Health Administration 2

Session objectives

Definition and activities of Organization
Organization structure
Organization types
Motivation
Stages of Needs that are essential to the development of human
items can induce strong motivation in humanbeing
Evaluation of health program
Scientific Hospital administration

Organization:

i.e. the taking of measures so that different functions can be coordinated and eventually integrated into one system to achieve more effectively and more efficiently a common goal.
Organization is both a process and entity.

As a process , it include the main necessary activities:

• Definition of organization goal and objectives.
• Determining and classifying the required work and dividing it into manageable job components .This include combining the work to be done with facilities necessary for its performance.


3) Grouping job components into an orderly organized structure , for the following reasons:
a- Making effective use of resources.
b- Defining responsibilities and authorities.
4) Selecting the staff.
This include training before or during the function of the organization (individual or manpower development).

5) Formulating and defining methods and procedures for performing the organization activities and individual tasks(i.e. the simplest and best way to do each task so that work can be accomplished easily , economically , systematically and understandingly).
6) Adaptation.
Organization should be adaptive to internal and external needs and demand.

Important consideration:

1- International action is recognized to be essential to control pandemics and quarantinable diseases.
2- Systemic epidemiological investigations and the provision of effective weapons to attack epidemics are important.
3- Efficient national health services are required too.
4- The health work can not continue in isolation from other social and economic national developmental agencies . Thus an international cooperation had arisen against comunicable diseases control.

Organization structure:

i.e. authorities responsibilities relationship among various levels of persons who perform different organizational tasks.
It is designed to formalize work assignment both vertically and horizontally including relationships and other duties.
Organization structure is often summarized in organization chart and supplemented by job description , work manual , …etc.
Organization chart:
It is a static representation and seldom capture the realities of organization life which is dynamic in nature.


Organization types:
• Organization pyramid.
• It is the classical type of organization.
• Typified by a pyramid(triangle structure)where there is a continuous flow of orders from top to bottomi.e. from the chief or organization director e.g. hospital administrator. Orders flow in a one way direction from above down wards.
• This type available in many developing countries and orders are accepted as it is.
• 2) Feedback ideas.
• There are continuous re-opinion taking from lower level to intermediate level where again studied and continue to reach high levels(decision making).

3) Horizontal exchange of opinions.

It is found by experience that two directional exchange of opinions is not enough so a third level started function which study the subject in the same level before referring it to higher levels.
It is important to make opinions getting mature and raising the new suggestions for better work and smooth organization and more productivity.

4) Sphinx organization.

There is a big constriction at the bottle neck in the intermediate level towards the upper levels, This constriction will hinder the exchange of opinions , suggestions and ideas. This model usually applied by many professions both in developing and developed countries e.g. nursing staff needed(1/10th the actual need according to doctors/nurses ratio).
Other example is in technology(between intermediate poor workers and the engineers).

Motivation: It is one of the life necessities , considered one of the behavioral sciences subjects.
Defined as: it is the way to induce people to act in a desired manner.
Motivation is a state of having internal force that moves one to do some kind of action.
Motivation is generated from within a person and can not be imposed upon him.
The concept of human behavioral science is a systematic understanding and measurement of attitude , action and of factors that affect them.
Behavioral scientist and doctors direct their efforts towards developing theories explaining the relationship between motivation and human action.


Innominate object can be made to perform certain functions with the direct application of force or hunger.
No one can exercise similar control on humanbeing to perform quality of activities.
Motivation is very old problem which need the understanding of human nature and behavioral sciences.
Motivation theories attempt to explain individual behaviors and how to influence this behavior and to explain the relationship between motivation and human action.

The connection between the two seems to represent a set of high complex opinions and notions about human nature and what motivate them to do the required action quality.
People always seek needs , any action or mean used to attain a goal is called a drives, the acting out of drives seem an evidence of one’s motivation to reach a desired goal.
This theory of motivation terms goals into human needs which are categorized and ranked into a pyramidal hierarchy of human need.

