Maladministration and its impact on healthcare services

Introduction

Before one can talk on maladministration and its impact in Healthcare Services there is need to look at the term Health and Healthcare Services. Originally, the World Health Organisation (W.H.O) (1947) defined health as “a complete state of physical, mental and social wellbeing of an individual and not merely the absence of disease or infirmity”. The original definition was amended to reflect the evolution of the concept, thus in 2002 at Ottawa Conference health was accepted to mean the extent to which an individual or group is able, on one hand to realize aspirations and satisfy needs on the environment.

According to W.H.O (2015), health services include all services dealing with the diagnosis, or the promotion, maintenance and restoration of health. They include personal and non-personal services. Health services are the most visible functions of any health system both to users and the general public. Service provision refers to the way inputs such as money, staff, equipment and drugs are combined to allow the delivery of health interventions.

Mumbor (2007) opined that health services is a goal directed process and methods in which healthcare personnel and other resources are organised and financed with varying degrees of formality, they strive to meet the health needs of people and community. Okiro in Mumbor(2004) also defined health services as a service that is society accepts some, however limited responsibility for their availability and performance, they minister unto the ill/sick, seek to prevent disease and set goals for the maintenance and promotion of health services.

On the other hand, maladministration in health services , according to Advice Services Alliance (2012) it include delay, incorrect actions, failure to provide information, misleading or inaccurate statement. Maladministration as the lack of care, judgment or honesty in the management of an organisation. Osemwota(2007) said that maladministration include ‘bias, neglect, inattention, delay, incompetence’. Maladministration in health services occurs if the patient or individual suffered because he or she received poor services or treatment or were not treated properly.

Conceptual framework

According to Akpala (2010), maladministration in healthcare services involves failing in the way an action or decision has been taken, or where the healthcare giver or administrator has not taken action when it ought to have been done. It is a broad term and could include unjustified delay, unfair discrimination, failure to abide by agreed procedures in place, failure to carry out legal duties and treatment that does not respect dignity and human rights.

Oyibo (2012) referred to maladministration in healthcare services as any activity, neglect, default or other practice that results in the healthcare provider or administrator not complying with the specified requirements for delivery of the healthcare profession, as set out in the relevant codes of practice where applicable. Oyibo (2012) further stressed that in practice, maladministration in Healthcare services is not normally deliberate though it can be perpetrated by healthcare personnel, administrators and healthcare certificate bodies.

In the opinion of Charns and Schaefer (2008), maladministration in healthcare services is the actions of healthcare professionals which can be seen as causing an injustice which include delay, incorrect action or failure to take any action, failure to follow procedures or the law, failure to provide information, inadequate record-keeping, failure to investigate , failure to reply, misleading or inaccurate statements, inadequate liaison, inadequate consultation, rudeness, bias, faulty procedures, offering misleading advice and refusal to answer questions.

History of healthcare administration in Nigeria

According to Mumen (2009), the modern health practice in Nigeria originated from British Army Medical Service which served British colonies and protectorate. The British Colonial gun boat diplomacy resulting in the formation of West African Frontier Force (WAFF) which needed medical services for her soldiers and the British masters required health services for colonial soldiers. These medical services were later extended to local communities new government stations.

The colonial medical services were later extended to colonial services – officers, their wards and relatives and communities before it was extended to native communities after Second World War. Lord Luggard development plan had first-hand plan for health for colonial Nigeria which enables the Anglo-Saxon Government to plan for effective health administration in Nigeria. A ten-year programme was designed as a catechism for subsequent healthcare programme for the people of Nigeria.

Akpala (2010) stated that the first and second development plan, in health sector, was designed to correct, some injustice and deficiencies that exist in health administration in Nigeria. The third National development plan was a deliberate attempt to draw up a comprehensive national health policy, dealing with issues of manpower development, provision of comprehensive health services based on basic healthcare services scheme, disease control and efficient utilization of health resources medical research, health planning and management.

Akinsola (2009) stated that 1978 saw the adoption of Alma-Ata declaration which emphasized community based participation. This means that the people in the grassroots must participate firmly in the provision of services at village level and street level through planning, implementing and managing the system through collective endeavour, it ramified self-reliance, and treated healthcare as an element of development. This means that community need not wait until a doctor is available before health services can be delivered.

