Basics of Hospital Management

2. Self Introduction
Name Brigadier General Dr Zulfiquer Ahmed Amin
Organization Bangladesh Army
Present Unit Bangabhaban
Appointment Personal Physician to Hon’able President
Qualifications
MBBS Dhaka Medical College
PGD (Health Economics) Dhaka University
MPH (HM) Armed Forces Medical Institute (AFMI)
M Phil (HHM) Armed Forces Medical Institute (AFMI)
Advance Course
(Hospital Admin)
All India Institute of Medical Sciences
(AIIMS), Delhi

4. Thesis Guide 4
Book Publication ‘Contemporary Social Concerns’
Medical Publications
National Journal 6
International Journal 3
Publications in the Daily Star 25
Married with 2 daughters
Faculty NSU
AIUB
IUB

5. SUBJECTS OF HOSPITAL MANAGEMENT
Serial Topic
1 Hospital Management- Introduction
2 Management Functions, Skills and Roles
3 Human Resource Management in Hospitals
4 Material Management in Hospitals
5 Financial Management in Hospital
6 Hospital Acquired Infection (HAI)
7 Hospital Waste Management
8 Quality Management in Healthcare
9 Hospital Linen and Laundry Services
10 Measurement of Hospital Performance
11 Motivation in Healthcare Delivery
12 OPD Management in Hospital
13 Communication in Healthcare Delivery
14 Strategic Planning by SWOTAnalysis
15 Hospital Planning

7. Grade Conversion Scheme

9. HOSPITAL MANAGEMENT – INTRODUCTION
Brigadier General Dr Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), Fellow (AIIMS, Delhi), MBBS (DMC)

10. What is Hospital?
The English words hospital, hostel, hotel, and hospice are all etymologically related
to the Latin noun ‘hospes’—a word having the diametric meanings "a guest or
visitor" and "one who provides lodging or entertainment for a guest or visitor."
Hence a hospital can be interpreted etymologically as a place where strangers who
suffer come to be cared for.

11. WHO Expert Committee, 1963:
‘A hospital is a residential establishment which provides short-term and long-term medical
care consisting of observational, diagnostic, therapeutic and rehabilitative services for
persons suffering or suspected to be suffering from a disease or injury and for parturients. It
may or may not also provide services for ambulatory patients on an out-patient basis’.

12. WHO expert committee, 1956:
‘The hospital is an integral part of a social and medical organization, the function of which is to
provide for the population complete healthcare, both curative and preventive, and whose out-
patient services reach out to the family in its home environment; the hospital is also a centre
for the training of health workers and for bio-social research’.

13. Evolution of Hospitals

14. Hospitals in Antiquity
The historical time period from 2000 BC to first century BC is known to us from various forms
of early written accounts, works of art and architecture, as well as many religious and
mythical beliefs. In earliest civilizations of Mesopotamia, Egypt, and Greece, medicine and
religion were closely interrelated. They sought divine aid from their gods. In fifth century BC
Greek medicine used mineral baths, massage, diet, and herbal drugs. The patient slept
within the confines of the temple, probably aided by an opiate, and the god would visit in a
dream. The patient would wake in the morning and have his dreams interpreted by a priest-
physician, who would then perform the proper animal sacrifice and administer an herbal
medicine as a cure.

15. GRAECO-ROMAN ERA (332 BC -395 AD)
Primitive health care associated with the temples of Asclepius are considered by many to
have been the forerunners of hospitals. Ancient Roman hospitals were established by the 1st
century BC as military and slave hospitals. The Graeco-Roman medicine was combination of
religion, magic, surgery, herbs, diet etc. Physicians were religious figures. Two notable Greek
physicians, Dioscorides (Army physician) and Galen, practiced medicine and recorded their
discoveries. Hippocrates rejected all magic and believed in herbal remedies. Galen followed
Hippocrates' theory of the four humours, believing that one's health depended on the
balance between the four main fluids of the body. Asclepiades was a leading Roman
physician. Greek and Roman physicians relied on naturalistic observations rather than on
complete spiritual rituals.
The caduceus, a staff wrapped with two snakes, the symbol associated with health and medicine came into
being.

