Are doctors ideal candidates to run hospitals?

PETALING JAYA: Who is to be blamed for expensive healthcare? Medical practitioners are pointing their fingers at the management of the hospitals as they are running them like any other businesses.

Those favouring healthcare for profit claim that the increased role of entrepreneurs and competition in the delivery of healthcare could result in a more efficient and effective system.

While for others, the pursuit of profit is unethical as it contravenes the Hippocratic Oath, which all medical practitioners had to swear by, that they would act in the best interest of their patients.

So, who are the best people to run a hospital? Should they be a team of doctors, those with business administration degree or seasoned businessmen?

According to the Malaysian Medical Association’s president Dr NKS Tharmaseelan, it is best if the doctors trained in hospital administration manage the hospitals.

“Of course, not every doctor could manage a hospital. But, doctors who have undergone a course in hospital administration would be the best option in managing hospitals,” he said.

He said the patients would be more at ease knowing that the hospital they were seeking treatment from was being managed by medical practitioners rather than an MBA or a business professional.

“A medical practitioner would be able to differentiate what is urgent and what is not when it comes to treating patients. Thus, it would be an added advantage for the medical practitioner to manage the hospital if he is trained in administration,” said Tharmaseelan.

According to INS Specialist Centre chief executive officer Tejvinder Singh Randhawa, about 70% of tprivate hospitals in Malaysia were managed by those without medical qualification.

“The conformist wisdom is that doctors should focus on patient-care while managers with a business or administrative background are better suited to running the day-to-day operations of a hospital,” he said.

He said the best way to manage a hospital was not through direct marketing but through quality service and patient care.

“A leader who provides optimal working conditions for the core workers is likely to create a more efficient organisation,” he said.

Disadvantage

A hospital was not only a bustling treatment centre for patients but also a complex, interdisciplinary workplace for healthcare personnel. Despite that, he added that only one person was responsible for the running of this symbiotic infrastructure.

On the disadvantage of having a medical practitioner managing a hospital, Randhawa said many public and private hospitals run by doctors often had the management favouring a certain discipline, resulting in its flourishing while creating a disharmonious working atmosphere for the doctors specialising in other disciplines and nurses.

“In view of that, it is crucial that we have non-medical practitioner to monitor the finances and to supervise the personnel to ensure that each ward strictly abides by the the distinct set of policies and procedures to ensure no regulations or laws are broken as well as to explore the advances in technology, which the hospital could adopt to better serve its patients,” he said.

The CEO also believed that in a multi-disciplined hospital, all medical consultants must be given a platform to achieve clinical excellence, and that resources must be distributed equally to enable medical consultants to thrive.

A private healthcare group operations manager, Sanggat Singh, concurred with Randhawa that running a hospital is similar to managing any other businesses.

While the medical practitioners managed the clinical aspect of the hospital, Sanggat said the human resource team managed the staffing while the others such as the marketing team and general manager managed the business aspect and operations of the organisation.

“If the medical practitioners are not happy with the way it is managed, they could bring it up with the management or use relevant channels in communicating their grievances as there are many medical bodies in Malaysia to do so,” he said.

Sanggat also said business professionals know best on soliciting business for the hospitals, similar to medical practitioners knowing what was best for their patients.

Meanwhile, Prabu Ramanathan, a physiotherapist at a medical centre did not agree with the earlier view as he opined that medical practitioners should manage hospitals because only they know what was best for the entity.

“The management usually focuses on driving customer volume for the hospital, while the medical practitioners strive for quality healthcare,” said Ramanathan.

Through his experience in dealing with patients, he said medical practitioners knew the technical aspects of the field and would understand the role of the clinical team and thus able to provide a conducive work environment for the team.

He, however, said medical practitioners and business managers could extend the best healthcare to the patients if they collaborated well.

“Doctors could be actively involved in the decision-making process as it is right for them to do so since they are well trained in the medical field,” he added.

Pros and cons

Supporting Ramanathan’s views, an obstetrics and gynaecology consultant who insisted on remaining anonymous said hospitals should be managed by medical practitioners if not, the management team should at least posses some medical knowledge.

“The management of some hospitals do decide on the drugs to be dispensed and best medical procedures to be carried out on the patients,” he said.

However, he reiterated that input from the doctors treating the patients should be taken into consideration since he was personally attending to the patients.

“Drawing conclusions upon the advice of pharmaceutical companies may not be the best solution as the doctors would know the side-effect of certain drugs and if the patients are able to tolerate it or fatal to them,” he said.

He urged the management of private hospitals to balance the pros and cons of equipment and drugs purchased after considering the feedback of the medical practitioners.

“Why do we invest so much of time and money in obtaining our medical qualification when the non-medical administration team pays no heed to our advice?” he asked.

As for general surgeon Dr George Varughese, he believed that even if the hospitals were not managed by medical practitioners, there should be a balance in the decision-making.

“Doctors must have a role to play in patient care, procedures and drugs as they are the experts in the field. Even if the hospitals are managed by non-medical practitioners doctors could be actively involved by giving their medical opinion,” said Varughese.

He also gave a scenario where patients were likely to blame the medical practitioners for the high charges.

“Patients do not know that a bigger chunk or 70% of the medical payment received goes to the hospital with only the remaining to the medical practitioners. Hence, charges must be reasonable as patients are likely to blame the doctors for the high medical bill,” he said.

Varughese also suggested that a committee comprising medical practitioners and management to make decide on business management matters should be set up in all hospitals.