Feature

'Multi'ple Benefits

Multi-tasking has helped automobile and manufacturing industry gain higher efficiency. Is that the case with the people- driven healthcare industry? Sonal Shukla tries to find out

In an era of hi-tech clinical practice and corporatisation of healthcare, each element of work process is becoming extremely specialised. Largely our normal attitude is that an area which is not our core competency, should not be endeared to. However, given the scenario of high attrition of paramedical staff, maximum utilisation of manpower is the need of the hour. To manage overheads to keep the running budget low, multi-tasking is an area to explore as a good cost-effective strategy. Today, when the world is witnessing a recession, healthcare as an industry sector is not immune to this global phenomenon, particularly the developed markets. Markets like India have also witnessed a decrease in demand for healthcare services, in view of the fact that patients are deferring treatments that are not critical in nature. In such a scenario, experts feel that multi-tasking is a welcome idea if executed appropriately in hospitals. An interaction with the experts on whether multi-tasking is a feasible idea or not in healthcare, we received mixed reactions. The few renowned hospitals like Fortis Healthcare, Apollo Hospitals and AIMS, Kochi have actually implemented the concept of multi-tasking at different non clinical levels, while here are others who are not very keen on the idea.

Multiple Benefits

"For fast tracking of services, our public relation assistants also do billing" - Dr Sanjeev Singh Senior Medical Administrator AIMS Kochi

"The concept of multi-tasking can be brought in effectively in hospitals by having an expert team" - Shrabani Basu Managing Consultant & Corporate Mentor

"We linked each of the process with a detailed task analysis" - Dr K Prabakar Senior Vice President Corporate HR, Apollo Hospitals Chennai

"Multi-tasking has helped us in achieving better Turn-Around-Times" - Pankaj Mittal Vice President - Human Resources & Chief People Officer Fortis Healthcare Limited Delhi

Many functions and departments in the hospital follow a cyclical pattern, wherein there are peaks and troughs in the volume of work managed by the employees. A comprehensive understanding of these patterns would help in trimming excesses and gaining efficiency. "Multi-tasking, be it any industry, is the order of the day. It improves productivity by reducing redundancy. All organisations, today, have to improvise and innovate. Healthcare is no different. Multi-tasking is very much feasible and required," shares Pankaj Mittal, Vice President - Human Resources & Chief People Officer, Fortis Healthcare Limited. Multi-tasking would help in reducing counter-to-counter approach, thereby improving patient's and bystanders satisfaction. A single window approach for better delivery of services and efficient management would also be possible with multi-tasking. To deal with high attrition rate, ongoing expenditure on skilled training and to improve patient satisfaction.

Apt for Multi-tasking

In hospitals, multi-tasking is possible in most of the areas concerning the non-technical jobs and administrative jobs (completely) and technical jobs (partially). Patient care services, patient welfare, front office, doctors in certain OPD/ IPD areas, human resources, administration - including housekeeping, security, concierge, services such as F&B, paramedical, nursing and secretarial support are few areas where multi-tasking can gain efficiency for the hospital. "Multi-tasking is possible in areas where the work has to be done in batches and the work is intermittent," says G Devender Rao, Director - Finance & HRD, Yashoda Group of Hospitals, Hyderabad.

Experts cite a few areas where multi-tasking is feasible. Nursing can do the administrative function such as duty roster management, attendance management, leave management, feeding patient data into the computer as part of HIS, rather than relying on administrative support. On the other hand, doctors can fill up discharge summaries and patients' medical reports themselves rather than relying on administrative support. Patients facing departments like front office, billing, patient care services are completely utilised only at times when the patient inflow is the highest (typically the OPD hours). They are thus available for deployment to other areas like performing back-end tasks like reporting, training and filing of records at the off-peak times. Para-medical staff can do 'total productive maintenance' by cleaning their own workstations/ bio-medical equipment rather than relying on general duty assistants, who are technically not equipped. Further, secretaries can be shared for a department. This would lead to enhanced productivity, greater focus on patient issues and increased speed of service delivery. It would also help the hospitals in minimising their payroll costs.

Multi-Taskers

Only a small group of hospitals are actually implementing the concept of multi-tasking in their work environment. One of them is Fortis Healthcare Limited which utilises multi-tasking in various departments like front office, patient care, human resources, administration and secretarial staff through on-the-job training and classroom-based learning programmes. "It has helped us in achieving better Turn-Around-Times (TATs), greater utilisation and enhanced productivity of our resources with regards to patient satisfaction, roster management, leave management, reporting, filing of records and other back-end paper work," shares Mittal.

Apollo Hospitals, Chennai is also doing multi-tasking in various non-clinical areas but with a carefully carved systematic approach. "We first did a process map and linked each of the process with a detailed task analysis. Then we did an analysis of the common task and training needs. Build modules and trained the relevant task to the workforce. This helped us create a pool of workforce that is trained to multi-task. Then we did an active and passive monitoring during the work till the outcome was 100 per cent compliant and accurate," shares Dr K Prabakar, Senior Vice President, Corporate HR, Apollo Hospitals, Chennai. This has helped the hospital trim the workforce (reduced HR cost for replacements) and the existing members have been redeployed to work on other projects at the national and international levels.

To streamline its front desk activities and help the staff to multitask, Kochi-based Amrita Institute of Medical Sciences (AIMS) has adopted Mayo Clinic's (US) concept of keeping all support service facility co-located in an OPD, to run the OPD. This model is extremely comfortable to all patients, since they need not move from location to location, in search of rooms to give bills and prescriptions. On the contrary, all services are provided at the point-of-care in the centre of excellence specialised OPD.

