HOSPITAL ORGANISATION AND MANAGEMENT

1. DEFINITION:Hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering from or suspected to be suffering from a disease or injury. It may or may not provide services for ambulatory patients on an outpatient basis. (As per WHO expert committee definition, 1963) HOSPITAL ORGANISATION AND MANAGEMENT

2. OBJECTIVES OF A HOSPITAL: • To describe the framework for the organization's activities concerning health promotion as an integral part of the organization's quality management system. • To support patient treatment, improve prognosis and to promote the health and well-being of patients. • To ensure that the patient is informed about planned activities. • To support the establishment of a healthy and safe workplace, and to support health promotion activities for staff. • To ensure collaboration with relevant providers and to initiate partnerships to optimise the integration of health promotion activities in patient pathways.

3. FUNCTIONS OF A HOSPITAL: 1. Patient care: The primary function of the hospital is to provide observational, diagnostic, therapeutic and rehabilitative, preventive care to the patients. 2. Public health: Promoting public health is an important activity of hospitals. Prevention is always better than cure and the best way to keep the society healthy is to make them free from diseases. Hospitals through their public health activities help the community reduce the incidence of sickness, disease, injury, accidents and epidemics.

4. 3. Education: Hospitals are the best centers for initiating educational programs for doctors, nurses, pharmacists, laboratory technicians, dieticians and other health care professionals. Hospitals are involved in conducting in-service training and residency programs for the health care professionals. Many courses like medical, dental, nursing, pharmacy, radiology, laboratory technology, physiotherapy etc. are being conducted in hospitals. 4. Research: Hospitals are the best suited centers to carry on research activities on health related issues and subjects. Research is essential to control the new diseases and to develop newer techniques and methodologies in the treatment. Research will help to improve the services of the hospital.

5. CLASSIFICATION OF HOSPITALS: 1. Based on ownership and management: • Owned by the Central government • Owned by the State government: • Aided by the Central goverment/ State government / Union territory Owned by the Government agencies/ departments like -railways, public sectors, industrial units etc.: • Owned by the Defenceorganisations such as for army, navy or air force Private ownership: they may be further classified as- • Individual companies • Partnership firms • Mission/ Charitable trusts • Religious organisations • Corporations

6. 2. Based on Levels of care: • Primary level hospitals: It includes primary health centres (PHCs) and small clinics, which are small hospitals, providing first level of treatment. • Secondary level hospitals: Health care at these centres is provided to patients by a specialist, in a hospital setting, normally referred to by primary care centres. Direct access to the patients, without a reference is also allowed. A range of specialities including general medicine, general surgery, orthopaedics, etc. are available in the hospital. The taluk hospitals and district hospitals are examples of secondary care hospitals in India. • Tertiary care hospitals: It includes Medical colleges and speciality hospitals that are more complex, sophisticated and specialised. The patients of primary care hospitals and secondary care hospitals are referred to tertiary care hospitals where specialised treatments such as organ transplantations, open heart surgeries, neurosurgeries etc. are needed.

7. 3. Based on the size of the hospital: • Large hospitals: Having more than 1000 beds. • Medium hospitals: Having 500-1000 beds. • Small hospitals: Having 100-500 beds. • Very small hospitals: Having less than 100 beds.

8. 4. Based on the objectives: 1. Teaching hospitals with research facilities/ Medical Colleges: Teaching hospitals are established as a part of medical colleges in India and are regulated by the medical council of India. They are generally known as medical college hospitals. These hospitals besides offering patient care services, provides medical education and also possess research facilities. 2. General hospitals: The primary function of a general hospital is to provide patient services, diagnostic and therapeutic, for a variety of general medical ailments. They are designed to take care of the common and widely occurring health care issues of the society. 3. Speciality hospitals: Speciality hospitals provide diagnostic and therapeutic services for the patients who have specific medical ailments. Examples of speciality hospitals include TB hospitals, cancer hospitals, skin hospitals, obstetrics and gynaecology hospitals, psychiatry hospitals, eye hospitals etc. 4.Rehabilitative hospitals: These hospitals offer rehabilitative services to the patients such as alcohol and drug abuse dependence withdrawal, restorative and adductive services for physically disabled patients etc.

9. 5. Based on the system of Medicine: • Allopathic hospitals • Ayurvedic hospitals • Homeopathic hospitals • Unani hospitals • Acupuncture hospitals • Naturopathy hospitals • Yoga hospitals etc..

