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Hospital Operations Management and Gandhian Ideals
Hospital Operations Management and Gandhian Ideals
Hospital Operations Management and Gandhian Ideals
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management system provides hospital marketing system feedback relating to effectiveness, efficiency, quality and productivity of the hospital service delivery. Mahatma Gandhi always held the view that medical staff should also focus on healing soul rather than being merely concerned with treatment of body. Hipocrates, Father of the Western Medicine (Circa 460 BC-Circa 370 BC) observed (Byme, 2010), Natural forces within us are the true healers of disease. According to sports psychologist and famous author, Thomas Tulko (b.1931), Your emotions affect every cell in your body. Mind and body, mental and physical, are intertwined. Gandhiji always stressed on efficient management of services, high standards of cleanliness, rendering service with devotion, doing ones work without mistakes and once detected quickness to admit them and not allow them to recur, taking self care for maintaining health, etc. all of which are highly relevant for management of hospital services. The paper envisions creation of an enlightened hospital that works with service motive and not-for-profit objective. The paper highlights relevance of Gandhian ideals as strategy for hospital operations management particularly and achieving the loftier objective of transformation into enlightened hospital.
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According to Gandhiji, for administration to be efficient, it must always be in the hands of the fittest. There should be certainly no favouritism (Young India, May 29, 1924). Service with Devotion A hospital is essentially a service provider and its staff therefore has a pious duty to serve others. Medical staff should always derive pleasure in their service remembering that life spent in service is the only fruitful life (Bapu-ke-Ashirwad, September 16, 1946). Medical staff should work with sincerity and devotion to their best of ability. Gandhiji once said, Work done sincerely and in the spirit of service will have its effect on all in the long run, and will most assuredly help those who are badly in need of assistance. (Harijan: Nov 28, 1936). On a separate occasion, Father of the Nation explained that a service provider such as hospital should work with a spirit to provide service to people but not to be served by them. It will not be incongruous to recall what he said in this regard, Let us not forget that organizations are meant for the service of the people, and not the people for the service of the organizations (Young India, August 18, 1927). In running any business entity including hospitals people with commitment and sense of devotion are needed as without them no organization can survive for long. It will be apt to remember what Gandhiji often said, I know no organization that has died for want of funds. Organizations die always for want of men i.e. honesty, efficiency and self-sacrifice (Young India, June 3, 1926). The religion of a doctor is no other but continuous service of patients which alone justifies the existence of hospital and resulting peace and joy that it would bring to the medical staff. Gandhiji said, As we cannot live without activity of some sort, there can be only one right channel along which it should flow and that is the service of others. The man, who engages himself in it, can experience supreme peace (Desai, 1968, p. 268). Medical Expertise A British National Health System Survey in 2009 reported that 15 per cent of its patients were misdiagnosed, while an American study published in the Journal of the American Medical Association in 2000 reported that there were 2,000 deaths every year from unnecessary surgery, 7,000 deaths from medication errors in hospitals; 20,000 from other errors in hospitals; 80,000 from infections in hospitals; and 106,000 deaths every year from non-error, adverse effects of medications. In all every year there occur 225,000 deaths in the US due to unintentional medical errors (Iyer, 2011). According to Gandhiji, The quickest remedies are always fraught with the greatest danger and require the utmost skill in handling them, (Gandhi, 1934, p.615). Variability in diagnosis often raises doubts on medical expertise available in a hospital. Gandhijis viewpoints are very pertinent in this regard Remedies vary with the variation in diagnosis. The same physician one day detects malaria and gives a large dose of quinine, detects typhoid the next day and stops all medicine and orders careful nursing and fasting, later detects consumption and orders change and solid food. Is the physician capricious or cautious and honest? (Gandhi, 1934, p.682). It is common knowledge that anyone can commit errors and hospital staff is no exception. However, whenever a medical or paramedical staff commits a mistake, there should be