AN APPRAISAL OF OPEN SYSTEM BUSINESS POLICY MODELS IN THE MANAGEMENT OF MISSION HOSPITALS IN SOUTH SOUTH NIGERIA

ABSTRACT

The purpose of this research is to analyse the appraisal of open system business policy model in the management of mission hospitals in the South South Nigeria, the study was motivated by the need to give possible strategies and solution through the use of open system business policy model in the management of mission hospitals in the South South Nigeria. The population of the study was 732 staff of the 10 selected mission hospitals in Edo State, Delta State, River State and Cross River State in south- south Nigeria. A sample size of 502 was determined from the population using Taro Yamane’s formula in conjunction with two-tail test. The hypotheses were tested using non parametric statistical technique which included: Friedman Chi-square and Z-test. The findings reveal that the reasons for failure in service delivery among mission hospitals in South South Nigeria are due to abortive business policies, increasing rate of changes in technology, unhealthy work environment and high bureaucratic difficulties (x2c = 496.660 > x2t= 7.815, df =3 p<0.05).There is a significant relationship between open system business policy model and the management of mission hospital in South South Nigeria (Zc= 372.422 > Zt= 1.96, a<0.05). That Open system model to large extents has assisted the mission hospitals in South South Nigeria to benefit from its environment through exchange of information, procurement of both input and economic resources, ability to adapt to changes in the environment and effective quality service to patients (Zc= 4.179 >Zt= 1.96, a<0.05). The appropriate means for improving quality of service to patient among mission hospitals in South  South  Nigeria  are  adaptation  of  suitable  open system  business  policy  model, enabling work environment, implementation of constant training programs and the presence of foreign professionals (expatriate) (x2c = 372.422 > x2t= 7.815, df =3 p<0.05). Environmental effect on quality service delivery to patients among mission hospitals in South South Nigeria  are unstable  Government  policy,  increasing  rate of changes  in technology, environmental conflict and poor innovation  (Zc= 4.186 >Zt= 1.96, a<0.05) Based on the result of the study, the following recommendations were made: Hospital Organizations should adopt a suitable open system business policy model that will enable them interact properly with their environment for exchange of information and procurement  of  both  input  and  economic  resources.  Hospital  Management  should

continually implementing  constant  staff training  programme to  improve synergy and cooperation in work place Hospital Management should acquire the model equipment and foreign professionals (expatriate) which will be advantageous in the production of quality of service to patients. The study concludes that with appropriate implementation of suitable open system business policy models and proper environmental consideration there will be effective and improved service quality for patients among mission hospitals in South South Nigeria, environmental prediction and adaptation, effective and improved synergy, team spirit and cooperation in work place

CHAPTER ONE

1.2      Background of the Study

A  policy  is  considered  the  general  guideline  for  decision  making.  Kalejaye,  (1998) defines policy as the objectives, the mode of thought and the body of principle underlying the activities of an organization Business policy is a guide and roadmap to create awareness and direction to the management of any organization. It publicizes the rights and obligations of different rung of the ladder- horizontal and vertical-of the different capital human resource engagement, finance utilization etc. It ensures that organizations deliver better end product within a framework. It encourages, promotes and improves performance attainment in an organization. Policy provides the bedrock for vision and mission statement of the business organization along the corporate objectives and goal. Policy enables the business to be assessed and given an image by the way they carry out their responsibility along with their relationship with their clients/customers. It is the

‘barometer’  of  playing  by  the  rule  and  gives  purpose  to  the  strategy thrust  of  the organization. Business Policy defines the scope or spheres within which decisions can be taken by the subordinates in an organization (Wikipedia, 2012). It permits the lower level management to deal with the problems and issues without consulting top level management every time for decisions. It is the study of the roles and responsibilities of top level management, the significant  issues affecting organizational success and the decisions affecting organization in long-run.

