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Kavisha Sheth
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organisation structure & culture of asian heart hospital - January 21st, 2007

organisation structure & culture
submitted to ms.sumi narendran

ASIAN HEART HOSPITAL

INTRODUCTION


Asian Heart Institute (AHI) has been set up by Contemporary Healthcare Pvt Ltd. with an aim to provide world-class cardiac care in India. The hospital promises to provide quality cardiac care to patients at reasonable costs. AHI was set up with a holistic approach to heart care based on ethics, quality care and professional backed by competitive prices. It prides itself on quality in terms of design, patient care, medical, paramedical and general staff and infrastructure facilities. The hospital has been designed as per guidelines from Cleveland Heart Clinic, USA to ensure International Standards. It is a Patient-centric design with stress on safety and comfort of Patients. All Patient areas have been designed to minimize the risk of infection. The hospital was started to set a benchmark in quality care, ethical practice, reasonable costs and training for those in the profession. Patients are not charged premium rates for the care they receive. Set up outside the noisy streets of a city, the Asian Heart Institute spread across an area of 400,000 sq feet is today looked upon as the most trusted cardiac hospital in the country.

MISSION

The mission of the hospital is worded and framed as below-

“To operate as a world – class heart hospital, incorporating the latest technological advances and ethical practices to provide quality heart care at reasonable cost."







ORGANISATION STRUCTURE

Organisation structure is the framework that defines formal reporting relationships between different levels of management of an organization. Organisation structure is the mechanism that operationalizes the management of the organization. In the context of a hospital, organizational structure refers to the levels of management within the hospital. It also defines the chain of command of the hospital.
Each hospital is composed of a set of units, individually specialized for the execution of special activities and the delivery of particular services; all units of the hospital, however, must mutually interact consistently for the effective working of the global structure.

VICE CHAIR PERSON

HOSPITAL CHIEF EXECUTIVE

↓ ↓ ↓ ↓
General Manager General Manager General Manager General Manager
↓ ↓ ↓ ↓
Corporate service Hospital Planning Patient & Community Quality
Department Department Department Department

Finance Infrastructure Human Resources Nursing
Banking Décor Safety Clinical work
IT Kitchen Medical Records Pharmacy
Procurement Library Counseling Linen
Supplies Training Event Reporting Ethics

To execute and maintain these departments and the sub departments within these departments, there are Chiefs of Services, who on the orders of their respective General Managers regulate these departments.



Different ways by which, the structure of this hospital can be understood and analyzed. -

Work specialization

This aspect is very important in any organisation as the hospitals need to provide a task to that individual who is an expert in that. They cannot take chances of giving any work to anyone who is free. When we took their interview we asked them for an example that can help us understand the work specialization in the hospital. They said, For example, in case of the ASIAN CHILDREN”S HEART CENTRE, when they are treating the babies out there, they do it efficiently with the help pf at least 4 people operating on 1 baby. The 1st person, who is very good and efficient in keeping the children clean and safe, does the washing of the baby with specific medicines and harmless solutions. The 2nd person is the doctor who operates on that baby. He is not just any cardiologist but the 1 who is specialized in operating on the babies. The 3rd person is the assistant/ nurse of the doctor, who is not that intelligent as doctor but knows his/her work and is flawless in his/her area of expertise. The doctor athough more intelligent than the nurse will never perform even 1 single task of the nurse/assistant. Once the operation is done the job of the doctor is over so then the next task of that job is given to the 4th person whose job is to place back all the equipments in the way they were and wrap the baby back after the 1st person washes the baby.
Thus the hospital has been able to operate at least 18 babies per day. The division of small tasks which when completed helps us achieve 1 result, has helped the hospital increase its efficiency and provide maximum
patient satisfaction.


Chain of Command

The hospital has given high importance and emphasized the function of chain of command because the hospital understands that if their hospital does not have a formal chain of command, policy and procedures will their staffs know to do when presented with a situation in which they question the care a patient is receiving? What Miss Suchitra said is that-“if we hadn’t given importance to the chain of command, then the staff would be forced to rely upon their decisions and their own judgments to determine whom to call for assistance.
Lets take any department in the hospital. Each department has the same level of authority and in each department the design of chain of command is the same.
Hospital Chief Executive

General Manager

Manager

Executive Officer

Team Leader

Supervisor

Officers

Operation Assistants

This chart makes it very clear that there is a formal chain of command in the hospital. The hospital also provides training to the recruited people regarding how they are expected to behave in situations where the question is patient care and to whom they should report in such cases. They have adopted this chain of command system so that it will reduce the potential confusion that can occur in situations of questionable patient care by establishing a formalized procedure to follow in reporting concerns. The formalization of this policy also demonstrate the hospital's commitment to deliver an optimal level of quality patient care and sets forth the expectation that staff place the well being of the patient above all else. This has helped the officials of this hospital to take actions against those doctors who do not give correct orders or when the doctor has not responded in timely action. There are people who are available 24 hours a day to handle cases wherein one particular line of authority has not been able to take decisions or not been present to solve the decisions.




