Thoughts on hospital administration
Dr. Mohammad Zaman, USA
Quality of medical care is directly related to quality of the providers (doctor) and ancillary support structures (nurses, pharmacists, laboratory, radiology and even the 4th class employees). Many of my friends are still in the medical-college-systems in Bangladesh. They are excellent physicians with dedication and a real love for what they do. But they suffer utterly from lack of administrative care in providing appropriate ancillary support. The treatment-strategy of any medical illness depends largely on the availability of this appropriate support. In the absence of readily available lab-support (I mean chemistry, ECHO etc), the best of heart doctors will not be able to do his best for the patient. It goes for almost every other disease processes. I have a friend, who holds an appointment as a nephrologist for some time, yet he still has no facility to do a single dialysis … what a waste of money and talented human resources… Proper administration and management thus is the most important aspect of proper health care delivery. Hospitals are large organisations with groups of peoples doing various things. Hospitals need good administrators with appropriate training both in human relations and business management. Administrators in turn need to learn intricacies of health care that is unlike any other business. The government always ignored this very fact. They always imposed certain colonels or brigadiers as the top man in the hospitals. Well, I am not saying that they all are the same, but most of them keep on residing in their military cocoons even after their emergence as the top-man in a civilian hospital. This administrative structural fault is easily remediable. I do not want to see a fellow doctor as the hospital administrator. I shall be perfectly happy to see a bright business school graduate or anyone with proven track in management of "men-and-money" as the top man. The Daily Star in a recent article alluded to the extra power of organised 4th class employees that has corrupted the emergency care and admission process. It is basically a management issue with a significant political fervour. Hospital administrator must use his/her authority to address the issues. If needed, he always can go to the law enforcement authorities and even to the respective minister. An already successful person with stature can always say "no" and in dire situation will have the guts to resign. Only in such a scenario, employees of all creeds shall heed to the helm. Getting more money and grant from government is always nice, but spending the available money with a bigger bang is even nicer.
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