Health care industry is a multidimensional occupational sector where various professions from various discipline come together to provide the best of health care to the patients. The field of health care utilizes the professional expertise of doctors, nurses, pharmacists, dieticians, diagnostic technicians and other biomedical staff, working as a well oiled business world machine. Undoubtedly it is vital that all the professionals within the health care organization perform harmoniously through cooperation and collaboration. However, with so many different individuals with difference in discipline, designation and what not, it is very natural for conflict to arise (Numerato, Salvatore and Fattore 2012).
Although it has to be considered that health care is people focused industry, where the lives of innocents depends on the efficiency and competency of the entire staff, there is no room for internal conflict to interfere in the care process. The concept of care management becomes of paramount importance here. The role of the management is to maintain harmony in the hospital operations and resolve any conflict that may arise in the care and overlook the different practices being performed in the hospital (Momsen et al. 2012).
Managerial role and responsibilities:
The designation of a managerial post in the health care organization holds a lot of power along with a myriad of different responsibilities. The entire operation of the healthcare can go to mayhem if there is no regulatory body overlooking the tids and bits of almost everything. The responsibility of a manager comprises of fostering a safe and motivational working environment for the employees to work in care facility so that the staff can harmoniously and cooperatively contribute to the necessary quality care to all the patients (Elvidge and MacPhail 2009).
The basic responsibilities of the managers within a health care organization include determining and managing the budget, flow of hospital supplies, administration of payrolls and benefits and lastly distribution of effective communication. It has to be considered that the facility runs under the managerial discretion and hence it becomes the managers’ responsibility to handle anything and everything related to the successful operation of the health care facility (Weaver, Dy and Rosen 2014). In this context a vital responsibility for the managers is also compliance with all the laws and regulations. For example, there are a vast number of regulations put forth by the NHS and each and every health care facility of England has to comply with it. The responsibility of the managerial staff is to circulate the information of the new amendments and regulations and ensure that the entire staffs comply with the regulation (Elvidge and MacPhail 2009).
Staffing and payroll is another huge burden of unending work on the shoulders of the managerial staff, there usually are hundreds of employees working in a health care facility, including doctors, nurses, midwives, pharmacist, medical technicians, pathologists, ground staff and pharmacists, each with different designation and different pay scale. It is the managers’ responsibility to keep track of their pay roll, assign work schedule, and prepare a roster and sometimes even hiring and firing of staff (Weaver, Dy and Rosen 2014). Apart from that the managerial staffs also have to overlook any expansion, both technological and infrastructural, and at times even marketing and promoting the health care facility so that they the facility can generate profit and continue to expand their consumer base along with retaining existing customers.
It may seem as a lot of burden for a single designation but there are subdivisions within the managerial staffing. In the scenario of a health care facility the managerial staffs generally consists of hospital administrators, clinical managers, chief administrators and health information mangers and human resource managers. Different designation has generally different roles and responsibilities. For example the hospital administrators generally are in charge of the patient s admission, and upkeep of the medical centres to ensure that the patients receive the necessary care required to meet their each and every need (Elvidge and MacPhail 2009). The clinical managers are generally responsible for specific health care departments and its operations details, the HR managers are tasked with details of recruitment and staffing and suspension and lastly the health information managers are responsible for safekeeping the sensitive medical data and ensure that there is no occurrence of unauthorized access or data theft.
Apart from the above mentioned roles and responsibilities, there are other issues that the manager of a health care facility has to deal with on a daily basis. For example the internal conflict, in the scenario of numerous employees working together rising internal conflict is unavoidable to some extent. However it is the management that sweeps in between a verbal or nonverbal match to resolve the issue in order to retain the professional conduct in the health care facility (Chronicle 2017).
Ethical dilemma contrasting with patient needs is another key issue in the health care sector that a administrative staff cannot begin to avoid. It has to be mentioned that there still is a lack of knowledge within the public about different treatments and the costs attached to it, hence the patient and their families will continue to make unrealistic demands and the managerial staff needs to handle. Another rising concern for the health care management sector in the recent years is the ever rising influx of patients. With the recent changes to the lifestyle structure of the general public the number of patients with complicated diseases is continuing to increase (Chronicle 2017). The hospital staffs however are nowhere near prepared to deal with the magnitude of influx that they are experiencing. For example in the Royal united hospital, the managerial hierarchy decided to opt for black operation to deal with the influx in patient, this colour coded care delivery system eases the trouble of the managerial staff to some extent to cope with the struggle of handling so many patients in vastly outnumbered workforce (Chronicle 2017).
