Impact of management on employees communication in medical and hospital centers in Sarajevo

© 2013 Munib Smajoviæ et al.; licensee University of Sarajevo Faculty of Health Studies. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UNIVERSITY OF SARAJEVO FACULTY OF HEALTH STUDIES INTRODUCTION In those relationships a person sends and receives messages, behavioral cues, in short it communicates. Communication is an integral part of human relationship process and originates from the human need to establish contacts with others and in the process to gain self-understanding and direction about his own behavior. Also, communication generates emotional satisfaction, a result of establishing of relationships, as well as a consequence of feeling connected and being part of a group (1). Poor communication between patients and healthcare providers frequently occurs in today’s healthcare practice (2). If a patient becomes dissatisfi ed with a provided service, it is less likely that it will use that type of service in the future. Dissatisfi ed patient will more likely use services that satisfy its emotional needs than the ones that satisfy his medical needs. In addition, an unhappy patient is more likely to want ABSTRACT


INTRODUCTION
In those relationships a person sends and receives messages, behavioral cues, in short it communicates.Communication is an integral part of human relationship process and originates from the human need to establish contacts with others and in the process to gain self-understanding and direction about his own behavior.Also, communication generates emotional satisfaction, a result of establishing of relationships, as well as a consequence of feeling connected and being part of a group (1).Poor communication between patients and healthcare providers frequently occurs in today's healthcare practice (2).If a patient becomes dissatisfi ed with a provided service, it is less likely that it will use that type of service in the future.Dissatisfi ed patient will more likely use services that satisfy its emotional needs than the ones that satisfy his medical needs.In addition, an unhappy patient is more likely to want Impact of management on employees communication in medical and hospital centers in Sarajevo to seek to get another physician or avoid healthcare services, potentially leading to endangering his/her own health (3).Improvements in the area of communication are an important factor in the process of providing healthcare services.Th e communication improvements aspect is in a signifi cant degree dependent on the leadership style (4).If a manager cannot satisfactorily to address his job needs, the resulting stress and confl ict will make him dissatisfi ed, ultimately leading to diffi culties in making decisions and concentrating, loss of motivation, lack of enthusiasm and similar.If widespread such systemic defi ciencies aff ect the healthcare system: healthcare workers and patients.Consequently, the quality of service can decline, indirectly exposing the patients to the consequences of stress (5).Managers and those in the healthcare management roles who work with people need to understand human behavior in order to correctly address relationship challenges and better utilize human resources while striving to achieve organizational and professional aims (6).Th e aim of this study is in advancement in the communication processes, especially in the domain of management psychology and organizational effi cacies that could be improved through a better effi cacy in managing healthcare facilities.

METHODS
Th e study consisted of a sample of 52 study subjects from the Clinical center at University of Sarajevo who were at the time of the study employed at the functions of chief and/or lead medical nurse/technician.Th e subjects were placed in two groups, according to their gender.Th ere were 34 (65.38%)female subjects.Th e second sample of the subjects was drawn from the employees from Healthcare clinic in Sarajevo Canton.64 subjects were included.Th e subjects drawn were from the functional roles of chief and/or lead nurse/technician.Our sample consisted of 38 (59%) females.All participants voluntarily participated in the study that started in January 2011 and lasted until February 2012.Survey method and a method of a theoretical analysis were used in the data collection and processing.
Th e Survey method is a descriptive modality that aims to collect data with help of appropriate instruments and techniques, and processes the information gathered with certain statistical processing techniques.After the conducted analysis the relevant conclusions were derived.Th ere are numerous sources and implementations for the theoretical analysis method.In this study the key focus was on general and the subject specifi c literature in the fi eld of management phycology and the fi eld of healthcare facilities organization and operation.Applying this method, we tried to indicate, where and when possible, the theoretical and practical importance of the key factors that arose from the realized empirical study of work practice in the investigated segment of the healthcare system.Th e participants in the study did a self-assessment of the level of importance of skill developments for managers.Th e self-assessment consisted of 13 questions/indicators. (Appendix 1).Th e questions related to the infl uence of management on their leadership role in leading the healthcare institutions, to what type of competence such persons should have and to the communication among team members.Th e participants were asked to mark with "X" one of the off ered answers: 'I completely agree with this' -A, 'I agree with this' -B, 'I'm not certain' -C, or 'I don't agree' -D, 'I completely disagree' -E.Typically, this kind of assessment is called a fi ve-step process of Likert type.Th e participant's categorical data type answers, in the data processing step, were converted to the following numerical values: In 6 out of 13 statements (questions: 2, 4, 6, 8, 9 and 10), the answers were scored on a reverse scale.Th e maximum possible total score for this survey was 65 and the minimum 13.A high total indicates on a high and a low score on a low value of management development initiative.Participation in the survey was voluntary and anonymous with the written consent provided by the directors of Clinical center at University of Sarajevo and the Healthcare clinic in Sarajevo Canton.Same questionnaire and the data collection style were used in both facilities, not to introduce any systematic diff erences between the two study groups.Moreover, from the point of the subject of the study, there was no a-priori reason to believe that one facility is diff erent from the other in any employment based, professional or management factor that was relevant for our study.

