Management of Healthcare Quality of Medical Personnel of the Royal Thai Police

8/9/2019 Management of Healthcare Quality of Medical Personnel of the Royal Thai Police

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PSAKUIJIR Vol. 2 No. 1 (2013)

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Introduction

Nowadays, healthcare business has an increasing tendency to

grow due to particular causes; the investment made by the publicsector to promote quality of life of the people through UniversalHealthcare Coverage Scheme and the policy to transform Thailandinto a medical hub that focuses on developing service quality (Office ofthe Secretariat of the Prime Minister, 2010). In order to become amedical hub, competencies of medical personnel are a matter of greatimportance, and that has made a major contribution to such

occurrence of competent medical personnel increasingly being drawntowards the private sector. Moreover, hospitals in Thailand will haveto face any challenges arise from the aftermath of ASEAN EconomicCommunity (AEC) agreement; by 2015, healthcare sector would bepushed through liberalisation, so hospital industry has become amatter that member states of AEC pay much regard to and are veryinterest in, and has a tendency to suffer brain drain, given thatprofessionals will be able to travel to work abroad more easily under

free professional movement of AEC (Wattanasirichaigoon, 2010, 23).Additionally, from the positioning of Thailand in the AEC, healthcareindustry has been given a high priority, and hence nationalcompetitiveness must be enhanced accordingly (Center forInternational Trade Studies, University of the Thai Chamber ofCommerce, cited in Wattanasirichaigoon, 2010, 84). There areseveral problems surfaced among public hospitals, such as the impactfrom the shortage of medical personnel, the impact on patient carecaused by medical personnel resigning from the public sector to theprivate sector, and the impact on the production of medical studentsand medical specialists in medical schools from brain drain of greatand/or eminent medical teachers, which consequently degradingmedical personnel production (The Impacts of Medical Hub of AsiaPolicy on Public Health System of Thailand, 2005), and, according tothe research Thailand Medical Hub of Dr,Viroj na Ranong, Research

Director of Thailand Development Research Institute (TDRI), it is


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stated that the implementation of Medical Hub Policy has causedmedical care costs to rise and medical personnel to be drawn out ofthe public sector more, and the Universal Healthcare Coverage

Scheme has prompted the people to exercise their right to receive freehealthcare, forcing medical personnel to work in a hurry as aconsequence to increasing number of people visiting hospitals, thusposing higher risks of hazard during diagnoses and treatments(National News Bureau, Government Public Relations Department,2009).

Police hospitals and institutions thereunder, which are DaraRassami Hospital, Nawut Somdetya Hospital, Police Nursing Collegeand Institute of Forensic Medicine, have been considered as publicmedical institutions that have a primary duty to tend medicine-relatedaffairs of the Royal Thai Police and are directly responsible for theprovision of healthcare for police officers and their families. Hence,they certainly are under the influence of aforementioned issues ofhealthcare industry, and subsequently, such difficulty will impair thepolice officers efficiency in serving the public, which has made the

author become concerned and eager to conduct a study on this matterin order to construct a conceptual framework to be utilised in thedevelopment of management of healthcare quality of the Royal ThaiPolices medical personnel.

Objectives

To review relevant literatures and researches in order toconstruct a conceptual framework to be utilised in the development ofmanagement of healthcare quality of the Royal Thai Polices medicalpersonnel later on.

Research Methodology

In reviewing relevant literatures and researches to construct a

conceptual framework to be utilised in the development of


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management of healthcare quality of the Royal Thai Polices medicalpersonnel, secondary data of both relevant literatures and researcheshave been examined in the first step to conceive a conceptual

framework to be employed in the second step accordingly.

