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The Role of the Administrator In looking at the role of the administrator, it is first necessary to look briefly at some of the recent trends in administration, particularly hospital administration. The most significant development affecting the administrative process is the increased size and complexity of the hospital organisation and the bureaucratisation of all sectors of modern industrial society. Related to these developments are such other changes as the advances in science and technology with increased specialisation, extended lines of communication, and new language, related to growth and specialisation. In addition, the presence of unions, the progress in transporting methods, and finally, new discoveries and innovations in science and technology resulting in new material, plus new techniques and equipment to improve functions, have all had their impact on the process.

Doctors are seen as key to embedding health improvement and patient safety initiatives and there has been much international debate over how best to engage doctors in healthcare leadership and management. This paper explores the current focus on leadership development programmes for doctors through taking a comparative approach to initiatives in New Zealand and the UK. It also considers the challenges to embedding leadership development programmes at all levels of training, education and continuing professional development and highlights some of the implications arising from the two approaches.

The purpose of this paper is to address the research question using qualitative research methods: how and why medically trained managers choose to undertake postgraduate management training?

This research used two qualitative methods to gather data. Both methods used purposeful sampling to select interviewees with appropriate management expertise, qualifications and experience. The first stage utilised convergent interviews and was exploratory. The five interviewees were managers and academics. The second stage used case research methodology and was confirmatory. The fifteen interviewees were medically qualified chief executives and chief medical officers. In total, 20 in-depth interviews were carried. Rigorous content analysis of data collected showed emergent themes.

The first theme that emerged was that doctors move into management positions without first undertaking training. The second theme was that doctors undertake such training in the form of a masters-level degree and/or a specialist fellowship. The third theme was that effective postgraduate management training for doctors requires a combination of theory and practice. The fourth theme was that clinical experience alone does not lead to required management competencies. The fifth theme was that doctors choose to undertake training to gain credibility.

This research was exploratory and descriptive in nature and limited to analytical rather than statistical generalisation.

This research has provided insights into the importance of understanding how and why doctors undertake postgraduate management training, and may assist policy makers and training providers in the development of such training for doctors.

Hospitals consume the largest share of government health resources, yet, until recently, they have not been a focus of health policy and research in developing countries, where the resources are in negative proportion to the demands placed on services of health care institutions, and where the possibility of resources being increased in the short run is very remote, the only hope for the increase in the effectiveness of the health care system being the effective management of hospitals. A professional administrator with multidisciplinary training would ensure the optimal use of resources. We live in the age of perfection at all levels. Hence, professional training is the basic requirement for the personnel to function effectively in a hospital. Professional training is required to be imparted by the institutions specialised in professional training. Professional management has an immense scope and a bright future market on account of the increasing demand for specialised and quality health care. Better management or lack of it will determine the future of health service. This paper focuses on development of management and the requirement for professional administrators in India.

The Institute for Healthcare Improvement (IHI) has broadened their campaign focus to include protecting hospital patients from five million incidents of medical harm through 2008. A critical component of this campaign is the engagement of governance in the process, noting evidence of better patient outcomes for hospitals with governing boards that spend at least 25% of their time on quality and safety. St. Francis Medical Center (SFMC), a 384-bed hospital in Southeast Los Angeles serving a high number of uninsured and underinsured patients and a population characterized by significant poverty, has initiated through a top-down approach, an aggressive plan to improve the care at its facilities through a call to action by its board of directors. In this article innovative methods are shared, tools are provided, and the initial positive results achieved are reported which show how a cultural change is occurring regarding quality and patient safety (QPS) at this hospital's organizational and delivery system level.

Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety.

The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored.

The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes.

FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions.

FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type.

The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.

Describes a methodological study to evaluate the quality of care for an elderly population in the treatment of hypertension from a fairly simple analysis of medical records in primary care, with or without the use of additional information from patients, and shows how this type of data can be used to point out shortcomings in primary care. The data derive from a community survey of elderly people in one area of Jerusalem and relied on personal interviews, blood pressure measurements and an analysis of medical records over a period of four years. The measures used are: the percentage of persons without blood pressure (BP) measurement in a given year; the maximum “gap” between consecutive BP measurements in a given year; the rate of BP measurement per clinic visit; the percentage of hypertensives treated; and the percentage of hypertensives under control. The prevalence rates for hypertension in this elderly population vary between 40 per cent and 59 per cent according to the definition used. Using a simple and straightforward analysis of sick‐fund records several shortcomings in the surveillance and control of hypertension were detected. Calculation of the percentage of untreated hypertensives required a separate information source ‐ the screening. A BP survey is an important complement to an analysis of records. An ongoing evaluation of the quality of care of hypertensives in an elderly population should be based on screening, interviews with patients and analysis of the physician′s records. These provide an overall picture of the care in each medical practice enabling the physician to improve the quality of care provided to his or her patients.

Organizational culture is defined as the shared values and beliefs that guide behavior within each organization, and it matters because it is related to performance. While culture is generally considered important, it is mysterious and intangible to most leaders. The first step toward understanding organizational culture is to measure it properly. This chapter describes methods for measuring culture in health care organizations and how these methods were implemented in a large academic medical center. Because of the consistent empirical link between the dimension of communication, other culture dimensions, and employee satisfaction, special attention is focused in this area. Specifically, a case study of successful communication behaviors during a major “change management” initiative at a large academic medical center is described. In summary, the purpose of this chapter is to demystify the concept of culture and demonstrate how to improve it.

This paper aims to show the impact of service failure and to shed light on the vengeance of consumer in the health-care service.

A qualitative research through a retrospective study based on individual interviews was conducted. As this study is a sensitive topic, projective techniques were used to complement individual interviews, especially with care consumers who are reluctant subjects who prefer methods which preserve confidentiality. Practically, drawing interpretations method was used. The use of these drawings is to encourage reluctant interviewee to discuss on the study’s sensitive theme.

Empirical findings allowed first to approach care service failure in Tunisia that is an emerging post-revolutionary country-owned MENA. In this context, a comparison between the public and private sectors was proposed. Moreover, the results helped to understand service failure’s consequences related to patient’s reaction.

The Ministry of Health in collaboration with managers of public and private medical institutions will have to work on capitalization of knowledge, especially those learned from unsuccessful experiences.

Medical service failure can have multiple sources. The care consumer’s reaction to these failures can sometimes be extreme in form of revenge.