Medical Institutions | From Clipped Wings to Soaring High: Could We Have Done Better?

The Humble Petition for Reclaiming the Past Glory - Part I

What’s the worst pain you have experienced? For many past alumni, it is seeing their alma mater not doing well. Getting your wings clipped can be a deeply painful and emotional experience. This is because the institution holds personal and nostalgic significance to them.

Setting new goals can help you move forward and provide a sense of direction but as a health care quality professional with hindsight, we'd all do things differently. Could we have done better-? This question haunted me as I headed out the marriage hall door after discussing with three former professors the status of our medical institution with its glorious past and the challenges on its autonomous status.

An important caveat for readers to keep in mind is that it is hard --in empirical field studies, such as this one, to clearly separate out the impact of a poor (or good) conceptualization of autonomy from a poor (or good) implementation of autonomy measures, it was not possible for us during discussion to control for one or the other or eliminate confounding variables.

Moreover, in the absence of counterfactual evidence, it was not possible for us to assess what the outcome on autonomy would have been if the approach to autonomy had been different from its past managers.

What is an autonomous healthcare organization? I need a brainly genius to help me with this question. As you read my writeup, it seems to be a reflection on the past and current state of an institution, possibly a public service organization or a teaching school.

The question "could we have done better" indicates a sense of regret or uncertainty about past decisions and actions which lead to the current scenario. Institutional declines occur more abruptly than institutional improvements. It’s natural to have such thoughts when looking back at the history of any organization, once considered glorious but is currently facing challenges on status repositioning.

You need to identify the factors that led to the current situation and use that knowledge to make informed decisions for going forward. The effective leadership clearly defines a vision, values, and team norms or agreed-upon behaviors—the “why” of their organization—and make sure their teams know and buy into them, too.

Furthermore, engaging in professional discussions with past heads of institutions, faculty, and alumni can offer insights into the organization's history and what might have contributed to its current state. Learning from their experiences and incorporating their wisdom into the organization's strategy can be beneficial.

Remember that every organization goes through ups and downs, and it's how they respond to challenges that determines their future success. Since the early 1980s, public sector hospitals around the world have come under intense scrutiny in policy circles due to the bureaucratic complexity of these institutions, the heavy burden they impose on public funds, and the perceived difficulties in ensuring their efficient and effective functioning under centralized government control.

One policy option that has found particular favor with governments is the granting of greater autonomy to these public sector hospitals in running their operations. As a result, in many developed countries and in many developing ones “hospital autonomy” initiatives have been proposed as an integral part of a broader health sector reform process.

However, despite the implementation of hospital autonomy in several public sector hospitals around the world, relatively little research has been directed towards evaluating the experiences of these hospitals and assessing the overall merits and limitations of hospital autonomy as public policy.

What does it mean to take responsibility for your actions at work? Public administration is a field in which CEOs serve the community to advance the common good and achieve constructive change. Putting the patient first into the story of a decoupled hospital, the disempowerment has caused an upheaval among the medical fraternity saying that the snatching away of autonomy undermines the hospital’s identity and purpose and would affect its functioning.

I discourage politics on the functioning of medical institutions. Instead, my plea is for a review through reproachment purely on professional terms where the ultimate beneficiary of all exercise is patient first.

In this humble submission, I should be able to plead my case professionally on quality terms facing the tough questions on KPIs-key performance indicators, “how do we say your hospital is or was doing good?”

Putting the onus on healthcare leadership, anybody can be a manager not everyone can be a leader. Directors could become top-performing leaders by raising aspirations, re-strategizing early on, plan setting organizational culture towards mission, vision, core values, & team norms of the institution and resource allocation to meet moving priorities.

No one said heading a medical institution was easy, and it's definitely not for the faint of heart. Excellence requires bravery, vision, reframing the game, raise aspirations, and redraw team terms for success, operational strategy, to make big moves early and drive ambitious plans forward at the enterprise level.

Resource allocation takes the outside view needed most and where leaders cultivate an inclusive culture by allowing diverse voices to be heard not drowned out in nodding. How visionary leaders inspire action, perhaps the execution did not match expectations. The reality is that we all tend to get pulled in many directions, even noble ones, but can lose sight of “True North” until we are reminded of the primary purpose.

Accepting responsibility when things go wrong while giving away the credit when things go well, running headfirst in the fire when everyone else is running in the next direction.

Over the past few years, in specific power corridors, there has been indications of noticeable dissatisfaction towards organizational culture and in specific areas of concern, e.g., quality of academics, recruitments, financial handling raising a big question mark on strategic and operational planning of its past headmasters. No names, no blame, no shame many of these proved only managers, just completing their tenures.

When the house is not in order and the leader of the house pretends not to notice, or chooses not to deal with something, or willfully ignores the priorities of building strong futuristic healthcare organizations, or getting a formal, independent verification (accreditation) that a program or institution meets established quality standards and is competent to carry out specific administrative or executive decisions, the State authority usually intervenes takes either full or partial ownership.

It is my sincere hope that this feedback is taken in a constructive light, with the intention of improving organizational culture for the betterment of all stakeholders, including patients, students, staff, and the community at large.

I would like to emphasize my strong belief in the importance of institutional autonomy and its role in our society. It is with this belief in mind that I bring to your attention certain issues that might have been affecting the institution's effectiveness and efficiency. Undeniably, I understand that Government intervention is not a decision to be taken lightly, but it may have been necessary to ensure the institution's future viability and to safeguard the interests of those who depend on it.

May I ask, could we have done better?

(To be concluded: Part II Strategies for Overcoming Setbacks and Learning to Fly Again...)

(The author is alumnus of SKIMS, and an international expert on Healthcare policy planning, and reforms)

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