cross cultural managment in bangkok hospital

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CROSS CULTURAL MANAGMENT IN BANGKOK HOSPITAL

KAIYAN QIN

A THEMATIC PAPER SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF MANAGEMENT

COLLEGE OF MANAGEMENT MAHIDOL UNIVERSITY

2014

COPYRIGHT OF MAHIDOL UNIVERSITY

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Thematic paper entitled

CROSS CULTURAL MANAGEMENT IN BANGKOK HOSPITAL

was submitted to the College of Management, Mahidol University for the degree of Master of Management

on

December 21, 2014

……….….…..………

Asst. Prof. Peter De Maeyer, Ph.D.

Advisor

……….….…..………

Assoc. Prof. Annop Tanlamai, Ph.D.

Dean

College of Management Mahidol University

……….………….…..………

Mr. Kaiyan Qin Candidate

……….….…..………

Asst. Prof. Winai Wongsurawat, Ph.D.

Chairperson

……….….…..………

Asst. Prof. Pornkasem Kantamara, Ed.D.

Committee member

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ACKNOWLEDGEMENTS

I would like to use this opportunity to express my gratitude to everyone who supported me throughout this Thermatic Paper, without support from the following person I would not able to accomplish this work.

Above all, I would like to express my kind thank to Assoc. Prof. Dr. Peter De Maeyer, my thematic paper advisor for his guidance, support, and suggestion given to me along the way to complete this paper. My family has always given me their support throughout the course, as always, for which my mere expression of thanks likewise does not suffice. Also, I would like to extend my sincere thanks to all interview participants who contributed their valued of knowledge and experience on this research.

I would like to acknowledge the academic and technical support of the College of Management, Mahidol University (CMMU) and its staff which provided the necessary support for this research. Apart from that, I also would like to thank all of my teachers and friends for a memorable friendship for almost two years in CMMU.

Kaiyan Qin

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USE OF LEADERSHIP STYLES & THEIR INFLUENCE ON EMPLOYEES’

PERFORMANCE IN A SMALL COMPANY

KAIYAN QIN 5649123

M.M. (GENERAL MANAGEMENT)

THEMATIC PAPER ADVISORY COMMITTEE: ASST. PROF. PETER DE MAEYER, Ph.D., ASST. PROF. WINAI WONGSURAWAT, Ph.D., ASST. PROF.

PORNKASEM KANTAMARA, Ed.D.

ABSTRACT

According to the 2013 annual report of Bangkok Hospital Medical Center, we have welcomed more than 800,000 patients in which 200,000 are foreigners. In terms of revenue, foreign patients contribute almost 40% of total revenue of Bangkok Hospital Medical Center. In terms of human resource, Bangkok Hospital Medical Center has a dedicated international marketing department in charge of oversea market, which has total 15 head count, in which mostly are foreign employees. Here brings the interesting part of the study, the team (international marketing department) found some obstacles while working with other department. In this research, I would like to find out what is/are going wrong and provide possible recommendations.

KEY WORDS: BANGKOK HOSPITAL/ CROSS CULTRUAL/ MANPOWER MANAGEMENT/ OPPORTUNITY/ OBSTACLE

19 Pages

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LIST OF TABLES

Table Page

4.1 Typical Patient Travel Flow Inside Bangkok Hospital 10

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CHAPTER I INTRODUCTION

Bangkok hospital (Bangkok Medical Services Public Company Limited) was founded on 26th February 1972 with initial registered capital of 10 million Baht.

In the year of 1991, Bangkok hospital listed on the Stock Exchange of Thailand.

Over the past few years, Bangkok hospital has become the largest private hospital operator in Thailand through acquisitions. In year 2013 it is the top 3 medical service provider in world. Currently Bangkok hospital has about 35 network hospitals throughout Thailand and Cambodia. Bangkok hospital owns 6 brand names, they are:

Bangkok Hospital group, Samitivej Hospital group, Phyathai Hospital group, Paolo Memorial Hospital Group and BNH Hospital.

Thailand has being rated the most popular tourists destination for years, every year millions of tourists come to visit Thailand. With the great number travelers, Bangkok hospital sees the business opportunities as its starts focus on „medical tourists‟.

