Tuesday, September 07, 2010

The Dean - from Dr Nadkarni's book, Healing the Sick Healthcare System

The head of the medical college hospital is Dean. A person who holds the post of professor is eligible to compete for the post of the Dean after five years of experience. The Dean is an academic post. He comes from amongst professors who are expected to be masters in their own subjects. As I had discussed previously, these professors ought to be good either in their professional work or teaching or research. It is pertinent to note that the teaching staff does not have any formal training in administration. They do not attend any training course-not even a few lectures-to understand administration. The professor who heads the department i.e. senior most amongst professors in each department learns some administration out of compulsion because he is forced to take part in the administration. All this clearly proves that the post of Dean is an academic post and his primary duty is to promote good medical education, research and provide good medical services to the patients through properly supervised system of clinical practice. It is surprising, therefore, that such an academic person is suddenly forced to spend 90% of his time in purely administrative aspects of running the hospital. On the other hand, there are administrative posts in the colleges and hospitals like Assistant Medical Officer (A.M.O) or Assistant Dean. (now a days called Assistant Commissioner) who look after all the administrative aspects. For them the ladder stops at the post of Assistant Dean. They are not eligible to apply for the post of Dean. Similarly, now people are getting trained and qualified in hospital administration and/or business administration, and others obtain degrees in I.I.M.s. or do financial management etc. or become masters in administration. It is a crime to waste medical talent on the administrative duties which he normally does not understand fully and to waste the talents of qualified administrators by not appointing them to do the administration.

Even in India, in Triruanantapuram, Kerala e.g. the Dean has his office in the medical college which is about 2 to 3 kms away from the campus of medical college hospital. The hospital campus is managed by hospital superintendent. In institutions like All India Institute of Medical Science (AIIMS) of Delhi or Chandigarh, the Dean is an Academic Head and is not burdened so heavily with the administrative duties. The hospital is looked after by another person. It is high time that the hospital management should be entrusted to the qualified hospital administrators; MBAs or even graduates from Institute of management. The problems and solutions which I am trying to emphasize here will be easily understood by the IIM graduate and they would easily surpass the ideas mentioned herein.

The Deans, apart from the academic activities, should be involved in the administration only to the extent of major policy decisions like budgetary provision for each department, purchase of additional equipments for various departments either to maintain the present services or for expanding the services. Day-to- day routine administrative problems must be dealt with by the administrative person appointed for that purpose. He need not be a medical professional.

What is true for the Dean ought to be true for medical superintendents in secondary care hospitals in municipalities or district hospitals in the state governments. The medical superintendent ought to be concerned with the clinical aspects of administration namely, appointment, supervision and maintaining performance records of all medical and paramedical personnel. He has to plan the schedule of working, emergency duties, etc. of clinical departments, as also the need for more equipments for modernising the medical services. But all the purely administrative functions of the hospital like maintainence and repairs of buildings and equipments, electrical and civil work administration of the entire staff, salaries and leaves must be the function of an administrative officer who may be suitably called hospital superintendent or chief administrator.

Similarly, the financial management of the hospital must be entirely relegated to the Chief Accountant or Financial Manager. The entire staff at the registration, billing and medicine supply counters must work under the chief accountant, In the government and municipal set-up. The accountant in not answerable to the Dean and has almost the same independent powers as the judiciary has, in respect to the collector of the district. At present, this semi-independent authority of the accountant is playing more obstructive role than constructive role in the hospital management. They are not responsible for any short-falls in the services. Yet they have the full authority to raise audit objections for purchases - for that matter - for any expenditure proposed by the superintendents. I have already suggested, in an another chapter, that the registration and billing department should work under the accountant, so that the department will be responsible to show adequate collection of the charge from the patients. If the Dean or the superintendent is not answerable for the collection of the fees for medical services or the charges of investigations or medicines supplied, they will also be freed from the pressures from politicians and relatives to reduce the charge. And the chief accountant will become answerable to show adequate collection of charge on the one hand, and purchase of essential in terms for clinical services on the other. The obstructionist will now become practical and constructive. Their answerability towards proper functioning of the hospital will increase. A major problem of successfully running medical services will be solved.

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