The Emerging Role of the Trained Health Care Managers

The Emerging Role of the Trained Health Care Managers in Nepalese Context

By Bachchu Kailash Kaini

 

Health care management or administration as a profession seems to be still in its post-natal stage. The idea of management and management training in health care is quite a recent development in Nepal. It is yet to be recognized as a vital area of management where formal training could help and improve the functioning of our hospitals and other health agencies. Due to the increasing pressures on hospitals due to changes in legislation, people's expectations, financial support policies and spiraling costs, there is a growing awareness of the importance of the management process and of training in management. The experience of management training in health care has only justified the great need for such training. Some reluctance in various groups to accept the trained non-physician manager or administrator is seen.

In Nepal, as in most developing countries, there has been a gradual evolution in health care administration. The initial stage has been the era of the physician administrator. Physicians competent in their clinical work were posted as administrators due to their clinical proficiency and seniority. The rationale was that the unavailability of professional trained managers on healthcare organizations. It requires someone from among them to plan and coordinate their work. The administrator has to have credibility in the eyes of all those whom s/he is administrating. This is possible only of he too is a member of a professional group. Since doctors have been traditionally higher in the social and professional hierarchy, it is only natural that one of them should be the administrator.

Thus ran the argument for a physician administrator. Patients with their awe for doctors as healers have had a lot do with this reasoning. A society, which compartmentalized its people in terms of power and status also, contributed to it. To this day this is the system of administration prevalent in our healthcare organizations and hospitals. Some of the voluntary and mission hospitals, however, have had a different pattern of administration. Voluntary hospitals run by the religious orders and private hospitals place non-medical managers in the position of the hospital administrator. It is felt that this would ensure the reflection of the principles of charity and love in their hospitals, dispensaries, rehabilitation centres and community health projects.

With the increased acceptance and need for normally trained managers in industry, those in authority in hospitals and health agencies have evinced interest and awareness for the need for formal management training. Health institutions like industrial organizations have become complex systems to manage. Even so, it is only since the beginning of this century that health care and hospital management in Nepal has begun to recognize the significance of administrative and management sciences in hospitals. The need of organized education for hospital and health managers in Nepal became apparent from the beginning of nineties. Pokhara University launched health care management program in Nepal in 2000 and National Open College (NOC) started  formal degree in health care management in Nepal in 2000 and now runs master, post graduate diploma and bachelor programs. Nobel College has followed the NOC with Pokhara University's Bachelor program in health care management. 

With the onset of these formal academic courses two changes are expected. The idea of formal training in health care management will gain increased acceptance among health professionals especially in the private health sector. Secondly, a small band of trained administrators will occupy administrative posts as chief executives and administrative heads. They will be useful in establishing the validity of the idea. And the trained non-physician administrator will replace the physician administrator in due span of time. The private health sector will be pioneered many such new roles in the health field.

However, some major points are still being debated, though with less intensity. Is health care management or administration important enough to merit investment of time and money in long years of training? Can management be studied like medicine or economics? Is there practical data to support the benefits of employing trained administrators?

In many of the government health care organizations in Nepal, the potential of training for administration and the trained non-physician administrator, have had halting acceptance from the medical elite. The trained non-physician administrator is often relegated to a secondary role in the management process of the government hospitals. The reasons advanced for advocating the non-physician administrator are however convincing. The most convincing reasons for preferring non-physician administrator are the uneven distribution of medical manpower in this country - the shortage of doctors and medical professionals; physician administrators have shown reluctance to give up their professional interests and as a consequence most physician administrators neither do justice to their medical profession nor to administration and finally the formal training of the physician in management sciences results in the cost of double professional education in terms of money as well as years spent in training.

There are many technical streams in healthcare institutions - medical, nursing, pharmacy, laboratory and so on. There are areas of work where these technical streams converge to provide patient care services; areas like the out-patient section, wards, intensive care unit, operation theatre, emergency department, laboratory, radio imaging unit and so on. Knowledge and skills in organizing and managing this 'convergence' or confluence is what we seek in the administrator. It is not the status or power that is of primary concern. His or her competence in ably steering the many groups towards the provision of inexpensive, timely and accessible service to the community with particular attention to the needy groups in the community is the single most overriding attribute we should look for. The administrator's job is full time one and needs the attention of a trained mind.

There is a tremendous need for formal training in health and hospital management in Nepal. The awareness of such training in this field has not kept pace with similar awareness and growth in industry.