CHAPTER ONE: INTRODUCTION
- Background to the Study
In the wake of the global financial crisis, governments have been searching for effective ways to increase efficiency within their operations, and one policy has emerged in response: a state that rolls back its powers to allow room for markets to respond (McCann, 2013). Governments throughout the world are striving to achieve great feats with less resources, attempting to allow for more market-based reforms and sometimes to cope with higher budgetary constraints. The attempts to modernize and gain value for money have led to a greater focus on private-sector management practices, resource frugality, and increased emphasis on performance management and output (Lapsley, 2009).
Public institutions and business organizations are in a constant flux. Whether the catalyst is provided by tightening environmental regulations, emerging IT innovations, stagnating profits, a decreasing market share, or any other contemporary or classic business interruption; organizations keep changing. It is this constant change that has enabled the proliferation of one particular form of business – management consulting (Nuorkivi, 2009,p1). Management consultancy is a management technique and practice increasingly seen as a global phenomenon. OECD (1993), Walsh (1995) refer to it as management services coming from external sources instead of providing such services in house. It involves legal agreement for the provision of services between a public organization and a private sector firm or between one public organization and another or between management and an internal work force who bid to provide such services in-house (Paddon, 1993; Sneath, 1993). The responsibility of the public organization is to specify what is wanted and let the private or voluntary sector provide it (Larbi, 1999).
Management consultancy represents more explicit efforts in the management and delivery of public services, especially where outright privatization, i.e, change of ownership, has not been possible (Savas, 1989). The rationale for consulting is to stimulate competition between service providing agencies in the belief that competition will promote cost-saving, efficiency, flexibility and responsiveness in the delivery of services (Savas, 1989). It also imposes discipline that results in improved performance (Isreal, 1987). Thus, according to Metcalfe and Richards (1990) management consultancy puts competitive market forces directly at the service of government.
Management consultancy may take the form, where government transfers to private providers the responsibility for managing an operation such as a water utility, railway or hospital, (Larbi, 1999). Under this management, assets are retained by the government, but the responsibility for managing and operating these assets is transferred to a private firm (Larbi, 1999). This, quoting World Bank (1994) would increase the autonomy of management and minimize the risk of political interference in the day-to-day operations of the public organization.
Management consultancy is an element of New Public Management (NPM) in public administration. It is a market-based solution to the delivery of services by the public sector. According to Blackmore (2014, p.1) “the reliance of public sector on private-sector management consultants has increased since the global financial crisis, with governments striving to find ways to increase efficiency and reduce costs to respond to both the international economic reality and the demands of the public”. It is this ethos that has borne the idea of engaging management consulting firms to spearhead the modernization process and act as effective agents of change within the public service (Blackmore, 2014).
According to ACCA (2010) management consultants may provide knowledge that helps clients take better decisions, bring experience in management that helps clients to execute their plans more effectively and bring skills to help improve the capability and team work of managers. Likewise, Nuorkivi (2009, p.1) opined that “management consultants make their mark in the ever-changing spaces and fleeting moments of organizational change”. He continued that while client organizations are supposedly experts in what they do normally, management consultants claim to be experts in different types of organizational ‘anomalies’ – instances, where the organization is shifting direction or changing pace in one way or another. When an organization is faced with a need for temporary tools, expertise, and manpower to support a change, a management consultant is often called in (Nadler & Slynotzky, 2005).
Consultancy intervention occurs when there is need for organizational reform. Sturdy (2011) captured it rightly when he stated that consultants are seen as key agents and symbols of contemporary social change and Thrift (2005) called them key generators and distributors of new knowledge.
This new knowledge tends to remove public administration from politics and thus from public scrutiny (Saint-Martin, 2004). Accordingly, Fincham and Clark (2002, p.1) claim that “this new knowledge has made millions of people to adjust to new ways of working” and as O’Mahoney (2010, p.2) added “new ways of thinking”. Qualitative outcomes such as helping to develop creativity and achieve radical organizational innovation have also been identified (Clegg et al, 2004).
