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ORIGINAL ARTICLE
Year : 2015  |  Volume : 9  |  Issue : 1  |  Page : 4-8

Knowledge, attitude, and practice of basic hospital management principles among medical doctors in Lokoja, Nigeria


1 Hospital Management Nigeria, Rutany Services Limited, Lokoja, Nigeria
2 Federal Neuro-Psychiatric Hospital, Benin-City, Nigeria

Date of Web Publication21-Aug-2015

Correspondence Address:
Ohireimen Ohioze
Hospital Management Nigeria, Rutany Services Limited, Lokoja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.163326

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   Abstract 

Background: Good management skills are required by medical doctors to offer optimal service to clients (patients). Though doctors are often managers, basic hospital management principles are lacking in the training curriculum, and may affect how they organize multi-disciplinary teams or units in synergizing healthcare delivery.
Aims: This study sought to determine the level of knowledge, attitude, and practice of management principles among private and public medical doctors in Lokoja.
Materials and Methods: A cross-sectional study of 160 medical doctors using a pretested 23-item closed-ended questionnaire. Descriptive and bivariate analyses (using the Chi-squared, Pearson's correlations and Students' t-tests) were performed to compare categorical and continuous outcomes respectively.
Results: A total of 70.9% of respondents were found to have a high knowledge of basic management principles, 80.6% had a positive attitude toward management principles while only 35.6% of respondents actually used formal management principles in their administrative work. Public sector doctors had significantly better knowledge (P < 0.001), positive attitudes (P < 0.003), and higher level of practice (P < 0.004) compared to private sector doctors. There was a positive linear relationship among knowledge and attitude (R = 0.47), knowledge and practice (R = 0.33), and attitude and practice (R = 0.38).
Conclusion: Public sector doctors had higher knowledge and better attitudes toward management principles compared to private sector colleagues. Low levels of practice of basic management principles were seen in both groups. This study sets the groundwork for future research.

Keywords: Attitudes, doctors, hospital management, Nigeria


How to cite this article:
Ohioze O, James BO. Knowledge, attitude, and practice of basic hospital management principles among medical doctors in Lokoja, Nigeria. Ann Nigerian Med 2015;9:4-8

How to cite this URL:
Ohioze O, James BO. Knowledge, attitude, and practice of basic hospital management principles among medical doctors in Lokoja, Nigeria. Ann Nigerian Med [serial online] 2015 [cited 2020 Mar 29];9:4-8. Available from: http://www.anmjournal.com/text.asp?2015/9/1/4/163326


   Introduction Top


Management is a process consisting planning, organizing, actuating, and controlling performance to determine and accomplish organizational objectives by the use of people and resources. [1] Management is not just common sense. It is codified experience. It is an organized body of knowledge. Management is the dynamic, life-giving organ of the institution it manages. [2] Service institutions like hospitals are formal organizations and need management like business organizations. The differences in management between hospitals and other organizations may be theoretical rather than practical. [2]

In today's world, healthcare management is becoming extremely important and large health organizations face increasing demands for leadership and system change. [3] This has led to a growing acknowledgment that doctors need to develop leadership and management competencies to become more actively involved in planning, delivery, and transformation of patient services. [4] Previous surveys have noted that doctors generally hold a positive attitude towards the subject of management and management development. [5],[6],[7] In Nigeria, medical education is primarily regulated by the Medical and Dental Council of Nigeria under the Medical and Dental Practitioners Decree No 23 of 1988. With 26 fully accredited and four partially accredited medical schools in Nigeria graduating about 4,000 doctors annually, [8] Nigerian health institutions/hospitals still seem to be poorly managed. {16} This could be because many Nigerian medical schools still utilize a version of the curriculum adapted from the original form introduced by the University College, London almost 60 years ago. [9]

A previous survey in the United Kingdom and Portugal that established the opinions of medical students and other medical educational stakeholders on the value and structure of management and leadership courses in medical schools also concluded that leadership and management education is relevant to medical students. [3] Similarly, a National Medical School Survey carried out in 2012 by the Federal Ministry of Health of Nigeria, captured the opinions of executives, lecturers and students of eight medical schools about their curricular and graduate competencies. It discovered a general lack of managerial and entrepreneurial skills among medical doctors in Nigeria and saw health administration and management as an area needing improvement in the medical curriculum. [10]

This study aimed to determine knowledge of basic management principles, as well as attitudes and practices of these principles among doctors working in public and private hospitals in Lokoja, Nigeria. It also sought to determine the relationship among knowledge, attitudes, and their practices.


   Materials And Methods Top


Study design

The study was conducted in Lokoja. Lokoja is a small metropolitan area and is the capital of Kogi State in North-Central Nigeria.

The target population for this study was medical doctors in the public and private medical sectors in Lokoja and its environs. The inclusion criteria allowed House Officers, Medical Officers, Resident Doctors, Consultants, and General Private Practitioners with no age limit to participate in the study. The total target population was 251.

Sampling and sample size

Krejcie's table [11] was used to determine a sample size with 20% added for nonresponse giving a value of 182. Stratified sampling technique was used to select 37 private doctors and 145 public doctors.

