INTRODUCTION Many aspects of health organizations are managed by health professionals.

The physician who finds himself, as chief of staff, in charge of and responsible for many activities of several hundred fellow physicians needs management skills; the physician in charge of a laboratory or a radiology department needs management skills; the nurse, who as director of nursing is responsible for the largest department in the typical health services organization, must be an effective manager; the head nurse, directly responsible for supervising the nursing care of a group of patients, needs management skills; the pharmacist who is responsible for a critical area of the health services organization needs management skills; the physical therapist in charge of the department is a manager; the list could go on and on.

The point is that, in many cases, the health professional is also a manager in a health services organization.

Management or administration, on a planned and scientific basis, in necessary for the smooth running of every institution, including hospitals. In order to perform its function efficiently, hospitals today must be organized and administered in a scientific manner. This demands that every staff-member should be adequately trained.

Hospital administration is a complex task and can causes headaches and one is likelihood of developing high blood pressure or ulcers if it is not handled properly. It involves planning, organizing, controlling and evaluating and this can be done better by knowing the principles of management and administration.

Administration is often tense. Things happen in spite of the best rules. Problems do not respect rules and regulations, or procedures. One may win or lose, depending on how one handles people and problems. Insolvable-looking problems may melt away with surprising ease, like the shadow at dawn. Problems, which look small and simple, may snowball into extremely difficult issues for which one should be watchful and deal with the problems more efficient and effectively without making any premature assumption and one should be open to all suggestion and comments.

Failure is a part of human experience and if it is seen as a challenge, one will find that it is truly a step on the road to success and personal growth.

One should not become miserable if something goes wrong. It can happen to the best of administrators. Nobody is infallible; nobody is right all the time. One has the right to make mistakes and the only person who never makes a mistake is the man who does nothing. But one should learn and profit from the mistake, which is a learning experience.

Hospital personnel, be they in administration, medical staff, para-medical or general employees, must all be concerned with one goal, i.e. to provide the best possible patient care. It is unfortunate that administration has frequently lost sight of the fact that patient care is dependent upon the skills and attitudes not only of the hospital personnel with whom the patient is in direct contact but also upon the skills and attitudes of many employees whom the patient may never get to see. The personnel policies of a hospital should help employees realize their individual goals and need to ultimately improve the quality of patient care.

Distinction between Hospital & Industrial Organization: Though hospitals have been compared to industry, there is a distinct difference. The product of a hospital is service to people provided by its personnel with a variety of skills. The nature of the demand for hospital services is also distinctive to the hospital- as admission to the hospital for services is rarely voluntary. The decision is made for the patient; he is ill and requires services, which cannot be provided at home.

The patient leaves home, family, friends, his work place, his way of life for new environment (hospital). In this environment, he becomes one of the many. In his home, he has a definite role. In the hospital, his role is similar to 30 or 40 others in the ward or unit in which he is a patient. If he is a patient in a multiple-bed unit and confirmed to bed, he is housed with strangers and carries out several intimate functions in the presence of these strangers. He is subjected to a new set of values and a new way of life. In his new environment, he meets many new people, and he is expected to relate and communicate with them. On occasions, patients encounter more than 30 different hospital personnel in the room in one day, each performing different functions.

A hospital deals with the life, suffering, recovery and death of human beings. For the direction and running of such an institution, its administrative personnel need a particular combination of knowledge, understanding, traits, abilities and skills.

Conditions particular to Administrative work in Hospitals: A hospital obviously has many organizational and operational elements in common with hotels, industrial organizations and educational institutions. However, a hospital is a n unique institution as it includes all activities present in each of the above-mentioned groups. The difference between administrative work in hospital and in other organizations can be attributes to the existence of the following conditions peculiar to hospitals:

1. The consumers of the services provided in a hospital (the patients) are physically or mentally ill and are rendered services within the four wall of the hospital. As compared with most other institutions of business, government and education, this is an unusual situation and present quite different problems of management.

2. The customers of the hospital (the patients) have individual needs and require highly personalized and custom-made services. The diagnostic, therapeutic and preventive services provided by physicians, nurses and technicians, and the aid of expensive and specialized equipments and medication are tailored to the need of each individual consumer.

