Hospital management

1. Hospital Management
17 June 2016

2. Hospital
• An institution that provides medical,
surgical, or psychiatric care and treatment
for the sick or the injured
• A hospital, in the modern sense, is an
institution for health care providing patient
treatment by specialized staff and
equipment, and often, but not always
providing for longer-term patient stays

3. WHO’s Hospital
WHO defines the term “hospital” as an
institution that provides in-patient
accommodation for medical and nursing
care. It further elaborates the definition to
cover hospital that assume additional
functions – curative, rehabilitative and
preventive services – directly or in a
consultative capacity, also participating in
the training of personnel and in research
work.

4. Terminologies
The word hospital comes from the Latin hospes,
signifying a stranger or foreigner, hence a guest.
Another noun derived from this, hospitium came
to signify the place or establishment where a
guest is received. Hospitium - Hospitale
Hospes is thus the root for the English words
hospital, hostel and hotel.

5. Changing role of Hospitals
With emphasis shifting from
• Acute to chronic illness
• Curative to preventive medicine
• Restorative to comprehensive medicine
• Inpatient care to outpatient and home care
• Isolated function to area-wise or regional
function
• Tertiary and secondary to primary health care
• Episodic care to total care

6. Factors Changing role of Hospital
The important factors which have led to the
changing role and functions of the hospital
are as follows:
1.Expansion of the clientele from the dying,
the destitute, the poor and needy to all
class of people
2.Improved economic and social status of
the community
3.Control of communicable diseases and
increase in chronic degenerative

7. Factors Changing role of Hospital
contd.
4. Progress in the means of communication and
transportation
5. Political obligation of the government to provide
comprehensive health care
6. Increasing health awareness
7. Rising standard of living (especially in urban
areas) and sociopolitical awareness (especially
in semi-urban and rural areas) with the result
that people expect better services and facilities
in health care institutions

8. Factors Changing role of Hospital contd.
8. Control and promotion of quality of care
by statutory and professional
associations
9. Increase in specialization where need for
team approach to health and disease is
now required
10. Rapid advances in medical sciences
and technology
11. Increase in population requiring more
number of hospital beds

9. Factors Changing role of Hospital contd.
12. Sophisticated instrumentation,
equipment and better diagnostic and
therapeutic tools
13. Advances in administrative procedures
and management techniques
14. Reorientation of health care delivery
system with emphasis on delivery of
primary health care
15. Awareness of the community

10. Hospital from different perspectives
1. Client-oriented perspective:
which is that of access to services, use of
service, quality of care, maintenance of client
autonomy and dignity, responsiveness to client
needs, wishes and freedom of choice
2. Provider-oriented perspective:
that of the physician, nurses and other
professionals working for the hospital, and
include freedom of professional judgment and
activities, maintenance of proficiency and
quality of care, adequate compensation,
control over traditions and terms of practice
and maintenance of professional norms.

11. Hospital from different
perspectives contd.
3. Organization-oriented perspective:
which covers cost control, control of quality,
efficiency, ability to attract clients, ability to
attract employee and staff, and mobilization of
community support

12. Group dynamics in Hospital
• The First Group is the providers of medical
care, viz. the doctors, nurses, technicians
and paramedical personnel
• The Second Group is management,
administrative and support group
comprising of personnel dealing with non-
clinical functions of the hospitals, such as
diet, supplies, maintenance, accounts,
housekeeping, security etc.

