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HOSPITAL
ADMINISTRATION
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
The definitions given by various authors can be explained as follows:
As a hospital administrator, he has to carry out
man...
Input process output
Manpower
Materials
Money
Machines
Methods
Minutes
information
Planning
Organizing
Staffing
Directing
...
1. Productivity: it is an output input ratio within a time
period with due consideration for quality
Productivity = Output...
2. Effectiveness: when a manager is able to achieve his
objectives, he is called an effective manager/
administrator. The ...
Role of hospital administrators
General roles
The hospital administrator like any other manager performs
various roles; th...
Specific roles
By virtue of serving a healthcare organization the
hospital administrator performs some specific roles
whic...
1. Role towards patients
The hospital administrator has a great responsibility to
understand and appreciate the emotional ...
2. Role towards hospital organization
To handle the hospital resources for maximizing the
output is one of the fundamental...
a. Strategic planning
b. Environmental influence on the hospital
c. Operational management
d. Management of hospital staff...
3. Role towards community
a. Integrating with primary health care
b. Integrating hospital with other healthcare
organizati...
Health System in India
04/10/2015www.drjayeshpatidar.blogspot.com
13
Introduction
The political economy context
The organisational structure and delivery mechanism
Health financing mechanisms...
The Political Economy
Context
A democratic federal system which is subdivided into 28 States, 7 union
territories and 593 ...
Characteristics of Indian
Health System
Complex mixed health system
- Publicly financed government health
system
- Fee-lev...
Different Phases of Indian Health
System Development
Pre-independence phase
Development centred phase
Comprehensive Primar...
Main Systems of Medicine
Western allopathic
Ayurveda
Unani
Siddha
Homeopathy
04/10/2015www.drjayeshpatidar.blogspot.com
18
Government Health System
Three levels of responsibilities-
- First-
- health is primarily a state responsibility
- Second-...
Administrative Structure
1. Central Ministries of Health and Family
Welfare –
- Responsible for all health related program...
Service Delivery Structure
Sub Health Centres- staffed by a trained female
health worker and/or a male health worker for a...
Service Delivery Structure
Community health centres- with 30-50 beds and basic
specialities covering a population of 80,00...
Health Financing Mechanisms..
Revenue generation by tax
Out of pocket payments or direct
payments
Private insurance
Social...
Spending on Health
Annually over 150,000 crores or US$34 billion, which
is 6% of GDP (Government spending on health Is onl...
The Aspects of Neoliberal Economic
Reforms Affecting Public Health
Increasing unregulated privatisation of the health care...
Contradictions
India has the largest numbers of medical colleges in the
world
It produces the largest numbers of doctors a...
But... the current situation….
Only 43.5% children are fully immunised.
79.1% of children from 6 months to 5 years of age ...
Contd….
poor are being excluded from health services
Increased indebtedness among poor (Expenditure
on health care is seco...
Health Inequities
The infant mortality Rate in the poorest 20% of the
population is 2.5 times higher than that in the rich...
Health Inequities
A girl is 1.5 times more likely to die before reaching her
fifth birthday
The ratio of doctors to popula...
NATIONAL HEALTH POLICY
• The Ministry of Health and Family Welfare, Govt. of
India, evolved a National Health Policy in 1983 and
2002.
• The poli...
objectives
• A greater awareness of health problems and means to solve them.
• Supply of safe drinking water and basic san...
Roles and responsibilities of Government
in the health sector, health system in India
I. At the centre
1. The ministry of ...
• Headed by a cabinet minister, a minister of state and a
deputy health minister.
• Union health ministry has 2 department...
Functions
I. International health relations
II. Administration of central institutes like AIIMS, National
Institute for co...
2. The directorate of general health services
• Principal adviser to the union Govt. in both medical
and public health mat...
Functions
I. International health relations – all major ports and international
airports are directly controlled.
II. Cont...
• To promote coordinated and concerted action between
the centre and the states in the implementation of all
the programme...
Functions
I. To recommend broad outlines of policy concerning health –
preventive and remedial care.
II. To make proposals...
II – At the state level
State health administration comprises of
State ministry of health
State health directorate
04/10/2...
1. State ministry of health
Headed by a minister of health and family welfare and
a deputy minister of health and family w...
2. State health directorate
Director of medical and health services is the chief
technical adviser to the state government...
The regional directors inspect all the branches of
public health irrespective of their specialty.
The functional directors...
Health planning in India
The guidelines for National health planning were
provided by a number of committees.
These commit...