3. The hospital provides a wide range of scientific and technical services such as nursing, diet therapy, anesthesiology, pharmacy, radiology, clinical laboratory, physical therapy and medical social work. Also, many of its services are provided continuously, round the clock, every day of the year.

4. Nurses and certain other personnel must accept direction from both the matron and the physicians under whom they work closely every day. They also have to fulfill the emotional, physical, mental and medical needs of the patients. The human relations problems in such situations of dual authority are much more frequent, delicate, varies and complex than in organization where this situation does not exist.

5. Handicapped by low wages, rigid discipline and some apprehension of exposure to disease, hospital personnel are expected to maintain a very high level of efficiency, as their functioning affects the lives of patients.

6. The amount and the variety of training programmers that the hospital has to provide. Training is provided for medical interns and residents (6 months to 1 year), technicians (2 years), medical laboratory technicians(2 years), physical therapists, pharmacists, medical social workers, dieticians,

nurse aids and nursing orderlies. Classrooms, clinical and different training methods are used in varying combinations. The administrator is responsible for planning and operating these various training programmers. Very few other types of institutions combine such major educational responsibilities with other operating activities.

7. The efficiency and quality of health care services in any hospital is directly dependent on the use of bio-medical equipment in diagnosis, surgery and therapeutic process. These equipment invariably employ sophisticated technology made of complex systems. The problem of maintenance and management of these bio-medical equipment is complex because there is acute shortage of technical hands who have suitable and adequate training in the maintenance and repairing of these specialized hi-tech equipment.

These peculiarities of hospital administration call for a high degree of professional competence to do justice to the job. It is, therefore, obvious that hospital administration should be entrusted on these who have the necessary training and the right kind of attitude to perform this vital task.

Definition of Management: Management is an art with a scientific base. Management as a science can be learned through the study of basic rules, principles and formulas, but as an art it is often acquired through trial-and-error and years of experience.

Management is a process, with both interpersonal and technical aspects, through which the objectives of the health services organization are specified and accomplished by utilizing human and physical resources and technology. This process can be viewed as a simple input-output relationship in which inputs (human and physical resources and technology) are transformed into desired outputs (accomplishment of the objectives of the organization or part of it).

Inputs

Transformation (influenced by management)

Outputs

Flow of human resources / physical resources / technology

Principles of Planning Hospital Facilities & Services: A well-planned hospital requires a great deal of preliminary study and planning. It must be designed to meet all the needs of people it is to serve. It must be a size which the people can afford to build and operate. It must be well-staffed with a sufficient number of physicians, nurses and other trained personnel to give adequate and efficient service.

In too many areas in the country, adequate hospital service is not available. There are many reasons for this: Lack of planning. Lack of locally available funds.

The goal of adequate hospital service for all people can be reached only by: Determining present and future needs. Evaluating services which now exist. Developing a long-range program. This program will bring the new and existing facilities together in a systematic pattern of service.

The hospital as a key institution in the community health care system, should recognize the public nature of its services and that its primary objective should be render as essential community service. In fulfilling this responsibility, the hospital should accept the following principles to guide its planning and operation: 1. Patient care of a high quality. 2. Effective community orientation. 3. Economic viability. 4. Sound architectural plan.

1-Pateint Care of High Quality: This should be achieved by the hospital through: a) Provision of competent professional and technical staff and of the equipment and facilities necessary to support the hospital's patient care.

b) An organizational structure that assigns responsibility appropriately and requires accountability for the various functions within the institution, including those particularly related to the patient care. c) Interaction of members of the medical staff with each other and with other members of the health team through consultations and conferences. d) Continuous review by appropriate persons of the adequacy of care provided by physicians, nursing staff and paramedical technicians and of the adequacy with which patient care is supported by other hospital activities. e) Educational activities designed to improve patient care and to keep the hospital' professional and technical staffs abreast of new medical and technological knowledge. f) Enforcement of standards and provision of programs for patient care that are considered desirable by the various health professions.

2-Effective Community Orientation: This should be achieved by the hospital through: a) A governing board made up primary of persons who have demonstrated concern for the community as well as leadership ability. b) Policies that assure availability of services as needed to all of the people in the hospital service area. c) Service programs that extend beyond the walls of the hospital into the community, and that complement and are coordinated with service programs of other hospitals, mental facilities, rehabilitation centers, nursing homes, homes for the aged, community clinics, home-health services and health departments. d) Participation of the hospital in community programs to provide preventive, emergency and casualty care and to teach good health and health care practices to community residents. e) Leadership of the hospital's administrator and other key management personnel in the planning and implementation of community health, health care and welfare programs.

f) Integration of the hospital's programming and planning with objectives established for the community as a whole. g) A public information program that keep the community informed about and identified with the hospital's goals, objectives and plans.

