Case study deals with a Kenyan Hospital which is fighting for its survival as operating costs are too high and revenues are too low due to most of the operative and pre-operative treatment are being done on very low cost or at no cost due to varied reasons primarily being situated in the most poor stricken place but at the same time it has also been highlighted that the place has dearth of varied complex cases with low sensitivity providing immense learning opportunities and also the real pleasure of the profession- to work for man-kind.
Identification of Sustainability factors
So in general if we see ‘Kijabe Hospital’ is working on namely following underlined factors to help it sustain in society
1. Service to mankind
2. On funding’s and donation’s which it receive from following channels
a. Through missionaries
b. From employees from their salary
c. From NHIF (National Hospital Insurance fund)
d. Through its low cost high quality services
e. Through private, public, government bodies
f. Through social media and websites like Watsi.org
g. Through local Kenyan communities the fund they receive
3.Through its various sponsored programs which are now accredited worldwide like residency programs (U S NATIONAL LIBRARY OF MEDICINE)
4.Intensive learning opportunities available as compared to their US and European compatriots
5.Variety of cases involved
6.Low sensitivity involved in the cases
7.Its partnerships with the foreign society
8.Effort to retain staff on quality selfless work rather than highly paying low quality work
9.Infrastructure updating that is continuously going on with the help of outer experts who are slowly and slowly arranging resources for creating an unmatched world-class hospitals
10.Staff Benefits more in physical form rather than in payment form
11.Level of commitment is very high
Structure of Kijabe Hospital if we see the type of cases it is dealing and with the kind of expansion it is possessing is unmeasurable as compared to others.
Things ‘Kijabe Hospital’ is deficient in are
- Proper talent and quality staff as hygiene factor with high salaries is missing
- High profile cases missing and so less publicity
- Negative locational factor (KENICHI OHMAE)
- Quality equipment and machines
- Proper well prepared design of execution of its various processes like water, waste management and sewage is not proper.
- Electricity had been a big issue which is slowly getting integrated with the world class by replacement of old worn out generators and transformers with new switched devices to ensure 24X7 and also all seven days presence of electricity
- Proper management
- Surgical equipment and their credibility against the infection due to continuous reuse again and again
- Success rate questionable
- Regretful delays in service
- Slow bed turnover
- Lower availability of ICU’s as compared to the number of cases recorded per day
Some improvements which can be suggested are
1. Attract Talent
By tie-ups with foreign university and exchange programs
By publicity of learning opportunities available
By peer-groups and word of mouth publicity
2. Increase intake of staff
3. Salaries in kinds and other channels be given priority
4. Research development by establishing laboratories (PHILIP KOTLER, KEVIN LANE KELLER, ABRAHAM KOSHY, MITHILESHWAR JHA)
5. Prioritize cases and allocate resources quality and quantity wise to the same
6. Expansion of channels like
If we would like to summarize the whole case it has been clearly mentioned that it is not a competitive organization from any statistical parameter and the only reason it is working is to provide quality healthcare. Management and leadership is one thing and on the other hand is proper delegation and optimum channeling of resources which is somehow missing (STEPHEN P. ROBBINS, TIMOTHY A. JUDGE, SEEMA SANGHI, 2009). Lack of funds is one major issue which cannot be tackled too in effective manner. Based on numbers it has maximum operations being done of the average of 9000 as per data available but still success rate is questionable (CDC, 2017).
- U S National Library of Medicine, Medline Plus, viewed on 27 April 2017 from https://medlineplus.gov/surgeryvideos.html
- CDC 2017, ‘Diseases and Conditions| CDC’ viewed on 27 April 2017 from https://www.cdc.gov/diseasesconditions/
- Kotler, Philip, Keller, Kevin Lane, Koshy, Abraham, Jha, Mithileshwar, Marketing Management, 13thedition, Pearson Education
- Robbins, Stephen P., Judge, Timothy A., Sanghi, Seema 2009, Organizational Behaviour, 13thEdition, Pearson Prentice Hall
- Ohmae, Kenichi 2013, The Mind of the Strategist: The Art of Japanese Business, 16thEdition Tata McGraw Hill
Surgery is a very interesting as well as an important part of the treatment in the medical science and year by year with the technology inputs and detailed invasion it has been possible to carry out very minute rare surgeries making it possible to treat un-treatable diseases. In this case we have dealt with demography of a poor nation ‘Kenya’ with widespread diseases like HIV/AIDS, cancer, malaria, TB etc. with prevalent cases of Gyanaeocology and Obstrecian and in addition to it rising Padeatratic cases which has already made the center number one in the world (Medical Services).
Analysis and Evaluation of the authenticity of sustainability initiatives
Quality of cases is present but there exist high negative locational hygiene factor with also low attractiveness towards pay with demography of high prevalence of viral-diseases. It’s suitability to attract talent on the base of exposure to intense complex low sensitive cases can be a positive point to lure on the base of learning opportunities (Kenya Tourism Board 2014). Its tie ups with the outside big institutions will also help it gain publicity and will allow talent with more commitment to join the center and work for the noble cause for the profession i.e. for mankind.
Infrastructural issues are there in the center which can be addressed only through proper channeling of resources in which funds, proper know-how, properly trained staff, proper disposals, equipment and electricity all in a whole are, as stated, of the second grade as compared to the world quality standard. It can be addressed and is being addressed by channeling savings and donations to the buying of the equipment and there installment slowly and slowly in the centers to make available the features listed above (AIC Kijabe Hospital).