Management consultants and the ideas they purvey are highly significant. “They exert such enormous influence on the modern world” (McKenna, 2006, p.7) “and the impact they have had on clients, their employees, and society at large cannot be denied” (O’Mahoney, 2010, p.2). Although management consultancy is not new to management in government, what is new is the extension of the practice to activities that have traditionally been carried out by in-house bureaucratic arrangements, including various activities within public health services (Larbi, 1999).
In Nigeria, research has shown that public health institutions do not perform their public service functions effectively and efficiently (Ogohi, 2014). These public health institutions like other public institutions in the country suffer from gross mismanagement and consequently resulting to inefficiency in the use of productive capital, corruption and nepotism (World Bank, 1991).
In the South East of Nigeria, government hospitals seem not to have performed differently. There seem to be apparent outcry by patients and customers on the quality of services rendered by these hospitals. There also seem to be a great deal of concern by the government on the poor revenue generation by these health institutions. All these suspected anomalies necessitated the need for solution and hence the evolvement of management consultancy.
Management consultancy is evolving in public health institutions in Nigeria especially in South East. Since the year 2012, three Federal and State owned hospitals in the region comprising of University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu State University Teaching Hospital Enugu and Nnamdi Azikiwe University Teaching Hospital Nnewi in a supposed bid to improve services and reposition these public health institutions in the path of profitability, accountability and administrative efficiency have engaged the services of a management consultancy firm known as HealthStation Hospital Management Information Service.
This consultancy firm was designed to meet the entire needs of public healthcare organizations in dynamic environments. They were expected to improve overall efficiency and revenue realization, initiate a comprehensive approach to the information of process and information management. According to Imene (2011), HealthStation is a healthcare solution service provider that is committed to preparing public hospitals to meet current and future challenges through leveraging on ICT. In that regard, an onsite facility-HealthStation Hospital Management Information Service (HMIS) was designed to meet the entire needs of public healthcare organizations in challenging and dynamic environments. The service provides for collective hospital resource planning with 24-7 access to information for effective hospital management as well as automated revenue collection, realization and reconciliation (Imene, 2011).
HealthStation Hospital Management Information Service was also consulted to facilitate the delivery of effective, patient-centric services and provide real-time access to vital hospital management information to management personnel and administration of the hospitals. Other tasks they were contracted to do to improve services include:
- Automation of core processes around Electronic Medical Records, Billing & Invoicing, Drug Inventory & Prescription Management, Laboratory Management, Radiology Management, Patient Clerking, Accounts & Collections Management, E-Payment and NHIS Management.
- Establishing a strong & stress tested business case for financing the entire service infrastructure, management & operational cost 100% for the healthcare institutions involved.
- Deploying IT infrastructure for high-availability service delivery.
- Deploying IT operations management personnel to run 24-7 shifts at the facility ensuring 100% service up-time and 100% infrastructure availability.
- Providing detailed personnel training programs initially and on an on-going basis and put in place mature change management processes to ensure initial and sustained entrenchment of the system into the facility.
- Providing high levels of system robustness, redundancy and reliability as well as friendly and intuitive user experience, and ease of extensibility.
- Helping the hospitals experience net increase in revenue (accretion) as a result of increased operational efficiency, transparency and revenue assurance (Imene, 2011).
In the light of this background, this thesis investigated the impact of the use of HealthStation Hospital Management Information Service in the administration of services in these noted public health institutions in the South East of Nigeria between 2009-2016. This study is justified because the period under review (2009-2016) represent the last few years the hospitals managed the administration of services themselves and the years they contracted the services to a management consultant. The research investigated under this period, the level of services before the engagement of the consultant and after its engagement. This is in a bid to discover the impact of the engagement of the consultant.
- Statement of the Problem
Public institutions are created in all countries of the world to accelerate economic and social development. Yet, increasing evidence indicates that most public institutions “either do not contribute strongly to national development or do not perform their public service functions effectively and efficiently” (Ogohi, 2014, p. 24).
Public health institutions in Nigeria fall under this category. They have been mired by problems identified as including inefficiency, non profitability and outright financial deficit, embellzement of public funds, low quality personnel and in fact total service failure. Public healthcare facilities are fraught with several challenges that are traceable to dwindling funding and subventions from government and other donor agencies. They are bugged down also by poor performance and massive wastages/leakages (Imene, 2011). These are some of the failures of public health institutions in Nigeria and indeed other sectors of the country’s public institutions. They have been mired with staff, inadequate in knowledge and use of information technology (I.T). These have resulted in poor quality of service delivery and escalating administrative costs. There have also been shortfalls in the revenue collection of some of these public health institutions due to inadequate supervision and corruption.
