INTRODUCTION

According to the World Health organization, Health is a “State of complete physical,

mental and social well-being and not merely the absence of disease or deformity”. One of
thefundamental rights of every human being without distinction of race, religion, political
belief, etc. is the enjoyment of the highest attainable standard of health. The word
‘HOSPITAL’ means a charitable institution for the needy, aged, infant, or young. It is an
institution where the sick or injured are given medical or surgical care. It also means a
repair shop for specified small objects.

The hospital is a strategically designed body where the patient care is the navel point
and aroundwhich all activities related to hospital move. The physician who examines and
takes care of the patient is in the principal position and special facilities and trained
personnel are provided to him to make his work easy and efficient, trained personnel
includes technical staff of nurses, dieticians and pharmacists. From the organizational and
administrative point of view, a hospitalis virtually a city within a city.

Within its four walls, it has an operation theatre, a hospital whichis in the shape of
the patients room, a dormitory for student nurses, residents and interns, a school for
training of nurses, technicians, dietician, laboratories, a pharmacy, food vending
operations, laundry and linen service, delivery service, a post office, massive internal and
external communication system, blood bank, accounting and credit services, a public
relation department, a motor service, and security patrols. In short, the hospital is a
healthcare organization. Thus, the hospital is a specialised body where the patient care is
the focal point and about which all activities of the hospital revolve. According to Mary
Parker Follet, "Management is the art of getting things done through people."

Hospital Management: It is a term very broad in scope and may be defined from
different aspects. It mainly relates to management of all aspects of a hospital, a
coordination of all elements of a hospital. This may range from patient care to record
keeping to inventory of medicines and cleanliness. To be able to become a hospital
management professional requires taking care of each and every element of the hospital.
In every healthcare setting, including hospitals, health centres and clinics, coordination is
the soul of hospital management. However,in the hospital setting, having such advanced
technology in health care facilities, a host of facilities and features, need to be integrated
and synchronized, thus requires a strict coordination. Advanced technology is an
important factor in the hospital facility and functions. Another attribute of hospital
1
 management is the specialities and sub-specialities in which many sub-categories are
specialisations themselves.

Finally, and most important attributes of hospital management is a strong backend

or ensuringthat all aspects of the hospital are kept up-to-date. This is probably the most
important requirement of hospital management. In the hospital to manage its activities
hospital management is concerned with the productivitythat implies effectiveness and
efficiency. The aim of all administrators is the same that is to maximise the output. It
involves administration at all levels whether lower level or top level. As a hospital
administrator he has to carry out management functions of planning, organising, staffing,
directing, controlling and coordinating.

Private Sector Hospitals

Healthcare today is the world’s largest and fastest growing industry. Today, the
average Indianis spending more on his well-being than ever before. Increase in purchasing
power of the middleclass, higher literacy rate, awareness and education on preventive and
curative health care, have all made the Indian an active participant in the health care,
rather than a passive recipient. 32%of the national bed strength is in the 150 plus private
corporate hospitals. Tatas, Apollo, Wockhardt, Escorts, Max India, Fortis, Piramal, Ispat,
Duncan, Escorts etc. have been the major contributors. Maharashtra indicates that the
middle and better off sections in these communitiesuse the services of both qualified and
unqualified private practitioners. The really poor are unable to afford the doctor’s charges
and hence, either opt for government hospitals or often gowithout care.

Public Sector Hospitals

The public health care delivery system has long been catering to nearly 75% of the
Indian population comprising rural India and the lower income below poverty line group
in urban India. Various national health programmes; health insurance schemes like ESIS
and CGHS, primary & secondary health centres, municipal and government hospitals are
the only options for the middle- and lower-income groups, who cannot afford the
treatment in private [Link] is well known that the government is not able to cope with
demand of the healthcare services. The focus had been on medical care and not on
comprehensive quality healthcare. Infrastructural bottlenecks in public system have
made the State and Central Governments to invite private players to deliver critical
2
healthcare.

Brihanmumbai Municipal Corporation (BMC), the largest Municipal Corporation in

India, is the major provider of public health care services in Mumbai. It has got a network
of 3 Teaching Hospitals, 14 Municipal General Hospitals, 26 Maternity Homes across
Mumbai. Apart from this there are 185 Municipal Dispensaries and 176 Health Posts to
provide outpatient care services and promote public health activities in the city. The state
government in addition has one medical college hospital and 3 general hospitals and 2
health units have a bed capacity of 2871 beds. Though there is an urban bias in location
of public health care infrastructure, delivery of these services especially in metropolitan
cities like Mumbai is again plagued by uneven public preference for health care services.
For example, people living close to hospitalsuse them for minor illnesses, which should
actually be treated in dispensaries. This is because there is a lack of an organised referral
system and the result is overcrowding of public hospitalswith minor ailments and under-
utilisation of dispensaries where the latter should actually be treated.

As far as utilisation of inpatient care services are concerned majority of the patients
use public hospitals, and the lower income groups mainly utilise public health care
services in Mumbai. Moreover, service statistics clearly show that public hospitals are
overloaded with patients. These public hospitals are not only major caregivers for a large
section of the population in thecity but also used by persons from rural areas of nearby
districts. BMC is also a major health care provider for women and children in Mumbai.
The Reproductive and Child Health Surveyhas shown that the public sector is a major
provider of immunization and family planning services plus a sizeable proportion of the
population in this district were depending on public sector for antenatal care services (40
per cent) and child birth (48 per cent). An analysis of BMCdispensaries in two wards in
Mumbai showed that an average of 85 patients is treated every day, clearly indicating high
level of utilisation of dispensaries also. The other alternative sourceis private health care
which is relatively inaccessible to the poor but also characterized by poor quality
infrastructure and manpower and was found to be indulging in profit motivated medical
malpractices.

These super-specialty hospitals supported by NRI’s and pharmaceutical companies

are at the core of the burgeoning medical tourism industry. The Investment Commission
of India has estimated that the number of medical tourists has increased almost 20-fold
since 2000 to about1,80,000–2,00,000 in 2006. By 2012 medical tourism is expected to
become a US$ 2.2 billionindustry.
3
India’s Perspective to Management Effectiveness

Healthcare today is the world’s largest and fastest growing industry. In India
healthcare is a US 17 billion industry accounting for 4% of GDP. Public health care system
is responsible for spending of 1% of the GDP (effectively about Rs1000 per capita). In
contrast approximately 3% of the GDP (an average of Rs.3675 per capita) per annum is
spent in the private sector on healthcare. With the demand for healthcare far exceeding
supply, India’s healthcare industry isexpected to grow by around 13% a year for the next
five years. Today, the average Indian is spending more on his well-being than ever before.
Increase in purchasing power of the middle class, higher literacy rate, awareness and
education on preventive and curative health care, have all made the Indian an active
participant in the health care, rather than a passive recipient.

Statement of the Problem:

Hospital is a unique and highly complex organisational entity. To the community, it

is an important social and economic asset; to patients, it is a place to receive care; to
physicians, it isa place to treat patients; to employees, it is a place to work; and to managers,
it is a multifaceted organisation embracing clinical, financial, ancillary and support
activities. It is a place where sophisticated equipment’s, technology and personnel are
organised to provide health services. Health is a real product of any social system and
health care system for the people is one majorindex of social justice. Health and health
care services are a reflection of prevailing socio- cultural and political conditions. If the
health services are ‘sick’, it reflects the sickness of the society. The sickness of health care
system has been attributed to various reasons, most important of which is its curative
bias, highlighted by many scholars and research workers including Peter Drucker in
whose opinion, provision of health care is done by public health measures such as
vaccination, providing pure drinking water and adequate treatment of [Link] rightly
observes, “Hospitals, in effect, are the result of failure of health care rather than agencies
to provide it.” Growing community consciousness due to expansion of education and
communication have increased society’s expectations of hospital performance. Regional
Director, WHO for Europe Leo, A. Kaprie opines that improvement in efficiency of hospital
services are only possible if appropriate changes are made in the structure of the health
servicesas a whole. This is true for developing countries too including India, since the
health administration in newly independent countries preserved the organisation they
had inherited from colonial government and only tried to improve it. As in colonial times,
the super-structure was better developed than the infrastructure. This had led to
4
 problems with regard to management of services in hospitals. As per the constitution of
India, health is the subject matterof state. Different states in India have different health
policies, though there is a central direction. Health status of the people of different states
are also different. At present, different forms of organisations are rendering health
services, namely, government, semi-government, local bodies, private firms, co-operative,
bodies, trusts, societies, corporates, etc. With the increasing awareness of the public
regarding the individual and family health and role of the hospitals therein, a greater
responsibility lies on the modern hospitals to cater to the growing needs of the health
care. Besides, there is an increasing expectation of the user groups, viz., theclientele of
patients about the hospitals and hospital services.
Objectives of the Study:

1. To study the conceptual framework of Management and Hospitals

2. To study and understand the various areas of hospital management.

3. To study the performance of hospitals in relation to management.

4. To study and identify the management practices in hospitals.

5. To study the management effectiveness of public sector hospitals and private

sectorhospitals in Mumbai city.

6. To study and find out ways of good management practices in hospitals for
effectivemanagement in hospitals.

7. To study ways in which management effectiveness in hospitals of both private and

publicsectors can make a positive contribution to the society as a whole.

Hypothesis of the Study:

1. H0 There is no significant relationship between public sector hospital management

andprivate sector hospital management.

H1 There is a significant relationship between public sector hospital management

andprivate sector hospital management.

5
 2. H0 There is no significant relationship between private and public sector hospitals
and thefacilities provided to them for better management.

H1 There is significant relationship between private and public sector hospitals

and thefacilities provided to them for better management.

3. H0 There is no significant relationship between public and private sector hospitals

andprovision of required resources for efficient management.

H1 There is a significant relationship between public and private sector hospitals

andprovision of required resources for efficient management.

4. H0 There is no significant relationship between public sector hospital management

practicesand private sector hospital management practices.

H1 There is a significant relationship between public sector hospital management

practicesand private sector hospital management practices.

5. H0 There is no significant relationship between the management effectiveness of

public sector and private sector hospitals with the population of patients visiting the
hospital.

H1 There is a significant relationship between the management effectiveness of

public sector and private sector hospitals with the population of patients visiting the
hospitals.

Scope of the Study:

The medical profession has broadened its horizon globally and India is no exception.
Corporate hospitals are emerging as new breed in healthcare industry in India. These
hospitals are attracting a number of patients because of their super-specialties. There is
keen competition among these hospitals for market share. The emphasis is not only to
provide specialized services more efficiently and effectively, but also to maintain the
quality of overall services.

In view of changing needs of customers, changing world, changing life style and
technologicalinnovations, the market has become customer service oriented. Therefore,
effectivemanagement has become an essential need in this competitive environment. As
the physiological contentment of the people got satisfied; there is a demand for more
satisfaction. Human’s desire to live long has resulted in special healthcare services like
6
health and fitness clubs, multi-specialty hospitals, nursing homes etc.

Hospitals these days need to be managed professionally the way the other business
organisations are managed, i.e., offering quality services satisfactorily to the patient
community. Keeping in view this focus, the present study intends to assess the
management effectiveness in public sector hospitals and private sector hospitals in the
city of Mumbai. Themanagement practices were assessed in order to ascertain the extent
of professionalism in the hospitals covered under the study. Various managerial practices
have been studied. Secondly, the study has focused on the effectiveness of management
rendered in the hospitals covered under the study. Effectiveness is the degree to which
hospitals accomplish their goals. Whereaseffectiveness of services rendered is the extent
to which each service line accomplishes its [Link], this study was undertaken to
assess managerial effectiveness and to compare the efficiency of management of public
sector and private hospital in Mumbai city. Secondly, the study has focused on various
areas of hospital management in public sector hospitals and private sector hospitals in
Mumbai city. Thirdly, the research is to study the performance of hospitals in relation to
management. Fourthly the study is undertaken to identify the management practices in
hospitals. Fifthly the study was undertaken to find out ways of good management
practices in hospitals for effective management in hospitals. Sixthly the study was
undertaken to study the scope of Hospital management advance technology contribution
to hospitals in Mumbai city. Lastly the study was undertaken to study ways in which
management effectiveness in hospitals of both private and public sector can make a
positive contribution tothe society as a whole.

Research Methodology:

The present study being an exploratory research investigation involves original field
interviewson a limited scale with interested parties and individuals with a view to secure
deeper insights into the aspects of the problem.

Level of Research The prima facie nature of the present study appears to be that of a
‘descriptive-diagnostic investigation.’ It is a maiden venture in the study area to research
the problems of hospitals from management science’s perspective. In the absence of prior
researchon the topic in the study area, the overall character of the present study has been
maintained at‘exploratory level’ with the hope that the findings on analysing the empirical
data under investigation would bring forth promising research hypotheses for future
study.

7
Sampling Design:

Selection of samples and data collection is the most importantpart of research

study as it is not feasible to contain all populace in the study. Thus, it is significant to draw
out data samples that can take the satisfactory size of population. Simple random sampling
method is used as probability sampling for availing respondents’ opinion in the subject
whereas convenience and judgemental sampling is used as non-probability sampling for
selection of hospitals. The simple random sampling method is fitting for this research as it
undertakes to limit the possible data to those which are less extreme by ensuring that all
sectionsof the populace are corresponding to the data in order to increase the effectiveness
byminimising the error of probability. The respondent of the structural questionnaire were
mainlythe patients of the public sector hospitals and private sector hospitals in Mumbai. As
a group ofsample data was brought into reflection therefore it was important that the data
collected for thepurpose were enough for interpreting the research results. Data size refers
to the number of elements to be included in the study. Determining the sample size is
difficult and it involves numerous qualitative as well as quantitative reflection to the
research study. Some important qualitative dimensions that should be measured in
formulating the data size include the significance of the judgement, environment of the
investigation, number of items, nature of theanalysis, data size used in familiar works and
resource constraints.

Sampling Population:

The population of the study are all the patients in public sector and private sector
hospitals in south Mumbai and certain hospitals in suburban Mumbai. Out of all the public
sector and private sector hospitals situated in south Mumbai and certain parts of
Suburban Mumbai we have selected 10 hospitals from public sector and 10 hospitals from
private sector. From each public sector hospital around 20 patients have been given the
questionnaire to collect data for analysis. Similarly, from each private sector hospital
around 20 patients have been selected to collect data for analysis. Total sample size 400
was decided.
Sampling Method:

A stratified random sampling procedure was used for selecting the participants in
this study. This technique was employed to ensure a fairly equal representation of the
variable for the study. The stratification was based on state government and private
8
 owned hospitals in the cityof Mumbai. Within each sector the patient’s selection was by
simple random sampling.

