Posted in Marketing & Strategy Articles, Total Reads: 2022
, Published on 04 October 2012
The course is Healthcare Management. It is an MBA with a very domain-specific knowledge base/ skill set. What do healthcare managers do? What are the things that they should know? How or rather why are they so different from the rest? Health organizations; do they really need a special breed of these so-called "managers" who seem to infest this country at an alarmingly increasing rate?
This article is just going to attempt to open that Pandora's Box. And how better to do it than by being there. I decided to go to an hospital. I know, when we say healthcare management, it does not necessarily mean only hospitals but hospitals are a mainstay and a lot of the other allied organizations can also benefit from the perspective gleaned from this exercise.
So, I went to a hospital ; but not as an observer, or as a visitor, but as a real patient. And not just any patient, a real-life trauma unit patient. Because well, Trauma Unit yields very transparent and very quick results. It's about the high contrast of life & death and pain & relief. And they literally have very low scope of eclipsing the core services with non-necessary or necessary non-value-added work. How did I manage to do it is another story; essentially I went and got myself admitted for a number of injuries accrued from a bike accident with some scope/ possibility of serious damage to head and pelvis.
The very first thing I noticed was how unaware, and totally at a loss a patient is when he steps through those glass doors. There are people sleeping on the floor in the reception area, there are stretchers being carted inside a barrage of doors and there are people lined up against the various counters, all of which cater to specific needs. There is this palpable sense of urgency and desperation. I come in and I am more than slightly bewildered. In fact I recollect , I put the blame on the possible contusion/ concussion to my head. The flurry of activity unnerves me. I don't see signs and notices and instructions. I just see people scurrying and hurrying about me. I am asked to go to the Emergency Triage. I have no clue where that is, I just blunder in and a shadily lit corridor has a number of avenues leading away from it , I flounder my way to the Emergency Triage.
There are four patients already on beds and I can distinctly see blood stained clothes. One of them is a lady and she is either really hurt or has a very low tolerance/ threshold of pain . She is screaming as the assistants try to calm her down and do the first of the basic duties, clean up the wounds and administer some painkiller and other similar requirements. As a science student for many long years and now as a management student, I find the scene eerie. Not the patients , or the blood or the screaming but the process. People are doing work, the nurses are addressing the patients; the assistants are fetching gowns, dressing material and syringes; and trash cans are filling up, but it looks so very disorganized, in a very high level of disarray. I cannot pinpoint what it is, but I can see no semblance of order or pattern or process, I just see people.
Interestingly, the people working don't looked fazed or bewildered or panicky. In fact, not in a cruel kind of way but I could see some of them even exchange a smile and a word as they pass each other, both headed towards different patients. I realize, suddenly, it's all part of a day's work for them. They know what they are doing and they are doing it to the best of their abilities. They are clearly understaffed and over worked, with crazy work hours but work in undeniably being done. And that is the first indicator of how this system really works.
Management is well defined. In fact , it's so well defined we have people chalking out their life plans, (and of their future generations) based on tomes of knowledge that they bequeath to us , the hapless management students. We have clear cut domains, hierarchies, laws, rules and definitions . MBA is so much of a science, that we even have sums and equations , hypotheses and corollaries. And it teaches , above all to generate wealth. It runs on some basic premises of how people react , how logic prevails and rationale drives the process. Of course exceptions are discussed and described. And this is where healthcare takes a major detour from most other industries.
Derived Demand: The huge sway in the balance, the skew in favour of the doctors / physicians / consultants and surgeons. People may argue its the age of the Internet and we are all better educated, but when you have your closest friend lying in a pool of blood and the doctor asks you to do that really expensive technique, are you really going to fish out your mobile and check it up on Google before signing the consent form?
Knowledge: That leads to the knowledge skew.
There is a palpable shift in the environment of the trauma centre when a doctor finally steps in. Conversations are hushed as he flits from bed to bed issuing instructions, checking and speaking . I observe as the heads crane and follow the doctor as he moves from bed to bed , I see the eyes of the people yet to be seen by the doctor and how they follow him with a strange primal stare. It’s a strange feeling realising how much power/ influence a single individual, a mortal can have over another mortal. That's what we are talking about, that is what this field is all about.
