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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.