HOSPITAL AND ITS ORGANIZATION
Definition
The Dictionary meaning of the term Hospital is; “an institution for the shelter and care of people who require medical or surgical treatment”. The hospital is a complex organization utilizing specialized scientific equipment and functioning through a team of trained staff educated to the problems of modern medical science. All these are co-ordinated together for the common purpose of restoration and maintenance of good health.
Variety of healthcare services provided in the hospital are integrated and co-ordinated to achieve the common objectives of provision of medical care. It is the place where all the resources viz.
(a) Services of healthcare professionals,
(b) Physical facilities and equipment and funds are organized together and utilized to fulfil the healthcare needs of community.
Thus, it is a complex organization and works with objective of achieving, restoration and improving the health status of community at large. Early hospitals operated to take care of sick; it was the homeless sick for whom they operated. Later for treating and housing the wounded soldiers in the world wars and for isolating and treating the victims of epidemics, the need to establish hospitals was felt. Certain factors simulated the growth and development of hospitals to expand their role.
These include:
- Realisation of importance of good health by public at large.
- Public awareness regarding preventive healthcare.
- Advances in medical and related biological sciences.
- Assuarance about the quality of care provided by the hospitals; creating faith in the
- Time demanded needs about health care wounded soldiers in world wars or victims They provide ‘medical care’ which encompasses preventive, curative and even rehabilitative Modern hospitals thus, are not only centres of cure but centres of promotion of health. of epidemics, etc.
Functions of Hospital
The primary function of any hospital is to organise and co-ordinate the resources and services for successful diagnosis and treatment of their patients.
The main functions of hospital are:
(i) Medical care.
(ii) Training of medical and health professionals and patient.
(iii) Medical Research.
(iv) Public health.
- Medical Care:
It encompasses preventive, curative and even rehabilitative measures. Apart from diagnosis and treatment for ill patients, the modern hospitals take measures to prevent the occurrence of diseases through immunization, community screening to identify people at risk (early detection) to tackle their health problems. Hospitals take the efforts to raise the quality of care and general standards of medical practice. In certain diseases, the patient may remain permanently disabled. Modern hospitals extend their services to rehabilitate such patients so that, they can lead comfortable and productive life. Hospital is a centre of community health and contributes to a great extent to preventive and social medicine.
- Training of Medical and Health Professionals and Patient:
Training or education is an important function of a hospital. Education in a hospital has two different forms namely, educating the medical and health professionals and educating the patient. A hospital could be considered as a workshop where the student learns by observing and practicing under the supervision of his superiors. Training to the nurses medical and social workers, X-ray and laboratory technicians and other staff is an essential facet of hospitals. Such training programmes should be arranged periodically under the supervision of experienced superiors. Hospital also educates the general public through lectures and demonstrations on the preventive aspects of common and serious diseases Hospital provides the means and methods by which people can work together in groups to take care of patients and the community. Hospitals provide facilities for continuing education to all people.
- Medical Research:
treatment and improving a hospital services. Some of the common areas of research in a Research is important as it helps in the hospital that helps in developing new methods of hospital are development of new techniques in surgery, laboratory diagnostic procedures evaluation of investigational drugs in diseases, etc. It lowers the incidences of disease through early detection and treatment. It develops and maintains an effective system of clinical and administrative records and reports. Hospital and its Organization The hospitals are required to support all the activities carried out by various public health and voluntary agencies such as; immunization programmes, blood donation camps, social and economic rehabilitation, health education, etc. by providing facilities and advice. Hospital also participate in the financial plan and safety programmes.
1.2 CLASSIFICATION OF HOSPITAL
Hospitals are classified in different ways and any hospital could fall under more than one category. Three basic classifications are the type of clinical services offered, the length of stay and the ownership/control of hospital.
- Clinical Services Offered: Clinical services offered by hospitals are either specialized or general. Most of the Government hospitals typically offer general hospital services, providing a wide range of service areas such as; surgical, internal medicine, orthopedic, dental and obstetric care. The specialized care include medicine and surgery.
(a) Tuberculosis
(b) Internal medicine
(c) Paediatrics
(d) Psychiatrics and nervous diseases
(e) Communicable diseases
- Based on: Length of stay: Surgery
(a) Orthopedic
(b) Otolaryngologic
(c) Gynaecologic
(d) Ophthalmic
(a) Short term (Acute): Average length of stay of patient is less than 30 days.
(b) Long term (Chronic): Length of stay of patient is more than 30 days.
e.g. Psychiatric condition.
- Ownership and Control Basis: The group that controls, owns or operates the
hospital may be either Governmental or voluntary organizations (Non-Governmental).
(a) Governmental: This includes those hospitals that are owned and/or operated by an
agency of the central/state government, or other political subdivisions of Government.
Governmental
Central Government
State Government
e.g. 1. All India institute of e.g. 1. Civil hospitals
medical sciences
and hospital, Delhi
- Central Govt. health
scheme hospitals
- Cottage hospitals
- Primary health
centres.
Others
e.g. 1. Military hospitals
- Corporation
Hospital Non-Governmental:
(1) Private: (a) Profit (b) Non-profit.
