepatitis-C amongst the addict population [MTDF (200510)]. In Pakistan, the probability child mortality (less than five year age) is 101 per 1,000 live births with a life expectancy of around 62 years. Table 1 indicates some comparative health indicators. It can be seen that child mortality remains the major problem faced in Pakistan. In 2004, figures on immunization of children under 12-monthsage show that 33 percent did not get immunization against measles and 20 percent did not receive immunization against tuberculosis in Pakistan. The immunization includes treatment against tuberculosis, diphtheria, pertussis, tetanus, polio and measles. Immunization is the most cost-effective and highest-impact health intervention that reduces under-five child mortality, hospitalization and treatment costs in childhood [Pakistan MDG Report (2006)]. The internal administrative structure of hospitals in most Commonwealth countries is broadly derived from practice in the UK. The arrangements will differ from one country to another, and varying organizational practices will sometimes be found in different hospitals within the same geographical area. However, certain areas of homogeny can be acknowledged. Hospitals normally have one or more central administrative departments, dealing with policy, personnel, finance and domain matters, if responsibility for these issues has been assigned to the individual hospital. Hospitals will also deal with institutional services such as cleaning, catering and etc. Overall management duty for these services within the hospital, or within a group of hospitals, will normally rest with the hospital administrator, who may have a designation such as hospital secretary, general manager or chief executive. Where the hospital has its own governing body, efficient control over the majority of institutional matters may rest with that governing body. The administrator may perform as a driving force for the governing body, or the administrator may have substantial executive powers of his or her own. Where there is no governing body and the administrator has a direct link to a ministry or agency of central government, he is liable to have considerable powers and responsibilities.

There are also likely to various standing committees in the hospital. For example, there may be a principal medical committee to direct the hospitals management on clinical affairs. Many hospitals may have financial, establishment and general purposes committees. Moreover, ad-hoc committees may be established from time to time to look into particular issues of current interest. There are likely to be senior staff with certain executive powers. In addition to its administrative departments, the hospital will have a number of clinical departments, in which the mainstream of staff will be employed. The clinical departments may be under the power of the hospital administrator, or there may be a separate post, with a title such as Medical Superintendent, Medical Director, to whom the heads of the clinical departments account. However, senior medical staffs in many hospitals have substantial independence from the administrative command. The relationship of the medical director to the hospital administrator and to any governing body will also vary according to restricted situation. The nursing service will be under the control of a chief nurse. In-patients will be accommodated in wards, often divided by specialty. Each ward is likely to be managed by charge nurse, responsible to the chief nurse or to a subordinate. The working relationships between the chief nurse and the hospital administrator or medical director and between the ward sisters and the medical staff and heads of other departments will vary among between hospitals. The only common feature is that in almost every case they will confirm to be complex. The arrangements for out-patients may differ widely from one hospital to another. Many hospitals have specialist out-patient clinics, where the same patient may reattend for ongoing treatment over an extensive period. These clinics are usually supervised by consultants who are specialists in one or more fields. Other hospitals may merely have a general clinic, headed by a generalist, where patients without appointments are treated for relatively minor ailments. There can be an accident and emergency department or casualty department. The functions and relationships of the various out-patient departments within a hospital are generally matters of practice and convenience. In many countries, individual hospital departments benefit from a substantial degree of independence, with only insignificant supervision by the administrator or medical director. Some hospitals have lately adopted the American system of clinical directorates, in which more than a few wards and departments are grouped within a directorate with a clinical director exercising substantial authority over each of them. Hospitals that provide medical or nursing education or research facilities will have a further set of administrative structures for the management of these activities. Once again, broad dissimilarity in practice will be found. In some instances the medical or nursing school will be a primary part of the hospital, while in other cases it will be an administratively separate body or a faculty within a university, subject to the universitys governance. Where the school is not a part of the hospital, formal or informal working arrangements will be in place to permit educational activity to be synchronized with the care of patients.

The deteriorating condition of the government hospitals may have several reasons behind it; however, one of the greatest problems lies with the unequivocal usage of the manpower. Considering the situation of many private hospitals within and outside Pakistan, a huge difference is observed in the inside culture and norms of the hospitals despite the fact that the budget allocated to the health sector remains sufficient enough to observe reasonable changes. The main fault line is inability in assessing the role of a Health Manager. It is very inopportune that Hospital Administration is held responsible for performing tasks which otherwise could be laid down by Health managers which in turn could have helped the situation and management of Government Hospitals to be corrected. In addition, almost all comparative studies among different countries rank Pakistan quite low in public sector management, institutions and Governance. These reports originating from World Bank, Global Competitiveness Report of the World Economic Forum and other think tanks and institutions consistently rate Pakistan low on the World Banks CPIA (country policy and institutional assessment) score which is rated between 1-5. The score depends on the Performance; part of which regards to corruption and the quality of Governance. One typical organizational structure is shown below.

