This work aims to provide information on management aspects primarily in a naval hospital center and the Principles of Hospital Administration by fields of Action. The proposals made here are of general application, adaptable and applicable to all types of medical establishments, regardless of their level of care.
During the professional development of the naval medic, there will come a time when you may be appointed as the Director or Assistant Chief Medical Officer of a Naval Medical Establishment.
This designation represents a change in his professional life, because although he may have previously held an administrative position, such as Head of External Consultation or Hospitalization, the Directorate of a hospital will require a greater effort, since in this case he must develop strategic skills in administrative and financial matters. The contemporary reality has forced the various public and private educational centers to design and offer not only courses, but also diplomas, specialties and masters in Administration of Health Institutions, since there is a lack of professionals dedicated to this field.
The responsibility that is acquired then is greater, since it must attend to aspects not only of a medical nature in a strict sense, but also to attend to aspects of a financial, administrative, maintenance, services, etc. nature with which it is not fully familiar. It should be noted that the financial aspect, in the case of a naval hospital, includes not only the handling of money, but also the handling of the goods that are acquired and the payment of the services necessary for the operation of the hospital. For this reason, we must understand that the financial aspect encompasses the entire hospital as a whole and the proper management of it depends largely on the operation of the entire Naval Medical Establishment.
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Before starting
World War II, England, June 1944. Days before launching Operation Overlord, popularly known as “D-day”, the commander of the British forces Bernard Law Montgomery (“Monty”) presented to General Dwight David Eisenhower (” Ike ”), Supreme Commander of the Allied Forces, a checklist of needs for the planned invasion of Normandy. Among the items listed was "a dentist's chair."
"Because a soldier with a toothache is useless for me to fight." Ike signed and authorized the petition.
Conceptual framework of Hospital Administration through Campos
Let's start by defining: what is administration? More than an exact science like Chemistry or Physics, Administration is neither a social science, nor an "administrative" science (we cannot define a concept with the same concept). It is something more special, based on fundamental principles and that uses creativity to the fullest, since there are no magic recipes to manage. It's an art. The art of Administration…
We can say that Administration is the “art of doing through others” (Reyes Ponce, 1984) through the application of a system that generates an Administrative Process that, based on a Planning; allows answering the questions of what, how, when, where, with what and for what? And that in turn, allow Organize and Integrate Human, Financial and Material Resources; so that a Directorate of the same can be carried out to achieve the objectives set, carrying out Control evaluations that allow analyzing the correct application of resources, efforts and activities, correcting deviations or generating strategic changes in the operation of the organization or business.
The Administration is not static, but changing before the new social, political and economic environments that surround the person or organizations. The "doing through others" responds to the need to achieve objectives to achieve goals. The Administrative Process is a concept that through the classic model of 5 elements: Planning, Organization, Integration, Direction (now called Leadership) and Control, will allow the person or organization to achieve its ends, seeking to do so efficiently, effectively and effectively.
Administrative Process and Hospital Administration
The knowledge of the administrative process and its interaction, allows to elucidate the Critical Chain in Hospital Administration, which is why it is convenient to think in set theory.
A set is the meeting of several components, which can be identical or similar to each other. When two or more sets are joined, they give rise to what we will call a substantive process, from which another series of sub-processes derive.
In this way, the conceptual framework of hospital administration will consist of the sum of the set of 4 fields of action: The Medical Care Field, the Administration Field, The Services Field, and the Maintenance Field.
Fields of Action in Hospital Administration
The Medical Care is the primary function of the hospital and can not give without good management, with optimal management of human and material resources, financial. Similarly, various services are required to complement medical care. Without adequate and timely maintenance of infrastructure, equipment and vehicles, medical care becomes difficult.
Defining the fields of Action.
These fields of action, in t Egran the general operation of a Naval Medical Hospital and its management is showing the effectiveness, efficiency, quality and capacity of the Directorate of the establishment.