BMC (Bangkok Medical Center) where the HQ located, is dedicated to serve international patients, provide them one stop service, from medical treatment till travel route advise, hotel booking, air ticket booking even Visa service all can be done by BMC service team. Recent years (according to annual financial report) about 40%

of BMC revenue is contributed by international patients.

Thanks to the rising numbers of international patients, BMC sees its limitation of using Thai staffs to service international patients. Firstly, communication problems: some countries may able to communicate in English, but some others are not.

Secondly, cultural and custom: only the native person can understand and use the best way to treat patients.

Lastly, promote Bangkok hospital into other counties: native people will have better understanding of their people‟s consumer behavior; they will have much

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more efficient way to promote Bangkok hospital service into their home country. So BMC decide open its gate to welcome foreign staffs, most of them being recruited into Customer Services and correspondent Team. Some staffs also being recruited for Marketing and Business Development.

With the rising number of foreign staffs, its puts a huge challenge to the hospital management system, different country has different culture and working style.

How to manage those employees and create synergy with Thai employees has become a hot topic internally.

For this study, I would like to find out what issue has happened internally, how I could understand those issue and hopefully I could find out some solutions to solve those problems.

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CHAPTER II

LITERATURE REVIEW

There are quite a lot of studies on cross-cultural issues, but before talk about cross-culture management, I would like to starts with my recognition towards Thai culture.

Firstly, the Thai culture is characterized by high power distance (Hofstede, 1980), so the social level differences among people are quite significant. Komin (1990b) found that the Thai social system is first and foremost a hierarchically structured society. Thai society is a vertical society compare to most western societies are horizontal societies (Pornpitakpan, 2000). For example, children are taught to respect their elders. One of the most iconic symbolize shows respect in Thai society is

"wai." It is also the traditional Thai way of greeting in which one places the hands together as if praying. The hands are supposed to go lower or higher depending on the rank of the person who receiving the "wai." High level of power distance also can be explained by who should starts a "wai” and who should receive a “wai” (Textor, Bhansoon Ladavalya, & Prabudhanitisarn, 1984; Keyes, 1987). For example, a professor will never supposed to starts a wai to a student, however, she/he may return a “wai” if he/she received a “wai”. The younger person is supposed to starts a "wai" to the elder; however, the superior would never offer “wai” to the subordinate even though the subordinate is older.

Social differences in the Thai culture also have a lot to do with gender differences. Traditionally, women have lower social status compare to men. However, today many middle and upper-class women work outside the home and have become professionals or the owners of major commercial enterprises. Educational also serves as an indication of position: within the national society (Keyes, 1987). The people who do go on to tertiary education assume a quite different class-linked status depending

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on which Thai educational institution they attend and whether they obtain college and university degrees abroad.

Secondly, the Thai culture is characterized by low individualistic (Hofstede, 1980) which can be reflected in values of the “parent-child relationship”, calling someone dad or mom is quite normal in Thai, when you trying to show your close relationship and respect senior. For example, employee normally calls its manager as “mai/pao”, and manger calls her/his staffs as “luke”.

The kindness and gratefulness behavior is highly valued in Thai society (Komin, 1990b). This is characterized by "Bunkhun" (indebted goodness), which means, "out of sheer kindness and sincerity" (Komin, 1990b), gives help or favors to another person, who remembers and returns the kindness (Komin, 1990a, 1990b;

Niffenegger et al., 2006; Pornpitakpan, 2000). Bunkhun is not limited by time or distance and "should not and cannot be measured quantitatively in material terms"

(Komin, 1990b).

Thirdly, the perception towards uncertainty shows highly avoidance (Hofstede, 1980). Thai people are really careful about what they are saying; they like to carry out “appropriate” communication. For example, when meeting someone at the first time, Thais automatically employ the correct pronouns and postures of respect, deference, and intimacy. Politeness and tact dominate acquaintance-level relationships.

There is one extreme example: most foreigner think Thai people are not honest, however, this also can be explained by uncertainty avoidance. As they answer yes to all you request (in the mind set of shows respect and avoid conflict), does not means they truly agree. Principles, rules and policies are likely to be less important for Thai people, and it is quite common for them to change their decisions and behaviors according to the situation. The flexibility and adjustment is an important element in maintaining smooth social relationships.