Figure 1: Typical Organizational Structure

1.10 Effective Concepts: Professional services of trained persons namely Hospital administrators/ managers have now become crucial to manage hospitals and medical facilities. It is the hospital administrators/ managers who manage hospitals, outpatient clinics, hospices, drug-abuse treatment centers etc. They would be responsible for overall patient care, education, research and community health care associated with the organization, and make sure that they be conventional to the rules of the Hospital. These people with the help of a group of assistants look after the managerial affairs i.e. plan, coordinate and direct the delivery of health services within a hospital. In early days, senior doctors used to carry out the role of a hospital manager. But now things have changed and the services of these qualified professionals are required for the even functioning of hospitals. The services of these professionals go a long way in making the hospital more fruitful, profitable and comfortable for the patients. The work of hospital managers, therefore, includes the recruitment and management of staff, the safeguarding of the hospital and of services other than medical services, accounts and finance, marketing and communications and security. Hospital managers work from the grounds of the hospital and need to be physically present in the hospital. They need to walk around the hospital and supervise the different services. They also need to maintain effective communications with the management and staff of all departments, doctors and medical specialists, Para-medical staff, health workers, and ensure the comfort of all patients A number of policies emphasize better health care service provisions in Pakistan. These include: Millennium Development Goals, Medium Term Development Framework, Poverty Reduction Strategy Papers and National Health Policy. In the following subsections, we shall discuss some salient features of these policy documents underlining health related strategies. CHAPTER 3 1 RESEARCH METHODOLGY

1.1 Research Strategy Data used in the current study has been taken from the following sources: Visits and surveys of various health sectors

Conducting discussion interviews with the experts in the relevant fields including professor, Consultant, pharmacists, General physicians, nurses, paramedical staff, government and non government hospital, donor agencies and private sector specialists Published and unpublished documents including government reports, peer review journals and other literature such as local journals are a source of information for this paper (secondary data).

1.2

Population: Data used in the current study has been taken from the following sources: Visits and surveys of various health sectors Conducting discussion interviews with the experts in the relevant fields including professor, Consultant, pharmacists, General physicians, nurses, paramedical staff, government and non government hospital, donor agencies and private sector specialists Published and unpublished documents including government reports, peer review journals and other literature such as local journals are a source of information for this paper (secondary data).

1.3 1.4

Research Instruments Survey Questionnaire (for primary data collection) Research setting: A methodological review of available literature was undertaken and data was collected for almost all health information systems currently present in Pakistans health sector. Most of the information is collected through questionnaires; therefore, we can easily say this research is quantitative in nature. Thirty three (33) samples were collected from different health organizations. These questionnaires were distributed to various groups of health sector that have different positions in health industry like administration, teaching, clinician and students. Seven variables were questioned viz. clinical effectiveness, staff orientation and responsiveness, patient focus, competitiveness, social responsibility, supportiveness and innovation. Hence, data is analyzed to find significant factors in different sectors. Results and discussions based on the above mentioned methodology are articulated in Section 6. Drafting Questionnaire: The questionnaire is considered as the most important aspect in a survey operation. Hence, it should be carefully constructed. Structured questionnaires consist of only fixed alternative questions. Such type of questionnaire is inexpensive to analysis and easy to administer. All questions are closed ended. 1.5.1 Sampling: It was divided into following parts:

1.5

Sampling universe: All interviewers are the sampling universe for the research. Sampling technique: Judgmental sampling: Sample was taken on a judgmental basis. The advantage of sampling are that it is cost effective, quicker and analysis are relatively easier. Sample size taken was 100 employees.

Chapter 4 2 2.1 DATA PRESENTATION AND ANALYSIS:

Data Collection and Procedure:

The task of data collection begins after the research problem has been defined and research design chalked out. While deciding the method of data collection for the study, the researcher should keep two types of data in mind viz. Primary and secondary data. Primary Data: The primary data are those, which are collected fresh and for the first time. Thus, it happens to be original in character. The primary data were collected through welldesigned and structured questionnaires based on the objectives. Secondary Data: The secondary data are those, which have already been collected by a third person and passed through statistical processes. The secondary data required for the research was collected through various newspapers and Internet.

2.2

Limitation of Study

The study was restricted to the Government Hospitals of Karachi only and other being the time as a constraint. 2.3 Data Analysis Procedure This is a primary type of descriptive research. It focuses on the managerial area of the government hospitals which unfortunately is a neglected one. A methodological review of available literature was undertaken and data was collected for almost all health information systems currently present in Karachi, Pakistans health sector. Most of the information is collected through questionnaires; therefore, we can easily say this research is quantitative in nature. Thirty three (33) samples were collected from different health organizations. These questionnaires were distributed to various groups of health sector that have different positions in health industry like administration, teaching, clinician and students. Seven variables were questioned viz.

clinical effectiveness, staff orientation and responsiveness, patient focus, competitiveness, social responsibility, supportiveness and innovation. Hence, data is analyzed to find significant factors in different sectors. Results and discussions based on the above mentioned methodology are articulated in Section 6.

