When I started my medical practice in my hometown, Chitradurga, there were very few doctors and a minimal number of specialists. Patients had to go to other places for subspecialty consultations. Within two decades, the number of doctors has increased by 10 times, and we have the most super-speciality doctors. Besides, many corporate hospitals from nearby cities run weekly clinics. Now, small hospitals are under constant pressure to operate efficiently while maintaining high standards of care. Unlike large corporate hospitals, which often have complex hierarchies and bureaucratic processes, small hospitals have the advantage of being more nimble and adaptable. Small hospitals must streamline their organisational structure to fully capitalise on this advantage, promoting agility, facilitating quick decision-making, and enhancing overall operational efficiency. With his article, I am exploring how small hospitals can restructure their operations to thrive in a rapidly changing healthcare landscape with examples of the country’s best practices, which I have studied closely.

The Case for a Flat Organizational Structure

A key strategy for small hospitals is to adopt a flat organisational structure. In contrast to the layered management systems standard in larger hospitals, a flat structure minimises the number of hierarchical levels between frontline staff and senior management. This approach has several distinct advantages:

  • Improved Communication: In a flat organisation, communication flows more freely between all levels of staff. When frontline workers, such as nurses, doctors, and administrative staff, can easily communicate with decision-makers, issues can be addressed more promptly. For example, if a nurses notice a recurring issue with patient discharge procedures, they can directly approach the hospital manager with their concerns, allowing for quick resolution.
  • Faster Decision-Making: A flat structure enables quicker decision-making. Without multiple layers of approval, decisions can be made more swiftly, which is crucial in a healthcare setting where time is often of the essence. For instance, in an emergency situation where a new protocol needs to be implemented, a flat structure allows the hospital to respond rapidly without the delays caused by bureaucratic red tape
  • Rapid Responsiveness to Change: Healthcare is a dynamic field with constantly emerging new challenges and opportunities. A flat organisational structure allows small hospitals to respond more to these changes. Whether it’s adapting to new regulations, implementing the latest medical technologies, or responding to shifts in patient needs, a streamlined structure ensures that the hospital can pivot quickly and effectively.

Multidisciplinary Teams: Breaking Down Silos

Another crucial aspect of streamlining the structure in small hospitals is the creation of multidisciplinary teams. Traditional hospital structures often operate in silos, with each department functioning independently. While specialisation is necessary, it can also lead to inefficiencies, miscommunication, and fragmented patient care. Multidisciplinary teams offer a solution by bringing together professionals from various specialities to work collaboratively.

  • Integrated Care Delivery: Multidisciplinary teams enhance patient care by integrating various aspects of treatment. For example, in managing chronic diseases like diabetes, a team might include an endocrinologist, a dietitian, a nurse educator, and a physiotherapist. By working together, these professionals can develop a comprehensive care plan that addresses all aspects of the patient’s condition. This integrated approach improves patient outcomes and reduces the likelihood of errors and redundancies.
  • Efficient Use of Resources: By breaking down silos, small hospitals can make more efficient use of their resources. For instance, a multidisciplinary team managing a cancer patient might include oncologists, surgeons, radiologists, and social workers. By coordinating their efforts, they can avoid unnecessary tests and procedures, streamline treatment schedules, and ensure that the patient receives cohesive care. This enhances patient satisfaction and optimises resource utilisation, which is particularly important for small hospitals operating on tight budgets.
  • Examples in Practice: The benefits of multidisciplinary teams are evident in several small hospitals across India. For instance, the Karuna Hospital in Kerala has implemented an interdisciplinary approach to treating patients with complex medical conditions. By forming teams that include doctors, nurses, pharmacists, and physiotherapists, Karuna Hospital has significantly reduced patient recovery times and improved overall care outcomes. Similarly, Sneha Care Home, a small hospital in Bangalore specialising in pediatric care, has successfully used multidisciplinary teams to provide holistic treatment to children with chronic illnesses, resulting in higher patient satisfaction and better health outcomes.

Empowering Frontline Staff

Empowering frontline staff to take initiative and make decisions is essential in a streamlined organisational structure. Frontline workers are often the first to identify problems or inefficiencies in patient care processes. Small hospitals can improve their operations and patient outcomes by allowing them to implement changes.

  • Training and Development: Empowering staff begins with providing them with the necessary training and development opportunities. This might include workshops on leadership, decision-making, and quality improvement. For example, Life Care Hospital in Maharashtra offers regular training sessions for its nurses and administrative staff, focusing on patient communication, crisis management, and workflow optimisation. As a result, staff members are better equipped to handle challenges independently and contribute to the hospital’s efficiency.
  • Delegation of Authority: Another critical aspect of empowerment is delegating authority. Small hospitals should ensure that decisions are made as close to the point of care as possible. For instance, a ward nurse at Sunrise Hospital in Tamil Nadu can make decisions about patient discharge times based on their observations and assessments without needing approval from multiple supervisors. This delegation speeds up the discharge process and frees senior management to focus on strategic planning and other high-level tasks.
  • Recognition and Accountability: To maintain a motivated workforce, it’s essential to recognise and reward staff members for their contributions to the hospital’s success. Regular performance reviews, staff awards, and opportunities for career advancement can all help to create a culture of accountability and excellence. At Nirmala Hospital in Andhra Pradesh, staff members who propose and implement successful efficiency initiatives are publicly recognised and rewarded, fostering a sense of ownership and pride in their work.

Adapting Structure to Changing Needs

As small hospitals grow or face new challenges, their organisational structure may need to evolve. It’s essential to regularly assess the effectiveness of the current structure and make adjustments as needed.

  • Scalable Structures: As a small hospital expands its services or patient base, the organisational structure should be scalable. This might involve adding new roles or teams to address emerging needs while maintaining the agility and efficiency a flat structure provides. For example, a hospital that expands its surgical department might need to create a dedicated surgical team, but this team should be integrated with other departments to ensure continuity of care.
  • Regular Reviews: Conducting regular reviews of the hospital’s structure can help identify areas for improvement. This could involve surveys, focus groups, or interviews with staff members to gather feedback on how well the current structure works. Based on this feedback, the hospital can make informed decisions about restructuring or reallocating resources.

End-note: A Roadmap to Efficiency

For small hospitals in India, streamlining organisational structure is not just a matter of efficiency—it’s a necessity for survival in an increasingly competitive healthcare market. Small hospitals can enhance their agility, improve patient care, and optimise their operations by adopting a flat organisational structure, creating multidisciplinary teams, empowering frontline staff, and regularly reviewing and adapting the structure. With these strategies in place, small hospitals can not only compete with larger corporate entities but also thrive by delivering high-quality, personalised care that meets the unique needs of their communities.

Prof. Dr. Prahlada N. B
19 August 2024
Chitradurga.

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