Survey instrument


The survey instrument used was a questionnaire designed by the researchers. It contained four sections and is available from the authors on request.

Section 1: Bio-data

This section contained 8 questions used to establish the demographic particulars of the respondents.

Section 2: Knowledge of management principles

This section contained 5 items. Questions had true, false or don't know responses. Respondents were asked to tick the box with the correct answer. Each correct response got 1 point. Incorrect and "don't know" responses received no point. The correct answers for each respondent were calculated. The higher the score obtained, the higher the level of knowledge of management principles. The scores were divided into 3 categories. Low knowledge: 0-1, fair knowledge: 2-3, and high knowledge: 4-5. [12]

Section 3: Attitude toward management principles

This section contained 5 items each in a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) indicating the extent to which the respondent agreed with the statement. Low, medium, and high scores were calculated using the formula (Max-Min/3). Since there were 5 Likert scale questions to evaluate attitude, the minimum score was 1 and a maximum score was 25. The scores were divided into 3 categories. Low attitude: 1-8, medium attitude: 9-17, high attitude: 18-25. High scores indicated a positive attitude. Low and medium scores indicated a negative attitude.

Section 4: Practice of management principles

This final section of the questionnaire also had 5 items each in a 5-point Likert scale (1 = very unlikely of me, 5 = very likely). These questions indicated the extent to which the respondents applied management principles in their administrative duties. The minimum score was 1 and the maximum score was 25. These were categorized into 3. Low practice: 1-8, medium practice: 9-17, and high practice: 18-25. Higher scores indicated positive management principles practice

Questionnaire validation and reliability

The questionnaire was validated by a small team of experts. This team included a resident doctor, a medical consultant, a Masters of Business Administration graduate and an academic lecturer. This was done to ensure that the questions were simple enough for medical doctors to respond to without undue mental stress. The subscales showed good reliability with a Cronbach's alpha of 0.90 (knowledge), 0.85 (attitude), and 0.85 (practice).

Data analysis

The data analysis in this research was done with the use of tables, graphs, and charts. Descriptive and bivariate statistics was used to calculate percentages, mean scores, and standard deviations. Chi-square tests and Students' t-test (using the mean values) were used to compare the Knowledge, Attitude, and Practice (KAP) as dependent variables with the type of practice (public or private) as independent variables. Pearson correlation coefficient was also used to test the strength of relationship between the research variables.


   Results Top


A total of 182 questionnaires were distributed to respondents. 160 (87.9%) of these were returned. This number formed the basis on which the results were analyzed.

The demographic detail of the respondents is shown in [Table 1]. A majority; 128/160 (80%) of the respondents are males. Over 51% (N = 83) of the respondents had <5 years of experience. 19.4% (N = 31) of respondents are medical doctors with over 16 years clinical experience. Most were public sector doctors 78.1% (125/160).
Table 1: Bio-data of respondents

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In a majority (115/160, 70.7%) of the respondents rated their level of management knowledge as average. Only 19.5% (N = 31) rated their management knowledge as high. 9 (5.3%) respondents rated their knowledge was low while 7 (4.5%) did not respond to this statement.

Sixty-three (39.9%) respondents agreed to ever receiving management training. A majority; 70.9% (113/160) of the respondents had a high knowledge of management principles. 80.6% (129/160) had a positive attitude toward management principles while 19.4% (N = 31) had a negative attitude. In section 3 of the questionnaire, majority (54.4%) of the medical doctors strongly disagreed with the statement that a doctor without formal management training will make a poor manager/administrator. Only 35.6% (57/160) had high practice of formal management principles in their nonclinical duties.

Public sector doctors had significantly higher scores in all KAP variables when compared to private sector doctors. 98/125 of doctors in public service had significantly higher knowledge of management principles compared to 15/35 doctors in private practice (X2 = 16.65 P < 0.001). 86% (107/125) of public doctors as against 62.9% (22/35) of private doctors held positive views to management principles (X2 = 9.054, P < 0.003). 41% of public doctors actually used management principles when performing administrative duties and only 14% of private doctors used management principles administratively (X2 = 8.397, P < 0004 [Table 2].
Table 2: Comparison of KAP scores between doctors in public and private practices

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Public sector doctors had a higher mean knowledge score of 4.03 when compared to private doctors (mean score 2.51) with a statistically significant difference (T = 4.6265, df = 158, P < 0.001). Public sector doctors had a higher mean attitude score of 21.20 when compared to private doctors (mean score 18.60) with a statistically significant difference (T = 3.5833, df = 158, P < 0. 0.001). In addition, public sector doctors had a higher mean score of 15.88 when compared to private doctors (mean score 13.11), with a statistically significant difference (T = 3.2597, df = 158, P < 0.001).

The relationship among knowledge, attitude, and practice of management principles among medical doctors in Lokoja was tested using the Pearson correlation test. There was a small but positive correlation between knowledge and practice (R = 0.33, P = 0.01), between attitude and practice (R = 0.38, P = 0.03). There was a much stronger relationship between knowledge and attitude (R = 0.47, P = 0.002).