2.4

Survey findings & statistical analysis In general, operations of a hospital need managerial personnel not only to ensure the sustainability but also to organize the tasks performed by the Staffs This research also aims to support hospitals in assessing their performance, analyzing their own results, and translating them into actions for improvement. This, in turn, will create an understanding of different managerial positions which ultimately will lead to enhance effectiveness and productivity without wasting much efforts, time and resources. The overall sample size was 35 different Health Care facilities. Statistical analysis of collected information has done by plotting bar charts representing various factors, the percentages of their variables and conclusion of results. 2.5 Graphic illustration & conclusions of results: 2.5.1 Observation: Table 3.1: Need of a separate Manager Factors Always Usually Sometimes Never No. of Respondent 17 11 5 2 Percentage of Respondent 48.57 31.43 14.29 5.71 Do you understand the need of separate manger at hospital ward?

Graph 3.1: Need of a separate Manager According to this graph, it is evident that almost 50% of the people understand the need of a separate manager in hospital wards while only a small percentage which barely reaches 10% think that need of a manager in hospital wards isnt required

2.5.2 Observation:

The poor outcome in health sector is mainly due to the ineffective delivery of services in hospital?

Table 3. 2: Ineffective Delivery Factors Always Usually Sometimes Never No. of Respondent 24 8 3 0 Percentage of Respondent 68.57 22.86 8.57 0.00

Graph3. 2: Ineffective Delivery As this graph shows, majority of people that is almost 68% believe that the poor outcome in health sector is mainly due to the ineffective delivery of services in hospital while only a small percentage thinks its not.

2.5.3 Do you think the person who has administrative

degree is better manger for govt. Hospital? Observation: Table 3.3: Administrative Degree Factors Always Usually Sometimes Never No. of Respondent 26 3 1 5 Percentage of Respondent 74.29 8.57 2.86 14.29

Graph 3.3: Administrative Degree As assumed, more than 74% of people who answered the query about the person who has administrative degree is better manger for govt. Hospital while 14% of people dont think it could be a requirement.

Delay of patient care due to involvement of administration person?

Observation: Table 3.4: Involvement of Administrative Person

Factors Always Usually Sometimes Never

No. of Respondent 5 12 3 15

Percentage of Respondent 14.29 34.29 8.57 42.86

Graph 3.4: Involvement of Administrative Person The opinion for this question varied since people who think (always, sometimes, usually) that delay of patient care due involvement of administration person sum up to be almost 42% equivalent to the number of people who think its not.

Working efficiency is increased after inducting of Health Manager?

Observation: Table 3. 5: Increase in Working Efficacy Factors Always Usually Sometimes Never No. of Respondent 15 13 3 4 Percentage of Respondent 42.86 37.14 8.57 11.43

Graph3. 5: Increase in Working Efficacy 42.8% people understand the importance of working efficacy which could be improved if only a manager is introduced into the current system; only 11.4 % of people think that cant happen. Delay of patient care due to involvement of clinical staff in administration?

Observation: Table 3.6: Clinical Staff in Administration Factors Always Usually Sometimes Never No. of Respondent 21 9 3 2 Percentage of Respondent 60.00 25.71 8.57 5.71

Graph 3.6: Clinical Staff in Administration A huge percentage of people (60%) understand that the delay of patient care due to involvement of clinical staff in administration outweighing only 5.7% of people who think thats not the case.

2.5.7

The poor outcome in health sector is mainly due to low spending on the health sector in Pakistan?

Observation: Table3.7: Spending on Health Sector Factors Always Usually Sometimes Never No. of Respondent 22 8 3 2 Percentage of Respondent 62.86 22.86 8.57 5.71

Graph 3.7: Spending on Health Sector 62.8% of people think that the poor outcome in health sector is mainly due to low spending on the health sector in Pakistan while only a minority of the people being interviewed believe that this is not the case, the percentage of which is 5.7% only.

2.5.8 Ineffective delivery of health services at govt. hospital ward due to low
capacity of occupancy?

Observation: Table 3.8: Low Capacity or Occupancy Reason Factors Always Usually Sometimes Never No. of Respondent 5 22 5 3 Percentage of Respondent 14.29 62.86 14.29 8.57

Graph 3.8: Low Capacity or Occupancy Reason The opinion did not vary to this graph as neither always nor did never percentage confirm to the opinion, however, more than 62% of people think usually the low capacity of occupancy maybe due to ineffective delievery of health services at govt, hospital ward.

2.5.9 Govt.

Hospital Working Environment Pleasant after Inducting of Ward Manager?

is

Observation: Table 3.9: Pleasant Environment in Hospitals Factors Always Usually Sometimes Never No. of Respondent 5 22 5 3 Percentage of Respondent 14.29 62.86 14.29 8.57

Graph 3.9: Pleasant Environment in Hospitals As assumed, 62.8% of people have the opinion that working environment is pleasant after inducting of ward manager while 9% of people believe thats not the case.