17. THE CHRISTIAN ERA
During early part of Christianity, evidence-based practices of Hippocrates and Galen during
Greco-Roman period was purged, and care of body was taken over by the church. Illness was
considered as punishment for sins. Concept of care was that both body and soul are
interconnected, and none can be cured without spiritual remedies. The earliest hospices,
called xenodocheia were initially built to shelter pilgrims and messengers between the
various bishops, eventually also housed diseased and mentally infirm persons. St. Basil of
Caesarea founded a monastery-based hospital in 369 AD for care of disabled and sick in
modern-day Turkey.

18. MEDIEVAL TIMES (476 A.D-1450 AD)
In Medieval Europe, sickness existed as a product of destiny, sin, and astral influences on the
body. The church forbade dissection, the cutting open of dead bodies. This made it difficult for
doctors to learn human body. Some women who treated people with herbs and potions were
accused of being witches and put to death by hanging or drowning. In the 13th century, a new
type of craftsman emerged, barber-surgeon who cut hair, pulled teeth and performed simple
operations such as amputations and setting broken bones.
On second half of the medieval period (c. 1100–1450 AD), medicine was institutionalized and
illnesses, and disease, were attributed not to sinful behaviour, but to natural causes.
Hospitium or hospice began to appear in great numbers in monasteries in France and England
for pilgrims. Hospitals were mostly to support the crusaders on-way from Europe to
Jerusalem. During the Renaissance of the 12th century, Ibne Sina's The Canon of Medicine, De
Gradibus by Al Kindi and Kitab Al-Tasrif by Abul Kasis were translated from Arabic.

19. ‘Golden Age of Islam’ (9th to 13thcenturies)
The medical dogma, based mainly on the teachings of Galen and Hippocrates were followed
in medieval Islam included the use of plants as a type of remedy or medicine, natural
substances as a source of medicinal drugs. Physicians like Al Razi (866-932), Abul Kasis (936-
1013), Ibn Sina (980-1037), Ibn Zuhr (1091-1162), Ibn Rushd (1126-1198) and Moses bin
Maimon (1135-1204) made important contributions. Islam developed its own impressive
hospitals (Bimaristans) at Cordoba, Baghdad, Damascus, Bokhara, and Cairo. The first mental
hospital for the insane in Europe was built by Islam in Granada in 1365. The hospitals also
served as centres of medical education, attracting students from Europe and the Far East.
Hospitals were forbidden by law to turn away patients who were unable to pay. The United
States National Library of Medicine credits the hospital as being a product of medieval Islamic
civilization.

20. 16th and 17th centuries Hospitals
After the dissolution of the monasteries in 1540 by King Henry VIII, the church ceased to
control the hospitals in protestant countries. Hospitals started to move towards evidence-
based practices. For the first time in history, cure of the body and care for the soul were
separated, and physicians, rather than the church took charge of medical institutions. It was
at St. Bartholomew that William Harvey conducted his research on the circulatory system in
the 17th century. Leonardo Da Vinci (1452-1519) dissected some human bodies and made
accurate drawings. However, the greatest surgeon of the age was Andreas Vesalius (1514-
1564). In Catholic lands such as France and Italy, convents and monasteries continued to
provide free health services to the poor, through mixture of common sense, magic and prayer.
William Harvey

21. 18th Century hospitals
During the 18th century, medicine made slow progress, and superstition declined. Doctors still
did not know what caused diseases. Some continued to believe in the four humors. Other
doctors thought diseases were caused by ‘miasmas’ (odorless gases in the air). However,
surgery did make some progress. During the 18th century, the mentally ill were not regarded
as ‘truly’ human. They were therefore confined in chains. The first civilian hospital in America
opened in 1751. French Revolution (1789-1799) changed many institutional structures
including hospital medicine radically. Physicians began to correlate signs and symptoms in the
sick with pathological conditions found during autopsies of deceased patients. The religious
impulse behind hospital creation began to be supplemented by civic and private philanthropy.
Stethoscope; Laënnec, René