One more phenomenon, if you have living in Thailand long-term, you may find out that Thai communities can get along pretty well with other ethnic group, especially Chinese. This can be also understand by utilize smooth interpersonal relationship, and flexible and adjustment in order to get well with others (Komin, 1990a, 1990b).

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Lastly, Thai culture is characterized by low masculinity (Hofstede, 1980).

This is why Thai people give others feeling of warm, gentle, smiling and easy going.

Due to Thai people value on non-assertive and non-competitive. Often we can found out a successful Thai person expresses a lower opinion than is probably deserved of her or his own ability, knowledge, skill, successes, etc.

Older Thai people are not happy when younger people argue with them or give more critical opinions than requested. Many Thai people would prefer not to say anything if their comments tend to lead to conflict.

Despite their reputation for being gentle and smiling, Komin (1990a) claims that Thai people "have big egos and a deep sense of independence, pride and dignity. Violation of this 'ego' self, even a slight one, can provoke strong emotional reactions". The ego things also can be understand by face-saving, avoidance of criticism and the Kreng jai attitude (Komin, 1990a, 1990b).

Another iconic value in Thai, and the most difficult to be understand by foreigner is the “Kreng jai” attitude. Its means "to be considerate, to feel reluctant to impose upon another person, to take another person's feelings (and 'ego') into account, or to take every measure not to cause discomfort or inconvenience for another person"

(Komin, 1990b). This way of behaving is observed by all Thai people, whether with superiors, equals or subordinates. It is found even in more intimate relationships, such as between husband and wife, and among close friends (Komin, 1990a, 1990b). When evaluating or judging other people, making sure the other person does not 'lose face' is most important, regardless of the other person's rank (Komin, 1990a). Conversely, 'giving face' can help to strengthen and smooth a relationship (Punturaumporn, 2001).

It is difficult for Thai people "to separate ideas/opinions from the person holding those ideas. Therefore, criticism, particularly strong criticism, is usually taken personally.

Criticism of whatever type is a social affront, an insult to the person" (Komin, 1990a).

Therefore Thai people avoid criticism, and try to use indirect means of conveying their ideas/opinions.

Most Thai social interactions are pleasant, light, might be superficial, yet fun and humorous in nature. Joyful behaviors can be observed in any Thai party, which is usually characterized by small talks, gossips, jokes, teasing one another, making fun of all kinds of non-personal inconsequential things and events … in a

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clever, humorous and amusing fashion (Komin, 1990b). This love of fun in personal interactions extends into the workplace (Mabry, 1979).

Despite the general study of Thai society, there are also few studies do the comparison on the genders. How the difference of Thai female and Thai male behaved (Amazing Thailand: Organizational Culture in the Thai Public Sector, written by Nattavud Pimpa). The findings are rather interesting, mostly confirmed what Hosfstede‟s finding, with some further development.

The study shows that there is a significant different in gender of the masculinity. Thai male with high level of education shows more aggressive and goal- driven than their colleagues, and they also more respect gender equal rights.

In the aspect of individualism, the study also shows that the people who work in public sector shows their collectivistic since their young, however, when they reach high positions; they have turned to be individualism. This seems like conflict with Hosfstede‟s finding as it shows Thai are collectivistic, however, it‟s not. It is just a side reflection of Thai people avoid conflicts and not challenge boss. When someone reaches high position, very few people able to be with him, so he turns to be individualism (lonely at the top).

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CHAPTER III

RESEARCH METHODOLOGY

In this research I would like to find out what are the causes make employees not communicate well in side organization.

For this thematic paper I am using Bangkok Hospital as a case study and I would like to conduct a qualitative research by using interview to check what the employees think about Bangkok Hospital. In order to make samples relatively more accurate, there will be a mixture of gender, career levels and nationalities.

Totally I am going to interviewed 6 people, with 3 males and 3 females.

Staff level employee 2 people, HOD level employee 2 people, manager level employee 1 people and director level employee 1 people. And they are from Thai, Greece, German and Russia.