3-Economic Viability:

This should be achieved by the hospital through: a) A corporate organization that accepts responsibility for sound financial management consonant with optimum quality of care and the hospital's responsibility for community services and that raises funds, when necessary, to supplement the hospital's earned income.

b) Patient care objectives that are consistent with projected services demands and the availability of operating financing for adequate personnel and equipment required to maintain patient care of a high quality.

c) A program to attract the medical staff, an adequate number of physicians engaged in family practice as well as the essential medical-surgical specialists to maintain optimum occupancy of inpatient facilities and a full utilization of outpatient services.

d) A planned program of expansion or development of facilities and services based solely on demonstrated community need, with consideration of plans of other community health resources to avoid unnecessary duplication and to confirm with health care objectives for the hospital's service area as a whole.

e) A specific, planned program for capital financing that will assure appropriate replacement, improvement and expansion of facilities and equipment without imposing amortization and interest payments too heavy to be met from equitable patient charge.

f) Community participation in the hospital's programs through sponsors, contributions, auxiliaries and volunteers.

g) An annual budget plan for maintaining: Services at a high level of quality. Appropriate standby equipment and services. Competitive salary and wage scales and employee benefits. Interest and payments on mortgage and other indebtedness. Depreciation funding and capital accumulation for a modernization program that will permit the hospital to keep pace with modern medical and hospital practices.

4-A Sound Architectural Plan: This should be achieved by the hospital through: a) Retention of an architect experienced in hospital design and construction. b) Selection of a site large enough to provide for parking and future expansion and readily accessible to water and sewage lines and to population concentrations through highway, rail, rapid transit or bus lines. c) Determination of facility size appropriate to projected service demands of the hospital's service area and of departmental areas large enough to provide the diagnostic and treatment services required by the hospital's medical staff on an emergency and day-to-day basis. d) Recognition of the importance of establishing convenient traffic patterns, both within and outside the hospital, for movement of physicians, hospital staff, patients and visitors and for efficient transportation of food, laundry, drugs and other supplies. e) Adequate attention to important hospital concepts such as: infection control. Disaster planning.

Use of hospital services by ambulatory inpatients as well as outpatients. Intensive and extended care units. Psychiatric care programs.

Increasing concentrations of medical-surgical specialists at hospital locations.

f) An architectural design that will: Permit efficient use of hospital personnel. Place departments with complementary activities conveniently together. Anticipate future department expansion. Provide privacy, flexibility, and dayroom areas and adequate work space on patient units. Provide interchangeability of patient rooms for clinical departments with fluctuating census.

PRE-PLANNING

It is important to start the pre-planning a long time enough before construction. The aim of pre-planning is to make a program before the construction begins and see the type of the facilities required to meet this program.

Factors to be considered during Pre-planning:

1-Objectives, Type, and Size of the Hospital: The hospital may be private, governmental, educational or special one (hospital for orthopedics or for labor).

The type of the hospital and the nature of services offered are more significant than the size. For an example: if the specialty of the hospital is for orthopedic problems, the physical therapy program will differ from other specialty program.

Types of Hospital: 12 12 1. 2. 3. According to the Ownership: Nonprofit hospitals such as corporate hospitals to mosque or church. Profit hospitals as corporate and private hospitals.

According to the Length of Stay: Short-term hospitals (less than one month). Long-term hospitals (more than one month).

According to the Type of Services: General hospitals. Hospital restricted by age such as children or geriatric hospitals. Hospital restricted by diagnosis such as chronic chest disease and psychiatric hospitals.

2-Geography and Population: The location of the hospital is very important; if it is in an industrial area, we suspect that the more percentage of patients will be with industrial diseases.

If the hospital is located in suburban community, we expect most of the inpatients are form the same area as they always prefer to be hospitalized near to their residence.

3-Evaluation of the Existing Services: We must be realistic in this evaluation. Careful review of all facilities of the hospital should be performed. This aspect of pre-planning is important because it help to provide a defining of the proposed department and services.