frank admission with resolve to minimize its occurrences in future. According to Gandhiji, it is best to own the error. It is sure to add to our strength. Error ceases to be error when it is corrected (Young India, March 2, 1940). He further elaborated by adding, The only fitting penance for a lapse is to make a firm resolve not to allow it to happen again. You will thereby build, as it were; a solid wall of protection round you and gradually temptations will cease to assail you (Young India, January 10, 1929). He further explained, I have always held that it is only when one sees ones own mistakes with a convex lens and does just the reverse in the case of others, that one is able to arrive at a just relative estimate of the two (Young India, November 29, 1928). Reputation of a hospital depends upon the expertise of its medical and paramedical staff and their attitude towards patients. When staff works with devotion and hospital has also necessary equipment and facilities, its reputation is bound to go up. It will be apt to recall Gandhijis famous quote in this regard, Whoever has a desire to render service will certainly try to equip himself with the requisite knowledge, and his knowledge will be an ornament to himself as well as to society (Gandhi, 1952, p. 84). He further elaborated by saying that Real knowledge and true education can be had by devoted performance of ones duty (Gandhi, 1952, p. 107). According to Gandhiji, Organizations like men, if they are to command respect and grow, must have a sense of honour and must fulfill their promise (Young India, January 23, 1930). Timely Medical Aid In hospitals time is the essence i.e. if the precious moment to save a patient of medical emergency is lost the human life is at risk. Chances of recovery would be high when timely medical relief is provided. That is why Gandhiji also maintained, An organization weakens if its members continuously seek indulgence. I know that procrastination among members is the bane of most institutions (Young India, August 8, 1929). In a hospital, there is no room for rest any moment for medical staff as medical emergencies do not follow any time schedule. Hospitals need continuous activity and service all the time. Bapus words are very apt in this 843
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regard, God is continuously in action without resting for a single moment. If we would serve him or become one with him, our activity must be unwearied as his. (Gandhi, 1932, p. 47). Quality Medical Care In healthcare there is no room for any sub-standard medicine used or a poor quality health service provided. All medical staff should give their very best in terms of what could be called a true quality service i.e. making correct diagnosis, using medicines which are best suited and that are within their perishable life, attending patients on time, maintaining proper hygiene and cleanliness, attending medical emergencies on priority, etc. In this regard it will be appropriate to recall what Gandhiji said, I attach the highest importance to quality, irrespective almost of quantity I plead for quality and quality alone (Young India, April 30, 1925). At another occasion Gandhiji also added that God is pleased with quality work and not quantity when he said, It is the quality of our work which will please God and not quantity (Gandhi, 1934). In hospitals there is no room for any substandard work where human lives are at stake. It will be appropriate to recall what Gandhiji once said: Slipshod work is like half-baked bread, fit only to be thrown away. (Bapu ke Ashirwad, May 9, 1945). If medical and paramedical staff performs their duties in best possible manner their reputation is bound to go up. Good work spreads like the perfume of a rose. (Gandhi, 1961, p. 107). Harmony in Medical Teams Hospital activities are interdependent. An operation cannot be carried out unless an anesthetist first administers anesthesia. Nobel Prize-winning physicist Albert Einstein (1879-1955) once said (Byme, 2010), A hundred times every day I remind myself that my inner and outer life depend on the labours of other men, living and dead, and that I must exert myself in order to give in the same measure as I have received and am still receiving. Thus, cooperation from others is vital for human existence and any task we accomplish. There are situations, when some persons in a team might offend someone. For the success of the work on hand to which team members are committed, it becomes necessary to maintain interpersonal harmony. It will be most apt to remember what Rene Descartes (1596-1650), ancient mathematician and philosopher, advised (Byme, 2010), Whenever anyone has offended me, I try to my soul so high that the offense cannot reach it. Gautam Buddha always highlighted power of positivity in life, who advised (Byme, 2010), If a man speaks or acts with an evil thought, pain follows him. If a man speaks or acts with a pure thought, happiness follows him, like a shadow that never