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Issue 52 & 53 October 2009 - March 2010

Clipboard A Quarterly Update on Management Issues from the Administrators Section of the Christian Medical Association of India

Dear Members Members,, Greetings from the Administrators Section of CMAI!


ome new developments have taken place since my last letter. The Ministry of New and Renewable Energy, Government of India, has accepted our proposal to conduct awareness workshops regarding implementation of alternate energy sources and energy efficiency measures in hospitals. They are also willing to consider generous subsidies for hospitals which are willing to implement measures (ex utilisation of solar energy) in this financial year. If any hospital in our network is interested, they should contact me immediately. In this edition of Clipboard, I am presenting three excellent presentations made during CMAI’s 40th Biennial Conference held at Aurangabad, Maharashtra from 21-24 October 2009. They are listed below: 1. Competency Approach to Human Resources Management - Mr Samuel N J David 2. Professionalism Accuracy Courtesy Timelines (PACT) - Mr Sunny Kuruvilla 3. Resource mapping and scanning in planning process for mission hospitals – A case study - Mr Augustine Aiyadurai Please send in you comments and suggestions.

Stephen Victor Secretary, Administrators' Section



urpose of our life – ‘they may worship me’ “What do you have there in your hand?” The Lord asked him. And he replied, “A shepherd’s rod.” Exodus 4:2 God prompts us to do things that are insignificant and common, and things that have less or no value. Moses was told that when I am with you even insignificant things will turn out to be significant. The agenda given to Moses is to deliver His people; remind them that there is a God who is concerned, is eager to help them in trouble and to lead them into a relationship with Him. “Get up early in the morning, confront Pharaoh and say to him, ‘This is what the LORD, the God of the Hebrews, says: Let my people go, so that they may worship me.” Exodus 9:13-14 It is a reminder that we will constantly live as a testimony to God and worship Him in the land/space promised to us.

"If you would hit the mark, you must aim a little above it."

Henry Wadsworth Longfellow

Clipboard Issue 52 & 53

PACT – A framework for excellence


ow do we rate the services of a hotel, a taxi, a bank, a gas agency or any other service provider? It might be in terms of the quality of their service or the value of what we paid for. Our repeated visits to a service provider even when there are other choices could be an indicator of the good quality of their service. As providers of healthcare, hospitals are no different in this matter. Continuity of patients is important for the sustainability of a hospital. In their efforts to attract new patients, hospitals tend to improvise on technology, infrastructure and services. In this process, they are likely to ignore existing patients. Retaining existing patients has greater potential and is less expensive when compared to attracting new patients. It has been observed that most of the patient’s complaints are regarding failures in Professionalism, Accuracy, Courtesy and Timeliness (PACT). Who controls these parameters? Directly or indirectly, these are controlled by the healthcare staff! The ‘PACT framework’ (figure 1) is a model intended to design and introduce systems in healthcare institutions to enable effectiveness in patient care services.

Figure 1

Professionalism In this context, professionalism is ‘adhering to the best accepted practice of the industry in every function of a service area’. Professionalism brings a ‘system approach’ rather than an ad hoc way of functioning.


It demands SOPs (Standard Operating Practices) at functional levels. Continuous improvements through feedback and professional updating are also evident in professionalism. Safety and confidentiality are closely associated with it.

Accuracy Accuracy is error-free functioning. Right judgements and right documentation result in accuracy. Accuracy is indicated by right diagnosis, appropriate tests, correct values and calculations.

Courtesy Courtesy is the experience of a patient in the hospital in terms of politeness, respect, dignity and empathy.

Timeliness Timeliness is the ability of the organisation to value a patient’s time and to provide services accordingly. This is the responsibility of every employee in the healthcare organisation.

PACT framework process 1. First of all, the organisation should have a passion for improving the quality of its services. This should be reflected in its vision and mission statements. 2. In line with this, all departments should have objectives that can be achieved through their functions at the departmental level. 3. This is where ‘PACT’ comes in. Each function of the department should be tied with professionalism, accuracy, courtesy and timeliness, as applicable. A few functions of the HR department are given as an example in Figure 2. 4. Once the department functions are developed based on ‘PACT’, the effectiveness should be assessed periodically through appropriate measures such as:Ê Patient satisfaction survey/feedback Ê

Performance appraisal


Exit interview with staff


Staff satisfaction survey


Suppliers feedback


Time studies


Medical and other types of audits


Quality checks – internal and external

Clipboard Issue 52 & 53 5.