1. Bhore Committee 1946
2. Mudaliar Committee 1962
3. Chadah Committee 1963
4. Mukerji Committee 1965
5. Mukerji Committee...
Planning commission – health sector planning
Planning commission gave considerable importance to
health programmes in the ...
Five year plans
Planning commission gave considerable importance to
health programmes in the five year plans
The objective...
Healthcare of the community
Levels of healthcare
Primary care level
Secondary care level
Tertiary care level
04/10/2015www...
Health for all by the year 2000
Fundamental principal of HFA/2000 strategy is equity,
i.e. an equal health status for peop...
The important goals to be achieved by 2000 were,
• Reduction of infant mortality from the level of 125
(1978) to below 60....
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Hospital administration

Nursing administration & Management

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Hospital administration

  1. 1. HOSPITAL ADMINISTRATION Dr. Jayesh Patidar www.drjayeshpatidar.blogspot.com
  2. 2. The definitions given by various authors can be explained as follows: As a hospital administrator, he has to carry out management functions of planning, organizing, staffing, directing, controlling and coordinating Management applies to all kinds of organization, whether government or non-government, small or big hospitals, profit making hospitals or charitable hospitals. It applies to administrator at all organizational level, whether lower level or top level. The aim of all administrators is the same that is to maximize the output. It is concerned with productivity that implies effectiveness and efficiency. 04/10/2015www.drjayeshpatidar.blogspot.com 2
  3. 3. Input process output Manpower Materials Money Machines Methods Minutes information Planning Organizing Staffing Directing Controlling Coordination No. of lives saved No. of deaths prevented No. of investigations done No. of operations performed No. of patients treated. Decrease in morbidity rates Decrease in mortality rates Decrease in disability rate Decrease in absenteeism due to sickness Improved health status of community Input/resourc es Processing Output Outcome Feedback 04/10/2015www.drjayeshpatidar.blogspot.com 3
  4. 4. 1. Productivity: it is an output input ratio within a time period with due consideration for quality Productivity = Output/Input Productivity can be given by Increasing output and maintaining same input. Increasing output and decreasing input. By decreasing input but maintaining same output. 04/10/2015www.drjayeshpatidar.blogspot.com 4
  5. 5. 2. Effectiveness: when a manager is able to achieve his objectives, he is called an effective manager/ administrator. The focus is on the output. The end result is to be evaluated. 2. Efficiency: when a manager is able to achieve the objectives, with the least (optimum) amount of resources, he is called an efficient manager. 04/10/2015www.drjayeshpatidar.blogspot.com 5
  6. 6. Role of hospital administrators General roles The hospital administrator like any other manager performs various roles; the managerial roles as described by Mitzberg can be grouped as follows, which are equally relevant for hospital administrator also Decision role • Entrepreneur role • Disturbance handler role • Resource allocator role • Negotiator role Interpersonal roles • Figure head • Leader role • Liaison role Informational roles • Recipient role • Disseminator role • Spokesperson role 04/10/2015www.drjayeshpatidar.blogspot.com 6
  7. 7. Specific roles By virtue of serving a healthcare organization the hospital administrator performs some specific roles which are described below. The hospital administrator ensures that hospital runs effectively and efficiently. The role of hospital administrator varies, depending upon the nature and complexity of hospital. Various roles can be grouped as role towards patients, towards hospital organization, towards community. 04/10/2015www.drjayeshpatidar.blogspot.com 7
  8. 8. 1. Role towards patients The hospital administrator has a great responsibility to understand and appreciate the emotional aspects of the patient care, his responsibility is to understand the specific needs of certain groups of patients, i.e. patients on wheelchairs, stretchers, geriatric group of patients, pediatric patients, neonates, serious cases, foreign nationals etc. some of the aspects of patients are given below: Creation of friendly environment. Understanding patient‟s physical needs. Patient's emotional needs. Patient‟s clinical needs. Patients' satisfaction. Patients' education. Patient‟s communication needs. 04/10/2015www.drjayeshpatidar.blogspot.com 8
  9. 9. 2. Role towards hospital organization To handle the hospital resources for maximizing the output is one of the fundamental roles of the administrator. The role of administrator is more of coordination in nature instead of controlling, he is coordinating officer. 04/10/2015www.drjayeshpatidar.blogspot.com 9
  10. 10. a. Strategic planning b. Environmental influence on the hospital c. Operational management d. Management of hospital staff e. Materials management f. Financial management g. Hospital information h. Communication i. Public relation j. Risk management k. Law, ethics and code of conduct l. Marketing of health services m. Quality management 04/10/2015www.drjayeshpatidar.blogspot.com 10
