hospital and its organization

1. HOSPITAL
The word “hospital “derived from the Latin word hospitalis which in
turn derived from french word “hospes” that means “ a guest or a
visitor”
A hospital is a health care organization providing treatment to patients
thorough qualified staff and scientific equipments.
A hospital is an organization providing short-term and long-term
medical care including, diagnostic, therapeutic and rehabilitation
services to the subjects suffering or suspected to be suffering from a
particular disease or injury. It may or may not also provide services for
ambulatory patients on an out-patient basis’.

2. FUNCTIONS OF THE HOSPITAL
Patient care
Diagnosis and treatment of disease
Out patient services
Medical education and training
Working platform for hospital pharmacist
Improvement of public health
Prevention of disease and promotion of health.

3. CLASSIFICATION OF HOSPITALS
Hospitals are classified in different ways such as according to
1. Based on Objective/services
General hospitals Speciality hospitals Teaching cum Research Hospital Isolation Hospitals
Medicine surgery Maternity
Tuberculosis Orthopedic
Psychiatric & nervous disorders Cardiac
Communicable diseases Gynecologic

4. CLASSIFICATION OF HOSPITALS
2.Based on ownership and control
Governmental Hospitals Non-governmental
Semi Government Hospital Voluntary AgencyHospitals
Armed forces hospital
Provincial Hospitals
Teaching hospitals
Federal hospitals

5. CLASSIFICATION OF HOSPITALS
3. Based on Length of Stay
Short-term/short-stay hospitals Long-term/long-stay hospitals
(Stay less than 30 days) (Stay more than 30 days)
4. Depending on Type of Medical Staff
Closed-staff hospital Open-staff hospital

6. CLASSIFICATION OF HOSPITALS
5. Based on bed capacity (Size)
Small hospital Medium hospital Large hospital
(Upto 100 beds) (100 to 300 beds) (More than 300
beds)
6. Based on type of care:
Primary Care Secondary Care Tertiary Care

7. CLASSIFICATION OF HOSPITALS
7. By teaching affiliation
Teaching hospital Non-teaching hospital
8. Basing on system of medicine
Allopathic hospital Ayurvedic hospital
Homeopathic hospital Unani hospital
9. WHO Classification
Regional Hospital Intermediate/District Hospital
Rural Hospital

8. General hospitals
• General Hospitals provide wide-range of various types of healthcare
services.
• 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
• The services of speciality hospitals are restricted to a particular
conditions such as orthopedics, maternity, paediatrics, geriatrics,
oncology etc.
Teaching cum Research Hospital:
• These hospitals are also affiliated with medical, nursing, dental &
pharmacy education.
• Provide medical care, as well as teaching and research facilities

9. Governmental or public hospital
They are owned or controlled by the government and receives
government funding. They provide free medical care to the patients.
The governmental hospitals are controlled by the Ministry of Health.
Private Hospital
Privately owned and controlled by an individual or group of physicians
or citizens or by private organization.
Purpose is to provide services for profit making.
Semi Govt Hospital
Hospitals run through mutual collaboration of government and private
entity.
Voluntary Agency Hospital
Hospitals initiated by the Voluntary Organizations. These hospitals are
not meant for profit

10. Short-term or short-stay hospitals
These are hospitals where over 90% of all patients are admitted with stay less than 30
days.
Long-term or long-stay hospitals
These are hospitals where over 90% of all patients admitted with stay of about 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.
Close Staff Hospital 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.
Open-staff hospital
This type of hospital permits other physicians in the community to consult and treat
patients of the hospital.
Open Staff Hospital means Open medical staff, which means any physician can
request to practice at the facility, regardless of their hospital affiliation.