Revenue is a big cause of worry but you cannot cling to it when your objective is social. Allow the residents to develop their own revenue-base which in now-a-days can be through various channels which are websites, links, tie-ups and others but you need a good marketer to make it success. If we see the concept is good but the varsity and cost associated is very high with the kind of funding required. With many free cases being done daily and lack of revenue of the mark from the cases done it is clear that it will be difficult to get revenues from it. It cannot match salaries, perks of the other institutions as clearly stated in the passage and agencies as stated often are used to allow the talent come and taken on classified cases which are sensitive but it is rare and also time taking process.
To fill the gap research is something for sure which will help. They should align in parallel with world class laboratories and install something as per technology norms where they can keep fresh samples of cases where live experiments of drugs for better development of medicine can be carried out. It will involve revenue when samples will be exchanged and also it should share in revenue if possible by canvassing out a piece in the profit of the companies concerned when they sell the developed product or at least get it allowed for their center at lower subsidized rates.
‘Organ-donation’ and exporting it to various parts of world health centers will definitely change the whole scenario as it is one of the most lucrative and looking job of the organization. It will fetch high-revenue and also allow better utilization of existing resources. It will open up the channels for growth and also ease out deficiencies all due to funding.
Cost is an essential thing and to attach it to the selfless service with leisure and learning opportunity will definitely attract talent. Leaders since from 2010 when ‘Mary Muchendu’ has become the ED is exemplary as she has tried to leveraged on the points but not so emphatically. She is seeing experts of their field committed to mankind and is trying to associate them with the center which has definitely helped and situation is far better than when she joined. But still she has been lowered on the objectives with real results going down as she has failed on the very premise - which social cause has to be given priority and commitment should not be lowered - otherwise supporting numbers will go.
Suggestions for improving sustainability
Social cause is in itself self-explanatory to elucidate that hygiene factors will be missing and motivational factors of high salary, big-bash company, high perks are all missing and even in any area the hospital doesn’t stand in comparison to local private and government hospitals (STEPHEN P. ROBBINS, TIMOTHY A. JUDGE, SEEMA SANGHI, 2009). So how to attract and retain talent is a big question for the center. To give exposure to high class talent by providing exposure is the only motivational factor involved. They are using equipment from donation low cost and not the latest in many cases that too are reused again and again giving the whole scenario a taste of ‘bitter gourd’. Commitment and service to mankind are other motivational factors which can translate into long engagement if it meets the person’s long term commitment. It needs support of Christian missionary to allow local people get trained to the high-paid job of consultant and as stated the salary is just one-third. Experience can be other luring factor as now it is recognized more in the outside world and is helping persons there rise in their career with it.
‘Train locally and hire locally’ can be the new buzzword and it can be done by engaging local youth as technicians in wards and ICU’s by imparting them working knowledge to let repetitive low risk work be performed by lower paid staff which will help the local people in getting jobs and also in this case commitment would be high as people would be able to relate to the job more (Kotler et. al.). Error-free, adapted to atmosphere, local, less cost to center, high commitment, creating employment will be the motivational factors involved and it will also allow the area to witness growth (Cooper et. al. 2009).
If we now take up a new set-up and discuss the same identified sustainability measures it would do wonders. If proper experts are hired and are able to do high risk jobs again and again with proper guidance and support and they develop expertise it would lead to popularity and would attract high-paying crowd from around the world. Infrastructure crunches will go away and also to remain based on funding will too. And it can engage in social cause too under the aegis of corporate social responsibility. In a nutshell if the organization is for-profit and it adopts sustainability measures as outlined it will become the world’s best center as it will not compromise on quality and would demand pay for work.
If we take SME industry working for-profit it will too hire experts and would ensure their hygiene and motivational levels are maintained to optimum level and will take up cases only after accepting certain payments as and when possible. ‘Social cause’ in both the cases is not possible to be achieved in the set-up we are discussing and 80% points listed as sustainability initiatives would cease to exist.
In both the above cases we are considering the facts that the organization would become selective in choosing cases only on basis of factors like payment, growth, learning etc. and would hire talent with the same objective. It is thus clear that delays would reduce, quality will improve and better utilization would be available of the resources in hand and also future objectives of growth will too.
In government set up, being a poor country Kenya would definitely end up as a low getter of funding from the government but as discussed from the community, insurance fund and missionaries support it will reduce the gap between revenues and cost to earn profit. Social cause would definitely weaken it up more and situation will be worse than missionary hospital. For each technical support as well as expert it helps it has to channel it through its embassy which will be again very difficult. Definitely train locally and hire locally can here do wonders but funding, talent, quality, resources and ease of doing work will be low.
If we summarize the whole it is very clear when your objective is social profit you will always get a kick down in every situation and every place and in every field as compared to profit. So to balance the two you have to concentrate on the positives which are exposure, tie-ups, links, commitment, name, growth, learning and it should be marketed in synch with price, promotion, place and people with product-compatibility in such a way a balance is surged between all (Ohmae 2013). There will be mismatches time and again which will be corrected again and again through better approaches which can be through interventions, leadership change, and leadership style change from transactional to transformational.
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