TABLE OF CONTENTS
Page
Declaration – – – – – – – – – ii
Approval – – – – – – – – – iii
Dedication – – – – – – – – – iv
Acknowledgements – – – – – – v
Table of contents – – – – – – vi
List of Tables – – – – – – – – – x
List of Figures – – – – – – xi
Abstract – – – – – – – xii
CHAPTER ONE
- Background of the Study – – – – – 1
- Statement of Problem – – – – – 4
- Objectives of the Study – – – – 5
1.4 Research Questions – – – – – 6
1.5 Research Hypotheses – – – – – 6
1.6 Significance of the Study – – – – – 7
1.7 Scope of the Study – – – – – 7
1.8 Limitations of the Study – – – – – 8
1.9 Profile of the Selected Mission Hospitals under Study – 8
1.10 Operational Definition of Terms – – – 12
References
CHAPTER TWO
REVIEW OF THE RELATED LITERATURE
2.0 Introduction – – – – – 14
2.1 Conceptual Framework – – – – 14
2.1.1 The Purpose of Policies – – – – – 15
2.1.2 Characteristic of Business Policy – – – – 16
2.1.3 Element of Business Policy – – – – 16
2.1.4 Types of Policies – – – – – 17
2.1.6. Implementation of Business Policy – – – 19
2.1.7 Objectives of Business Policy – – – – 20
2.2 Theoretical Framework – – – – – 20
2.2.1 Introduction – – – – – 20
2.2.2 Open System Model – – – – – 20
2.2.3 Characteristics of Open Systems – – – 24
2.2.4 Open Systems Management – – – – 25
2.2.5 Closed-System Models: – – – – 25
2.2.6 Business Environment – – – – 27
2.2.7 Characteristics of Environment – – – – 29
2.2.8 Classification of Environment – – – – 30
2.2.9 External and Internal Environment of Business – 30
2.2.10 Classification Based on the Rate of Change – – – 31
2.2.11 Nigerian Business Environment. – – – 32
2.2.12 Environmental Effect of Businesses – – – 33
- Types of Environment faced by Business Organizations 33
2.2.14 Impact of Public Policies on Businesses – – 37
2.2.15 Open systems and Environments – – – 39
2.2.16 Nature and scope of hospital – – – 39
2.2.17 Functions of the Hospital – – – 40
2.2.18 Service Quality and Open Business Policy in Hospitals 41
2.2.19 Increasing Patient Satisfaction and Quality of Care – – 42
2.2.20 Challenges in the Administration of Mission Hospital – 43
2.2.21 Human Resource Management as a Profession in Mission Hospitals 45
2.2.22 Role of Human Resource Management in Hospitals – – 46
2.2.23 Human Resource Requirements in Hospitals: – 49
2.2.24 Causes for Poor Human Resource Management – 49
2.2.25 Manpower Planning – – – 50
2.2.26 Benefits of Manpower Planning – – – 50
2.2.27 Objectives of Manpower Planning – – – 51
2.2.28 Teamwork – – – – – 51
2.2.29 Team-building among Health Care Professionals – 52
2.2.30 Association among Health Care Professionals – 53
2.3 Empirical Review – – – – 54
2.3 .1 Introduction – – – – – 54
2.4 Summary of the Related Literature Review – – 56
Reference
CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction – – – – 61
3.2 Research Design – – – – – 61
3.3 Sources of Data – – – – – 61
- Instruments for Data Collection – – – 62
3.5 Population of the study – – – – 62
3.6 Sample Size Determination and Sample Technique – 64
3.7 Sampling Procedure – – – – 66
3.8 Validity and Reliability of Instrument – – 66
3.8.1 Validity of instrument – – – – – 66
3.8.2 Reliability of Instrument – – – – 66
3.9 Data Treatment Techniques – – – 66
References
CHAPTER FOUR
PRESENTATION AND ANALYSIS OF DATA
- Introduction – – – – – 69
4.1 Questionnaires Distribution and Response – – 69
- Hypotheses Testing – – – – – 91
4.3 Discussion of Results – – – – 103
CHAPTER FIVE
SUMMARY OF MAJOR FINDING, RECOMMENDATIONS AND CONCLUSION
5.1 Summary of Major Finding – – – – 110
5.2 Recommendation – – – – – 111
5.3 Conclusion – – – – – 111
5.4 Contribution to Knowledge – – – – 111
5.5 Areas for Further Research- – – – – 113
Bibliography – – – – – 114
Questionnaire – – – – – 118
Appendix 1 – – – – – 123
Appendix 11 – – – – – 137
Appendix 111 – – – – – 138
Appendix
1V – – – – – 139
LIST OF TABLES
Table 1 Population of staff – – – – 63
Table 2 Sample size allocation – – – – 65
Table 4 Question distribution and response – – – 69
Table 5 Distribution of respondents by Gender – – 70
Table 6 Distribution of respondents by Age – – – 71
Table 7 Educational Qualification of Respondents – – 72
Table 8 Marital Status of Respondents – – – – 73
Table 9 Work Experience of the Respondents – – 74
Table 11 Objective One To what extent is the quality of service to patients
in the mission hospitals dependents on having a suitable open system
business policy model – – – 75
Table 12 Objective Two What is the relationship between open system
business policy model and the management of human resource in
the mission hospitals – – – – – 78
Table 13 Objective Three What are the reasons for failure in service delivery among mission hospitals – – 82
Table 14 Objective Four What is the utmost challenge of adopting business
policy models in mission hospitals – – – – 85
Table 15 Objective Five What are the benefits from utilizing open system
business policy among mission hospitals – – – 88
LIST OF FIGURES
Figure 1 Basic open system model – – – 22
Figure 2 Overview of the open system of an oganisation – 23
Figure 3 An organisations environment – – – 38
Figure 4 Environmental factors surrounding a hospital employee and
industrial employee – – – – – 48
Figure 5 Pie chart Representing respondents Gender – 70
Figure 6 Bar chart Representing respondents Age – – 71
Figure 7 Bar chart of Educational Qualification of Respondents – 72
Figure 8 Pie chart of Marital Status of Respondents – 73
Figure 9 Bar chart of Work Experience of Respondents – 74
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
- 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 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). (www.managementhelp.org/orgs).
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. www.nou.edu.ng/pdf/pdf2/mpa%207)
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.
- 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.