Tracing the history of business policy, Kazmi (2006) states that it can be traced back to

1911, when the Harvard Business School introduced an integrative course in management in view of providing general management capability. This course was based on case studies which had been in use at the School for instructional purposes since 1908 (Christensen, et. al., 1982 cited in Kazmi, 2006). However, the real impetus for introducing business policy in the curriculum of business schools (as management institutes or departments are known in the United States) came with the publication of two reports in 1959. In 1969, the American Assembly of Collegiate Schools of Business), a regulatory body for business schools, made the course of business policy a mandatory requirement for the purpose of recognition. In the last two decades, business policy has become an integral part of management education curriculum. The practice of including

business policy in the management curriculum has spread from the United States to other

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parts of the world. The contents of the course, teaching methodology and so on vary from institution  to  institution.  But  basically,  business  policy  is  considered  a  capstone integrative course offered to  students who  have  already  been through a set  of core functional area courses. The term “business policy” has been used traditionally though new titles such as strategic management, corporate strategy and policy and so on are now used extensively for the course. Business policy in term of hospital management provides the guideline for deploying resources and mobilizing for the efficient provision of effective health service which involves planning, organizing, controlling, directing and leading (Olumide 1997)

Open system is a system that regularly exchanges feedback with its external environment. Open systems are systems, of course, so inputs, processes, outputs, goals, assessment and evaluation, and learning are all important. Aspects that are critically important to open systems include the boundaries and external environment. Healthy open systems continuously exchange feedback with their environments, analyze that feedback, adjust internal systems as needed to achieve the system’s goals, and then transmit necessary information back out to the environment. Hospital management open business policy provides guideline that governs the hospitals interaction with its environment. A hospital cannot operate independently without the presence of its suppliers, political cum cultural, competitors,  patients and  religions environment. Some of the subsystems  within  the hospital are the Nursing department,  Laboratory department, pharmaceutics department, emergency  department  etc need to  be  highly  controlled  and  predicted,  possessing  a considerable degree of self-regulation. A true open system needs to be able to cope with controllable and unexpected inputs and deal with these in predictable and contingent way (Katz 2004). .

Directory of Hospitals in Nigeria, 1988, states that a hospital is an institution which is operated for the medical, surgical and/or obstetrical care of in-patients and which is treated as a hospital by the Central/state/government/local body/private and licensed by the  appropriate  authority.  Steadman’s  Medical  Dictionary  defined  hospital  as  an institution for the care, cure and treatment of the sick and wounded, for the study of diseases, training of doctors and nurses. Open business policy provides guideline that governs the hospitals interaction with its environment.

The product of a hospital is service to people provided by its personnel with a variety of skills. The nature of the demand for hospital services is also distinctive to the hospital-as admission to the hospital for services is rarely voluntary. The decision is made for the patient that is ill and requires services which cannot be provided at home. The patient leaves home, family, friends, his work-place and his way of life for a new environment i.e. the hospital. In this new environment, he becomes one of the many. In his home, he has a definite role. In the hospital, his role is similar to thirty or fourty others in the ward or unit in which he is a patient. If he is a patient in a multiple-bed unit and confined to bed, he is housed with strangers and carries out several intimate functions in the presence of these strangers. He is subjected to a new set of values and a new way of life. In his environment, he meets many new people, and he is expected to relate and communicate with them. On occasions, patients encounter more than thirty different hospital personnel in the room in one day, each performing different functions. A hospital deals daily with the life, suffering, recovery and death of human beings. For the direction and running of such an institution, its administrative personnel need a particular combination of knowledge, understanding, traits, abilities and skills.

Nigeria has made progress in the last two decades in reducing maternal deaths, but the number of women who die in pregnancy or from complications associated with child- birth remains appallingly high. Nigeria is Africa’s most populous country and, despite being one of its wealthiest, continues to experience high rates of maternal deaths. The country has the 10th-highest  maternal mortality ratio  (MMR)  in the world with 630 women dying per 100,000 births a higher proportion than in Afghanistan or Haiti, and only slightly lower than in Liberia or Sudan. An estimated 40,000 Nigerian women die in pregnancy or childbirth each year, and  another 1  million to  1.6 million suffer  from serious disabilities from pregnancy- and birth-related causes annually. Nigerian women have an average total of 5.7 births in their life, with each pregnancy exposing them to the risk of maternal complications. Over her lifetime, a Nigerian woman’s risk of dying from pregnancy or childbirth is 1 in 29, compared to the sub-Saharan average of 1 in 39 and the global average of 1 in180. In developed regions of the world, a woman’s risk of maternal death is 1 in 3,800.