Span of Control

The Span of Control in the hospital is very narrow. There are more departments and hence more levels of management. If you observe the main chart of the structure of this hospital &Chain of Command table, you’ll see that in each department there are again sub departments and each department has further so many people in them. For example, the General Manager of 1 department has 2 managers under him, and then these 2 mangers again have 2 Executives under them and so forth.
Vice Chairperson

Hospital Chief Executive

General Manager General Manager General Manager General Manager
↓ ↓ ↓ ↓
2 Managers

2 Executive Officers

2 Team Leaders

2 Supervisors

2 Officers

2 Operation Assistants


Centralization OR Decentralization
One cannot say whether there is centralization or decentralization in the hospital. Now the Hospital Chief Executive takes decisions regarding the working of the hospital. And everyone else is expected to obey his decisions. But however if there are loopholes in his decision making ability, the General Managers under him are given the right to point of his mistakes and change the decisions. Now the General Managers are given all freedom to take the decisions regarding their departments and how they should regulate. But this is provided that these General Managers take decisions within the framework of the hospital and the code of ethics. The Chain of Command is much formalized in the hospital and every must follow it. Hence there is no flexibility in the authority and decision making level. But at the same time, there are certain cases wherein the rules can be changed according to the situation. The hospital considers all the employees over here and twice every year, they have a meeting wherein all the employees of the staff meet and give there opinion whether the decisions in place right now are flexible, without any loopholes, needs changes, are favorable to the staff that has to follow it, etc.

Formalization

With a high level of departmentation and certain degree of centralization, one is bound to find formalization in that organisation. The procedures are fixed. Whether it’s the number of beds to be in a room or the number of people required during an operation, everything is fixed. There is a particular design or pattern in which even the equipments are to be used and by whom for what, in case of bookings the number of bookings are fixed per month. The job descriptions are very fixed and during the training sessions also, the freshers can’t do what they want, there is a particular way for everything. Even in case of using scissors, they have to use specific scissors for specific operations. Thus there is standardization for every single task in the hospital.


Thus with high level of formalization, work specialization departmentation and certain level of centralization, it is right to say that there is BUREAUCRACY in the hospital.
Everything is standardized and every task has to be done within the frame work of the rules and regulations of the hospital.






ORGANISATIONAL CULTURE

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural






Mission

To operate as a world – class heart hospital, incorporating the latest technological advances and ethical practices to provide quality heart care at reasonable cost.

Now the main objective of a hospital is to maintain and provide safety to their patients. As health care organizations continually strive to improve, there is a growing recognition of the importance of establishing a culture of safety. Achieving a culture of safety requires an understanding of the values, beliefs, and norms about what is important in an organization and what attitudes and behaviors related to patient safety are expected and appropriate.

While taking an interview with Miss Suchitra( HR Department Official), we were told that PATIENT SAFETY is the most impornat of any hospital culture.

Others that make a part of the hospital culture are-
• Avoiding errors.
• Coordination between the doctor and nurse.
• Maintaining the beliefs of the hospital
• Event recording.
• Good ventilation.
• Accommodation for patients with good hygienic food
• Communication.
• Training to the freshers.
• Ethical practices.
• Accountability
• Achieving goals and objectives
• Flexibility and regular change in subcultures (if needed).
• Relation between the hospital staff and patients.
• Entertainment for the patients.
• Patient counseling.
• Use of fresh blood (when required).
• Employee forum.
• Performance assessment.

These all factors play has played an important role in bringing the success to this hospital. It is with the help of these cultural attributes that has helped this hospital to become a world class heart hospital.
The hospital believes that if they are able to achieve employee satisfaction then they can surely achieve 100% patients’ satisfaction.

We had conducted a survey as given below with a list of questions in the hospital.
The questions were answered by a staff member. We selected him to answer our questions because it is the staff (including the nursing staff) that is in close contact with the patients than the doctors. This survey gives us a rough idea of the culture that exists over here. It gives us information about the working staff, their attitudes, coordination between groups, error reporting, and many such other factors.

PATIENT SAFETY

Questions
Strongly Disagree Disagree Agree Strongly Agree

People support one another in the unit?

When a lot of work needs to be done, you work together as a team to get the work done?

Mistakes have led to positive changes here?


It is just by chance that more serious mistakes don’t happen around here?


Patient safety is never sacrificed to get more work done?


When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?


Important patient care information is often lost during shift changes?


They also said that they always use fresh blood for all requirements. So as the operations or treatments are already booked before hand, they request the relatives of that patient to come before two days to donate blood as per requirement.

From this survey 1 can conclude that every possible step is taken to maintain patient safety. There is no compromise on the most important culture of this hospital.







1. What are the core values of the hospital?

Ans. The core values of the hospital include- patient satisfaction, ethics and integrity, high-performance and innovation.

2. In order to keep your patients satisfied, you have to avoid errors. How do you avoid them?

Ans. Being a heart hospital, it is very important to take care of the patients as it is the matter of their life. So most of the times, our bookings and operations are planned before hand and very rarely on the spot. As a result we avoid mistakes as it is preplanned.

3. Do you reward your employees for any specific contribution they have made to the hospital?

Ans. Yes of course.

