Hospital and its organization

1. Hospital and its organization

2. Definition of Hospital
WHO Expert Committee, 1963:
‘A hospital is a residential establishment which
provides short-term and long-term medical care
consisting
therapeutic
of observational, diagnostic,
and rehabilitative services for
persons suffering or suspected to be suffering
from a disease or injury and for parturients. It
may or may not also provide services for
ambulatory patients on an out-patient basis’.

3. WHO expert committee, 1956:
‘The hospital is an integral part of a social and
medical organization, the function of which is to
provide for the population complete healthcare,
both curative and preventive, and whose out-
patient services reach out to the family in its
home environment; the hospital is also a centre
for the training of health workers and for bio-
social research’.

4. FUNCTIONSOF HOSPITAL
1. To upliftquality of law and generalstandardsof medical practice.
2. Toprovidefacilities& guidance,bywhichpersonscanworkin groups,withthe
intentionof bettermentof hospitaldepartment, patient& community.
3. Toreducediseaseoccurrence byearlydiagnosisand treatment.
4. Toestimateneedsfor facilities,supplies& equipment's, and their utilizationfor
evaluation,control & maintenance.
5. To estimatedepartmental necessities.

5. MAKERS
COMPETENT STAFF
6. To PROVIDE a COMMON LINK between GENERALPUBLIC & POLICY
7. To SUGGESTPOLICIES& PROCEDURESto maintain ADEQUATE&
8. To DEVELOP& MAINTAIN an effective system of CLINICAL &
ADMINISTRATIVE RECORDS & REPORTS.
9. To HARNESS growth of MEDICAL SCIENCE,by PROPERTRAINING of
DOCTORS & NURSES in large training hospitals.
10. To CREATE& DEVELOPFINANCIAL PLAN for the OPERATIONOF
HOSPITAL.

6. 11. To provide facilities for continuing EDUCATION of all the people.
12. To PARTICIPATE & IMPLEMENT SAFETYPROGRAMMES of HOSPITAL.
13. To INITIATE, UTILIZE & PARTICIPATE in RESEARCH PROJECTS,aimed at
IMPROVEMENT of PATIENT CARE, and other hospital services.

7. Classification of Hospital
1. Basing on Objective
a.
b.
c.
General hospitals
Special hospitals
Teaching cum Research Hospital
2. Basing on Administration, ownership, control or financial income
a.
b.
c.
d.
Governmental or public
Non-governmental or private
Semi Govt Hospital
Voluntary Agency Hospitals
3. Basing on Length of Stay
a.
b.
Short-term or short-stay hospitals (Stay less than 30 days)
Long-term or long-stay hospitals: (Stay more than 30 days)
4. Depending on Type of Medical Staff
a.
b.
Closed-staff hospital:
Open-staff hospital:

8. 5. Basing on bed capacity (Size)
a.
b.
c.
Small hospital (Upto 100 beds)
Medium hospital (More than 100 to less than 300 beds)
Large hospital (More than 300 beds)
6. Basing on type of care:
a.
b.
c.
Primary Care
Secondary Care
Tertiary Care
7. By teaching affiliation:
a.
b.
Teaching hospital
Non-teaching hospital
8. Basing on system of medicine
a.
b.
c.
d.
e.
Allopathic hospital
Ayurvedic hospital
Homeopathic hospital
Unani hospital
Hospitals of other system of medicine

9. 9. Basing on regionality
a.
b.
c.
Regional
District
Upazila Health Complex
d.Union Health and Family Welfare
Centres
e. Community Clinics
10. As per WHO Classification:
a.
b.
c.
Regional Hospital
Intermediate/ District Hospital
Rural Hospital

10. General hospitals:
General Hospitals are meant to provide wide-range of various types of
healthcare, but with limited capacity. They care for patients with
various-disease conditions for both sexes to all ages, medical, surgical,
paediatrics, obstetrics, eye and ear etc. Usually, General hospitals are
devoid of super-specialist medical care.
Special hospitals:
condition, orthopedics,
They limit their service to a particular
maternity, paediatrics, geriatrics, oncology etc.
Teaching cum Research Hospital:
College is attached for medical/ nursing/ dental/ pharmacy education.
Main objective is to provide medical care, teaching and research is
secondary

11. Governmental or public hospital: They are owned,
administered and controlled by the government. They
provide free care for patients. The governmental hospitals
are owned by:
• The Ministry of Health.
• The University
• Others.
A public hospital or government hospital is a hospital
which is owned by a government and receives
government funding. In some countries, this type of
hospital provides medical care free of charge, the cost of
which is covered by government reimbursement.
In Australia, public hospitals are operated and funded by
each individual state's health department. The federal
government also contributes funding.