*There are several theories of these needs but masellows theories suggested the hierarchy of 5 basic and related needs. He thought that these needs are essential to the development of human being and basically sequential in nature depending on a starting point which begins with zero level of human life.

Hierarchy of human needs.

5 Self actualization
creativity realizing –
mastery potential(health)

4 Self respect

social respect
self confidence -recognition
appreciation – status (health)

3 Love-Affection
Friend-ship-Acceptance
Respect-Member of team(health)

2 Safety-Security.
Body preservation, freedom financial security(health)


1 Physical-physiological
food , shelter , rest , work ,(health).
• Achievement needs
• Basic needs

Stage 1: Physical-Physiological Humanbeing needs to fulfill basic life necessities to keep living from these necessities:
Food basic to maintain physiological activities.
Shelter Protect body and to have the feeling to have a nation.
Work to prepare food , for agriculture and to have income.
Rest maintain ability to live and work.
Health Basic needs to maintain life-simplest health needs.

Stage 2: Safe and security.

Body preservation from external forces.
Freedom type of living , personal belief , personal ideas.
Financial security to ensure continuous safety , learning and living.
Health Factor to maintain healthy powerful mind and body..

Stage 3: Love and affection i.e. family member human relations , building a nucleus of new families communities.
Friendship Social well-being.
Acceptation feeling by community is essential to be more secure.
Respect by a friend , family and society.
Team member may be inherited(tribial related)or acquired(society)or member of an association or political position.
Here all basic needs become available.


Stage 4: self respect and social respect . This depend on the fulfilling of:
Self confidence.
Recognition by community members to be accepted.
Appreciation reflect the social respect.
Health is vital for life and person seek high specialty doctors.

Stage 5: Self actualization.

* Creativity new ideas ,new philosophy , thus might become a leader
scientific political others
Mastery it necessitate the presence of a religion … inner potentials.
Health ownership to a doctor who take care of this mastery.

Climbing all mentioned stages are not ready for every one , many people may stay at any stage.
Middle class population usually stay at stage3.Those scientific individuals with a distinguished personal characteristics and emotionally stable through special talents are subjected to go up to achievement stage and stay there for a fairly long period of life.
Those who climb the stages for certain circumstances are liable to fall down to any lower stage while opportunistic ones may fall from the top to the bottom.

• A.Patton found that one or more of the following items can induce strong motivation in humanbeing:-
• Challenge in work .
• people always try to challenge one another in every discipline in life . Thus challenge is normal and supposed to be a good motivation for winnings in life.
• Status. People struggle to have a good status.
• Money.
• Depend on the meaning of money to that person . If a real need present it is a strong motivation.


• Competition
• Intelligent leaders make organization members compete one another to get a better production.
• Urge for leadership.
• Certain people have strong urge and motive to be a leader specially those who think that they have the capability to be a good leader and can motivate others and improve working conditions
6) Fear fear from losing a jobs , a position , property , this can be considered part of shying or self blame … .
These theories are western in nature.

Eastern population have different sets of values which initiated from ancient civilization and all the religions and traditions are initiated there , this a special philosophy in making set of motivators strongly affected by these believes and religions in addition to the national feelings which might causes home sick in some peoples who change their environment . These types of motives do a great drive.
Friendship , family born , community relations are also motivators for eastern population.

Evaluation of health program:

WHO definition of evaluation:
Systemic and systematic way of critical analysis of different aspect of current activities and development of the program and its relevance, its formulation , its efficiency , its effectiveness , its cost and its acceptance by all parties involved.

Effectiveness indicate the achievement , of the organization and its components , for their efficient goal which was formed for it . e.g. T.B. control program organization if succeed effective program.
Efficiency means the way of utilization for the manpower and material (resources) by the organization completely or its components.
Productivity i.e. the value of product achieved by the organization or its components.


-Thus health services program evaluation is composed of the following six levels (for any conducted program):
• Health status outcome.
• Quality of service estimate.
• Quantity of service performed.
• Recipient attitude.
• Resources made available.
• Cost of the program.