Sampling Size:

The sample size predicts the value to a certain level of confidence. It is not possible
for most ofbusiness to undertake a census survey. So, a sample has to be drawn. Sample
size is not dependent on universe size. For drawing relevant information from the data, it
is necessary to select appropriate sample size depending on the study and target
population. In the current study, it is difficult to identify or set the complete list of
population

SAMPLE SIZE

Public Sector Hospitals Private Sector Hospitals

Variables Under Study:

A variable is a characteristic that takes two or more values. A variable is something
that [Link]’s a characteristic that is common to a number of individuals, groups, events,
objects etc. The individual cases differ in the extent to which they possess the
characteristic. A variable is a central idea in research. Simply defined it is a concept that
varies. Variable is defined as anything that varies or changes in value. Variable takes on
two or more values because variable represents a quality that can exhibit differences in
value, usually in magnitudeor strength. The study warrants two sets of variables namely
dependent and independent variables, the variables under these two sets are given below.

Dependent Variables: - The title of the problem suggests that there are two dependent
variables

1) Management effectiveness.

2) Patient satisfaction.

Independent variables: The selection of any variable as an independent variable was

9
 based on the assumption that there were measurable differences among levels with
regard to the perception of the dependent variables i.e. patient satisfaction and
management effectiveness. Selection of the variable was also made on the major
consideration that the factors selected should be amenable for objective measurement
and also facilitates group measurement. Considering the above criteria, the independent
variable as per the study is given below

1) Public sector hospitals in the city of Mumbai.

2) Private sector hospitals in the city of Mumbai.

Pilot Study:

Lindsey defines a pilot study as “A small version of the full study.” The pilot study is
to test the tool to be used for data collection. A pilot study is a small-scale replica and a
rehearsal of the main study. Pilot studies are concerned with administration and
organisational problems related to the whole study and the respondents.

Following are the objectives of undertaking the pilot study.

1) To test the research methods and research tools and their suitability.

2) To estimate the level of response.

3) To determine the homogeneous population of the study.

4) To test the responses of the respondents to the method of data collection.

The study was pilot tested with 50 respondents. The pilot study was initially undertaken
to ascertain the reliability of the questionnaire. After the pilot study changes were made
to the questionnaire in order to prepare the main survey investment. This helped
to check thereliability and validity of the questionnaire.

Pre-Testing of Questionnaire:

According to Maholira pre-testing is the trial run of the questionnaire on a small sample
of respondents to identify and eliminate potential problem. While preparing for a
researchinstrument to be used to collect data there were several mistakes that cannot be
easily identified before the actual field work. Conducting a pre-testing study gives an
advance warning to the research about where the main research could fail. Where
research protocols may be followed and whether the proposed methods or instruments
are appropriate or complicated.

Bryman and Bell noted that pre-testing has a role in ensuring the research instruments as
10
 a whole function well in order to eliminate variation in respondents understanding and
interpretation of the questionnaire in terms of ambiguity. The questionnaire was pre-
tested with50 respondents. After the pilot study changes were made to the questionnaire
with specific reference to wordings, sequence and language.

The pilot study equipped the researcher with a strong base in the development of
questionnaireand finalising the statistical tool to be used for further analysis of the data.

Reliability Check:

The reliability if an instrument refers to the degree of consistency between multiple

measurements of variables. It is the extent to which an experiment tests or any measuring
procedures yield the same results on repeated attempts.

Reliability test was conducted with Cronbach’s Alpha value. Hypotheses testing was done
withthe help of statistical tests. The conclusion and findings were drawn based on data
analysis testing.

Data Collection Method and Measuring Instrument:

The data collected from primary sources as well as secondary sources. A questionnaire
wasdeveloped for data collection which comprise of close ended questions.

Primary source- A questionnaire was developed for data collection which comprise of
closeended questions.

Secondary source- Secondary data was collected from various sources like
a) Books, magazines and newspapers.

b) National and International journals and websites.

c) Hospital data available from website and hospitals journals.

Research tools and data collection: Instrument in research refers to the tools or
equipment’s used for data collection. The instrument used in this study is developed in the
light of review ofliterature and consultation with health care providers. The primary tool
used in this study was structural questionnaire. The researcher visited the hospitals and
collected the data. Thequestionnaire was prepared to collect data from patients to find
their satisfaction level of hospitals in private sector and public sector. Satisfaction level
question were prepared based onseven levels on various aspects to find out the patient’s
satisfaction in various areas of hospital management to find the efficiency of hospitals.

11
 The data is collected through the structural questionnaire designed for the study mainly
consisted of seven levels of satisfaction of patients. The measuring instrument was used
for capturing customers perception of quality of services in the respective hospitals.
During the pre-test the participants were told that the study was a part of a doctoral level
research. The participants were told that their participation in this study

was voluntary and confidentiality was assured. The complete filling of the questionnaire
took 15 to 20 minutes. The research sample was selected from twenty-five patients from
public sector hospitals and twenty-five patients from private sector hospitals from
Mumbai.

Questionnaire Design:

The questionnaire is a structural technique for collecting primary data in a research

work. It is a series of written questions for which the respondents provide answers. A
well-designed questionnaire motivates the respondent to provide complete and accurate
information. Questionnaire was designed taken into consideration the objectives of the
study and the hypotheses that have been taken in the study for testing. Fixed alternative
questions were provided with multiple choice answers. Questionnaire was designed with
a specific purpose to obtain the require information to carry out the research work.
Multichotomous questions have a range of responses as in a multiple- choice test.
Whenever previously used scales were available, they were first screened by the research
for their easy interpretability in the Indian private and public healthcare context. When
appropriatescales were not found, new ones were designed subjected to the scrutiny of
the hospital acquaintances. This was followed by a formal test run in one hospital of each
ownership type. The analysis of the test run results pointed to the need for further
changes. A changed format was prepared and tried out on a different set of hospital
acquaintances. Pilot study helped us toeliminate the difficult questions, biased question
and difficult question and the questionnaire was corrected and reframed for actual data
collection with well tested and reframed questionnaire.

Data Processing and Analysis:

The responses collected through questionnaire are compiled and analysed with the
help of computer using the following software i.e. SPSS for statistical calculation,
electronic spreadsheet (Ms-Excel) for mathematical calculation and Ms- Word for typing
, editing and processing table creation etc. For analysis the responses receive from various
categories are compiled and rearranged. Further the analyses of responses are carried
out according to the following methodology.
12
 1) Reliability Analysis

2) Demographic Analysis

3) Cross Tabulation Analysis of the overall responses.

4) Z-test analysis on overall responses

5) Factor analysis.
The number of integration factors from the literature review are being identified which
directlyand indirectly affect, they are also renamed and rearranged to determine their
impact. Under each and every section factor are classified on the basis of the objectives,
the statement are designed and included accordingly.

Significance of the Present Study:

Many research studies that were confronted during literature scanning are on the
topics as Personnel Polices, Recruitment Sources, Selection Process, Induction,
Performance Appraisal,Training and Development, Employee Satisfaction, Strategic HR
and so on so forth. But there seems to be no research study available on management
effectiveness in public sector and private sector hospitals in Mumbai. There appeared to
be an urgent need to undertake a research study that exclusively discusses about
management effectiveness in the Hospital organizations in the emerging economic
scenario of the country. The study is based on the following areas: The current
management effectiveness scenario in Healthcare organizations. Management Practices
implemented in public sector and private sector hospitals in Mumbai city. Management
practices adopted in the hospital in the area of patient satisfaction in public sectorand
private sector. Management functions in the area of patient satisfaction which shows
management effectiveness in public sector hospitals with comparison to private sector
hospitals.

Limitations of the Study:

1) The study is confined to Public sector and Private sector hospitals only. The study has
been limited to Mumbai city which covers south Mumbai and certain parts ofsuburban
Mumbai. The study is limited to patient’s satisfaction only. Data is collected only from
patients and satisfaction of management efficiency is seen only from patients’ point of view.

13
 REVIEW OF LITERATURE
The review of literature guides the researcher for getting better understanding of
methodology used, limitations of various available appraisal, procedures, database, lucid
interpretation and reconciliation of the conflicting outcome. Besides this the review of
empirical studies explains the avenues for future and present research exertion related
with the subject matter. In case of conflicting and unexpected results, the researcher can
take the advantage of knowledge of other researchers simply through the middling of
their published works.

A large number of researches probing have been carried out on different aspects of
the working of public and private sectors by the researchers, economist and academicians
in India. Different authors have analysed management effectiveness in different
perspectives. A review of these analyses is important in order to develop and approach
that can be employed in the context of the study of selected Indian public sector and
private sector hospitals. Therefore, the present chapter reviews the various aspects of
management effectiveness of public sector and private sector and from local to global
level.
A considerable thinking and research have gone into the area of hospital
management and administration. Plenty of research papers and referral works have been
taken into the literature review on this aspect of hospital management in India. A brief
review of the indigenous literature available on hospital management is being attempted
here with a view to provide good theoretical and practical dimensions to this empirical
study. The reviews of research papers and the referral works and a few unpublished
doctoral researches works in this study have provided a good backdrop of the knowledge
input for a scientific analysis of the research findings in the areas covered by the study.

Globalization and medical tourism

In recent decades, significant political, economic and social changes have

encouraged a more international role in health policy development. These
interconnections between nations include the movement of people, capital and ideas,
which has subsequently resulted in new opportunities and challenges for health care
delivery and regulation.
The growth of medical tourism is supported by the regulatory regimes, recognition of
transnational disease patterns, industry development, rise in low-cost airlines and shifting
14
cultural attitudes about overseas destinations.

● Community Medicine and Public Health, Edition: 8th, Chapter: Hospital

Administration, Publisher: Time publishers, Editors: Shah KS, Mohamaed Iliyas, MA
Ansari, Muhammad Irfanullah Siddiqui, pp.235-46 Hospitals which utilize most of the
health budget play a very important role in the country’s health system. Hospital
Administration cannot be done on intuition. A hospital administrator must be well aware
of the scientific methods to run and evaluate the hospital functions and services in an
objective fashion. All the doctors should be having a good understanding of hospital
organization and management for better care of their patients. Moreover, they should also
have enough knowledge for management of human, material and financial resources in a
cost-effective way with optimum time approach. Hospitals are among the most complex
organizations in modern society. The modern hospital itself is a universe, with a variety of
objectives, and a scalar division of labour to achieve those objectives

 Anand K.K, (1976) Health is not only the basic to lead a happy life to an individual, but
also necessary for all productive activities in the society

 Methodist church, (1985) According to Christian Medical Commission “Health is a

dynamic state of well-being of the individual and the society of physical, mental, spiritual,
economic, political and social well-being in harmony with environment and God.”

 Goel S.L and Kumar, (2004) Health administration is a key part of governance and an
important social welfare activity of the government. The Government of India has a
separate ministry for health and family welfare. The ministry of health and family welfare
is the nodal agency to look after health services. The central government undertakes the
responsibility of policy formation regarding health and it develops new health
programmes. It provides financial help and technical assistance to the state governments
for the implementation of health policies.

 Goyal R.C, (2000) Administration plays a vital role in the functioning of a hospital, more
than it does in any other institution. In order to perform its functions efficiently, hospitals
today must be organized and administered in a scientific manner. There is now a greater
need for efficient administration in Indian hospitals because the number of people who
utilise hospital services has increased manifold, whereas the financial and other resources
available to hospitals in India have not kept pace with the growth in number of users. The
optimum use of resources is possible only with an efficient and professionally competent

15
administration. This demands that every member involve in hospital administration need
to be adequately trained. Moreover, with the increase in the hospital’s size and complexity,
as also with the changing socio- economic conditions, the organizational relationship
within the hospital has undergone a change. In short, having become a large-scale
organization, the hospital requires a more explicit organizational division of labour and
more efficient and responsible management.

 Armstrong and Michael, (2000) Human Resources Management Practice 7th Edition,
Kogan page limited, London, U.K, pp.3. stated that human resource management is a
strategic and coherent approach to the management of an organization’s most valued
assets - the people working there, who individually and collectively contribute to the
achievement of its goals. Quality care begins with human resource management. It
provides attention to functions such as staffing, training, appraisal and compensation to
ensure fit with organization’s goals: if goals change, function need to change.

 Suri R.K. and T.N. Chhabra (2001) Managing Human Resource: Techniques and
Practices, Vanity Books International. New Delhi, pp.1-5. concluded that, management can
never accomplish organizational objectives without the efficient use of human resources.
Therefore, creating and maintaining a motivated workforce is the central responsibility
of management everywhere. The study of HR practices and activities gives the extent of
success or failures of policies and practices.

 Chang (2005) stated that an HRM bundle includes diverse practices such as training,
sharing information, employment security, performance-based compensation, employee
participation, and ensuring employees’ well-being.

 According to Mamoraia and Gankar (2001), research of human resource

management provides an understanding of practices, policies that are successful and
those which are not, what changes are necessary and in what area. Management needs
information on employee job satisfaction in order to make sound decisions, both in
preventing and solving employee problems.

 S. M. Jha (2001) Hospital management, 1st edition, Himalaya Publishing House, New
Delhi stated that to bring efficiency in the function of a hospital by proper employee
selection, training and control is very important. Employee selection, training and control
require special skills, time and effort which cannot, usually be provided by the person
charged with the general administration work of the hospital. The increasing size of
hospitals has made impossible the continuance of the employee-employer relationship in
16
which employee and employer worked side by side, knew each other as individuals and
understood mutual problems. In small hospitals such a relationship is still possible. In big
hospitals, supervisors have been introduced to function as links between administration
and employees; but in most cases, these supervisors are only interested in getting the
work done and are in need of training in the human relationships which are involved in
their own work situation.