12. Private Hospital:
Privately owned or controlled by an individual or group of
physicians or citizens or by private organization. eg, Square
Hospital.
Purpose is to provide services for profit making.
Semi Govt Hospital:
Hospitals run both by the govt and private entity. eg Cantt Board
Hospital.

13. Corporate Hospital
Hospitals which are public limited companies
formed under the companies act. Run on
commercial lines. eg, Apollo
Voluntary Agency Hospital: Not for profit hospitals
by the Voluntary Organizations. eg, HOPE
Foundation Fistula Hospital

14. Short-term or short-stay hospitals:
These are hospitals where over 90% of all patients admitted stay
less than 30 days.
Long-term or long-stay hospitals:
These are hospitals where over 90% of all patients admitted stay
30 days or more, i.e. mental hospital.
Closed-staff hospital:
Physicians are held responsible for all medical activities in the
hospital including the diagnosis and treatment of patient fee
paying and emergency.
Open-staff hospital:
This type of hospital permits other physicians in the community
to admit and treat patients to the hospital' and treat them.

15. Open Staff Hospital: Open medical staff, which
means any physician can request to practice at
the facility, regardless of their hospital affiliation.
Close Staff Hospital: A closed hospital system is
one in which all doctors are on staff, and also
doctors that aren't on staff may not have access
or privileges at said hospital.

16. CLASSIFICATIONS
OF HEALTH CARE
Primary Care
Secondary Care
Tertiary Care

17. Primary Care
Consists of basic
curative care,
including simple
diagnosis and
treatment, provided
at the point of entry
into the health care
system.
(Example: walk-in-clinic)

18. Secondary Care
Consists of specialized
sophisticated and complicated diagnosis
care requiring more
and
treatment than is provided at the primary health
care level. Normally involves hospitalization.
(Example: Patient ward in general hospital)

19. Tertiary Care
Consists of highly specialized diagnostic and
therapeutic services which can usually only be
provided in centers specifically designed staffed
and equipped for this purpose.
(Example: Neonatal intensive care unit)

20. WHO Classification (Expert Committee 1957)
Regional Hospital:
Provides complex range of treatment and highly specialized services.
Serves a larger area than a local hospital. Example- Govt Medical
College Hospital
Intermediate/ District Hospital:
A district hospital typically is the major health care facility in its locality
(For Bangladesh in a district level). Specialty services in major
disciplines (eg, Medicne, Surgery, Gynae etc)
Rural Hospital:
Remote hospitals with small number of beds and limited service
capacity. It should have 20-100 beds. Upazila Health Complex in
Bangladesh

21. ORGANIZATIONOF HOSPITALS :
1. ORGANIZATION is defined as “A DYNAMIC PROCESS, in which various
MANAGERIAL ACTIVITIES bring & bind people together
, for the
ACHIEVEMENT of COMMON GOALS & OBJECTIVES”
2. Most important BODY of a hospital is the GOVERNING BODY/ BOARD OF
DIRECTORS/ BOARD OF TRUSTEES
3. GOVERNING BODY  Consists of various eminent personalities in the field
of :
a. MEDICAL EDUCATION
b. RESEARCH
c. ADMINISTRATION
d. POLITICS (Optional)
4. Function of GOVERNING BODY is to FRAME all major POLICIES, PLANS &
PROGRAMMES of hospital

22. 5. GOVERNING BODY  Appoints a HOSPITAL ADMINISTRATOR to get
various functions performed like CLINICAL SERVICES, NURSING,
PHARMACY SERVICES, etc…….

23. THE MEDICAL STAFF

24. Doctors represent the
initiators of every action
that results in the direct
provision of patient care
services.

25. Doctors determine:
 Who Will BeAdmitted
When
Where
What Medical Services Are to Be
Provided, in What Sequence, in
What Dosage, With What
Equipment and Supplies When,
Where and by Whom
 Who Is Discharged andWhen.