4-Refferal Sources: The number and the specialty of the referring physicians and the referring agencies should be considered.

5-Triends in Delivery of Health Care Services: Attention should be given to: Advanced research and technology that might affect the developing program. The possible technological changes that are occurring in the equipment.

MANAGEMENT SKILLS

The skills that an effective manager must utilize are: 1. Technical Skill: It is the ability to use the methods, processes and technical techniques of a particular field. It is easy to visualize the technical skills of a surgeon or a physical therapist, but in a similar way, counseling a subordinate or making out a departmental budget also requires a considerable amount of technical skills.

2. Human Skill: It is the ability to get along with other people, to understand them and to motivate and lead them in the work place.

3. Conceptual Skill: It is the mental ability to visualize all the complex interrelationships that exist in a work place- interrelationships among people, among departments or units of an organization, and even among a single organization and the environment in which it exists. Conceptual skills permits the manager to understand how the various factors in a particular situation fit together and impact on each other.

N.B: Not all managers will need to utilize these skills to the same degree, although every manager must rely on all three types of skills in performing his or her work.

FUNCTIONS OF MANAGEMENT PROCESS

In the practice of management, the manager must take a number of actions or functions which are: 1. Planning: It involves the determination of objectives. 2. Organizing: It is the structuring of people and things to accomplish the work required to fulfill the objectives. 3. Directing: It is the stimulation of members of the organization towards meeting the objectives. 4. Coordinating: It is the conscious effort of assembling and synchronizing diverse activities and participants so that they work harmoniously toward the attainment of the objectives. 5. Controlling: It is the action by which the manager compares actual results with objectives to provide a measure of success or failure.

N.B: It may seem that the management process is a series of separate functions to be treated as a discrete components of the whole. This is not the case at all. In practice, a manager performs each of these functions simultaneously and as a part of a continuum.
Planning Organization

Controlling

Directing

Coordinating

The management functions as a continuum. PLANNING: The primary management function is planning. Planning means to decide in advance what is to be done. It aim is to achieve a coordinated and consistent set of operations aimed at desired objectives. Without planning, random activities prevail.

Planning is basically an intellectual process that must be done by all managers whether they find it easy or not.

Planning as a first step of management functions: Lays foundation for organizing-an organization structure is designed to help carry out plans.

Dictates those activities to which employees are directed. Facilitates coordination. Sets standards against which actual performance could be measured when management carries out the control function.

N.B: As conditions changes, plans have to be constantly revised and updated. It is a continuous activity for management.

Significance of Planning: 1-To focus attention on objectives: Good planning yields reasonable organizational objectives and develops alternative approaches to meet these objectives. In this way, planning provides means of unifying the actions of all organizational participants toward common ends.

2-To offset uncertainty and chance: The only thing certain about the future is uncertainty. No one knows what changes will occur even one day in advance. However, if the manager thinks about the future and plans for those contingencies, he can imagine or foresee, he will greatly reduce the chance of being caught unprepared. He can not eliminate uncertainty or chance, but he can prepare for it through planning.

3-To gain economical operation: The costs of health services, particularly those provided in organized settings, are rising at a very fast rate. While many aspects of cost are beyond the manager's control, some can be minimized through planning for efficient operation and consistency. Planning is important as a mean of controlling service costs.

4-To facilitate control: Control implies comparing actual results with some predetermined desired results. The planning function yields information that van be used to set standards against which actual results can be compared.

ORGANIZING: The basic objective of the organizing function is development of a structure or framework called the formal organizational structure aiming to carry out the objectives that are stated through planning.

Organizing can be defined as relating people and things to each other in such a way that they are combined into a unit capable of being directed toward organization objectives.

Work Division: The most basic promise of organization is that division of work is essential for efficiency. Work activities required for organizational performance are separated through the process of vertical and horizontal differentiation (i.e., dividing the organization into operational units). This usually results in the formation of department within the organization: Vertical differentiation establishes the hierarchy and the number of levels in the organization.

Horizontal differentiation comes about because of the need to separate activities for more effective performance.

The formal organization depends on two basic relationships; responsibility and authority: 1-Responsibility: It is the obligation to execute functions of work. Its source is one's superior in the organization. By delegating responsibility to a subordinate, the superior creates a relationship based on obligation between him and the subordinate. The total work load of an organization is divided among available personnel by grouping functions that are similar in objectives and content. This must be done in a manner that avoids overlaps and gaps as much as possible. It may be continuing or it may be terminated by the accomplishment of a single action.

