The Doctor Who Treats Hospitals!
By Abhijeet Pendharkar (Based on Interview with Dr. Dhananjay Kelkar by Dhananjay Gokhale) | For DVDs write to gita@dgonline.in
Dr. Dhananjay Kelkar is not only a cancer surgeon, but also specialises in treating administratively ill hospitals. What follows is a case history of various administrative & managerial ailments of some of the medical institutions he has treated so far.
Case#1 :
Patient: Sanjeevan Hospital
Case History: Somewhere in 1993, Dr. Kelkar chose social medicine as profession & founded Dnyan Prabodhini Medial Trust with an objective of reviving sick hospitals. Sanjeevan was one of them.
Problem Description: Sanjeevan was in bad shape because about 70% people in the locality did not even know this hospital existed. Dr. Kelkar needed good doctors on his staff, but he was not in a position to promise them anything on monetary front.
Diagnosis: S.S.M.D. [Severe Stakeholders Management Disorder] - too many unaware stakeholders (patients)on one side & prospective staff (doctors) suffering from Vitamin-M (motivation) deficiency on the other side.
Treatment: Expert Judgment Supplement in form of consultation with a management expert. Followed by regular doses of Vitamin-M (motivation) such as promising only good teams (& not money), transparency in financial accounts, decisions by group not dictatorship.
Case#2 :
Patient: Deenanath Mangeshkar Hospital
Case History: In 1993, Dr. Kelkar approached Mangeshkar family & showed interest in managing Deenanath Hospital. Mangeshkar family declined due to lack of administrative experience on his part. Later in 1999, it was Mangeshkar family's turn to approach him & appoint him as the 'Medical Director'of Deenanath Hospital. That time, Deenanath had many problems. Dr. Kelkar took top-down approach & started addressing problems with organizational objectives first.
Problem Description: There were too many conflicting objectives (e.g.self-sufficiency, good medicine, excellence or rural service) at the organization level to choose from.
Diagnosis: A.P.C.D. [Acute Project Charter Deficiency]
Treatment: Standard Initiating Procedure called Develop Project Charter. Prescribed 'Rational Ethical Medical Practice' as the primary organizational objective!
Case#3 :
Patient: Deenanath Mangeshkar Hospital
Case History: Prescribed medicine 'Rational Ethical Medical Practice' was in short supply. It was observed that the more successful doctors became, more were the chances of they losing rationality. Then there was this question of pharmaceutical sponsorship (doctors favouring particular pharmaceutical companies by accepting gifts).
Problem Description: 'Rational Ethical Medical Practice' solely & ultimately depended on character of staff. And hence selecting the right people became a critical factor in fulfilling organizational objective.
Diagnosis: C.E.P.C. [Code of Ethics & Professional Conduct] Allergy
Treatment: A thorough scrutiny of the character of every potential candidate by going to the extent of investigating his / her school records (including 10th standard marks,) to determine whether the person was a good student or bad.
Case#4 :
Patient: Deenanath Mangeshkar Hospital
Case History: Deenanath was too big a hospital & it had legacy of problems. The hospital land was gifted to Mangeshkar family but without paperwork. The land was under reservation for the economically weak. There was slum on the land. It took permissions from 53 departments & almost 11 months to lift all reservations. Three Chief Ministers changed in between.
Problem Description: Dr. Kelkar lost lot of his medical practice. Because most of the time he was required to be on the site (Deenanath Hospital construction site). This was unlike his past experience with Sanjeevan wheredoctors were able to also manage administrative work. So what worked in Sanjeevan did not work on bigger scale in Deenanath.
Diagnosis: O.P.P.O.S. (Operational Paralysis Induced by Poor Organizational Structure)
Treatment: Injection of Matrix Type Organization Structure by appointment of dedicated managerial staff for administrative activities.
Case#5 :
Patient: Deenanath Mangeshkar Hospital
Case History: Changing organization structure from Functional to Matrix had its advantages. But it had its down side too.
Problem Description: Down side was that it created hierarchy. Managers started thinking their job was to say no. Administration became a bottleneck in progress. Just like our government.
Diagnosis: S.E.C.O.S. (Side Effects of Change in Organizational Structure)
Treatment: Autonomy Therapy - structure with no structure that runs on its own; Departments look after themselves; If there is a crisis, they come to superiors; Superiors act like advisors/helpers than managers;
Case#6 :
Patient: Deenanath Mangeshkar Hospital
Case History: Deenanath Hospital was a Mangeshkar Family initiative undertaken as a tribute to Master Deenanath Mangeshkar. Obviously they had envisaged a big hospital & not just a hospital.
Problem Description: This ambitious project needed lots of funds to sustain itself (at least till becoming self-sufficient).
Diagnosis: O.C. (Obsession to Charity)
Treatment: Beg-Borrow-Steal-Ask (like arranging Lata Mangeshkar Musical Programs, arranging Cricket Matches)
Appendix I: Pills of Wisdom :
Following are some pills of wisdom gathered from the 2 hours interview:
