1. Hospital and it’s organization.pptx

Hospital and it’s organization
Definition, Classification of hospital- Primary, Secondary and Tertiary hospitals, Classification based on clinical and non- clinical basis, Organization Structure of a Hospital, and Medical staffs involved in the
hospital and their functions.

1. Mr. Mangesh Bansod ASST. PROF. SDDVCPRC, Panvel Hospital and it’s organization

2. Definition of Hospital Hospital is a complex organisation . It is an institute of providing health to individuals with the help of complex and special scientific equipments in the presence of trained staff who are well-educated in the problems of modern medical science. For achieving the goal of maintaining a good health of individuals suffering from diseases and relieving them from pain, all the staff members of hospitals coordinate together. In modern hospitals, there is ample of space and well -qualified and skilled personnel who provide curative, restorative, and preventive services of extreme quality to all the patients irrespective of their race, colour , creed, or financial status. As per WHO, “Hospitals are reservoirs of critical resources and knowledge. They can be classified according to the interventions they provide, the roles they play in the health system and the health and educational services they offer to the communities in and around them.”

3. Classification of Hospital

4. Classification Based on Clinical Basis- Hospitals are classified as follows based on their anatomical- physiological specialisation : ENT (Ear, Nose and Throat) hospitals, Eye hospitals, Orhopaedic hospitals, and Kidney hospitals.   Hospitals are classified as follows based on the client group they serve: Paediatric hospitals for children, Gynaecological hospitals for women, and Maternity hospitals for mothers.   Hospitals are classified as follow based on the system of medicine adopted for treatment: Allopathic hospitals, Ayurvedic hospitals, Homeopathic hospitals, Unani hospitals, and Hospitals of other systems of medicine . Classification Based on Length of Stay of Patient- on this basis of short term and long term, the hospitals are categorised into acute care hospitals and chronic care hospitals Classification of Hospital

5. Classification Based on Non-Clinical Basis Classification Based on Ownership/Control Basis: Public Hospitals: These hospitals are under the control of Central or State Governments or local bodies on non-commercial lines. They can be general hospitals or specialised hospitals or both. Voluntary Hospitals: These hospitals are recognised and combined under the Societies Registration Act 1860 or Public Trust Act 1882 or any other act of Central or State Governments. They are supported by the public or private funds on a non-commercial basis. Private Nursing Homes: These are regulated by an individual doctor or a group of doctors on a commercial basis. Patients suffering from infirmity, advanced age, illness, injury, chronic disease, disability, etc. are admitted here. However, patients having communicable diseases, alcoholism, drug addiction, or mental illness are not treated. Corporate Hospitals: These hospitals are public limited companies running on commercial lines and formed under the Companies Act . They can be general or specialised or both.

6. Classification Based on the Objectives Teaching-cum-Research Hospitals: These are the hospitals having a college for education of medical, nursing, dental, or pharmacy. Teaching is the major aim of these hospitals and the provision of healthcare is secondary. AIIMS (New Delhi), PGIMER (Chandigarh), JIPMER, (Pondicherry), KR Hospital (Mysore), Victoria Hospital (Bangalore), etc. General Hospitals: These hospitals help for curing the common diseases. They have at least two or more doctors, who can offer in -patient accommodation and provide medical and nursing care for more than one category of medical discipline, such as general medicine, general surgery, obstetrics, gynaecology , paediatrics , etc. Their primary aim is to provide medical support to the people, and teaching and research are secondary. Examples of these hospitals are all districts and Taluk or PHC or rural hospitals. Specialised Hospitals: These hospitals provide medical and nursing care for one discipline or a disease or a condition of one system. They concentrate on a particular aspect or body organ and give medical and nursing care in the particular field, e.g., tuberculosis, ENT, ophthalmology, leprosy, orthopaedics , paediatrics , cardiology, mental health/psychiatric, oncology, STDs, maternal, etc. Isolation Hospitals: These hospitals treat patients who are suffering from infections and communicable diseases and need to be isolated. Epidemic diseases hospital (Bangalore) is an example of isolation hospital.

7. Classification Based on Size (Bed Strength) Teaching Hospitals: These hospitals have 500 beds and can be increased depending on the number of students. District Hospitals: These hospitals have 200 beds and can be increased up to 300 depending on the population. Taluk Hospitals: These hospitals have 50 beds and can be increased depending on the population. Primary Health Centres : These hospitals have 6 beds and can be increased up to 10 depending on the needs.