2.2.1 Administrative and Management Aspect of Review

External developments

Changes in health care technology are only second to information technology. The rate of
development has increased tremendously in the pharmaceutical, imaging and biomedical
sectors as well as in many hospital based-specialities such as oncology, cardiology and
anaesthesia. New and emerging investigative and treatment modalities are introduced
regularly, sometimes without an understanding of their full benefits or implications.
Due to this rapid evolution, a dilemma is ever present when planning a new service; as the
designs hit the drawing board, they are already considered out dated and not
commensurate with present, yet alone, future requirements. The globalisation of health
care and readily available information over the Internet has ushered in a new era in the
doctor/patient relationship. The traditional agency role of the doctor, playing the part of
the patient’s advocate, is no longer applicable in this age of empowerment and shared
responsibilities. Moreover patient’s expectations increase with every new discovery or
medical breakthrough and governments are expected to match these with an equal vigour
of new investment in services the above place an almost insurmountable strain upon the
financing of health care and, therefore, the issue of its future sustainability is a poignant
one, which needs to be addressed adequately.
Internal developments

There have been so many major developments in hospital practice, it is impossible to list
them all. Essentially most recent developments have sought to place the patient at the
centre of activity. For the lay person, this may seem an obvious choice. However, in the
past, few hospitals can claim to have been patient focused or friendly since most services
and care were centred around the professional and not necessarily on the patient.

 Strauss and Sayles - Management training an essential part of management

development, supplements other developmental techniques such a job rotation and

17
performance evaluation. Training is necessary to help promotable managers to prepare
for advancement, to assist managers having difficulties with their present jobs to prevent
managerial obsolescence, and to build moral in lower level managers by demonstrating
top management’s interest in them.

 John R. Welch and Brian H. Kleiner- Hospital over the past years have not truly been
challenged in a competitive business environment. Management techniques were not
tested, as they would have been in other industries. Now that Medicare and business have
become more sensitive to rising health care costs and to the fact that other forms of health
care delivery have arrived, hospitals have been forced to take a closer look at how they
can increase revenue, cut costs, and still maintain quality patient care. Hospitals are still
in their infancy when it comes to doing business in a competitive environment. It will be
interesting to see how they perform within the next few years.

 Henry Minzberg (1973), in his book the Nature of Managerial Work (cited in Robbins,
2003) provided ten roles of managers play for increasing managerial effectiveness, which
can be divided into interpersonal roles, informational roles and decisional roles. In order
to play these roles effectively, managers need some sets of skills; Robbins (2003) also
cited Robert Kaltz three types of managerial skills, which includes technical skills, human
skills and conceptual skills.

 Screwvalla Z.S (Feb.1988) in the article “Pursuit of Management Excellence in Banks”

states that an organization should sustain its viability and optimize its growth, according
to parameters offered by the potential in the market place. The effort and investment in
improving manpower requires the highest priority for a business organization. He insisted
for employee’s competencies building, proper training program arrangement and proper
performance appraisal systems implementation.

 Sharma P.S. (2002) in his article “Management Excellence in Cooperatives” has told that
for bringing about overall efficiency of the cooperative sector, promotion of leadership
development programme is essential and should be made an integral part of HRD strategy
within the overall plan of growth and development of cooperative organizations. The
members of the Boards of Directors should be trained in the leadership development
programmes. The ‘Cooperatives should take advantage of latest trends in the education
and training modules evolved under HRD network jointly set up by International
cooperative Alliance (ICA) ILO

 R. Rani Geetha Priyadarshini & Venkatapathy R. (2003-04) have published their

18
article titled as “Impact of HRD on Organizational effectiveness in the Banking Industry”
in which they have concluded that a) the HRD practiced in the banks have a strong
influence on their performance; b) greater the association between HRD practices and
organizational effectiveness, greater is the performance of the banks; c) private banks
have placed low emphasis on HRD practices in their organizations, which may be due to
lack of adequate orientation and resource allocation towards developing their human
factor. d) top performing banks have a higher extent of HRD practices in their
organizations, which influences the effectiveness of their organizations and e) HRD
practices in the organizations have impacts on the effectiveness of organizations and
hence on their performance irrespective of their size and ownership. They concluded that
high extent of HRD practices and better performance go hand- in-hand and vice-versa
which explicitly implies that HRD positively impacts organizational effectiveness and
hence performance of banks.

 Gordon, L. Simpson, (2004) in his Article “Performance Appraisal- an Important

Managerial Responsibility” quoted that performance appraisal should be viewed as a
beneficial process in HRD. It should be accepted as a normal management responsibility
to review the performance of all employees and should also discuss its results with them
regularly. The author feels that the key elements of an effective performance appraisal
system are like clearly defined performance standards, an effective monitoring system,
regular discussion of performance, and development of appropriate action plans as a
consequence of the appraisal etc. help employees to ensure, accept and yield more desired
benefits.

 Samwel Kalkuko Lopoyetum (2009), in his article titled as “Professionalization of

Management and Administration of Co-operative Business Organizations: Challenges and
Strategies” has stressed the imperative need for effective and efficient HRD in co-
operatives. The employees and management of co-operatives to be highly productive and
highly professionalized need continuous improvement in the new changing environment.
He further adds that co-operative leaders should enhance their professional skills and
knowledge through education, training and extension activities. Author says that co-
operatives must identify the training needs and job requirements of employees before
initiating a training programme. He has suggested many measures for reformation and
revamping co-operative business organizations in the context of new economic
environment and some of them can be cited here as a sample. Improvement in governance
and leadership development. Providing them with appropriate autonomy. Improving

19
work place, productivity, efficiency and effectiveness of these co-operative business
organizations. Education and training facilities, staff member’s participation in
management may eventually improve the performance of the cooperative business
organizations. Good governance in the public sector- Consultation draft for an
international framework. Aim- The aim of good governance in the public sectors is to
encourage better services delivery and improved accountability by establishing a
benchmark for good governance in the public sector.

 [Link] (1984), in his paper, ‘Problems of Hospital Administration’, has identified a

number of problems in hospitals, following being prominent among them: (i) Lack of
educational and in-service training facilities, (ii) Lack of full authority to a hospital
administrator, (iii) Limited availability of financial resources, (iv) Over-crowding the
existing hospitals because of shortage of hospital facilities in the country, (v) Over-
dependence on outside service agencies. (vi) Crowding in the wards by the patient’s
relatives and friends, (vii) Political interference in the running of certain hospitals,
(viii)Wastage of hospital administrators' time in calling and attending meetings, and (ix)
Employee-Union’s use of illegal strikes as a weapon to fulfil their demands. The author
recommends the following for overcoming these problems. (i) It is important for the
hospital administrator to develop and maintain a high morale among the personnel under
his control and at the same time satisfy the medical staff. (ii) In order to make a hospital
run efficiently, it is imperative that there should be a full-time administrator. (iii) There
should be prescribed training course in hospital administration at least in one university
in each state.

 S.F. Chandrashekhar (2000), in his paper, ‘Human Resources Management in

Hospitals’, has applied the functions of general management - planning, organisation,
directing, and controlling - to each one of the tasks of human resource management -
procurement, development, compensation, integration, maintenance and separation - to
give a holistic view. He gave a detailed working for manpower estimation and in
instrument for selection. His theme is, ‘from control perspective of personnel philosophy
to commitment perspective of human resources philosophy’.

 Nair R.N. (1998) in his Ph.D. Thesis “A study Of Effectiveness of Executive Development
Programs in Urban Co-Operative Banks with Reference to Konkan Region, Maharashtra”
studied existing executive training and development program of Banks and evaluated
newly developed system to confirm it’s utility. He advised Banks that, training need

20
should be properly identified, training should be time bound and restructured as per the
need, the schedule of training and infrastructure should be prepared, pre and post training
appraisal program should be conducted and cost benefit favourableness of training
program should be prepared.

 Rao, T.V. & Rao Raju (2002) have narrated their study under title “A Study of
Leadership Styles and Their Impact.” This study attempts to identify the impact of three
different leadership styles on the learning climate generated in the organization as
perceived by top level managers in a company. The leadership styles studied is:
benevolent or paternalistic style, critical style and developmental style. The impact
variables studies include the extent to which they produce loyalty and dependence,
resentment and counter dependence and learning, job satisfaction and morale. The study
indicated that while benevolent style creates dependence and resentment, critical style
creates resentment. The developmental style of leadership tends to create learning and
job satisfaction. The authors have concluded that the developmental style is the most
desirable style. It is associated with creation of empowerment, growth, learning, morale
and satisfaction on the part of the employees. Benevolent or relationship dominant style
has the potential of creating not only dependence but also resentment and avoidance of
work.

 David A. Latif research focuses on the management skills component of managerial

effectiveness. It reviews the relevant management literature related to what effective
management skills are, why they are important, and describes one model, based on
empirical research, for teaching management skills to pharmacy students. This paper
focuses on the last component of managerial effectiveness: management skills. The goal is
to use research findings from the business literature in an attempt to answer the
aforementioned questions concerning the managerial skills component of pharmacy
management education.

 Rastogi, Renu and Vandana Dave (2004) did research and published ―Managerial
Effectiveness: A Function of Personality Type and Organizational Components in
Singapore Management Review, Vol.26, No.2, pp.79-87. This study tests managerial
effectiveness of top and lower level managers in production and marketing departments
in relation to their personality type in private sector organizations. The major findings are
that in production department, both top and lower level managers having Type B
personality are found more effective and in marketing department top-level managers
having Type A personality and lower level managers having Type B personality have been
21
found more effective in comparison to their counterparts.

 Mohammed Abdullah Mamun and Ariffin Bin Mohamad (2009) present that an
attempt to understand the changing need of management expertise to face the
contemporary challenges of management and the roles of business school in this concern.
The business has to know the implications of the changes and accordingly has to prepare
the people by their capabilities required to implement the strategies for individuals
participating in the programmes.

 F. Analoui, H. Labbaf and F. Noorbakhsh (2000) suggested Managerial skills are

viewed as being of fundamental importance for improved managerial performance and
effectiveness as the whole. Recent developments in the field point to the presence of three
paramount and overlapping categories of managerial skills namely task, people and self-
related, that play a crucial role towards increasing the effectiveness of the senior
managers in both private and public sector organizations. The results of a survey of
executive and senior managers in the steel industry of Iran point to the emergence of
distinct patterns delineating clusters of skills with various degrees of 107 extent of
generalization to the universe of managerial skills. It is concluded that while people-
related skills are strongly interrelated, and should be regarded as an integrated set of
skills, the same does not apply, at least to the same extent, to the other two categories of
skills. People-related skills, however, constitute the most important category for the
increased effectiveness of senior managers, irrespective of their position in the hierarchy.

 Luthans et al. (1988) have convincingly shown that effectiveness and success are not
identical, that the distinction is at least real, if not of crucial importance. Their study was
four years long, large and rigorous, using multiple techniques, and collecting and
analysing information on 457 managers across many companies and industries. It
demonstrates that effective managers differ from successful managers in terms of what
they do and how often they do it. In 1988, Luthans, Hodgetts and Rosenkrantz published
results of their four-year study of management practices, involving 457 managers. Their
study produced findings directly relevant to the problem to be investigated in this thesis.
They distinguished, for the first time in the literature, between managers who were
successful in terms of career progression, and those who were effective in the sense of
satisfied, organizationally committed subordinates and work unit performance. They
found successful managers and effective managers systematically differed in relative
frequency of their activities.

22
 Sonia Rani researcher under Dr U.C. Sharma on management effectiveness of various
areas and as management effectiveness of executives. The researcher concludes that
managerial effectiveness and organisational effectiveness are correlated and cannot be
separated. Hence organization development programmes help develop and flourish
managerial effectiveness as well as organizational effectiveness. The researcher has
discussed vividly various issues related to managerial effectiveness. These issues are the
basis of the research study.

 Boedker (2011) This research report aims to open up the ‘black box’ of management
and provides insights into the leadership, culture and management practices that higher
performing work places deploy and benefit from. It also illustrates the productivity and
profitability benefits that accrue to higher performing work places. It is part of 2.5-year
project funded by the Dept. of education, employment and workplace retentions to the
society for knowledge Economics in December, 2009. It shows that HPWS consistently
outperform the rest both in regards to managing their intangible assets and their
productivity and profitability.

 Masthan (2005) in the research on performance management concluded that any

economy requires more performance-based organisations for its development. Better
performance means, achieving higher productivity with limited resources a fewer people,
lesser cost and time. In a dynamic environment the organisation for the survival and
growth need to focus attention in scaling up in performance. For which they need to
understand the key factors are quality innovation, productivity with quality, low cost and
quality, better people practices, collaborative leadership and learning culture

 Haslinda Abdullah on Major challenges to the effective management of Human

Resource training and development activities. Objectives to examine challenges to the
effective management of HR, T& D activities in manufacturing firms in Malaysia. Research
Method: In- depth interview were conducted with 58 HR managers managing employees
training and development, employing a purposive or judgemental sampling technique.
Findings: The study revealed three major challenges to the effective management of HR
T&D. These include a shortage of intellectual HRD professional to manage HR T&D
activities coping with the demand for knowledge workers and fostering leaving and
development in the workplace.

 “A Managerial Appraisal of Public Hospitals in Gujarat located at District Head

Quarters” Objectives of the study: The present research study had been undertaken with

23
the following Objectives in views. 1. To study theoretical concept of hospital and hospital
management. 2. To study and review national health policies of India.3. To study
Integrated Disease Surveillance Project in Gujarat. 4. To study health administration at
union and state level. 5. To study organization structure of selected public hospitals. 6. To
study availability of various services in selected public hospitals. 7. To study availability of
various wards in selected public hospitals. 8. To study number of beds at different wards
of selected public hospitals.9. To study charges for various services in selected public
hospitals. 10. To study present staff position at selected public hospitals. 11. To study
number of indoor patients treated at selected public hospitals. 12. To study number of
outdoor patients treated at selected public hospitals.13. To study availability of various
vehicles at selected public hospitals. 14. To study availability of staff quarters at selected
public hospitals.15. To study various methods used by selected public hospitals for staff
evaluation. 16. To collect and review patients’ feedback on managerial aspects of selected
public hospitals.17. To put forward over all findings and suggestions with a view to make
management practices of public hospitals more effective with special reference to public
hospitals located at district headquarters of Gujarat state.
2.2.2 Doctors and Paramedical Staff Aspect of Review

 R.C. Goyal’s (1998) book on, ‘Hospital Personnel Management’, has dealt with various
methods of organising a hospital’s personnel department and has discussed how those
methods could be implemented in a modern and scientific manner so as to improve the
overall services of the hospital. The book also has covered other important aspects of
hospital management such as organisational development, transactional analysis,
importance of teamwork, personnel audit and Indian legislation. The author has
highlighted the role of hospital administration in legal matters and has presented the
Supreme Court judgements on medicos.

 Dangwal R.C and Sacher Arun (2007), has examined the influence of various factors
of organizational climate on managerial effectiveness in Pharmaceutical industry in the
article entitled “Influence of Organizational Climate on Managerial Effectiveness a Study
of Selected Pharmaceutical Companies”. An in-depth study of Glaxo India Ltd and Novartis
India Ltd. has revealed existence of favourable organizational climate which leads to
managerial effectiveness as compared to the other two Indian multinational
pharmaceutical companies – Ranbaxy Labs Ltd and Nicholas Piramals Ltd.

