Framework on Managing Hospital Departments

Short Course on Hospital Organization and Management of Selected Clinical, Ancillary, and Support Departments

Nov. 17 – 21, 2008

College of Public Health

University of the Philippines Manila

Department of Surgery

OR-RR

ER Complex

8:30 – 11:45; Nov 18, 2008

Reynaldo O. Joson, MD, MHA, MHPEd, MS Surg

Head, Corporate Planning Office

Manila Doctors Hospital

A Framework in Managing and Leading a Hospital Department

Greetings!

In this short course of Hospital Organization and Management of Selected Clinical, Ancillary, and Support Departments, I was assigned to handle three departments, namely, Department of Surgery; Emergency Room Complex; and Operating Room and Recovery Room.

These three departments are considered clinical departments (and not ancillary and support departments) on the basis that they are directly involved in patient management and treatment. [In contrast, “ancillary” departments are primarily involved in diagnostic procedures while “support” departments are more involved in the non-medical aspects of patient care management but which are also important in a total care setting such as housekeeping and facility.]

We have the whole morning to tackle these three departments.

To facilitate maximal and efficient teaching and learning, I made this instructional plan which I am presenting for your information as well as for your approval.

When I made an instructional plan, I always consider first the type of learners that I will be dealing with.

I understand that all of you are either bona fide heads, administrators, managers or heads-, administrators-, managers-to-be, either of a hospital or a department, either in government and private hospitals, who want to be updated and who want to learn the framework and the essential approaches in effectively and efficiently organizing and managing hospital departments.

For today, you want to be updated and want to learn the framework and the essential approaches in effectively and efficiently organizing and managing the Department of Surgery; Operating –Recovery Room; and Emergency Room Complex.

I formulated two questions which I think will try to bring out the expected outputs of my sessions.

Question 1:

If I am the chief of hospital / hospital administrator / senior manager (I here refers to you), what essential competencies do I need to have to be able to ensure that my various departments (cases in point: Department of Surgery, OR-RR, ER Complex) are being adminstered properly by my middle managers?

Who are the chiefs of hospital / senior managers here? Is this question valid and applicable to you?

Question 2:

If I am the head of a department (cases in point: Department of Surgery, OR-RR, ER Complex), what essential competencies do I need to have to be able to ensure that my department is being properly managed?

Who are now heads or future heads of these three departments here?

Is this question valid and applicable to you?

So, are these two questions appropriately framed to bring out our ultimate outputs or terminal learning objectives in my sessions this morning?

If yes, allow me to present to you my proposed general and specific learning objectives.

General Learning Objective:

To acquire the requisite information on the framework and essential approaches in managing a department (specifically, Department of Surgery, OR-RR, ER Complex).

Specific Learning Objectives:

At the end of the session, the participant should be able to:

1. Discuss the roles and responsibilities of a head (both at hospital and department level) in directing and coordinating various departments and the services and activities within the departments. (cases in point: Department of Surgery, OR-RR, ER Complex).

2. Relate the goals and objectives of a department (cases in point: Department of Surgery, OR-RR, ER Complex) to those of the hospital.

3. Describe the roles and relationships of the various departments (cases in point: Department of Surgery, OR-RR, ER Complex).

4. Identify the organizational and operational requirements of a department of a hospital (specifically, Department of Surgery, OR-RR, ER Complex) in terms of philosophy, objectives, structure, staffing, operating policies and procedures, programs, and resources.

5. Identify common problems in the management of a department (specifically, Department of Surgery, OR-RR, ER Complex) and the commonly used approaches in controlling them.

Are these objectives acceptable to you? Do you want to add more objectives?

Before I go to my presentation proper, I like to declare as early as now, that the scope and intensity of the information that I will impart will be limited to concepts, principles, frameworks, and general processes. I will NOT go to too much details.

Let’s first assume all of you are chiefs of hospital.

If you are the chief of a hospital with several departments, which include Department of Surgery, OR-RR, and ER complex, what essential competencies do you need to have to be able to ensure that these departments are being administered properly by their respective heads?

First essential competencies needed by chiefs of hospitals are leadership and managership.

There is a difference between leadership and managership. There is a difference between a chief of hospital being a manager and being a leader.

Some differences between managers and leaders are the following:

Managers are people who do things right and leaders are people who do the right thing.

· The manager focuses on systems and structure; the leader focuses on people.

· The manager maintains; the leader develops.

· The manager administers; the leader innovates.

· The manager relies on control; the leader inspires trust.

Managers are preoccupied with activities of mastering routines (efficiency) while leaders are preoccupied with vision and judgment (effectiveness).

Management is a process of resource allocation while leadership is a human process.

