To investigate the impact of managing private hospital in Hong Kong by professional business managers instead of medical doctors

CHAPTER 1 - INTRODUCTION

1.0 Introduction to Healthcare Industry and Role of Medical Professional

The elevated expectations for improved performance and responsibility in healthcare industry has been rising with the improved standards of medical care and has lead to greater expectations from responsible authorities to policy office (Merry, 1993; Porter & Teisberg, 2007; Singer & Shortell, 2011). These requirements and expectations have lead to increased pressure on the healthcare infrastructure and the governments to make processes and services more customer oriented by increasing systemic focus on business performance and accountability that gradually enhances patient care and other healthcare expectations. One critical component of such changes and improvement strategy is to have a leadership that can effectively understand and drive these associated systemic processes and requires the person to have an in depth understanding of the impact and influence that these changes will bring on over-all performance and hence the hospital business. To be specific, the physician lead strategy is important for the effectiveness in engagement of critical medical processes and systems that can bring about improvement in aligning healthcare provider’s services and patient’s requirement. This in particular, is achieved by engaging doctors and other healthcare profession in both, setting the course for systemic change and making sure that an optimal level of execution is done for the desired systemic changes (Darzi, 2008; Department of Health, 2010; Devlin & Appleby, 2010; Dwyer, 2010; Ham et al., 2010; Singer & Shortell, 2011).

Traditionally, medical professionals are not linked to management skills and respective performance for the hospital services. However with the increase in commercialization of healthcare services many have adapted to managerial standards and have opted for various form of training to gain ground with the management professionals. However, it has been observed that even in these trainings specific emphasis has been given to clinical autonomy and professional allegiance over organizational and system values (Gillam, 2011). This raises question as to what are the performance parameters for a medical practitioner, particularly when they chose to deliver managerial responsibilities. Physician leadership are seen as an important partner in the realm of clinical business matters, as a source to governmental management and decision-making bodies with a command and control system. For many the physician managers and their engagement is a driving force for effective healthcare services. This is evident from recent studies where many of European and Western countries have assigned the leadership role to scholars or specialist instead of a management professional. Now, healthcare leadership and engagement are considered to be critical at all levels ranging from individuals to teams, organizations and systems.

1.1 Healthcare Specialist, Evolving Role and Influencing Factors

The entire study revolves around the effectiveness of various professional backgrounds in terms of bringing business results for healthcare administration or to be specific hospital services. The evolving understanding of healthcare professionals and management aspects like leadership and business engagement makes it even difficult to evaluate and quantify as to who is better when the specific purpose of business progress is to be achieved. However, as per Noordegraaf (2011), when a broader view of the concept of engagement and leadership is evaluated in context to physicians for healthcare system improvement, the conventional contrast between professional and organizational differences are no more valid for contemporary medical professionals. However, there are multiple other factors that have provided the medical professionals including others in the industry for developing organizational capabilities and higher engagement level that influences organizational performance. For the case of medical services and to be precise the medicine function, Noordegraaf (2011) has provided multiple examples of increasing complexities for medical care that may range from mental illness to other chronic physical conditions and has been pushing healthcare professionals to cross-over the confined line of either being a healthcare specialist or just management professional, making them develop organizational skills that support their skill and business both.

Based on studies in progression with above findings, what we observe today is emergence of an organized profession in the medical services domain. In this case medical organizations are no longer perceived from the perspective of business constrains and a balance is maintained between the relationship of the organization and the professional. What exactly does this balance means to the healthcare industry and how does it make sense for the level of quality that a specialist brings to medical services compared to a management professional is the subject of discussion. Despite these changes in perception and response to increasing healthcare requirement and services level, we understand from various studies that healthcare systems still struggle for increased physician engagement when it comes to organizational and structural issues. A way to understand this gap is to focus on how physicians contribute to healthcare support and business leadership, which would mean to concentrate on two aspect of this relation a) the engagement between physician and organization and b) the type of leadership a specialist or physician can provide to an organization. As per the role of a physician, we imagine engagement and leadership role as different constructs, which are still complementary and together they increase physician involvement with organization. As per studies on organizational behavior, engagement in a role refers to psychological connect or focus on activities & may be important for effective role performance‖ (Dickson, 2012; Rothbard, 2001: 656).

1.2 Overview of Hong Kong Healthcare Industry and Hospital Services

The core of the study is to have an understanding of various professional background, motivation, influence and qualification that has been impacting the healthcare industry for Hong Kong region. To be more targeted the work studies the effectiveness of doctors vs. management professionals in driving hospital performance and so business viability. To create an understanding of these aspects, it is important that we understand and evaluate the current condition and growth stage of Hong Kong medical industry and understand as to how the above mentioned factors are associated with individual performance making a doctor better than the management professional or vice versa.

To understand the current health industry condition and develop perspective the report studies various aspects and identified few key points about various medical industry initiative, achievement and milestones. With high-quality private hospitals, clinics and trained medical practitioners and health research facilities, Hong Kong has already well established itself as a global center for healthcare services.