Result

Parasuman, Zeithaml & Berry (1988, 86-98) has suggestedcriteria for the evaluation of service quality by clients in 5 aspects; 1)

Tangible, physical matters in service, 2) Reliability, dependability andability to provide proper services needed by clients, 3)Responsiveness, willingness to help customers promptly in a timelymanner, 4) Assurance, service providers must be competent, friendly,polite, courteous, honest, able to facilitate trust, ready to explain theprocedure of service to clients in order to establish credibility andsecurity in the clients, and 5) Individualised Empathy, serviceproviders attention, ease of contact, and good communication to a

client. Moreover, Berry (1994, 32-35) has concluded that the 5criteria in the evaluation of service quality would weigh differently inproportion from client to client, as exhibited in Table 1, which clientshave regarded reliability the highest, followed by responsiveness,assurance, individualised empathy, and tangible, respectively.

Table 1 Weightings of Service Quality Aspects (Berry, 1994, 32-35)

Aspects of Service QualityPercentage of Importance,

as perceived by clients

Reliability 32%Responsiveness 22%

Assurance 19%Individualised Empathy 16%

Tangible 11%


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It is observable that almost all of the significant criteria used byclients in the evaluation of service quality are directly associated withservice providers operations, so service provider organisations must

pay attention to their servicing agents, seeing that those agents woulddirectly influence the clients perceptions of the evaluation of servicequality. Hence, the researcher has become interested in studying fromthe perspective of service providers, or the medical personnel in thiscase, to find out which factors have contributed to the management ofhealthcare quality of the Royal Thai Polices medical personnel. Theoutcome of the study has revealed seven factors, as follows;

Length of ServiceKotler (2003, 186) has studied demographic segmentation, i.e.,

study the state of the population in various aspects and the factorscontributing to any alteration thereof, such as maturity, mortality andrelocation, which demographic characteristics may differ in patterns.

The demographic differences in length of service are acontributory factor to the capabilities of medical personnel. Provision

of medical healthcare is a service that requires knowledge, proficiencyand experience to perform, and the longer the length of ones serviceis, the greater his/her proficiency would be, which led to higherquality of service provided, compared to those whose length of serviceis shorter. Also, according to the article Public Health Rushes to FillTen Thousand Posts, Tackling Nurse Shortages, it is found that lengthof service is a problematic factor, that is, senior nurses have to bearheavy workloads. The long-term research project that would monitor

health and work life of nurse cohort for a period of 20 years, startingfrom 2009, supported by the Health Systems Research Institute andHuman Resources for Health Research and Development Office, inthe initial stage has discovered that new generations of nurses that arebelow 30 years of age would have a very short length of service in thisprofession, only 3 to 4 years, and if there is no measure taken tomotivate them to stay in this profession for five years, these nurses

would be lost. Furthermore, when considering the average age ofnurses who work in general hospitals of 40 years and of nurses in


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community hospitals of 37.8 years, a structure of aged workforce canclearly be seen, as the new nurses have resigned in a fairly largeamount. From the data collected, it has been observed that 30-40% of

nurses who are 45 years old or higher still have to work night shifts,rotate between shifts 32 times per month, and work both morning andafternoon shifts sometimes, which will affect the quality of patientcare in due course (National Health Commission Office, 2012).

OccupationAnother aspect of demographic differences that the researcher has

chosen to study is occupation. Group of doctors, group of nurses andmultidisciplinary group would have different methods of operationaccording to their professional standards, manifesting as particularitiesof each profession in providing quality patient care, which concurswith the conception of Peter F. Drucker (1998/2554, 274) whichstates that the case that the people of each profession deem themselvesas privileged individuals who have their own values may pose anobstacle to knowledge exchange between people of different

professions, as many specialists would disregard perspectives of peoplein other professions, even if every party has to reach a common goal;i.e., in healthcare service industry, researchers would disregarddoctors because they do not understand the relationship betweencauses and effects of certain matters, whereas the doctors woulddisregard the notions of the researchers, seeing that they do notunderstand that every patient is practically different in reality, anddisregard the nurses, seeing that they do not understand the principles

of medicine, but the nurses also disregard both the researchers anddoctors as unsympathetic towards other people, while, at the sametime, the three groups all hate hospital administers that manage in abureaucratic fashion and have no accomplishment, so to speak.