This unhealthy situation of the public health sector triggers the mission hospital to bring hope to the sick and unhealthy people. The Catholic Sacred Heart Hospital in Abeokuta was  the  first  standard  hospital established  in  Nigeria  in  1895.  The  Catholic  Health Services is the single largest provider of health care after the government, offering about

40% of health care in the Country. Their humanitarian, universally-accessible health care services reach to all Nigerians, especially citizens at the margins of society the poor, disadvantaged, persons with disabilities, the aged, the abandoned and those with stigma conditions, lepers, HIV/AIDS and teenage pregnant girls, etc. Accordingly, there are compelling grounds for constructive engagement with them to assure universal health coverage for all Nigerians.

Mission  hospital aims  at  the speedy recovery  of patients that  is why  its rooms are equipped with air-conditioners, call-bells and other devices. Several hospitals have libraries which provide books for the patients and the telephone to keeps the sick in touch with their friends and relatives. In most of the hospitals today, patients have newspaper and barber services in their rooms. The hospitals, keep in view the recreation needs of their patients, have provided televisions and radio sets in their rooms/wards. To save the precious time of the medical staff, secondary duties, are entrusted to another section of the staff called ‘medical social workers who  endeavors to  provide the  best  possible facilities to the patients within the hospital’s resources (www.cbcn-ng.org/docs/g13.pdf). But today the reverse is the case Chukwu, (2011) states that the greed for money has overwhelm the mission hospitals in the cities to the extent that patients are usually sent for surgery without proper examination, the nurses do not have respect and regard on patients, drugs are not supplied at the right time and patients are amputated even when there is no need for the amputation. Most of the mission hospitals in the villages have been covered with grasses and turned to homes for domestic animals.

1.4      Statement of Problem

The rate of failure in service delivery in the Nigerian health institution has reduced to the extent that patients cannot ascertained their fate in the hospitals. This unhealthy situation triggers the establishment of mission hospitals to submerge the inadequacy of the existing public and private hospitals but the mission hospitals are not able to perform as expected of them. The inadequacy in service delivery among mission hospitals is traced to be the

kind of managerial policy which is been adopted in the process of running the hospital.

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Some of these mission hospitals adopt policies that do not improve all round interaction between the employees, management, government. It was also noticed that the environment where the mission hospitals were located also have a significant role to play in their service delivery. Most of the mission hospitals in the South South Nigeria are constantly experiencing environmental violence

The greed for money has overwhelm the mission hospitals in the cities to the extent that patients are usually sent for surgery without proper examination. Most of the patients are not well treated, the nurses do not have respect and regard on patients, drugs are not supplied at the right time and patients are amputated even when there is no need for the amputation. Most of the mission hospitals in the villages have been covered with grasses and turned to homes for domestic animals. Others that are in existence are left with one or two auxiliary nurses operating in unhealthy environment

The inadequacy in performance of the mission hospitals is traced to the kind of human resource management  and business policy models that  were adopted by the Mission Hospitals which do not improve all round interactions between the management and the employees. The mission hospitals in Nigeria have, for the most part been organized along British line with strict hierarchical structure made them to experience high bureaucratic difficulties at different levels before goods and services are received. There are delays in services. Inadequate infrastructures, inefficiencies and government  interference in the management of some mission hospitals as revealed by the discussions held with the heads of various mission hospitals and in hospital seminars. The unhealthy growth of associations in hospitals has only added to the difficulties because the doctors and nurses belong to different public bodies governing their professions. Thus, the study focuses on an appraisal of business policy models in the management of mission hospitals

1.5      Objectives of the Study

The main objective of this study is to appraise the business policy models in the management of mission hospitals in south-south Nigeria. The specific objectives are as follows:

1.         To identify the reasons for failure in service delivery among mission hospitals in

South South Nigeria

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2.         To access the relationship between open system business policy model and the management of mission hospitals in South South Nigeria

3.         To  identify  the  benefits  from  utilizing  open  system  business  policy  among mission hospitals in South South Nigeria

4.         To determine the appropriate means for improving quality of service to patient among mission hospitals in South South Nigeria.

