location: nan, 'Thailand 
year: 2004 source: HSRI 
title: Baan Paew Management Development for sustainable Hospital 
abstract:This is a study on the management and an evaluation of the administration within the  organization  which has been conducted consecutively for the second year as a furtherance to the study in the first year  that started from the year 2001 and ended in January 2002. The study shall concentrate on  evaluation of the administration of the internal affairs for an assessment on the systems of management, the operations, materials management, information systems, accounting and finance, internal audit and control as well as a survey on the level of satisfaction of the personnel towards BanPaew Hospital’s departure from the original status of being government hospital for  reorganization into a public company under governmental supervision and conduct a survey on the level of satisfaction of the service users. The result of a study in the first year shows that many of the systems which are in  operation are not complete or fully operable and require further development and/or improvement. Moreover, the efficiency of the personnel which will handle the management and operation under the new type of organization is insufficient in certain aspects therefore modifications have been made in the second-year study for a focus on three perspectives i.e.  counseling, human resource development and evaluation of the management.   Objectives        The objectives of the study are chiefly in threefold as follows:-Provide counseling on development of the system and management, planning and benchmarking, internal audit and control, accounting and finance, human resource management, information systems, inventory   management.To develop the potentials of personnel on the levels of  executive directors  and managerial staff in various areas.To assess the management potentials within the hospital as well as conducting a survey on the level of satisfaction of the staff and the service users.Results of Study         The results of the study can be divided into three parts as follows:-Part 1 Counseling on  internal administration/ management          The results of a study on the provision of counseling on internal administration/ management appear below. Planning and BenchmarkingThe hospital had already  set  the directions and vision of its development during the year 2002 which had already been presented to the executive committee but have not yet been translated into practice concretely. The advisory board has been conducting educational seminars and workshops and transforming vision, eight-sided strategies into action plans and performance index. On the department  level, the department  has been advised to prepare the action plan and performance index, but some of the units were in the process of implementation nevertheless the preparation of the action plan and the performance index is  in compliance with the hospital’s process of generating preparedness  for implementation of Hospital Accreditation. Internal Audit and ControlThe  researchers has made an appraisal of the internal audit and control systems and given the advice on the establishment of the Audit Committee possessing knowledge on the aspects of management, accounting, techniques and  medical service, in addition, units for internal audit and risks assessment  should be set up  , offering training to strengthen the knowledge. 1.3 Accounting,  Finance and Budgeting     The  researchers  has  offered  counseling  on  finance,  the  development  and  improvement  of  the  existing  accounting  systems, account-recording  methods  i.e.  the  improvement  of  chart  of accounts,  recording of accounts receivable, petty cash, fixed assets etc. as well as  given  advice on verification of accounting data prior to the monthly preparation of  financial  statement,  offered  advice  and  training  on the application of accounting software. As regards the aspects of cost      accounting and budgeting, advice and training have been offered but have not yet been implemented hitherto. Data and Information SystemsThe researchers  have given advice on the matters concerning hardware, software and security measures on networks system and information system, surveying  and retrieval of data. Materials ManagementPolicies and objectives have been clearly defined with constant changes and improvement in the  methods of operation, the management of inventory of the pharmaceutical section which is responsible for  medicines and medical supplies that do not belong to the Ban Paew Hospital in order for the development and enhancement of efficiency in performance. During the past years modifications in the major operating procedures have been made as follows:-Purchasing of medicines with high volume of usage has been altered to a purchase sufficient for one-week usage with direct delivery to the pharmaceutical section, entailing a reduction in the work procedures and transportation procedures for  the medicines and thus a reduced inventory value. However this measure necessitates more frequent purchasing which can be witnessed from the much higher frequencies in purchasing and the increased risks for shortage of stocks. Reduction of reserved medicines in the various patient  wards  via arranging and dispensing medicines from the pharmaceutical section to each individual patient, with replenishment of medicines and medical supplies to the patients’ ward on a daily basis enabling the patient wards to be relieved from the burden of carrying a lot of reserves of medicines.  