organizational structure and design - a case for a mid-sized hospital
TRANSCRIPT
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Malar Hospital Organization Structure & Design
Prepared By: Group 5DoMS, IIT Madras, Batch of 2010
Cotnact: [email protected]
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Introduction to Fortis – Malar Hospital Subsidiary of Fortis Healthcare Ltd Fortis Healthcare, paid Rs 34.6 crores for a 48.8
percent stake in Malar Hospital in 2008
FORTIS HEALTHCARE LIMITED:
Leading healthcare group in India matching international standard
First hospital opened in “1999” at Mohali Hallmark is “patient-centricity” approach At present it has 22 hospitals and 2,500 beds.
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Malar Hospital Located in South Chennai 5 super specialty centers setup
• MALAR Heart Institute (MHI-Commencing shortly at Malar)
• MALAR Institute for Renal Sciences (MIRS) • MALAR Specialty Centre for Joints (MSCJ) • MALAR Health care for OBG and
Gynecology • MALAR Health care Centre for Diabetes
(MHCD)
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Organizational Life Cycle
Formation
Growth
Maturity
Decline
MalarHospital
F & C stage•Formalization of rules
•Stable structure
•Emphasis on efficiency
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Effectiveness
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Productivity and profit Net Profit for the year ended 31th March 2008
was Rs 77.56 Lac Profitability ratio is a healthy 26 percent Occupancy rate 70-80 %
Quality Wealth of medical expertise with the finest
talent amongst doctors, nurses, technicians and management professionals
Utilization of environment Located in best of residential locations
Malar Hospital - Effectiveness
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Evaluation by external entities Financial audits are conducted every year by
external auditors ISO 9001:2000 certified by International
Certification Services Limited
Emphasis on Training and Development New joiners go through an initial training
program Fortis training centers are also used
Participation Community outreach programs for senior
citizens named “Arokya”, Kids & Teens
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Applying strategic – constituencies approach Shareholders: Profit margins of 26 percent Doctors and Administrative Staff:
Competitive remuneration, Learning opportunities
Patients: Multi-specialty, Quality Service Community: Various community outreach
programs Government: Transparent in operations
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Competing Values Approach
Flexibility
OrganizationPeople
Control 905/03/23
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Structure
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Malar Hospital - Structure Structure can be analyzed on following
dimensions Level of complexity Centralization Formalization
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Complexity Horizontal Differentiation
37 Medical departments covering the entire breadth of medical specialities
6 other departments (HR, Finance, Marketing and Sales, Materials, Engineering and Nursing)
Social Specialization – Doctors Functional Specialization – Nurses, Technicians
Vertical differentiation 3 levels of Hierarchy
1. Zonal Director2. Head of Departments of all 43 departments3. Teams under each department
Wide span of control
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Formalization Standard operating procedures (SOP) High level of standardization for
administrative tasks Low level formalization for Doctors Subcontracts are highly formalized Recruitment process is highly formalized
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Doctor writes ARF to initiate the process
Patient registers the ARF at the reception
Admission confirmed after two forms filled
Patient/Family counseled about the estimated expenditure/ hospital rules & guidelines
Patient informed about interim bills on a daily basis. Bills settlement at the time of discharge
The doctor/nurse hands over the signed discharge summary and other relevant
documents.
Patient discharged after paying the bills in cash, debit/credit card or demand draft
1. Consent form for admission
2. Cashless facility form for insured patients
Patient expected to bring previous consultation & investigation records
Bills prepared at billing office (Admin)
Patient Cycle at Malar – A formalized procedure
Treatment carried out. Follows the consulting cycle (next slide)
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DMO allotted a patient, based on availability
DMO provides initial consultation. Refers to a specialist unit, if needed
Nurses divided into geographical zones, but are flexible on availability
Observations by DMO/subsequent departments are recorded on a chart
Diagnosis and treatment under a nurse, DMO/visiting consultant
Nurse/DMO confirms completion of treatment, based on expertise
Divided floor-wise & then department wise
These include diagnosis, tests, subjective tests, objective & subjective comments
Consultation Cycle at Malar – A formalized procedure
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Centralization All departments are controlled by Head of
Departments Heads report to Zonal Director Autonomy for each individual in the
organization is limited
Financially – Highly Centralized Functionally – Moderately Decentralized
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Size
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Malar Hospital - Size Medium-sized organization No apparent change in size, after Fortis
deal 37 departments 250-bed facility 256 full-time staff Workforce divided into department heads
and teams
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2 – MR co-ordination2- Marketing initiatives
NursesWard BoysTrainees
67 visiting consultants31 DMOs
External Contractors
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Impact on Structure Medium-sized but multi-specialty hospital Low Vertical but High Horizontal complexity Moderately formalized No direct impact on centralization
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Strategy
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External Threats and Strategy ImplementedExternal factors Strategy
Increasing cost of funds Cost effective business model
Availability of funds from Financial institutions