2.5.10 Clinical Staff has a Responsibility for Assuring

the Quality all Services of all Work Undertaken within the Hospital? Observation: Table 3.10: Quality Services Within Hospital

Factors Always Usually Sometimes Never

No. of Respondent 3 12 5 15

Percentage of Respondent 8.57 34.29 14.29 42.86

Graph 3.10: Quality Services Within Hospital Amongst the people the research was conducted almost 43% of people understand that clinical staff does not have a responsibility for assuring the quality all services of all work undertaken within the Hospital. However, a good majority of people also believe that always, usually, sometimes clinical staff bears the responsibility,

2.5.11 Ineffective delivery of health services at govt. hospital ward due to high duty hours? Observation: Table 3.11: High Duty Hours Factors Always Usually Sometimes Never No. of Respondent 8 19 3 5 Percentage of Respondent 22.86 54.29 8.57 14.29

Graph 3.11: High Duty Hours 54.2% of people think usually while 22.86% of people always think that ineffective delivery of health services at govt hospital ward due to high duty hours.

2.5.12 Ineffective delivery of health services due to involvement of non administrative person? Table 3.12: Health Services due to involvement of non administrative persons Always Usually Sometimes Never 7 19 2 7 20.00 54.29 5.71 20.00

Graph 3.12: Health Services due to involvement of non administrative persons 20% in this survey understand that ineffective delivery of health services isnt due to involvement of non administrative person while 54% of people think usually it is the case.

2.5.13 Ineffective delivery of health services due absenteeism of all type of staff is very high?

Table 3.13: Health Services due to absenteeism of staff Factors Always Usually Sometimes Never No. of Respondent 9 15 5 6 Percentage of Respondent 25.71 42.86 14.29 17.14

Graph 3.13: Health Services due to absenteeism of staff 42.8% of people do believe ineffective delivery of health services due absenteeism of all type of staff is very high while a good percentage of people 17.14% think its not the case.

2.5.14 Good Service relations ship between management & employees is very important for effective delivery of health.

Table 3.14: Management and Employees is very important for effective delivery of health services Factors Always Usually Sometimes Never No. of Respondent 12 13 5 5 Percentage of Respondent 34.29 37.14 14.29 14.29

Graph 3.14: Management and Employees is very important for effective delivery of health services Almost 73% of people believe always and usually that Good Service relations ship between management & employees is very important for effective delivery of However, 14.2% of people reject the opinion.

2.5.15 Think if thing that by managing thing properly at wards, we can reduce cost of hospitalization?

Table 3.15: Management at wards reduce cost of hospitalization Factors Always Usually Sometimes Never No. of Respondent 18 12 3 2 Percentage of Respondent 51.43 34.29 8.57 5.71

Graph 3.15: Management at wards reduce cost of hospitalization 54% of people think if thing that by managing thing properly at wards, we can reduce cost of hospitalization while a small number of people 5.7% believe we cant.

2.5.16 Health manager effectively designed to meet the specific needs within the context of health promotion as well as treatment, prevention, and control of diseases? Table 3.16: Health Promotion and treatment, prevention and control of disease Percentage of Factors No. of Respondent Respondent Always 21 60.00 Usually 8 22.86 Sometimes 4 11.43 Never 2 5.71

Graph 3.16: Health Promotion and treatment, prevention and control of disease 60% of people understand that it can only be a health manager who could meet the need within the context of health promotion, treatment, prevention and control of disease while only 5.7% they cant

2.5.17 Do you think health manager is a real person for communication with internal audiences of the hospital? Table 3.17: Means of Communication with External Environment Factors Always Usually Sometimes Never No. of Respondent 9 21 3 2 Percentage of Respondent 25.71 60.00 8.57 5.71

Graph 3.17: Means of Communication with External Environment 61% of the people who were interviewed think health manager is a real person for communication with internal audiences of the hospital while 5.7% think its not the duty of an administration.

2.5.18 Do you think health manager is a real person for communication with external audiences of hospital?

Table 3.18: Real person to communicate with external environment Factors Always Usually Sometimes Never No. of Respondent 7 22 4 2 Percentage of Respondent 20.00 62.86 11.43 5.71

Graph 3.18: Real person to communicate with external environement Almost 63% of people understand that manager is a real person for communication with external audiences of hospital while 5.7% of people dont agree with the question asked.

2.5.19 Do you understand introduction of health manager make more accountability at hospital or ward?

Table 3.19: Health manager makes hospital accountable Factors Always Usually Sometimes Never No. of Respondent 25 7 2 1 Percentage of Respondent 71.43 20.00 5.71 2.86

Graph 3.19: Health manager makes hospital accountable A huge number of people exceeding 71% believe that introduction of health manager make more accountability at hospital or ward while a small percentage i.e. 2.86% of people believe it doesnt make hospital accountable

2.5.20 Are you a non-smoker?

Table 3.20: Non Smoker Persons Factors Always Usually Sometimes Never No. of Respondent 15 4 12 4 Percentage of Respondent 42.86 11.43 34.29 11.43

Graph 3.20: Non Smoker Persons A good majority of people exceeding 65% believe always, : sometimes. And usually they are non smokers, contrary to 11% of people who regularly smoke.

