Challenges Hospital Management In Nepal

Ch on the wholeenges infirmary Management In NepalThe WHO desexualises health as A complete state of physical, kind and loving wellbeing, not merely the absence or dis gild (WHO, 1948). It means that complete state of wellbeing is health and infirmarys one of the major tool for promotion of health. WHO in 2010 has addressed the role and greatness of infirmary trouble for a look health (WHO, 2010). at that place is no swal small(a)themely accepted send away commentary for infirmary. There atomic number 18 several types of infirmarys based on the facilities, equipments and function, i.e. district hospitals, provincial hospitals, additionality hospitals and referral hospitals, teaching University hospitals and opposite types of health c argon facilities. There is no international prototype defining what should be the minimum services that each hospital should provide during a health crisis. Each country has to develop a national policy and technical guidelines to deal with a health crisis. Before defining the essential services, the ministry of health has to define the essential health services that the health sphere allow for provide to the community in order to identify what more specific services will be delivered by hospitals (WHO, 2009).Management is defined as the organization and coordination of the activities of an enterprise in accordance with certain policies and in achievement of defined objectives. Management is include as a reckon of production along with machines, materials and money. Renowned guru of counsel Peter Drucker (19909-2005) has said that the staple task of prudence is two fold marketing and innovation. Practice of modern concern owes its origin to the sixteenth century enquiry into low efficiency and failures of certain enterprises, conducted by the English statesman Sir. Thomas Moore (1478-1535). As a redress, attention consists of the interlocking services of formulating corpo swan policy and organizing, planni ng, controlling and directing an organizations resources to achieve the policies objectives (Walden University, 2011). hospital managenmnet.net suggests that infirmary Management provides a direct link mingled with healthc be facilities and those supplying the services they need ( Hospital trouble.net 2011) .WHO in 2009 suggests thought by hospital focusing as an effective and combined focussing of, the pastime factors-(a) Acute c be for emergency patients(b) Out Patient Department (OPD) activities(c) Investigation (laboratory X-ray some another(prenominal) symptomatic elements)(d) Referral for primary health c be (PHC) specialized consultations or services(e) Contri just nowion to public health programmes(f) voice of health information trunk (surveillance system, including a EWSComponent)(g) Public information and precept and(h) Prep argondness for health crisis guidance.Nepal is a landlocked country which is mostly covered by hills and mountains and it has a nation of 25.8 million as estimated in 2006. It is in the s verbotenh Asian continent, north to India and south to China. Its area is 147,181 sq. km (WHO, 2007). It has been face several altercates to sanction a functional health centering system (Thapa, 2010).This proposal deals with the challenges which Nepali health system is facing at extradite and suggests the possible ways for its improvement.Statement of the problemNepals health system is in transition. Nepal is an developing country where most of the geographical part (85%) is covered by mountains and hills. India is in the south and China is in the northern part of the landlocked country. The southern boarder is open where the northern part is separated by the high mountains called Himalayas. The health indicators are very poor. The health service facility is not adequate to Nepali people. So the hospitals are (Dixit, 2005). Nepals hospital bed per ten thousand populations is 4.26 (2001/02), physician per ten thousand population s is 2 and Nurses per ten thousand population is also 2 as per the data of 2004 Similarly, Total white plague on wellness (THE) as % of Gross domestic Product (GDP) 5.3% and Public Expenditure on health (PHE) as % of Total Expenditure on wellness (THE) is 28 while Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) 72(WHO, 2007). If it is compared with the other developing countries in the same part i.e. south east Asian region, the level of the problem may be perceived. Maldives, a small minute country with population 298 thousand has Total Expenditure on Health (THE) as % of Gross Domestic Product (GDP) 6.2. Maldives Public Expenditure on Health (PHE) as % of Total Expenditure on Health (THE) is 89 as compared with 28 of Nepal. Private Expenditure on Health (PvtHE) as % of Total Expenditure on Health (THE) in Maldives is 11. It shows that the state has better involvement in Maldives than in Nepal. More over, the population per hospital bed is 381, which are 26.2 hospital beds per 10000 populations. Similarly, number of populations per physician 959 and nurses per 10000 populations are 33 (WHO, 2007). It clearly shows the scenario of health development of Nepal.As part of health, curative health services see a major role in providing quality health service to the people. Until the health care provider organizations are strong, the curative