26. Medical Staff
Participation by the medical staff in the
decision-making process is in the best
interest of both the hospital and the
patients.
Physician involvement leads to
physician accountability.

27. Medical Staff
 The chief of medical staff is the
elected representative of the medical
staff.
 The chief of staff appoints all of the
committees other than the executive
committee whose members are
elected by the staff or appointed by
the board administrator.

28. Functions of the Medical Staff
 To advise the governing body on medical
affairs.
 To accept accountability for the quality of
care rendered to patients in the hospital.
 To request, review and act upon
reportso
f
medical staff committees.
 To scrutinize the professional ethics of
its members and to initiate corrective
action as indicated.
 To develop, implement, and review medical
staff policies.

29. Functions of the Medical Staff
 T o recommend action to the
administrator on all medical-
administrative matters.

31. SERVICES PERFORME
D B
Y HOSPITAL
ORGANIZ
ATION:
Include:
A. NURSING SERVICES:
- LARGESTpart of a hospital
- Functions all 24 hours
- Nurses  assigned specific number of beds  have to give personal
attention to patients
- Nurses are trained for PRENATAL CARE, OBSERVATION, PATIENT
COMFORT DURING LABOUR, etc.
- NURSING DIRECTOR is the in-charge of NURSING SERVICES……….

32. B.OUT-PATIENT SERVICES:
- Focus on COMFORT for OUT-PATIENTS, as the approach for major/minor
illnesses
- These services  make a hospital an IDEAL COMMUNITY INSTITUTION
- Hospital is duty-bound to provide DIAGNOSTIC, PREVENTIVE & CURATIVE
measures to the OUT-PATIENTS………………….

33. 3.RADIOLOGICAL SERVICES:
- Performed under direction of a competent RADIOLOGIST
- CHIEF RADIOLOGIST  assisted by various TECHNICIANS
- Services include UTILIZATION of EQUIPMENTS like:
a. SONOGRAPHY
b. X-RAY
c. ECG
d. CT-SCAN, etc……………

34. 4.CENTRAL SUPPLY SERVICES:
- Refers to MEDICAL & SURGICAL SUPPLYSERVICES
- Meant for DIAGNOSIS, TREATMENT
, PREVENTION, EDUCATION & RESEARCH
- Involves their COLLECTION, PROCESSING, STORAGE & ISSUANCE against
proper INDENT FORM
- Qualified & skilled staff personnel are responsible for its
maintenance…………………

35. 5.HOSPITAL PHARMACY SERVICES:
- Controls PHARMACY OPERATION in any hospital
- FILLSPRESCRIPTION & no. of NECESSITIESfrom wards
- Functions begin from DRUG PROCUREMENT to DISTRIBUTION to I.Pand O.P
- Responsible for :
a. PROPER DRUG DELIVERY
b. INFORMATION SYSTEM
c. DRUG STORAGE
d. MANUFACTURE
e. STERILIZATION
f.ADVICING PATIENT ON DRUGUSE

36. 6.MEDICAL RECORD SERVICES:
- VALUABLE MATERIALS, as they help MEDICAL & PARA-MEDICAL STAFF for
EVALUATION
- Also used for EDUCATION, RESEARCH & TRAINING
- Consists of :
a. PATIENT HISTORY
b. LAB- TESTREPORTS
c. PHYSICAL EXAMINATION DETAILS
d. PHYSICAN’S ADVICE, etc.
- Itis mandatory to store medical records properly to FACILITATE EASY ACCESS
on requirement…………………..

37. 7.STORE SERVICES:
- RECEIVE, STORE & ISSUEmaterials against REQUISITION FORMS of various
DEPARTMENTS & WARDS
- Hospital consists of:
a. MEDICAL STORE
b. STORE FOR GENERAL ITEMS
c. SURGICAL STORES, etc
- Maintain a BUFFER STOCK of certain materials, including LIFE-SAVING
DRUGS…………………….

38. 8.MISCELLANEOUS SERVICES:
- Aimed atoverall BENEFIT & PATIENT
CARE
- Include:
a. DIETARYSERVICES
b. AMBULATORY SERVICES
c. LAUNDRY SERVICES
d. TRANSPORT SERVICES
e. MORTUARY SERVICES
f. LIBRARYSERVICES………………………….

39. THANK YOU!!!