Service EncounterJames A. Fitzsimmouns (2011,213-215) has presented a notion

that every type of service tends to have transactional interactionsbetween clients and service providers. In this relationship, a term


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associated to service quality as perceived by clients during servicereception has been given as the Moment of Truth(time to impress),concurrently with Richard Normann (1984, 89) who has stated that a

conclusion of service evaluation is determined during ones servicereception, clients will have to face service providers of different kindsand each period of the time to impress during service reception is anopportunity to influence ones perceptions of service quality, whichalso agree with Jan Carlzon (1987, 89) who has remarked thatcognisance during such time to impress is very critical to building areputation of being superior service providers. Reforming organisationstructure to concern and include everyone in the responsibility tosupport the operations of service agents, who has directresponsibilities to serve clients, and give the power to make a decisionto the agents would shift the focus onto client satisfaction andfacilitation of such moments of impression. Additionally, according toSittichai Pattanasuwan (2004, 324-330), a research which studies theeffect of doctor-patient relationship on diabetes care from a case studyof Sampran District Hospital, Sampran, Nakhon Pathom, has found

that all of the diabetes patients in the research have receivedinconveniences during diabetes care reception in various forms fromthe doctors, and tend to deal with the issue by changing doctors. Inconsequence to such dissatisfaction to the service, it has been realisedthat doctors who have a flexible and negotiable type of doctor-patientrelationship during provision of healthcare tend to satisfy the patientsmore than those who are dictatorial and inflexible.

Evaluation of service quality is difficult to perform as it is an

abstract matter and the healthcare services are categorised as high-contact, that is, usually, clients would have to visit the sites to obtainservices and stay within the process throughout the duration ofservice, so the management of servicing procedure is very significantto service quality.

Talent Management

Robert E. Lewis & Robert J. Heckman (2006, 139-144) haveproposed a concept that talent management is a type of managerial


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tool, a strategic planning of human capital assignment throughout theorganisation. The organisational trends in modern days have placedhigher values on highly-competent individuals; thus any organisation

should have a strategy to manage such in an efficient manner.Medical personnel can be reckoned as highly valuable assets to an

organisation, as they are classified as highly-proficient, corecompetent, and uniquely talented. The capabilities of talented peopleare not limited to knowledge and skills, but also include innate gifts aspersonal attributes. This group of people is scarce and hard to replace,and if received a good management, they will effectively apply theirtalents to facilitate quality healthcare and render the organisationefficient as well.

Knowledge Management

Peter F.Drucker(1998/2554, 255-280) has demonstrated anidea to manage specialists. In the modern era, success of anorganisation depends on its body of knowledge and organisationalsystem more than solid assets, and thus makes knowledge

management a matter of great necessity. Particularly, knowledge ofspecialists is proved to be a great source of value addition in the neweconomy, which the benefits therefrom can be more clearly seen inlarge-scale service industries, especially in healthcare industry andinverting organisations, which are organised in patterns specificallytailored to create values from the intellect of specialists of theorganisation; e.g. when doctors have the power to make a decision onhow to proceed with patient care independently and are able to give

orders to any lines of work responsible for the coordination of theorganisation, it will affect the service quality provided by thespecialists. Plus, the network strategy Spiders Web is used whenknowledge of organisation is scattered among its numerous specialists,the group of people that must jointly participate in finding solutions tocomplex issues of clients. A type of organisation that could bebenefitted from such strategy is teams of diagnosticians, that is, the

knowledge of specialists would create additional values from being


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low level and it affected hospital management, hospital services, healthpersonnel, quality, efficiency and the finances of the hospital.

By encouraging people to obtain healthcare services while the

number of medical personnel within the country is still relativelyinadequate and consequently increase their workloads, their chancesto suffer from stress and to make mistakes at work have grown. Whilemedical personnel requires independency to work in accordance withtheir knowledge, competencies, and professions, being constrained bysome limitations of health insurance of certain types, directing theirpractices of patient care, could definitely influence the healthcarequality that the patients receive, as a consequence.