Multi-tasking has helped Fortis Healthcare to attain better turn around time

AIMS, Kchi follows Mayo Clinic’s practice of co-relating all support services to OPD

Apollo Hospital, Chennai multi tasks in non clinical areas

"In order to be cost effective and less manpower intensive and also to provide a single window approach for fast tracking of services, we have trained and asked front desk, public relation assistant to also do the billing," shares Dr Sanjeev Singh, Senior Medical Administrator, AIMS. This also makes patients happy as they don't have to stand at different queues, responsibility of reconciliation is with one staff and guidance / communication for OPD services is also given by one staff who the patients encounters with, at the front desk.

The hospital can get rid of the excess flab in the areas where multi-tasking is introduced. The hospital can stop recruitments and look at internal job rotation. Job and skill enrichment and employee motivation is achieved leading to higher customer satisfaction and less HR cost gives an opportunity to increase pay in few pockets. The hospital has introduced a new category of staff 'physician assistants' who undergo a comprehensive structured three-year course and after graduating from it, assists the physicians on their daily activity, thereby relieving consultants to spend more dedicated time with clinical, academic, research activity and not to get hassled with mundane paper writing. They are also trained to assist surgeons during minor procedures like dressings, taps, sedation. They have been trained to do thorough work up of the patient and keep them ready for consultation by the faculty. In an in-patient area, they would take care of preparing discharge summary and instructions to the patients.

Nurses can do administrative function such as duty roster management, attendance management and leave management

Doctors can fill up discharge summaries and patients' medical reports themselves rather than relying on admin support

Para-medical staff can do 'total productive maintenance' by cleaning their own workstations/ bio-medical equipment

The hospital also started the course for OR and anaesthesia technicians under the banner of the Institute and Applied Sciences wing, where the graduates go through a structured course for two years and they multi-task (as per the requirement of the specialised theatres) between OR technicians (while shifting), anesthesia technicians (during the case) and again OR technicians (while shifting and wheeling in new case). They undergo a strict infection control practice and BCLS drill as per the curriculum. Besides that some of the floor nursing staff also are cross trained and as need be, do multi-tasking in the hospital.

Says Anthony Handa, Manager - Personnel, Ruby Hall Clinic (RHC), Pune, "Employee skills can be utilised optimally so as to achieve the desired results. When we have few people handling multiple jobs it helps us in reducing excess staff that can be relocated elsewhere on other assignments." In RHC, a lab technician who has been doing haematology tests is trained in bio-chemistry and histopathology over a period of time. When an employee from these departments is on leave or falls sick, this employee who is trained to do these additional jobs takes the control which ultimately helps the organisation to deliver results in time.

Seeking the Right Approach

Most organisations look to optimise productivity, decrease costs and deliver the best. Multi-tasking, however, is concerned with parallel processing of many unrelated tasks. It might conflict with the natural attention mechanism in humans. While multi-tasking is often recommended as a tool to enhance one's operational efficiency, not everyone is cut out for that sort of functioning. For those organisations where the attrition rates are high and thus multi-tasking is valued to evade a crisis situation and also for those employees who are naturally gifted at it, experts suggest ways of optimising the talent by keeping a few things in mind such as recognise the talent and address to its needs, develop a clear reward system and understand `switch costs' (the switch costs in terms of shoddy work, mistakes increase with the complexity of the tasks on which the employee is multi-tasking).

However, one must take into account the multitasking limitations of people. "If an organisation's expectations from the employee or an employee's expectations from himself are unrealistic, performance is bound to worsen along with the deterioration in self \-worth of employees," quips J Seetharam, Deputy General Manager, BGS Global Hospitals, Bangalore.

A fairly recent approach to cost cutting and research on multi-tasking has indicated that it increases stress, diminishes perceived control, causes psychosomatic symptoms such as stomach aches and headaches and leads to behavioural symptoms like memory loss and insomnia.

Agrees Priyanka Borah, Full-time Director, GNRC Hospital, Guwahati, "Though multi-tasking helps keep employees motivated, it may sometimes lead to lack of concentration or aim due to the variation in tasks." Says Shrabani Basu, Managing Consultant and Corporate Mentor, "Not just non-clinical staff but also clinical staff are today seen multitasking." She cites an example of one of the management institutes which in its curriculum of Masters of Hospital Administration course has included topics like people management, soft skills and finance which are required by doctors who are looked upon as not just good clinicians but also good people managers.

"Overall, the concept of multi-tasking can be effectively introduced in the hospitals by having an expert team comprising a mix of trained HR and clinical personnel who would deftly work out and implement these training backed processes," feels Basu. However, multi-tasking may be harmful in areas where critical issues are involved like providing care to patient. "In any hospital scenario, especially in clinical field, multitasking is not advisable because the quality will deteriorate and patient care and safety would be at stake. Therefore, the trimming of manpower and opting for multitasking may not be a wise decision in a hospital," feels Suyash Borar, Chief Operating Officer, BM Birla Heart Research Centre, Kolkata.

Hence, in retrospection, while implementing multi-tasking in the hospital, the human resource department needs to carry out a thorough job analysis and detailed job responsibilities. This will help in eliminating the duplication of jobs and at the same time help in cutting the costs. Proper training should also be implemented to execute multi-tasking.

"The concept of multi-tasking can be implemented in an organised manner, but only with the help of very sound HR department which is in synergy with the clinical department, which studies the processes and does the work time study. This multi-tasking doesn't start at the mid-way in the organisation but actually starts at the recruitment level," concludes Basu.

sonal.shukla@expressindia.com