OVERVIEW HOSPITAL AS A SYSTEM ROLE OF HOSPITAL ADMINISTRATION

Dr. Rajesh Bhalla

MD (Hosp.Adm.), DNB (Health Adm.), M.Sc (Defense Studies)

DEFINITION OF HOSPITAL
Hospital is an integral part of a Social and Medical Organisation, the functions of which are to provide the population complete Healthcare both Curative and Preventive with Outpatient Services which reaches out to the family in its own environment and also to carry out Training of health workers/functionaries and the Biosocial Research.

CLASSIFICATION OF HOSPITALS
1. According to Directory of Hospitals (a) General Hospital (b) Rural Hospital (c) Specialised Hospital (d) Teaching Hospital (e) Isolation Hospital

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2. According to Ownership and Control

(a) Public Hospital (b) Voluntary Hospital (c) Private Nursing Homes (d) Corporate Hospital

3. According to the Systems of Medicine 4. According to the Bed Strength 5. According to Clinical Basis 6. According to Length of Stay of Patients

HOSPITAL AS SYSTEM
The Hospital System has its External Environment and Linkages. To understand the Hospital System, one has to look at the hospital as an Open System. A general hospital, within the immediate environment of health care organisation and the larger environment of the community are interdependent. The hospital services have to be considered as a socio-technical system within the health care system that copes with the constraints from both the internal and external environment.
ENVIRONMENT

Input

Transformation process Feedback (Reenergizing the System)

Output

System Boundary

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Definition of System
A system has been defined in the Oxford English Dictionary as simply a set or assemblage of things, connected, or interdependent, so as to form a complex utility; A whole composed of parts in orderly arrangement according to some scheme or plan.

"To be more precise a system is a hierarchical chain of systems and sub-systems, interconnected and interdependent, having clear objectives at each level of the system or subsystem, obtains enough inputs from its environment to offset its output, and operates with varying processes or methods to achieve the ultimate objective of the system. As per Katz and Khan social systems are anchored in the attitudes, perceptions, beliefs, motivations, habits and expectations of human beings.

Definition of System

HOSPITAL AS A SYSTEM IN HUMAN HABITAT

INFORMATION: Facts or knowledge provided or learned as a result of research or study. HMIS: Managing a hospital with facts or knowledge of resources a complex whole. HOSPITAL: An Institution providing medical and surgical treatment and nursing care for sick or injured people. -- Patient is Central. SUB - SYSTEM: Systems within Systems network.

SYSTEM: A complex whole; set of

things working together as a mechanism or inter connecting network.

Integrated Services in Hospital

Clinical and Nursing Services 1. Outpatient 2. Inpatient 3. Emergency 4. Operation Theatre Supportive Services General Administrative Business Services 1. Personnel Management 2. Financial Management 3. Material Management Utility Services 1. Laboratory 2. Blood Bank 3. Imaging 4. Drug and Dispensing 5. CSSD 6. Medical Documentation 7. Medico-Social Work 8. Physical Medicine & Rehabilitation 1. Communication 2. Transportation 3. Public Relations 4. Fire & security 5. Dietary 6. Linen & Laundry 7. Housekeeping 8. Emergency Maintenance

FUNCTIONS OF HOSPITALS
(a) Restorative or Curative (b) Prevention of Diseases and Promotion of Health (c) Surveillance Centre (d) Education and Research (e) Professional Support (f) Early detection of epidemics

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(g) Primary Health Care (PHC) Programme To become a part of primary health care (PHC) programme, every hospital need to take some role such as:
i) ii) To provide support to PHC. To promote community health development action.

iii) Basic and continuing education to workers engaged in PHC. iv) Research on PHC
The hospital should regard health as a value and focus on prevention, use of appropriate technology, community involvement and multi-sectoral approach. The strengthening of co-ordination through improved exchange of information collected through passive surveillance by the hospital is an important aspect.

ROLE OF HOSPITALS AND PECULIARITIES

The peculiarities of a hospital as an organisation are: a) The product of the hospital is service which cannot be qualified in any economic terms and no objective criteria can be laid down to evaluate the standard of services. b) The service in the hospital is always personalised, professional and directly rendered by the medical, nursing and other specialised personnel according to the needs and requirement of each case or client. As such the hospital service cannot be mechanised, standardized or pre-planned to meet the specific need. The hospital service is a team work rather than an individual service.

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c) The hospital service is normally emergent in nature and no two situations are similar needing the same treatment. So the Hospital Administration cannot always be preplanned in micro level implementation, with straight jacket formula. It is more often in management by crisis than management by objective. d) The wide spectrum of people involved in the hospital activity ranges from the highly skilled professional to the man who may not have visited a school (unskilled). Therefore, the management of this varied group of people calls for a balanced psychosocial approach.

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e) The dual control by way of professional authority and the executive authority in the Hospital invariably leads to management conflict which is a peculiar situation every hospital administrator has to face in the day to day operation. f) Of late the hospital being treated as Industry for Profit as well for maximization of the output with minimal input has led to application of management tools and techniques for its administration. E) There is a sense of urgency and it functions 24 hrs a day.

ROLE TOWARDS ORGANISATION

Strategic Planning and Management of the Hospital Formulation of objectives of the hospital Defining of present objectives and strategy Environment appraisal to determine strengths and weaknesses of the hospital Finding out opportunities and threats Modifying the present strategy to bring it up to the desired level Implementation of the strategy Monitoring and Control

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Relating the Hospital to the External Environment Material supplies Manpower supplies Supply of finance Consumers Regulatory agencies Political groups Other similar organisations Press and other media Environmental Protection Activist

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Technology change Economic environment Social and cultural milieu Political, legal and ethical environment International environment Operational Management of the Hospital Policies Procedures Rules

ROLE OF HOSPITAL ADMINISTRATION

ROLE TOWARDS PATIENTS Profile of a Hospital Patient Creation of a Friendly Environment Patients Physical Needs Patients Emotional Needs Patients Clinical Needs Patients Satisfaction Patient Education

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Managing Hospital Staff

Manpower planning Recruitment Selection Training Performance Appraisal Grievance Procedure Discipline Wage and Salary Administration Collective Bargaining

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Managing Hospital Materials

Developing specification for materials Materials planning and programming Procuring materials through centralized purchasing Receiving Distribution Inventory control Storage and preservation Transportation Materials handing Disposal of scrap and obsolete materials, equipment and surplus material

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Managing Hospital Finance Managing Hospital Information

The essential functions to be included in the hospital information system are Medical functions, Administrative functions and Financial functions.

Management of Information is yet one of the most important aspect to be looked into by the hospital administration i.e. Medical Records Department. This is the most important source of hospital information.

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Maintaining Relationship with the Medical Staff Maintaining Relationship with the Public Risk Management of the Hospital Managing Ethics and Code of Conduct

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