The field of Medical Attention refers to the set of all aspects referred exclusively to patient care in the sense of outpatient consultation, hospitalization, rehabilitation and other specialties. That is, the ability to provide these services to users. This field is the reason for the hospital or clinic. In this sense, it is worth mentioning a principle that in a civil health institution may seem questionable, but it is not so for a naval medical establishment. That principle is that the primary function of a naval medical establishment is and will always be, first of all maintain the health and recovery of naval personnel, so that they are ready for combat. Let us remember that a naval hospital is a military institution. The Administration fieldrefers to the management of human, financial and material resources, with which the medical care service can be provided. In this field, financial management stands out. Financial management basically consists of two principles: obtaining funds and allocating resources. In this sense, obtaining funds from a naval hospital consists of the budget assigned to it by the Senior Officials Office, the General Directorate of Naval Health and the General Directorate of Administration. The allocation of resources is the destination that is given to these funds: purchase of goods and payment of services.
The Services field refers to all other services that contribute to the provision of medical care: laboratory services, Imaging, hematology, collection of Hazardous Biological Infectious Waste (RPBI) and common garbage, payment of fees to specialists as well as mail, electric power, water, gas, medicinal gases, internet, telephony and others. In other words, all kinds of services that directly or indirectly support the provision of medical care. The Maintenance field refers to the conservation of infrastructure and equipment: hydraulic, electrical, gas, structured cabling, roofing, masonry, biomedical equipment, computer equipment, office equipment, laboratory equipment, emergency plant, lights, vehicle fleet, etc..
Principles of Hospital Financial Administration
We will use the word principle as “the base // foundation of something” // rule of conduct ”(Larousse 2011).
Based on this definition, the principles of hospital financial management that are proposed are: Situational diagnosis, Information system evaluation, Determination of needs, application of the administrative process and Generation of the strategic vision.
Principles of Hospital Financial Administration
Principle of Situational Diagnosis.
The Director of a naval medical establishment must carry out an initial situational diagnosis when taking over a hospital. This will allow you to get to know the existing problem and start planning actions to solve them. Likewise, after the execution of the actions, carrying out a situational diagnosis allows you to evaluate the impact, effectiveness, efficiency and economy of the actions carried out.
Principle of Evaluation of the Information System and Transparency.
The existence of procedures that form a system that allows obtaining financial-accounting information that is reliable for decision-making must be evaluated. This reliability is based on the transparency of the use and use of the resources obtained and the destination to which they were applied.
Principle of Determination of Needs.
The real needs for the operation of the Hospital must be established, in order to be able to request in a timely manner the necessary human, financial or material resources, discriminating what is essential from what is not, considering the aphorism of “Not always what is required is what is what is needed ”.
Principle of Application of the Administrative Process.
The Administrative Process model that has been selected must be applied consistently, supervising that the various stages of the process and its components are carried out effectively and efficiently.
Principle of Generation of the Strategic Vision.
Once the situational diagnosis of the hospital and the execution of actions have been established, the result obtained must be evaluated to create a strategic vision that determines the plans and new objectives and goals to be achieved, the correction of deviations, the management indicators and the creation of new control and supervision procedures and / or mechanisms.
Creation of the strategic vision in the management of a naval hospital
The good administration of a Naval Hospital is not a matter of luck, but of the generation of adequate strategies to achieve the goals set and establish new objectives.
Each of the fields of action that have been mentioned, use the administrative process within its sphere of competence. In this way, each one of them is added individually to make the general set of the naval hospital.
Now, the creation of the strategic vision in the management of a hospital is not complete if it is only based on the development of an adequate administrative process. The last phase of this process is Control and with it it is analyzed and evaluated. To carry out these two actions, the analysis known as Strengths, Opportunities, Weaknesses and Threats commonly called (SWOT) is recommended.
As medical personnel and as administration professionals, we know that human beings frequently change their minds about something, depending on the personal moment in which they are. The SWOT analysis is basically conceptual, but the concepts are emitted by the human being, which is why it is recommended that the SWOT analysis be carried out between three elements of each field of action.
Ideally, these elements work as follows: The element with the highest hierarchy in the field in question coordinates the analysis, while a hierarchy element at the leadership level and another at the operation level are those who present the information from the various areas, focusing them by section and item. (Strengths, Opportunities, Weaknesses and Threats) In this way, more consistent, reliable and accurate information is obtained, with less propensity to present information with a tendency of the type “everything is good” or “everything is bad”, decreasing the quality of the information for the integration of the situational diagnosis and the subsequent decision-making and planning.