leaves him. Similar views were expressed by the Chinese philosopher, Mozi, who visualized group harmony (Byme, 2010), as when When all the people in the world love one another, then the strong will not overpower the weak, the many will not oppress the few, the wealthy will not mock the poor, the honoured will not disdain the humble, and the cunning will not deceive the simple. As a related example in hospital services, for the success of surgical operation harmonious relationship between anesthetist and doctors is very essential. A quote by Gandhiji shall be apt to highlight the point, No organization can run smoothly when it is divided into camps, each growling at the other and each determined to have its own way by hook or by crook (Young India, November 9, 1929). Service and love are helpful in building harmony in work teams. This is also reflected in Bapus such views, Real affection is not shown through praise, but through service (Young India, March 14, 1929). Hospital Communications Communication is a process by which a leader or a manager transfers and receives information in managing business. In fact, communication is the nervous system of a hospital. Communication processes within a hospital are vital for achieving healthcare goals. They are the processes that link different departments outpatient services, inpatient services, emergency services and laboratory services, and other hospital functions, which are relevant at all levels, connecting all hospital staff in some capacity or the other. The effectiveness of the communication system the way in which it is managed has a significant impact on the ultimate effectiveness of the hospital. Information is power which is conducive for problem solving, decision making, change management, and building trust and relationship. In a hospital typically a message from the chief medical officer or medical superintendent may be a directive to complete a pending surgery on priority; it may be an advice to perform a medical procedure in different manner to suit patient conditions; it may be an approval or disapproval of the hospital expansion proposal submitted; it may be new hospital policy to be in force, or a feedback about the hospital performance from the community. In hospitals medical staff deal with superiors, equals and subordinates at regular intervals through verbal and written communication, involving horizontal and vertical communication. Horizontal communication is as important as vertical communication in hospital systems. In hospitals unless communication is essential for clinical reasons, silence is otherwise rewarding as patients heal more in silence than in noise. Gandhiji observed, My experience tells me that silence soothes nerves in a manner no drug can. With me, it also induces sleep. To produce the effect I have described, silence has to be 844
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liked. No one, however, need be silent out of love of imitation, or merely for the knowledge that it produces on me the effect described by me. (The Health Guide, p.197). Hospitals should maintain utmost calm. In hospitals, these noises are simply maddening. They are made in total disregard of the feelings of other patients. Many patients and their relatives indulge in loud talks which they can easily carry on in gentle tones. Gandhiji once said, I have often tolerated maddening noises which could have been easily avoided. I am well aware that they are injurious to health (The Health Guide, p 192). Hospital Productivity Resourceful hospital managers are capable of improving productivity even with the severe budget cuts, which results in doing more with the same or fewer resources. Hospital administration should be in constant touch with its staff as it is only they who can provide clue for developing creative and innovative solutions that my drive hospital productivity as it lies in the minds of those who are closest to the work. According to Gandhiji, in any performance measurement exercise it is the results achieved that counts. He noted, It is our actions which count. Thoughts, however goods, in themselves, are like false pearls unless they are translated into action. (Collected Works of Mahatma Gandhi, Vol. LI, p. 41). He further elaborated by saying that in the Divine account books only our actions are noted, not what we have read or what we have spoken (Gandhi, 1934, p.122). Medical emergencies are common feature of a hospital which sometimes gives rise to panic. However, it is important to avoid panic as it has adverse impact on hospital productivity. Bapu was believer in God and he held that everything, good or bad, occurs in this world with His concurrence only. In hospital environment it is absolutely important that panic must be avoided at all costs. We must refuse to die before death actually takes toll (Harijan, Feb 17, 1946). According to Gandhiji, The nectar of Ramanama imparts joy to the soul and rids the body of its ailments (Bapu-ke-Ashirwad, July 9, 1946).