2-Authority: When responsibility is given to a person, he must also be given the authority to make commitments, use resources and take the actions necessary to carry out his responsibilities.

N.B: Authority and responsibility must be commensurate. If authority exceeds responsibility, a misuse of authority can occur. Conversely, a person who is delegated responsibility without adequate authority to fulfill it finds it to be a most frustrating and often embarrassing position.

 The tangible product of the delegation of responsibility and authority is a formal organization structure.

DIRECTING: Once plans have been made and an organization has been created to put them into effect, the next logical function of management is to stimulate the effort needed to perform the required work. This is done through the directing function which includes the following activities; order giving, supervising, leading, motivation and communicating. 1-Order Giving: The order is the technical means through which a subordinate understands what is to be done. 2-Supervising: It includes follow-up to ensure the prompt and proper execution of orders. In this sense it is also a part of the control function. Supervising is a required function for every manager from the top of the health services organization on down. 3-Leading: Leadership is the ability to inspire and influence others to contribute to the attainment of objectives. Successful leadership depends partially on the traits of the leader and it is the result of interaction between the leader and his or her subordinates in a particular organizational situation. This means that a single pattern of leadership behavior used without discretion is not likely to be successful in a wide variety of managerial situations. Thus, the successful leader is not a blind follower of particular leadership methods but chooses the method that he or she considers most appropriate for a given situation. 4-Motivating: The manager must motivate or cause the employee to follow directives. There is a growing body of sound empirical evidence that the best motivator is a challenging job- one that allows a feeling of achievement, responsibility, growth, advancement, enjoyment of the work itself and earned recognition. 5-Communicating: Communication with workers is the final activity of the effort to direct their work performance. It is the key to directing because unless a manager can effectively communicate what

is to be done, how it is to be done, by whom it is to be done and why it is to be done, the chances of adequately carrying out the directing function are greatly reduced. As personnel are performing work and solving problems, they communicate facts, ideas, feelings and attitudes. If this communication is effective, the work gets done more effectively and the problems are solved more efficiently. COORDINATING: Coordinating is the act of synchronizing people and activities so that they function smoothly in the attainment of organization objectives. It is the closest thing to a synonym that could find for management. The more differentiation of activities and specialization of labor, the more difficult the problems of coordination. Hospitals, for example: Are among the most complex organization in modern society in terms of differentiation of activities and specialization of labor. They are characterized by a detailed division of labor into a number of technical skills. Its organizational activities are often contingent on one another. It is this condition of functional interdependence among organizational parts and activities that make coordination so important in hospitals.

Coordinating, in a very real sense, means managing conflict. Conflict may be between various functional groups in the health services organization, such as between the medical staff and administration, between nursing service and the laboratory, between subordinate and superior, or between two peers. Any one of these and other relationships is a potential source of conflict.

N.B: Not all conflict is bad, but even such low levels of conflict as are evidenced by "disliking" or "difficulty in getting along with" are often associated with reduced effectiveness. In essence, coordination is a preventive managerial function concerned with heading off conflict and misunderstanding.

Coordination could be achieved by effective channels of communication among the various staff members and among the various departments within the agency. The useful method used for this is the creation and utilization of committees:

Committees: The purpose of committee is to solve a specific problem or to work on s specific activity requiring the input of different individuals and time for its solution. There are two types of committees: 1. Standing committees that deals with problems of activities of continuous nature such as program, personnel financeetc. 2. Special committee that is called "ad-hoc committee". It is a short-term committee and deals with special immediate problem situation.

N.B: Committee meetings can be great time wasters, especially if they are inadequately directed and poorly staffed.

CONTROLLING: Controlling is the regulation of activities in accordance with the requirements of plans. It is directly linked to the planning function.

The managerial function of control consists of measuring and controlling activities of people and things in an organization to ensure that objectives and plans are accomplished.

Controlling is the function of all managers on all levels, and its basic purpose is to ensure that what is intended to be done is what is done. Control techniques are based upon the same basic elements regardless of whether people, quality of care, money or morale is being controlled.