Keeping up with the ever changing and ever demanding regulatory guidelines and policies are also a big challenge for the managerial staff. For example the regulatory authorities like NHS poses new amendments to their health care and hospital administration policies very frequently, complying with the guidelines that they mandate can be very difficult sometimes. Data and resource theft is another issue that the managerial staff needs to tackle more frequently than what is expected (Thistlethwaite 1999). In most times the culprit behind the theft is the one of the hospital staff members themselves with either some financial crisis to add an element of sympathy in the mixture, handling with such misconduct within the staff is another huge hurdle in the path of the managers. Lastly, noncompliance is probably the most frustrating administration issue that frequently occurs in the health care sector, often the physician or the nursing staff refuses to comply with amendments in the hospital policy or NHS guidelines. All these issues are a norm within the health care sector on a daily basis and the managerial staff can only overcome it with a strong leadership capability and assertive authority without being offensive or crude top the rest of the staff (Hall 2009).
Health care albeit being a people focussed noble professional industry, is still an industry with a specific consumer base. Now more than ever the face of health care and the care standards have changed drastically. With all the advancements and progressive technologies the competition in the health care industry continues to rise. In order to keep up with rising competition and retain the consumer base different facilities are investing their fair share of efforts (Hendry 2010). It has to be considered the care standards have improved radically from what it used to be a few years ago. Now the patients have all their woes taken care of at a single facility in a completely hassle free manner by the experts, so that the patient does not have move to move from wing to different wing to receive care for different aspects of their health conditions, by the virtue of multidisciplinary teams (Magner et al. 2006)
Multidisciplinary teams can be defined as a group of health care professionals belonging to different discipline within medical sciences coming together to construct optimal care delivery for a single patient with differential care needs (McKenzie et al. 2001). A standard multidisciplinary team generally contains a general physician, the point of entry for diagnostic process of the patients. the next member within the multidisciplinary team include the clinical decision maker, usually a specialist that arrives at a conclusion regarding the prognosis for the patients. the third vital member of a interdisciplinary team includes nursing professionals without whom the care delivery top patients would be impossible. Other than these three vital elements, other team members may include pharmacists, physiotherapist, technician, pathologist, dietician and patient instruction manger. it has to be highlighted that the team members of a multidisciplinary teams are never prefixed, the multidisciplinary teams are customized depending on the needs of the patients to cater for each and every requirement of the patients (Elvidge and MacPhail 2009).
As mentioned above the benefits of a multidisciplinary team to the patients are endless, but it has some issue for the operational sector (Kesson et al. 2012). It has to be considered that in a multidisciplinary team a number of varied professionals come together to work in a care environment to care for a single patient. In such conditions the care needs of the patients will undoubtedly be interlinked. In order for a multidisciplinary team to work in harmony it is important that all team members cooperate and effectively communicate with each other so that the patient is properly cared for and attains speedy recovery (Saini et al. 2012). However, with different professionals from different designation and discipline coming together there will be conflict and communication gap. But it is the responsibility of the managerial staff to resolve any conflict that may arise and ensure that the staffs perform collaborative towards the common goal of patient care and treatment in appreciable harmony (Momsen et al. 2012).
Strategies to enhance the abilities of multidisciplinary teams:
As mentioned above there are endless benefits in the multidisciplinary health care system, it allows the patients to receive optimal care for all of their needs and complains and it allows different health care professionals to enhance their knowledge and skill while working with experts from different streams within health care in a productive environment of team (Numerato, Salvatore and Fattore 2012). The minor issues that are there can be removed by incorporating carefully curated strategies which will also contribute to enhancing and enriching the efficiency of the team performance (Cherry and Jacob 2016).
The first and foremost strategy to incorporate in this scenario is the effective communication within the team members to develop a mutually respectful and cooperative relationship among the team members (VanVactor 2012). Taking the assistance of the science of teams in the health care there is need for employing some inputs in order to generate outcomes that will yield efficiently performing teams. These inputs must include variable like team task, team composition and organisational support. Setting up a benchmark to meet will inevitably generate a positive encouragement in the team to work together to achieve the goals (Gopee and Galloway 2013). Along with that it is the responsibility of the management to ensure that the staff are encouraged to effectively communicate and volunteer in team environment and the added boost of organisational support will definitely yield positive results. Another important element in this scenario is the assertive leadership, without proper guidance a team can go haywire, it is important for there to be n experienced leader to guide the rest of the members in the right direction (West and Lyubovnikova 2013). Flexibility and reflexivity are two highly important factors of the multidisciplinary team, if the team members are too pressured or are too crowded it will impact their performance, hence there should be a flexible and reflective environment in the members can give their bet effort and can also reflect on their performance to rectify the mistakes they might commit (West and Lyubovnikova 2013).