 Satya Prakash (1998), in his paper, ‘Hospital Planning and Administration: Some

24
Overlooked Aspects’, has discussed critically the layout, building, physical facilities,
equipment and has suggested as to how a good planning can ensure savings and more
benefits. Based on his experience, he has rightly come to the conclusion that the public
hospitals cannot meet fully the needs of the society and tends to be very crowded and thus
do not attract the relatively better off sections of the society. Except a few, they cannot
afford to provide the more sophisticated and recent diagnostic facilities. On the other
hand, private sector units tend to be unpredictable and undependable in their charges,
equipment, dependability and honesty. Charges are often arbitrary and the profit motive
may be overwhelming.

 S.L. Goel (1998), in his paper, ‘On Records Management in a Hospital’, has discussed
the essentials, contents and classification of record management. He has recommended
useful suggestions to improve the record management system, which can help in a number
of ways in providing decent care to patients.

 S.L. Goel (1998), in another paper, ‘Materials Management with Special Reference to
Equipment and Drugs’ has discussed the important aspects of management in hospitals.
He has rightly concluded that the thorough understanding and use of the techniques of
material management would help in ordering supplies when need, controlling their use,
keeping them safely and in working order and also motivating the personnel in the best
use of the equipment and drugs. This also prevents the changes of non-availability of
equipment and drugs as being out of stock of these reduces the usefulness of the hospital
system.

 K.M. Mangla (1998), in her research article, ‘Management by Objectives in Hospitals’,

has discussed the use of this modern management technique to make the personnel
working in the hospital efficient and responsible. The author has discussed the various
stages of this technique, which can help, in designing an MBO in hospital.

 Advani Mohan (1975), Carried out a study on Doctor Patient Relationship in General
Hospitals for his doctoral work. He reported that the social status provided to the doctors
and their professional values influence their practice to a large extent. In regard to doctors
preferred role relations with patients he finds that doctors tend to maintain affective
neutrality in order to avoid emotional involvement with patients and to avoid impairing
of their efficiency. At the same time the patient’s behaviour is affected by the duration of
contact, previous experiences & image of the hospital. The choice of hospital, mode of
treatment & level of satisfaction of determined by their socio-economic status.

25
 Chaudhary Rena (1986), In her study on nurses generalized that nurses reveal a
humanitarian attitude towards patients in contrast to doctors who show an instrumental
orientation. Nurse in a hospital setting is liaison between a patient, his family, the hospital
and the health team, the leader of which is a physician. She being close to the patients has
a greater responsibility from the total patient care, than the physicians who makes expert
diagnosis and recommends suitable therapeutic treatment. Despite the recognition of
services provided by nurses’ attitude of the Indian society towards them is still negative
as nursing was mainly associated earlier with the low castes and poor widows struggling
for a meagre existence. This social stigma still carries on with them. This is indicative of
the fact that still the attitude of the society towards them is unchanged.

 Mr Suryawanshi Subhash Masanappa June 2012 from Tilak Maharashtra

University Pune, “Human Resources Management Practices a critical study with special
reference to Hospital Organisations in Pune Metropolitan Region.” The main objectives of
the research were to study the conceptual framework of human resource management and
hospitals. Also, to study the percentage of hospitals in Pune and Pimpri Chinchwad area
those have adequately fulfilled the human resource management objectives.

 S.L. Goel and Kumar (1998), in their research paper, ‘Challenges of the Administration
of Hospital Services’, have discussed the nature, functions, classification of services and
gave concrete suggestions to improve the functioning of the hospital services based
upon their analysis. They have rightly concluded, ‘we must attend to all these problems
to ensure efficiency of the hospitals. These problems also emanate from a number of
constraints on hospital authorities, e.g., shortage of staff at all levels, absence of proper
accommodation to provide space to the ever increasing number of patients, shortage of
funds, shortage of medicine, shortage of equipment, political and administrative
interference, etc., which need to be attended to by the Governments at the Union and state
level to provide satisfactory hospital services. Besides, the patients and their relatives
must co-operate with the hospital authorities to make the best use of the available
resources.

 S.L. Goel (1998), in his paper, ‘Administration of out-patient and in-patient services’,
has discussed the management of two important services, i.e., out-patients and wards. He
has observed that the inadequacies in managing these services and gave concrete
recommendations to make them effective and efficient.

 R.D. Sharma and Hardeep Chahal (1999), in their paper, ‘A Study of Patient

26
Satisfaction in Outdoor Services of Private Health Care Facilities’, have reported the
findings of a survey to understand the extent of patient satisfaction with diagnostic
services. They have constructed a special instrument for measuring patient satisfaction.
The instrument captures the behaviours of doctors and medical assistants, quality of
administration and atmospherics. The role of demographic characteristics like gender,
occupation, education and income is also considered. Based on the findings, the paper
suggests strategic actions for meeting the needs of the patients of private health care
sector more effectively

 Murthy, Nirmala (1999), conducted a household survey in Ahmednagar district of

Maharashtra to gauge the extent to which the respondents were satisfied with the
government & private services. Most women looked upon private services as ideal. On all
items the respondents rated the government services as inferior to the private services.
The overall score for the government services was lower than that for the private services
significantly, more women thought that private doctors examined them properly and gave
more effective treatment than they received from government doctors.

 C. V. Subramaniam in his article titled “need to consider human element”

comprehensively covers participation, communication and motivation for the purpose of
organizational development. ‘Human Element’ is the live force in the organizations & the
human resources are the precious resources that tend all its other resources. Hence the
management’s approach towards its human resources ought to be human and all
members of the organizations ought to work in coherence to achieve the common goals.
The work place now is the primary focus of people’s lives & it is here that people look for
gaining a sense of achievement. The three characteristics of Japanese industrial
organizations are: First, Japanese people’s ability to achieve a consensus around a high
goal. Secondly, their necessity for fulfilment of purpose, ‘which drives then to intense
effort & thirdly their tremendous adaptability the willingness ‘to change’. In India too
management policies & practices should be re-oriented towards people & their
development.

 A system approach was published by Professor M. Chandrasekhar and Sri Balaji

Prasad (1997), A paper on health management in an edited book titled “Health Panning
in India”. M. Chandrasekhar observed that health care management in India has failed to
create adequate health facilities in rural areas in spite of the increasing plan allocations.
Growing inequalities in the quality of healthcare between private and government
hospitals is the cause of concern. The cost of health care is enormously increasing. The
27
author suggested policy aspects like collection of user charges in government hospitals,
promoting health, insurance scheme and improving health information systems which are
the top priorities for better health management system in India.

 Baishakhi Dey, Anindya Mitra, Katakam Prakash, Amrita Basu, Supriya Ray,
Analva Mitra. (2013), Effectiveness of Care Pathways in Ideal Hospital Management
System. A Review of Indo Global Journal of Pharmaceutical Sciences, 3(3) :185-191
Objectives: What hospital should look like in the near future to fulfil the requirements of
modern medicine and demographic changes? Proper motivation for work and
commitment to achieve the desired target, fulfilment of mission can be regarded as key
factors for success of the top performing noteworthy hospitals. Such commitment should
be reflected among the administrative bodies to working class. Discussion is done on the
implementation of care/critical care pathways in terms of quality, efficacy and safety,
stroke care pathways and stroke rehabilitation, clinical decision making and the role of
medical staff including Hospital managers and administrators in the hospital management
systems. Findings: Critical pathway should stress upon standardisation in order to
improve control over patient care rather than only concentrating how to control
expenditure and proper use of resources. An important current challenge for Physicians
is to participate in pathway development and implementation so that the management
protocols reflect their beliefs about care. Although critical pathways clearly hold the
promise of reduced cost and improved quality, the fulfilment of this promise requires the
full and informed participation of physicians.

 [Link] (2000), in his paper, ‘Health Care in India - Profile and the Future’,
contained five parts, and the first is an analysis of the official statistics on health care
leading to an estimate of number of hospital administrators that will be required in the
country by the year 2001, to support the growing number of hospitals. In the second and
third parts he has presented different vistas on the health care sector in India. It closes
with normative and prescriptive long-term projections for the future and estimated the
size of the market. The author has traced what has been taking place in the Indian health
care sector, to prove its economic potential, the possibility of it becoming an engine for
growth and provides some suggestions for proactive decisions. He sets the theme for
private initiative to open up a segment which will bring health to more people and provide
economic benefit to many more.

 S.F. Chandrashekhar (2000), in his paper, ‘Hospital Organisation Structure’, has

28
mentioned that there is a blend of theoretical rationality and pragmatism. He traced
various aspects of a structure which is applicable for any organisation and applied them
to four types of hospitals, classified by ownership - a large government-run hospital, a university
teaching hospital, a trust hospital and a corporate hospital. He has concluded that there is no one
right structure that is appropriate for all hospitals, but the circumstance in which an organisation
finds itself leads to its structure. He extols the current thinking regarding flat structures to
increase efficiency, quicker decision-making and a close relationship.

 P. Jangaiah (2000), in his paper, ‘Financial Management for Hospitals’, has traced that
many corporate and private owned hospitals though technologically superior, are
insufficient in managing finance. A proper management of finance will not only give a
larger surplus, but will also help in cost control and minimisation, the gains of which can
be passed on to the patients. He has suggested sources for funding a hospital project, be it
total creation or expansion, provides rationality for measuring its return and works out
various ratios to keep business operations in check. Many of the principles are supported
with live data.

 V. Venkatareddy (2000), has collected almost all classificatory systems in one place in
his paper, ‘Hospital Materials Management’. He has illustrated each one of them, discussed
when and how to use them and where needed combined two systems in a matrix form for
decision- making. For the sake of clarity, he has provided a compare and contrast study
between the material managed in a hospital and the ones in an engineering manufacturing
organisation. He said that once the classificatory system in operation and the policies are
stated, a computer programme will help automation by working out the inventory levels,
order quantity and order date.

 D'Souza, Mario C (1990), In his article, "Quality Assurance of Hospital Care'' explained
the concept of quality assurance as establishing quality control programmes to evaluate &
monitor the quality of hospital care and to ensure that care of reasonable standard is
provided in a most efficient, effective and economic manner. Dr. D’Souza points out that
unreasonable attitude of patients and their attendants along with inadequate
infrastructure, lack of equipment’s, improper maintenance of hospital buildings &
equipment’s, non-availability essential drugs & medical supplies, non-availability and
inadequacy of medical & Para medical staff are the major constraints in the provision of
quality care. Dr. D’Souza maintains that if the general public becomes well informed about
the hospitals functioning if hospital accreditations laws are enforced strictly and if the
medical faculty themselves lay down minimum hospital/professional standards in
29
institute an accreditation process and regulate the quality of hospital services, the quality
of care could be improved.

 S.L. Goel (1998), in his article, ‘Manpower Planning’, has discussed the nature and
meaning and ingredients of manpower planning to ensure optimum preference and
satisfaction among the hospital personnel. He has rightly remarked an important
operational objective for the future is, therefore, to improve personnel systems, develop
manpower planning and expand the opportunity for education and training of personnel
in the hospitals to achieve the goals of the hospitals, as it is the human capacities which
transform the resources into active agent of production.

 Nalini V. Dave’s (1999), research study on ‘Hospital Management’ has focused on

following major objectives: (i) the major objective was to study hospital
management, its professionalization and organisational behaviour in government district
civil hospitals. (ii) The study also has tried to concentrate on the problems of efficient
management of public hospitals. Her study was done in the state of Gujarat and restricted
to 9 district civil hospitals for intensive and analytical study. The study has revealed some
of the distinguished characteristics of hospital organisations such as professionalization
in the hospital management for better performance. She has noticed that there are no
comprehensive departments on hospital management side in the selected study units. The
author has suggested that specially trained personnel should be appointed for all non-
technical areas of hospital management.

 Yesudian, C.A.K (1979), In his study on "Utilization of health services in a metropolitan

city'' found that various health services were utilized more by the rich than the poor. The
selection of a health centre by the well-to-do persons was on the basis of their personal
knowledge of the doctor in the centre and, at the same time, they utilized the private
health services also. The poor, on the other hand depend entirely on public health services
for all their health needs. Lack of resources and ignorance were the main causes for the
poor being unable to properly utilize the health services.

 Nandraj, Sunil and Ravi Duggal (1997), Carried out a study on physical standards of
private health sector in an average district of Maharashtra the study revealed that the
standards in private hospitals were poor. Most of them were located in residential
premises. Many lacked space-entrances were narrow, passages were congested and it was
impossible to manoeuvre either a trolley or stretcher. Some had converted kitchens into
operation theatres. Many of the hospitals were ill equipped. Few had doctors round the

30
clock. Most hospitals employed unqualified nurses and other staff. Supportive services
like ambulance services, blood, oxygen cylinders, generators, etc. were inadequate. Many
of the hospitals did not have continuous water supply sanitary conditions of the hospitals
left a lot to be desired. The number of toilets and bathrooms were not keeping with the
number of beds in the hospital. Far from incinerating infectious waste material, hospitals
dumped waste in ordinary municipal bins.

Ulrich.D. (1998), in a new mandate for Human Resources published in Harvard Business
Review, argues that HR has never been more necessary, today, than ever. According to him
the competitive forces that managers face today will continue to confront in the future,
demand excellence. The efforts to achieve such excellence through a focus on learning
quality, teamwork and reengineering are driven by the way organizations get things done
and how they treat people, and these are fundamental HR issues. According to him, HR can
help deliver organizational excellence in the following four ways:- First HR should become
a partner with senior and line managers in strategy executions, second it should become an
expert in the way work is organized and executed, delivering administrative efficiency to
ensure that costs are reduced while quality is maintained, third it should become a
champion for employees vigorously representing their concern to senior management and
at the same time working to increasing employee contribution, that is employees
commitment to the organization & their ability to deliver results and finally HR should
become an agent of continuous transformation, shaking processes and a culture that
together improve an organization's capacity to change.

 Schular, R.S., MacMillan, I.C. (1984), the role of human resource management in
gaining competitive advantage has been discussed in the western literature since the early
80’s. Schular and MacMillan (1984) discussed how companies can strategically utilize
their infrastructure requirements to gain competitive advantage particularly through
their human resources & human resource management practices: Although there are
many ways by which companies can gain a competitive advantage, as MacMillan (1983)
has suggested one way often overlooked is through their human resource management
practices. HRM practices enable companies to gain competitive advantage in two major
ways: one is by helping themselves and the other is by helping others. There appears to be
a significant benefit from having HRM considerations represented in strategy formulation
stage rather than only in the complementation stage.