22. Modern Hospitals (19th and 20th century)
Germ Theory of Robert Koch in 1880s changed the concept of diseases. Royal College of
Surgeons was established in 1800. In the mid 19th century, hospitals and the medical
profession became more professionalized, with a reorganization of hospital management.
Florence Nightingale pioneered the modern profession of nursing during the Crimean War,
when she set an example of compassion, commitment to patient care and diligent. Alongside
general infirmaries, a number of specialist hospitals were set up during the 19th century.
Discoveries multiply, and the number of eminent doctors is so great that the medical-history
of 19th century is apt to become a series of biographies. The 20th century produced such a
plethora of discoveries and advances that in some ways the face of medicine changed out of
all recognition. The rapid progress of medicine in this era was reinforced by enormous
improvements in communication (Computers) between scientists throughout the world.
Royal College of Surgeon

23. Contemporary Hospitals
Following the 2nd World War, many west European nations developed welfare states to
enhance the health and security of their populations. From provider centered, the healthcare
has shifted to patient-centered. Hospitals are turned more like a hotel to keep the patients
satisfied in terms of services, maintaining the high standard of professional quality. This the era
of transplantation, innovative technologies, application of AI, robotic surgeries, and genetic
treatment. Although hospitals have become the focus for cutting-edge medicine, 20th century
also have forced the development of new rules for the management of hospitals so that they
can continue to offer high-quality care to all.

24. Ancient Hospitals in Asia
The oldest archaeological evidence of a hospital in Asia can be found in the ruins of Mihintale
in ancient Srilanka, dating back to the ninth century. This may be one of the oldest hospitals
in the world. Early medical practices emerged early on in the Indian subcontinent with the
practice of Ayurvedic, unani medicine. Some early Buddhist communities (5th century BCE)
established monastic communities with monasteries, and many of these monasteries were
centers of learning for medicine. While sick monks within the monastic communities were
usually treated in their own cells. In 1707, the first hospital in Calcutta was built in the
premises of the Old Fort. Founded in 1875, Mitford Hospital is the oldest medical school in
Bangladesh.

25. About 40,000 years before, a group of people called Neanderthal habited this planer earth.
They lived a lonely life confined in the boundary of family, detached from the external world.
There was no social collective efforts, and no exchange of skill.
Nearly 10,000 years before, another group of people called Cro-Magnan appeared in this
earth. They lived united with various families, and collectively they went out to meet their
necessities. In doing the collective work, they developed the skill of management of
distribution of tasks, group coordination, supervision etc. When Neanderthal and Cro-Magnan
faced each other in the race for limited food resources, Cro-Magnan better equipped with their
organizational skill, eliminated the Neanderthal. Thus from primitive time, unknowingly people
were practicing the skills of management for survival.
Role of Management

26. What is Management?
Management is the art and science of getting things done with and through people, in a
formally organized group.

27. Management is the process of creating and maintaining an environment in which
individuals working together in groups, efficiently accomplish the selected tasks.

28. Science vs Art
SCIENCE ART
Objective Subjective
It has theories and hypothesis It is abstract
Phenomena can be explained
by science
Can not be explained by theory
It is scientifically established
fact
It is philosophical
Logical Rational imaginative
Advances by knowledge Advances by practice
It proves It feels like

29. Management is both science
and arts
Management is a science, because it has universally accepted principles, it has cause and
effect relationships. At the same time, it is art, because it requires perfection through
practice, practical knowledge, creativity, personal skills etc. Science provides knowledge and
art deals with the application of knowledge skillfully. Science teaches to ‘know’ and art
teaches to ‘do’.
A manager to be successful in his profession must acquire the scientific theories of
management and through conceptual and human skills of art apply it to manage the human
resources and solving problems. Thus management is a judicious blend of both science, and
art.

30. What is Hospital Management?
‘Hospital Management’ is a specialty like other clinical disciplines, which creates an
environment, where clinicians and co-workers can work effectively to deliver quality
healthcare and ensure patient satisfaction.

32. Basic Functions of Management

34. Management process is how inputs are systematically processed by management functions
to make an output. Feedback is taken to adjust or correct inputs for desired quality or
quantity of output.
Management Process

36. Hospital Administration is getting quite popular as a career option. Without the leadership of
a competent Hospital Administrator, a hospital is like ‘a ship in the vast ocean without a
compass’.