Based on the assessment, if the ‘PACT’ score is found to be low, the following reinforcement measures can be adopted:B Training B Motivation B Close monitoring B Developing accountability 6. This cycle should be an ongoing process as it focuses on the refining of staff and the systems, leading to customer satisfaction and eventually to excellence. Ultimately, the patient determines the level of excellence of the hospital services. That’s probably why Gandhiji said, “A customer is the most important visitor on our premises. He is not dependent on us. We are dependent on him. He is not an interruption in our work. He is the purpose of it. He is not an outsider in our business. He is part of it. We are not doing him a favour by serving him. He is doing us a favour by giving us an opportunity to do so.”

PACT for HR department Functions





Assessment methodology

HR budgeting:Cadre positioning exercise in January and August

Adherence to industry’s practices, hospital’s policies and SOPs

Error-free cadre positioning; minutes for new approval

Recruitment and selection :-

Adherence to industry’s practices, hospital’s policies and SOPs

Error-free HR requisition, advertisement, test and interview score, appointment offer

Communication on test and interview; well received for interview; seating arrangement

Informing at least three days before the interview; informing the results on time; appointment offer / regret letter within four days of the interview

Audit of SOP, policies, HR requisition file, copy of advertisement, interview list, score sheet, appointment/ regret letter

Adherence to policy and SOPs, updates First day reception of orientation Medical check-up methodologies Orientation Appointment letter

Giving welcome letter and employee handbook; error-free salary fixation and calculation and appointment terms

Welcoming and introducing to the hospital and to the concerned staff

Hospital tour and medical check-up on the first day; orientation within a week of joining; appointment letter within five days of joining

Audit of SOP, policies, welcome letter, staff service register entry; first day reception letter; orientation registers and check list; staff satisfaction survey

HR requisition Advertisement Test and interview Appointment offer

Orientation and induction:-

January & August Audit of SOP, policies, cadre position statement

Figure 2

Sunny Kuruvilla Head – Administrative Services Bangalore Baptist Hospital


Clipboard Issue 52 & 53

Resource Mapping and Scanning in Strategic Planning Process for Mission Hospitals by Mr Augustine Aiyadurai and Dr Mannam Ebenezer



trategic planning is an organisation’s process of defining its strategy and making decisions on allocating resources effectively. To pursue this strategy, various business analysis tools and techniques can be used. The importance of strategic planning exercise for mission hospitals lies in the fact that the health demands, community expectations, health awareness and resourcing keep changing at a fast pace. The importance also lies in the burden placed on most mission hospitals to continue to meet health demands, especially of the marginalised and lower/middle income groups. The mission hospital can develop strategies (through strategic planning exercises) for its services and continue to serve the target groups or succumb to the changing environmental forces. This paper is an attempt to share the dynamics involved in strategic planning.

Stages involved Anticipated outcomes: The Administration should set out what it hopes to achieve through the strategic planning process in the light of existing difficulties and emerging needs. Terms of reference: Based on the anticipated outcome, a clearly spelt out Terms of Reference (TOR) for the strategic planning group needs to be set. Strategic planning team: The identification of the team that would undertake the strategic planning process should include external persons who have wider knowledge and experience in the different areas of the strategic planning process. Strategic concerns and priorities: The Administration, through a participative process, should ‹ ‹ ‹ ‹


Identify strategic concerns and priorities Crystallise strategic priorities Develop a road map for the process Set the timeline

Resource Mapping The resource mapping exercise involves the gathering of such information as would throw light on the current status in relevant and identified areas like patient care, human resource, staff mix, financial details, research papers, training programme and infrastructure. The issues to be kept in mind while developing resource mapping documents are: 1.

Identification of areas in which the information is to be collected


Identification of the right persons for the resource mapping exercise


The extent to which the information is to be collected


Converting information into analysed and classified data that would be relevant to development of strategies


Use of statistical tools, trends, projections, regression analysis etc, and interpretation of analysed data


Consciously developing checks in resource mapping that would avoid “bias” that can creep into resource mapping


Analysis of financial statements in relation to the patient statistics financial forecasts (ie relating finances with outputs and outcomes)

Environmental scanning Environmental scanning can include the external environment as well as the internal environment: The key factors in scanning are: 1.