 Stephen T. and John J. Rodwell (1998), In their article examined the level of

31
operational and strategic involvement by human resource department the influence of HR
departments and the level of strategic integration as predictors of human resource
management performance. They surveyed 146 senior line managers and HR executives in
commercialized and non- commercialized public sector agencies in Australia. Their
results indicated a positive relationship between the degree to which operational HR
activities were transferred to line managers. HR influence, strategic integration and the
performance of the HRM function. Relationship was found between the level of strategic
involvement by HR department and perceived performance of the function. The study
highlighted the challenges faced by HR practitioners needed to be operational to be valued
strategically.

 Roy Massey (1994), Explored the reasons as to why strategic HRM is a critical issue
facing NHS trusts in U.K. He identified the risk associated for not taking a strategic
approach. According to Roy organizations that do not adopt a strategic approach are easily
recognized to the development and implementation of human resources activities. In
those organizations that do not adopt a strategic approach; existing approaches often act
as barriers to the implementation of strategy rather than as levers to support or facilities
if they are at risk of reacting to somebody's agenda. Failure to have a strategic approach to
HRM will directly impact on the performance of the organization; however, it is measured,
critically. Failure to make a strategic approach will have implications for costs, efficiency,
productivity & quality.

 Kaniz Marium Akter- According to most- of the HRM literature it is through employees
that such competitiveness can best be developed, because employees possess the kinds of
skills that allow flexibility & which are difficult to imitate. In other words, among all the
resources possessed by the organization, it is only manpower or the HR that create the
real difference. Because all organizations can have the same technology, they can possess
same type of financial resources, same sort of raw material can be used to produce the
goods & services but the organizational source that can really create the difference is work
force of the organization. Therefore, they are the main sources of innovation & creativity
in the organizations that can be used as a competitive advantage. Of course, the
organization should gain high commitment, pride & trust which will bring a sustained
competitive advantage because it will take years for competitors to reproduce the same
level of commitment & trust. If organization are able to manage, its workforce efficiently
& effectively this will be beneficial for all stakeholders (organization, employees &
society). The quality of the organization’s employees, their enthusiasm & their satisfaction

32
with their jobs and the company all has a significant impact on the organization’s
productivity level of customer service, reputation & survival.

 In a paper, Kenworthy (2003) proposes the use of the Hay/McBer (McBer, 1997)
Managerial Competency Questionnaire (MCQ) as a reliable, valid set of scaled 100
competencies that have sets of behaviours ordered into levels of sophistication or
complexity (Spencer & Spencer, 1993), as a suitable assessment tool to examine the extent
to which the different programmes impact on the managerial competency of the The
Hay/McBer MCQ competencies found to be the most critical for effective managers
include Achievement Orientation, Developing Others, Directedness, Impact and influence,
Interpersonal Understanding, Organizational Awareness, Team Leadership. The
Hay/McBer MCQ provides a robust, reliable tool to consider as a basis of measuring
managerial behaviours suitable for this research study (Kenworthy, 2003). The use of a
well-tested competency instrument to assess behaviours change on a 180° basis provides
sufficient objectivity (Wimer, 2002) without being overly burdensome to the participants,
the client organization and the researchers.

 In Australia, the Karpin Report (1995), was commissioned by the Federal

Government to review the performance of Australia ‘s managers compared to their
counter parts in other countries. Its findings conclude: [a] Australian managers lack
competitive leadership skills and even awareness of the need, [b] this twin deficit requires
urgent redress, and [c] redress is constituted by on-going measures. Particularly, research
supporting this report found that international best practice warranted high priority to
upgrading front line managers’ leadership skills in an Australian context (Vines, Ivanoff,
Griss and Prentice 1995); yet Australian management education, training, and
development practices neglected them (Rothman and Stewart-Weeks 1995).

 Dr Yasin Olum (2004), Modern Management Theories and Practices, Paper presented at
15th East African Central Banking Course, held on 12th July 2004 at Kenya School of
Monetary Studies. Objectives: Some managers in different parts of the world could have
achieved managerial success without having basic theoretical knowledge in management,
it has to be unequivocally emphasised that those managers who have mixed management
theory in their day-to-day practice, have had better chances of managing their
organisation more efficiently and effectively to achieve both individual and organisational
objectives. Therefore, managers of contemporary organisation ought to appreciate the
important role they play in their respective organisations if they are to achieve set goals.

33
Secondly there is need to promote excellence among all persons in organisations
especially among managers themselves. Findings: It has to be restated that management
is the process of designing and maintaining an environment for the purpose of efficiently
accomplishing aims. Managers carry out the functions of planning, organising, staffing,
leading and controlling. Managing is an essental activity at all organisational level.

 Kenneth. A. Potocki and Richard.C. Brocata (1995), A system of management for

organisational improvement by Quality management in Johns Hopkins, APL Technical
Digest Volume 16, Number 4. Faced with cutbacks in funding, escalating costs, global
competition for limited resources and a demand for higher quality outcomes,
organisations of all types have felt the pressure to operate more effectively. Organisational
improvement is required. Based upon various management approaches five guiding
principles are being used to make outstanding improvement in organisational
performance: measurements/benchmarking, leadership, employee involvement, process
improvement and customer focus. However not every organisation trying to apply these
principles is successful. What is required for success is that these principles be
understood and applied as an integrated system of management.

 Farhad Analoui, Mirza Hassan Hosseini, (2001), present that the effectiveness of the
processes involved in business administration programs for managers in Iran. It aims to
understand the foundation of appropriate business administration for managers and to
explore their views and perceptions in relation to the skills and knowledge required of
them. The results showed that a combination of these skills enables the managers to work
more effectively. However, there seems to be a gap between what is offered and what
managers actually need. Also, it was discovered that in Iran business managers tend to
place more emphasis on the importance of the task and self-development categories of
knowledge and skills rather in related ones. These results have numerous implications for
the business schools and other universities who deal with managers in Iran.
Developments in Business emulations and Experiential Learning indicates that
traditionally, the views surrounding the issue of managerial effectiveness have tended to
be largely based on the assumptions about what managers do, and what they should do to
be successful according to Robotham and Jubb (1996). These assumptions are challenged
(Luthans, Rosenkrantz, & Hennessey, 1985) in that rather than relying on an evaluation
of managers performance that is based on the activities traditionally prescribed for
managerial success, a focus on the activities managers actually perform has emerged.
Models abound in the literature for measuring the behaviours and knowledge of

34
managers and provide a suitable basis to measure managerial effectiveness

 Fadi El - Jardali, Victoria Tchaghchagian and Diana Jamal. Assessment of Human

Resource Management Practices. Sound human resources (HR) management practices
are essential for retaining effective professionals in hospitals. Given the recruitment &
retention reality of health workers in the 21st century, the role of HR managers in
hospitals and those who combine the role of HR managers with other responsibilities
should not be under estimated. The objective to this study is to assess the perception of HR
managers about the challenges they face and the current strategies being adopted & study
also aims at assessing enabling factors including role, education, experience and HR
training. Conclusion of this study is to enable hospitals to deliver good quality, Safe
healthcare, improving HR management is critical. There is a need for a cadre of competent
HR management who can fully assume these responsibilities and who can continuously
improve the status of employees at their organizations.

 Luthans, Hodgetts and Rosenkrantz (1988) have shown that effectiveness and
success are not identical concepts. In this thesis, research results are classified into four
categories. Managers recognized as achieving both individual success and leader
effectiveness are classified as excellent. Those who are comparatively high in individual
success but low in leader effectiveness are classified as career managers. Highly effective
managers with low individual success are classified as achievement managers. Finally,
those low in individual success and low in leader effectiveness are classified as student
managers

 Sylvia J. Hysong submitted a thesis, The Role of Technical Competence in Managerial

Effectiveness: Mediators and Moderators to Rice University, Houston, Texas. This study
tested three hypotheses: (a) technical skill provides incremental value over
administrative and interpersonal skill in managerial effectiveness; (b) technical skill is
related to social power and influence tactics; and (c) group autonomy significantly
moderates the relationship between technical skill and expert power. The purpose of this
paper is to summarise the findings of a study to establish the attributes demonstrated by
managers deemed to be effective, in Singapore. The paper synthesizes relevant previous
research in the field of study and develops a useful new competency framework from
research forums with business leaders, practicing managers and human resource
professionals. This study attempts to identify the attributes or characteristics or
behaviours associated with effective managers such that a useful framework may be
developed that may be used to help organizations recruit, retain or develop their
35
managers – be they foreigners or Singaporeans – to the benefit of the individuals,
organizations and the economy

 Dr. Farhad Analoui (2003) researches on ―Increasing Women Senior Managers

Effectiveness: Evidence from Romania. In the wider context of increased participation of
women to managerial positions, the issue of effectiveness at work has become equally
important for female managers. Therefore, it is important to identify the factors, which
can determine an increase in their managerial effectiveness. This article looks at the
factors conducive to managerial effectiveness in organizations, as perceived by women
senior managers in Romania. The research was carried out through questionnaires and
semi-structured interviews applied to a sample group of 35 Romanian 117 women
managers at various levels, in both public and private institutions. The main conclusion of
the research was that, for Romanian female managers, work effectiveness is determined
primarily by the managerial skills and knowledge acquired by women. These in turn are
connected with the years of accumulated work experience, seniority, and education,
especially if it is centred on managerial education. The empirical results were then
analysed with theoretic instruments.

 [Link], Perttu. H. Dietrich. Strategic Business Management through Multiplan

projects. Objective: Management of whole collection of projects as one large entity and
towards effective linking of this set of projects to the ultimate business purpose. Method:
Mapping the types of Development Projects portfolio management contents are used to
manage multiple projects. Suggestion: For successful multiproject management, it is
essential that the managers and decision makers understand the sphere of ultimate
potential purposes of any project or idea. This occurs only if a mature understanding is in
place that makes a clear distinction between effectiveness and efficiency.

 Adeojo, Adeyinka Lawrence thesis submitted in (2012) Effective Time management

for High performance in an organisation business school, Degree programme in business
Administration International Business under Seinajoki University of applied
sciences. Objective: Main objective of this thesis is to determine the effect of time
management on high organisational performance. Method: A quantitative approach was
used as the methodology. Suggestion: The study brought out the difference between
effective time management and time management. Effective time management is a great
tool for obtaining high performance thus helping organisation to control their financial
future and improve productivity.

36
 Eva Gergely. Ph.D. Thesis University of Debrecen (2012). “Performance
Management examinations in Human resource management of certain profit-oriented
organisations and Mayor’s offices.” Objectives: General objective is the uniform
examination of performance management system of profit-oriented organizations and
Mayor’s offices. Method: Statistical test used for performance management examination
based on own constructed questionnaires, and data collected by help of surveys for
revealing blockages factors. The examination of performance management system was
carried out by self- made questionnaires, while the investigation of blockages factors was
based on questionnaires of Wood cook-Francis. Findings: With respect to the appraisal
neither in profit-oriented organizations nor mayor’s offices performance appraisal
system is used for every employee. Performance management is a complex system,
researching its modifying factors and elements, using the research results may
significantly improve the success of the operation of organisation.

 Silvana Nicoleta Muntean under University of Sibiu. Ph.D. thesis. Streamlining

Human Resource Management in order to increase the performance of National and
Multinational organisations. Objectives: Establishing the relations between the human
resource management, the general management and other components. Knowing the
characteristics of human resource management in some modern countries of the world.
Identifying issues and specific modalities of the efficiency of human resource management
in national and multinational organisations. Assessment of the effectiveness of human
resource management within the organisations. Findings: Human resource management
will require more easily targeted measures, will go easier through the process of
developing human resource strategy it will train the organisation staff in the process.
Thus, organisation members will be encouraged and motivated to form similar opinions
about the strength and weaknesses of the organisation as well as the environment in
which it operates. For this it is necessary to pay more attention to the communication
process so that national and multinational organisations members to show sufficient
confidence and interest in the establishment of the organisation perspective.

 Robert.D. Herman, David.O. Renz Non-profit Organization effectiveness- Thesis

University of Missouri Kansas City. Objectives: To distil from the literature assertion and
conclusions that help us understand what we know about NPO effectiveness. Overall
organisational effectiveness on the basis of assessment of the performance of subunits or
various functions. Overall NPO effectiveness. Findings: Effectiveness boards lead to
effectiveness organisation. Board effectiveness depends in part on the board leadership

37
skills of the CEO. More effective NPO’s are more likely to use correct management
practices. The evidence for concluding that correct management practice enhance NPO
effectiveness is scanty. Non-Profit Organisation effectiveness is a social construction.
Research intended to uncover the bases that people use to form judgements of
effectiveness will need to be both situation specific and clever in securing responses to
probing question. Program outcome indicators as measures of NPO effectiveness are
limited and can be dangerous.

 Sheppeck.Y. Militello (2000) was of the view that over a period of time organisation
from stable operating configurations (pattern) which has a bearing on their
organisational effectiveness. These configurations are affected by factors like operating
environment business strategy, HRM practices and senior manager’s values and
behaviour regarding employees. However once established, the configuration or patterns
guide employee behaviour their resistance to change, and are associated with different
level of organisation effectiveness.