At present, stocking of tablets has been cancelled with the exception of 1-5 ampoules of injection doses. In March 2003, the system of dispensing medicines to the in-patients through the use of facsimiles for higher efficiency in servicing has been adopted in order to reduce the blunders involved in arranging and dispensing of medicines as the pharmacists could have a first-hand information on the doctor’s prescriptions.The application of  the software programs is  present in the management of the medical supplies’ inventory but the manual system has been applied in tandem because of insufficient confidence in the operation of the software programs.The management of durable articles in the hospital still lacks directly responsible persons, as a result,   it is not  systematic and has not made much progress. Presently, the hospital is adopting a policy of a combined purchasing of all materials therefore the maintenance and care of the durable articles should be added to  the scope of responsibility  of this section as well. The management of all types of materials in the hospital such as medicines and medical supplies, office supplies, household supplies including various durable articles involves a total of several thousand items and constant movement and transfer thus an up-to-date, reliable and automatic information system shall render supports for higher efficiency in supplies  management.In addition, modification in the methods of operation  including the application of new systems or technologies  must rely on collaboration and readiness on the part of the officials and the units concerned, therefore arrangements should be made for the enhancement in competency and visions of the managerial staff, as well as expanding the potentials of the operational staff in order to make concerted advancement in the same direction for the achievement of the organizational objectives. Human Resource Management      Counseling on Human Resource Management      The study reveals that the hospital’s Human Resource Management still remains at the developmental stage while attempts have been made for the introduction of information technology.  There  is  a  start  in  the        review of work in the minor units of the human resource section however  due to  a lack of competent personnel to take up  responsibility for the  job earnestly, the formulation of policy on this side could not be  efficiently effected to which the problem must be urgently addressed by raising the skills of the personnel  in order to undertake the job thereafter. There must be  coordination among the various minor units in the section  for integrated and concerted actions in accordance with the commitments and strategies of the hospital.  The study also sheds light  on some recommendations and solutions to personnel-related problems regarding the recruiting selection, training, performance evaluation and development of career paths etc.Part 2  Developing the Human Resource’s Potentials                               The study on this part has been carried out as follows:-2.1  A Study along the Line of Human Resource DevelopmentThe  researchers has conducted a survey on the training, Needs and career development,  the results of which have been used as guidelines in  determining the  curriculum for training and in  developing  human resources capabilities.2.2  Human Resources Capabilities DevelopmentTwo projects are designed for fostering and  developing the potentials of the hospital board and management i.e. program for the development of  the hospital’s executive directors and program  for the development  of the hospital’s management.Program for the development of the Hospital’s Executive Directors. 	A three-days seminar program was organized  in order to impart knowledge on the role of the executive directors, good-governance, internal audit and control, risk  assessment,  towards excellence in management, the operation of a hospital, the concept of organizational management, strategic management, and evaluation of organizational performance, reading and understanding income statements, personnel management, materials and information management.             The result of the seminars found that the topics which the executive directors had few knowledge were internal audit and control, risk assessment, strategic management,  materials management, information system, meanwhile courses with the highest applicability  were the role of executive directors and good governance, the concept of organizational management, strategic management  with linkage to implementation plan and evaluation of organizational performance,  internal audit and control and risk assessment.	Program for the Development of Hospital’s Management           Workshops on Hospital Management Seminars for the hospital’s executives cover 5 modules i.e. workshops on strategic planning and translating into action plan through the use of the Balanced Scorecard  techniques, seminars on human resource management  techniques, job-training, coordination, leadership, team-work, personality, novelties in the field of hospital management, ex. information technology in the hospital, customer relation, management, supply chain management, supplies management, accounting and finance systems for hospital, including costing of the activities, budgeting, internal audit and control systems.          