The scanning needs to be carried out in identifified sections (ie targeted healthcare, other priority health needs, administration, financial, spiritual, research, training etc)

Clipboard Issue 52 & 53 2. Constitution of smaller groups/committees from within the institution with inputs from experts identified in this area 3. Development of guidelines and boundaries, and time frame for each group 4. Spelling out the non-negotiables 5. Educating the groups on conducting exercises leading to: ‹

SWOT (Strength, Weakness, Opportunities, Threats analysis)


PEST (Political, Economic, Social and Technological analysis)


STEER (Socio cultural, Technological, Economic, Ecological, Regulatory factors)

Conclusion Resource mapping and scanning help in generating the information required, classifying the same, analysing and making it available to the strategic planning team in such a manner that it enables an accurate understanding of the prevailing status. The material made available through resource mapping and scanning ensures that the strategic planning group is more focused in its approach and have very little opportunity to lose focus. Since the resource mapping and scanning is done mostly by personnel within the institution, with ‘external expert’ contribution, the acceptability of the strategic planning outcome among the staff (who would be actually implementing it) would be higher.

Competency Approach to Human Resources Management by Mr Samuel N J David


ompetency is defined as an underlying characteristic of a person which enables him/ her to deliver superior performance in a given job, role or a situation. Competency is a cluster of ¾ ¾ ¾ ¾

Knowledge Skills Ability Attitude

KSAA… Knowledge describes a body of information, usually of a factual or procedural nature, applied directly to the performance of a function/task


Skill describes a present, observable competence to perform a learned act (could be motor, psycho-motor and/or cognitive).


Ability describes a general, more enduring capability an individual possesses at the time when he/she begins to perform a task.


Attitude describes an internal state that influences an individual’s choices or decisions to act in a certain way under particular circumstances.


Definition of Competency: Competency is a characteristic of an employee that contributes to successful job performance and the achievement of organisational results. These include knowledge, skills, and abilities, plus other characteristics such as values, motivation, initiative, and self-control.


Clipboard Issue 52 & 53

Basic information about Competencies Competency is a critical tool in workforce and succession planning. At a minimum, it is a means to identify the capabilities, attitudes, and attributes that are needed to meet current and future staffing needs as organisational priorities and strategies shift. It is also a means to focus employee development efforts to eliminate the gap between capabilities needed and those available.

Implications of competencies as a basis for HR People have and get COMPETENCE (combination of knowledge, skills, attitude & ability)

We apply these in the form of BEHAVIOUR (actions, thoughts, feelings)

Our behaviour produces OUTPUTS (products and services)

How this is done yields RESULTS (Criteria for managing the prior three steps)

Classification of Competency • Basic competencies: These are inherent in all individuals. Only their degree differs. For example, problem solving is a competency that exists in every individual but in varying degrees. • Professional competencies: These are over and above the basic competencies, and are job related. For example, handling a sales call effectively is a competency that a sales personnel would be required to have. It can be simply said that, Competencies = Basic Competencies + Professional Competencies

Types of Basic Competencies 1. Intellectual Competencies 2. Motivational Competencies


3. Emotional Competencies 4. Social Competencies Intellectual Competencies — — — —

Continuous learning Perseverance Achievement orientations Time management

Social Competencies — — — —

Teamwork Interpersonal skills Responsibility Customer satisfaction

Motivational Competencies — — — —

Communication Creativity Analytical ability Planning and organising

Emotional Competencies — — — — — —

Initiative Optimism Self confidence Leadership Managing stress Managing change

Competency Mapping Competency mapping is a process of identifying the key competencies for an organisation and/or job and incorporating those competencies throughout the various processes (ie job evaluation, training, recruitment) of the organisation. Through this process, one can assess and determine one’s strengths as an individual worker and in some cases, as part of an organisation. This also helps to analyse the combination of strengths in different workers to produce the most effective teams and the highest quality work. The steps in competency mapping: Step 1: To classify the competencies under the types of competencies. Step 2: To determine the type of competency that is the most critical for an organisation. Step 3: To determine the critical competencies that are required for superior performance at a given level in the organisation.