With these scientific and logical strategies the team members can achieve excellence performance quality and expand their skills exponentially. Along with that a highly functional and efficient interdisciplinary team will ensure commendable patient satisfaction and patient retention which will take the reputation of the health care facility to new horizons (Weaver, Dy and Rosen 2014).
Royal United Hospital Bath NHS foundation Trust deals with providing acute treatment and care to about 5 lakh people living in the areas of Bath and surrounding village of Somerset and Wilshire. In order to manage its comprehensive range of acute services, a systematic recruitment process is necessary to continue with maintain the flow of work and manage work demands. Currently there are about 4, 800 staffs engaged in outpatient, diagnostic and surgery case service for local community hospitals (Ruh.nhs.uk. 2017).
The recruitment process for NHS jobs starts with advertising about vacancies in professional websites as well as social media platforms. This helps job aspirants to be updated with recent opportunities and current vacancies. There is also shortlisting and induction process in place to prepare shortlisted employees in understanding the work process and set up at the specific clinical setting (Ruh.nhs.uk. 2017). The recruitment manager plays a crucial role in reviewing each application against the required job specification. The analysis of the current issue at the Royal United Hospital in Bath reveals staffs at the hospital are struggling to cope with large influx of patients (Chronicle 2017). In such case, the responsibility of recruitment manager has become important to balance the high demand and ratio of staffs at the hospital. They are involved in selecting the appropriate candidate for specific positions and making them aware about the rules and regulations of working in NHS. All recruited candidate must also be well-versed with current laws and legislation related to working in health care facility. This helps to prevent situations of ethical and legal conflicts due to violation of health related laws (Parand et al. 2014). Hence, managerial activities at the hospital comprises developing strategies and culture to promote appropriate work culture, quality of care, goal setting and responding to feedback.
In response to the issues of warning given to staff at the Royal United Hospital at Bath regarding their inability to cope with high influx of patients, they had established a system based on colours green, amber, red and black. It helped to identify the clinic with the highest level of demand. This system can be efficient in managing fluctuation in demand, work capacity and staff ratio at particular clinic. The ultimate outcome of this process is that number of internal escalation related to work performance has decreased and system of work has been aligned to current demand. This has helped to promote excellent and safe service despite high pressure at the clinic (Chronicle 2017).
Induction is also an important aspect of recruitment process at the Royal United Hospital. The induction process is necessary to prepare staffs and get them acquainted with the environment of work. It gives the staff an opportunity to interact with peers and seniors and understand work roles in a better way. The main objective of the recruitment and selection policy at the hospital includes recruiting and retaining the skilled staffs to enable the Trust to achieves their aims and values in care. Their goal is to maintain consistent and fair practice by dissemination of clear work guidelines at the clinic. Another important part of recruitment and selection policy is that recruitment managers need to be competent enough to fulfil all their obligations within the policy. The hospital has clear mention about the duty of the recruitment manager such as assessing all applicants fairly and making the appointments on the basis of assessment process (Recruitment and Selection Policy 2017).
The following are the stages of recruitment and selection process at the hospital:
- It starts with identifying vacancy at the hospital and reviewing the detail of job specification and needs of the department.
- Then the recruitment manager is involved in advertising the vacancies by means of coordinating with divisional recruitment team to assist in publishing advertisements. If the role of approved, the vacancy is send to the recruitment team for publishing.
- The third stage is the application process in which desired candidates can apply through NHS jobs in a fair and anonymous manner. There are certain requirement for the application process which needs to be followed.
- The Trust is committed to equality and diversity at the hospital by supporting a culture where diversity is accepted and valued.
- All health and disability information in recruitment is maintained by means of the Equality Act 2010 so that disabled job applications are rejected in the early phase of recruitment process (Conley and Wright 2015).
- Another important aspect is planning the selection process by means of which recruitment manager engages in shortlisting process and interview panels are made to hire staffs with specific expertise. According to the Data Protection Act, candidates also get access to all information related to job role and contract.
- Furthermore, employment checks are also made at NHS organization for the management of staff related conflicts in particular hospital (Recruitment and Selection Policy 2017).
Analysis of budget statement
In order to examine the viability of the business activities of Royal United Hospital, statement of budget has been estimated and evaluated for the current financial year. The statement has been compared with the actual financial year to measure the variances for the current month as well as for the year to date. The comparison and variances have been determined to assist the organizational management to control the cost of business and plan the effective level of service production to achieve the target goals.