 Jacobson Ralph (2006) in his research paper he has emphasised that the most widely
used and an effective tool for performance appraisal as perceived by human resource
professional in 360-degree competency assessment process. The issues involved with the
360-degree assessment include the determination of competencies, interpretation of
results and subsequent efforts to use the data to create development plans. These are
simple most cost effective and more powerful methods for providing feedback that are
more likely to improve individual and organisational performance. The 360 degree
involves giving a list of competencies and a set of behavioural anchors to co-workers and
managers to use in evaluating performance. They are then asked to check the level of
agreement. Two clear issues emerge with this method of assessment since 5 to 8 people
are involved, one or two answers have a significant impact in the averaged score for that
item. Secondly it is difficult to specify the context in which they expect particular
competencies to be exhibited. He stated the purpose of competency assessment should be
to pinpoint and develop those few critical competencies that yield extraordinary and
disproportionate performance. He mentioned about some feedback alternatives
providing direct feedback and using leadership tools. According to him the direct feedback
approach actively involves the employee and all critical stakeholders in the improvement
process. The leader’s toolbox approach skips the diagnostic assessment completely and
instead provides a common language for leadership at all levels, as well as many
management and leadership tools to more directly achieve bottom line improvement.
38
 Basel Shahin Victoria University Melbourne Australia (2011). Evaluating the
effectiveness of strategic planning within the Middle Eastern public sector. Objectives: To
discourse the nature and the extent of strategic planning formation process within Middle
Eastern public sector organisations particularly in Dubai. This includes an assessment of
the formality of the strategic planning formation process, determining the influence of the
extend contextual and internal organisational barriers on the formality of the planning
process and evaluating the quality of the strategic plan document produced. The research
aims to evaluate the influence of the organisational characteristics on the planning
process as well as the determinants of the planning horizon. Research Method: a mail
questionnaire survey was considered appropriate method for this study. Findings: the
findings of the research indicate that organisations practising, to a great extent, a formal
strategic planning process are more likely to formulate strategic plan documents than
organisations with low process formality. Also, the formality of the process is influenced
by organisational elements such as size, age, organisational level and the availability of
the strategic planning unit. In addition, process formality was found to enhance the
implementation of strategies and plans. This research provides a coherent framework
to link the public sector strategic planning process formality with the inter related
variables. This has led to clear implications for theory and practices and make clear
contributions to management in the Dubai public sector.

 Piers Cain and Don Brech. Managing public sector records Objectives of managing
financial records: To provide a management framework for the control of financial
records as a vital resource for public sector financial management, economic policy
development planning, assist record managers and non-records staff, including
accounting and audit personal to manage financial records in support of public
accountability and good governance. To inform policy makers and administrators
associated with the financial management process of the value of and necessity for the
effective management of financial records.

 John Burgoyne, Wendy Hirsh and Sadie Williams. The development of management
and leadership capability and its contribution to performance. The evidence, the
prospects and the research. Research report members of the management and leadership
development research network. Aim: The aim of the investigation reported here are
several. The first is to be clear what we might mean by management and leadership
capability and what we can say about its state, quantitatively and qualitatively, in the UK
at least. The second is to see how confident we can be on the basis of evidence that
39
management and leadership development creates management and leadership capability,
which in turn contributes to the achievement of economic and social performance. The
third is to find how management and leadership development contributes. Conclusions:
Management and leadership development can and does in the UK and elsewhere enhance
performance for economic and social benefit. It does not currently do so to its full
potential and there are therefore further performance gains to be had from improving it.
The improvement can come as much or more from improving the rescission with which
the management and leadership development investment is made than by increasing the
scale of the investment though the latter might usefully grow as confidence in performance
benefit becomes more secure. This is because management and leadership development
contribute to performance in multiple rather than a single way, and what is effective varies
very much with situation and context, fitting the right approach to the specific context as
the key. Management and leadership capability is located collectively in organisation
sectors and regions and initiatives to develop these in addition to ones based on
education, training and development to create individual capability are needed. Not all
capability that exists at the individual level is fully used in collective organisational
process, for a mixture of motivational, organisation and reward reasons.

 Katelyn Smith in March (2012). Best practices for effective corporate crisis
management: A breakdown of crisis stages through the utilisation of case studies. A senior
project presented to the faculty of the Journalism Department, California Polytechnic State
University, and San Luis Obispo in partial fulfilment of the requirement for the degree
Bachelor of Science in Journalism. Objectives: To discover the reasons behind the
ineffective crisis management responses through the inspection of past corporate case
studies in crisis management as well as what can be done to help corporation use crisis
management more effectively. Research Method: Data collected by administering
interviews with three experts in the field of corporate crisis management, emergency
management and crisis communication.

40
 DATA ANALYSIS AND INTERPRETATION
The Literature surveys revealed the existence of management effectiveness problem in
both private and public hospitals. The present study is an attempt to find out the
management effectiveness prevalent in both the public and private sector hospitals in the
city of Mumbai with the purpose of suggesting improvements if necessary.

Hospital is an institution dedicated to the attention of human suffering of ailment

promotion ofgeneral health of the community. The people who are directly involved in this
exercise basically include doctors, nurses, para-medical staff, class IV employees,
administrative staff. It is the responsibility of the management of the hospital to provide
due attention to improve their performance and thereby inculcate a sense of commitment.

In the previous chapters there is a detail discussion of the method of conducting this
research. The data was subjected to appropriate statistical procedures to test the
hypothesis with which the study is initiated. Data was collected by conducting sample
survey through the questionnaire. Specimen of the questionnaire is part of the annexure.

In this chapter detailed statistical analysis of various aspects of “A Comparative study of

management effectiveness in public and private sector hospitals with reference to
Mumbai city.” and the results obtained through analysis and decisions regarding an
acceptance or rejection of the hypothesis are presented.

In statistical application data analysis is divided into descriptive statistics and inferential
statistics. The present study comprises of both the statistical tools i.e. descriptive and
inferential,primary and secondary data is used while analysing. This study is divided into
two parts viz descriptive analysis and inferential analysis. Primary data is collected from
patients to study the effectiveness of the management and secondary data which was
available is used to show the present performance of management of public hospitals as
well as private hospitals by wayof growth and development of the respective hospitals as
well as satisfaction of the patients which has led to the growth of the hospitals indirectly.

41
 Table No. 1: Age Wise Distribution of Respondents (In Percent)

Sr. Government Hospital Private Hospital

Frequency Percent Frequency Percent

No. Age Group
1 Below 18 50 25.0 13 6.5
Percentage (%)

2 19 – 25 32 16.0 15 7.5
3 26 – 45 75 37.5 104 52.0
4 46 – 60 39 19.5 52 26.0
5 Above 60 4 2.0 16 8.0
Total 200 100.0 200 100.0

Graph No. 1: Age Wise Distribution of Respondents (In

Percent)

60.0

50.0
52.0

40.0 Government
Hospital
37.5
30.0
Private
26.0 Hospital
20.0 25.0
19.5
10.0 16.0

6.5 7.5 8.0

.0
Below 18 19 - 25 26 - 45 46 - 60 2.0 60
Above
Age Range

42
 Table No. II: Gender wise Distribution of Respondents (In Percent)

Government Hospital Private Hospital

Sr. No.
Gender Frequency Percent Frequency Percent

Male 122 61.0 76 38.0

1
2 Female 78 39.0 124 62.0
Total 200 100.0 200 100.0

Graph No. II: Gender wise Distribution of

Respondents (In Percent)

70.0

60.0

50.0

40.0 61.0 62.0

Male
30.0
Female
20.
0
Percentage (%)

39.0 38.0
10.0

Government Hospital Private

Hospital
Type of Hospital

43
 Table [Link]: Education of Respondents (In Percent)

Sr. Education Government Hospital Private Hospital

No. Education Frequency Percent Frequency Percent

1 Illiterate 45 22.5 44 22.0

2 SSC 61 30.5 53 26.5
3 HSC/Diploma 61 30.5 45 22.5
4 Graduate and Other 33 16.5 58 29.0
Total 200 100.0 200 100.0

Graph [Link]: Education of Respondents (In Percent)

35.0

30.0 30.5 30.5

29.0
25.0 26.5
Government
22.522.0 22.5 Hospital
20.0
16.5
15.0 Private
Hospital
10.0

5.0

.0
Illiterate SSC HSC/Diploma Graduate and
Other
Education

44
 Table [Link]: Distribution of Respondents according to Family size (In Percent)

Family Government Hospital Private Hospital

Sr. No. Member Frequency Percent Frequency Percent
s
1 Up to 4 70 35.0 88 44.0

members
2 5-8 member 113 56.5 99 49.5
3 9 and above 17 8.5 13 6.5

members
Total 200 100.0 200 100.0

Graph No. IV: Distribution of Respondents according

to Family size (In Percent)
56.5
60.0
49.5
50.0 44.0

40.0 35.0
Government
Hospital
30.0 Private
Hospital
20.0
8.5
6.5
10.0

.0
Up to 4 members 5-8 member 9 and above members
No. of Members

45
 Table No.V: Occupation of the Respondents (In Percent)

Sr. Government Hospital Private Hospital

Occupation
No. Frequency Percent Frequency Percent

1 Students 69 34.5 16 8.0

2 Business man 21 10.5 15 7.5
3 House Wives 42 21.0 90 45.0
4 Service 60 30.0 73 36.5
5 Professionals 8 4.0 6 3.0
Total 200 100.0 200 100.0

Graph No.V: Occupation of the Respondents (In

50.0
Percent)
45.0 45.0
40.0
35.0 36.5
34.5
30.0 30.0
25.0
21.0 Government
20.0
Hospital
15.0
10.0 10.5 Private
8.0 7.5 Hospital
5.0 4.0 3.0
.0

Occupation

46
 Table [Link]: Type of Hospital (In Percent)

Sr. No. Type of Hospital Frequency Percent

1 Government Hospital 200 100.0

2 Private Hospital 200 100.0

Graph No. VI: Type of Hospital (In Percent)

120.0

100.0 100.0
100.0

80.0

60.0
Percent
40.0

20.0

.0
Government Hospital Private Hospital
Type of Hospital

47
 Table [Link]: Working Hours of the Hospital (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 4 2.0 2 1.0

2 Dissatisfied 17 8.5 6 3.0
3 Neutral 41 20.5 27 13.5
4 Satisfied 47 23.5 89 44.5
5 Highly Satisfied 91 45.5 76 38.0
Total 200 100.0 200 100.0

Graph No. VII: Working Hours of the Hospital (In

Percent)
50.0
45.0
40.0
35.0 Government
30.0 Hospital

25.0 Private
20.0 Hospital

15.0
10.0
5.0
.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

48
 Table [Link]: Fees Charged by Hospital (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent

1 Highly Dissatisfied 16 8.0 52 26.0

2 Dissatisfied 21 10.5 30 15.0
3 Neutral 37 18.5 35 17.5
4 Satisfied 67 33.5 28 14.0
5 Highly Satisfied 59 29.5 55 27.5
Total 200 100.0 200 100.0

Graph [Link]: Fees Charged by Hospital (In

40.0
Percent)

35.0

30.0 33.5
Government
29.5 Hospital
25.0 27.5
26.0
Percentage (%)

20.0 Private Hospital

15.0 18.517.5
15.0 14.0
10.0
10.5
5.0 8.0

.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

49
 Table [Link]: Satisfaction Level with the Hospital Management (In Percent)

Sr. Government Hospital Private Hospital

Level of Satisfaction Frequency Percent Frequency Percent
No.
1 Highly Dissatisfied 15 7.5 11 5.5
2 Dissatisfied 19 9.5 45 22.5
3 Neutral 38 19.0 40 20.0
4 Satisfied 52 26.0 49 24.5
5 Highly Satisfied 76 38.0 55 27.5
Total 200 100.0 200 100.0

Graph [Link]: Satisfaction Level with the Hospital

Management (In Percent)
40.0 38.0

35.0

30.0 27.5
26.0 Government
24.5 Hospital
25.0
22.5

20.0 19.020.0
Private
15.0 Hospital

9.5
10.0 7.5
5.5
5.0
Percentage (%)

.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

50
Table No.X: Fund Allocation by State / Central Government to Hospitals (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 13 6.5 13 6.5

2 Dissatisfied 64 32.0 35 17.5
3 Neutral 58 29.0 76 38.0
4 Satisfied 29 14.5 55 27.5
5 Highly Satisfied 36 18.0 21 10.5
Total 200 100.0 200 100.0

Graph No. X : Fund Allocation by State / Central

Government to Hospitals (In Percent)
40.0

35.0

30.0

25.0 Government
Hospital
20.0
Private
15.0 Hospital

10.0

5.0

.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

51
 Table [Link]: Fund Allocation from Management to Hospitals

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 17 8.5 19 9.5

2 Dissatisfied 24 12.0 48 24.0
3 Neutral 39 19.5 87 43.5
4 Satisfied 36 18.0 32 16.0
5 Highly Satisfied 84 42.0 14 7.0
Total 200 100.0 200 100.0

Graph [Link]: Fund Allocation from Management

to Hospitals (In Percent)
50.0
45.0
40.0
43.5
42.0
35.0
30.0
Government
25.0
Hospital
20.0 24.0
15.0 19.5 Private
18.0
10.0 16.0 Hospital
12.0
5.0
8.5 9.5
7.0
.0
Percentage (%)

Highly Dissatisfied Neutral Satisfied Highly

Dissatisfied Satisfied
Level of Satisfaction

52
 Table [Link]: Satisfaction Level of Admission Procedure (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent
Percentage (%)

1 Highly Dissatisfied 12 6.0 9 4.5

2 Dissatisfied 30 15.0 17 8.5
3 Neutral 31 15.5 21 10.5
4 Satisfied 48 24.0 84 42.0
5 Highly Satisfied 79 39.5 69 34.5
Total 200 100.0 200 100.0

Graph No. XII : Satisfaction Level of Admission

Procedure (In Percent)
45.0
40.0 42.0
39.5
35.0 Government
34.5 Hospital
30.0

25.0 Private
24.0 Hospital
20.0

15.0
15.0 15.5
10.0
10.5
8.5
5.0
6.0
4.5
.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

53
Table No. XIII: Satisfaction Level of Facilities Provided by Hospitals (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 9 4.5 2 1.0

2 Dissatisfied 26 13.0 9 4.5
3 Neutral 24 12.0 25 12.5
4 Satisfied 39 19.5 75 37.5
5 Highly Satisfied 102 51.0 89 44.5
Total 200 100.0 200 100.0

Graph No. XIII: Satisfaction Level of Facilities

Provided by Hospitals (In Percent)
60.0
51.0
50.0
44.5

40.0 37.5
Government
Hospital
30.0

19.5
20.0 Private
Percentage (%)

13.0 12.012.5 Hospital

10.0 4.5
4.5
1.0
.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

54
 Table No. XIV: Level of Satisfaction of Attention Call bell (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 20 10.0 5 2.5

2 Dissatisfied 23 11.5 11 5.5
3 Neutral 47 23.5 44 22.0
Percentage (%)

4 Satisfied 38 19.0 102 51.0

5 Highly Satisfied 72 36.0 38 19.0
Total 200 100.0 200 100.0
.

Graph No. XIV: Level of Satisfaction of Attention

60.0
Call bell (In Percent)

50.0
51.0

40.0
Government
Hospital
30.0 36.0

Private
Hospital
20.0
23.5
22.0
19.0 19.0
10.0
11.5
10.0

.0 5.5
2.5
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

55
Table No. XV : Level of Satisfaction of Latest Techniques used towards Diagnostic
Procedure (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 9 4.5 5 2.5