13. Group dynamics in Hospital contd.
• The Third Group and the most important
one for whose benefit the first two groups
exist in the first place, is that of the
patients, who seek hospital service and
their attendants, relatives and associates
who, along with patient come in close
contact of the hospital. This group is
broadly termed as the Community

14. Group dynamics in Hospital contd.
• It is not unusual to expect conflict between
the two groups – the providers of care and
intermediate support group on the one
hand and the patient and the community
on the other. The nature of relationship
between the two groups influences
community relationship, and on this
relationship depends the image of the
hospital. To better this image, hospitals
have to re-orientate themselves to the
expectations of the community

15. Group dynamics in Hospital contd.
Relevant communication and information must
reach the user community in order to promote
their participation and involvement. A community
that is well-informed and aware of its social
responsibilities can become an effective
instrument of cooperation and support.
However, the unpleasant fact that this
community participation can be distorted by
sectional interests trying to use the community
as a pressure group (to attain specific objectives
which are not always compatible with the
paramount aims of the hospital programs) need
also to be remembered.

16. Expectations in Hospital
• People go to the hospital with high expectations
believing that every disease is fully and quickly
curable. The average health consumer regards
contemporary hospitals as the panacea to all
their health problems. They cannot appreciate
the limitations of the hospital. There is an
increasing demand for better and quick cure.
Besides giving care to every patients public
expects sympathetic understanding of the
behaviour of the patient and his/her attendants
and relatives. This shift has necessitated a new
approach to doctor-patient and hospital-
community relationship.

17. Expectations in Hospital contd.
• On the other hand, some questionable
assumptions on which the value system in
hospital is based are still prevalent among
medical personnel. These are that cure
is more important that the care of patients,
and the staff assume power over the
patients, that every problem has a
solution, and that death is the worst thing
that can happen to a person.

18. Expectations in Hospital contd.
• Respect for the dignity of the patient is
one of the most basic rights and needs of
the patients. Concerns for care of the
human being as a whole needs
contribution from everyone working in the
hospital. The hospital is like a federal
system with several departments each
enjoying considerable autonomy and
discretion in its management of work. The
great challenge is one of coordination.

19. Realities of Hospital Organization
The following differentiates the hospital as an organization
in comparison to other service organizations:
1. Every organization has a head. In every organization
there should be a clear line of authority for every
individual. In a hospital, there are a number of
important people who consider themselves as heads.
Bringing together highly skilled professionals to work in
a bureaucratic organization has in-built organizational
conflict.
2. The hospital organization is besieged with absence of
single line of authority and with two chains of
command. On the one hand, there is the chief
executive or medical superintendent. This authority
flows to the matron, housekeeping, accounts etc. from

20. Realities of Hospital Organization contd.
the top to the bottom (scalar chain). On the other hand,
there is the hierarchy of the doctors and consultants.
The smallest gradation of rank and status in the
hierarchical character of medical and nursing
organization is notorious.
3. The hospital organization is characterized by high
interdependence. Because of the extensive division of
labour and accompanying specialization of work,
particularly every person working in the hospital
depends upon some other person or persons for the
achievement of his/her own organizational goal.
Specialists and professionals can perform their
functions only when a considerable array of supportive
personnel and auxiliary services are put at their
disposal at all times. For example, a surgeon cannot
operate on a heart case unless catheter studies have

21. Realities of Hospital Organization contd.
been completed. Even before that, other investigations
have to be available from the respiratory laboratory and
biochemistry laboratory.
4. The timing of the movement of patients through the
systems in largely controlled by chance or by a set of
uncoordinated, individual decisions.
• Organization of universities and research institutions
have some semblance to hospital organizations in
looseness of formal structure and in the degree of
independence by their staff. In industry, the levels of
authority , width of the span of control, ratio of
managerial to total staff and indirect to direct labour can
easily be determined. There is extensive division of
labour in hospital, but at the same time great
interdependence of special skills. A hospital has been

22. Realities of Hospital Organization contd.
described by an industrialist as a wildest kind of jobbing
shop.
• However, two additional factors characterize hospitals
and hospital organizations. As opposed to other
organizations, the individual goals of staff coincide more
with hospital goals, and most of the hospital staff will
identify themselves with hospital goals.
• Hospitals organization is both authoritative and
permissive, highly formalized yet loose-knit. The reason
is the very special nature of hospital work. The crisis
nature of work demands from a number of people –
collaborative performance. Hospitals are extreme cases
of an organization peculiarly dependent for effectiveness
on people, although crisis nature of work demands
collaborative performance in other industries as well.