As per the budget statement for the current month, it has been observed that the actual income was slightly higher than the budgeted income by around 0.44% whereas the actual total income year to date has been higher by 0.63%. However, the organization expects to derive total income around £1,583,633 while the budgeted total direct cost amounted to £1,082,489. As a result, the organization expects to earn contribution margin at around 31.65% for the entire financial year. Besides, the statement provides that the actual contribution during the month has been 17.90% while the budgeted was 35.43% hence, it can be said that the preparation of budget was not appropriate due to high difference in actual and budgeted amounts. On the contrary, actual contribution for year to date period was 21.78% whereas the budgeted contribution was 29.53%. The difference in the contribution margin implies that the direct cost of the company has been high due to which the overall contribution has been declined. Staff cost as well as non- staff cost of the organization reflected higher amount due to which the contribution margin has been declined. Consequently, it is expected that the actual contribution margin for the full year would be lower than that of the budgeted contribution.
As per the budget statement for staff cost, it has been noted that the company did not estimated the payment of bonus as part of staff salaries that has been actually paid during year to date. Similarly, payment for ERS Pension, occupational sick and maternity pay to the organizational staffs was not estimated during monthly budget period but was actually paid to the staffs hence the total staff cost reflected increased value. During the budget period year to date also the company did not estimate the payment for occupational sick as well as occupational maternity pay but actually been paid to the staffs which increased the total staff cost.
Considering the non- staff cost of the company, it has been observed that during monthly budget, actual rent paid was higher than the estimated payment by an amount £128. On the other hand, actual rent paid during the period year to date was lower than the estimated amount by £130. In general situations, payment of rent is considered to be a fixed payment hence, there should not be any difference between the budgeted rent payable and actual rent paid. Accordingly, in case of full year budget, it may be assumed that the estimated rent amount £108,996 would be equal to the actual amount payable so that the accurate amount of cost can be derived. Considering the cost of specialist equipment servicing the management incurred higher cost than the estimated cost resulted in adverse variance and declined the actual contribution margin. Similarly, non- staff cost with respect to the day- to- day maintenance and water rates, company incurred actual cost but while estimating the budget statement, these costs were not considered. As a result, the actual contribution percentage was lower than the estimated contribution rate.
Accordingly, it can be said that the budget statement for the full year reflects total staff cost amounted to £842,850 and total cost of non- staff amounted to £239,639 which does not include certain payments. Total revenue of the company includes gross registered fees and block grant at higher rate as compared to that of the actual amount during the period year to date. Considering the past data on actual earnings, it can be said that the company is expected to generate higher income along with the higher contribution margin. It is further examined that due to higher actual costs incurred during the month and year to date, the management is required to control the costs with respect to the salary payments, occupational payments and other non- staff costs to generate higher contribution rate.
Payment to different management reflects unfavorable variance since the actual amount paid during the month was higher for local and area management. Besides, the payment for central management has been lower than the amount estimated. However, estimated amount for full year reflects an increase by around 50% for the payment to local management hence it can be predicted that the variance between the actual and budget payment for the full year would be minimal. In case of central management, estimated payment amounted to £163,694 has been reflected which is predicted to be the equivalent amount for actual payment for the full year.
The statement further reflects surplus balance for the actual amount as well as for the estimated amount but at adverse variance amounted to £21,807 that is around 80% during the month. Besides surplus balance during the period, year to date reflects 43% decline in the actual surplus compared to that of budget amount. The difference in variance reflects improvement in estimation calculated in year to date as the estimate resulted in around 40% accuracy. Moreover, considering the estimates for full year, it is predicted that the company will incur accurate payments and direct costs; hence, the accurate surplus amount will be determined with an increase by around 15%. Even though the actual performance of the company during the monthly budget and year to date has been negative, it is expected that the surplus amount would reflect higher value. Further, prediction of total income that will be generated at higher rate would improve the contribution margin of for the full year reflecting favorable variance. Accordingly, it is expected that the company’s performance will increase by around 20% reflecting better profitability during the full financial year.
Based on the above discussion, it can be concluded that there are various professionals in the health care sector to who tries to provide the best health care service to the service users. It is very important that all the professionals in a health care organization perform through cooperation and collaboration. People depend on the health care industry for their wellbeing of their lifestyle. Therefore, they depend on the care providers. The management need to maintain discipline and regulation in the hospital operations and resolve the arising conflict, which may arise in the care organization and overlook the different practices being performed in the hospital. The entire operation of the healthcare can go to disorder if there is no regulatory body that is overlooking the minor aspects of almost everything in the organization. The managers tries to understand the problems of the staffs and manage them efficiently that decreases the problems in health care organization. The process of recruiting managers is clear. On should have the ability to understand the strategies to maintain and enhance effective multi- disciplinary working relationships. There is an overview of an annual budget demonstrating understanding of profit and loss by review and prediction.
