HOSPITAL MANAGEMENT

OVERVIEW OF HOSPITAL ADMINISTRATION

1. HOSPITAL MANAGEMENT Sub Code: OBM752 Credit : 3

2. Course Objective To understand the fundamentals of hospital administration and management. To know the market related research process To explore various information management systems and relative supportive services. To learn the quality and safety aspects in hospital. OBM752-Hospital Management 2

3. A hospital administrator has to carry out management functions of planning (1) organizing (2), staffing (3), directing, controlling (4) and coordinating(5). OBM752-Hospital Management 3

4. Syllabus UNIT I OVERVIEW OF HOSPITAL ADMINISTRATION Distinction between Hospital and Industry, Challenges in Hospital Administration – Hospital Planning- Equipment Planning – Functional Planning OBM752-Hospital Management 4

5. UNIT II HUMAN RESOURCE MANAGEMENT IN HOSPITAL Principles of HRM – Functions of HRM – Profile of HRD Manager –Human Resource Inventory – Manpower Planning. OBM752-Hospital Management 5

6. UNIT III RECRUITMENT AND TRAINING Different Departments of Hospital, Recruitment, Selection, Training Guidelines – Methods of Training – Evaluation of Training – Leadership grooming and Training, Promotion – Transfer. OBM752-Hospital Management 6

7. UNIT IV SUPPORTIVE SERVICES Medical Records Department – Central Sterilization and Supply Department – Pharmacy – Food Services - Laundry Services. OBM752-Hospital Management 7

8. UNIT V COMMUNICATION AND SAFETY ASPECTS IN HOSPITAL Purposes – Planning of Communication, Modes of Communication – Telephone, ISDN, Public Address and Piped Music – CCTV.Security – Loss Prevention – Fire Safety – Alarm System – Safety Rules. OBM752-Hospital Management 8

9. TEXT BOOKS R.C.Goyal , “Hospital Administration and Human Resource Management”, PHI – Fourth Edition, 2006. G.D.Kunders , “Hospitals – Facilities Planning and Management – TMH, New Delhi – Fifth Reprint 2007. OBM752-Hospital Management 9

10. Course Outcome At the end of the course, the student should be able to: Explain the principles of Hospital administration. Identify the importance of Human resource management. Explain the various strategies followed in recruitment List various training given to the human resource in the hospital Identify Information management systems and its uses. Understand safety procedures followed in hospitals OBM752-Hospital Management 10

11. UNIT - 1 OVERVIEW OF HOSPITAL ADMINISTRATION OBM752-Hospital Management 11

12. Definition of Hospital WHO Expert Committee, 1963: ‘A 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 or suspected to be suffering from a disease or injury and for parturient. It may or may not also provide services for ambulatory patients on an out-patient basis’. OBM752-Hospital Management 12

13. The hospital is a complex organization and an institute which provides health to peoples through complicated but specialized scientific equipment and a team of trained staff educated in the problems of modern medical science. They are all co-ordinate together for the common goal of restoring and maintaining a good health of the people who go there for relief from the pain, suffering and disease. OBM752-Hospital Management 13

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17. Hospital Administration Administration, on a planned and scientific basis, is necessary for the smooth running of every institution. In order to perform its functions efficiently, hospitals must be organized and administered in a scientific manner. This demands that every staff-member should be adequately trained. OBM752-Hospital Management 17

18. The number of people who use hospital services has increased The optimum use of resources is only possible with an efficient and professionally competent administration. Hospitals have lagged far behind business and industry in the development of management policies and techniques pertaining to their administrative functions They continue to make ad hoc arrangements rather than having a carefully planned administrative policy. OBM752-Hospital Management 18

19. Role of Administrator - Patient Creation of friendly environment, Understanding patient’s physical needs, Patient’s emotional needs, Patient’s clinical needs, Patient’s satisfaction, Patient’s education, Patient’s communication needs, OBM752-Hospital Management 19

20. Role of Administrator – Hospital Organization Strategic planning, Environmental influence on the hospital, Operational management, Management of hospital staff, Materials management, Financial management, Hospital information, Communication, Public relation, Risk management, Law, Ethics and Code of Conduct, Marketing of health services, Quality management, OBM752-Hospital Management 20

21. Role of Administrator - Community Integrating with primary health care, Integrating hospital with other health care organizations, Community participation in planning of services and also for utilization of hospital services, Outreach program: Outreach program like health camps, camp surgery, swarthy melas, immunization camps, etc. OBM752-Hospital Management 21

