Clipboard October 2009 - March 2010

A Quarterly Update on Management Issues from theAdministrators Section of the Christian Medical Association of India

ClipboardIssue 52 & 53 October 2009 - March 2010

Dear MembersDear MembersDear MembersDear MembersDear Members,,,,,

Biblespeak

Stephen Victor Secretary, Administrators' Section

[email protected]

Greetings from the Administrators Section of CMAI!

Some new developments have taken place since my last letter.The Ministry of New and Renewable Energy, Government ofIndia, has accepted our proposal to conduct awareness workshops

regarding implementation of alternate energy sources and energyefficiency measures in hospitals. They are also willing to considergenerous subsidies for hospitals which are willing to implement measures(ex utilisation of solar energy) in this financial year. If any hospital in ournetwork is interested, they should contact me immediately.

In this edition of Clipboard, I am presenting three excellentpresentations made during CMAI’s 40th Biennial Conference held atAurangabad, Maharashtra from 21-24 October 2009. They are listedbelow:1. Competency Approach to Human

Resources Management - Mr Samuel N J David

2. Professionalism Accuracy CourtesyTimelines (PACT) - Mr Sunny Kuruvilla

3. Resource mapping and scanning inplanning process for missionhospitals – A case study - Mr Augustine Aiyadurai

Please send in you comments and suggestions.

P urpose of our life – ‘theymay worship me’

“What do you have there in yourhand?” The Lord asked him. Andhe replied, “A shepherd’s rod.”Exodus 4:2God prompts us to do things thatare insignificant and common, andthings that have less or no value.Moses was told that when I amwith you even insignificant thingswill turn out to be significant.The agenda given to Moses is todeliver His people; remind themthat there is a God who is concerned,is eager to help them in trouble andto lead them into a relationshipwith Him.“Get up early in the morning,confront Pharaoh and say to him,‘This is what the LORD, the Godof the Hebrews, says: Let my peoplego, so that they may worship me.”Exodus 9:13-14It is a reminder that we willconstantly live as a testimony to Godand worship Him in the land/spacepromised to us.

"If you would hit the mark, you must aim a little above it.""If you would hit the mark, you must aim a little above it.""If you would hit the mark, you must aim a little above it.""If you would hit the mark, you must aim a little above it.""If you would hit the mark, you must aim a little above it."Henry Wadsworth Longfellow

Clipboard Issue 52 & 53

2

How do we rate the services of a hotel, a taxi, abank, a gas agency or any other serviceprovider? It might be in terms of the quality of

their service or the value of what we paid for. Ourrepeated visits to a service provider even when thereare other choices could be an indicator of the goodquality of their service. As providers of healthcare,hospitals are no different in this matter.Continuity of patients is important for the sustainabilityof a hospital. In their efforts to attract new patients,hospitals tend to improvise on technology,infrastructure and services. In this process, they arelikely to ignore existing patients. Retaining existingpatients has greater potential and is less expensivewhen compared to attracting new patients.It has been observed that most of the patient’scomplaints are regarding failures in Professionalism,Accuracy, Courtesy and Timeliness (PACT). Whocontrols these parameters? Directly or indirectly, theseare controlled by the healthcare staff!The ‘PACT framework’ (figure 1) is a model intendedto design and introduce systems in healthcareinstitutions to enable effectiveness in patient careservices.

PACT – A framework for excellence

ProfessionalismIn this context, professionalism is ‘adhering to the bestaccepted practice of the industry in every function ofa service area’. Professionalism brings a ‘systemapproach’ rather than an ad hoc way of functioning.

It demands SOPs (Standard Operating Practices) atfunctional levels. Continuous improvements throughfeedback and professional updating are also evidentin professionalism. Safety and confidentiality areclosely associated with it.

AccuracyAccuracy is error-free functioning. Right judgementsand right documentation result in accuracy. Accuracyis indicated by right diagnosis, appropriate tests,correct values and calculations.

CourtesyCourtesy is the experience of a patient in the hospitalin terms of politeness, respect, dignity and empathy.

TimelinessTimeliness is the ability of the organisation to value apatient’s time and to provide services accordingly. Thisis the responsibility of every employee in the healthcareorganisation.

PACT framework process1. First of all, the organisation should have a passion

for improving the quality of its services. This shouldbe reflected in its vision and mission statements.

2. In line with this, all departments should haveobjectives that can be achieved through theirfunctions at the departmental level.

3. This is where ‘PACT’ comes in. Each function ofthe department should be tied with professionalism,accuracy, courtesy and timeliness, as applicable.A few functions of the HR department are given asan example in Figure 2.