The results of the seminars in the topic which are of significance are ex. team-work, planning, efficiency in work, leadership. Courses with high applicability are team-work, efficiency  in work, CRM, leadership, planning and performance indicators.Part 3 The Assessment of the Potentials of Ban Paew Hospital (Public Organization) can be broken down into 6 parts as follows:- The Survey of Management Capabilities 3.1.1 Planning and BenchmarkingThe  result of implementation of the units: on the whole, action       plans and  performance  indicators have been prepared however       some units have not  completed such process.Work in some of the units has not shown consistency between the       work plan and the company’s operation ex. in the implementation       for the Hospital Accreditation.Lack of  units responsible for the integration of plans and       follow-up.Changes and resignation of personnel have impact on the       continuity and  the specified duration for execution.3.1.2  Audit and Control  Systems     Currently, the internal control of the Ban Paew Hospital has been achieved by allowing the various units to analyze the risks in operation and arrive at the conclusive measures in  internal control in order to generate a reduction of the possible risks and  improvement in operation to attain efficient control in the future. An assessment of the above control plan shows that  the units having proper control plans  and thus efficient operation are mostly the servicing units while most of the ancillary  or supporting units should make more efforts in the improvement of internal control planning and reduction of risks.      At present, the internal audit unit has only one staff-member with managerial background and still lacks staff-members with competency and experience  in accounting, finance and medical knowledge to enable the unit to perform its duty  thoroughly in accordance with the objectives.               Appointment  of the members in the Audit Committee can be made by choosing from the hospital’s executive directors with competency and experience in accounting, finance, management, and medicine.3.1.3  Accounting and Finance    At present, the hospital has not been able to finalize its income statements which include the Balance Sheet, the Income  statement for the first and second quarters of the year 2003 due to the exposure of mistakes in the systems of finance, accounting, and the computer programs currently being applied, and is still under preparation  for the implementation of cost accounting and budgeting systems as has been planned.      3.1.4  Information Systems    The information systems of the hospital still remain broadly in the state of island of information, consequently there are repetitive collection of information, moreover, the efficiency of the hardware and software is inconsistent  with the amount of work, security measures of the network systems have been kept at low level, while the systems for data survey are inefficient and the potentials of personnel in information system have not yet been fully developed.       3.1.5  Materials System     Constant improvement in performing the jobs relating to the management of medicines and medical supplies have been made,  enabling a reduction in inventory value of the medicines and non-medicinal supplies on a continuous basis.   As a consequence, there must be more frequent purchasing resulting in the risks from shortage of materials. The benefits from full utilization of the express program have not yet been realized  by the hospital, entailing repetitive work. Besides, there is still a shortage of integrated material management systems.A considerably systematic measure for durable articles has not yet been put in place, due to a lack of the unit directly responsible for the job, thus the policy for combined purchasing of all types of materials and durable articles shall help in the  making of  the more distinct  functional lines.        3.1.6  Human Resource Management      The study shows that the major problems are the lack of personnel competent in human resource management to undertake the job in the hospital. In addition, the systems of operation have not yet been fully established and in the broad sense, it reflects a situation that the human resource management in the hospital still remains at the developmental stage for enhanced efficiency in administration.3.2  Results of the Survey on the  Level  of Satisfaction      3.2.1 The Results of the Survey on the Satisfaction of  Service Users               The study on the assessment of the level of satisfaction in the service users have been conducted  consecutively  both in the year 2001 and 2002.  