1.2.1 Understanding new tends and events for overall Healthcare Sector

The region is also poised to be a global leader in many branches of high-end medical research. Below are some key achievement as per “The Hong Kong Association” that can help develop understanding about the current industry competency and effectiveness:

  • As per the association their researchers have achieved breakthroughs results in adult-to-adult live donor liver transplantation with non-invasive prenatal diagnosis and use of oral arsenic trioxide to treat leukemia.
  • The association highlights thatthe Times Higher Education World University Rankings 2011-12 Asia’s second top university and 34th rate The University of Hong Kong in the world for clinical, pre-clinical and health-related subjects.
  • Further the association claims that the public health laboratory services of the Centre for Health Protection has been nominated by the WHO (World Health Organization) as one of the global reference based laboratories that provides services for Severe Acute Respiratory Syndrome (SARS) and influenza A H5, a supranational reference laboratory for tuberculosis, and a regional reference laboratory (Western Pacific Region) for measles.
  • The association claims that the Hong Kong is poised to become center for biotechnology research, driven by China’s leading company, Beijing Genomics Institute, basing its main laboratory, BGI (Hong Kong), in the city.

1.3 Significance of the study

The significance of this study is in creating an understanding for effectiveness of professional background in dealing with medical services. Based on earlier literature and an awareness section for the region of Hong Kong, we can be sure that there has been significant movement in the direction of academic and research oriented work. However, whether this level scholar achievement contributes to hospital services and make a specialist better than the general management professional is yet to be understood. To understand the relationship with hospital performance we have to understand the organizational behavior and motivation engagement that plays a critical role in making a professional more effective in dealing with organizational challenges and requirement. As per research conducted by Dickson (2012) engagement for a business role refers to a person’s psychological attendance in or focuses on role actions and can be an imperative component for an effective business performance‖ (Dickson, 2012; Rothbard, 2001). Dickson (2012) further indicates that other than the investment somebody puts in the role, the engagement between hospital environment and the professional plays a critical role in deciding the performance level (Dickson, 2012; Kaissi, 2012; Spurgeon, Mazelan, & Barwell, 2011). There are other scholars who identified other dimensions to the above condition, as per Rothbard (2001) the engagement level has a significance bearing for identification and commitment that a professional reflects in a job. In this case identification is the recognition or alignment that a doctor or hospital professional achieves by being associated with a role. On the other hand commitment is the level of devotion that professional reflects basis the identification he/she receives from the role.

It is important that performance and influence of a professional background is deeply affected by the engagement and commitment people show towards their profession. In this study the core is understanding this relation and identifying how these factors are reflected by various performance components giving a comprehensive understanding of who is better for hospital management, a doctor or a management professional. For this report, we will look at various components and strategies that may indicate or stimulate the engagement level of physicians as individual professionals and so their performance contributing to entire business. Collectively business roles that go further than their usual clinical responsibilities for individual patients in order to support health system improvement there is an increased demand and motivation that is indeed a contributing factors and is mostly driven by the background of the professional. This study has a significant importance as it is not a conventional approach at understanding the role and motivation of doctor or professionals but rather it is a participative assignment that takes people perspective into consideration to evaluate hospital management performance.

1.4 Overall Research Aim

The aim of this research is to identify and evaluate various factors that establish professional background as a core competency for success at being a hospital administrator. At the center if the assignment is the question of who is a better manager a doctor/specialist or a management professional and what makes them better than their counterparts. Since the quality or effectiveness of services provided by these doctors or management professionals is more linked to their individual motivation, engagement and commitment the work gets complicated as all these are intrinsic factors and cannot be evaluated simply by asking questions. The key area then would be to identify performing hospitals and get feedback from hospital services providers and users to interpret the effectiveness and source factors that they assume to be the contributor for services.

The current research aims at understanding this relationship between service provider and user understanding of hospitals leader’s capability and link it back with their qualification and other motivators. To perform this study, the work approaches the assignment by identifying various performance criteria and how the service provider group (middle management and execution staff) and users understand the contribution made by the leadership. Further the research would be used to create quantitative understanding of various demographic factors and will attempt to find trends that may reflect understanding of business performance other than financial results. The hospital and its technical staff would more in terms of effectiveness of services and so more effectiveness of solutions offer these performance factors.

1.6 Research Objectives

As per specific learning and objective of the research the assignment would be based on quantitative analysis of data gathered in form of survey and reports on various effectiveness parameters. The type of research is exploratory for secondary data collection and descriptive for primary data collection with quantitative survey approach. Following are the key aspects that the research would try to understand by means of the survey:

  • Identifying key performance indicators for hospital services based on literature review for industry and survey analysis.
  • Developing effective constructs for understanding performance and its relation to key performance indicators.
  • Evaluating management professional’s performance in hospital services with help of survey and data analysis.

1.7 Limitation

The work is highly hypothetical in nature as it is trying to establish effectiveness of leaders for hospital performance and services. The fact that the report considers their background as the key driving force behind the success or failure it makes it even more complicated. Further, the report is based on survey and inputs from various users and services providers who use leadership provided by hospital management. This makes the inputs provided as highly individual interpretation of same service and hold great deal of inconsistency in terms of calibration of output.

