hospital planning

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Hospital Planning
Hospitals

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HP Ch 01
Hospital
A hospital is an integral part of a Social and
Medical organization, the function of which is to
provide for the population complete health care,
both curative and preventive, and whose out-
patient services reach out to the family and its
home environment; the hospital is also a center
for training of health workers and bio-social
research.
-WHO definition of a hospital.

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 The hospital can be defined as an
institution whose primary function is the
provision of a variety of diagnostic and
therapeutic services to patients, both in
the hospital and in out-patient clinic
 It is the umbrella organization under which
many individual healthcare professionals
provide some or all of their services.

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 More than 30 disciplines are represented
in most hospitals, each having it’s own
professional structure, body of knowledge,
code of ethics, and technical procedures.
 A hospital is also a social institution,
dealing daily with a broad panorama of
human hopes, fears and concerns.

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 Finally, a hospital is a business, responsible for
the efficient, cost-effective provision for a wide
range of services.
Functions of the Hospitals
1. Universal function is patient care.
- Diagnosis
- Treatment
- Rehabilitation
- Preventive care.

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Patient care directed by physicians and
assisted by hospital staff.
2. Education of the Health Professionals
 Medical and nursing professions – clinical
training and education.
 Today paramedical personnel are also
trained.
 For continuing education opportunities for
its own personnel.

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3. Research
 Hospital coordinate the work of a scientist and
clinician to promote the development of research
that may be applied to the practice of medicine.
4. Community outreach services.
 Recently hospitals have taken a more active role
in community service through outreach
programmes. Promotion of good health habits
and emphasis on preventive medicine.

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Classification of Hospitals
1. Age .
 Peadiatrics
 Geadiatrics
2. Sex
 Female
3. Specialty
 Heart
 Eye
 kidney

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4. Size
a. Category A - 25-50 beds
Category B – 51-100 beds
Category C – 101- 300 beds
Category D – 301-500 beds
Category E – 501-750+ beds

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b. Small – 100-300 beds
Medium – 301-500 beds
Large – 500+ beds.
5. Ownership
Government & Non-Government.
Government:
Central, State, District, Panchayath, etc.

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Non-government
 Private
 Corporate
 Individual
 Trust
 Family, etc.
6. Financial
 Profit
 Not-for-profit.

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7. Region wise
 Rural
 Semi-urban
 Urban
8. Academic
 Teaching
 Non-teaching
 Research

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9 Systems of Medicine
 Allopathic
 Ayurvedic
 Unani
 Homeopathic
10 Levels of care
 Primary (Basic)
 Secondary (specialized)
 Tertiary (highly specialized)

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HP Ch 01
History of Hospitals
Hospital the word derived from Latin word
‘Hospice’.
Hospital, hostel, hotel – all originated from
the same word.
‘Hospitium’ or ‘Hospitale’ – the place or
establishment where a guest is received.

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 The term ‘Hospital’ has at different times
been used to refer to –
- An institution for aged and infirm.
- A place of rest.
- A hostel where people lived as a small
community.
- An institution for the care of the sick and
wounded.

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Early Greek and Roman Civilizations
- Temple of gods were used as hospitals.
- Service of sick a integral part of temples.
- Part of religious practice.
- Priests were the people ‘who got the
healing power from god’.
- Sickness curse from gods.

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 In these civilizations
- Little distinction was made between the disease
and the supernatural powers that causes
diseases.
- Where ‘mysticism’ and ‘superstition’ saddled
medical practice.
- Where more soul healing than physical healing
was practiced.
- Charity was the principle source for defraying
illness cost of the poor.

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 It was in Greece that Hippocrates –
universally known as ‘Father of Western
Medicine’ was born in 460 BC
 With the Birth and spread of Christianity
- Hospitals became an integral part of the
church and its monasteries.
- Gradually Christian hospitals replaced
those of both Greek and Roman.

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 During 1100 – 1300 AD over 19,000
hospitals were found in Europe.
 In 1163 AD ‘the Church’ formally restricted
the clergy from working as physicians.
- This restriction saw the downfall of
hospitals.

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Some notable hospitals:
- Hotel Dieu – started in 542 at Paris.
- St Bartholomew's Hospital – started in
1123 in London.
- Spaniard built the first hospital in Mexico
City (South America) in 1524.

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Nineteenth Century
Middle of nineteenth century -Crimean War
(1853-1856) between joint forces of
Britain and France with Russia
- Was the turning point in the history of
hospitals in the Western World.
- Main person to change the history was –
Florence Nightingale.