2.5.21 Do you think after inducting of health manager faster treatment and care from specialist staff is early?

Table 3.21: Inducting of Health manager results in faster treatment Factors Always Usually Sometimes Never No. of Respondent 5 11 12 7 Percentage of Respondent 14.29 31.43 34.29 20.00

Graph 3.21: Inducting of Health manager results in faster treatment

14.29% of people think always contrary to 20% of people who think never. However, almost 66% of people usually and sometimes think that after inducting of health manager faster treatment and care from specialist staff is early

2.5.22 Do you understand ineffective delivery of health facility due to shortage of staff at govt. hospital? Table 3.22: Ineffective Delivery of Health Facility due to staff shortage Factors Always Usually Sometimes Never No. of Respondent 6 15 10 4 Percentage of Respondent 17.14 42.86 28.57 11.43

Graph 3.22: Ineffective Delivery of Health Facility due to staff shortage

17.14% of people think always, 42.86% of people think usually, 28.57% of people think :sometimes, while only 11.43% of people understand ineffective delivery of health facility due to shortage of staff at govt hospital

2.5.23 Do you think hospital culture is very important for effective delivery of health services? Table 3.23: Hospital Care important for health care delivery Factors Always Usually Sometimes Never No. of Respondent 9 15 6 5 Percentage of Respondent 25.71 42.86 17.14 14.29

Graph 3.23: Hospital Care important for health care delivery 14.29% of people think never while as per the data collected, 42.86% of people understand that hospital culture is very important for effective delivery of health services is required usually.

2.5.24 Do you think ineffective delivery of health facility at govt. hospital due to involvement of physician, surgeon, nurse and professor in administrative matter? Table 3.24: Ineffective Delivery due to involvement of Physicians, Surgeons Factors Always Usually Sometimes Never No. of Respondent 18 9 6 2 Percentage of Respondent 51.43 25.71 17.14 5.71

Graph 3.24: Ineffective Delivery due to involvement of Physicians, Surgeons A good majority of people i.e. 51.43% of people understand ineffective delivery of health facility at govt. hospital due to involvement of physician, surgeon, nurse and professor in

administrative matter while a small number of people 5.7% of people think its not the case.

2.5.25 Do you think involvement of the hospital physician, surgeon, nurse

and professor is necessary for administrative matter? Table 3.25: Physicians, surgeons necessary for Administrative Matters Factors Always Usually Sometimes Never No. of Respondent 3 6 21 5 Percentage of Respondent 8.57 17.14 60.00 14.29

Graph 3.25: Physicians, surgeons necessary for Administrative Matters

Contrary to 8.57% people who understand that involvement of the hospital physician, surgeon, nurse and professor is necessary for administrative purpose, a huge amount of people agree to the opinion only usually 17.145 and sometimes 60%.

Table 3.26 Number of Respondents and Results of the Questionnaire Satisfaction Level Strongly satisfied Satisfied Slightly satisfied Dissatisfied Strongly dissatisfied No. Of Respondents 72 18 2 6 2 Percentage 72 18 2 6 2

Table 3.27 Number of Questionnaires and Quantified Options Selected No of Questionnaires 34 Always 238 Usually 374 Sometime s 136 Never 78

400 350 300 250 200 150 100 50 0 Always Usually Sometime Never

Graph 3.26 Overall Results of Questions Answered

Chapter 5 3
3.1 Findings

Summary & Recommendation

The table above shows that 74.08% respondents potentially agreed to the need of a health manager at Government hospitals, while 16.46% responded for some times and only 09.44% of the responders are dissatisfied with need of a health manager in government hospitals. It can be interpreted that only 09.44% are not satisfied with the need of a manager, the number of which apparently isnt high. As this research elaborates the need of manager in Government Hospitals with enough supporting discussions, the crucial role of a manager becomes inevitable. Several questions were asked from the population we studied on. Most of them revolved around the management criteria of the Government hospitals and the changes that most doctors are eager to see in their respective hospitals. The workload which gets equally divided among persons concerned always turn out to be better then only one person dealing with it. Population that participated in the study understand the need of separate manger at hospital ward, the poor outcome in health sector is mainly due to the ineffective delivery of services in hospital, the person who has administrative degree is better manger for govt. Hospital, delay of patient care due involvement of administration person, working

efficiency is increased after inducting of manager, delay of patient care is due to involvement of clinical staff in administration, the poor outcome in health sector is mainly due to low spending on the health sector in Pakistan, think ineffective delivery of health services at Government hospital ward due to low capacity of occupancy, and health manager effectively designed to meet the specific needs within the context of health promotion as well as treatment, prevention, and control of diseases. 3.2 Scope of a Manager The scope of a manager is reasonably broad and far-reaching. Management functions and principles are worldwide. They apply to all areas of human activities, though the techniques and procedures of their function may fluctuate. It is imperative for profitseeking organizations as well as for non-profit organizations dealing with education, social services, sport and crisis management. So good and professional management is essential for all the fields of human activity, just the way it is for industrial organization or Government departments, and hospitals are obviously no exception. They also need good management for effective performance. However, in Pakistan, hospitals are run by persons not trained in the art of management. 3.3 Conclusion