5.         To  examine  the  environmental  effect  on  quality  service  delivery  to  patients among mission hospitals in South South Nigeria

1.4      Research Questions

The following research questions guides the conduct of this study:

1.   To what extent does the identified reasons for failure influence service delivery among mission hospitals in South South Nigeria.

2.   To what extent does open system business policy model has influence on the management of mission hospitals in South South Nigeria?

3.    What are the benefits from utilizing open system business policy among mission hospitals in South South Nigeria?

4.   What are the appropriate means for improving quality of service to patient among mission hospitals in South South Nigeria?

5.   To what extent does the environment affect the quality of service delivery to patients among mission hospitals in South South Nigeria?

1.5   Research Hypotheses

The following hypotheses served as aids in finding answers to the research questions and in fulfilling the objectives of the study.

1.   The reasons for  failure in service delivery among  mission hospitals in South South Nigeria are due to abortive business policies, increasing rate of changes in technology, unhealthy work environment, and high bureaucratic difficulties

2.   There is significant relationship between open system business policy model and the management of mission hospitals in South South Nigeria

3.   The benefits from applying open system business policy among mission hospitals in South South Nigeria are for exchange of information, procurement of both input and economic resources, ability to adapt to changes in the environment and

effective quality service to patients

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4.   The appropriate means for improving quality of service to patient among mission hospitals in South South Nigeria are adaptation of suitable open system business policy model, enabling work environment, implementation of constant training programs and the presence of foreign professionals (expatraite)

5.   The environmental effect on quality service delivery to patients among mission hospitals in South South Nigeria are unstable Government policy, increasing rate of changes in technology, environmental conflict and poor innovation

1.6      Significance of the Study

The finding of this study will be of importance to the founders of the mission hospitals, the government, the patients, the employees, and to further researchers.

Founder (Legal Owners): The owners of mission hospitals will understand that implementation and  execution of business policy model will bring effectiveness and efficiency in the running of mission hospitals

The  Government:  The  findings  of  this  study  will  encourage  the  government  in formulating policies that will create an enabling environment for the country’s health sector.

The Hospital Employees: The outcome of this work will bring an increase to team spirit in the work place.

The patients: The findings of this study will improve quality of service to the patients. The Scholar: The study will serve as reference point to any future researcher on the subject area.

1.7      Scope of the Study

This work emphasis on the appraisal of business policy models in the management of mission hospitals in the South -South Nigeria. Open system business policies were used in analyzing the quality of service and human resource in the management of mission hospitals.  Ten (10) mission hospitals in the south-south of Nigeria were selected for the study. The study recognizes similarities in religion and cultural among these mission hospitals. The study is limited to two hospitals in Edo State, six hospital in Delta State, one hospital in River State and one hospital in Cross River State

The study was carried out within the period of three years (2012-2014)

1.8      Limitations of the Study

This study encountered some limitations which includes but not limited to

1.   Time Constraints: This required a lot of time in setting up the questionnaire and also it took considerable time to conduct the interview and analyse data. transcribing the recorded interviews and participant observation was time consuming

2.   Financial  Constraints:  This  was  encountered  in  the     area  of  fund  for procurement of paper and printing, postage, specialist software for data analysis, travel and transport, specialist book and articles which in most cases had to be procured overseas, an interview-recording devices and media to store data.

3.   Attitude of some of the respondents: Theattitude of some of the respondents were not very willing to participate in the survey due to their work schedule or other commitment

1.9     Profile of the Selected Mission Hospitals under Study

The following mission hospital were selected from South South Nigeria and selection is based on the number of years in existence which is above ten years.

St. Philomena Catholic Hospital (SPCH), Benin City.

