Chapter_02_A.ppt

Chapter 02 Hospital Organization
Hospital Organization
Hospital is a complex social, economic and
scientific organization whose main function is to
provide comprehensive health care to the
society and to act as a referral center.
Complexity of function in hospitals is increasing
due to growth of various specialties and super-
specialties.

The more complex the organization, the more
difficult is its management.
To overcome this, every organization has to define
its goals/objectives.
The goals should be comprehensive and
achievable, defining the services a hospital
wishes to offer.
Organization is the process of establishing the
relationship between functions and materials
and grouping them together for a common
purpose.

The organization structure locates specific
duties and responsibilities of the individuals.
These individuals are grouped into units and
subunits according to the types of duties they
will perform.
An organization cannot function on its own
because personnel need resources,
motivation and leadership to act.
To provide the above, power and authority are
required.
Power ids derived from authority and authority
is delegated through legislation and rules.

Hospital organization
 Clinical and Nursing Services
1. Out-patient Services
2. In-patient Services
3. Emergency Services
4. Operation Theatre Services.

 Supportive Services
1. Radiological Services
2. Laboratory Services
3. Central Sterile Supply services
4. Laundry Services
5. Blood Bank Services
6. Mortuary Services
7. Rehabilitation
8. Dietary services
9. Medical Records
10. Medical Social Service
11. Pharmacy Services

 General Administration Including Business
1. Personnel Management
2. Financial Management
3. House-keeping Services
4. Material Management
5. Marketing
6. Hospital Engineering Services
7. Transport Services
8. Public Relations
9. Communications
10. Security and Fire Services.

Governing Board
Except in a single-proprietorship hospital, there
has to be a body of persons statutorily
responsible for running the hospital.
This body is variously called as the “board of
directors”, “governing board”, “board of trusties”,
“governing body” or “management board”.
A governing board, as a body of persons, can
make and guide policy but cannot, by its vary
composition, “run” a hospital.
The “running” of the hospital is carried out by the
hospital administrator.

Hospital administrator as the board’s chief
executive officer he has overall charge of the
affairs of the hospital.
However, the extent of his control depends upon
the following factors:
1. How he perceives his job.
2. How the board perceives the job.
3. How much freedom he is allowed in doing the
job.

A typical hospital management board is
different from many other dissimilar
organizations.
Some boards may interpret their own role as
of “running” the Hospital’s day-to-day
affairs.
On the other hand, the administrator could
be inhibited from showing his initiative.

Hospital Administrator
So many names for a office: hospital administrator,
chief executive officer, medical superintendent,
director (administrator), hospital manager,
hospital director………. Etc.
Nevertheless managing a hospital always involves
partnership with the medical and nursing staff.
Therefore, the hospital administrator can never
have quite the same degree of autonomy as his
industrial counterpart.

One of the principles of organization is that
responsibility must be matched by authority.
Therefore, it is natural to suppose that the
administrator, charged with his responsibility
would have the board’s full authority to act on
its behalf.
The job of the administrator is to plan, to organize,
to direct and to control – functions which are
inherent to the job of every administrator.

As a manager , he represents the organisation to
higher authorities and to the outside world.
he is responsible for policies and procedures, the
overall administrative structure, financial
management, personnel management, reporting
to the board, relation with the medical staff,
overseeing medical care, maintaining physical
faculties, legal matters and maintaining good
public relations.

Having to deal with multiple groups with
conflicting interests, the demands on a top
hospital administrator are almost unending.
He must be a generalist and a specialist combined
in one, capable of understanding and
interpreting medical, financial, economic,
functional and logistic matters, and he must
excel at personnel management.
Hospital Administrator – Medical or Non-
Medical Person?

Roles and Functions of Hospital Administrator
1. Working with peoples.
Balance the goals of the hospitals by working with
patient care teams where physician is the
kingpin who in turn works with others in
rendering patient care. Understand workers,
their motivations and aspirations, and knit them
together as a team.

2. The Enabling Role.
Ensure the provision of necessary physical facilities
and ensure that the supportive services are
available in the right amount, of the right
quality, and at the right time and place.
3. Hospital administration and Staff.
Understand the staff and understand variations in
styles of administration.

4. Staff Motivation
Develop measures to keep up motivation of all
categories of staff, and be constantly on the
look-out for cases of dissatisfaction and conflict.
5. Facilitating Decision Making
provide appropriate inputs to decision making at
the clinical department level, and coordinate
decision making at the interdepartmental level.

6. Management of Resources
His judgement may not necessarily be superior to
that of the experts who propose the case, but
his position is the most appropriate one from
which to make it.
7. Negotiating
Steer closer to “creative problem solving” situation,
rather than turning to a “choice” situation.
Emotions do play a part in negotiation session,
but guard against them.

