Hospital Hospital Organizational Organizational

StructuresStructuresBy

MATHANKUMAR.S

CLASSIFICATIONS OF CLASSIFICATIONS OF HEALTH CAREHEALTH CARE

Primary Care Secondary Care Tertiary Care

Primary CarePrimary Care

Consists of basic curative care, including simple diagnosis and treatment, provided at the point of entry into the health care system.

(Example: walk-in-clinic)

Secondary CareSecondary CareConsists of specialized care requiring more

sophisticated and complicated diagnosis and treatment than is provided at the primary health care level. Normally involves hospitalization. (Example: Patient ward in general hospital)

Tertiary CareTertiary CareConsists of highly specialized diagnostic and

therapeutic services which can usually only be provided in centers specifically designed staffed and equipped for this purpose.

(Example: Neonatal intensive care unit)

CLASSIFICATIONS OF CLASSIFICATIONS OF SERVICESERVICE

GENERAL HOSPITALSPECIALITY HOSPITALREHABILITATION HOSPITALLONG-TERM CARE HOSPITAL

(AUXILIARY)NURSING HOME

GENERAL HOSPITALGENERAL HOSPITAL

Provides primarily for the diagnosis and short-term treatment of patients for a wide range of diseases or injuries.

SPECIALITY HOSPITALSPECIALITY HOSPITALProvides primarily for the diagnosis and

short-term treatment of patients for a limited range of diseases or injuries.

REHABILITATION REHABILITATION HOSPITALHOSPITALProvides for the continuing assessment

and treatment of patients whose condition is expected to improve significantly.

LONG-TERM CARE LONG-TERM CARE HOSPITALHOSPITAL

Provides primarily for the continuing treatment of patients with long-term illness or with a low potential for recovery.

NURSING HOMENURSING HOME

Institution where residents are accommodated who require nursing and personal care on a continuing basis.

REGULATORY AGENCIESREGULATORY AGENCIESProvincial hospital authorities responsible for:◦ Approving hospital budgets◦ Licensing and inspecting hospitals◦ Health and safety of hospital workers

Agencies regulating the various health professions

Agencies approving various hospital based training programs

REGULATORY AGENCIESREGULATORY AGENCIESReview committees within hospitalsHospital administration and regulationsCanadian Council on Healthcare Facility

Accreditation (CCHFA), representing:◦ Canadian Hospital Association◦ Canadian Medical Association◦ Royal College of Physicians and Surgeons of Canada◦ L'Association des Medecins de Langue Francaise du

Canada◦ The Canadian Nurses Association

A hospital is perhaps the A hospital is perhaps the most complex most complex

organization in our society.organization in our society.

Clinical Engineer Must UnderstandClinical Engineer Must Understand

Roles and interaction between multiple professional groups

Role of the hospital administration in coordinating these groups

WELL DEVELOPED WELL DEVELOPED INTERPERSONAL SKILLS INTERPERSONAL SKILLS

ARE ESSENTIAL TO ARE ESSENTIAL TO CLINICAL ENGINEERING!CLINICAL ENGINEERING!

Impact of TechnologyImpact of TechnologyAdvancements in medical technology have had

an enormous impact on hospital management.Each new development has given birth to

another discrete body of knowledge.◦ Ultrasound, CT, MRI◦ Lithotrity◦ Nuclear Medicine◦ Laser Surgery◦ Laparoscopic Surgery

Each technology has its own:Each technology has its own:Professional GroupCherished RoleDiversified NomenclatureSelf Image.

Professional GroupsProfessional GroupsMedical SpecialtiesNursing SpecialtiesClinical Technicians (i.e., Lab Techs, X-Ray

Techs, Respiratory Therapists, Physiotherapists, etc.)

There are more than 200 health occupations!

Administrative ChallengesAdministrative Challenges

Professionals typically cherish their "right" to self-regulation.

Administrative ChallengesAdministrative Challenges

Group conflict is unavoidable.Internal communications are impeded.Consensus is more apt to be absent.

Administrative ChallengesAdministrative ChallengesInternal◦ Medical Staff◦ Competition Between Health Professions◦ Unions◦ Physical Resources◦ Size and Complexity of Organization

External◦ Government◦ Funding◦ Regulatory Agencies◦ Public Demands

Hospital Administrators Require:Hospital Administrators Require:Interpersonal skillsEffective communications skills.Leadership skills.

THE HOSPITAL AS A DELIVERY THE HOSPITAL AS A DELIVERY SYSTEMSYSTEM

Primarily a non-profit system.A third party (government) financed system.Demand for services can bear no direct

relationship to societal needs or the available supply of necessary resources.

The rate of hospital admissions has increased, but the average length of stay has decreased.

The health care system is presently undergoing rapid, radical change.

