Friday, June 21, 2013

Financial Management In Hospital



Objectives
1.      Provide financial resources for all essential services and then for other desirable activities
2.      Maintain the service charges within the reach of the people served by the hospital including free and concessional care for the poor and needy.
3.      Improve employee satisfaction by increasing benefits such as salaries, PF, gratuity, pension, housing, training loans etc.
4.      Reduce dependence on grants, donation or contributions,
5.      Provide for community health development work in the neighborhood if that is an institutional objectives.


Financial Planning

Hospital need both-short term and long term planning. Majority of the hospital do not have long-term (5years or more ) plan. Financial planning must be based on analysis of the hospital objectives,both in term of quality and quantity of services.

The policies influencing financial plan are :-
·         Service mix and decisions regarding specialization.
·         Pricing
·         Free and concessional care
·         Community health and involvement in social development activities
·         Training and research
·         Growth ,expansion and modernization


Budget
Budget is an important financial procedure, which must receive full attention by the administrator . Budget brings about guidance,stability, balance and direction. A budget is a financial planand it is usually a short-term(annual)plan.
Hospital budget is the process of expenditure and the means of financing this expenditure. A budget ia an operational plan expressed in monetary terms. The budgetary plan incorporates the operating budget.

·         Operating Budget
·         Capital Budget

Budgeting is an opportunity to consider better performance by the hospital. While planning a budget,we must apply our minds to think in terms of improved quality and quantity of care.

Different Kind of budget :
1.      Appropriation
2.      Forecast
3.      Flexible

Operating Budget
Operating Revenue Budget
Operating Expenditure Budget

Operating Revenue Budget
In order to have a proper operating revenue budget,we musy have full statistics dat.The prediction revenue is some what speculative even with good quality data. Any change in workload will effect revenues. It depends upon the rate or schedule of charges. The revenues come from the following activities of the hospital
1.      Patients service
2.      Activities incidental to patients services
3.      Income from investment
4.      Other income-donation,grant etc

Operating expenditure budget
Operating expenditure budget is required for the  operation or maintenance of facilitiesand services. The most important costs are for salaries and wages ,supply like drugs,dressing,reagent,fuel etc and wtilities including electricity,water,telecome etc and equipment maintenance and purchase of spare parts.


Capital Budget
Funds should be available for expenditure on capital (non-recurring) iteams. These are required for:
a)      Growth (new facilities being provided)
b)      Replacement of obsolete & worn-out equipmental,furniture and machinery

(new facilities may be of building,plant and machinery or equipment)

Capital b is the estimated fund requirements forcapital iteam needed for growth,for providing new facilities and replacement of worn-out equipment,machinery,and furniture.

Cash Budget
Cash budget is the budget that record the forecasted cash inflow from various sources and also records the forecasted demand of cash. The cash budget is usually broken down by monthly or quarterly period.



Categories of expenditure

The Hospital expenditures classified in three categories
Capital Vs Recurring (Revenue)
Capital Cost
Capital cost are initial one time expenses to make available a particular service.Example expense on building,equipment,instrument,fixture and furniture

Recurring Cost
Recurring cost are incurred on a continuing/periodical annual basis. Example salaries, consumables and supplies, water, electricity, maintenance and contingent(emergency) expenses .

  Fixed vs Variable
Fixed costs are those costs which do not vary with volume of output and hence fixed are defined in terms of time like per day, or per month, or per year.

Variable cost
Variable costs are those costs that changes directly with the production and hence they are defined in terms of units.

The following are examples of fixed costs and variable costs:
  • Indirect labor- fixed costs could be variable under certain circumstances
  • Indirect materials- variable costs
  • Insurance on building- fixed costs
  • Depreciation on building (straight-line)- fixed costs
  • Overtime premium pay- variable costs
  • Property taxes- fixed costs
  • Polishing compounds- variable costs
  • Depreciation on machinary (based on machine hours used)- variable costs
  • Employer's payroll taxes- variable costs
  • Machine lubricants- variable costs
  • Employees' hospital insurance (paid by employer)- fixed costs
  • Labor for machine repairs- variable costs
  • Vacation pay- variable costs
  • Patent amortization- fixed costs
  • Janitor's wages- fixed costs
  • Rent- fixed costs
  • Factory electricity- fixed costs
  • Plant manager's salary- fixed costs




Note : It is important to note that total fixed costs remain same but per unit fixed cost keeps changing while in case of variable costs total variable costs keeps changing depending on the level of output but per unit variable cost remains constant.

Direct vs Indirect  

Direct Cost
Direct Cost are costs incurred in running a department or service for fulfilling the primary purpose of that department or service. They can be apportioned direct  to the particular activity or procedure. Usually, these are expenditures incurred by the concerned department covering salaries and labour costs, and costs of supplies and stores in rendering the service.

Indirect Cost

Indirect cost are the costs incurred by the other department or service in support of the primary function of direct patient care. The same cost may be direct for one department but indirect for another . Ex maintenance supplies are direct costs to maintenance department, but indirect cost to CSSD or mechanized laundry .

A STUDY ON MOTIVATION AND IT’S EFFECT ON PERFORMANCE ON NURSES IN LUMBINI MEDICAL COLLEGE AND TEACHING HOSPITAL TANSEN,PALPA,NEPAL












DATA ANALYSIS AND RESULTS














4. ANALYSIS AND RESULTS

The data collected through questionnaire that was done on nurses who work at
Lumbini Medical College. Out of 24 questionnaires distributed and  24 were
answered. The data obtained are analyzed as followed:


1.    GENDER:

Figure No. 1

The inquiry was made to find information about the gender of the nurses. As
nursing is a female job in nature; the result showed highest number of female
100% were female nurses while the male were  0%. Woman has major role to playing the life and they compromise their sleep to take care of their children and family tasks.