CHAPTER 2 - LITERATURE REVIEW AND CONCEPTUAL DEVELOPMENT

2.0 Literature Indicating Relation to Educational Background for Healthcare Services

For the region of Hong Kong or Asian countries, data supporting or indicating healthcare industry preferences between a management professional and a physician are very less or are inconclusive. However, there have been serious studies and market research on the healthcare industry practices regarding the choice of leadership for governing positions. For creating a contextual learning and understanding of various industry practices, the research makes use of studies conducted in western and European countries. As per studies conducted by Horton (2008) historic preferences were observed for doctors over management professional for leading various function and hospital administration. However, that trend has been on decline for the referred countries of USA and Europe, studies for these countries reflect that most of the hospitals prefer leaders (CEO’s) who are non-physician (Horton, 2008; Falcone and Satiani, 2008; Halligan, 2008; Darzi, 2009).

As per Gunderman and Kanter (2009) who conducted studies on over 6500 hospital a mere count of 3.5% were found to be lead by physicians. There have been further supportive studies that indicate that a leadership of non-physician background can provide improved hospital business performance and patient care services (Horton, 2008; Halligan, 2008; Falcone and Satiani, 2008; Darzi, 2009; Candace and Giordana, 2009; 2009; Stoller, 2009; Dwyer, 2010). However, for the region of the UK there have been recent moves that indicate that healthcare industry is more inclined towards scholars or physicians when it comes to research driven initiatives. The United Kingdom in the line has established five scholastic health sciences institutes (AHSC’s) with an aim of connecting medicine practices with research and hope that such initiative will make research transition to medical practices an easy job (Smith, 2009). This however would indicate a rather interesting aspect that the industry has a preferential approach as per the overall aim of the organization. A research institution is more of non-profit making body as compared to a hospital and this perhaps can explain why physicians were chosen to lead the initiative. There are other supportive indicators that reflect an organizational influence on the selection, as per Darzi and Horton (2008) Physician leadership was preferred and prioritized for National Health Services review (NHS, 2008). There are significant indicators that the healthcare industry does prefer physicians for healthcare services, however, some studies and cases indicate that the choice of selecting management professional for leading hospitals is also declining and the proof can be found in new courses and training structures, where the institutions have started training doctors for management skills too.

As per Berkowitz and Bailin (2007), some of the western medical facilities, for example the Cleveland and Mayo clinics have exclusively adapted to leadership training and management education for medical degrees (Fairchild, Benjamin, Gifford and Hout, 2004; Stern and Papadakis, 2006; Baker and Hafferty, 2007); these have support from new and revised literature that focuses on key management competencies that are required for a physician to deliver management services (Chaudry, Jain, McKenzie, and Schwartz, 2008; Stoller, 2008). However, it should be noted that at present there are no empirical studies that could conclude with conviction that there is a relationship between hospital performance and educational background of the leader/management (Dwyer, 2010). It is therefore challenging to establish clear relationship between the leadership and hospital performance output. This paper is an attempt at understanding the performance factors and the influence of professional background on overall hospital result. The paper uses feedback from various receivers or users who engage with leadership directly, as the input for the study and evaluates the effectiveness likelihood based on that feedback.

2.1 Studies Identifying Business Performance Parameters for Healthcare Services

Understanding hospital quality and people preference can be highly competitive and challenging, this is since no single medium of evaluating hospital performance can be said to be comprehensive. However, for the purpose of this report the literature considered similar industry and evaluated quality rating of hospitals basis the US News and World Report (USNWR). The USNWR provides ranking for hospitals keeping the consumers aware and informed about where they can go for various type of treatments. The purpose here is to understand the quality of listed hospitals and the leadership. As per the USNWR ranking (2009), a total of 4861 healthcare facilities were evaluated across 16 different specialties. Out of these sixteen specialties 12 included Cancer, Diabetes and Endocrine Disorders, Digestive Disorders, Ear, Nose and Throat, Geriatric Care, Gynaecology, Heart and Heart Surgery, Kidney Disorders, Neurology and Neurosurgery, Orthopedics, Respiratory Disorders, and Urology. The other four were Ophthalmology, Psychiatry, Rehabilitation, and Rheumatology. For the purpose of this evaluation the first set of criteria for the hospital was to be part of either the Council of Teaching Hospitals (COTH), or be affiliated with a medical school (American Medical Association or American Osteopathic Association), with a least of 200 hospital beds facility including proper staff assignment. Further the criteria included that the identified hospital should have four of eight identified important technologies (for example, a cardiac intensive care unit (ICU), or endoscopic ultrasound). This further required the identified hospitals to have least of 100 beds set up and staffed. For the second criteria for the process stated the hospitals to must demonstrate that they can effectively treat and discharge an identified number of complex cases in any given specialty. From the 4,861 medical facilities initially assessed by USNWR in 2009, 1,859 hospitals were deemed eligible for analysis in at least one of the IHQ-driven specialties. This study set’s the background for understanding the relation between management effectiveness, qualification and performance of the health institute.