All the respondents will have to answer following questions:

1. How long you have been working here?

2. Generally speaking, are you happy working here?

3. In terms of career, do you think foreign employees and Thai employees have the same amount of opportunities?

4. Do you think the information in side hospital can be well shared by employees?

5. In terms of fairness, do you think Bangkok hospital treat everyone equally?

6. Do you think management knows how to manage different cultural employees?

7. How do you feel when working with other nationalities? Do you have any obstacles?

8. Can you share with me some interesting stories that you think can contributing to this research?

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CHAPTER IV RESEARCH FINDINGS

Before talking about findings, I would like to state that due to 30% of the patients in Bangkok Hospital are foreigners, so employees here more or less are exposure to multi-culture environment. Therefore, the findings here may not able to apply in traditional Thai companies (where have very few amount of foreign employees).

For the second interview question, surprisingly every respond gives me positive answer, says they like working here. However, they may not be the true answer as Thai people value in giving positive answer in order to reduce conflict. For more details, i will explain in below paragraph.

4.1 Intranet does not function well

Every big organization will have their own internal web site, which can be access by staff only. And it is the same in Bangkok Hospital. The intranet plays a very big role in Bangkok hospital, it is a plant form where all the internal information being shared. It is good plant form, however, it is not behave well enough.

Most of information inside is in Thai, this makes foreign employee really headache. Due they lost the opportunities to acquire information. Make things worse, the documents which contains in Thai are normally very important, like strategies, management job transfer, and hospital products information etc. without those important information, it is very difficult to get synergy from foreign employees, because they don‟t even know what direction Bangkok Hospital want to go.

Let me make an example to explain how important intranet is, and how it‟s fall to serve foreign staffs. There is a build-in function call E-phone, basically is a contact list for internal use. The entire program inter face are in English however,

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staffs name and position are recorded in Thai, if they are Thai nationality. This makes foreign user feels hopeless, because the program can help them to find result, however, they cannot read. Due to all information are in Thai.

4.2 Miss communication

Thai people are very soft and indirect during communication; this is because their cultural teach them to do so. They will not telling you what they truly think, they will tell you yes to your entire request, under the name of avoid conflict.

To back up my saying, I would like to share a story from my respondent.

Once he stills an interpreter in Bangkok Hospital, he being call up to deal with a hot temper patient. He being told that the patient is very rude and yelling in the room. So he went to visit patient and try to find out what was went wrong. After several minutes of investigation of nurse and patient, the result turns out to be quite interesting. The nurse is Thai nationality and patient is European. It happened during lunch time, nurse deliver lunch for patient, however, the soup is cold, the patient don‟t want cold soup, he wants warm soup, so ask nurse to change him a warm soup, of cause patient using English to communicate with nurse. Due to Thai cultural, the nurse respond yes, even she don‟t understand what the patient talking about, and leave the patient room with a smile. At this moment, nurse is thinking, there is microwave inside patient room, so he can warm up soup by himself; patient is thinking, the nurse says yes to my request, and smile at me before leave my room, so she will for sure bring me a new warm soup.

After half an hour waiting, when both party understand each other differently, then the issue happened.

4.3 Manpower is not well allocate

As a hospital, in service industry, things have to be customer oriented or patients oriented. This sounds easy however, not easy to do.

According to internal figure about 35 % of revenue is generated by foreigner in Bangkok hospital. So there have a lot of foreigners are recruited as

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customer service. Interpreter department for example, currently they have about 150 full time + part time interpreters (most of interpreters are foreigners) supporting more than 30 languages. There are 2 things I discover seems to be wrong in this department.

Firstly, in order to manage such a big number of employees require great skills, especially management and planning skills. Why management? Because we are human not machine, everyone has its own mind set, to make these 100+ people working together seamlessly is very tough, moreover, these people are from different nationalities with different cultural background.

Let‟s move on to planning, why planning? This have to link to nature of business, forecasting the number of patients every day is not easy, which directly affect to efficiency manpower allocation. In order to have a relatively accurate plan, a lot of planning skills and experience has to be involved.

Secondly, manpower is not very well allocated into foreign patient service cycle. Every foreign patient service is heavily depending on interpreter department.