Cherry, B. and Jacob, S.R., 2016. Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.
Chronicle, B. 2017. Royal United Hospital in Bath issues “black” warning to staff due to high demand at A&E. [online] Bath Chronicle. Available at: https://www.bathchronicle.co.uk/royal-united-hospital-bath-declares-8220-black/story-26088873-detail/story.html [Accessed 30 Mar. 2017].
Conley, H. and Wright, T., 2015. Making reflexive legislation work: stakeholder engagement and public procurement in the Public Sector Equality Duty. Beyond, p.54.
Elvidge, F. and MacPhail, G., 2009. The ‘Quality in Care’model of quality assurance and safeguarding for older people in institutional care. The Journal of Adult Protection, 11(1), pp.28-37.
Gopee, N. and Galloway, J., 2013. Leadership and management in healthcare. Sage.
Hall, E., 2009. Being in control: Personal budgets and the new landscape of care for people with learning disabilities. Mental Health Review Journal, 14(2), pp.44-53.
Hendry, A., 2010. Lanarkshire's Managed Care Network: An Integrated Improvement Collaborative. Journal of Integrated Care, 18(3), pp.45-51.
Kesson, E.M., Allardice, G.M., George, W.D., Burns, H.J. and Morrison, D.S., 2012. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. bmj, 344, p.e2718.
Magner, N.R., Johnson, G.G., Little, H.T., Blair Staley, A. and Welker, R.B., 2006. The case for fair budgetary procedures. Managerial Auditing Journal, 21(4), pp.408-419.
McKenzie, K., Matheson, E., Paxton, D., Murray, G. and McKaskie, K., 2001. Health and social care workers' knowledge and application of the concept of duty of care. The Journal of Adult Protection, 3(4), pp.29-37.
Momsen, A.M., Rasmussen, J.O., Nielsen, C.V., Iversen, M.D. and Lund, H., 2012. Multidisciplinary team care in rehabilitation: an overview of reviews. Journal of rehabilitation medicine, 44(11), pp.901-912.
Numerato, D., Salvatore, D. and Fattore, G., 2012. The impact of management on medical professionalism: a review. Sociology of health & illness, 34(4), pp.626-644.
Parand, A., Dopson, S., Renz, A. and Vincent, C., 2014. The role of hospital managers in quality and patient safety: a systematic review. BMJ open, 4(9), p.e005055.
Recruitment and Selection Policy. 2017. https://www.ruh.nhs.uk. [online] Available at: https://www.ruh.nhs.uk/about/policies/documents/non_clinical_policies/black_hr/HR_169.pdf [Accessed 30 Mar. 2017].
Ruh.nhs.uk. 2017. Royal United Hospitals Bath | About the RUH. [online] Available at: https://www.ruh.nhs.uk/about/index.asp?menu_id=1 [Accessed 30 Mar. 2017].
Ruh.nhs.uk. 2017. Royal United Hospitals Bath | RUH Vacancies. [online] Available at: https://www.ruh.nhs.uk/careers/recruitment_process/shortlisting.asp?menu_id=4 [Accessed 30 Mar. 2017].
Saini, K.S., Taylor, C., Ramirez, A.J., Palmieri, C., Gunnarsson, U., Schmoll, H.J., Dolci, S.M., Ghenne, C., Metzger-Filho, O., Skrzypski, M. and Paesmans, M., 2012. Role of the multidisciplinary team in breast cancer management: results from a large international survey involving 39 countries. Annals of oncology, 23(4), pp.853-859.
Smith, D., 1997. Managing Care and Managing Budgets: The Development of Care Management in Suffolk. Journal of Integrated Care, 5(4), pp.121-127.
Thistlethwaite, P., 1999. Care management. Journal of Integrated Care, 7(2), pp.33-37.
VanVactor, J.D., 2012. Collaborative leadership model in the management of health care. Journal of Business Research, 65(4), pp.555-561.
Weaver, S.J., Dy, S.M. and Rosen, M.A., 2014. Team-training in healthcare: a narrative synthesis of the literature. BMJ quality & safety, pp.bmjqs-2013.
West, M.A. and Lyubovnikova, J., 2013. Illusions of team working in health care. Journal of health organization and management, 27(1), pp.134-142.