Hospitals can also be classified on the basis of:
Hospital and its Organization
(ii) Community
accreditation procedure which considers the compliance to specified standards of healthcare
- By Accreditation: In the United States, hospitals are also classified on the basis of
(a) Accredited
A teaching hospital is one where clinical instruction is imparted to medical hospital training and get broad experience in the clinical care of patient, teaching and students. Teaching hospitals are the places where new medical graduates undergo 1 year of research. The hospitals are also classified on the basis of bed capacity as:
Under 50 beds
50-99 beds
100-199 beds
200-299 beds
300-399 beds
400-499 beds
500 and over beds
A clinic is an establishment where ambulatory patients are admitted for special study and treatment by a group of physicians practicing together, and where the patient is not confined as in a hospital.
1.3 HOSPITAL ORGANIZATION
The organization and management of a hospital differs based on the type of hospital and on the ownership and control of hospital. In the case of a smaller hospital, there are fewer administrative positions of associate or assistant directors whereas in larger hospitals, the general areas of clinical and administrative services may be further subdivided in units. The corporation and the board of trustees go segment of the organization is standard for all private hospitals. Government hospitals usually have a board of trustees but no corporate body. A representative organizational chart of a hospital is shown here: Personnel, Corporation, Board of Trustees, Director(Hospital administrator)
Out patient clinicospital and Its Organization
The Management process of any business involves the following: Planning, Organizing, Staffing. Directing. Controlling. Reviewing, Communicating, Co-ordinating and Decision- making. Directing:
- On-duty and Work Schedules: Some departments such as; ‘nursing’ need staff on duty every hour, every day and some such as: ‘catering two shifts every day. Other departments such as; Administration and business require staff on duty Monday to Friday with ‘on-call’ arrangements. Work schedules are routine tasks listed in order of performance and the workers to whom they are assigned. Tasks are specific as to what is to be done, where and during what time?
- Job Introduction: It is nothing but adjustment of new workers in their job and work situation. It entails:
(a) Welcome by the department manager.
(b) Introduction to colleagues.
(c) Broad explanation of department work.
(d) Explanation of worker’s own duties.
(e) Administrative schedules.
(f) On-duty and work schedules.
Effective job introduction reduces a new worker’s anxieties and it should be given by the
department manager on the first day of employment.
- Training: It helps workers to acquire and develop skills for effective and efficient work performance. It is helpful for:
Reducing labour turnover.
(ii) Reducing health and injury hazard.
(iii) Giving a sense of job security.
(iv) Increasing promotion opportunities and raising morale.
(v) Facilitating exchange of jobs between workers.
Training is needed for new staff as well as for operating new equipment. Hospital training methods include; ‘on-the-job’, apprenticeship and programmed instruction. Other training methods include; discussions, conferences, seminars, workshops, demonstrations and lectures.
- Supervision: It is the verbal or written direction to subordinates for commencing, modifying or stopping an activity. In a hospital, according to the necessity or emergency, supervisory directions are essential. Controlling: It may be quantitative (e.g. the number of patients admitted) or qualitative (e.g. controlling the clarity of radiograph). The control on narcotics is stricter than aspirin tablets. The information is needed on actual performance such as; the number of patients, days of care provided and resources used such as money. Controlling information includes statistics which measure actual performance in quantitative terms such as; surgical operationsHospital and Its Organiza should be performed and the number of operating room hours needed.
The information obtaine location time and worker, for deviations caused. The root cause of deviations: evaluated by the departmental manager and corrective action if necessary is taken by the The corrective action may be prompt and vigorous adjustment of activities so that, anu performance is consistent with expected performance. This action is facilitated by knowing sought eg late delivery of clean linen to the wards may be caused not by laundering delamay need more training. The corrective action may require raising of morale and increasing but by transportation delays. Work schedules may need revising. Workers and supervise P modern hospitals extend the services to community people of almost all age groups Hospitals were once considered as institutions where, patients are treated but tota addition to medical services, large number of paramedical and supportive services are organized and co-ordinated for successful functioning of hospital. Each such service i motivation of workers organized itself in an institution.
Thus, many institutions function within a big institute hospital. Almost every person from the community receives the services provided by moden hospitals, directly or indirectly. There is saying that “The first and the last person we see in our life is doctor”. Extending this saying for hospitals we can say that; “Almost everyone of ahave taken first breathe and shall take last breathe in the hospital”. Thus, hospitals become part of our life.
Though big teaching hospitals do have facilities to provide all sorts of clinical services 42- the time access to such hospitals is neither possible nor advisable. Depending on the disea condition and state the levels of care be provided to individual patient needs and requirements. As such the levels of care provided by the hospitals/clinics/nursing homes dispensaries is categorized into different categories like: primary care, secondary care, tertan care and quaternary care. This categorization is based on severity and complexity of medica M cases as well as facilities, skills and specialities of the providers. Primary Care: When a person firs time experience illness and decided to consult aclinical practitioner, then his/her first stop for receiving care is primary care. Usually, for acute medical problem of any severity, you seek out primary care. Primary care providers may be healthcare. doctors, nurse practitioners or physician assistants. Primary healthcare providers offe enhanced access to health care services. Thus, the care provided first in time is primary
Secondary Care: When a need of intervention by specialist is felt by the primary provider, he then refers you to a specialist. This care provided by the specialist is secondary care. A focus by the specialist is on a specific system, or a specific disease condition A Cardiologist, endocrinologist, oncologist are some of the examples of specialist cat (secondary care) providers.
Tertiary Care: When specialist feels the need of higher level of speciality care within the hospital, he may refer the case to tertiary care. Tertiary care involves use of specialized equipment and experts. Eg. coronary artery bypass surgery, neurosurgeries, severe burns treatment