23. Realities of Hospital Organization contd.
• To the sick, a hospital is a place where they will receive
treatment. To the domestic staff, it is a special kind of
hotel with rooms to be cleaned and meals to be
prepared. To all the staff, it is a place of employment,
and to the junior doctors and nurses, it is a temporary
home. Hospitals may mean different things to different
groups of people at different times. But to the hospital
administrator, it is an organization, a consciously
designed arrangement for management of people,
services and things for a purpose. From the
organizational point of view, the question to ask what is a
hospital for, is more meaningful than what is a hospital.

24. Multiple Pyramid of Hosp. Organization
The salient characteristics of hospital is the absence of a
single line of authority in the organization; the authority
does not flow along a single line of command as it does
in most formal organizations. A dual and at times
multiple pyramid of organization because of the
relationship of medical component to administrative
component, is a peculiar characteristic of hospital
organization. The ultimate authority is vested in the
policy making body – the governing board – which
provides leadership and direction to the organization.
The board appoints the chief executive officer
(administrator) as well as the chiefs of medical services,
who are two different streams of authority. The chief
executive officer (called superintendent, director,
administrator or by some other title depending upon local
preference) who is charged with the responsibility of

25. Multiple Pyramid of Hosp. Organization contd.
of effectively managing the administrative components of
the institution in turn delegates authority to each
department head in the administrative component. A
typical pyramid organization, with a unified chain of
command results within the administrative component.
But a second conglomerate of organizational pyramids
results from the organization of the medical staff into
clinical services, with each having a chief of service. Had
this been also a pyramidal structure with one single chief
or director of medical staff, it would result in only a
second pyramid in the organization structure. However,
seldom is it possible to have a medical staff organization
where there is only one chief with other clinical service
heads directly under him/her in the line of command.

26. Multiple Pyramid of Hosp. Organization contd.
At the same time, none in the administration hierarchy
gives command to the medical staff. Often, doctors give
command to those in administrative hierarchy, but this is
also is not direct. Therefore, full responsibility gets
divided or blurred.
In matters of direct patient care, the physician exercise
professional authority, in matters of administrations the
chief executive exercise authority. Thus, many
employees (such as nurse) are subject to more than one
line of authority. Line officers in the administrative units
may find that their authority is limited in some areas
because of the specific jurisdiction of the medical staff.
The multiple pyramidal structure therefore calls for a lot
of coordination. This is achieved through the extensive
use of committees to bridge the gap.

27. Suggestive Hospital Organization
Looking at the differences in task complexity within the
hospital, departments performing routinised activities
(CSSD, laundry, kitchen) have more task-oriented
workers, more formalized structure than those having
different levels of task complexity (wards, ICU,
laboratory) who are informally structured and more
interpersonally oriented.
Experts in the hospital field have recognized that
complex tasks and highly skilled professional workers
call for a colleagueal participatory structure, while the
repetitive tasks performed by semiskilled and unskilled
workers call for a hierarchical formalized structure. At
one extreme are the physicians with their loose organic
structure and at the other end relatively unskilled
workers of housekeeping, dietary, laundry and
maintenance, with more hierarchical centralized
supervision.

28. Suggestive Hospital Organization contd.
Nurse and skilled technicians fall in between. The
colleaguely structured medical staff structure, coupled
with hierarchically controlled nonprofessional
departments is fundamentally the appropriate form of
organization for a hospital, given the tasks it is faced
with. Nevertheless, a difference of opinion still exists
among two major schools of thought: (i) those who
consider the formal organization with its associated
hierarchical authority structure as superior, and (ii) those
who differ as to the degree to which procedures should
be specified hierarchically and imposed on organization’s
members.