2 Dissatisfied 21 10.5 50 25.0
3 Neutral 42 21.0 35 17.5
4 Satisfied 47 23.5 69 34.5
5 Highly Satisfied 81 40.5 41 20.5
Total 200 100.0 200 100.0

Graph No. XV: Level of Satisfaction of Latest

Techniques Used Towards Diagnostic Procedure (In Percent)
45.0
40.0
35.0
40.5
30.0
34.5 Government
25.0
Hospital
20.0
Percentage (%)

Government
25.0
15.0 23.5 Hospital
21.0 20.5
10.0 17.5
5.0
10.5
.0
Highly
4.5 Dissatisfied Neutral Satisfied Highly Satisfied
2.5
Dissatisfied
Level of Satisfaction

56
 Table No. XVI : Level of Satisfaction of Cleanliness of the Hospitals (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 21 10.5 8 4.0

2 Dissatisfied 22 11.0 48 24.0
3 Neutral 44 22.0 30 15.0
4 Satisfied 57 28.5 63 31.5
5 Highly Satisfied 56 28.0 51 25.5
Total 200 100.0 200 100.0

Graph No. XVI : Level of Satisfaction of Cleanliness of

the Hospitals (In Percent)
35.0

30.0 31.5
28.5 28.0
25.0 25.5
24.0
22.0
20.0
Government
Hospital
15.0
15.0
Private
10.0 Hospital
10.5 11.0

5.0
4.0
.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

57
Table No. XVII: Level of Satisfaction of Quality Diet and Behavior of Dietary staff (In
Percent)

Government Hospital Private Hospital

Sr. No.
Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 22 11.0 43 21.5

2 Dissatisfied 19 9.5 25 12.5
3 Neutral 78 39.0 48 24.0
4 Satisfied 36 18.0 53 26.5
5 Highly Satisfied 45 22.5 31 15.5
Total 200 100.0 200 100.0

Graph [Link]: Level of Satisfaction of Quality Diet and

Behaviour of Dietary Staff (In Percent)
45.0

40.0
39.0
35.0
Government
30.0 Hospital
25.0
Private
20.0 26.5 Hospital

15.0 24.0
22.5
21.5
Percentage (%)

10.0
18.0
5.0 15.5
.0 12.5
11.0
Highly Dissatisfied
9.5 Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

Source: Field Survey.

58
Table [Link]: Level of Satisfaction of Attitude and Behavior of Office Staff (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 24 12.0 12 6.0

2 Dissatisfied 31 15.5 54 27.0
Percentage (%)

3 Neutral 39 19.5 30 15.0

4 Satisfied 44 22.0 43 21.5
5 Highly Satisfied 62 31.0 61 30.5
Total 200 100.0 200 100.0

Graph No. XVIII: Level of Satisfaction of Attitude and

35.0
Behaviour of Office Staff (In Percent)

30.0

25.0

20.0 Government
Hospital
15.0 Private
Hospital
10.0

5.0

.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

Table [Link]: Level of Satisfaction of Guidelines and Instructions at Entrance

59
 Government Hospital Private Hospital
Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 6 3.0 5 2.5

2 Dissatisfied 26 13.0 18 9.0
3 Neutral 47 23.5 29 14.5
4 Satisfied 69 34.5 85 42.5
5 Highly Satisfied 52 26.0 63 31.5
Total 200 100.0 200 100.0

Graph No. XIX: Level of Satisfaction of Guidelines and

Instructions at Entrance (In Percent)
45.0

40.0

35.0 42.5

30.0
34.5 Government
25.0 31.5 Hospital
20.0 Private
Percentage (%)

26.0
Hospital
23.5
15.0

10.0
14.5
5.0 13.0
9.0
.0
Highly
3.0 Dissatisfied Neutral Satisfied Highly
2.5
Dissatisfied Satisfied
Level of Satisfaction

60
Table No. XX : Level of Satisfaction of Diagnosis Potential of the Doctors (In Percent)

Government Hospital Private Hospital

Sr. No. Level of Satisfaction Frequency Percent Frequency Percent

1 Highly Dissatisfied 9 4.5 7 3.5

2 Dissatisfied 20 10.0 12 6.0
Percentage (%)

3 Neutral 40 20.0 25 12.5

4 Satisfied 44 22.0 108 54.0
5 Highly Satisfied 87 43.5 48 24.0
Total 200 100.0 200 100.0

Graph No. XX: Level of Satisfaction of Diagnosis

Potential of the Doctors (In Percent)
60.0

50.0

40.0 Government
Hospital

30.0 Private
Hospital
20.0

10.0

.0
Highly Dissatisfied Neutral Satisfied Highly
Dissatisfied Satisfied
Level of Satisfaction

61
 Source : International Monetary Fund, World Outlook Database,
April 2018 Figure 5.5.3 Rising Healthcare Demand factors are rising
Income and Ageing Population

1) With the rise in income the ability to access healthcare and related services also rises.

2) Per Capital GDP of India is expected to reach US$ 3,273.85 in 2023 from US$
1,481.56in 2012.
3) With the rise of elderly population from current 98.9 million to 168 million by
2026will contribute to greater healthcare spending.

D: Growth In In-Patient And Out-Patient Market In India

The figure below shows the in-patient and out-patient market in India as per
ApolloHospital Annual report 2015.

62
 Source : Apollo Hospital Annual Report
Growth In-patient and Out-patient Market in India.

1) The inpatient and outpatient diagnostic market size is growing from 2008 to
[Link] has grown from 5% in 2012 to 12% in 2015.
2) Over 2015-20 the In-patient market is expected to grow at CAGR of 13%.

3) Over 2015-20 the Out-patient market is expected to grow at CAGR of 10%

E: Healthcare A Key Factor In 12th Five Year Plan (2012-17)

The figure below shows healthcare as a key factor in the 12th five-year plan in between the
year2012 to 2017.

63
Figure 5.5.5 Healthcare a Key factor in 12th five-year plan (2012-17)

1) As per the data of Ministry of Health and family welfare source the 12th
five-year plan has healthcare a key focus area.
2) The NITI Aayog has allocated USD55 billion under 12th five-year plan.

3) Healthcare plan allocation is set to rise to 2.5 percent of GDP in 12th plan from

0.9 percent in 11th plan.

64
F: Demand for Healthcare Market In India

The figure below shows the demand for healthcare market in India as per NHP health
profile 2019.

Source: KPMG Deloitte Hospital Market – India by research on India, Frost and Sullivan,
LSI financial services,‘Report on healthcare, Telemedicine and Medical Tourism in India-
ASA and Associates, LLP, Aranca Research, Indian Journal of public Health.

Figure 5.5.6 Demand for healthcare market in India.

1) As per National health profile 2019 India healthcare market is expected to

reachUS$372billion by 2022.
2) India will require 2.07 million more doctors by 2030 to achieve a doctor to
populationratio of 1:1000.
3) Government of India aims to increase healthcare spending to three percent of the
GDPby 2022.
4) Government aims the develop India as a global healthcare hub.
65
 5) Ayushman Bharat healthcare scheme was launched on September 23, 2018.
G: FDI Inflows in India

The figure below shows the cumulative FDI inflow from 200 up to 2018 into the
healthcare sector with reference to drug and pharmaceuticals, Hospital and Diagnostic
centres and medicaland surgical appliances.

Source: Department of Industrial Policy and

PromotionFigure 5.5.7 FDI Inflows in India.
1) As per the department of Industrial Policy and promotion the above pie chart shows
thecumulative FDI inflow from 2000 up to September 2018 into the healthcare
sector. It shows 5.40 US$ FDI inflow in hospital and diagnostic centres.

66
H: Healthcare Spending as A Percentage of GDP (2015)

Below given is a table of healthcare spending as a percentage of GDP by World Health

Statistics2015.

Figure 5.5.8 Healthcare spending as a percentage of GDP (2015)

As per WHO World Health Statistics 2015 India spends on healthcare 4.2% as a
percentage ofGDP against 10.6% as a percentage of GDP by the world. There is a vast
opportunity for investment in healthcare infrastructure in both urban and rural India.

I: Growth Of Health Expenditure Over The Years In India

Health expenditure has been growing over the years in India which is shown in the figure
givenbelow.

67
 Figure 5.5.9 Growth of Health Expenditure over the years in India.

1) Healthcare has become one of India’s largest sectors both in terms of revenue
andemployment.
2) During 2008-20 the market is expected to record a CAGR of 16.5%.

3) The total industry size is expected to touch USD160 billion by 2017 and USD280
billionby 2020.
4) According to NASSCOM, the Indian healthcare market is valued at USD 1 billion
in2016, and is expected to increase by 1.5 times by 2020.

Expenditure on Healthcare Penetration In India J: Per Capita

Healthcare Expenditure

As per world bank economic survey in the year 2018 the government healthcare
expenditure asa percentage of GDP is shown in the figure below.

68
Source: World Bank Economic Survey
FY18. Figure 5.5.10 Per Capita
Healthcare Expenditure.

1) Due to rising income and high-quality healthcare facilities and greater

awareness ofpersonal health and hygiene the healthcare expenditure has risen.
2) Greater penetration of health insurance has given rise to healthcare spending.

3) The Government expenditure on the health sector has grown to 1.4 percent of GDP
in2018 from 1.2 percent of GDP in 2014.
4) The government of India is planning to increase public health spending to 2.5% of
thecountry’s GDP by 2025.

69
K: Sector Wise Healthcare Expenditure in India

The pie chart shown below shows sector wise healthcare expenditure in India as per
NationalHealth Accounts estimates for India economic survey 2018.

Source: National Health Accounts estimates for India, M/o, H & FW; Economy Survey
[Link] 5.5.11 Sector Wise Healthcare Expenditure in India.

1) The current health expenditure by Government is 23.1% as per economy

survey 2018, private expenditure on health is 31.3%, Pharmacies expenditure
on health is 28.9% and others spending on health is 16.7%.

70
L: Union Health Budget 2018-19

The union health budget 2018-19 is given below in the figure as per Ministry of health
andfamily welfare.

Source: [Link]

Figure 5.5.12 Union Health Budget 2018-19

1) Allocation to the Ministry of health and family welfare has increased by 11.5%
year- on-year to US$ 8.16 billion in the Union Budget 2018-19. Also, the
Government ofIndia has announced one major initiatives under the Ayushman
Bharat programme, namely National health protection scheme which is the
largest government funded healthcare programme in the world, expected to
benefit 100 million poor families inthe country by providing a cover of up to
rupees 5 lakhs per family per year for secondary and tertiary care
hospitalization.

71
M: Private and Public Healthcare in Rural and Urban India

The figure below shows the private sector contribution to the growth of Hospitals in India.

Figure 5.5.14 Private sector contribution to growth of Hospitals in India.

1) The above graph shows the growth of private sectors in healthcare from2009 to
2015 asper WHO.
2) The market size of private hospitals has grown from 22 USD billion in 2009 to
81USDbillion in 2015.

72
Public and Private Sector Contribution to Healthcare in India

The figure below shows a comparison of public and private sector contribution to
healthcarespending in India in the year 2005 with 2015.

Figure5.5.15 Public and Private Sector contribution to Healthcare in India.

1) In 2005 the share of Government hospitals is only 34% in healthcare spending

whereas the share of private hospital is 68% as per the report on Indian hospital
services marketoutlook by consultancy RNCOS.
2) In 2015 the share of Government hospitals has increased to 40% in healthcare
spendingwhereas the shar of private hospital is 60% which has come down.
3) This is due to the initiative of the government in hospitals and catering to the needs
of the healthcare sector.
4) There is a growth of medical tourism in India in which the government is taking
keen interest along with the private sector.
5) There is public-private partnership in the healthcare sector growing.
73
P: Private Sector Hospitals Contribution Of Beds To HealthcareSector In India

The figure given below shows the private sector hospital contribution of beds in
Healthcaresector in India.

Figure 5.5.16 Private Sector Hospitals Contribution of Beds to Healthcare Sector in India.

1) Private hospital like Apollo contributed 9215 beds to the healthcare sector in
India asper the company website financial records.
2) Aravind eye hospitals contributed 3649 beds to Indian private healthcare sector.

3) CARE hospitals contribute 2100 beds to the Indian private healthcare sector.

4) Fortis healthcare ltd contributed 10,000 beds to Indian healthcare sector.

5) Max Hospitals contributed 2016 beds to the healthcare sector.

6) Manipal group of hospitals contributed 4900 beds to the Indian healthcare sector.

7) Narayana health contributed 7452 beds toe the Indian healthcare sector.

8) The above data is collected by the source in 2017.

74
 FINDINGS, CONCLUSIONS AND SUGGESTIONS

This chapter summarises the entire study including the results and then makes
important recommendations for management effectiveness in public and private sector
hospitals. The future scope of the study is then defined and limitations of research work
articulated. Through rigorous literature review, the study revealed that the management
of private and public sector hospitals has evolved through time. Management is an age-
old concept and it has undergone tremendous transformation. In the beginning
management concept was not known and developed as it is today. With fast growing
economy and technological development management effectiveness is a key factor for the
growth and development of any sector. In the healthcare sector today, patients are the
customers of the sector and due importance need to be given to them. This study shows
the management effectiveness of public sector and private sector comparison with
regards to hospitals and the reason for performance of the best and demanded sector. It
also shows at the end in suggestions to each sector on the area of improvement in their
respective sectors. The study comprises of six chapters. The first chapter shows
‘Introduction’ to the study undertaken. This chapter gives a detail of the method of
investigation carried out, what are the problems and objectives of research, what is the
sample size, how samples are selected, what are the tools that have been used and how
the study justifies the work undertaken by the researcher. The second chapter of the study
‘Review of Literature’, this chapter is dedicated to review of the literature comprising of
earlier studies related to the management effectiveness of public and private sector
hospitals across the world. Relevant literatures are reviewed to find the gap in the
literature and accordingly framed the problem, hypothesis and objectives of the study.
The third chapter of the study is ‘Conceptual Framework of the study’. This chapter deals
with various concepts such as hospital, private sector hospital, public sector hospital,
management effectiveness and their comparative study, management infrastructure of
public and private sector hospitals in India, Areas of hospital management.