Participants from Clinical center at University of Sarajevo
Of the total number of the participants, 52 (100%), from the Clinical center at University of Sarajevo 34 (65.34%) were females .Based on the research conducted and the analytical data processing it was determined that there was no statistically signifi cant gender diff erence about the general opinion about the value of development of managers, as a factor that aff ects communication in healthcare (t-test score equals 2.213) (Table 1).Th e detail scores for the individual indicators are given in Table 2.   nurses should be deciding who should lead a healthcare institution.On the other hand, the lowest score of 77 goes to the indicator fi ve, which is about the claim that the management role is a responsible and demanding job.

Th e results given in
Figure 2 shows the occurrence frequency for the type of answers given by the participants.Th e answer 'I completely disagree' is the most dominant in 8.22% of the participants, 'I don't agree' in 8.49%, 'I'm not certain' in 17.99%, 'I agree' in 19.69% and 'I completely agree with this' in 45.61%.Figure 1 shows the total frequency of the occurrence of different type of answers.

Participants from Healthcare center from Sarajevo Canton
Among the participants from the Healthcare center from Sarajevo Canton 38 (59%) were females and 26 (41%) were male.Th e study shows that there was no statistically signifi cant gender diff erence about the general opinion about the value of development of managers, as a factor that aff ects communication in healthcare(t score equals 2.210) (Table 3).
Th e detail scores for the individual indicators are given in Table 4. Indicator No. 13 doctors and nurses should be deciding who should lead health institutions, not politics and politicians show results got the highest score at 280.Th e indicator number 5, 'Managerial role in healthcare is an important and a high responsibility function', ranked the lowestat 102 (Table 4).Th e study shows that 12.89% participants answered 'I completely disagree' as the most dominant answer, 8.91% had 'I don't agree', 11.85% had 'I'm not certain', 19.68% 'I agree' and 46.57% had 'I completely agree with this' as the most dominant answer.Figure 4 shows the total frequency of the occurrence of diff erent type of answers for the participants from Healthcare center Sarajevo Canton.

DISCUSSION
Communication is a form of most commonly thought about as interaction among live beings.Th us it is not very appropriate to include as a form of communication exchange of information among objects, e.g.data exchange among computer systems.
A quality personal interactions and relationships, in the professional domain as well, do not form accidentally, but as a result of quality communication and mutual respect (7).A quality communication and group work generate opportunity for new ideas and problem solving, due to effi cient exchange of experience and knowledge (8).Managing, as a concept, is about managing human resources and utilizing the most eff ective usage for those resources, as well as about making organizationally critical decisions.A number of studies show that the knowledge and skills about successful managing are universal, even though some analysis have shown that managers in healthcare fi led tend to be more successful if they have some clinical experience (9).Healthcare system is somewhat specifi c in that aspect that most of the managers come from the ranks of healthcare professionals.Such managers can be more successful in development of healthcare practice that would champion quality communication with patients (in an indirect way) and the healthcare professionals employed in the team (in a direct way) (10).
Comparing the study results from the two participating medical institution, we determine that there is no statistically signifi cant diff erence in the frequency of the 'I completely agree with this' answer, while the answer 'I completely disagree' is higher for APPENDIX 1. Below statements express a range of different attitudes towards the value of dealing with the management of health institutions.We expect that in the appropriate column with an X mark the extent to which you agree or disagree with any of the listed claims: Table 2 indicate the indicator 13 as the one with the highest score, at 235.Th e indicator suggests that the physicians and medical

TABLE 1 .
General opinion about the value of development of managers, as a factor that affects communication in healthcare.The data given is for the Clinical center at University of Sarajevo.

TABLE 2 .
Study results for Clinical center at University of Sarajevo FIGURE 1. Occurrence frequency for different type of answers given by the participants in Clinical center at University of Sarajevo.

TABLE 3 .
General opinion about the value of development of managers, as a factor that affects communication in healthcare.The data given is for the Healthcare center Sarajevo Canton.

TABLE 4 .
Detail study results for Healthcare center Sarajevo Canton.
Absolute and relative score comparison of the distribution of scores across the thirteen indicators for the two healthcare institutions.