The control process involves four steps:

1. Establishing standards. 2. Measuring performance. 3. Comparing actual results with standards. 4. Correcting deviations from standards.

CHARACTERS OF GOOD ADMINISTRATOR

Characters of Good Administrators are:

1. Good design maker. 2. Judge wise. 3. Knowledgeable and skillful in different sciences (administration, medicine- sciences which are useful for directing and administrating the hospital). 4. Good communicator at all levels with internal and external society to solve problems that may face him/her in the work. 5. Intelligent and open minded. 6. Has good sense of perception and guessing to solve problems for individuals. 7. Active, dynamic, flexible, democratic, creative, patient, responsible, leader and fair. 8. Self-confidant, update in knowledge and has good memory. 9. Looking with good scope for the future of the hospital. 10. 11. Presentable, healthy with suitable appearance and attitude. Knows ethics and laws of the organization and the other organization that have a relation with his organization. 12. 13. Understanding the philosophy and objectives of the hospital. Making his job his hope.

ORGANIZATION

Definition: Organization represents the congregation, cooperation and participation by a number of people in pursuit of a common mission. This mission is one that an individual could not accomplish alone and which requires the coordinated effort of the personnel who make up the organization.

The classical organization table is pyramidal in shape with a centralized top management at the top of the pyramid and the services units and the subunits are at the base of the pyramid. This organizational table has two dimensions; horizontal and vertical dimensions: The horizontal dimension represents the distribution of the manpower on the different jobs and job description. The vertical dimension represents the different standards, positions and power in the organization so that this is the dimension of authority and responsibility which connects each position with those above and below it in the organization.

An example of a hospital organization structure is seen in the following figure (Page 46).

The hospital is a very complex social system with substantial conflicts among the participants-patients, physicians, trustees, administrative staff and other personnel. The diversity of the organization creates major problems. The governing board has the legal authority over and, responsibility for, the organization. The medical staff possesses the technical knowledge to make decisions regarding patient care and treatment. The administrative staff is responsible for day-to-day functioning of the hospital.

HOSPITAL PERSONNEL The success of any hospital is more dependent upon the competency and attitudes of its personnel than upon almost any other factor. This is true for each member from the administrator to the least skilled worker.

Organization of Hospital Personnel: Sound personnel organization with policies and procedures in writing with continuous supervision at all levels are the best investments of efficient management, financial stability and quality of care. The personnel department consists of personnel director and personnel staff. The staff of the personnel department will vary according to the size, type and objectives of the hospital.

Functions of Personnel Department: There are almost nine elements that represent the functions of the personnel department:

1-Personnel Policies: The philosophy, concepts, goals of any successful organization must be based on well developed written policies. These policies include: 1.1. Employment: It is the policy of the hospital to provide steady employees. Employment of all personnel should be the joint responsibility of the personnel director and the respective department head.

There must not be an age limits other than required by the laws. There should be a general policy not to discriminate between individuals because of religious, race, nationality, sex or marriage. Relative may not be employed in the same department.

All candidates must pass satisfactory pre-employment medical examination.

1.2. Promotion & Transfer: Present employees should be considered for promotional positions before outside applicants. Merit rating and seniority should be the determining factor for promotion. An employee may be transferred from one position to another on request. This includes change in occupation or environment. Application for transfer will be considered on the basis of the employee qualification, reason for request and requirement of the department.

1.3. Termination of Service: Dismissal: Discharge of an employee for a cause by his department head in conjunction with the personnel director. In regular employee discharge; at least 2 work week notice should be given. In case of gross mistake, an employee may be discharged immediately by the administrator. Resignation: All employees resigning from the hospital should give a reasonable notice not less than 2 weeks. An unexplained absence for 3 days is considered as a resignation.

1.4. Merit Rating: There will be a regular review of each employee to determine the efficiency and qualification that will be considered in promotion and transfer.

1.5. Employee Services: Providing privileges for the employees. Providing adequate rest rooms for all employees. Distribution of personnel mail only for the employees who are living in the hospital quarter. Providing and maintain of uniforms for all professions. Providing living quarters for interns, residents, students and nurses. If possible, rent rooms are provided for employees.

Parking should be provided if possible. Pension program should be provided for employees to help them in their old age.