  11. 11. 3. Role towards community a. Integrating with primary health care b. Integrating hospital with other healthcare organizations. c. Community participation in planning of services and also for utilization of hospital services. d. Outreach program: outreach program like health camps, camp surgery, immunization camps, etc. 04/10/2015www.drjayeshpatidar.blogspot.com 11
  12. 12. Health System in India
  13. 13. 04/10/2015www.drjayeshpatidar.blogspot.com 13
  14. 14. Introduction The political economy context The organisational structure and delivery mechanism Health financing mechanisms Coverage patterns Current status of health and health care 04/10/2015www.drjayeshpatidar.blogspot.com 14
  15. 15. The Political Economy Context A democratic federal system which is subdivided into 28 States, 7 union territories and 593 districts In most of the states three local levels of government (Panchayat-raj) Per capita income US $440 435 million Indians are estimated to live on less than US $ 1 a day 36% of the total number of the worlds’ poor are in India Tax based health finance system with health insurance 80% health care expenditure born by patients and their families as out-of -pocket payment (fee for service and drugs) Expenditure on health care is second major cause of indebtedness among rural poor 04/10/2015www.drjayeshpatidar.blogspot.com 15
  16. 16. Characteristics of Indian Health System Complex mixed health system - Publicly financed government health system - Fee-levying private health sector 04/10/2015www.drjayeshpatidar.blogspot.com 16
  17. 17. Different Phases of Indian Health System Development Pre-independence phase Development centred phase Comprehensive Primary Health Care phase Neoliberal economic and health sector reform phase Health systems phase 04/10/2015www.drjayeshpatidar.blogspot.com 17
  18. 18. Main Systems of Medicine Western allopathic Ayurveda Unani Siddha Homeopathy 04/10/2015www.drjayeshpatidar.blogspot.com 18
  19. 19. Government Health System Three levels of responsibilities- - First- - health is primarily a state responsibility - Second- - the central government is responsible for developing and monitoring national standards and regulations - sponsoring various schemes for implementation by state governments - providing health services in union territories - Third- - both the centre and the states have a joint responsibility for programmes listed under the concurrent list. 04/10/2015www.drjayeshpatidar.blogspot.com 19
  20. 20. Administrative Structure 1. Central Ministries of Health and Family Welfare – - Responsible for all health related programmes - Regulatory role for private sector 2. State Ministries of Health and Family Welfare 3. District Health Teams headed by Chief Medical and Health Officer 04/10/2015www.drjayeshpatidar.blogspot.com 20
  21. 21. Service Delivery Structure Sub Health Centres- staffed by a trained female health worker and/or a male health worker for a population of 5000 in the plains and a population of 3000 in hilly and tribal areas. Primary Health Centres- staffed by a medical officer and other paramedical staff for a population of 30,000 in the plains and a population of 20,000 in hilly, tribal and backward areas. A PHC centre supervises six to eight sub centres. 04/10/2015www.drjayeshpatidar.blogspot.com 21
  22. 22. Service Delivery Structure Community health centres- with 30-50 beds and basic specialities covering a population of 80,000 to 120,000. The CHC acts as a referral centre for four to six PHCs. District/General hospitals- at district level with multi speciality facilities (City dispensaries) Medical colleges, All India institute of Medical Sciences and quasi government institutes 04/10/2015www.drjayeshpatidar.blogspot.com 22
  23. 23. Health Financing Mechanisms.. Revenue generation by tax Out of pocket payments or direct payments Private insurance Social insurance External Aid supported schemes 04/10/2015www.drjayeshpatidar.blogspot.com 23
  24. 24. Spending on Health Annually over 150,000 crores or US$34 billion, which is 6% of GDP (Government spending on health Is only 0.9% of GDP) Out of this only 15 % is publicly financed 4% from social insurance, 1% by private insurance remaining 80% is out of pocket spending ( 85% of which goes in private sector) Only 15% of the population is in organised sector and has some sort of social security the rest is left to the mercy of the market 04/10/2015www.drjayeshpatidar.blogspot.com 24
  25. 25. The Aspects of Neoliberal Economic Reforms Affecting Public Health Increasing unregulated privatisation of the health care sector with little accountability to patients Cutting down government Health care expenditure Systematic deregulation of drug prices resulting in skyrocketing prices of drugs and rising cost of health services Selective intervention approach instead comprehensive primary health care Measure diseases in terms of cost effectiveness Techno centric approach( emphasis on content instead processes) 04/10/2015www.drjayeshpatidar.blogspot.com 25
  26. 26. Contradictions India has the largest numbers of medical colleges in the world It produces the largest numbers of doctors among developing countries It gets “medical Tourists” from developed countries This country is fourth largest producer of drugs by volume in the world 04/10/2015www.drjayeshpatidar.blogspot.com 26