22. Distinction between Hospital and Industry OBM752-Hospital Management 22

23. The product of a hospital is service to people provided by its personnel with a variety of skills. The nature of the demand for hospital services -as admission to the hospital for services is rarely voluntary . The decision is made for the patient ; he is ill and requires services which cannot be provided at home. The patient leaves home, family, friends, his work-place, his way of life for a new environment , i.e , the hospital. he becomes one of the many. his role is similar to 30 or 40 others in the ward or unit in which he is a patient. He is subjected to a new set of values and a way of life. He meets many people, and he is expected to relate and communicate with them. OBM752-Hospital Management 23

24. On occasions, patients encounter many different hospital personnel in the room in one day, each performing different functions. A hospital deals daily with the life, suffering, recovery and death of human beings . For the direction and running of such an institution, its administrative personnel need a particular combination of knowledge, understanding, traits, abilities and skills. OBM752-Hospital Management 24

25. Matter of need A hospital deals daily with the life, suffering, recovery and death of human beings. For the direction and running of such an institution, its administrative personnel need a particular combination of knowledge, understanding, traits, abilities and skills. Typing Organization Healthcare organization as different is the classification of organizations by type, that is by mentally assigning organizations to categories such as health care, manufacturing, retail, commercial, financial and so on. Two theoretical Extremes Job organization system Cooperative motivation system OBM752-Hospital Management 25

26. FUNCTIONS OF THE HOSPITAL To provide care for the sick and injured. Accommodating them according to their physical condition and financial status. There should be sufficient diagnostic and treatment facilities available OBM752-Hospital Management 26

27. 2. Training of physicians, nurses and other personnel. They receive their training in both theory and practice in approved schools and colleges. must employ highly trained personnel so that they may train others They make surveys of hospitals and accord their approval. Only these approved hospitals can provide training 3. Prevention of disease and promotion They can treat patients of communicable and non-communicable diseases, notify to the recognized authorities of any communicable disease of which it has knowledge, assist in vaccination programmes of the government, etc. OBM752-Hospital Management 27

28. 4. Advancement of research in scientific medicine In light of the broad social responsibility maintaining and restoring the health, it is an important function, but no hospital is permitted to do direct experiments on patients. It must resort to necessary tests in laboratories and on animals. They can do so by making observation of functions of the body in health and in disease but they will have to maintain clinical record of patients accurately for which they have to engage qualified and trained medical record technicians who will preserve the record in such a manner that it can be made available for study at any time to physicians and surgeons. OBM752-Hospital Management 28

29. CHALLENGES TO HOSPITAL ADMINISTRATION Challenges to administrative abilities have come from within the health field as well as from the public: business and professional leaders who were initiated into the hospital scene as trustees or voluntary hospitals; the large number of physicians who comprise the Staff of today's hospital and who are especially concerned about the facilities and services available for the care of their patients; professional organizations which prescribe various standards of hospital operation while granting approval to the hospitals; OBM752-Hospital Management 29

30. academicians who are concerned about matching what they teach with the requirements of the patients and hospital administrations; labour demanding standards of employment and working conditions at least equal to if not better than those prevailing in other industries; trustees of the Trust Hospitals, members of Registered Society Hospitals, shareholders or Corporate Hospitals, and others who have been their own masters and have been operating with no restraints so far will have to face increasing professionalism threatening their power and existence. OBM752-Hospital Management 30

31. Environment friendly When the international focus is on a safe environment, hospitals which do not pay enough attention to this sensitive issue will be eliminated from the community either through enforcement of legal regulations or consumers' boycott. Creditability and effectiveness are mutually dependent and proportional. to provide latest technology and vision push for change when it is required in the interest of the patients, employees and the community at large CEO as a catalyst for relationship building between patients and employees, government agencies and his hospital and between hospitals and his own hospital; OBM752-Hospital Management 31

32. HOSPITAL PLANNING 1)Dream of Hospital 2)Pilot Study 3)Committee of founder members 4)Initial efforts to collect funds 5)Mentality of Urban and Rural Patients vis-à-vis hospital building 6)Appointment of a consultant/project director 7)Preliminary survey 8)Appointment of a consulting firm 9)Appointment of hospital architect and interior decorators 9)Appointment of clerk of works OBM752-Hospital Management 32

33. 10)Simultaneous efforts to collect funds 11)Appointment of one accountant 12)Formation of Governing Board 13)Appointment of key personnel 14)Purchase policy 15)Preparing various policies and organization charts 16)Licenses 17)Appointment of all department heads and some employees 18)Recruitment of staff OBM752-Hospital Management 33