N.B: Personnel department does not provide transportation or personnel telephone calls. 1.6. Health & Hospitalization: Health Services: There is a separate personnel health clinic with special personnel physician in charge. All employees must have pre-employment medical examination and annual regular examination. All special health services such as x-rays, laboratory investigation and drugs should be provided on request of the personnel physician at plus cost.

Hospitalization: The hospital should discount portion of hospital bill for their employees.

1.7. Hospital Holidays: The hospital should consider the general holidays of the country.

Employees who can not absent from their duties, should be given a substitute day off or should be paid for the holiday.

1.8. Hours of Work: No employee should work more than 8 hours/day, 40 hours/week except in emergency situations. There must be scheduled starting and finishing times. Because of the nature of hospital's work that require rotating shifts, all employees must share in the rotating shifts. Overtime work should be paid (on call time is not considered as an overtime).

1.9. Sick Leave: All regular employees should be entitled to 12 days of sick leave per year. Sick leave should not be cumulative from one year to another. Sick leave over 12 days may be granted but not more than 16 days. No sick leave would be paid without authorization of the personnel health physician.

1.10. Leave of Absence:

 Leave of absence may be granted for regular employees after one year service for a period up to 6 months or one year in certain cases.

Leave of absence more than one month must be approved by the administrator while that is less than one month must be approved by the department head and the personnel director. When computing the length of service, the leave of absence should not be counted. Special absence such as in case of attending a meeting or conference, may be granted with or without pay.

1.11. Safety: The hospital will attempt to maintain safe work conditions. Leave due to accident or injury during duties will be compensated. Any accident even minor ones must be reported immediately to department head and the injured employee must be sent to the personnel department clinic. Time lost because of accident while on duty should be deducted when computing length of service. 1.12. Vacations: Annual vacations with pay should be granted to all regular employees. Vacation time should not be cumulative. Annual vacation should be granted in one or maximum two periods.

1.13. Salary & Wages: Scheduled salary system for all positions. Minimum and maximum rates should be presented for each position. Number, amount and frequency of salary increases should be established. New employees will be paid the minimum rate of each position except for unusual skilled and experienced persons. Employees who receive promotions for higher grades will have their salary reviewed at the time of promotion.

2-Job Requirements: Once the regular and specific policies relating to personnel have been formulated, it is necessary to document details of each job to be filled. This means:

All jobs must be reviewed, described, evaluated, grouping positions alike together in one class and eliminate over lapping and conflicts of jobs. There should be central control over all jobs with regular review of jobs that might change in course of its content or nature.

3-Qualifications: The qualifications of the individuals who are to be recruit to carry out the duties of the job must be determined.

Factors to be considered when measuring qualifications are: Education and training. Experience. Judgment. Contacts. Accuracy. Physical, mental and emotional domains. Responsibility for work of others, for safety of others and for equipments and supplies. 4-Employment: Employment means getting the right person on the right position at the proper time. The personnel department must be aware of the personnel needs.

5-Training: Training is especially important in hospitals in order to keep skilled personnel up to date and to make untrained personnel to assume many of the non-professional tasks. Job instruction training is the responsibility of the department head while general orientation is conducted by the personnel department.

6-Supervision: Supervision is an educational not an evaluating process. It is an art rather than a science.

The responsibility of the supervisors with the assistance of the personnel department are: Making the employees aware of the job title requirements, objectives, policies, work conditions and schedule.

Sympathetic but firm direction of work activities. Proper attention to morale and grievances.

7-Utlilization & Staffing: There are a number of factors that influence the quantity and quality of personnel such as; the general objectives of the hospital, size of the building, number of beds, occupancy rate of beds, kind and amount of supplies and equipments and the type of services provided to the patients.

The distribution of the personnel in the various departments is usually as follows:

Department - Administrator and general. - Dietary. - Housing. - Professional care. - Others.

Percent of Personnel 10% 12% 14% 57% 7%

The proportion of full time and part time workers are usually ranged from 10-20% for part time employees.

8-Compensation & Costs: The production of the hospital is usually effective if wage and salary administration approved in a coordinated manner by all hospitals. This mean review, study and evaluation of wage and salary and merit rate.

9-Evaluation: Continuous evaluation of every facet of the personnel program included in the previously mentioned eight sections to ensure competency, stability and high quality of patient care. Hospitals with good personnel program will have fewer personnel problems and will often get the quantity and quality of personnel it recruits, trains and utilizes properly.