St. Philomena’s Catholic Hospital is situated at Dawson Road Benin City St. Philomena Catholic Hospital (SPCH), is a mission hospital established 74 years ago and is located in the centre of Benin City, the Edo State capital. Its pediatric section consists of a special care baby unit (SCBU) with eight cots and three functioning incubators, and a children’s ward with 87 beds, 94 beds for adult and two semi-private rooms each with ten beds. The hospital has a fairly equipped laboratory capable of performing routine laboratory investigations such as blood smears for malaria parasites, full blood count, urinalysis and urine culture. Other investigations performed include genotype, serum urea and electrolytes, bilirubin, protein, alkaline phosphatase, blood grouping and cross-matching. It also has a good blood bank facility. Other hospitals in Benin City (both public and private) also make use of SPCH’s laboratory and blood bank facilities. The laboratory and blood bank have 24-hour coverage by six trained full-time medical laboratory scientists. The pediatric section enjoys 24-hour coverage by a consultant pediatrician, resident  doctors  (senior  registrars)  from  the  University  of  Benin  Teaching  Hospital

(UBTH), eleven senior medical officers and seventeen medical officers (with five-year

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and three-year post-qualification experience respectively). The nursing personnel consist of a trained pediatric nurse and 40 trained staff nurse midwives. The hospital patients consist of private fee-paying patients and staff/ dependants of private companies, which have retained the services of the hospital. The patients therefore represent various strata of the society cutting across social classes, religions and ethnic groups. The place of residence of majority of the patients extended from the immediate location of the hospital to a distance as far as 50km approximately.

St. John’s Catholic Hospital, Agbor

St. John’s Catholic Hospital started as a Maternity Home in 1953 by Sr. Lazarian, an Irish OLA sister. It was an out station clinic of St. Philomena’s Catholic Maternity Hospital Dawson Road Benin City. The Hospital is situated at Agbor within the local community of and around Alika Street, just five minutes’ walk from the ever busy old Lagos-Asaba Road in Ika South Local Government Area of Delta Stat. It is easily accessible by all means of transportation; pregnant women in labour can easily walk to the place. It is a very popular hospital among the natives, income earners, small scale business people, self-employed, artisans, petty traders, hawkers and peasant farmers. It is a ‘grass-root’ hospital. A forty bedded hospital, neat with respectful and dedicated staff, the hospital sees and  treats about  six thousand  patients and  delivers about  three hundred  babies yearly. It offers comprehensive health care services; Health Education, dietary Education; preventive health care, screening for HIV, breast, cervical and prostatic cancers; medical diagnostic cancers; medical diagnostic investigations, weight management, curative, rehabilitative care and women’s  health. The  hospital has a bed space of 160 which comprises a female ward, male ward, paediatrics ward, a maternity ward. St. John’s Catholic Hospital meets the Mission statement of the catholic health services in Nigeria – To share in the healing ministry of Jesus Christ through provision of health services that are based on a holistic approach and respect for human life.

Eku Baptist Hospital, Eku

Eku Baptist Hospital is situated at 1st  Urhusi Road, Eku a town in Ethiope-Eastlocal Government Area of Delta State. Founded in 1945 by the American missionaries. Eku Baptist Hospital blazed a trail in Medicare in Nigeria. American Baptists did a great job of providing health care services which made Eku the Mecca of healthcare in the region.

The  American  missionaries  left  the  country  in  1998  and  handed  over  the  hospital administration to the Nigerian Baptist convention (NBC).The hospital has a bed space of

235 which comprises a female ward, male ward, paediatrics ward, a maternity ward, different theatres, and different laboratories, and pharmacies. The hospital is now treating some 270 Leprosy patients and has about 3000 registered patients who have been cured of which some 80% retain some form of disability.  Because of their disabilities and/or permanent damage to their immune systems, these patients are a great burden to the available resources of the Delta State TBL Control Program. With an estimated 7000 TB patients in Delta Sate. The wards have modern hospital beds, shiny marble floors, while the walls are beautifully painted with cheery colours and designs. Each ward also has its own toilets and bathrooms. There is also a new integrated 20-bed capacity Accident and Emergency Ward; 10 each for males and females. The ward incorporates independent units like a laboratory, pharmacy, theatre, medical records office, and sleeping-in rooms for  doctors,  nurses,  and  other  healthcare  practitioners  are  there.  There  is  also  an integrated ultra-modern dental unit.