2. AGE:

Figure No. 2
The inquiry was made to find information about the rate of the age of the nurses. The data result showed above or less than 30 years old were responded to the questionnaires. 4% of the nurses were more than 30 years old and 96% were under 30.

3. MOTIVATION TO WORK

Figure No. 3
The inquiry was made to find how motivated the nurses with their work are. The result showed that 29% of the nurses are motivated and around 71% of them are not motivated to work. Unfortunately about three fourth of the number of nurses are not motivated which is a large percentage. This indicates that, there is a serious problem with motivation among nursing.

4. FACTORS OF DE-MOTIVATION

Figure No. 4

The research inquired to find out factors that might affect nurses' motivation and performance. The highest number agreed that lack appreciation is affecting their performance more. 19%of the nurses are suffering from workplace hazard or injuries it could be because of the not using the high technique in the hospital to prevent such problems. 17% got a problem with night shift;16% agreed that lack of appreciation is the reason of being de-motivated. 16% only agreed that workplace violence is a factor of de- motivation. 13% feeling that their payment is unfair comparing with other health staff.11% seen that, unreasonable workload as a factor of de-motivation. while8% of the nurses found long working hours is a problem for them.

5. UNDERSTANDING THE REQUIREMENTS



 
Figure No. 5

The inquired was made to find out withier the employees understand their
requirements or not. The highest number knows well what their requirements are it is about 67% of the nurses, 33% has a fair knowledge understanding.
understanding what the requirements are will help the employees to perform their work well.


6. Attractiveness to work before practicing nursing in reality

Figure No. 6
This inquiry showed the rate of motivation to work before practicing the
work with its de-motivation factors and stresses. 100% were motivated by
their certificate.

The result showed 100% motivated to work but later on this percentage has been changed from 71% to 29% as shown in Figure No. 3.


7. JOB SATISFACTION


Figure No. 7

This inquiry showed how satisfaction the nurses are with their work. The highest rate was given as fair satisfaction which is not the rate needed to satisfy the employees to work and be creative at their work. 50% of the nurses rate their satisfaction as fair satisfaction. 37% are well satisfied with their work but this is a very low rate to perform a good job. 13% are high satisfied .








8. RECOGNITION OF THE EFFORTS BY THE BOSS

Figure No. 8
This inquiry showed the recognition of the efforts by the boss. The busses need to recognize the work and the effort of the employees because they have an effect on the performance and the motivation of the workers. 58% feel that their boss is fair in recognizing their efforts. 25% agreed it is well recognized. 4% are highly recognized, but it is a very small number. 13% of them are not recognized which is unfair for an employee to do effort with no appreciation.

9. FAIRNESS OF PAYMENT


Figure No. 9
The inquired was made to find out the fairness of the payment of nurses comparing to other health workers. 71% feel that their payment is unfair which a very huge number. Only 29% are satisfied with their salary.

10. REWARD SYSTEM



 
Figure No. 10

The inquiry was made to find information about the reward system followed in Lumbini Medical College. Non-monetary reward considered one of the important rewards to the nurses as seen in the figure. 88% agreed that non-monetary reward is important to them like education, promotion or growth opportunities.. 12% seen monetary rewards are much important to them .











11. THE EFFECT OF NIGHTSHIFT ON THE FAMILY


Figure No. 11


The research inquired to find the effect of night shift on the family. The result
showed. 83% has no problem with their family because of the shift work. 17% of the nurses are affected by nightshift


12. THE EFFECT OF NIGHTSHIFT ON THE WORK

Figure No. 12

The research inquired to find the effect of night shift on the nurses' work. A
rate of  71% has no affect ontheir work by the nightshift. 29% of nurses’ work is affected b y nightshift.  Nurses’ work means patients’ life; so, it is very
important to put this into consideration.

13. PRODUCTIVITY RATE

Figure No. 13

The research inquired to find the productivity rate of the nurses. The result
Showed 67% are fair in their productive.29% are well productive and 4% highly in their productivity.











14. THE PRODUCTIVITY RATE

Figure No. 14

The research inquired to find the rate of the productivity again, but this time in
specific period of time. 67% of the result showed the rate of productivity gone up. 33% has no motivation to raise their productivity, so it is at the same rate.

15. DROPPING OUT RATE


Figure No. 15
The inquiry was made to find information about dropping out and turnover
problem with nurses, since it is a serious universal problem. According to the
result 87% of the nurses agreed that there is a dropping out problem in Lumbini Medical College. 13% only do not feel dropping out as a problem in the Lumbini Medical College.

16. RATE OF STRESS





 
Figure No. 16

The inquiry was made to find out how stressed the nurses are. The result indicated that 63% have no stress. While 37% has stress in their work. The percentage of the stress rate is not an easy number. If the nurses have such rate it could affect on the patient care and the organization itself.








17. THE EFFECT OF SHIFTWORK ON SOCIAL EVENTS



 
Figure No. 17

The inquired was made to find out if the work shift has effect on the family or the social events. 62% of the results  are affected by nightshift. Only 38% has no effect. Nightshift causes imbalance an between lifestyle and work.