11. Primary Care Hospital
Primary care is the day-to-day healthcare given by a health care provider.
Typically this provider mostly Provides basic health care. It is generally
regarded as the ‘gateway’ to receiving more specialist care.
Secondary Care Hospital
It provides more complicated/specialist services particularly beyond the
scope and capacity of primary care e.g. internal medicine, gynecology, and
obstetrics.
Tertiary Care Hospital
This level deals with highly specialized services provided at provincial or
federal level e.g. cancer hospitals, mental hospitals

12. Based on system of medicines
1. ALLOPATHIC HOSPITALS
A system in which medical doctors and other healthcare professionals
(such as nurses, pharmacists, and therapists) are licensed to practice
and treat symptoms of diseases using drugs, radiation, or surgery.
2. AYURVEDIC HOSPITALS
A system in which medical care is provided through Ayurveda system of
medicines.
Ayur means life or living, and Veda means knowledge, so Ayurveda has
been defined as the "knowledge of living“
Ayurvedic medicine utilizes diet detoxification and purification
techniques, herbal and mineral remedies, yoga, breathing exercises,
meditation and massage (Indian)

13. 3. HOMEOPATHIC HOSPITALS
Hospital that uses homeopathic system of medicines for the medical care of
patients
(Homeopathy, or Homeopathic Medicine, is the practice of medicine that
embraces a holistic, natural approach to the treatment of the sick. It is based
on two important theories
• “Like cures like”—disease can be cured by a substance that produces
similar symptoms (same type of disorder) in healthy people
• “Law of minimum dose” (lower the dose, greater will be effect) or dilution
increases potency (German)
4. UNANI SYSTEM HOSPITALS
A hospital setting that utilizes the unani system of medicines to fulfill the
needs of medical care to patients .
Unani medicine, also called Unani tibb, Arabian medicine, or Islamic
medicine, a traditional system of healing and health maintenance observed
in South Asia. Hijama therapy & aroma & spasm massage therapy (Asian).

14. WHO Classification (Expert Committee 1957)
1. Regional Hospital
Provides complex range of treatment and highly specialized services.
Serves a larger area than a local hospital. District hospitals in some countries are called
regional hospitals.
The World Health Organization defines a regional hospital or provincial hospital as a
secondary level hospital providing 5 to 10 clinical specialties and with 200 to 800
hospital beds. It is different than a smaller primary-level hospital and larger tertiary-
level hospital.
2. Intermediate/ District Hospital:
A district hospital typically is the major health care facility in its locality
Specialty services in major disciplines (e.g., Medicne, Surgery, Gynae etc).
3. Rural Hospital:
These hospital are located in remote areas with small number of beds and limited
service capacity. It should have 20-100 beds.

15. BOARD OF DIRECTORS
BOARD OF GOVERNORS
MEDICAL DIRECTOR
CHIEF OF SERVICES
PERSONNEL ADMINISTRATIVE STAFF
ORGANIZATIONAL
PATTERN OF PRIVATE
HOSPITALS

16. Commanding Officer
Station Health Officer Matron Second In-charge Quarter master
Unit Accountant Company officer Staff officer Medical Squad Surgical staff
Medical officer
outdoor
Other Specialist
Medical officer
IN-door
DEPARTMENTAL
ORGANIZATION IN A MILITARY
HOSPITAL

17. Medical Superintendent
Office
Establishment
Basic
Department
Hostels
Matron
Library
Clinical
Department
Physiology
Bio Chemistry
Anatomy
Pathology
Pharmacology
Community
Medicine
Forensic
Medicine
Surgery
Medicine
Gynecology
Pediatric
Ophthalmology
Orthopedic
ENT
Anesthesia
Cardiology
Dermatology
Other
Services
Each Clinical
Department
Has Typically
Professor
Associate
Professor
Assistant
Professor
Each Basic
Department
Has Typically
Professor
Associate
Professor
Assistant
Professor
Demonstrator
Supportive
Staff
ORGANOGRAM FOR A TEACHING
HOSPITAL

18. 1. Management
• Management is a distinct process of planning, organizing, motivating
and controlling individuals as well as allocated resources to
accomplish the stated goals of an organization.
• Hospital Management is a term very broad in scope
• Hospital management relates to management of all aspects of a
hospital which includes the coordination of all elements of a hospital.
• This may range from patient care to record keeping to inventory of
medicines and cleanliness.