  27. 27. But... the current situation…. Only 43.5% children are fully immunised. 79.1% of children from 6 months to 5 years of age are anaemic. 56.1% ever married women aged 15-49 are anemic. Infant Mortality Rate is 58/1000 live births for the country with a low of 12 for Kerala and a high of 79 for Madhya Pradesh. Maternal Mortality Rate is 301 for the country with a low of 110 for Kerala and a high of 517 for UP and Uttaranchal in the 2001-03 period. Two thirds of the population lack access to essential drugs. 80% health care expenditure born by patients and their families as out-of - pocket payment (fee for service and drugs) Health inequalities across states, between urban and rural areas, and across the economic and gender divides have become worse Health, far from being accepted as a basic right of the people, is now being shaped into a saleable commodity 04/10/2015www.drjayeshpatidar.blogspot.com 27
  28. 28. Contd…. poor are being excluded from health services Increased indebtedness among poor (Expenditure on health care is second major cause of Indebtedness among rural poor) Difference across the economic class spectrum and by gender in the untreated illness has significantly increased Cutbacks by poor on food and other consumptions resulting increased illnesses and increasing malnutrition 04/10/2015www.drjayeshpatidar.blogspot.com 28
  29. 29. Health Inequities The infant mortality Rate in the poorest 20% of the population is 2.5 times higher than that in the richest 20% of the population A child in the „Low standard of living‟ economic group is almost four times more likely to die in childhood than a child in a better of high standard living group A person from the poorest quintile of the population, despite more health problems, is six times less likely to access hospitlisation than a person from richest quintile. 04/10/2015www.drjayeshpatidar.blogspot.com 29
  30. 30. Health Inequities A girl is 1.5 times more likely to die before reaching her fifth birthday The ratio of doctors to population in rural areas is almost six times lower than that for urban areas. Per person, government spending on public health is seven times lower in rural areas compared to government spending urban areas 04/10/2015www.drjayeshpatidar.blogspot.com 30
  31. 31. NATIONAL HEALTH POLICY
  32. 32. • The Ministry of Health and Family Welfare, Govt. of India, evolved a National Health Policy in 1983 and 2002. • The policy lays stress on preventive, promotive, public health and rehabilitation aspects of healthcare. • The policy stresses the need of establishing comprehensive primary health care services to reach the population in the remote area of the country. 04/10/2015www.drjayeshpatidar.blogspot.com 32
  33. 33. objectives • A greater awareness of health problems and means to solve them. • Supply of safe drinking water and basic sanitation. • Reduction of existing imbalance in health services by concentrating on the rural health infrastructure. • Establishment of dynamic health management information system to support health planning • Provision of legislative support to health protection and promotion. • Research into alternative methods of healthcare delivery and low cost health technologies. • Greater co-ordination of different systems of medicine. 04/10/2015www.drjayeshpatidar.blogspot.com 33
  34. 34. Roles and responsibilities of Government in the health sector, health system in India I. At the centre 1. The ministry of health and family welfare. 2. The directorate of general health services 3. The central council of health and family welfare. 04/10/2015www.drjayeshpatidar.blogspot.com 34
  35. 35. • Headed by a cabinet minister, a minister of state and a deputy health minister. • Union health ministry has 2 departments. • Department of health • Department of family welfare. 04/10/2015www.drjayeshpatidar.blogspot.com 35
  36. 36. Functions I. International health relations II. Administration of central institutes like AIIMS, National Institute for control of communicable diseases Delhi, etc. III. Promotion of Research IV. Development of Medical, Dental, Nursing professionals. V. Establishment and maintenance of drug standards. VI. Prevention of communicable diseases VII. Control of drugs and poisons. VIII. Collection of vital statistics. IX. Population control and family planning X. Labour welfare. 04/10/2015www.drjayeshpatidar.blogspot.com 36
  37. 37. 2. The directorate of general health services • Principal adviser to the union Govt. in both medical and public health matters. • Directorate comprises of 3 main units. • Medical care and hospitals • Public health • General administration 04/10/2015www.drjayeshpatidar.blogspot.com 37
  38. 38. Functions I. International health relations – all major ports and international airports are directly controlled. II. Control of drug standards III. Maintaining medical store departments IV. Post graduate training V. Incharge for medical education VI. Medical research – ICMR, etc. VII. Central Govt. health schemes VIII. National health programmes – AIDS, etc. IX. Health intelligence – collection, analysis, evaluation of all information on health statistics. X. National medial library – to help in the advancement of medical, health and related sciences. 04/10/2015www.drjayeshpatidar.blogspot.com 38