4. Once the department functions are developed basedon ‘PACT’, the effectiveness should be assessedperiodically through appropriate measures such as:-

Patient satisfaction survey/feedback

Performance appraisal

Exit interview with staff

Staff satisfaction survey

Suppliers feedback

Time studies

Medical and other types of audits

Quality checks – internal and external

Figure 1


3

5. Based on the assessment, if the ‘PACT’ score is found to be low, the following reinforcement measures canbe adopted:-

TrainingMotivationClose monitoringDeveloping accountability

6. This cycle should be an ongoing process as it focuses on the refining of staff and the systems, leading tocustomer satisfaction and eventually to excellence.

Ultimately, the patient determines the level of excellence of the hospital services. That’s probably why Gandhijisaid, “A customer is the most important visitor on our premises. He is not dependent on us. We are dependenton him. He is not an interruption in our work. He is the purpose of it. He is not an outsider in our business. He ispart of it. We are not doing him a favour by serving him. He is doing us a favour by giving us an opportunityto do so.”

Figure 2

Sunny KuruvillaHead – Administrative Services

Bangalore Baptist Hospital

PACT for HR departmentFunctions Assessment

methodology

HR budgeting:-Cadre positioningexercise inJanuary andAugust

Adherence toindustry’s practices,hospital’s policiesand SOPs

Error-free cadrepositioning;minutes for newapproval

January & August Audit of SOP,policies, cadreposition state-ment

Recruitment andselection :-

HR requisition

Advertisement

Test and interview

Appointment offer

Adherence toindustry’s practices,hospital’s policiesand SOPs

Error-free HRrequisition,advertisement,test and interviewscore, appoint-ment offer

Communicationon test andinterview; wellreceived forinterview;seating arrange-ment

Informing at leastthree days befo-re the interview;informing the re-sults on time;appointmentoffer / regretletter within fourdays of theinterview

Audit of SOP,policies, HRrequisition file,copy of adver-tisement,interview list,score sheet,appointment/regret letter

Audit of SOP,policies, wel-come letter, staffservice registerentry; first dayreception letter;orientationregisters andcheck list; staffsatisfactionsurvey

Orientation andinduction:-

First day receptionMedical check-upOrientationAppointment letter

Adherence to policyand SOPs, updatesof orientationmethodologies

Giving welcomeletter and em-ployee handbook;error-free salaryfixation andcalculation andappointmentterms

Welcoming andintroducing tothe hospital andto the concernedstaff

Hospital tourand medicalcheck-up on thefirst day; orienta-tion within aweek of joining;appointmentletter within fivedays of joining

Professionalism Accuracy Courtesy Timeliness


4

Introduction

Strategic planning is an organisation’s processof defining its strategy and making decisionson allocating resources effectively. To pursue

this strategy, various business analysis tools andtechniques can be used. The importance of strategicplanning exercise for mission hospitals lies in the factthat the health demands, community expectations,health awareness and resourcing keep changing at afast pace. The importance also lies in the burdenplaced on most mission hospitals to continue to meethealth demands, especially of the marginalised andlower/middle income groups.The mission hospital can develop strategies (throughstrategic planning exercises) for its services andcontinue to serve the target groups or succumb to thechanging environmental forces. This paper is anattempt to share the dynamics involved in strategicplanning.

Stages involvedAnticipated outcomes: The Administration should setout what it hopes to achieve through the strategicplanning process in the light of existing difficulties andemerging needs.Terms of reference: Based on the anticipatedoutcome, a clearly spelt out Terms of Reference (TOR)for the strategic planning group needs to be set.Strategic planning team: The identification of theteam that would undertake the strategic planningprocess should include external persons who havewider knowledge and experience in the different areasof the strategic planning process.Strategic concerns and priorities:

The Administration, through a participative process,should

Identify strategic concerns and prioritiesCrystallise strategic prioritiesDevelop a road map for the processSet the timeline

Resource Mapping and Scanning in StrategicPlanning Process for Mission Hospitals

by

Mr Augustine Aiyadurai and Dr Mannam Ebenezer

Resource MappingThe resource mapping exercise involves the gatheringof such information as would throw light on the currentstatus in relevant and identified areas like patient care,human resource, staff mix, financial details, researchpapers, training programme and infrastructure.

