ORD FINAL

F14 A
GROUP
Group Number : 7
Deepak Krishnan (F14015)
ASSIGNMENT
Promod A Raj (F14039)
Harish TCS (F14023)
A Surendaran
STUDY
OF
S (F14055)
Rose Mary Bino (F14047)
THE
Madhavan (F14031)
HEALTHCARE
Anugraha.S (F14007)
SECTOR

Contents
INTRODUCTION:..................................................................................................... 2
ORGANIZATIONAL STRUCTURE OF RSRM GOVERNMENT HOSPITAL.......................2
Work Specialization............................................................................................ 2
Departmentalization........................................................................................... 2
Chain of Command............................................................................................. 5
Span of Control................................................................................................... 6
Centralization and Decentralization....................................................................6
Formalization...................................................................................................... 6
METHODS OF MOTIVATION THAT ARE EMPLOYED IN RSRM GOVERNMENT
HOSPITAL............................................................................................................... 7
CONTROL MECHANISM IN RSRM GOVERNMENT HOSPITAL.....................................9
SOURCE............................................................................................................... 11

INTRODUCTION:
The purpose of this study is to analyse and understand various factors of management in a
specific sector. The RSRM Government Hospital serves as the base of our study in the health
care sector. In this study we analyse the hospitals organizational structure, the various
motivational methods that it uses and its various control mechanisms.

ORGANIZATIONAL STRUCTURE OF RSRM GOVERNMENT

HOSPITAL
The six dimensions of organizational design are
Work specialization
Departmentalization
Chain of command
Span of control
Centralization and Decentralization
Formalization
We have analysed the RSRM government hospital based on these dimensions and the
observations are as follows
Work Specialization
Work specialization describes the degree to which tasks in an organization are divided into
separate jobs. The main idea of this organizational design is that an entire job is not done by
one individual. It is broken down into steps, and a different person completes each step.
Individual employees specialize in doing part of an activity rather than the entire activity.
In the healthcare field, work specialization is followed to varying degrees. Here the process is
broken down into steps and individuals at the same level maybe assigned to one or more
steps.
For e.g., a doctor who diagnoses an ailment may also prescribe a medication or conduct a
test. At the same time, a doctor specializing in Cardiology cannot prescribe medications for a
respiratory ailment.
Departmentalization
It is the basis by which jobs are grouped together. For instance every organization has its own
specific way of classifying and grouping work activities. Hospitals have their own specific
way of grouping work activities. The below chart depicts the 2

Ministry of
Health and
Family Welfare
State Health

Minister

Department of
Public Health

Deputy
Director

Sub Centre
Village Health
Nurse

Block Primary
Health Centre

Block Medical
Officer

Department of
Medical
Service Joint

Director

Department of
Medical
Education
Director of Medical

Director of Medical
Education
Education

District HQ
Hospital

Covers 10
taluks

Government
Hospital
Covers 4
taluks

Primary Health
Centre
Medical
Officer

Functional Departmentalization:
In this method, jobs are grouped based on the functions. In a hospital, the admissions and
billing are done by a separate department, treatment is done by a separate department,
diagnostics is handled by a separate department and the support services are done by a
separate department.

Hospital

Informational
Services

Admissions
Billing
Human Resources

Support Services

Diagnostic Services

Housekeeping
Maintenance
Waste Management

Medical Laboratory
Imaging
Blood Bank

RSRM falls under the Department of Medical Education. It is affiliated to the Stanley
Medical College, Chennai. This is the organizational structure followed at RSRM,
Royapuram, Chennai. It specializes in maternal care. In addition, contract workers may be
employed by the Inspector or Dabedar.

Docto
rs

Nurse
s

Senior Civil
Surgeon

Nursing
Superintend
ent

Civil Surgeon

Head Nurse

Asst. Civil
Surgeon

Staff Nurse

Sergeant
(Admin for
workers)

Inspector

Male Nursing
Assistant
Stretcher
boy, sanitary
worker,
waterman

Chain of Command
It is defined as a continuous line of authority that extends from upper organizational levels to
the lowest levels and clarifies who reports to whom.
In the RSRM hospital, the chain of command is followed in all departments. The three
important concepts of Chain of Command are followed;

Authority exists, wherein; there is a head for each department and all others in
that department conform to his decisions. For eg., there is a Senior Civil
Surgeon who is the head of the doctors and exercises authority and there is
also a Matron who is the corresponding authority for nurses.
Responsibility exists, wherein; all subordinates comply to the decisions made
by the higher authority.

