The Study on the Management Restructuring of Community Hospital with Five-Element Physiological Mechanism Model

Erh-Hsin Tsai/Vice-President/Pak Moroto Hospital

Hospitals face a very dynamic environment today, not only in medical services but also in health policy, other social and economic changes. It's especially a difficult situation to those small community hospitals. Due to the financial pressure of our national health insurance program, the policy is modified all the time. This causes those small-sized community hospitals have to face the great cost pressures and managerial conflicts. Several researches in recent years, point out the application to those small-sized community hospitals of new managerial measures help reduce the hospitals cost and effectively enhance administrative performance. Many of the medical organizations in Taiwan utilized the managerial concepts and methods to manage their hospitals, whereas those managerial measures are originally designed for enterprises, may not fit for hospital in many aspects. Because of the professional characteristics of hospital, to transfer those ideas directly for hospital can produce gap or misunderstanding for our superintendents who may be an excellent medical specialist but may not be a sophisticated manager. For th0se reasons above, the purpose of this study is trying to establish a friendly and easy-to-access model, which is based on the notions of physiologic mechanism for our community hospital directors in dealing with hospital administrative management.

This study in the beginning chapters attempted to view the community hospital from health promotion perspective through literature reviews. First, the study discussed the relationship between health promotion and healthy institute. Then, the paper introduced the concept, definition and evaluation criteria of healthy organization. The study explored the development strategies of a healthy hospital organization. From health promotion perspective, a healthy organization should be a work environment that supports and encourages development of one's ability through effective and humanity management. So, embarking on a strategic approach to a healthy institute must be through the system and structure.

The central concern for hospital management is the organization structure. It's necessary for an organization to search its own construction elements that we designate these elements here as “organization DNA”. Through the establishment and the implementation of construct elements (DNA), an organization can develop its core capability which will introduce future development of the organization and create distinctive competitive advantages. This study, empirically taking advantage of the theories of cell gene and physiological mechanism functions together with the knowledge of anatomy, biochemistry and ecology, has an intention to establish an adaptable and survivable set of DNA blueprint for hospital. We would also explain what kinds of internal structure would be, how the differentia of internal relationship is and when the exchange of value would occur if an organization with high quality administration does exist. to develop each organization's characteristics from different DNA elements. These elements in each organization would be unique and superior in genius from the other organizations. By way of arranging these DNA elements, a Strategic Management Analysis System (SMAS), which is the integration of the planned entire strategy direction, strategy objective, key successful factor, and defined specific measure indicators as well as concreted improvement plan to offer a reference to those community hospitals which has been at the edge of shutting down their business under the overwhelming competitive pressures.

This SMAS, utilizing a new “Fiv e- Element Physiological Mechanism Management Model”( 五行生理機能管理模式 ), is a strategic management tool to transform strategies into practice step by step, to effectively implement strategies so as to meet organization's missions. The study was designed to be an interventional study, applying SMAS in the case hospital, to establish strategic objectives and performance indicators, improve the performance of case hospital, and compare the differences of each performance indicator after implementing the SMAS.

The study takes a practical and innovative operation for introducing a new hospital management model. This “Five-Element Physiologic Mechanism Management Model” is to fulfill the organization DNA elements as following: Administration, Medicine, Finance, Personnel and Service. The operations of this management system actually simulate the ancient Chinese medicine therapy which believes in human body there is co-existence of two streams of invisible and untouchable energy with stimulation power and inhibition powe r, confined by the five cosmological elements of Metal, Wood, Water, Fire, and Earth. This pattern of construct of this management model is also similar to the functions in human neurology of sympathetic nerve and parasympathetic nerve actions which are opposed each other and yet also complement each other as well. Based on above-mentioned conceptions and management theories together with my ten-year working experience as a hospital a superintendent, this innovative model is then designed for the purposes to provide an easier and more effective way for handling hospital management that are required to consider how to supply a health care to satisfy the customer needs and to maintain a favorite position in the competitive market. In this chapter, we also take a lot of sections to discuss the relationship of each pair of elements from an interactively circulative structure. such as Administration vs. Medicine regarding their stimulation and inhibition powe r, which are the essential factors in the system of hospital management.

In order to verify the feasibility of this new model, the survey data are collected by self-administrated questionnaires, hospital internal indexes and external targets from 65 employees and 66 patients in a local community hospital during a six months period. Study instruments include employee satisfaction questionnaire, customer satisfaction questionnaire for the case hospital, nursing technique audit statistics, quality monitoring statistics, and monthly services reports. Data collection was done from Feb to Aug in 2007. We used descriptive statistics, pair-t test, independent-t test, and nonparametric Wilcoxon test for data analysis.

The result of this study shows that the components, constructing processes, and coordination with organizations all have impact on the implementation performance of this new hospital management model, however, the findings in this study also suggest that the importance of systematic and comprehensive management of whole elements, otherwise, it may produce the complications of unbalanced development. The results of this study are as follow: (1). Administrative perspective: The administrative efficiency is improved but not in the significant level. (2). Medicine perspective: Nosocomial infection rate, fee deduction rate and the rate of unexpected transfers/discharges to other hospitals all experienced a slight increase. The reason may be due to the delay of recruiting new members of nurses after staff members quit their job. (3). Financial perspective: The total income was increased and the average cost for each acute bed was decreased. (4). Personnel perspective: (a). Employees' satisfaction was improved, and the difference is statistically significant (p<.05). (b). Personnel turnover rate decreased from 12.1% in 2006 to 7% in 2007 whereas the rate was not good enough to reach the 5% goal value. (5). Service perspective: The rate of customer complaints was decreased . Meanwhile, the satisfaction score of customers for the case hospital was improved, and the difference was statistically significant (p<.05). In this study, the disfavor results were that most of indexes, reflected each pair of relative elements, being performance of positive impacts except medical perspective which showed the medical quality has been sacrificed under the situation for the promotion of others elements especially the financial perspective. The findings also revealed the number of nurses affected the medical quality significantly and positively.

We suggested that “Five Elements Physiological Mechanism Management Model” is an effective measure for community hospital management however hospital administrators should pay more attention to the performance evaluation with respect to compressive and systematic approach. Additionally, when designing performance evaluation indicators, hospital administrators need to associate with their strategies as we have demonstrated the “Strategic Management Analysis System” SMAS in this study.