   Discussion Top


Studies on the knowledge, attitude, and practice of basic management principles among medical doctors in Nigeria are few. Majority of doctors in the study had never had any form of management training despite the fact that over 70% of them perceived their level of management knowledge as average. This high percentage of average management knowledge perception may be due to the fact that many people feel that management knowledge is equivalent to common sense. The duration of training given to the majority is hardly enough to earn the least qualification in management education, a National Diploma in management that takes 24 months.

Though, the study showed that medical doctors in Lokoja generally possess a high knowledge of basic management principles, as well as a positive attitude toward management principles, only one-third of them actually apply the formal knowledge of management principles when performing nonclinical tasks. The apparent high knowledge scores may be due to the fact that the questions were made as simple as possible to encourage doctors (who are generally busy people) to participate in the study. However, there was a knowledge-practice gap of 70.9-35.6%. It appears that despite the seemingly high knowledge of basic management principles, many doctors have not translated their knowledge into practice. This may be explained by Bloom's Taxonomy of Cognition. [13] Many of these doctors may not have passed through the stage of simply having head knowledge to comprehension and then to application of that knowledge.

The finding of an 80.6% positive attitude is similar to that of Gatrell and White [7] who reported a 30:70 split between doctors against management and those favorably disposed to management. It is worthy to note that in spite of a general positive attitude, slightly more than 1/2 (54.4%) of the medical doctors strongly disagreed with the statement that a doctor without formal management training will make a poor manager/administrator. It could, therefore, mean that doctors probably feel that management could be based on intuition and experience rather than on formal learning.

This study also revealed that public sector doctors had significantly higher mean scores in knowledge, attitude, and practice of management principles when compared to their private colleagues. A bias in sampling and an over-representation of public service doctors could account for these differences.


   Conclusion Top


There is a growing acknowledgment that doctors need to develop management competencies to become more actively involved in planning, delivery, and transformation of patient services. [4] This is similar to a recent article, which advocated for the creation of a chief executive officer (CEO) position in tertiary hospitals. The CEO will be a medical doctor with management qualifications and experience. [14] This study also agrees with the conclusion of the National Medical School Survey. [10] The senate of the various Nigerian universities should expeditiously accept and implement the new draft medical curriculum developed by the Federal Ministry of Health in 2012. This will prepare future medical doctors for their role as doctor-managers of health institutions. Further research in this area to address issues that were not handled in this study is required.


   Acknowledgments Top


Thanks to Mr A.A. Adefokun (ANIMN,) the research consultant for this work, Dr. A Okoyomo; Dr. Yinka Amusan; Dr. Bidemi Owa, and Dr. (Mrs) Norbertta Anegbe.

 
   References Top

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2.
Drucker PF. Management Tasks, Responsibilities, Practices. New York: Truman Talley Books/E. P. Dutton; 1985.  Back to cited text no. 2
    
3.
Martins HM, Detmer DE, Rubery E. Perspectives on management education: An exploratory study of UK and Portuguese medical students. Med Teach 2005;27:493-8.  Back to cited text no. 3
    
4.
Abbas MR, Quince TA, Wood DF, Benson JA. Attitudes of medical students to medical leadership and management: A systematic review to inform curriculum development. BMC Med Educ 2011;11:93.  Back to cited text no. 4
    
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Palmer R, Spurgeon P, Clark J. Doctors in management: Career views. Health Serv J 2001;111:269.  Back to cited text no. 5
    
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Walker R, Morgan P. Involving doctors in management. A survey of the management development career needs of selected doctors in NHS Wales. J Manag Med 1996;10:31-52.  Back to cited text no. 6
    
7.
Gatrell J, White T. Doctors and management - the development dilemma. J Manag Med 1996;10:6-12.  Back to cited text no. 7
    
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Obom-Egbulem K. Medical School Curriculum Too Old, Says Momoh. Available from: . [Last accessed on 2013 Sep 10].  Back to cited text no. 8
    
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ANPA Provides Technical Expertise For Curriculum Review For Nigeran Medical And Dental Schools. Available from: . [Last accessed on 2013 Sep 23].  Back to cited text no. 9
    
10.
Federal Ministry of Health of Nigeria. Health Systems 20/20 Project. September 2012. Nigeria Undergraduate Medical and Dental Curriculum Template. Health Systems 20/20 Project. Bethessda MD: Abt Associates Inc.; 2012.  Back to cited text no. 10
    
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Sample Size Table - The Research Advisors. Available from: accessed on 2013 Sep 23].  Back to cited text no. 11
    
12.
Rajna A. Financial management attitude and practice among medical practitioners in private and public medical services in Malaysia. Int J Bus Manage 2011;6:105-13.  Back to cited text no. 12
    
13.
Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR, editors. Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook 1: Cognitive Domain. New York: David McKay; 1956.  Back to cited text no. 13
    
14.
Ogunrin B. Who Should Be Chief Medical Director? Available from: . [Last accessed on 2013 Sep 23].  Back to cited text no. 14
    



 
 
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    Materials And Me...
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