HOSPITAL ORGANIZATIONHOSPITAL ORGANIZATIONGOVERNING BOARD

MEDICAL HOSPITAL STAFF

ADMINISTRATOR

Hospital Management ModelHospital Management ModelGoverning Board (government

appointed)Chief Executive Officer (Hospital

Administrator)Medical Staff Organization.

Functions of the Governing BoardFunctions of the Governing Board

To determine the policies of the institution within the context of community needs.

To provide equipment and facilities to conduct patient care programs.

To see that proper professional standards are defined and maintained.

To co-ordinate professional interests with administrative, financial and community needs.

Functions of the Governing BoardFunctions of the Governing Board

To provide adequate financing by securing sufficient income and by enforcing business like control of expenditures.

To provide for the safe administration of funds given in trust, (e.g., gifts and contributions).

To maintain accurate records of its finances and activities.

To surround the patient with a safe environment.

THE HOSPITAL ADMINISTRATORTHE HOSPITAL ADMINISTRATOR

Function is identical to that of the president of any corporation.

Individual styles are judged to be successful if the determined results further the organization toward its goals.

Being a hospital Being a hospital administrator places more of administrator places more of a strain on character than on a strain on character than on intellect.intellect.

Functions of the Hospital Functions of the Hospital AdministratorAdministratorSubmitting for board approval a plan of

organization and recommending changes when necessary.

Preparing a plan for accomplishing the institutional objectives as approved by the board and periodically reviewing and evaluating it.

Selecting, employing, controlling, and discharging employees.

Submitting for board approval an annual budget.

Functions of the Hospital Functions of the Hospital AdministratorAdministratorSafeguarding the operating funds of the

enterprise.Maintaining all physical properties (plant and

equipment) in safe operating condition.Representing the hospital in its relationships

with the community and other health agencies.Serving as liaison between the board or its

committees and the medical staff.

Functions of the Hospital Functions of the Hospital AdministratorAdministratorAssisting the medical staff with its

organizational and administrative responsibilities.

Submitting to the board annual reports which describe the nature and volume of the services delivered during the past year.

Advising the governing board on matters of policy formulation.

THE MEDICAL STAFFTHE MEDICAL STAFF

Doctors represent the Doctors represent the initiators of every action that initiators of every action that results in the direct provision results in the direct provision

of patient care services.of patient care services.

Doctors determine:Doctors determine:Who Will Be AdmittedWhenWhereWhat Medical Services Are to Be

Provided, in What Sequence, in What Dosage, With What Equipment and Supplies When, Where and by Whom

Who Is Discharged and When.

The doctor is not an The doctor is not an employee of the hospital, employee of the hospital,

he/she is outside of the he/she is outside of the hospital organization.hospital organization.

Doctors control, yet are not Doctors control, yet are not accountable, for nearly 90 accountable, for nearly 90

percent of hospital percent of hospital expenditures.expenditures.

Medical StaffMedical StaffParticipation by the medical staff in the

decision-making process is in the best interest of both the hospital and the patients.

Physician involvement leads to physician accountability.

The physician may view the The physician may view the problems of medical practice problems of medical practice from a from a personalpersonal rather than rather than

an an organizationalorganizational perspective. perspective.

The administrator is The administrator is primarily concerned with the primarily concerned with the

maximum utilization of maximum utilization of available health resources and available health resources and

personnel.personnel.

Organization of medical Organization of medical resources may require a resources may require a

degree of control and degree of control and surveillance over the doctor's surveillance over the doctor's

work which maybe work which maybe unattractive to him/her.unattractive to him/her.

Medical StaffMedical StaffThe chief of medical staff is the elected

representative of the medical staff.The chief of staff appoints all of the

committees other than the executive committee whose members are elected by the staff or appointed by the board administrator.

Functions of the Medical StaffFunctions of the Medical StaffTo advise the governing body on medical affairs.To accept accountability for the quality of care

rendered to patients in the hospital.To request, review and act upon reports of

medical staff committees.To scrutinize the professional ethics of its

members and to initiate corrective action as indicated.

To develop, implement, and review medical staff policies.

Functions of the Medical StaffFunctions of the Medical StaffTo recommend action to the

administrator on all medical-administrative matters.

To assure that the standards of the Canadian Council on Healthcare Facility Accreditation (CCHFA) are followed as a basic guideline for standards of care.

INTERRELATIONSHIPS INTERRELATIONSHIPS AMONG HEALTH AMONG HEALTH

WORKERSWORKERS

The complex tasks of highly The complex tasks of highly skilled professionals demand a skilled professionals demand a participatory decision-making participatory decision-making structure while the repetitive structure while the repetitive tasks performed by unskilled tasks performed by unskilled

workers require a more workers require a more formal hierarchical structure.formal hierarchical structure.

Organizational StructuresOrganizational StructuresHighly structured and routine tasks can

lead to worker alienation and boredom.Loosely knit, associational activities of

highly skilled professionals results in personal gratification to the individual employee but works against the centralized control and co-ordination needs of management.