health service stomach not be delivered to the beneficiaries properly (Edelman and Mandle 2006). Hospitals are the find fixings of health care address system and they needs to be reformed to ensure a quality health care system (McKay and Healy, 2000).Unfortunately the hospitals in Nepal take a leak very poor in quality management and they are not able to deliver quality health services to the people (Dixit, 2005).To address the needs and requirement of the hospital, the administration of Nepal ( GON), Ministry of Health and Population ( MOHP) has published The guideline on the take ment, Operation policy and standard and infrastructure for Private and Public Health Hospitals in 2004 ( MOHP,2004). But it is still overleaping in the expression of the standard for the hospitals run by the government (Dixit, 2005). However, the policy published by the MOHP tries to clarify on the fundamental parameters of the infrastructures required for the hospitals which may be applied for the general hospitals as well. But the memorial does not verbalize roughly the application in the government run hospitals (MOHP, 2004). That is wherefore in that respect is a lack of clear cut guideline for the management of hospital.Nepals health area is facing a challenge regarding the management (Dixit, 2005). As part of whole system of health in Nepal, management of the hospitals is also a sever challenge for the country.1.2 Summary of the problemNepal has set a tar get in to achieve the millennium Development goals by 2015. It has to border the target in all health indicators. Goal no 3 and 4 are c loosely related with health and as part of curative health, hospital and hospital management take on crucial role in health promotion. In Nepalese context, hospital management skill and fantasy of hospital management is still beyond the priority of the government and the government still does not have any policy guidelines over the hospital management area (Dixit, 2005).People skill is a key asset for the development of key management styles. Dealing the people is a professional skill in itself. Being able to see from the perspective of others is essential, and caring for their wel furtheste is also of prime brilliance. There are many high-profile examples of how to develop a successful management style. Managers like Bill Gates and Warren Buffett have famously developed their own distinctive management style from which others potbelly learn. However, the fact that the two examples are very divergent management styles shows that in that respect is no si ngle route to success (Bono and Hellers, 2009). But unfortunately, thither are no clear guidelines or policy found in the government documents. The recent document on the guideline on the requirement of a hospital, government does not speak virtually the hospital management, its skill development and transfer for the improvement of a hospital (MOHP, 2004).Lack of professional skill in the person trusty to manage the hospitals has created a problem in hospital management. The government run or supervised hospitals still do not have coiffes for the hospitals. MOHP in its policy document has not mentioned anything approximately the hospital managers (MOHP,2004). However, the toffee-nosed hospitals have started hiring them which is still out of the government policy (Thapa, 2010).Nepal is an underdeveloped country where the literacy rate is provided 62.7% for male and 34.9% for female as per the report of census 2001 (CBS, 2001). It means still 64.1% women are out of literacy cove rage. Nepal has poor health facilities all over the country except in capital Kathmandu and other urban areas. Most of the doctors are not willing to go to the rural areas hospitals and they are often streamlet without (qualified) doctors (Dixit, 2005).In conclusion, the poor socio-economic conditions, hard geographical conditions and lack of sensibleness of the people and traditional beliefs and superstitions, lack of will in the political parties and their leaders are the main burning issues for the improvement of health sphere of influence in Nepal (Chaulagain, 2004). These all are problems associated with the hospitals and ultimately with their management.The factors associated to hospital management are still not uncovered in Nepal (Thapa, 2010). So, itPurpose of the domainAs mentioned above, it has been obvious that Nepal is facing the problems to strengthen the management of the health firmament. The documents are not found to have been lacking regarding the strategies a nd policies on the health management. So, the proposal aims to identify the clogging factors affecting the hospital management in Nepal. It will study the existing policies and strategies of the government of Nepal on hospital management, international principles, theories and practices on hospital management and identify the factors which are affecting the betterment for hospital management sector of Nepal.So, the conclusion of the study is to identify the hindering factors of hospital management in the case of Nepal and suggest the concerning authorities slightly improving the hospital management system, formulating the policies and implementing them. This proposal will analyse the strength and limitations of the hospital management system in Nepal and help all the concerned to mitigate