Dr. Kainikkara, an Associate of the American College of Health Care Executives (ACHE) in the United States, says, "The individual requirements of medical experts may conflict with that of the hospital and with the resources available. This is where the hospital administration steps in, he explains. "A hospital administrator has to see that the hospital functions smoothly. He/she has to provide logistical support for the consultants," explains Dr. Kainikkara, who honed his managerial skills in hospital administration at the All-India Institute of Medical Sciences (AIIMS), New Delhi. AIIMS was one of the first to introduce a course in hospital administration. An administrator has to oversee the complete functioning of the hospital. From patientcare and financial planning to maintenance, marketing and, a hospital administrator's job covers miscellaneous areas of responsibilities that would require specialized skills in diverse areas. A hospital administrator is accountable to the owners or the board for all matters pertaining to the hospital. The conclusions drawn are based on the analysis and interpretation of the primary data through assessing the need and role of a health manager in government hospitals of Karachi From the analysis and interpretation, it is concluded that most of the respondent are satisfied with the need of a health manger in the Government hospitals and only a few responders and employees are not satisfied with need of manger in the hospitals which

are negligible in number. And similarly, in case of infrastructure most of the respondents are satisfied and a very small number of respondents are unsatisfied with the infrastructure of the Government hospitals. Therefore, we can conclude that the workplace and infrastructure of the Government Hospitals appear to be satisfactory. It is also concluded that about all the employees are satisfied with implementation of rules and responsibilities. Only some of them dont seem to be satisfied with the implementation of the rules and responsibilities in Government hospitals. Therefore, it explains that implementation of rule and responsibility is done fairly. 3.4 Recommendations

The structure and financing of hospitals are changing quickly. Future medical and health services managers must be equipped to deal with the incorporation of healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care. The suggestions are drawn from the analysis and observations. Some of the suggestions are given as under: Health is one of the neglected sectors in Pakistan. Reallocation of resources and reformulation of the health strategy that targets to benefit the disadvantaged groups, improves the health care system for the low income people and their access to medical services is the desired need of the time. By implementing better health policies, we can make a huge difference in the living standards of the poor. The government should invest in colleges and universities teaching Management to overcome the limited human capital in the health sector. Private sectors can play a vital role in this regard. The government should encourage the private sector to train and produce Health managers in Pakistan. Indeed, Diploma in programs like Health Administration (DHA) can be effective for Hospital administration; however, limited knowledge through short training can not overshadow the place of a professionally trained Managers. the private sector is playing a vital role in the health care service delivery in Pakistan. However, this sector needs to be regulated and monitored by ?

3.5

Future research recommendations:

The need for professionally qualified managers for managing hospitals has emerged as a new area of opportunities in the field of health care. Clinical managers have experience in a particular clinical area and, accordingly, have more specific responsibilities. Managers institute and implement strategies, objectives, and procedures for their departments; evaluate personnel and work quality; develop reports and tackle with finances; and coordinate activities with other managers.

Health information managers are responsible for the maintenance and security of all patient records. Recent regulations enacted by the Federal Government require that all healthcare providers maintain electronic patient records and that these records be secure. As a result, health information managers must keep up with current computer and software technology, as well as with legislative requirements. In group medical practices, managers work closely with general practitioner. While an office manager handles business dealings in small medical groups, leaving policy decisions to the physicians, larger groups usually employ a full-time administrator to help formulate business strategies and co-ordinate day to day business. A small group of physicians might employ one manager to run personnel matters, billing and collection, budgeting, planning, equipment outlays, and patient flow. A large practice of several physicians might have a chief manager and several assistants, each responsible for a different areas of expertise. A mutually reinforcing inter-sectoral HEALTH MANAGMENT agenda should be driven by forceful supporting will. The grouping of measures has to be synchronized with the health systems. A system for National Health accounts will have to be developed; this must leverage technology to enhance efficiency and promote greater transparency in health systems. The government should invest in HEALTH MANAGMENT colleges and UNIVERSITY to overcome the limited human capital in the health sector. Private sector can play a vital role in this regard as well. The government should encourage the private sector to train and produce HEALTH MANAGER in Pakistan.

Bibliography / References

A comprehensive review of literature, research materials, articles and evaluation reports is done to assess the existing situation and policy debate. This includes documents and reports available from: 1. Better hospital services for Leeds, 2. World Health Organization (WHO) 3. United Nations Childrens Fund (UNICEF) 4. Asian Development Bank (ADB) 5. Centre for Poverty Reduction and Income Distribution (CRPRID) 6. Poverty Reduction Strategy Papers (PRSP) 7. Ministry of Health (Islamabad) 8. Mehbub ul Haq Human Development Centre 9. Hyun, H. Son (2006) Assessing the Pro-poorness of the Government Fiscal policy in Thailand. International Poverty Center, UNDP. (Working Paper No.15.)