In addition Osemota (2007) stated that healthcare services in Nigeria have evolved through a series of historical development, succession of policies, introduced by each Government. Traditional birth attendants also existed as a means of delivery of healthcare services to the people. 1988 reorganisation of the Federal Civil services presented an excellent opportunity for the crystallization of internal reorganisation of healthcare system in Nigeria. This reform were targeted at professionalization of ministries, it provided for three mandatory departments, personnel and management, finance and supplies, planning research and statistics.

Theories of healthcare management

Healthcare managers have the important task organisation administering entire healthcare systems, such as hospitals. Differing opinions exist as to how these healthcare systems should be run. The effectiveness of a hospital or other healthcare facility is dependent upon the type of healthcare management theory it subscribe to and how well that theory is implemented. According to Palmieri and Peterson (2009), the theories of healthcare management are as stated below:

Attribution theory

Attribution theory, as applied to healthcare management is a way of assessing the successes and failures of a healthcare system or programme. Palmieri and Peterson (2009) described Attribution theory as one possible healthcare management theory that can be used to create a safer environment for patients. Although not fully developed as a healthcare management theory, the authors suggest that Attribution theory can be used as a conceptual framework to foster a positive and safe work environment for both healthcare workers and patients.

Attribution theory assumes healthcare management can be improved by understanding that error in healthcare can sometimes occur. When it does it can lead to feelings of cynicism and “organisational inertial” in the healthcare system. By understanding where these feelings arise, healthcare managers can learn to foster positive work environment that will improve employee response to errors in healthcare. By learning to recognise these mistakes as simply “human” errors, healthcare workers can learn to focus on continuing to provide a positive environment for patient recovery rather than focusing on what they have not done successfully.

Evidence-based management

A second healthcare management theory according to Palmieri and Peterson (2009) is the evidence-based management theory. An evidence-based approach requires doctors, nurses and other healthcare professionals to make decisions based on the best available evidence. They stated that some researchers suggest that there is a need to impose these same standards on the decision-making process of healthcare managers. Stressing that doing so will bring a level of uniformity to the decisions of healthcare officials. Practical considerations such as time constraints and deadlines often make the transition from evidence-based theory to practice somewhat difficult.

Utilization management

Palmieri and Peterson (2009) stated that utilization management is third healthcare management theory, one that has received wider application in the healthcare industry than the more theoretical attribution and evidence-based theories. Utilization management is a proactive approach to managing healthcare through preset guidelines. The American College of Medical Quality (2010) identifies several tasks in the utilization management that are essential to effective management of a healthcare organisation. First, it is essential to determine the organisation’s priorities. This is followed by research and a determination of who will benefit from the major decisions that are made. From this information, healthcare managers then determine what goals to set and how to go about implementing further research. Once data is collected and evaluated, policies, guidelines and procedures can be developed and implemented.

Factors responsible for maladministration in healthcare services

David (2006) stated that the following are the factors responsible for maladministration in healthcare services:

Lack of organisational adaptation
Poor organisational allocation
Problem of co-ordination
Lack of organisational integration

Lack of organisational adaptation

This refers to the inability of the healthcare system to adapt itself to the external world and carry on an effective interchange with that world at all times. In order to reduce maladministration in healthcare services, the healthcare system must be able to respond successfully to relevant changes in its environment, to obtain resources and personnel, maintain advantageous relationship with its community and generally to influence its environment in the ways to benefit the system and its members.

Poor organisational allocation

This problem deals with the inability of the healthcare system to deploy, allocate and utilize the available resources which include facilities, fund and personnel in the most appropriate manner. To handle related problems of access to an information among the participants, also to ensure participation among the concerned in decision making process and question of allocation of task and functions among departments, groups and members.

Problem of co-ordination

Lack of proper cognitive-ordination of healthcare service system to articulate, interrelate and regulate the activities of various participants has resulted to maladministration of healthcare services. To continually coordinate in time and space in many diverse and interrelated activities of the different members. How the healthcare administrators do coordinates the activities for the doctors, nurses, accountant, laundry etc. to contribute to the healthcare, if the healthcare fails to do this, it fails to function as an organisation.

Lack of organisational integration

Lack of organisational integration possess problems to the healthcare system and deprived it the ability to integrate itself (unite itself). This will include all necessary functions associated with the problem of integrating the individual members into the organisation and securing the cooperation. It also includes integrating all parts. Also, development of common organisational values and shared norms, attitudes and mutual understanding must be integrated. Each members need to be socialized into the life of the organisation.