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 Later discoveries which helped the
development of hospitals
- Anesthetia
- Principles of antisepsis,
- Steam sterilization in 1886,
- X-ray in 1895,
- Rubber gloves in 1890, etc…….

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Hospitals in India
India did not lag behind in health care sector
from early ages.
- At the time of Buddha care was taken of
the sick people because of his teachings
on ‘Ahimsa’.
- King Asoka after the famous ‘Kalinga War’
embraced Buddhism and started hospitals.

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The writing of
- Sushruta (6th c BC) – famous Surgeon.
- Charaka (200 AD) – famous physician.
‘Charaka Samhita’ – has instruction for
- Creation of hospitals.
- Provisions of lying-in and children rooms.
- Maintenance and sterilization of bed linen with
steam and fumigation
- Use of syringes and other medical appliances.

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There were rituals laid down for the
attendants and physicians who were
enjoined to wear white clothes and
promise to keep the confidence of the
patients.
Mohammedan invasion – brought with them
‘Hakims’ who followed Greek system of
medicine which came to be known as
‘Yunani’.

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 The Modern System of medicine in India
was introduced in the 17th C. with the
arrival of European Christian missionaries
in South India.
 1664 first hospital for its soldiers at
Chennai by East India Company.
 In 1668 first hospital was established in
Chennai for civilian population.

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 Organized Medical Training was started
with the First Medical College opening in
Calcutta in 1835,
- Then in Mumbai in 1845,
- And later in Chennai in 1850, etc …..
 In 1885 there were 1250 hospitals and
dispensaries in British India.
- But medical care scarcely reached 10% of
the population.

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Hospitals in Independent India
In 1947:
- Bed population ratio 1:4000.
- Doctor population 1:40,000.
In recent times the health care services have
undergone a steady metamorphosis, and the
role of hospital has changed, with the
emphasis shifting from:………….
1. Acute to chronic illness.
2. Curative to preventive medicine

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3. Restorative to comprehensive medicine.
4. Inpatient care to outpatient and home
care.
5. Individual orientation to community
orientation.
6. Isolation function to area-wise or regional
function.
7. Tertiary and secondary to primary health
care.
8. Episodic care to total care.

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Impediments to medical care delivery:
 Geographic barriers
 Climatic features
 Insufficiency of resources.
 Inability to provide finances.
 The conditional nature of the right to
services under Social Security Institutions.
 Poverty, illiteracy, etc……..

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Factors lead to changing role and functions of the
hospitals.
1. Expansion the clientele from the dying, the
destitute, the poor and needy to all classes of
people.
2. Improved economic and social status of
community.
3. Control of communicable disease and increase
in chronic degenerative diseases.

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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 and socio-
political awareness with the result that
people expect better services and facilities
in health care institutions.

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8. Control and promotion of quality of care by
statutory and professional associations.
9. Increase in specialization where need for team-
approach required. 10. Rapid advance in
medical science and to health and disease is
now technology.
11. Increase in population requiring more number
of hospital beds.
12. Sophisticated instrumentation, equipment and
better diagnostic and therapeutic tools.

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13. Advances in Administrative procedures
and management techniques.
14. Reorientation of the healthcare delivery
system with emphasis on delivery of
primary health care.
15. Awareness of community.

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Functions of the Hospital
The core function of a hospital is to treat patients
who are ill, but an analysis confined to this
function would be misleading.
The hospital may also be an important setting for
teaching and research and may actively support
its surrounding health care system.
Furthermore, the hospital may be an important
source of local employment and may play
several societal roles.
The expectations that accompany each of these
roles have important implications for the
organization of the hospital and its relationship
with its wider environment.

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The functions of a hospital can be:
1. Patient care
 Inpatient, outpatient and day patient
 Emergency and elective
 Rehabilitation
2. Teaching
 Vocational
 Undergraduate
 Postgraduate
 Continuing education

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3. Research
 Basic research
 Clinical research
 Health services research
 Educational research
4. Health system support
 Source for referrals
 Professional leadership
 Base for outreach activities
 Management of primary care

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5. Employment
 Inside hospital:
 Health professionals
 Other health care workers
 Outside hospital:
 Suppliers
 Transport services

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6. Societal
 State legitimacy
 Political symbol
 Provider of social care
 Base for medical power
 Civic pride