8. Classification Based on Management Union Government/Government of India: These hospitals are controlled by the Government of India. Hospitals run by the railways, military/ defence , mining or public sector activities of Central Government State Governments: These hospitals are controlled by the state or union territory. Government authorities and public sector activities running through the state or union territories comprising the police, prison, irrigation department, etc. Local Bodies: These hospitals are managed by the local bodies, such as municipal corporation, municipality, Zila Parishad , Panchayat , Autonomous Bodies: These hospitals are formed under a special act of parliament or state legislation. They are financially supported by the Central/State Government/Union territory. AIIMS (New Delhi), PGIMER (Chandigarh), NIMHANS (Bangalore), KMIO (Bangalore), etc Private: These hospitals are run by an individual or by private organisation . MAHE ( Manipal ), Manipal Hospital (Bangalore), Hinduja Hospital (Mumbai), etc. Voluntary Agencies: These hospitals are run by a voluntary body, a trust, or a charitable society registered under a suitable authority under Central/State Government laws. They include hospitals run by missionary bodies and cooperatives. CMC hospital (Vellore)

9. Classification Based on Cost Elite Hospitals: These hospitals are a symbol of high -tech medical development. The per day room rates vary between 300-1200. The deluxe rooms have fridge, television, and telephone. Excluding the medical care, they are similar to five -star hotels, thus, are also called five-star hospitals . These institutions reserve a particular percentage of their capacity for poorer sections and also support a particular percentage of their accommodation cost. For example , Jaslok has reserved 25% for the poorer sections and 30% at half the rates. In Mumbai hospital, 315 beds out of 680 are free and 112 beds are funded. Budget Hospitals: These hospitals are for moderate budget and low budget users, e.g., civil hospitals, corporation hospitals, etc.

10. Classification Based on the Level of Care Primary Hospitals: These hospitals denote the first level of contact between the individuals (including their families) and the health system. According to Alma Ata Declaration of 1978 , primary health care indicates serving the community it served; including mother and child care, which comprised of family planning, immunisation , prevention of locally endemic diseases, treatment of common diseases or injuries, delivery of essential facilities, health education, pro vision of food and nutrition, and adequate supply of safe drinking water. Primary healthcare in India involves a network of sub- centres and primary health centres in rural and urban areas, which are provided through health posts and family welfare centre s. A sub -centre has one auxiliary nurse midwife and multipurpose health worker . Secondary Hospitals: These hospitals are provided by such medical specialists, who do not have direct contact with the patients, like urologists, dermatologists, cardiologists, etc. According to National Health System Policy , a patient proceeds further for secondary care after being referred by a primary care professional. A patient cannot directly move to secondary care as sometimes health systems impose a restriction of referral on a patient in terms of payment; however, this varies from countries to countries. The following two systems come under this category: District Health System: This system provides child health and maternity care. It serves around 25,000 -50,000 users and includes various healthcare centres and district hospitals. These healthcare centres receive referrals from various primary health cares and remain open for 24×7. District hospitals include emergency services, neonatal care, comprehensive emergency obstetrics, etc.   County Health System: This system includes hospitals that receive referrals from district and community health systems. County hospitals provide gynaecologic services, general medicine, obstetrics, general surgery, etc. and remain open for 24×7. Tertiary Hospitals: These hospitals are a third level of health system. They provide a specialised consultative care to a patient referred from primary and secondary medical care. Specialised intensive care units,advanced diagnostic support services, and specialised medical personnel are the key features of tertiary health care. Tertiary care service in India is provided by medical colleges and advanced medical research institutes.

11. Organization Structure of a Hospital The organisation of modern day hospitals is a complex network of committees, departments, personnel, and services. The hospitals are not only caring, people-oriented institutions, but also many -faceted, high -tech business. They operate like other large businesses constantly concerned about their bottom line, and have a hierarchy of personnel and channels of authority. However, the number of administrative personnel depends on the hospital size. The organisation of hospitals includes the following: Administrative staff, Medical staff, Associated medical services, and Supportive paramedical services and staff.

12. Administrative Staff The administrative services of a hospital are controlled by a chief executive officer or president . They have day -to-day responsibility for handling all the hospital businesses. He or she is the highest ranking administrative officer who manages all the administrative departments associated with financial operations, public relations, and personnel. In many large hospitals, a chief operating officer manages the activities of certain departments, and a chief financial officer guides the financial activities of the hospital. These key administrative officers are corporate vice presidents of the hospital. The huge number of employees and the extensive collection of individual skills needed to staff a hospital calls for a personnel or human resources department with specialised labour expertise. This department is also headed by a vice president for human resources. Nursing is a great component of the hospital’s service operations, thus larger facilities also have a chief nursing executive at the vice president level.

13. Medical Staffs in the Hospital and Their Functions Each hospital should have a medical staff with the aim to provide medical care to the patients as per the ethical conduct and professional practices of their membership. The structure of medical staff is different in every hospital. Residential Medical Staff: These staff members remain available for 24 hours to attend the patients. They are also responsible for the organisational and administrative duties. Associate Medical Staff: These staff members include the physicians allotted to different services similar to the members of the active medical staff. These can be progressive as the residential medical staff. Consulting Medical Staff: These staff members include medical physicians of known professional ability. Honorary Medical Staff: These staff members are like part-time consulting medical staff. These members are retired physicians or physicians possessing a clinic and providing nominal facilities to the hospital.