8. Containing Costs
Exercise control over financial matters through
costing. Cost-control, budgeting and judicious
investment of hospital funds.
9. Dealing with New Technology
Strike the judicious balance between new
technology and the hospital’s needs, cater for
training and retraining to catch up with new
technologies, innovations and improvements.
Organise such training at formal, informal,
institutional and individual levels.

10. Establishing Managerial Climate
Administrative personnel must be
compatible with each other and with
organisation. Where a change in
managerial climate is called for, by
prepared to recognise the need and be
capable of meeting it. Provide the main
lead in this direction.

11. Management Development
The quality of patient care depends upon the
quality of the hospital’s human resources, which
in turn is determined by the quality of the
leadership at various levels. Facilities this most
critical input by planned leadership development
at different levels.
12. Evaluation
Continuous, ongoing self-evaluation is a means of
quality assurance.

13. Fact-Finding and Investigation
Fact finding and investigation call for caution
so that the workers sensibilities are not
offended.
14. Social Commitment
Balance the conflicting requirement of
looking after the business interests of the
hospital with social obligation towards
society.

Characteristics of Effective Manager
 Clear and Realistic Goals
 Professional Par-Excellence
 Perceptual and Cognitive Flexibility
 Professional Growth
 Commitment to the chosen field
 Attitude and Confidence

 Communication
 Diversity
 Creative Orientation
 Motivation
 Satisfaction
 Self-esteem

Hospital Architect
An architect is trained and licensed in planning and
designing buildings, and participates in
supervising the construction of a building.
Etymologically, architect derives from the Latin
architectus, itself derived from the Greek
arkhitekton (arkhi-, chief + tekton, builder), i.e.
chief builder.
With patients today looking for better facilities and
a pleasant environment in a hospital besides
competent doctors, hospital architecture has
become a very important factor in efficient
healthcare delivery.

Hospitals are not just ordinary buildings in
terms of their design; there are spiritual,
cultural, economic, social and
demographic dimensions, which play an
effective role in the appearance of the
building. Architects who design healthcare
buildings should keep in mind the
environment.

He is the member of Hospital Planning
Team.
The architect has to acquire an
understanding of the comprehensive
technical and administrative needs of the
hospital.

His responsibility is to translate clinical and
administrative requirements into
architectural and engineering realities
which encompass site, selection,
orientation of building, supervision of
construction, utilities and electrical and
mechanical installations.

The requirements have to be understood in depth
by the architect from the hospital consultant,
from which should develop a programme in
writing stating clearly all the requirements in
comprehensive terms, viz. number of beds, their
distribution, departmental needs, area
requirements, major equipments, number and
type of personnel to be employed, departmental
functions and relationships.

Architectural creativity is synthesising all elements
into appropriate solution pattern.
For a hospital architect, to create as hospital which
satisfies the functional requirements of the
profession (medical, nursing, administrative),
meets the cost limits set by the owners and yet
retain some quality of architecture, is a task
requiring imaginative approach, a high degree of
professional skill and ingenuity.

Architect’s brief
It is also called functional brief.
An architectural brief is, in its broadest sense, a
requirement a client may have that an architect
designs to meet, usually by creating a building
to accommodate the requirement(s).
A brief is a written document that might be
anything from a single page to a multiple
volume set of documents.
It is often formulated by or with the architect, and
includes opportunities assessed, constraints
identified and needs for further investigation
clarified.

Before an architect can develop a hospital
design that will best serve its functions, he
has to be provided with a written
programme explaining hospital’s
operational policies, particularly those
related to the design of clinical areas.

The differentiation, interlrelationships and
interdependence between the out-patient
departments, ward wings, diagnostic
departments, nursing units, consultation
rooms, X-ray, surgical suits, laboratory,
kitchen, store rooms, etc,.
To enable a hospital to serve its purpose,
“design must follow function”.

Choosing a site
Site is a very important factor for, upon the
suitability of it, will depend the hospital’s
fate and utility in future.
With increasing demand on hospital beds,
planning for expansion at a future date
should always be kept in mind right at the
outset while choosing the site.

It must have the following characteristics:
 Easy approach by people
 Enough land availability
 Sub-soil water must be deep.
 Sufficient supply of water and electricity.

Determining the requirement of land
depends upon many factors.
In rural and semi-urban areas, plentiful land
may be available permitting the hospital to
grow horizontally.
However, in urban areas there will always be
great premium on land and the only
available avenue will be a vertical growth.

Site survey
In selection site, two very important factors that
should be looked into are
 Level of subsoil water
 The structure of the soil.
A preliminary soil survey to determine subsoil
water level and the “bearing” quality of the soil
will help determine the type of foundation,
possibility of constructing a basement, and
effectiveness of sewage plant (if it is to be built
on the site).

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