This document discusses hospitals as complex adaptive systems. It defines a system and describes hospitals as adaptive systems that are dynamic, massively entangled, emergent, and robust. The document outlines the internal environment of a hospital including the governance, administrative, and patient care systems. It also discusses the external environment and how hospitals interact bilaterally with factors like demographics, socio-cultural issues, economics, politics, and law. Finally, it presents hospitals using an input-conversion-output model where inputs like human resources, supplies, technology, information, and patients are converted through processes to create individual patient outcomes and organizational work results as outputs.

1. Hospital as a System Dr SandeepMoolchandani

2. We will be focusing mainly upon following points: Systems Concept Internal and External Environment Analysis Input Conversion Output Model of a Hospital

3. “School of Health Systems Studies” “The Indian Healthcare system is in Transition” “The U.S. health care system is in crisis” “Health systems are consolidating and integrating.”

4. Systems Concept A System is defined as “a set of interacting elements responding to the inputs to produce outputs”. Hospitals are considered to be Adaptive type of complex systems. “Complex” implies diversity – a wide variety of elements. “Adaptive” suggests the capacity to alter or change – the ability to learn from experience.

5. Properties of Complex Adaptive Systems Dynamic : There are large number of agents, connections among them and the influence of external forces; all combine to result in constant and discontinuous change in the CAS Massively entangled : Numerous and interdependent, parts and variables, and their relationships, can be nonlinear and discontinuous. Small changes in variables can have small impacts at some times, and large impacts under other conditions. Emergent: Behaviour of the resulting whole is more than the sum of individual behaviours. Robust : A CAS may be sensitive to certain small changes in initial conditions. An apparently trivial difference in the beginning state of the system may result in enormously different outcomes. This phenomenon is sometimes called the “butterfly effect”. (Eoyang and Berkas, 1999; Marion and Bacon, 2000)

6. System Environment Who or what is Internal to the organization and what is external to it? This question leads immediately to the problem of defining the boundary between an organization and its environment. Depends upon the perspective of the observant

7. Input Conversion Output Model of a Hospital system

8. E X T E R N A L E N V IR O N M E N T INTERNAL ENVIRONMENT

9. Environment Scanning Internal Environment The internal environment includes three major systems Governance System Administrative System Patient Care System

10. The Governance System The governance system consists of the various mechanisms used by the hospital for policy making. This is a strategic level where the purposes and the policies of the hospital are decided.

11. The Administrative System The policies and the activities determined by the governance system are to be implemented by the administrative system. The Administrative system constitutes of: Chief Executive Officer Finance and Accounts Department, Medical Superintendent, Asst. Medical Superintendent Administrative Medical Officer Personnel Department Chief Nursing Superintendent and Associate Nursing Superintendents Maintenance Incharge Chief Security Officer EDP department

12. The Patient Care System The patient care system includes two categories: Permanent Staff Resident Doctors Registrars Nursing Staff Paramedical Staff

13. E X T E R N A L E N V IR O N M E N T

14. External Environment Demographic Environment Socio Cultural Environment Economic Environment Political Legal

15. Input Conversion Output perspective Hospitals are formal settings in which outputs are created (objectives) through utilisation (conversion) of inputs(resources). Managers are the catalysts who bring about the conversion of inputs into outputs through the act of managing. The hospital and their mangers interact with the external environment bilaterally. Inputs are obtained from external environment and outputs go into it.

16. Inputs Human Resources: Managers, Doctors, Nurses, Technologists, Pharmacists, Dieticians, Social workers and House Keeping Personnel Material Supplies: Linen, Drugs, X Ray Films, Instruments, Gas Supply, Electricity Technology/Equipment: Xray Machine, Ultrasonograph , Monitoring Equipment, Surgical Instruments etc. Information: EDP Department which manages the HMIS, Books maintained in the departments, Internal reports covering diverse areas such as census, supplies, schedules Capital Resources: Consists of the Total Assets and Funds for hospital operations. Patients/Clients: They are input resources which can be viewed as primary raw material that has to be converted.

17. Conversion The conversion component includes: Various Processes of the Hospital Process or processing typically describes the act of taking something through an established and usually routine set of procedures to convert it from one form to another.

18. Conversion Example : Ward Indenting Process Supplied

19. Output Output of a hospital is conceptually present at two levels – specific individual and organisational work results. Specific Individual: The health outcomes after the delivery of healthcare services to a patient are considered as outputs at individual levels. The various states of the output can be cured, improved, referred or died. Organisational Work Results: Which includes accomplishment of objectives of the Parsi General Hospital and to serve the community.

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