For example, new potential patients call to hospital call center or write hospital an Email to make a reservation, the call center has to transfer to call to interpreter department because they don‟t speak foreign patient language, or they may forward the Email to interpreter department, ask to help translate, after they knows what patient want, they will reply Email and still ask interpreter to translate. This makes interpreter department extremely vital in the service cycle. However, when interpreters are busy doing their own job (help communicate with doctor and patient), who will take care new potential patients?

Above explanation may be difficult to be understood. Here I would like to use service touch point to explain this issue. Please refer to the table below:

Table 4.1 Topical Patient Travel Flow Inside Bangkok Hospital

TOUCH POINT JOB TASK

Call center / Email team Booking appointment with doctors or inquires

Bellboy Escort patient to registration

Registration / Information Create patient profile Clinic nurse counter Arrange patient to meet doctor

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Table 4.1 Topical Patient Travel Flow Inside Bangkok Hospital (cont.)

Doctor room Treatment

Clinic nurse counter Prepare document before patient go to cashier Cashier Collect money (cash or credit card) Pharmacy Provide medicine and inform patient how to eat

Bellboy Call taxi for patient

*above table shows a typical Out Patient journey in Bangkok Hospital

According to job description of interpreter, they only need to present in the doctor room. Other touch point of service flow, interpreters are required to assist by phone when they are free. Mind you, the real situation in side hospital are not interpreter provide help to other touch point, is that, interpreter have to do it otherwise, and the whole medication service cannot perform.

Now try to imaging that you are a foreign patient, they very first thing you want to do before you decide go to any hospital is go online or call them to acquire information. So you will send an Email or call to Bangkok Hospital, unfortunately, no one in the Email team or contact center could speaking in your language, so your call will be transfer to interpreter department (Email will be forward to interpreter department too), interpreter can answer your some general questions, however, they do not have any authority to do things, even like make a doctor appointment, they cannot do it. Interpreters have to send you request back to contact center, let staff there to accomplish the job.

Now let‟s say, you have successfully arrived in the clinic that you have booked, now you have to contact nurse and tell them you are here and need to meet the doctor, however, this will not easy, because the same thing, no one speaks your language.

And the same thing will goes on and on. All the problems happened because nobody speaks your language. Currently management thinks that interpreter department just a sort of „contingency plan.‟ They didn‟t know how important interpreter is, and how to use them.

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4.4 Thai nurses are Thai

Despite the close relationship between patients and customer services, another key position to maintain a good service flow is nurse. As I have mentioned above, due to lots of foreigners in customer service position, there are not much cultural issue, however, when patients contact nurses that is another story. According to Thailand laws and regulations, foreigners almost impossible to get nurse registration(because all the exam paper are in Thai language only), so it is not surprise to see all the nurses in Bangkok Hospital are Thai even itself claim to focus on international market.

Thai values have great impact on nurses day to day behavior due to all of them are Thai nationality. When they deal with foreign patients, it is difficult to keep a pleasant service cycle. Because sometimes cultural difference really creates problems.

For example, handing over things by using left hand to Arabic people considered to be very rude in Arabic cultural. However, without cultural training, staffs in Bangkok Hospital do make this mistake. So when it‟s happened, Bangkok hospital needs to spend money and manpower to solve problem.

4.5 Managers lack of cross-cultural background

It is quite difficult for someone to understand other cultural or different behavior, if he/she has never been exposing to other cultural. As in Bangkok Hospital, they have patients from all over the world, different cultural and behavior plays quite significantly.

In order to maintain smooth service flow, managers play important roles in term of allocating manpower and understand customer need. However, due to uniqueness of industry, most management positions are obtained by doctors or nurses.

And according to current laws and regulations, it is very difficult to have foreign doctors and almost impossible to have foreign nurses.

For doctors, most of them who work in Bangkok Hospital are have over sea education background, so they will not experience too much cultural shock, however, for nurses, they are educate in Thailand by using Thai language, this make

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them hardly have any cross-cultural awareness. Unfortunately, they are the one who spend most of time with patients.

4.6 Different working style

Cultural has great impact on how to individual will behave. Thai cultural value in “sak nook” (have fun), “zhai yan” (take your time) and “grin zhai” (don‟t be offensive and respect).