and minimize them.Main interrogation questionThe study can not answer all questions that come on surface while perusal virtually the issue. So, to narrow down the study area and sharpen the fo cus, the study has defined the main study questions as follows-What are the hindering factors that effect the hospital management in Nepal?Subsidiary QuestionsTo supplement the main re attend question, these questions are defined as subsidiary questions as follows-What will be the appropriate modality or best practices of hospital management that are applied in the world by other countries andWhat are the factors that are hindering in the betterment in the hospital management in Nepal?What is the most potent factor to promote the hospital management in Nepal?HypothesisLindsen and Jong (2005) have defined hypothesis as an alternative explanation of residual switch trial costs or, more precisely, of the experimental finding that the repetition trial (RT) distribution for switch trials with a long preparation intervals can be modelled as a mixture of the RT distributions for repetition trials and for switch trials with a short preparation interval (Lindsen and Jong, 2010). In here, the hypothesis tries to establish an alternative factor that might be supposed to be the commonest hindering factor for the management of hospitals in Nepal. The hypothesis taken here is the lack of professionalization of hospital managers or the persons who are involved in the management of either government run or private or community run hospitals in Nepal is the most influential limiting factors in hospitals in Nepal.Significance of StudyAs mentioned above there are no special policies and practices constituted for hospital management in Nepal. The hospitals are managed by the medical examination examination doctors or surgeons so far (MOHP, 2004). The doctors are not entitled to diagnose the patients, treat them, run medical and surgical and public health cams campaigns in the hospitals or in the periphery of the hospitals. The health check council is liable to pose the job responsibilities of the doctors in the case of Nepal. But it has not mentioned about the management part of the hospital and its regulation, Nepal Medical Council Act, 1964 (amended in 2001).It does not speak who is responsible for that (Nepal Medical Council, NMC, 2001). There is no one professionally responsible for the hospital management in the present context. In the country where the government policy about the medical sector does not speak about the role of hospital management, it poses obvious that the hospital management sector is not running smoothly. No presence of the monitoring body to supervise and evaluate the hospital management is found in the present documents whether published by the government or private organizations. So, the studies significance is in establishing the fact what are the main barrier and other minor barriers in the hospital management of Nepal. That is why this study is has a significance value.Literature Review2.1 Concept of Hospital ManagementHospital management provides a direct link between health care facilities and those supplying the se rvice they need. This enhances the capacity of decision making and managing hospitals and health care centres and all other health care providers and other health care industries (Hospital management.net, 2011).The discipline hospital management is found to be conceptualised from the WHO Ottawa Charter for Health Promotion in 1986. It was introduced in the name of Health Promoting Hospitals (HPH) in the beginning since hospital was regarded a mean of health promotion. So, this concept is only 25 years old and newer to other disciplines. The Ottawa Charter recognised five areas of hospital management i.e. health promoting hospital prospect, health promoting workplaces, the provision of health related services, training, education and research. It has identified the hospital sector as the change agent and advocate for health promotion (WHO, 2011). From the declaration of WHO, it becomes obvious that hospital is not only a place of treating the patients, but also a place where the activities for health promotion are run, all heath services are provided, trainings are conducted, education is given and researches are carried out. It rules out the understanding of the government on hospitals. The Bir Hospital, which is one of the units or part of the Ministry of Health and Population and the biggest government run hospital (MOHP) of Nepal has defined Bir Hospital only as a treatment and diagnosis service centre. In this definition, the other four parts defined by the Ottawa Charter are missing. However, it adds something in its website as its activities. accord to it, Bir Hospital offers training to the students through its Post Graduate programme of its Medicine School (Bir Hospital, 2008). It clearly shows that the government of Nepal has some how realised the integrated approach of the hospitals, but not mentioned in its policy or strategy. There seems a gap between the Ottawa Charter and the understanding of the regimen of Nepal in terms of its concept. ho me(a) Health Service (NHS) of the UK has presented a model of its Week Hospital in its journal. It says that it has developed and validated an sophisticated integer programming model, based