The issues to be kept in mind while developingresource mapping documents are:

1. Identification of areas in which the informationis to be collected

2. Identification of the right persons for the resourcemapping exercise

3. The extent to which the information is to becollected

4. Converting information into analysed and classifi-ed data that would be relevant to developmentof strategies

5. Use of statistical tools, trends, projections, regres-sion analysis etc, and interpretation of analyseddata

6. Consciously developing checks in resource map-ping that would avoid “bias” that can creep intoresource mapping

7. Analysis of financial statements in relation to thepatient statistics financial forecasts (ie relatingfinances with outputs and outcomes)

Environmental scanningEnvironmental scanning can include the externalenvironment as well as the internal environment:

The key factors in scanning are:

1. The scanning needs to be carried out in identifi-fied sections (ie targeted healthcare, other prior-ity health needs, administration, financial, spiri-tual, research, training etc)


5

2. Constitution of smaller groups/committees fromwithin the institution with inputs from expertsidentified in this area

3. Development of guidelines and boundaries, andtime frame for each group

4. Spelling out the non-negotiables5. Educating the groups on conducting exercises lead-

ing to:SWOT (Strength, Weakness, Opportunities,Threats analysis)PEST (Political, Economic, Social andTechnological analysis)STEER (Socio cultural, Technological,Economic, Ecological, Regulatory factors)

ConclusionResource mapping and scanning help in generatingthe information required, classifying the same,analysing and making it available to the strategicplanning team in such a manner that it enables anaccurate understanding of the prevailing status. Thematerial made available through resource mapping andscanning ensures that the strategic planning group ismore focused in its approach and have very littleopportunity to lose focus.Since the resource mapping and scanning is donemostly by personnel within the institution, with ‘externalexpert’ contribution, the acceptability of the strategicplanning outcome among the staff (who would beactually implementing it) would be higher.

Competency Approach to HumanResources Management

by

Mr Samuel N J David

Competency is defined as an underlyingcharacteristic of a person which enables him/her to deliver superior performance in a given

job, role or a situation.

Competency is a cluster of

KnowledgeSkillsAbilityAttitude

KSAA…

Knowledge describes a body of information,usually of a factual or procedural nature, applieddirectly to the performance of a function/task

Skill describes a present, observablecompetence to perform a learned act (could be motor,psycho-motor and/or cognitive).

Ability describes a general, more enduringcapability an individual possesses at the time whenhe/she begins to perform a task.

Attitude describes an internal state that influencesan individual’s choices or decisions to act in a certainway under particular circumstances.

Definition of Competency: Competency is acharacteristic of an employee that contributes tosuccessful job performance and the achievement oforganisational results. These include knowledge, skills,and abilities, plus other characteristics such as values,motivation, initiative, and self-control.


6

Basic information about CompetenciesCompetency is a critical tool in workforce andsuccession planning. At a minimum, it is a means toidentify the capabilities, attitudes, and attributes thatare needed to meet current and future staffing needsas organisational priorities and strategies shift. It isalso a means to focus employee development effortsto eliminate the gap between capabilities needed andthose available.

Classification of Competency• Basic competencies: These are inherent in allindividuals. Only their degree differs. For example,problem solving is a competency that exists in everyindividual but in varying degrees.• Professional competencies: These are over andabove the basic competencies, and are job related.For example, handling a sales call effectively is acompetency that a sales personnel would be requiredto have.It can be simply said that, Competencies = BasicCompetencies + Professional Competencies

Types of Basic Competencies1. Intellectual Competencies2. Motivational Competencies

Implications of competencies as a basis for HR

People have and getC O M P E T E N C EC O M P E T E N C EC O M P E T E N C EC O M P E T E N C EC O M P E T E N C E

(combination of knowledge, skills, attitude & ability)

Our behaviour producesO U T P U T SO U T P U T SO U T P U T SO U T P U T SO U T P U T S

(products and services)

How this is done yieldsR E S U L T SR E S U L T SR E S U L T SR E S U L T SR E S U L T S

(Criteria for managing the prior three steps)

We apply these in the form ofB E H A V I O U RB E H A V I O U RB E H A V I O U RB E H A V I O U RB E H A V I O U R

(actions, thoughts, feelings)

3. Emotional Competencies4. Social Competencies

Competency MappingCompetency mapping is a process of identifying thekey competencies for an organisation and/or job andincorporating those competencies throughout thevarious processes (ie job evaluation, training,recruitment) of the organisation. Through this process,one can assess and determine one’s strengths as anindividual worker and in some cases, as part of anorganisation. This also helps to analyse thecombination of strengths in different workers to producethe most effective teams and the highest quality work.The steps in competency mapping:

Step 1: To classify the competencies under the typesof competencies.Step 2: To determine the type of competency that isthe most critical for an organisation.Step 3: To determine the critical competencies thatare required for superior performance at a given levelin the organisation.Competency - Broad categories

Generic Competencies

Competencies which are considered essential for allemployees regardless of their function or levelcommunication, initiative, listening etc.

Managerial Competencies

Competencies which are considered essential foremployees with managerial or supervisoryresponsibility in any functional area, including directorsand senior posts, strategic thinking, scenario-building,change management etc.