34. 19)Orientation of employees 20)Meeting with the department of heads 21)Trial run of the hospital 22) Fixing of signage and placement of facilitators 23)Taking over the hospital and its drawings 24)Scope for future expansion 25)Commissioning of the hospital 26)Readying for the D’day 27)Inauguration of the hospital OBM752-Hospital Management 34

35. EQUIPMENT PLANNING When and why to buy what from whom for how much! Avoid: buying what you don’t need for a high price and at the wrong time Buying the right equipment, for the lowest price, for the right reasons and at the right time. OBM752-Hospital Management 35

36. Hospital planning is not complete if careful attention is not given to the fixed and movable equipment needed for the hospital. With the exception of items of current operating expense such as food, fuel, drugs, dressings, paper, printed forms, soap, etc., the term "equipment" means all items necessary for the functioning of all services of the hospital including accounting and records, maintenance of buildings and grounds, laundry, public waiting rooms, public health and related services. OBM752-Hospital Management 36

37. The time to attend to this is early in the design development Stage. A series of meetings are arranged with the medical staff and other personnel to discuss the equipment needed. A room by room equipment list is then compiled and reviewed by the administrative, medical and departmental staff. The first step in developing a list is to consider each room in the plans as a separate entity and to list all items of "built-in equipment" and "depreciable equipment". This information may be supplemented with such additional items as experience and knowledge would indicate as necessary for the proper functioning of the services. The valuable information thus compiled and documented is used to coordinate details and sizes of rooms, utility services, lighting and workflow. This information is also needed for financial planning. OBM752-Hospital Management 37

38. It is necessary to consult with the architect designing the building early so that the facilities planned will be of sufficient size to accommodate the equipment and render the necessary service. It is imperative that those preparing the equipment list are familiar with the building plans as any attempt to visualize the equipment needs of the hospital would not be successful. OBM752-Hospital Management 38

39. The operational plan with all the details of the hospital's needs leads to the next phase of planning, which is the planning of physical facilities on a functional basis. It is at this crucial stage that promoters of hospitals are likely to make the worst mistake that more often than not stems from not receiving competent advice and guidance. Some succumb to the glamour of having an outwardly beautiful edifice. an artist's concept, which is no better than raising a structure instead of designing clinical and administrative services to patients. As a result, they are saddled With an attractive but totally inefficient building. Good planning must result in an efficient, functional and economical hospital. OBM752-Hospital Management 39

40. Puzzle We all know that a chess board has 64 squares. This can be completely covered by 32 cardboard rectangles, each cardboard covering just 2 squares. Supposing we remove 2 squares of the chess board at diagonally opposite corners, can we cover the modified board with 31 rectangles? If it can be done how can we do it? And if it cannot be done, prove it impossible. OBM752-Hospital Management 40

41. No. It cannot be done. Each rectangle covers 1 white square and one black square, because on a chess board the white and black squares are always adjacent. The two squares which we remove from the chess board are of the same colour, and so the remaining board has two more boxes of one colour than the other. And after the rectangles have covered 60 boxes, there will be left two squares of the same colour. Obviously the remaining rectangle cannot cover these two squares. OBM752-Hospital Management 41

42. FUNCTIONAL PLANNING The survey, other studies and detailed preliminary planning which were discussed in the earlier section logically lead to the next phase Of building a hospital—operational planning which is a written programme needed for any architectural project. The requirements of the hospital in terms of the services it is going to provide, number of beds it is going to have, departments, major items of equipment, space, personnel, relationships and adjacencies—must form this written programme. OBM752-Hospital Management 42

43. Even minor defects in designing can make the operation of the hospital inefficient, require more employees and significantly increase the cost of maintenance. Functional planning in hospitals is important, and the key to this is the understanding that travel and adjacencies affect the operational cost over the life of the building. It should be remembered that economy of operation over the life of the building as well as the quality of care given to patients depends to a large extent on the proper planning and designing of the hospital and is more important than the economy of construction. The initial cost of building a hospital is insignificant When compared to the cost of running, staffing and maintaining it. By one reckoning, it is 18 to 20 times over a period of, say, 20 years: Another study suggests that within two or three years, the cost of construction will have been equalled or surpassed by operating expenses. It will be worse in the case of poorly designed hospitals. Inefficient hospitals cost more to the patients too because they get less health care services for the money they pay. OBM752-Hospital Management 43