on clinical resources allocation and beds utilization. According to NHS, the model aims at programming Week Hospital patients admission/discharge, possibly reducing the length of stay on the basis of an for sale timetable of clinical services. The performance of the model has been evaluated, in terms of efficiency and robustness, by considering real data plan of attack from a Week Hospital Rheumatology Division. The experimental results have been satisfactory and demonstrate the effectiveness of the proposed approach (NHS, 2011). We can see the factors that contribute in hospital management by this example mentioned above.The hospital management has become an emerging field in India, the neighbouring of Nepal and a developing country in the south Asian sub-continent. India education in its hom e page of its website says that hospital management and administration has become a priority and importance for healthcare industry and providing health and hygiene care in India. The government of India is paying attention on providing healthcare in both rural and urban areas by improving the management of the hospitals. It further adds that hospitals are expected to deliver quality service 24 hours a day at a nominal cost. The urgent nature of its work and the level of efficiency that is expected have increased the need of well-formulated hospital management system throughout the world (India Education, 2011). It shows that India has seriously taken the hospital management stream to leaven the quality of the service delivery of the hospitals in India. These writingss presented above describe the concept of hospital management.2.2 Benefit of Hospital ManagementWorlds renowned management Guru Peter Drucker developed the concept of Management by Objective (MBO) in 1954. He has def ined MBO as a systematic and organised approach that allows management to focus on achievable goals and to attain the best possible results from available resources. He has further said that the strong management system of the organization increases its performance by aligning the goals and subordinate objectives through out the organization. He adds that the employee get strong input to identify their objectives and timeline for completion. He has described the benefits of management to have nutritioning in setting objectives, organising groups, motivating and communication, measuring performance and developing people ( Peter Drucker,1954).NHS has defined its hospitals as organizations where high qualities of health care services are delivered to the clients (NHS, 2011). So, all the theories of the organization may be applied in hospitals and the importance of the hospitals may be assumed based on the benefits of a good management system as described Drucker. So, it has become obv ious that to achieve the goals of the nation, the hospital management sector should be regarded as an crucial discipline in the context of Nepal as well.Limitations of Hospital ManagementManagement is not a solution, but only the means of the solution which organises the resources in a proper way. For the effective management, every surrounding factor should be appropriate. Verzuh (2001) has identified five sectors that are required for effective management. They are good agreement between service providers and clients, an effective and realistic plan, constant and effective communication, a controlled scope and top(prenominal) management support (Verzuh, 2001). Hospital as an organization can not provide its best services if the factors mentioned above are not available. In Nepalese context, the hospital management can not take the hospitals in the position to achieve its goals until there is an effective service giving and taking culture, until the planning body is capable enoug h, until the inter and intra organizational communication is strongly developed and there is a political commitment to prove upper support toward the bottom. So, these are the limitations of the hospital management.Barriers of Hospital Management in NepalNepals literacy rate is low, the national income and per capita income is also low. The vexed geographical situation is not also favourable for rapid development in Nepal. The socio-economic development is far behind as compared with other developed and even with developing countries (Dixit, 2005). As mentioned above, financial strength, political commitment, social culture and context need to be favourable for the good management of every development sector and the hospital is not an exception. The people can not consume the facilities well if they are not aware about the facilities they have been provided with (Thapa, 2010). But hospitals are managed by the Department of Health Services under the Ministry of Health Population and the, So, for the hospital management, this context has become a barrier.Hospital management practice in different countries i.e. Nepal, USA, UK, India, Japan and ThailandHospital management is a new discipline. In Nepal, the Pokhara University strated Hospital Management course in 2001 only. Then it has put a milestone in the way of hospital management. Then some private hospitals have started to recruit hospital managers due to its influence and the government is in the way to start sentiment on the need of separate hospital management stream under