CommunicationCreativityAnalytical abilityPlanning and organising

Social Competencies

TeamworkInterpersonal skillsResponsibilityCustomer satisfaction

Emotional Competencies

InitiativeOptimismSelf confidenceLeadershipManaging stressManaging change

Continuous learningPerseveranceAchievement orientationsTime management

Intellectual Competencies Motivational Competencies


7

Technical/Functional

Specific competencies which are considered essential to perform any job in the organisation within a definedtechnical or functional area of work. Eg. finance, environmental management, industrial process sectors, investmentmanagement, finance and administration, human resources management etc.As can be inferred from the above model, an organisation’s vision and mission gives direction through short/longterm goals and this leads to strategies. However, the vision and mission of an organisation would fail if thestrategies are made without understanding and evaluating the Competencies (Core Competency and RoleCompetency). In fact, Competencies may dictate the whole process and the feedback they give would determinethe direction of the organisation as shown by the upward arrows in the model shown below:

At every level in an organisation, different sets of competencies are required. A successful organisation is onewhich has the whole gamut of competencies in place and is effective in managing them in order to get their fullestadvantage.

CLIPBOARD GOES ELECTRONICCLIPBOARD GOES ELECTRONICCLIPBOARD GOES ELECTRONICCLIPBOARD GOES ELECTRONICCLIPBOARD GOES ELECTRONICHenceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.Henceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.Henceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.Henceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.Henceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.

ChristianMedicalAssociation ofIndia

Clipboard

Published by

The General SecretaryCMAI, Plot no. 2, A-3 LocalShopping Centre, JanakpuriNew Delhi 110 058Tel: (011) 2559 9991/2/3E-mail: [email protected]

[email protected]: www.cmai.org

CMAI Bangalore Office

HVS Court, 3rd Floor21 Cunningham RoadBangalore 560 052Tel: (080) 2220 5464, 2220 5837E-mail: [email protected]

Editorial Committee

Dr Vijay AruldasDr Jeyakumar DanielMr Innocent XessSr VijayaMr Samuel NJ DavidMr Edward DavidDr CAK YesudianMs Jaya Philips

EditorMr Stephen VictorEditorial CoordinatorMs Jaya PhilipsDesign & ProductionLata AnthonyPrinter: Seema Printing Press

A CMAI publication focussing on issuesrelated to hospital administration

In order to reach more people, we will be sending Clipboard only by emailfrom now on. However, if you would prefer to receive a printed version,

please send a donation of Rs 100/- by Demand Draft to CMAI, Delhi,towards cost of publication and postage.

To receive Clipboard by email, please send a request by email withthe following information — name, address & pin code, phone number,email id, membership number (if CMAI member.) If the label in whichyou received this issue has the “Reader ID”, please send that to us.This may be sent to [email protected] we do not hear from you, we will assume that you have changedyour address, and discontinue mailing to you. Please ignore this noteif you have already sent in your preference.

Clipboard goes electronic


8

Q 1: A person is declared brought dead by a competent doctor in a nursinghome/hospital. The relatives who brought the person require no recordfrom the hospital and no death certificate. More so, they do not wanta MLC to be sent to the police. What should the doctor do?

A: The doctor can permit the relatives to take the body from the hospital.Legally, it means that they never brought the person/body to thehospital. The hospital should take this stand in future also, beforeany forum.

Q 2: An MLC has been sent to the police in a case. Can a doctor recallthe MLC?

A: A doctor is authorised to send an MLC to the police only if he issuspicious about the nature of injury/disaster or death of a person.Once intimation is sent to the police, the doctor has no control overit and hence he has no authority to recall or withdraw it.

Q 3: A doctor has sent intimation to the police under MLC. The body is inthe mortuary. If the police request the doctor to hand over the bodyto the relatives, can he release the body directly without sending itfor a post-mortem?

A: Yes, but on condition only. After receiving the intimation from thedoctor, it is the police who have to act. The doctor has only expresseddoubt over the death of the person. If the police, on the basis offurther investigation, feel that no foul play is involved in the death,a letter, duly signed by an officer, not below the rank of Inspector ofPolice, requesting the doctor (who sent the MLC) to hand over thebody to the relatives, can be sent.The doctor has to keep the letterunder safe custody for future reference and record. Later if the caseis reopened and further investigation reveals that the facts of thecase are contraryto the police version, then it is the police officerwho signed the letter for release of the body who will be answerable.The doctor, who released the body under the intructions of the police,will not be held responsible. After the receipt of such a letter from thepolice, the doctor has no authority to withhold or retain the body.

LEGAL WATCH

Documents

Clipboard October 2009 - March 2010