14. Associated Medical Services Medicine Division: i )Internal medicine, ii) Cardiology, iii) Gastroenterology, iv) Nephrology, v) Pulmonary diseases, vi) Psychiatry and neurology, vii) Infectious diseases, viii) Allergy, ix) Skin and venereal diseases, x) Endocrinology, xi) Geriatrics, xii) Immunology, and xiii) Paediatrics . Surgery Division: i ) General surgery, ii) Obstetrics and gynaecology , iii) Orthopaedic surgery, iv) Ophthalmology, v) Otolaryngology, vi) Dental and oral surgery, vii) Nephrology, viii) Neurological surgery, ix) Cardiothoracic surgery, x) Plastic surgery, and xi) Anaesthetics .

15. Radiology: It is the branch of medicine that deals with the diagnostic and therapeutic application of radiant energy in the form of roentgen X-rays and radium. The radiology department is headed by a M.D., who provides services on receiving a written order by a member of medical staff. Radium or sealed radioactive sources can be therapeutically used by those physicians who have been given permission in consultation with the radiologist and/or radiation safety committee. Radioactive substances should be handled by appropriately trained and experienced personnel. This department includes physicians trained as radiologists, physicists, technicians, radiotherapists, isotope -pharmacists, nurses, assistants, and secretarial persons. Modern radiology departments also have facilities of sonography , Computer-aided Tomography (CT) scanning, MRI (Magnetic Resonance Image), etc. Pathology and Clinical Biochemistry Services: These services provide the facility of collecting samples of blood, urine, sputum, faeces , etc., in order to detect the presence of pathogenic infection or abnormality in biochemical parameters such as sugar, urea, etc. The related processes are done as per the instructions of the physician, surgeon, etc. Blood Bank: This service provides facility of collecting, processing, and supplying blood and its products (blood plasma, etc.). A blood bank is a store or a bank of blood and its components collected (from blood donations), stored , and preserved to be used later in blood transfusion.

16. Supportive Paramedical Services and Staff Nursing Services: The nursing team comprises of workers with variable degrees of skill in nursing and are directed by a professional nurse. This team replaces the single nurse who has done everything for the patient. . These were started by National League of Nursing in the U.S.A. in 1964: Nursing care includes health promotion, care and prevention of disease, rehabilitation, teaching and counselling , emotional support, and treatment of disease. It is an essential part of the healthcare system and is performed in combination with related medical, educational, and welfare facilities. The nursing team should respect individuality, dignity, and rights of every person irrespective of race, colour , breed, origin, and social and economic status. Dietary Services: Food service plays an important role in hospitals. This is also a therapeutic measure directly related to scientifically-prepared nutritious diet meant for certain diseases. These services impose on the clinical care of the patient. Plans menu for general or special diet for patients and employees, Selects and purchases food, Maintains relationship with food vendors, Receives and stores food, Prepares and distributes food, Maintains cleanliness and safety in the department, Trains and supervises the staff, Educates nations on dietary habits along with the medical or nursing staff, and Conducts research programs in teaching hospitals.

17. Medical-Social Service Department: This department serves as a link between the hospital and the patient and his/her relatives. The qualified social worker is a discipline who focuses on the social aspects of the patient and his/her family. The worker gives information regarding the medical and social study of suitable patients, and their home environmental particulars. Central Sterile Services: The main function of the Central Sterile Services Department (CSSD) is to give sterile items, linens, and equipment to wards and OT’s. The department sterilises the reusable equipment and linens received from various wards. The department exchanges items as per the need. The linens are sent for washing to the laundry either directly or via CSSD, and the washed linens are then sent to CSSD for sterilisation . These sterilised items are then issued t o the wards and OT’s whenever they demand for. Medical or Patient Treatment Records: These are the systematic documentation of a patient’s medical history and care. Medical record is a physical folder for each individual patient as well as an information body that contains the complete history of patient’s health. Drug Information Services or Centre: The aim of these services or centre is to document drugs by extracting information about them. Drug information is the information on physical, chemical, biological and health care sciences collected either in written forms (i.e., books, journals, periodicals, etc.) or conveyed by oral communication or by electronic devices.

18. Drug Distribution System: Every hospital use drugs and therapeutic substances in in-patient and out -patient departments. Bigger the institution, bigger is the problem of procurement and distribution of drugs. The following two types of drug distribution system exist in hospitals: Drugs are distributed to indoor patients, operation theatres, X-ray, and other specified departments. Drugs are distributed to outdoor patients (i.e., who are not admitted). Two more drug distribution types are: Dispensing of narcotics and other controlled substances, and Distribution and dispensing of ancillary substances and articles.