10. Pakistan, Government of (2004-05) Pakistan Social and Living Standards Measurement Survey (Round1), 2004-05. 11. Federal Bureau of Statistics. 12. Pakistan, Government of (2005-06) Economic Survey of Pakistan (200506). Islamabad: Finance Division, Economic Advisers Wing. 13. Planning CommissionUNDP (2005) Pakistan Millennium Development Goals Report (PMDGR) 14. Centre for Poverty Reduction and Income Distribution (CRPRID), Islamabad. 15. Managing Hospitals, The Hindu Newspaper online edition, Tuesday, Jun 08, 2004 http://www.healthcareadministration.com/healthcare-management-historical-background/ 16. http://dictionary.cambridge.org/dictionary/british/ (Online Cambridge Advanced Learner's Dictionary & Thesaurus Cambridge University Press)

Appendices
List of Abbreviations Govt. = Government No. = Number BOD= total burden of disease NCD= Non-communicable diseases WHO= World Health Organization UNICEF= United Nations Childrens Fund ADB= Asian Development Bank CRPRID= Centre for Poverty Reduction and Income Distribution PRSP= Poverty Reduction Strategy Papers List of Tables Table 3.1: Need of a separate Manager Table 3. 2: Ineffective Delivery Table 3.3: Administrative Degree Table 3.4: Involvement of Administrative Person Table 3. 5: Increase in Working Efficacy Table 3.6: Clinical Staff in Administration Table3.7: Spending on Health Sector Table 3.8: Low Capacity or Occupancy Reason Table 3.9: Pleasant Environment in Hospitals Table 3.10: Quality Services Within Hospital Table 3.11: High Duty Hours

Table 3.12: Health Services due to involvement of non administrative persons Table 3.13: Health Services due to absenteeism of staff Table 3.14: Management and Employees is very important for effective delivery of health services Table 3.15: Management at wards reduce cost of hospitalization Table 3.16: Health Promotion and treatment, prevention and control of disease Table 3.17: Means of Communication with External Environment Table 3.18: Real person to communicate with external environment Table 3.19: Health manager makes hospital accountable Table 3.20: Non Smoker Persons Table 3.21: Inducting of Health manager results in faster treatment Table 3.22: Ineffective Delivery of Health Facility due to staff shortage Table 3.23: Hospital Care important for health care delivery Table 3.24: Ineffective Delivery due to involvement of Physicians, Surgeons Table 3.25: Physicians, surgeons necessary for Administrative Matters Table 3.26 Number of Respondents and Results of the Questionnaire Table 3.27 Number of Questionnaires and Quantified Options Selected List of Figures Figure 1: Typical Organizational Structure List of Graphs: Graph 3.1: Need of a separate Manager Graph3. 2: Ineffective Delivery Graph 3.3: Administrative Degree Graph 3.4: Involvement of Administrative Person Graph3. 5: Increase in Working Efficacy Graph 3.6: Clinical Staff in Administration Graph 3.7: Spending on Health Sector Graph 3.8: Low Capacity or Occupancy Reason Graph 3.9: Pleasant Environment in Hospitals Graph 3.10: Quality Services within Hospital Graph 3.11: High Duty Hours Graph 3.12: Health Services due to involvement of non administrative persons Graph 3.13: Health Services due to absenteeism of staff Graph 3.14: Management and Employees is very important for effective delivery of health services Graph 3.15: Management at wards reduce cost of hospitalization Graph 3.16: Health Promotion and treatment, prevention and control of disease Graph 3.17: Means of Communication with External Environment Graph 3.18: Real person to communicate with external environment Graph 3.19: Health manager makes hospital accountable Graph 3.20: Non Smoker Persons Graph 3.21: Inducting of Health manager results in faster treatment