the health service (NOC, 2011).In USA, the hospitals are governed by the United States Department of Health. Its history goes to 1798 from when USA has started on managed health service (USDHHS, 2001). UK established field of study Health Service ((NHS) in 1948 from which it has been running the hospitals. All together, 12000 doctors are working in its hospitals all over the UK (NHS, 2011). Ministry of Health and Family Welfare is res ponsible for hospital management in India. It has Department of Health and National Rural Health Mission for managing the hospitals (Ministry of Health and Family Welfare, India, 2011). Likewise, Ministry of Health, Labour and Welfare looks health activities in Japan. It has Health constitution Bureau under the ministry and it looks after the hospitals and it has prepared a policy to manage the hospitals properly (Ministry of Health, Labour and Welfare, 2011). In Thailand, Ministry of Public Health looks after the hospital management. Under the ministry, there is Department of Health and under this, there are 9n divisions. They are supporting the hospitals for their management in an integrated way (Department of Health of Thailand, 2011)2.6 Previous empirical research findings on challenges in hospital managementThe Hospital of St Raphael in UK has pen in its website about the challenges it suffering in terms of the management. It says that the demand is growing and the challenge is increasing. Patient satisfaction concerns, hospital management demand, smart mind and smart technologies to keep healthcare system smoothly are the challenges seen in the present context. Likewise, recruiting hospital management and their turnover are other challenges (St Raphael Hospital, 2011). In Nepal context, There are no special resources are found either in published copies or in the websites. The National Open College has written about the importance of the Hospital Management course which is like an advertorial (NOC, 2011). But it does not speak about the challenges of the hospital management. So, relevant literatures are not enough as per the topic.Discussion and ConclusionAfter studying the literature and analysing the present hospital management system in Nepal, the points come into mind to be discussed-The Government of Nepal has still not considered the hospital management as a separate sector.There is a lack of Hospital management professionals.There is no proper p olicy addressing hospital, management issues in Nepal.Hospital management sector has not been regarded as an integrated issue so far.Public and private sector are also not actively participating for the professionalization of hospital management human resources.In conclusion, we can say that hospital management is a new discipline. The developed countries like UK have already started to conceive on the management issues of hospitals as a separate sector. But in Nepal, the hospital management sector is not visible separately and it has not been regarded as a separate need or requirement. The hospital has not felt the need of hospital managers to manage the hospital smoothly. Lack of awareness, culture and customs low literacy rate, low income and difficult geographical situation are the factors which are hindering the hospital management sector to grow and become strong.Methodology3.1 InstrumentThe study was carried out by using systemic literature critique method. The literatures were searched in the website of the Universities of UK i.e. Bournemouth. The Medical Journal of America and USA were searched. The government policies of NEPAL, India, USA, Japan, Thailand and UK were other sources. The documents were collected, materials were searched and the materials retrieved were analysed before applying them in this search. The WHO website and other journals were considered as most reliable sources. Library use was the mostly used mean for search and writing the paper. This study will apply qualitative methodology to find the hindering factors of hospital management in Nepal where face to face interviews will be arranged during this study.4 ConclusionsThe hospital management is a new term which is derived from the separate words hospital and management. Hospital is a mean of healthcare delivery while management is a way to utilize the resource in an efficient way. The hospital management is not very old concept in even in the developed countries while the coun tries while Nepal is very far behind in the development of this sector. Lack of professionalization of the existing human resources, slight availability of skilled human resources, poor socio-economic situation, low interest of government towards the hospital are the hindering factors for the development of hospital management in Nepal. These all information was collected through literature review available in the library and websites developed by the governments, universities and academic institutions.It recommends the government of Nepal to recognise the hospital management as a separate and independent discipline under the health service. It suggests the academic institutions to focus on the development of hospital management professionals in their course and curriculum. It also suggests the private sector involved in running private hospitals in Nepal to start hospital management principles in their management.