Holy Family Catholic Hospital lkom

Holy Family catholic hospital is situated beside holy family parish corner lkom, Cross River. The hospital was established by Irish priest bishop Magretic in 1956 to share in the healing ministry of Jesus Christ through provision of health services that are based on a holistic approach and respect for human life. The hospital is currently having 261 beds and it is managed by the diocese of Ogoja

Daughter of Charity Rehabilitation Hospital Ogan

Daughter of Charity Rehabilitation Hospital is situated at Ossiomo in Ogan,  Edo state. The hospital was established by Daughter of Charity of St. Vincent de Paul in 1976 providing care for the most abandoned in the society is the priority for the Daughter of charity of St. Vincent de Paul. The hospital is 104 bedded and is currently managed by Sr.  Elmamary Ekewuba  who  is working  round  the clock to  see that  efficiency and effectiveness is maintained

St Theresa Catholic Hospital and Maternity Isselu-Uku

St Theresa catholic hospital and maternity is situated at Ukpai in Issslu-Uku,  Aniocha

North local Government Area of Delta State. The hospital was established by Catholic

missionary in  1965  to  ensure safe delivering  and to  assist  the sick.  The hospital is currently having 85  beds and  it  is managed by Mrs V. Nwazomor who  is ensuring efficiency in service delivery

St Elizabeth Catholic Hospital and Maternity Umunede

St Elizabeth Catholic Hospital and Maternity is situated at old road in Imele quarters Umunede in Ika North- East local Government Area Owa of Delta State. The hospital was established by Catholic missionary in 1944 to ensure safe delivering and to assist the sick. The hospital is currently having 43 beds and it is managed by Sr. Rolex Ekon who is ensuring efficiency in service delivery in the society

Our lady Fatimal Catholic Hospital Rumukurushi

Our Lady Fatimal is situated at 39 Elelenwo Road, Rumukurushi, Obio/Akpor, Port Harcourt in River State. The hospital was established by Catholic missionary in 1961 to ensure safe delivering, to assist the sick and share in the healing ministry of Jesus Christ through provision of health services that are based on a holistic approach and respect for human life. The hospital is currently having 154 beds and it is managed by Sr. Perpetua

St. Joseph’s Catholic Hospital Asaba

St. Josephs Catholic Hospital Asaba, is situated at number 142 Nnebisi Road in Oshimili south local Government Area of delta State. The hospital was established by OLAsister in

1956  to  care  for  the sick  and  the  needy through  Medicare  and  general  health  care delivery. The hospital is currently having 84 bed spaces and it is managed by Sr. Anthonette Adone

St Mary Catholic Hospital Ogwashi Uku

St.  Mary  Catholic  Hospital  is  situated  at  Ogwashi-Uku  in  Aniocha  South  local

Government Area of Delta State. The hospital was established by Catholic missionary in

1955 to ensure safe delivering and to assist the sick share the healing ministry of Jesus Christ through provision of health services that are based on a holistic approach and respect for human life. The hospital is currently having 146 beds and it is managed by Mrs. J. Ikem who is ensuring efficiency in service delivery

1.10    Operational Definition of Terms

For the purpose of clarification and understanding of this study, some concepts require operational definition.

Business Policy: Business Policy defines the scope or spheres within which decisions can be taken by the subordinates in an organization (Wikipedia, 2012).

Environmental  turbulences:  Bower,  Christensen,  Hamermesh,  Andrew  and  Porter (1995) describe environmental turbulences as the increasing rate of changes. Specifically those related to technology that make increasingly difficult to identify causes or predict results of competitive initiatives with reasonable certainty.

Hospital Management: Hospital management is process of mobilizing and deploying resources for the efficient and effective provision of health services.

Mission Hospitals: Mission hospitals are seen as non-government, non- profit making organizations that provide health services and owned by religious institutions

Model: Redmond (2009) describes a model as a plan, design, pattern or representation to be followed in the achievement of a particular task. It is a perfect example or an excellent example that deserves to be imitated.

Open system: An open system is a system that regularly exchanges feedback with its external environment (Katz and kahn, 2004).

Service Quality:  Lewis and Booms (1983) define service quality as a measure of the

degree to which the service delivered matches customer’s expectations

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