  39. 39. • To promote coordinated and concerted action between the centre and the states in the implementation of all the programmes pertaining to the health of the nation. 04/10/2015www.drjayeshpatidar.blogspot.com 39
  40. 40. Functions I. To recommend broad outlines of policy concerning health – preventive and remedial care. II. To make proposals for legislation in the fields of activity relating to medical and public health. III. To make recommendations to central government regarding distribution of available grants for health purposes to the states. IV. To establish any organization having function for promoting and maintaining co-operation between the central and state health administration. 04/10/2015www.drjayeshpatidar.blogspot.com 40
  41. 41. II – At the state level State health administration comprises of State ministry of health State health directorate 04/10/2015www.drjayeshpatidar.blogspot.com 41
  42. 42. 1. State ministry of health Headed by a minister of health and family welfare and a deputy minister of health and family welfare Health secretariat is the official organization of the state ministry of health and is headed by a secretary. The secretary is a senior officer of the Indian Administrative service. 04/10/2015www.drjayeshpatidar.blogspot.com 42
  43. 43. 2. State health directorate Director of medical and health services is the chief technical adviser to the state government on all matters relating to medicine and public health. Responsible for the organization and direction of all health activities. The director of medical and health services is assisted by a suitable number of deputy and assistant directors. The deputy and assistant directors of health may be of two types – regional & functional 04/10/2015www.drjayeshpatidar.blogspot.com 43
  44. 44. The regional directors inspect all the branches of public health irrespective of their specialty. The functional directors are usually specialists in a particular branch of public health such as mother and child health, family planning, nutrition, TB, leprosy, health education, etc. 04/10/2015www.drjayeshpatidar.blogspot.com 44
  45. 45. Health planning in India The guidelines for National health planning were provided by a number of committees. These committees were appointed by the government of India from time to time to review the existing health situation and recommend measures for further action. The following are some of the committees, which are important landmarks in the history of public health in India. 04/10/2015www.drjayeshpatidar.blogspot.com 45
  46. 46. 1. Bhore Committee 1946 2. Mudaliar Committee 1962 3. Chadah Committee 1963 4. Mukerji Committee 1965 5. Mukerji Committee 1966 6. Jungawalla committee 1967 7. Kartar singh committee 1973 8. Shrivastav committee 1975 9. Rural health scheme 1977 10. Health for all by 2000 AD – report of the working group 1981 04/10/2015www.drjayeshpatidar.blogspot.com 46
  47. 47. Planning commission – health sector planning Planning commission gave considerable importance to health programmes in the Five year plans. For purposes of planning the health sector has been divided into the following subsectors 1. Water supply and sanitation 2. Control of communicable diseases 3. Medical education, training and research 4. Medical care including hospitals, dispensaries and primary health centres. 5. Public health services. 6. Family planning 7. Indigenous systems of medicine. All the above received due consideration in the five year plan. 04/10/2015www.drjayeshpatidar.blogspot.com 47
  48. 48. Five year plans Planning commission gave considerable importance to health programmes in the five year plans The objectives of the health programmes during the five year plans have been 1. Control and eradication of major communicable diseases. 2. Population control 3. Development of health man power resources. 4. Strengthening basic health services through the establishment of primary health centres. 04/10/2015www.drjayeshpatidar.blogspot.com 48
  49. 49. Healthcare of the community Levels of healthcare Primary care level Secondary care level Tertiary care level 04/10/2015www.drjayeshpatidar.blogspot.com 49
  50. 50. Health for all by the year 2000 Fundamental principal of HFA/2000 strategy is equity, i.e. an equal health status for people and countries, ensured by an equitable distribution of health resources. National strategy for HFA/2000 (for India) • Government of India was committed, to taking steps to provide HFA to its citizen by 2000 • The national health policy 1983 committed the government and people of India to the achievement of HFA. • It has laid down specific goals in respect of various health indicators. 04/10/2015www.drjayeshpatidar.blogspot.com 50
  51. 51. The important goals to be achieved by 2000 were, • Reduction of infant mortality from the level of 125 (1978) to below 60. • To raise the expectation of life from the level of 52 years to 64 • To reduce the crude death rate from the level of 14 per 1000 population to 9 per 1000 • To reduce the crude birth rate from the level of 33 per 1000 population to 21 • To provide water to the entire rural population. 04/10/2015www.drjayeshpatidar.blogspot.com 51

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