In the year 2001,   321 samples were selected  (120 in-patients and 201 out-patients.) Whereas in the year 2002, 350 samples were selected (117 in-patients and 233 out-patients.) The result of the study showed  the overall level of satisfaction in 2002 is higher than that in the year 2001   i.e. in the year 2002 and 2001 the level of satisfaction had been recorded as 78.86% and 76.21%, respectively.Level of Satisfaction3.2.2  Result of the Survey on the Level of Satisfaction of the PersonnelThe assessment of the level of satisfaction of the personnel have been conducted for two consecutive years. In the year 2001,  315  questionnaires were distributed with  299 responded, whereas in the year 2002,  330  questionnaires were distributed with 266 responded  . The result of the survey is as follows:-Ranking of Personnel’s Satisfaction (5 point scale = 5 is the highest satisfaction)20012002Ranks inSatisfaction of PersonnelOn a 5-pointsOn a 5-points2001ScaleScale1Relationship between colleagues               3.963.852Capability to work among colleagues         3.943.753The chief officer has suitable qualification   3.943.394The chief officer is fair                                 3.803.285Adaptability                                                  3.733.486The supervisor support  free  development3.713.187Relationship between the staff and the superior            3.703.318Suitability of the job to one’s own ability                         3.683.609The scope of responsibility in the job                             3.583.2210Efficient tools in performing the job                                3.503.15             The above table shows that in the year 2001, the level of satisfaction was higher than 70% (3.5 marks) in 10 aspects but the same thing was true for only 3 aspects in the year 2002 i.e. the relationship between colleagues (3.85), capability to work among colleagues ( 3.76) and suitability of the job to one’s own ability (3.60) .          The aspects which the staff showed low level of satisfaction for both years        (the marks for the level of satisfaction were lower than 60% or 3 marks) are criteria in determining the escalation of wage scale, the compensations in case of removal from job, allocation of residential quarters to the staff. Apart from this, the level of satisfaction in the year 2002 was lower than that in the year 2001 in all aspects.Low Level of Satisfaction of the Personnel20012002RankMarksMarks1Criteria for promotion and salary increase                           2.83                     2.202Compensations in case of removal from  the job                                                                         2.99                      2.323Allocation of housing facilities to suitable staff members                                                            2.90                      2.39                                                    The study reveals that in the broad picture, the level of satisfaction in an overall scale and from all groupings in the year 2002  was comparatively lower than that in the year 2001 in which the overall level of satisfaction showed an average of 3.34 or 66.8% while in the year 2002, the figure was 2.90 or 58.0%.                                                      (Figure)             .RecommendationsPlanning and Benchmarking of the OrganizationA responsible unit should be set up to take up the responsibility for submission of the plan for approval and execution including reviewing and summarizing  to give an overview of operation,  the planning and implementation for Hospital Accreditation which should be integrated with budgeting.        Implementation needs to be clearly defined  in unwavering directions with follow-up as well as the performance-based remuneration. Auditing 	There should be structural improvement of the organization, appointment of the auditing unit and Audit Committee in accounting, finance and budgeting.       Further development should be made in documentation of reports, training of personnel, implementation of cost-accounting system, and activity-based budgeting.   In addition, there should be software programs which have linkage to the other systems of operation.Information SystemAs far as the development of the information systems is concerned, the management must be capable to acquire knowledge about the demand for information, access to the data, dissemination of information and be able to assess the capacity of the hardware and software suitable for application as well as responding to the needs of the users.Human Resource Management	There should be planning for the requirement in manpower, training and development of personnel, planning for the career paths of the staff, evaluation of performance, reward system, motivations, staff retention and development of information systems for human resource management.Materials Management        Materials should be properly managed with both short-term and long-term planning  distinctly laid down together with improvement in the documentation of reports, and the information systems so as to be updated, accurate and complete as well as the enhancement of knowledge and   acquisition of knowledge about the roles of the staff.Suggestions for Further Study          The study on the management in the hospital reveals that all the 6 systems i.e. planning and benchmarking, materials management, internal audit and control, data and information, personnel management , accounting and finance and budgeting have not been fully developed even in the second year, with the exception of materials management and planning and benchmarking  in which the development of both systems has been achieved. The other remaining systems such as accounting, finance, budgeting are crucial to the operation and require advice from eligible and proficient persons. The internal audit and control, the data and information and human resource management systems also need counseling from the experts in each field in order to enhance the hospital’s capacity to serve as a model of the hospital pioneering the transformation into public organization.