Adekunle (1998) also pointed out the following as factors responsible for maladministration in healthcare services.

Organisational strain
Poor organisational output
Poor organisational maintenance

Organisational strain

The presence of organisational strain and inability to resolve or minimize and manage the tensions and conflicts which must be addressed by the healthcare system lead to maladministration in the healthcare service if it must be effective particularly free from frictions and confrontations among the key groups. The key groups that are always having frictions are doctors and nurses and others. The healthcare administrators must also look at the strain among highly interdependent groups and members and among unequal status participants (nurses and cleaners, professional and non-professionals) healthcare administrators must try to manage stress and strain throughout the system, the healthcare administrators can set up grievance committees.

Poor organisational output

The healthcare services must possess the ability to reach and maintain high levels of output if it is going to be an effective organisation in terms of quality, quantity, acceptability and cost. The healthcare system deals with patient-care and provision of health services to the community, in order to attain the high level of quality, quantity, acceptability and cost, there must be qualified staff, enough staff, needs of the community must be met and at affordable cost. The problem of output will also involve the ability to maximise the efficient and reliable performance by all departments, groups and members. This assumes that a system of personal goal achievement and job satisfaction on the part of the members is entrenched.

Poor organisational maintenance

This is the inability of the healthcare system to preserve its identify and integrity as a distinct and unified problem-solving system or to maintain itself and its basic character and viability in the face of changes which are constantly occurring in its environment. The healthcare system must look for a way of maintaining itself to ensure efficiency

Bad attitude of health workers towards the actualization of health services

Poor attitude of healthcare services administers and healthcare workers according to Oyibo (2012), the collapse of public health sector in terms of provision of facilities and equipment as well as adequate manpower to cater for the teaming masses trouping into such places more or less their only succour and hope contributed a lot in the pharmaceutical shops which in disguise also provide hospital services. It is all part of the private sector driven economy and of course people have now come to terms with reality that working with Government establishment alone will put enough food on the table.

Health sectors which is no longer a social service but essential and protective service has suffered a lot of deprivation which include the exodus of doctors to greener pasture and the attitude of combining Government work and a private practice which is popularly tagged private practice syndrome. In essence they are combing the two works compromising one and aiding one to flourish and proliferate. The irony of private practice is such that it is the same people working in Government hospitals that operate the private hospitals and laboratories too and to the bewilderment of the masses, they work in the government hospitals for only few hours with no zeal and commitment to attend to patients need and before closing hours, rush to attend to clients at private hospitals and if they are on duty (on call) at Government hospitals, they hardly turn up because they are busy making money elsewhere. The same people at the end of the month will queue up to collect full salary and even at times expect increment, money they have not earned, justify and deserve to have (Oyibo, 2012).

The technicians and experts in the laboratories will come up with bizarre laboratory findings if working in Government laboratories, one may not be able to interpret and any meaning out of that result. But visit them at private laboratories, where they put in their best to attend to clients from government hospitals to private health industries. One will come across a medical doctor telling a patient that he may not be able to attend to him/her because of some pressing issues elsewhere, but will recommend the patient to a private hospital where his/her needs will be adequately catered for, only for the patient to go there and discover that the same doctor that attend to him/her at the Government hospital own or is a partner to that private hospital in question (Osemota, 2007).

The major problem bedevilling health sector is nonchalant attitude on the part of health workers combining 2 to 3 works at a time, thereby compromising their main responsibilities to patients with patience, care, love and affection.

The influence of maladministration in the healthcare system

Maladministration in the Healthcare system has a number of influence on quality of healthcare delivery resources and indirectly by not taking the best out of the healthcare providers in the delivery of healthcare services to the public, Smith (2006) furthermore, he stated the issue of maladministration in healthcare system has been the centre of various studies since the early 1960s, providing its influence on healthcare givers performance, as well as on their mental and physical health.

Smith (2009) highlighted some influence of maladministration in healthcare system they include:

Morale drop
Physical effects
Resources mismanagement
Lack of motivation
Poor quality of healthcare services

Morale drop

Maladministration as a result of poor administration by leaders who do not inspire the members of the healthcare services nor prove their abilities through rational and accurate administration can be the reason of low morale between individuals in the healthcare sector. Low morale can be subsequently leads to lack of discipline and will be very difficult for healthcare givers to give their best.