Unity of command also exists. Every subordinate will report to only one head
and not multiple heads. For eg., a Staff nurse will report to a Head nurse who
in turn will report to the Matron.

Span of Control
Span of control is important to a large degree because it determines the number of levels and
managers an organization has. Also, it determines the number of employees a manager can
efficiently and effectively manage.
The RSRM Hospital, being an educational institution in addition, has both narrow and wide
span of control with a maximum of five levels in any department. The span of control is
narrow at the top level and grows more wide as we move down.
This makes it easier for the top level manager to monitor and control his immediate
subordinates and thereby increases the efficiency and effectiveness of the process. But at the
same time the lower level manager has a larger number of subordinates to monitor and his
work may start stagnating.
For e.g., The Matron monitors the Head nurse who in turn monitors the Staff nurse. The
Male/Female Nursing Assistant will report to the Staff Nurse. But all other employees like
Sanitary workers, Male/Female Social worker, Health inspector will report to the M/F
Nursing assistant.
Centralization and Decentralization
Centralization is the degree at which decision making is done at a single point in the
organization. Decentralization is the degree to which lower level employees provide input or
actually make decisions, i.e., employee empowerment.
Hospitals, RSRM in particular, are very centralized structures. The top management frames
the rules and makes decisions and the rest of the working body is expected to follow them.
Any non-compliance with these norms will result in the relevant repercussions.
For eg., the Senior Civil Surgeon will pass on his decision to the Civil Surgeon who will
monitor and instruct the doctors.
Formalization
Formalization refers to the degree to which jobs within the organization are standardized and
the extent to which employee behaviour is guided by rules and procedures.
In the RSRM Hospital, jobs descriptions are well defined. Roles at the lower level are routine
and are governed by the rules framed by the top management. This leads to a high degree of
formalization.

METHODS OF MOTIVATION THAT ARE EMPLOYED IN RSRM

GOVERNMENT HOSPITAL
Motivation is the sum total of all the Internal/External factors that simulate desire and energy
in people to be continually interested and committed to a job or a goal. Work motivation has
been described as psychological processes that direct, energize, and maintain action toward
a job, task, role, or project. Different people are motivated by different factors. Just as
different individuals have different motivations to be engaged in a particular type of work, the
same is true for motivation within that type of work. For example, some individuals are
motivated by benefits such as an adequate salary, job security, good working conditions and
organizational policies. These motivations are called external motivational needs. Some
individuals are motivated by factors such as achievement, growth, advancement, respect and
recognition, independence, and responsibility. These motivations are called internal
motivational needs.
TABLE: Typology of Incentives

Individual incentives
Financial
Salary
Pensions
Illness, health, accident, and life
insurance
Travel and transport allowances
Child care allowance
Rural location allowance
Heat allowance
Retention and professional allowances
Subsidized meals, clothing, and
accommodation
Nonfinancial
Vacation days
Flexible working hours
Access to training and education
Sabbatical and study leave
Planned career breaks
Occupational health
Functional and professional autonomy
Technical support and feedback systems
Transparent reward systems
Valued by the organization

Organizational
incentives

Environmental
incentives

Internal
Autonomy
Accountability
Market exposure
Financial responsibility
External
Governance
Public finance policy
Regulatory mechanisms