1) Health status outcome.
To measure the effect of health services in term of health status changes in the target population(in numerical value).
Such studies should be carried out on the basis of comparison with usually another locality not included by the program(Case-Control); taking in consideration the effect of different factors e.g. living conditions , genetic factors(T.B. in Jewish and black races )and other epidemiological variables e.g. :
1-family planning program with subsequent birth rates
2-immunization program(polio vaccination effect on mortality , morbidity and disability among population after program application.)

2) Estimated quality of services:

i.e. comparing the quality of service directly or indirectly with accepted standard . The judgment may be given a numerical score e.g. accuracy rate of diagnosis ; for appendicectomy rates in association to histopathology.

3) Quantity of services provided:

Certain types of health services may regarded as generally beneficial to population so that higher rates for providing these services is considered more favourable than lower rates e.g. nursing services.
Problems of utilization and coverage should be considered e.g.:
1- Dental services(prophylactic services , filling , extraction , … etc)all are needed more than what available.
2- Immunization rate should cover the whole population in all Immunizable diseases.
3- Hospitalization services all are urban centered.

4) Attitude of Recipient:

A survey of people attitude may be used to evaluate certain health services programs , although such judgments may often be superficial but it is a good approach to measure certain criteria for good medical care such as acceptability , accessibility and continuity.
5) Resources made available:
This may be viewed as in outpatient clinics , e.g. the rate of doctors to population (1/2500); doctors/nurses ratio , hospital beds available for each 1000 population and its distribution.


6) Cost of the program:
Since the health services resources are limited , it is important to achieve the stated outcome at the lowest possible cost . It means saving money and resources to meet other needs.
We have to compare different methods to have the best and cheapest results with our limited resources e.g.:
1- comparison between organizing home care program with long term hospital care program.
2- comparison between fluoridation of water to prevent dental carries , and the periodic topical fluoride application to children teeth or the addition of it to table salt.

Scientific Hospital administration

There are several criteria to assess the scientific level of the perfect performance of hospital administration and the type of work in a general or specialized hospital . From these criteria , the followings:
1) Bed-occupancy rate: it is the number of days during which the bed is used by a patient per year (as an average).It depend on the type of hospital:
a- Emergency hospital → 70 days/year is normal.
b- Ordinary patients hospital (general hospital) →
110-150 day/year.
c- Chronic patients hospital e.g. T.B. , mental illnesses , →180-210 days/year.

2) Period of hospitalization:

i.e. period of patient stay at hospital and this is variable according to the nature of the disease and nature of hospital
It is usually ranging between 5-13 days/year.
Average 9days for females and 11days for males.
Long stay reflect the chronicty of disease or poor nursing and late doctor care.

3) Result of patient at discharge:

It is a sensitive measure about the health services quality towards patient.
Condition at discharge could be:
Cure →best result.
Improved or progress → favorable.
Deteriorated or worsen(untreated) or death of patient before treatment.


Leave hospital late consultation
late treatment
patient dissatisfaction with
disease progress.
patient has been told to
consult other doctor or other hospital.
Death of patient → critical measure for skillful treatment.

4) Hospital records or statistics:

Special record for each case admitted.
Mortality rate records including case fatality.
M.R. 3-4% medical ward , 1-2% in surgical ward/after 48 hours from admission.
Mortality rate records including disease specific morbidity rates.
Disability rate − distributed according to type of disability (specific rates).

5) Consultation rate; death conference for example.

The high the rate of consultation , the better is the result.
It should be within the range of 15-20%.
6) Cross infection rate. Very common specially with tetanus or clostridium (rate =1-2%).
7)Complication rate. 3-4% of beds e.g. hepatitis from blood transfusion.
8) Unnecessary or unqualified surgical interventions.
e.g. midwifery wards , tonsillectomy , appendicectomy , … etc.


9) Postmortem rate.
This is more occurring in mental hospitals and when death is rare →30-40% of such cases need postmortem to safeguard the responsibility of doctors and other hospital staff.
10) Scientific conferences rate.
Usually done for difficult cases diagnosis or about rare cases for teaching purposes.
(various scientific individuals are necessary to meet such conference).