Bureaucratic Organisational StructurePower and Resistance: The Untold Stories in the Context of a

Local Health Officeof Naree Palalikit (2007, 187-190) has revealedthat instances of high-ranking bureaucrats use of power leading toresistance on the part of subordinates are exemplified by both formaland informal commands. The formal exercise of power is used to

reward or punish subordinates, at the discretion of their superiors.Power is also exercised informally, through oral commands, in orderto avoid rules and regulations, to maintain the authoritys network ofsupporters, or to seek private gain under the context of patronisingculture of Thailand.

From the publication of strategic plans of Police General Hospital(Police General Hospital, n.d.), it is discovered that the majorchallenges to service quality are the growing competition and the

governments policy to reduce workforce, which leads to shortages ofspecialists as well as increasing amount of workloads of medicalpersonnel, causing them to be more at risk of getting sued while onactive duty. Being a medical person under the Royal Thai Police has itspros and cons; one of the pros is being employed in police service,which is one of the incentives to join the organisation in a conditionthat medical personnel is scarce, whereas one of the cons is every

medical person is an officer with rank, which is quite troublesome,seeing that the promotion process is not exactly fair, which deprives


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employee morale. Being subjected to the rules and disciplines ofpolice force and a long hierarchical chain of command, if theadministration of the Police Hospital is inflexible in patient-centred

performance management, the medical personnel who have to employtheir professional proficiency in work performance would becomeconstrained and have no power to make a decision, which ultimatelywill affect their healthcare quality as a result.

Discussion

The study on the contributing factors to the management ofhealthcare quality of the Royal Thai Polices medical personnelthrough literature reviews in order to develop a conceptualframework has discovered that 7 factors -- length of service,occupation, service encounter, talent management, knowledgemanagement, health security system impact, and bureaucraticorganisational structure contribute to the management, which havebeen brought to construct a conceptual framework accordingly, as

seen in Figure 1;

Figure 1Conceptual Framework of Service Quality Management ofMedical Personnel of Royal Thai Police

Demographic Characteristics

1.Length of Service 2.Occupation

Healthcare

QualityofMedical

Personnel

Contributing Factors to Management1. Service Encounter2. Talent Management3. Knowledge Management4. Health Security System Impact5. Bureaucratic Organisational Structure


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Police General Hospital. n.d. Strategic Plan of Police GeneralHospital, B.E. 2553-2556.Bangkok: Police General Hospital.

Gerdprasert, S. 2009. Development of Interactive Midwifery

Web-based Learning Units for Improving NursingCompetencies and Reducing Stress in Nursing Students.Doctoral Dissertation, Mahidol University.

Pattanasuwan, S. 2004. Effects of Doctor-Patient Relationshipson Diabetic Care: Study at Sampran District Hospital,Nakhonpathom Province. Doctoral Dissertation, MahidolUniversity.

Wattanasirichaigoon, S. 2010. Country Strategy for ThailandsDevelopment Prior to the Integration into ASEANEconomic Community. Bangkok: Sintaweekij.

Berry, L., Zeithaml, V. & Parasuraman, A. 1994. Improved ServiceQuality in America: Lessons Learned. Academy ofManagement Executive8 (2): 32-35.

Fitzsimmouns, J. 2011. Service Management. 7th ed. New York:McGraw-Hill.

Carlzon, J. 1987.Moments of Truth.

Cambridge.Kotler, P. 2003. Marketing Management. New Jersey: Pearson

Education.Parasuman, A.,Zeithaml, V. & Berry,L.1988.SERQUAL: A

Multiple Item Scale for Measuring CustomerPerceptions of Service Quality.Marketing ScienceInstitute,Working Paper Report No.86-98.

Normann, R. 1984. Service Management.New York. 89.

Lewis, R., Heckman, R. 2006. Talent Management: A CriticalReview.Human Resource Management Review16: 139-144.

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Management of Healthcare Quality of Medical Personnel of the Royal Thai Police