I come in with some injuries, but I have to stay till a doctor from every department ( in my case, orthopaedics ( broken bones) , and neurosciences (damage to brain) ) have come, inspected me and declared me fit. It’s only their stamp of authority that matters.
By the way, I leave almost 1o hours after I come in, and the entire barrage of tests reveal I am perfectly alright. The doctor’s total time ( all the doctors) with me was under 3 minutes and consisted primarily of a lot of peering, poking , rubbing and the standard set of questions.
Organic working: I am admitted to the trauma centre at 9 am. There are 4 patients ahead of me, victims of a nasty accident. The doctor bluntly tells me: “You are on your feet, you haven't lost consciousness and you are able to talk coherently. You will have to wait , it may be 2 hours before we can get to you. “ I mumble something about missing classes and hostel perm time; Sharp comes the retort : “Or, you can sign a form that you do not want to be treated by us , voluntarily and walk out.” No mincing of words, no cushion. It’s their way or the highway. Of course I accede, meekly. Do I even have a choice?
Three and a half hour later, they have just managed to stitch up the 4 victims, one of them escalated to ICU , 2 to general OPD , etc . and I am on my bed awaiting my turn. And in comes 2 more people; one is a kid with a very noticeable head injury. The doctor doesn't even bother looking at me and starts on the kid. Can I blame him, can I complain, can I protest and ask him to see me first? Silently I wait , hours more. The organic way of how work is achieved is something which a healthcare manager needs to embed in his psyche.
Pain: When you are in pain what are you willing to do ? Let's make it simple: You have broken a bone, you are in excruciating pain, as in , the exact meaning of the word “excruciating” suddenly becomes very clear to you. No matter how many staff members are around you , you will not be administered a single drug unless a doctor comes along, inspects you and decides; ‘xyz drug at such and such concentration only’ and the first stages of relief creeps in. Imagine that power.
The very basic-ness of the actual need of this field is unnerving. It isn't money, or house , of clothes, or for that matter food. We are not talking about hunger or starvation. They may be hygiene factors or dissatisfiers. But this is critical. You are in pain. You are suffering or you have an ailment. And nothing else matters. Nothing. Not a signature, not a premium, not wearing a proper uniform or speaking your language or following rules. Just make me well. Just make this pain go away.
It’s such a small , simple word, but it’s a game changer when you bring in management. Healthcare is a recession-proof industry , experts claim, why so? Because it emerges from the very basic needs of a human. It caters to the most unspoken of needs, the need to stay healthy, the need to remove pain (physical at least) from one’s life. and under most circumstances , no price is big enough to achieve this.
Emotion : We are not just dealing with patients but with their support group present with them as well. I was asked to do an Ultrasound, I looked back at the assistant sceptically. And he goes, “We can only suggest what you should do to verify that you are ok from inside, what you finally do is totally your decision” What argument do you bring to that ? Logic, rationale goes for a toss when you see a lot of blood , your own blood staining and soaking your own clothes. u seek. u crave. it boils down to basic human nature. Not lofty managerial principles, vision and mission and every healthcare manager , no matter how far flung is he from an actual interface with a trauma patient needs to know. It is a hypothalamus run business.
Thus , in conclusion, the world today needs Healthcare Managers, undoubtedly so. The field of healthcare is not, should not, cannot ever be only a profit making venture, not for organizations that want to survive indefinitely and grow roots and not be ashamed of themselves. But the healthcare managers need to have a very clear perspective as well, no matter their level of interaction with a human or their designation. They are not a run-of-the-mill manager. their decision isn't governed merely by the dictums of the organizations alone. They should not be automated machinations, a frictionless gear in a complex machinery. There is, always human life involved and human emotions and pain. And the complex driving process has a severe dependence on the knowledge of certain individuals, it is as much a team game as it’s a solo performance. Embracing this and other similar dualities as part and parcel of this industry and adapting the management principles learnt in a B- school to fit these needs best is crucial for any healthcare manager to call the profession his own.
This article has been authored by Sambit Kumar Mohanty from TAPMI.