4. Do you have any specific characteristics for the way nursing staff should speak and dress themselves?

Ans. While appointing the nursing staff we inform them before hand while the training sessions are going on, about the way they are supposed to talk. We expect them to speak in a low and gentle volume while they speak to patients in order to improve the comfort level of the patients. As for dressing, they are supposed to wear neat, well ironed and washed blue colour dress as designed by the hospital.

5. Does one find team work in the hospital?

Ans. Yes there is teamwork in every work in the hospital. People seem to share a lot of themselves. They work as a family and coordinate with each others work. To give a small example, from the décor of the room to the procedures and operations in the operation theatre, there is just not 1 person who does it all. They work in groups as per there ability, responsibility and their specialty.


6. Do you provide the patients with “How does it feel now visits?”?

Ans. This is one of the most important ways in which we keep our relations with our patients. The patients have to come for these visits once their treatments. A certain number of visits are decided after the treatment. If the patient feels that the number of visits decided is not enough then they can consult the doctor that operated them and fix such visits.

7. Do you have festivals in the hospital?

Ans. This is a heart hospital so we try to keep the atmosphere very quiet over here for our patients and their safety. But occasionally we do have a few festivals were in we encourage our patients also to participate if they are in stable condition.

8. You have a separate children care unit also, so how do you make it favorable for the children?

Ans. The entire Children’s Heart Centre has been designed keeping the safety and comfort of children in mind. Beginning with the décor in the clinics, the soft linen for wrapping babies, the stringent infection control measures to around-the-clock physician care; everything has been planned to optimize a child’s care in a very special way.

9. How do you take care for the relatives of the patients regarding when can they meet, their accommodation?

Ans. We have accommodation for just 1 relative in case they want to stay overnight. The relative will be handed the 24 hr attendant pass, visitor pass and car parking pass. This special provision of giving them a car parking pass is an additional benefit which distinguishes us from other hospitals regarding this comparison.




10. In other hospitals we see that fro a majority of the patients’ one kind of food is made. It is healthy but they donot take into account an individual and his/her health. Is the condition same over here?

Ans. Our dieticians take into account each patient and decide their food and also the time for their food. These small aspects have helped us to be different and a better hospital. Outside food and utensils are not permitted inside the hospital.

11. What are the other characteristics that this hospital follows?

Ans. Our hospital believes that it is very important fro the patients to give accurate information regarding their pain and conditions. It’s on this information that we decide the treatment. So our hospital encourages the patients to speak out their problems. We are very particular about the ventilation and cleanliness over here.

12. Has this hospital encouraged the doctors to take risks during the operations?

Ans. Our team of doctors is very capable. While they are in the OT they are very much aware of what risks they are taking incase they are not sure of the results. Our hospital has operated more than 1000 operations in the last year and not more than 5 have lost their lives while they have been operated. This shows that we are very careful and fully aware of what risks we are taking.

13. Does this hospital give importance to the way in which the result is obtained or just the result without taking into consideration how it is achieved?

Ans. Being ethical is the core value of this hospital. Hence we take into consideration both- the means and the ends.




14. To keep the atmosphere conducive for the relatives of the patients, what all steps do you all take?

Ans. We have a counseling department for the patients as well as their relatives which offer them psychological services

15. How often does staff report errors, near misses and ideas for improved care and how often do you make changes based on this information?

Ans. There are very few errors so we hardly report them. Yes ideas are taken into consideration. For example, it was the idea of one of our doctors to make a separate unit for children and have a different décor fro them which was accepted by all and implemented.

16. What stories are publicly shared within your organisation?
Ans. Till last year we never disclosed the stories, but from this year yes we have started disclosing stories of how staff got adapted to accommodate patient needs, how mistakes were made and improved in order to pass on our culture and honesty to the freshers.

We can conclude from the above that the culture in the hospital is very formal and very much suitable to all. The core values are kept in mind and maintained from time to time. They consider the feedback given to them by the patients and their family and work upon that. These values and good maintenance of these values has helped the hospital to receive accreditation from JCI (USA). This hospital is very determined to respect its culture. Moreover for their international patients too they have maintained its culture and provide them with separate prayer rooms, hotel accommodation, visits to different places in the city, etc. the hospital shows aggressiveness to be the best and inculcate this culture in each and every staff member of the hospital. Hospital’s mission statement inculcates a very broad spectrum of the patient care deliverables, setting the performance benchmark, using feasible resources and people potential. A mission statement has to be carefully worded and written because all short term and long-term objectives of hospital operations shall be drawn out on the basis of it. This hospital has maintained its mission of being ethical, strives hard every day to be a world class hospital and uses the best of doctors and technology for the betterment of their patients.


Bibliography

Primary sources
Asian Heart Hospital- Miss Suchitra ( HR Head)
L&T Info Tech- Mr. V. Vishwanath & Mr. Atul Shah

Secondary sources
www.asianheart.co.in
www.larsentoubro/infotech.co.in
Organizational Behavior- Stephen Robbins
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Re: organisation structure & culture of asian heart hospital - July 23rd, 2007

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Re: organisation structure & culture of asian heart hospital - November 2nd, 2007

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