Physical influence

According to Patricial (2010), maladministration in the healthcare system can lead to physical influence as a result of poor leaderships, Patricial (2010) stated that a research on how maladministration in healthcare system influence service delivery show that an increase of systolic and diastolic blood pressure of nurses when they worked with supervisors they do not like, amplifying the risk of coronary failure, as well as the risk of stroke. In the same study the researchers also associate poor leadership and subsequent work stress with cardiovascular disease among healthcare givers and subsequently affected the quality of services rendered to the general public.

Resources mismanagement

Maladministration does not have an effect on healthcare system employees’ performance, but also on the administrators’ tasks. Managing resources, keeping a record of the healthcare organisation’s income and expenses, as well as the management of human resources, such as how shifts are scheduled are good leadership skills. Without these the healthcare system can face problems such as financial deficit, lack of raw materials and even low quality of health services rendered because of healthcare givers’ fatigue.

Lack of motivation

According to Olumide (2009), one basic type of leadership style in the healthcare sector is so called “buddy” who focuses on being nice to employees. Such leaders avoid confrontations and disregard negative issues, such as behavioural and performance problems. This can lead to lack of motivation on the employees behalf to try their best, since there is no penalty for below average results and no rewards for top managers.

Poor quality of healthcare services

Poor quality of healthcare services is one of the most common effects of maladministration in the healthcare system. This mostly stems from the fact that almost all management decisions affect the quality of healthcare rendered care givers in some ways. A happy excited manager affects the standard of healthcare delivered to the public by raising the spirits of the care givers. A micro managing manager hurts the quality of healthcare delivered by causing frustration in the care givers.

Possible solutions to issues of maladministration in healthcare system

Good management of healthcare system according to McFarland (2008) is the type of management which guides others through instruction and example. Good administration is a quality that is important in every aspect of an organisation especially in the healthcare system. Poor administration can cause many problems for healthcare administrators and for those who they manage. There will be a lack of direction, disorder, low self-esteem and motivation and a lack of discipline, which affects the quality of healthcare services rendered to people seeking healthcare services.

McFarland (2008) highlighted some solutions to the issue of maladministration in the healthcare system which includes the need for healthcare administrators to:

Building self-esteem of healthcare givers: Healthcare administrators should make healthcare givers and every other staff working in the health sector to feel important. Healthcare administrators should ask for their advice and suggestions from time to time, discuss subjects with them, compliment them, be willing to talk to them and show them respect.
Designing effective long-and-short-term plans: Effective organisation in the health sector is a key management tool. If health care administrators are well-organised, then other healthcare givers are more likely to follow their lead than if the healthcare administrators are in a state of disorder. Healthcare administrators should gather facts and information to allow them to plan ahead, placing key dates and events in a staff calendar.
Motivation: Healthcare administrators should motivate other healthcare professionals and make them feel essential to the overall process. They should learn what other healthcare service providers want to achieve and gain from their work. One person might want constant challenges while another might have a desire to be promoted. They should remember that recognition of achievements can be a bigger motivator than money.
Discipline when necessary: A healthcare administrators has to be able to deal with the bad as well as the good. They should improve on their knowledge of their staff and this can help them discipline them more effectively. Some people require healthcare administrators to be firm while others respond better to a suggestion of change. They should take the person aside and talk to them about the issue in a way that is not embarrassing, making sure to listen to their side of the story (Mumen, 2009).
Delegate effectively: A good healthcare administrator should be able to give others responsibility without trying to do everything themselves. They must think about whether a job could be done better by someone else or if it could free up time for you to take on another task. Delegation can make the healthcare administrators’ job easier and boost staff confidence and motivation.

References

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Akpala, A. (2010). Health Care Management: An Introduction and the Nigerian Perspective. UNN Enugu: Department of Management.

Charns, M. P. & Schaefer, M. J. (2008).Hospital Care Organisations. New Jersey: Practice hall.

David, P. (2006). Health Care Management. New York: Prentice Hall.

Mumbor (2004). Primary Health Care for Colleges/Schools of Health Technology: Ughelli. Mudis Press.

McFarland, D. (2007). Management Fundamentals and Practices (6^thed.)
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Mumen, L. (2009). Introduction to Health Administration in Nigeria. Lagos: Bemy Mark Books.

Olumide, A. (2009). Fundamentals of Health Service Management for Doctors and Senior Health Workers in Africa. Ibadan: Kenta Publishers.

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Palmieri, P. A. & Peterson, L. T. (2009). Advance in Health Management. New York: Sage Publishing.