Amenities
Transportation
Job for spouse
School for children

In government hospitals National interest is aligned with the goals of the doctors and other
healthcare staff. We contacted RSRM government hospital to study and analyse the
motivation methods that were employed in it. Some of the motivation methods that were
present in this hospital are as follows
Incentives through Government Insurance Scheme: Our government provides health
insurance to those people who come under a particular income level. This insurance comes
into effect when the person with the insurance gets treated in a government hospital. After the
treatment, a part of the insurance amount goes to the hospital and the rest of the amount will
be divided among the doctor and other hospital staff who were involved in that particular
treatment. This is a financial incentive for the individual which encourages the doctor/staff to
work more/ treat more patients.
A person that earns less than 72,000 rupees per year is eligible for this insurance. Insurance
amount of 1 lakh per year is provided to the insured for a period of 4 years.
Personal development: The hospital works hand in hand with the government medical
colleges. The doctors who are employed in this hospital work as lecturers in the medical
colleges. In order to become a permanent faculty in the college , doctors must write an exam
that is certified by the medical board
Recognition by the Organization: The hospital conducts an event called The Nightingale
Day to reward and recognize the work and contribution of various doctors and other
healthcare staff. One such award is the Best performing staff nurse award. Another such
event is conducted on the Doctors day where they reward the Best performing Doctor.
There is an internal satisfaction that is created when they get recognized for their work and
this encourages them to put in more effort to stay satisfied. It also makes them more loyal to
the organisation as people tend to stay in a work that satisfies them.
Access to training and education: The hospital provides free training in scanning and
anaesthesia to MBBS holders so that they can develop their knowledge and have wider areas
of expertise in their field. This satisfies the persons need for self-development.
Incentives to encourage contribution: The doctors in the hospital receive bonuses in
various cases. For example the doctors receive an amount of Rs.1000 for taking part in
various camps and area visits. The hospital also motivates them to work for longer hours by
giving an amount of Rs.500 for each delivery that is attended to after 5PM to 7PM. This
financial incentive encourages the staff to extend their work hours in case it is needed during
emergency situations.

CONTROL MECHANISM IN RSRM GOVERNMENT HOSPITAL

In the healthcare sector, we see 2 types of control mechanism: Bureaucratic and Clan type.
In bureaucratic, factors such as administrative rules and regulations, policies, standardization
of activities specified roles and budgets to ensure the standards are met by the employee.
In clan type, we see a union type of factor. The nurses union and doctors union are one of the
biggest examples of this type of control.
In the Bureaucratic control systems we see that the RSRM Government hospital being a
government hospital is subject to internal audit by other government hospitals. All the work
done by a hospital is monitored and the best practices are shared to other hospitals to improve
efficiency. Audit is taken in manners:

Audit for Finance: performed once in 3 months

Audit for Mortality: performed at the end of each month( conducted by

Superintendent)
Bribery Check: In case of complaints from public, the collector may visit the hospital
without prior information and look into the complaint.

Audit for Finance: Audit of the hospital is done on a quarterly basis. The audit team is
appointed by the state health ministry. They have to report the financial soundness of the
hospital. Any discrepancy in bills and invoices has to be explained to the trust/management.
Audit for Mortality: In case of mortality, the patients medical report must be forwarded to
Department of Public Health, Department of Medical Sciences and Department of Medical
Education. The Panel then selects a Doctor/Prof (from a different hospital/college
respectively). At the end of every month, on the last Thursday, the hospital staff (Doctors,
students) have to explain how the patient/s died to the selected person. He will inspect every
case and explanation must be provided by the concerned doctor/staff through video
conference. If the authority feels that there has been negligence on the side of the doctor/staff
or if the necessary procedure was not followed, he forwards the case to the collector.
9

The collector uses an independent outside counsel to peruse the case. If the collector is told
that the case for negligence is valid, he then suspends the doctor/s or issues a memorandum to
the hospital to do the same.
A patient, on the other hand, can take his case to the Human Rights Commission, Dean of the
medical college or superintendent and lastly the media. The Medical board, upon looking
through the petition of the patient, will either revoke the license of the doctor or debar him
from medical practise after conducting a thorough investigation.

10

SUB GROUP SPLIT UP

Organisational structure of RSRM Government Hospital Madhavan, Promod, Harish
Methods of Motivation in RSRM Government Hospital Anugraha, Surendaran
Control Mechanism in RSRM Government Hospital Deepak Krishnan,Rose Mary Bino

SOURCE
Dr.S.Mano Ramya . M.D.OG,
RSRM Government Hospital,
Royapuram,
Chennai.

11