The seriousness of the consequences of these public health institutions’ failures demands very urgent attention to stem further drift. The attempt to find solutions that can avert possible collapse of these health institutions thus necessitated the engagement of management consultants. This study focused attention on the impact of the possible inputs of a management consultancy firm (HealthStation Hospital Management Information Service) in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State University Teaching Hospital, Park Lane Enugu and Nnamdi Azikiwe University Teaching Hospital, Nnewi. This paper therefore seeks answers to the following agitating questions:
- What reasons prompted the management of UNTH, ESUTH and NAUTH to engage HMIS?
- How has the engagement of HMIS improved the services of these public health institutions in the South East?
- In what ways have the engagement of HMIS in UNTH, ESUTH and NAUTH affected staff improvement in these institutions?
- What are the challenges encountered by HMIS in executing their duties in these public health institutions?
- How can these challenges be tackled to ensure enduring services in these public health institutions?
- Objectives of the Study
The general objective of this study is to evaluate the impact of HMIS consultancy on the administration of UNTH, ESUTH and NAUTH. The specific objectives are to:
- discover the reasons that prompted the management of UNTH, ESUTH and NAUTH to engage the services of HMIS.
- enquire how the engagement of HMIS has improved services in these public health institutions in the South East.
- examine how the engagement of HMIS in UNTH, ESUTH and NAUTH has affected staff improvement in these public health institutions.
- investigate the challenges encountered by HMIS in the execution of their duties in these public health institutions and
- proffer solutions to these challenges to ensure enduring services in these public health institutions.
- Significance of the Study
This study has both empirical and theoretical significance. Empirically, this study brought out the roles played by HealthStation Hospital Management Information Service in the management of public health institutions in the South East and recommended these roles and indeed consultancy concept to other public health institutions in other regions of the country for better efficiency and accountability.
The study highlighted the problems of management consultants and proffer solutions that will help management consultancy firms in improving their services and value and bringing more changes to their client organizations especially public health institutions in the South East Nigeria. It also brought out the reasons for the poor performances of the studied hospitals in the South East of Nigeria.
Furthermore, empirically, this study is relevant because of its exposure of a new reform to policy makers in government. Before now, privatization and commercialization have been the known and popular reforms used by
governments to address the inadequacies of public institutions. But, with the introduction of a new reform in the form of management consultancy, its roles and impacts having been clearly analyzed in this paper, policy makers will be given the opportunity of a new administrative option to curb the dwindling fortunes of public institutions. This study also enables the public to know the extent of the rot in her public health institutions and the reasons why government is engaging the services of a management consultant.
Theoretically, this work is relevant because it will serve as literature to future researchers thereby extending knowledge and frontiers of public administration. Again, this research is theoretically significant to the field of public administration because it brought out the importance and impact of management consultancy on the economy of nations and how it will help in enhancing national development. This conforms with our theoretical framework which states that total quality management which involves continuous improvement in quality of services in organizations through new work methods and practices should be advanced.
- Scope and Limitations of the Study
This work is about management consultancy firms and administration of services in public health institutions in the South East of Nigeria (2009-2016). Selected hospitals that have engaged the services of a consultancy firm known as HealthStation Hospital Management Information Service were studied; these include University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla, Enugu State University Teaching Hospital (ESUTH) Enugu and Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi.
In carrying out this study, there was apathy on the part of our respondents that is, the staff of the three health institutions being studied, as regards the filling and answering of our questionnaire and making available explicit information in their computer systems and records. This apprehension stemmed from the fact that since they are public servants they are not supposed to talk to an outsider or divulge vital information to a non member of their organizations. These invariably affected the duration of the research. However, the researcher eliminated or reduced the above limitations by getting permission from the institutions’ management for their staff to participate in the research and cooperate with the researcher to get accurate findings and results. More importantly the researcher relied heavily on secondary sources of data.