Above values of cause translated in to Thai staffs behavior. That‟s why they can make fun in their job, not taking seriously. They perform task quite slow, because they don‟t like quite, always take their time. And finally, they don‟t like to show their opinion, because they don‟t want to offend anyone, they just followed whatever they senior people says, they believe senior people always right.

However, these working styles cannot understand by foreign employees, because they don‟t share the same cultural. And to contrast goes on extreme when actually a western employee has to work with a Thai employee. Because western cultural is exactly opposite compare to Thai cultural. They are serious in working, concerning in efficiency; once to decide where to go, they will move very fast; and they like to provide Their personal opinion, they think team work is everyone participate including to decision making process.

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CHAPTER V

RESEARCH DISCUSSION

5.1 Improve intranet

Intranet plays an important role in Bangkok Hospital. It is a plant form where the information can be shared, from top management to first line employees, from old employees to new recruit employees and cross department information sharing. All of this relies on intranet.

With such important task that intranet has to perform, so to improve the quality of intranet becomes vital. i understand that, most of its employees are prefer to use Thai, however, Bangkok hospital still have huge number of foreign employees who not able to read Thai. Therefore, i would like to advise Bangkok hospital starts to use both English and Thai to share information on the intranet. Make sure all information in the intranet is bilingual.

5.2 Provide English skill training

Most nursing schools in Thailand are teaching in Thai language, so it is not surprise to see that, most of nurses in Bangkok Hospital cannot speak English.

However, there are more than 30% of patients and not Thai in Bangkok Hospital, how could Bangkok Hospital provide quality service to foreign patients?

Here I would like to advise Bangkok Hospital conduct routine English training course to employees, and award them if their English level get improved. Also Bangkok hospital should setup a minimal requirement for English skills, make sure all the employees can pass that minimal requirement. So that, when nurses serving foreign patients, nobody will become bottleneck.

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5.3 Conduct service flow chart

For every service business, the most important thing is provide service that meet customer needs, and if you can, provide some additional features that can surprise your customers (surprise in a good way). However, before create surprise, you have to make sure that you already perform well in your main business.

The other important rule is that service providers have to keep in mind is that, your customer is human, they are not machines and you need to have certain levels of flexibility in your service, because every human is different from the other.

In order to full feel customer needs and better allocate man power inside Bangkok Hospital. Here I would like to advise to conduct or create a service flow chart. Choose 1 extreme OPD patient and 1 extreme IPD patient, to find out what they need and how our service people interact with them. By using this, every employee‟s role is clearly identified and then the manpower allocation issue will be solved.

5.4 Provide culture awareness training

The cause to cultural shock/issue is people from different cultural background have different behavior, and this behavior cannot be understood if they don‟t share the same culture.

So in Bangkok Hospital, in order to ensure its employees able to deliver a quality service, I would like to suggest that, Bangkok Hospital should perform routine cultural training to employees, especially to those who direct contact with foreign patients.

By doing so, employees will feel less cultural shock and more comfortable to handle foreigners.

5.5 Provide management training

Due to uniqueness of hospital business, so it is not surprise to see doctors and nurses to sit in management positions. Because they are naturally have better understanding of hospital products.

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However, promoting medical employees into management position also has its limitations. Doctors and nurses mostly only have medical background, when they perform their job as a doctor or nurse, they only need to manage only 1 or few people. But when the time they sit in management position, they have to manage dozens or hundreds of people. In this case, known how to planning and forecasting shows vital, really is a huge challenge to anyone who don‟t have any management back ground.

Thus, I advise Bangkok Hospital to provide management training course for newly promoted employees, in order to help them to know how to manage, planning and forecasting.

5.6 Starts job rotation

The reason why people don‟t understand or feel strange is because they are not familiar with that. So in order to solve working style difference issue, I think can be solved by using job rotation.

Once the job rotation starts, employees will start to work with different workmates and of course Thai native people will have more chance to work with foreigners. Thus they have more chance to expose to each other, when the time goes on they will become more and more familiar to each other. Therefore, the working style problem will become less and less of an issue.

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cross cultural managment in bangkok hospital