10. HOSPITAL ORGANISATION It is based on the following principles; • Team co-ordination : An individual supervises a professional team of medical/paramedical staff. • Division of services : Hospital undertakes a variety of activities-diagnosis, observational, treatment, rehabilitation or prevention. These activities are sub classified into various groups and sub groups and professionals are assigned to them. • Homogenous approach : Hospitals can cater to the needs of both ambulatory and bed patients. • Evaluation of services : The services provided are rated in terms of quality and adequacy. • Administrative responsibility : Responsibilities pertaining to management and professional duties are to be assigned properly • Budget preparation and financing : There should be a budgeting and planned program for capital financing. • Talent search : A hospital should be staffed by competent medical experts and non medical staff and for attaining this objective, the best talents available should be recruited. • Governing body : Each hospital has a top management which directs its course of action, provides policy guidelines and exercises overall supervision.

12. Management/Governing Body/ Corporation The legal status of a hospital is maintained by a society or trust or company named as board of trustees/ board of governors/ board of directors etc. Their chief objectives are as follows; • Responsible for functioning of hospital to provide high quality of patient care. • Maintain a standard of all the available facilities. • Remove all possible ambiguities and confusions. Their chief duties are as follows; • Adopt by laws in accordance with legal requirements and its responsibility to community. • Provide a procedure for selection of employees, adopt schedule of meetings and define attendance requirements and methods for documenting governing body proceedings. • Requires that medical staff establishes mechanisms designed to assure achievement and maintenance of high standards. • Shall appoint a chief executive officer whose qualifications, responsibilities, authority and accountability shall be defined in writing. • Provide institutional planning to meet the health needs of the community

13. The management/governing Body/ corporation is responsible for constituting various committees such as: • 1. Executive committee: Takes decision to form committees and task committees. They can act autocratically in emergencies. • 2. Joint conference committee: It is a combination of the representatives of the board and clinical services with the administrator as its secretary. It is a liaison committee. • 3. Professional committee: It is made of selected board members who study and make recommendations on all dimensions. The primary aim of this committee is to upgrade the quality of healthcare.

14. 4. Finance committee: • A finance committee is constituted to review the budget planning, financial statements and related problems. The financial resource of a hospital exerts influence on every patient, employees, trustees and the people who avail the service of the hospital. The sources from which the income may be derived for the hospital are: • Charges received from the patient (either paid by himself or by third party coverage such as central government scheme/insurance scheme etc.) against the hospital bills for the services rendered by the hospital to the patient. • Incomes derived from State/central government such as in government hospitals. 3. Incomes derived from investment endowment funds. 4. Incomes derived from gifts and contribution towards general functional expenses by friends and well wishers of the hospital. 5. Incomes received from research projects. 5. Human resource department: • This department is responsible for managing the human resources of the hospital, which includes services such as recruitment of new staffs for the hospital, addressing the grievances of the staff, arranging training facilities etc.

15. Administration department • The administrator is selected by the board to run the hospital. The administrator is a link between the board and the clinical services and between the board and all other employees. The chief functions of the administrator includes: • The administrator is privileged to attend the meetings of the governing body and medical staff. • He frames the overall administrative policies. • He is empowered to modify the internal organisation of the hospital. • He prepares a budget based on the approval of the governing body. • He ensures compliance of all the legal formalities.

16. Clinical departments 1. General medicine services: These involve general diagnosis, general medical and nursing care, psychiatry, cardiology, neurology, pulmonology, blood bank, urology, endocrinology, gynaecology, orthopaedics, immunology, gastroenterology, nephrology etc. 2. Pathology and clinical biochemistry services: Here medical testing of various samples of blood, urine, sputum, faeces etc. for the presence of pathogenic infection or abnormalities in biochemical parameters such as blood glucose, urea, creatinine etc. are carried out. These departments works under qualified pathologists and biochemist who are assisted by a number of medical technologists and technologies. 3. Surgical departments: Surgical services includes general surgery, neurosurgery, cardiovascular and thoracic surgery, ophthalmic surgery, orthopaedic surgery, plastic surgery etc. 4. Radiology: Consists of radiologists, radiotherapist, technicians, isotope pharmacists, nurses etc. primarily meant for radiodiagnostic and radiotherapy services.