Let us suppose that it is necessary to analyze the hospitalization area: The hospitalization deputy director coordinates the information presented to him by the hospitalization manager and the weekend nursing supervisor. In this way, the information provided by the head of hospitalization regarding the residents (for example) and that presented by the nursing supervisor combines an operational level view regarding the Strengths and Weaknesses of the area, and together with the information that he has, can determine the opportunities and threats so that the basic SWOT proposal of the area is firmly established, so that in this way the analysis is as truthful as possible. The conjunction of these analyzes by fields of action helps in the elaboration of the Situational Diagnosis of the Naval Medical establishment.
This diagnosis allows the Director, together with the Deputy Director, to create the Strategic Vision that allows the Management of Human, Financial and Material Resources, so that deviations are corrected, needs are determined, new procedures are established and the continuity or cessation of programs is determined or plans, and determine new objectives and goals to be met by each field of action and the various areas that comprise it.
Strategic vision for the Management of a Hospital
Conclusions
The career of a naval doctor is not exempt from being able to be appointed director of a naval medical establishment, for which he must know the conceptual framework of hospital financial administration. The naval hospital administration requires a high degree of specialization to supervise the adequate management of human, financial and material resources, regardless of the type of level of care that the hospital or clinic grants to the users of the service.
It is undeniable that there is no prescription that is fixed or some instructional for the administration of a medical establishment, because depending on the geographical point of the Naval Command in which it is located, the needs and resources will be totally different from each other.
The fields of action are functional areas that allow the disaggregation of activities to facilitate hospital administration, based on their respective area of influence and due to their functioning and operation, applying the principles of hospital financial administration. The application of the principles of hospital financial administration allows to properly manage each field of action individually and the entire hospital in general, seeking efficiency, effectiveness and economy as well as transparency in the management of financial and material human resources.
This segregation of fields of action and the application of the principles, facilitates the operation of the hospital system and in the same way to the realization and integration of SWOT analysis for each field of action. When the SWOT analyzes of the four fields of action are added, they allow the director to establish a situational diagnosis of the establishment and thus move on to the stage of designing a strategic vision for the hospital's management and its consequent implementation.
The application of the model of fields of action and principles of hospital administration allows the Director of any Naval Medical Establishment, to more easily carry out his work as a strategist of the unit that he has been commissioned to lead. , avoiding falling into situations in which he can be accused of committing offenses to Naval Discipline or the General Law of Administrative Responsibilities of Public Servants with the consequent impact on his naval career.
Bibliography
Reyes Ponce Agustín, 1983, "Introduction to Administration", Mexico, Ed. Trillas.
Goldratt M, Eliyahu 2000, "La Meta" Mexico, Ed. Diana.
Goldratt M, Eliyahu 2002, "The Needle in the Haystack" Mexico, Ed. Diana.
Goldratt M, Eliyahu 2001, "It's Not Luck" United States, Ed. North River Express.
Goldratt M, Eliyahu 2004, “Cadena Critica” México, Ed. Granica.
Ramírez and Ramírez Carlos Daniel, 2000, Notes of the Diploma in Strategic Administration, Mexico, Private Library.
Ramírez and Ramírez Carlos Daniel, 2016, Notes from the Master in Administration of Health Institutions, Mexico, Private Library.
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principles-hospital-administration-fields-actionAbout the author.
Lieutenant Commander of the Naval Administration and Intendance Service, Bachelor of Public Accounting, Candidate for Master in Administration of Health Institutions, Head of the Department of Financial Resources for the Improvement of Public Management. In the civil environment, he has held various managerial and executive positions in hospitals, services and health systems. Complementary to his professional training, he is a Technician in Medical Emergencies by the Mexican Red Cross since 1986, and a Technician in Comprehensive Risk Management by CENAPRED and SEGOB. He is currently the General Coordinator of the Kindo Search and Rescue Team in Harsh Emergency Control Areas as a volunteer.