19. Management of hospitals in Pakistan
• In broader terms, there are mainly three types of hospitals in Pakistan
1. Teaching/government hospitals
2. Private hospitals
3. Military hospitals
• Management responsibilities of a teaching/government hospitals are
done by medical superintendent who is appointed by ministry of
health.
• Military hospitals are managed by commanding officers
• While private hospitals is managed by governing body or Board of
directors/board of governors/Board of Managers. Total number of
member in governing body vary from hospital to hospital

20. • The partnership of some hospitals may sometime consist of large number of
members.
• From such members specified group of members is elected as board of trustees.
This group is also known as governing board, board of governors, board of
managers, boards of directors
• Governing body appoints chief executive officer responsible for the management
of entire hospital.
• The governing body is responsible for defining
1. Powers and duties of governing body officers.
2. Method of selection, Tenure and qualification of the governing body members.
3. Implementation and appropriate functioning of various committees.
3. Appointment and tenure of chief executive officers & other members of
committees.
4. Evaluation of performance of employee
Management of hospitals in Pakistan

21. 2. Administration
• Administration is defined as the act of managing duties,
responsibilities, or rules.
• The board of trustees of hospital delegate hospital’s active
management to an administrator and his staff.
• Administration of a hospital is developing, implementing, and
directing equipment & staff management programs to successfully
achieve patient care.
• Administration of a hospital is responsible for operation of whole
organization.
• The administrator of a hospital is specialist in administration and is
specially be qualified and trained for his position. Usually an
administrator holds the degree of masters of hospital administration

22. Functions of Administrators
1) Enforce trustee policy in the daily management
2) Establish organizational structure to carry out programs of a
hospital and to meet needs of a patients
3) Develop & implement a comprehensive management reporting
system thoughout an institution.
4) Implement the governing body’s policy on the financial
management of hospital
5) Provide, maintain and safeguard appropriate physical resources in
the institution
6) Look at the weakness influencing any aspect of institution

23. 3. Departmentalization
• Departmentalization is a grouping of various sections and division
according to the same nature of services provided.
• The degree of departmentalization of the hospital depends entirely
upon the extent of specialization of the staff
• Typically there are following departmental categories
a. Clinical department
b. Support services department
c. Biomedical engineering department
d. Finance/ account department

24. a. Clinical departments
• The extent of departmentalization of clinical services in a hospital
depends on the degree of specialization of medical staff.
• In small hospitals, only two departments are present
a. Medicine
b. Surgery
• In large hospitals, hospital staff is highly specialized and therefore
there are greater subdivisions within a clinical department
• Clinical department is broadly divided into medicine and surgery

25. Continue
The department of medicine include the following subdivision
Cardiology Infectious diseases
Dermatology endocrinology
Geriatrics immunology
Pediatrics nephrology
Neurology psychiatry
Pulmonary diseases Rheumatology

26. Continue
• The department of surgery is divided into
• Each of these subdivisions usually has a chief of service who in turn,
is responsible to the departmental chief
General surgery Orthopedic surgery
Neurologic surgery Obstetric and gynecology
Ophthalmology Dental and oral surgery
Otolaryngology Thoracic surgery
Urology Proctology (colorectal surgery)

27. Support services
• The functioning of clinical department is facilitated by supportive or
non clinical services.
• The supportive services include
i. Pharmacy services
ii. Nursing services
iii. Dietetic services
iv. Medical record department
v. Pathology services

28. i. Pharmacy department
• It is one of the department that exerts a great influence on the
professional position of institution and economy of hospital
• It is due to interrelation with and inter dependency of other services
upon it
• In a hospital setting, doctor diagnose and prescribe the medicines,
pharmacist dispense the medication, the nurse administer drug to
patient (unless the patient is on self medication regimen)
• Pharmacy department is staffed with pharmacist, pharmacy
technician and pharmacy aid and is supervised by director of
pharmacy or pharmacy in chief