Focus on improvement in revenues, improvement of occupancy rate
Stiff competition from other playersAddition of departments, quality health care, improvement in infrastructure facilities, focus on high end health care services
Unexpected eventualities Improvement in infrastructure and increase in buffer capacity
Change in regulatory framework Constant interaction with the market
Changes in parent company Company will try to increase its own brand value
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Different types of strategies
Corporate strategy Brand Extension by opening medical
college & school
Business strategy Focus on improvement in revenues and
cash-flow by enhancing neuro and ortho departments
Enhancing the facilities in Cardiac department
Focus on high end health care services (Minimal Invasive Surgery)
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Functional strategy Use of strong HIS backbone, and PACS
technology to safely transmit patient information Use of HL7 and DICOM standards for
telemedicine purpose Self-defining and self-expiring passwords for
maximum privacy
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Strategy - Structure Relationship (Chandler’s Theory)
Time
Multi specialty
Structure Simple Functional
Divisional
Low High
t t + 2 t + 1
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Miles and Snow’s Strategy Theory
Strategytype
Description Structure
Analyzer • High level of standardization, routinization and mechanization for efficiency• Also flexible in reacting to increased competition and changes in the market
• High Formalization
• Moderately centralized control
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Porter’s Competitive Strategy Differentiation focus strategy
Focused on upper middle class citizens of Chennai
Differentiated itself by emphasizing on high technology, patient-centric centers, high end health care service
Impact on structure Moderately flexible structure Moderate complexity in terms of hierarchy Moderate formalization at higher level Highly formalized, moderately decentralized
decision making at operational level2805/03/23
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Industry analyses
“C” category• Highly structured and standardized• Centralized structure
Capital requirements
Product-innovation rates
High
High
Low
low
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Environment
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Specific Environment
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Environmental Uncertainty
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Burns & Stalker Model
Characteristic Structure
Rigid Task Definition Mechanistic
Lateral Communication Organic
High Formalization Mechanistic
Expertise Influence Organic
Centralized Control Mechanistic 3305/03/23
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Lawrence and Lorsch Theory Fair collaboration exists Collaboration between the departments
defines the quality of service to the customer
Internal environment varies between departments
matches differentiation and integration activities
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Environment – Structure Relationship
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Technology
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Technology @ Malar Hospital Technology is applicable at all stages:
Input, Conversion and Output Inputs: Skills and Expertise of Personnel,
Softwares like HIS Conversion: Medical equipment and techniques
and Work procedures Output: Infrastructure (Ambulance etc), Periodic
checkups
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Perrow’s Model Few exceptions Many exceptions
Ill Defined
Task Variability
Problem Analyzability
CRAFTCRAFT NON-ROUTINENON-ROUTINE
ENGINEERINGENGINEERINGROUTINEROUTINE
Well Defined
Malar Hospital
Structural Predictions
Low on formalization
High on centralization
Moderately wide on span of control3805/03/23
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Thompson’s Model
Transformational Process
Resources A B C D E
Feedback
Output
Inputs
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Intensive Technology Model Form of task interdependence
Reciprocal
Main type of coordination Mutual adjustment
Strategy for reducing uncertainty Specialism and diversity of task activities
Cost of coordination High
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Structural Predictions High Complexity ---37 medical departments leads to high horizontal differentiation
Low Formalization ---Low formalization in the way doctors’ work
Moderate Decentralization ---Financially – Highly Centralized
---Functionally – Moderately Decentralized
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Culture
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Value system Confrontation
Facing, rather than shying away from, problems
Authenticity Congruence between claims and actions
Pro activity Take initiative, pre-plan, take preventive action
Autonomy Use and give freedom to plan and act in one’s
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Collaboration Give and ask for help to and from others
Experimentation Use and encourage innovative approaches to
solve problems
Direction Clear objectives and performance expectations
Management support Managers provide clear communication,
assistance, and support to subordinates
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Control Number of rules and regulations, amount of direct
supervision used to control employee behaviour
Trust Maintain confidentiality of information, integrity in
dealings
Conflict Tolerance Employees are encouraged to air conflicts and
criticisms openly
Reward System Reward allocations are based on employee
performance
Forgiving Nature
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Major Culture changes at Malar Hospital on its inception was positioned as
an elite hospital Changed its positioning as it realised the
acute need for quality health care in the poorer sections of the society
In 2008, Malar hospital was taken over by Fortis group Major decisions were taken by the owning
family and now the board of directors have taken the place.
More patient friendly than before. The look and feel of the hospital underwent a
major change 4605/03/23
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Thank you
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