Graph 3.22: Ineffective Delivery of Health Facility due to staff shortage Graph 3.23: Hospital Care important for health care delivery Graph 3.24: Ineffective Delivery due to involvement of Physicians, Surgeons Graph 3.25: Physicians, surgeons necessary for Administrative Matters Meetings of author with supervisor (details of work done) (1)6th November, 2010, Saturday (at Medicall Hospital) Corrections and Guidelines for finalized Research Proposal (proposal submitted on 9/11/2010) (2)15th December, 2010, Wednesday (at Medicall Hospital) Discussed different variables for survey questionnaire. Provided guidelines for literature review, & explained thesis format. th (3)7 January, 2011, Friday (at Medicall Hospital) Checked and corrected questionnaire. Required modifications done. (4)10th February, 2011, Thursday (at Medicall Hospital) Discussed reviewed literature necessary modifications done and formed further pathway. th (5)14 March, 2011, Monday ( at Civil Hospital) Started preparation for thesis report specially literature review from various websites (6)29th March, 2011, Tuesday (at Medicall Hospital) Discussed format / structure of thesis report, with all detailed guidelines th (7)7 April, 2011, Wednesday (Medicall Hospital) Research report primarily restructured for the submission, corrections & additions advised (Report is going to be submitted after completion of final draft on Tuesday, 12th April, 2011) (8) 2nd June, 2011, Thursday (at Civil Hospital) Discussion about literature review (9) 12 July, 2011, Tuesday (at Medicall Hospital) Guidelines and checking of ongoing format of project (10) 6th August, 2011, Saturday (at Sind Institute) Last checking of project, some corrections and final advices discussed. (11) 16th September, 2011, Friday (at Civil Hospital) Completed research project given to supervisor for final checking (12) 28th September, 2011, Tuesday (at Civil Hospital) Full final draft returned to writer for final editing and submission on next day to IHM (13) 9th December, Friday (at Civil Hospital) Corrections of mistakes of final draft (14)18th December, Sunday (at supervisors home)

4.1Review of questionniare 4.2DR. AQUIL AHMED KHAN 4.3Enrolment No. DUHS/HM/0033/2008 4.4MBA Batch: SA-003, CP-2008 4.5 MR. Siraj Salekeen
(SUPERVISOR) Survey questionnaire Assigning of manager at government Hospital? Please answer each question by placing a tick in ONE of the 4 boxes. Then, add up the number of ticks in each column and score your questionnaire (see over the page). Finally, answer the how much need of manager at government Hospital? questions. Question
Do you understand the need of separate manger at hospital ward? Do you think The poor outcome in health sector is mainly due to the ineffective delivery of services in hospital? Do you think the person who has administrative degree is better manger for govt.Hospital? Do you think delay of patient care due involvement of administration person?
Do you think working efficiency is increased after inducting of manager?

Always

Usually

Sometimes

Never

Do you think delay of patient care due to involvement of clinical staff in administration? Do you think The poor outcome in health sector is mainly due to low spending on the health sector in Pakistan?
Do you think ineffective delivery of health services at govt hospital ward due to low capacity of occupancy? Do you think working environment is pleasant after inducting of ward manager? Do you understand clinical staff has a responsibility for assuring the quality all services of all work undertaken within the Hospital?

Do you think ineffective delivery of health services at govt hospital ward due to high duty hours?

Do you think ineffective delivery of health services due to involvement of non administrative person? Do you think ineffective delivery of health services due absenteeism of all type of
staff is very high? Good Service relations ship between management & employees is very important for effective delivery of health service?

Do you understand quality of care is improved Indore or outdoor patient after inducting of ward manager?
Is it right patient ratio of govt.hospital is very high?

Do you think if thing that by managing thing properly at wards, we can reduce cost of hospitalization? Do you understand health manager effectively designed to meet the specific needs within the context of health promotion as well as treatment, prevention, and control of diseases? Do you think health manager is a real person for communication with internal audiences of the hospital? Do you think health manager is a real person for communication with external audiences of hospital? Do you understand introduction of health manager make more accountability at hospital or ward? Are you a non-smoker?

Do you think after inducting of health manager faster treatment and care from specialist staff is early?
Do you understand ineffective delivery of health facility due to shortage of staff at govt hospital? Do you think hospital culture is very important for effective delivery of health services?

Do you think ineffective delivery of health facility at govt.hospital due to involvement of physician, surgeon, nurse and professor in administrative matter? Does u think involvement of the hospital physician, surgeon, nurse and professor is necessary for administrative matter?
TOTAL NUMBER OF TICKS IN EACH COLUMN

4.5.1.1
Assigning of manager at government Hospital?
You score: 4 points for each always response 3 points for each usually response 2 points for each sometimes response 1 point for each never response.

What do you Think and Know about Your (Govt) Hospital? What you know about your Hospital?

What do you suggest for betterment of govt.Hospital ward?

What have you done well on?

What have you not done as well on?

What you think about your (Govt) Hospital? Do you think you need to upgrade the setup of govt.hospital for effective delivery of health? If yes, in what ways? What do you think you can change easily in govt.hospital which is more effective?

Hospital plans

State 3 things (actions) you could do over the next 3 months to improve the effective delivery of services in govt hospital or ward?

What will help you to do these things (actions)?

What might stop you from doing these things (actions)?

How confident are you that you will be able to improve your Hospital and working style over the next 3 months? Not at all confident Fairly confident Very confident 1 ___________________________5______________________________ 10

5Structure of Research Report

Recommended Research Project Format Main Heading Size 14 bold (Example Chapter 2 Literature Review) 1 Headings Size 13 bold (Example 2.1 Introduction) 2 Heading Size 13 (not bold) (Example 2.1.1 Market Situation) Normal text font Size 12 Font Style Times New Roman Line space Single Size Minimum 5000 words Layout Justified Minimum Sitting with Supervisor Eight (8) Page size A4 Color Black Time Duration One semester (4 months)