29. Continue
• This department offers following services
1. Drug distribution including floor stock and unit dose distribution
2. Dispensing of drugs to out-patients
3. Deals the intravenous admixture programme
4. Provide clinical services which include pharmacy consultation,
drug information for physician/nurses/ patients, recording
patient drug history, providing information about drug
interactions and effect of drugs on lab tests, patient drug use
review, therapeutic monitoring
5. Purchasing and inventory control of drugs and allied items

30. Continue
6. Conduct and support of pharmaceutical and clinical research
7. Serving functions for vital committees( P&TC, infection control,
research review)
8. Offers some special services which include radiopharmaceutical
services, total parenteral preparation, poison control centre

31. ii. Nursing service
• Nursing care is an integral part of total health care system and
necessary for regaining and maintain health
• Nurse is an individual who helps, teaches, counsels and takes care
of patients particularly in patients
• This department is staffed by the highly trained nurses. Now a
days, nurse may be specialized in oncology, blood bank, night
nursing care, floor nursing care
• Nursing service is headed by director of nursing with
administrative authority. The director of nursing is responsible for
participation in formulating policies and devising procedures
required for achievement of objectives, in developing and
appraisal of quality of nursing service.
• In some institutions director of nursing is also responsible for
administration and opening of school of nursing

32. iii. Dietetic services
• Dietetic service is one of the essential services in any hospital.
• It is staffed by dietitians, technical and clerical personnel and is
directed by personnel with professional qualification in nutrition
• This department is responsible for preparation of appropriate food
by applying the principles of nutrition science.
• In Pakistan, only large hospitals has instituted this service

33. iv. Medical record department
• Patient record keeping is the responsibility of medical record department
• Every hospital is required by law to maintain adequate medical records of
their patients
• This department is staffed by technically skilled personnel and is headed by
suitable qualified individual
• The purpose of this medical record are to
• serve as a basis for planning and for the continuity of patient care
• Provide a mean of communication among the physician and professionals
contributing to patient care
• Furnish documentary evidence for course of patient’s illness and treatment
for each hospital stay

34. Parts of medical record
• A sufficiently detailed medical records include
1. A Front Sheet or identification Summary Sheet
2. Consent for Treatment
3. Admisision history sheet
4. Admission notes, clinical progress notes, Nurses progress
note
5. Operation report if operation has been performed
6. Discharge Summary

35. Continue
7. Investigation reports like, X-ray, pathology etc
8. Orders for treatment and medication forms listing daily
medications ordered and given with signatures of the
doctor prescribing the treatment and the nurse
administering it
9. Autopsy report sheet is included if the patient dies during
hospitalization

36. v. Pathology Services
• The department of pathology services has staff of laboratory
technicians
• This department is supervised by qualified physician with training in
pathology and is able to assume professional, organization and
administrative responsibility for the services rendered.
• Clinical lab, clinical chemistry, microbiology, clinical microscopy,
hematology, serology and the section for drug analysis in blood
samples may be the sub divisions of a pathology department

37. Continue
• Some other support services are
• Blood bank
• Radiology
• Nuclear medicine
• Radiotherapy department
• Diagnostic services
• Anesthesia service

38. C. Biomedical engineering department
• The biomedical engineering department Is under the control of a
qualified biomedical, electrical or electronic engineer.
• This department is staffed by adequate number of engineers and
trained technicians

39. d. Finance and account department
• Finances of hospital affect every patient, employee, member and
trustee
• The finance department is staffed by accountants , financial
personnel and a well trained and qualified individual supervisors
• This department is responsible for financing of all operations in a
hospital and delivery of salaries to institutional employess
• The primary source of revenue is derived from the billing of patients
for the services rendered.
• A patient usually pay his bills by himself or the payment is reimbursed
from the third party coverage system

40. FUNCTIONS OF THE HOSPITAL

41. FUNCTIONS OF THE HOSPITAL