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Hospital authorities should always try to run hospital as a not-for-profit organization except when it becomes very necessary to earn some legitimate profits for maintaining the standards of hospital services. A private hospital can charge some nominal profits on its operations only when it needs money to make further investments on medical technology. While there can be some debate on degree of profitability hospitals should work at there can be absolutely no reason for overcharging hospital fees or indulging in violations of medical ethics. A hospital without medical ethics is a hospital at risk. According to Gandhiji, it is wrong to think that business is incompatible with ethics. I know that it is perfectly possible to carry on ones business profitably, and yet honestly and truthfully (Harijan, May 4, 1935). According to him, honesty is the best policy in such matters. He noted, It is difficult but not impossible to conduct strictly honest business. The fact is that the honester a business, the more successful it is. Hence, the proverb coined by businessman: Honesty is the best policy (Harijan, July 28, 1946). Gandhiji was always supporter of good moral conduct and ethical behaviour in every sphere of human endeavour. It is my firm conviction that all good action is bound to bear fruit in the end (Young India, June 2, 1927). Man is what his actions make him. He rises by good actions, and falls by evil ones (Bapu-ke-Ashirvad, March 10, 1945). Individual experience is not the only factor in an action. Faith and imagination do play their part (Speeches and Writings of Mahatma Gandhi, p.512). What the world needs is not words, but action. Actions and thoughts tell far more than speech (Harijan, Sept. 29, 1946). However lofty the ambition, it should embrace within its ambit even those considered the lowliest of creatures (Bapu-ke-Ashirvad, Sep 11, 1946).
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8. Concluding Remarks
India needs large number of small hospitals in rural areas that offer low cost quality healthcare. Affordable healthcare is not entirely new to the private sector. Deviprasad Shettys heart hospital Narayana Hrudayalaya and charitable eye hospitals Sankara Nethralaya and LV Prasad offer high-quality, affordable healthcare. Doctors are paid competitively; there is investment in t raining of auziliary staff; there are hospital information technology systems to keep track of patients and clinical outcomes; and patient feedback is actively sought in many upcoming low-cost hospitals in rural areas (Kamath, 2011). According to Bapu, I believe that a healthy soul should inhabit a healthy body. To the extent, therefore, that the soul grows into health and freedom from passion, to that extent the body also grows into that state. (Young India, June 5, 1924). It is with Gods grace that we are into this particular body and accordingly it becomes obligatory that we keep it healthy and fit to serve humanity. Gandhiji added, There is an incessant struggle going on within us between our Soul and Satan for the control of our body. If the Soul gains the ascendancy, the body becomes a most potent instrument of good; but if the Devil is victorious in the struggle, it becomes a hot bed of the vice (The Health Guide, p.19). Gandhiji observed, Man came into the world in order to pay off the debt owed by him to it, that is to say, in order to serve God and (or through) His creation. Keeping this point of view in front of him, man acts as a guardian of his body. It becomes his duty to take such care of his body as to enable it to practice the ideal of service to the best of ability. (The Health Guide, p.24). All that is given cheerfully and generously to another comes back to you and enriches your life in unexpected way. Gandhiji always believed that body needs to be maintained properly, among others, in order to serve society and mankind. He wrote, Our body has been given to us on the understanding that we should render devoted service to God with its aid. It is our duty to keep it pure and unstained from within as well as from without, so as to render it back to the Giver, when the time comes for it, in the state of purity in which we got it (The Health Guide, p.17). 847
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According to Gandhiji, The body can be of real service only when we realize it to be a Temple of God and make use of it for Gods worship; otherwise it is no better than a filthy vessel of bones, flesh and blood, and the air and water issuing from it is worse than poison. It is not most disgraceful that for the sake of this body, we should stoop to falsehood and deceit licentious practices and even worse? (The Health Guide, p.18). Numerous are our ailments; numerous, too, are physicians and their treatments. But we would be spared much bother if we regarded all diseases as one, and Rama (God) as the one and only Physician who can eradicate them (Bapu-ke-Ashirwad, Dec 29, 1944). Gandhiji also said, It is well that it (body) lasts whilst there is use for it. It is equally well that it perishes when there is no use for it. And since we dont know when it will outlast its use, we conclude that death through whatever cause means that there was no longer any use for it (Bapus Letter to Mira, p.210). At another occasion Gandhiji noted, Though death and life are the faces of the same coin and though we should die as cheerfully as we live, it is necessary while there is life to give the body its due. It is a charge given to us by God. And we have to take all reasonable care about it (Desai, 1932, p.124). Gandhiji had supreme faith in the Almighty as it is He who oversees all activities in this world. He once observed that when death extends its icy hands not the greatest medical power available on earth can save the person from the jaws of death.
9. References
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