Management is...	Leadership is....
Coping with complexity	Coping with and promoting change
Planning and Budgeting	Setting a Direction
Organizing and Staffing	Aligning People
Controlling and Problem Solving	Motivating and Inspiring People
Effective Action	Meaningful Action

Although there is a difference between leadership and managership, both are necessary and important. Though leadership is a higher level competency, managership is a prerequisite to leadership. One cannot be a good leader without being a good manager. All first-class managers are considered good leaders.

Please take note of the difference between leadership and managership. Aspire to be both, initially a manager then a leader.

Please remember that both are necessary and important to ensure successful management of a hospital and its departments.

Second essential competency needed by a chief of hospital is possession of knowledge and behavior related to the following:

Hospital-wide or Global Philosophy (Line of Thinking)

The hospital is the macrosystem while the units (clinical, ancillary and support departments) are the subsystems.

The vision-mission-goal-objectives of the macrosystem (the hospital) should be cascaded into and imbibed by the subsystems (units) to produce an organization with compatible, integrated, and unified elements or units.

Corollary to this, all units should be working towards the vision-mission-goal-objectives of the macrosystem (hospital).

Basically and universally, the vision-mission-goal-objectives of the hospital is rendering quality health care service while maintaining financial viability and sustainability.

The different units in the hospital should be systematically organized not only to accomplish their expected roles and responsibilities but also to interface with each other for reasons of integration, coordination and collaboration which will contribute to effectiveness and efficiency not only for the units but also for the hospital as a whole.

Third essential competency needed by a chief of hospital is possession of essential information on operations of the different departments starting with their functions and based on the functions, the structure including equipment, staffing, policies and procedures, programs and resources required for a successful operation and the problems commonly encountered together with known effective corrective and preventive action plans. Knowing the essential information on operations can facilitate organization and management of the different departments by the chief of hospital. It can facilitate his exercise of managership and leadership.

Department	Functions	Structure (Equipment)	Stafffing	Policies and Procedures	Programs	Resources	Problems and Solutions
Surgery
OR - RR
ER
ICU-CCU- Special Care Unit
OPD

Any questions so far on the essential competencies needed by a chief of a hospital?

Now, if you are head of a department or future head of a department, say, Department of Surgery, OR-RR, ER Complex, or any other department, what essential competencies do you need to have to be able to ensure that your department is being properly managed?

First essential competencies are still leadership and managership (same as in the case of chiefs of hospitals).

Second competency needed by a department head is possession of knowledge and behavior related to following:

Unit Philosophy (Line of Thinking)

	Philosophy to be adopted by unit manager.
	Although my unit is unique, it is still part of the hospital. Under my stewardship, my unit should deliver quality services expected of my unit specialty contributing towards hospital stability and sustainability (making my unit financially viable and sustainable). My unit should be collaborating with other units towards the hospital’s vision-mission-goal-objectives.
Surgery
OR-RR
ER
ICU-CCU- Special Care Unit
OPD

Third essential competency needed by a department head is possession of essential information on operations of his department starting with its functions and based on the functions, the structure including equipment, staffing, policies and procedures, programs, and resources required for a successful operation and the problems commonly encountered together with known effective corrective and preventive action plans. Knowing the essential information on operations can facilitate organizing the different intradepartmental activites and management of the whole department by the head of unit. It can facilitate his exercise of managership and leadership.

Department	Functions	Structure (Equipment)	Stafffing	Policies and Procedures	Programs	Resources	Problems and Solutions
Surgery
OR - RR
ER
ICU-CCU- Special Care Unit
OPD

To be able to integrate, coordinate, collaborate with other units, it is also recommended that a head of a particular unit must have essential information on the operations of other units in the hospital, at the very least, the authorized functions, structure, staffing, policies and procedures, and programs.

Any questions on the essential competencies needed by a head of a department?

If none, can we say that we have somehow accomplished these three specific learning objectives that we agreed upon earlier? And do you agree this is a framework easy to remember and to use?

Specific Objectives:

2. Relate the goals and objectives of a department (cases in point: Department of Surgery, OR-RR, ER Complex) to those of the hospital.

3. Describe the roles and relationships of the various departments (cases in point: Department of Surgery, OR-RR, ER Complex).

Let’s now tackle the other two specific objectives:

5. Identify common problems in the management of a department (specifically, Department of Surgery, OR-RR, ER Complex) and the commonly used approaches in controlling them.

In tackling these two specific objectives, I will do this from the point of view of a department head rather than from the point of a view of a chief of hospital. In doing this, I will be forced to be more specific in my information sharing. Being more detailed, I believe, will benefit all of you, regardless of your position or position to be. The presentation may be long though.

NOTE:

We will tackle first Department of Surgery, then OR-RR, and then ER. These three topics will be tackled individually but using the framework that I presented above.