The fourth chapter of the study is ‘Public sector hospital management and Private
sector hospital management- Indian perspective’. This chapter gives a detailed
explanation of origin and growth of public sector hospital management and private sector
hospital management in India, hospital management concept and policies in India, private
sector and public sector hospital management practices in India, performance of public
sector and private sector hospital management in India, public sector hospital initiative,
75
effective hospital management in city of Mumbai and contribution of public and private
sectors hospitals to the Indian society. The fifth chapter of the study is ‘Analysis and
Interpretation of Data’. This chapter analyses the data collected from patients of public
sector hospitals and patients of private sector hospitals in the city of Mumbai. The data
collected was evaluated to study the objectives and to test the hypothesis mentioned with
descriptive inferential analysis. The last chapter is ‘Findings Conclusions and Suggestions.
It deals with the outcome of the analysis and interpretation. It gives an idea about the
findings of descriptive and inferential analysis based on primary and secondary data
collection. Researcher has given the suggestion for the same and scope for future research
is also stated. The important findings of the research work are summarised in this section
to understand the management effectiveness in public and private sector hospitals in the
city of Mumbai. The study is divided into descriptive analysis and inferential analysis of
the study. Following are the findings based on descriptive analysis of the study.

1. Satisfaction level of hospital management: In this area the satisfaction level of

hospital management is based on five parameters of efficient service viz working hours of
hospital, fees charged by hospital, satisfaction level with the hospital management, fund
allocation from state government/ central government to hospital and fund allocation
from management to hospital. The findings on this level of satisfaction is as follows:

Overall, we see that government hospitals are in par with the private hospitals in training
of their hospital staff to pay attention to the patient’s needs.

Information regarding your daily progress: 70 (35%) respondents of government

hospitals are highly satisfied with the information of daily progress whereas 104 (52%)
respondents of private hospitals are satisfied with the information of daily progress. 7
(3.5%) respondents of government hospital are highly dissatisfied with the information
of daily progress whereas 9 (4.5%) respondents of private hospitals are highly
dissatisfied with the information of daily progress.

Overall, we see from this study that comparatively the patients of private sector
hospitals are more satisfied with the information of daily progress then the patients of
public sector hospitals. i)Information regarding prognosis and discharge
instructions: 88 (44%) respondents of government hospitals are highly dissatisfied with
the prognosis and discharge instructions whereas 99 (49.5%) respondents of private
hospitals are satisfied with the information of prognosis and discharge instructions in
their respective hospitals. 5 (2.5%) respondents of government hospitals are highly
dissatisfied with the information of prognosis and discharge instructions whereas 8 (4%)
76
respondents of private hospitals are highly dissatisfied with the information of prognosis
and discharge instructions. One reason for less satisfaction in government hospital as
compared to private hospital may be because of the overload of patients in government
hospital and lack of time with doctors to give detail discharge instructions.

j) Security and safety level of the hospital: 100 (50%) respondents are highly satisfied
with the security and safety levels provided in government hospitals whereas 63
(31.5%) respondents are highly satisfied with the security and safety level of the
hospitals. 12 (6%) respondents are highly dissatisfied with the security and safety level
of the government hospitals whereas 19 (9.5%) respondents are dissatisfied with the
security and safety level of the hospitals. Overall, we see from the study that the
patients of government hospitals are more satisfied with the security and safety level
of the hospitals.

k) Recommendation level to near and dear ones: 78 (39%) respondents of government

hospitals are highly satisfied with the government hospitals and prefer recommending
to their near and dear ones whereas 65 (32.5%) respondents of private hospitals are
satisfied to recommend to near and dear ones. 24 (12%) respondents of government
hospitals are highly dissatisfied with the hospitals to recommend them to their near and
dear ones whereas 17 (8.5%) respondents are highly dissatisfied with the private
hospitals to recommend them to their near and dear ones. Overall, we see that private
hospital patients are dissatisfied with the hospitals whereas government hospital
patients are satisfied to recommend them to their near and dear ones.

77
 BIBLIOGRAPHY
Books:
● A.V. Shrinivasan (Ed.): “Managing a Modern Hospital “Response Books, New-Delhi, 2000.

● Alikhan M.A: ‘Hospital Management’ (1999): APH Publication Corporation, New Delhi.

● Anand K.K: “Hospital Management (A New Perspective) (1996): Vikas Publishing House
Pvt. Ltd.,

● Arunkumar: “Health Administration”, Anmol Publications Pvt Ltd., New-Delhi, 2000.

● Arunkumar: “Hospital Administration” (2001): Anmol Publications Pvt. Ltd., New Delhi.

● Ashok Sahni: “Hospital and Health Administration” Indian Society of Health Administrators,
Bangalore, 1992.

● Brihanmumbai Municipal Corporation. 2000. Health Profile 1999 Mumbai: Public Health
Department, Brihanmumbai Municipal Corporation
● C.M. Francis and Mario’ De Souza: “Hospital Administration”, Jaypee Bros. Medical
Publishers (P) Ltd, New-Delhi, 2000.

● C.R. Kothari, Research Methodology - Methods and Techniques, New Age International
Publishers, Mumbai, 2010. 2. Chandra ballabh, Health Care Services in hospital, ALFA
publication, new Delhi,2007.

● Census of India 2001, Rural-Urban Distribution of Population, Series 28- Paper 2 of 2001:
Mumbai: Director of Census Operations, Government of India.
● Centre for Operation Research and Training (CORT). 2000. Rapid Household Survey RCH
● Chandorkar A. G. “Hospital Administration and Planning” Paras Publishing Hyderabad. 2000.
●Community Medicine and Public Health, Edition: 8th, Chapter: Hospital Administration,
Publisher: Time publishers, Editors: Shah KS, Mohamed Iliyas, MA Ansari, Muhammad Irfan
Ullah Siddiqui, pp.235-46.
● D.D. Basu: “Guide to Good Practices in Hospital Administration” Department of Health

● Darr, Kurt &J.S. Rakich (Ed.): “Hospital Organisation and Management - Text & Readings”
CBS

● Dave Nalini. V (1991): “Hospital Management” Deep & Deep Publications New Delhi

●Davis Julia, A Study of Hospital Management Training in its Organisational Context,

University of Manchester, Centre for Business Research in Association with Management
78
Business School,1972.

● Dilip T.R and Duggal R 2002. ‘Demand for a Public Hospital in K-East Ward Greater Mumbai.
(Draft report submitted to Brihan Mumbai Municipal Corporation), Mumbai: (Centre for
Enquiry into Health and allied Themes (CEHAT).
● Dr M.K. premi, Health planning in India, A.P.H. Publishing Corporation,1997. 6. Dr. A
Sanjeevan Rao and Dr. Deepak Tyagi, Research Methodology With SPSS, Shree Niwas
Publications, Jaipur, 2009.

● Dr. Ashok Sahni: “Hospital Planning Patient Satisfaction, Quality Assurance and Legal
Aspects of Health Care”, Indian Society of Health Administrators, Bangalore, 1996.

● Dr. Mohammad Akbar Ali Khan, Hospital management, A.P.H. Publishing Corporation,
1994. 14. Francis, C.M. “Hospital Administration”, Jaypee Brothers Medical Publishers Ltd.,
New Delhi 1995.

● Drucker Peter F, Practice of Management, New York, Harper & Row Publishers Inc. 1954.

● Duggal Ravi: “The Private Health Sector in India: Nature, Trends and Critique.” (2000):
Voluntary Health Association of India (VHAI), New Delhi.

● Durbin, R.L., Spring all W.H. Organisation and Administration of Healthcare: Theory,
practice and Environment, St. Louis, C.V. Mosley,1969.

●Ferror H.P., The Health Services Administration and Management, London, Butter
Worths,1972.

● Fiedler Fred E., A Theory of Leadership Effectiveness, New York, Mc Graw Hill, 1967.

● Focus 2010 Professional Hospital Administration in India Dr [Link].

● Francies C.M and D’Souza M.B: “Hospital Administration” (1991): Jaypee Brothers Medical
Publisher Pvt. Ltd., New Delhi.
●Friedson, E., The Hospital in Modern Society, London, Collier Mac Millian Limited, 1963.

● Gatherr A., Management and Health Services, New York, Pergamon Press,1971.

● George Erdosy: The Hospital Administration, Jaypee Brothers MedicalPublishers, New

Delhi.

● Ghei P.N. and Khokhar A.K., Selected Readings in Hospital Administration. New Delhi, 1990,
Indian Hospital Association (ed.).

● Ghei. P.N. (ed): “Selected Readings in Hospital Administration”, Indian Hospital Association,
79
New-Delhi, 1990.

● Gibson R.N., Studies in Hospital Administration, Chicago, Centre for Health Administration
Studies,1969.

● Goel S.L & R. Kumar: “Hospital Administration and Management” (2002) (Vol.I, II, III and
IV): Deep and Deep Publications, New Delhi.

● Goel S.L., Public Health Administration, New Delhi, Sterling Publishers Pvt. Ltd.,1984.

● Goel, S.L. and R. Kumar: Challenges of the Administration of HospitalServices, Hospital

Administration, Deep & Deep Publications, New Delhi.

● Goel, S.L., Emerging and Thrust Areas of Health Care System and Hospital Administration,
Deep & Deep

● Goel, S.L., Management Techniques and Good Governance in Health Care System and
Hospital Administration, Deep & Deep Publication Pvt. Ltd., New Delhi.2011.

● Goel, S.L., Organisation Structure of Health care system and Hospital Administration, Deep
& Deep Publication Pvt. Ltd., New Delhi.2008.

● Goel, S.L., Policies and Programmes of Health Care System and Hospital Administration,
Deep & Deep Publication Pvt. Ltd., New Delhi.2009. Publication Pvt. Ltd., New Delhi.2010.

● Goel, S.L., Public health Policy and Administration, Deep & Deep Publications Pvt. Ltd., New
Delhi, 2005.

● Goel, S.L., Resources of health Care System and Hospital Administration. Deep & Deep
Publication Pvt. Ltd., New Delhi.2007.

● Goel, S.L., Secondary and Tertiary Health Care System and Hospital Administration, Deep &
Deep Publication Pvt. Ltd., New Delhi.2009.

● Goel, S.L.: Hospital Managerial Services, Deep & Deep Publications, New Delhi, 2001.

● Gold Smith Seth B., Healthcare Management, Mary Land, Aspen Publications,1981.

● Grant Colin, Hospital Management, London, Churchil Living Stone, 1973.

● Hamilton,J.A., Decision Making in Hospital Administration and Medical Care: A Case Book,
Minneapolis, University of Minnesota Press,1960.

● Hampton, David,R, Summer Charles E and Webber Ross A., Organisational Behaviour and
The practice of Management, Glenview,III, Scott, Foresman & Co.,1978.
80
●Harold E Smalley: “Hospital Management Engineering - A Guide to the improvement of
hospital management systems” Prentice-Hall International, 1982.
●Health Service Research Scope and Significance- Patient safety and quality NCBI Book 2008
April Rockville (MD) , Hughes R . G.

● Healthcare Sector, Indian Brand Equity Foundation, India. March 23, 2007.

● Heggade Odeyar D.: “Hospital Management” (2000): Mohit Publications New Delhi.

● Hellriegel and Slocum: Organisational Behaviour, Thomson Learning, High Holbom House,
50/51, London, 2005.

● Hodgetts Richard M., Cascio Dorothy M., Modern Healthcare Administration, New York,
Academic Press,1983.

● Hospital & Health Services Administration: Principles & Practice, Edition: First (Reprint),
Chapter: Hospital Management: Challenges and Strategies, Publisher: Oxford University
Press,Editors: Dr. S. A. Tabish.
●Hospital Management: - A Guide to Departments, Howards. Rowland and Beatrice L.
Rowland, An Aspen publication, Rockville Maryland, 1984.
● Hospital organization & management – Malcolm Thomas, MacEachern.
● Jesani,A, Anantha Ram S., Private Sector and Privatisation in the Healthcare Services,
Bombay, The Foundation for Research in Community Health,1993.

● Jha S.M.: “Hospital Management” (2005): Himalaya Publishing House, New Delhi.

● Jha, S.M.: Hospital Management, Himalaya Publishing House, Mumbai.

● John R. Mcgibony: Principles of hospital administration, G. P. Putnam's Sons, New York.

1969, p.426.

● Joseph, T.M.: Management of Services, Himalaya Publishing House, Mumbai. 2002.

● Khan M.A., Hospital Management – A Focus of financing and cost efficiency of public
hospitals, New Delhi, APH Publishing Corporation, 1999.

● Khare, Dharwadkar and Gupte: ‘Useful Reading for Practical Hospital Management’
(1995):Indian Hospital Association, Maharashtra Branch.

● Klinoubol, Kriengkrai: “Public Health Development and Administration” (1989): Deep &
Deep Publications New Delhi.

● Kothari C.R.: “The Research Methodology, Method and Techniques” (1991): Wiley Eastern

81
Limited, New Delhi.
●Kother Philip, Marketing for Non-profit organisations, Engle Wood Cliffs, New Jersy,
Prentice Hall,1975.

● Kovner, Anthony R., Duncan Neuhauser, eds, Health Services Management: Readings
andCommentary, Ann Arbor M.I., Health Administration Press,1987.

● Kulkarni Mahesh: ‘Research Methodology’ (2008): Nirali Prakashan, Pune.

● Kurt.D & J.S. Rackich. “Hospital Organization and Management” 1992. New Delhi. CBS
Publishers and Distributors.
● L. Ramachandran: “A hand book of Management for Primary Health Centre Personnel”
VikasPublishing House, New-Delhi, 1993

●L.H.W. Paine and F Siem Tio: “Hospitals and the Health Care Revolutions” WHO Geneva,
1988
●L.M. Prasad, Principles & Practise of Management, Sultan Chand & Sons Co. ltd., New Delhi,
2001

● Letourneav,C., Hospital Administrator, Chicago, Starling Publications,1969.

●Levey S, Mc Carthy,T, Health Management for Tomorrow, Phildelphia, JB Lippin Cott

Company,1980.
●Levey Samuel, Loomba [Link], Healthcare Administration: A Managerial Perspective,
Phildelphia , JB Lippincott Company,1984.

● Liebles John Gratto, Levine Ruth Ellon, Dervitz Hyman Leo, Management
Principles forHealth Professionals, Maryland, An Aspen Publishers,1984.

● Longest Beaufort [Link]., Management Practices for the Health Professionals, Virginia,
RestonPublishing Co. Inc.,1984.

● M. Shankara Rao: “Hospital Organisation and Administration” Deep & Deep

Publications,New-Delhi, 1992.
●Manepatil U.R: “Hospital Management” (1996): Shakuntala Offset Printer, Kolhapur.

● Mc Farland D.E., Management Principles and Practice, New York, Mac Millian Co.,1974.

82