Competency - Broad categories

 Generic Competencies Competencies which are considered essential for all employees regardless of their function or level communication, initiative, listening etc.  Managerial Competencies Competencies which are considered essential for employees with managerial or supervisory responsibility in any functional area, including directors and senior posts, strategic thinking, scenario-building, change management etc.

Clipboard Issue 52 & 53 Â Technical/Functional Specific competencies which are considered essential to perform any job in the organisation within a defined technical or functional area of work. Eg. finance, environmental management, industrial process sectors, investment management, finance and administration, human resources management etc. As can be inferred from the above model, an organisation’s vision and mission gives direction through short/long term goals and this leads to strategies. However, the vision and mission of an organisation would fail if the strategies are made without understanding and evaluating the Competencies (Core Competency and Role Competency). In fact, Competencies may dictate the whole process and the feedback they give would determine the direction of the organisation as shown by the upward arrows in the model shown below:

At every level in an organisation, different sets of competencies are required. A successful organisation is one which has the whole gamut of competencies in place and is effective in managing them in order to get their fullest advantage.

CLIPBOARD GOES ELECTRONIC Henceforth Clipboard will be sent only by e-mail except to subscribers. Please see last page for details.


Clipboard Issue 52 & 53

LEGAL WATCH Q 1: A person is declared brought dead by a competent doctor in a nursing home/hospital. The relatives who brought the person require no record from the hospital and no death certificate. More so, they do not want a MLC to be sent to the police. What should the doctor do? A:

The doctor can permit the relatives to take the body from the hospital. Legally, it means that they never brought the person/body to the hospital. The hospital should take this stand in future also, before any forum. Q 2: An MLC has been sent to the police in a case. Can a doctor recall the MLC? A:

A doctor is authorised to send an MLC to the police only if he is suspicious about the nature of injury/disaster or death of a person. Once intimation is sent to the police, the doctor has no control over it and hence he has no authority to recall or withdraw it. Q 3: A doctor has sent intimation to the police under MLC. The body is in the mortuary. If the police request the doctor to hand over the body to the relatives, can he release the body directly without sending it for a post-mortem? A:

Yes, but on condition only. After receiving the intimation from the doctor, it is the police who have to act. The doctor has only expressed doubt over the death of the person. If the police, on the basis of further investigation, feel that no foul play is involved in the death, a letter, duly signed by an officer, not below the rank of Inspector of Police, requesting the doctor (who sent the MLC) to hand over the body to the relatives, can be sent.The doctor has to keep the letter under safe custody for future reference and record. Later if the case is reopened and further investigation reveals that the facts of the case are contraryto the police version, then it is the police officer who signed the letter for release of the body who will be answerable. The doctor, who released the body under the intructions of the police, will not be held responsible. After the receipt of such a letter from the police, the doctor has no authority to withhold or retain the body.


A CMAI publication focussing on issues related to hospital administration

Christian Medical Association of India Published by The General Secretary CMAI, Plot no. 2, A-3 Local Shopping Centre, Janakpuri New Delhi 110 058 Tel: (011) 2559 9991/2/3 E-mail: Website: CMAI Bangalore Office HVS Court, 3rd Floor 21 Cunningham Road Bangalore 560 052 Tel: (080) 2220 5464, 2220 5837 E-mail: Editorial Committee

Clipboard goes electronic


n order to reach more people, we will be sending Clipboard only by email from now on. However, if you would prefer to receive a printed version, please send a donation of Rs 100/- by Demand Draft to CMAI, Delhi, towards cost of publication and postage.

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Dr Vijay Aruldas Dr Jeyakumar Daniel Mr Innocent Xess Sr Vijaya Mr Samuel NJ David Mr Edward David Dr CAK Yesudian Ms Jaya Philips Editor Mr Stephen Victor Editorial Coordinator Ms Jaya Philips Design & Production Lata Anthony Printer: Seema Printing Press

Clipboard October 2009 - March 2010  
Clipboard October 2009 - March 2010  

A Quarterly Update on Management Issues from the Administrators Section of the Christian Medical Association of India