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Organizational Structures
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CLASSIFICATIONS OF
HEALTH CARE
Primary Care
Secondary Care
Tertiary Care
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Primary Care
Consists of basic
curative care,
including simplediagnosis and
treatment, provided at
the point of entry into
the health care system.(Example: walk-in-
clinic)
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Secondary Care Consists 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)
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Tertiary Care
Consists 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)
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CLASSIFICATIONS OF
SERVICE GENERAL HOSPITAL
SPECIALITY HOSPITAL
REHABILITATION HOSPITAL
LONG-TERM CARE HOSPITAL
(AUXILIARY)
NURSING HOME
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GENERAL HOSPITAL
Provides primarily for the diagnosis and
short-term treatment of patients for a
wide range of diseases or injuries.
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SPECIALITY HOSPITAL
Provides primarily for the diagnosis and
short-term treatment of patients for a
limited range of diseases or injuries.
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REHABILITATION HOSPITAL
Provides for the continuing assessment and
treatment of patients whose condition is
expected to improve significantly.
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LONG-TERM CARE
HOSPITAL
Provides primarily for the continuing
treatment of patients with long-term illnessor with a low potential for recovery.
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NURSING HOME
Institution where residents are
accommodated who require nursing and
personal care on a continuing basis.
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REGULATORY AGENCIES
Provincial 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
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REGULATORY AGENCIES
Review committees within hospitals
Hospital administration and regulations
Canadian Council on Healthcare FacilityAccreditation (CCHFA), representing:
Canadian Hospital Association
Canadian Medical Association
Royal College of Physicians and Surgeons of Canada
L'Association des Medecins de Langue Francaise duCanada
The Canadian Nurses Association
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A hospital is perhaps
the most complexorganization in our
society.
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Clinical Engineer Must
Understand Roles and interaction between multiple
professional groups
Role of the hospital administration in
coordinating these groups
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WELL DEVELOPED
INTERPERSONAL SKILLSARE ESSENTIAL TO
CLINICAL ENGINEERING!
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Impact of Technology
Advancements in medical technology have had an
enormous impact on hospital management.
Each new development has given birth to anotherdiscrete body of knowledge.
Ultrasound, CT, MRI
Lithotrity
Nuclear Medicine
Laser Surgery
Laparoscopic Surgery
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Each technology has its own:
Professional Group
Cherished Role
Diversified Nomenclature
Self Image.
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Professional Groups
Medical Specialties
Nursing Specialties
Clinical Technicians (i.e., Lab Techs, X-RayTechs, Respiratory Therapists, Physiotherapists,etc.)
There are more than 200 healthoccupations!
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Administrative Challenges
Professionals typically cherish their "right"
to self-regulation.
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Administrative Challenges
Group conflict is unavoidable.
Internal communications are impeded.
Consensus is more apt to be absent.
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Administrative Challenges Internal
Medical Staff
Competition Between Health Professions
Unions
Physical Resources
Size and Complexity of Organization
External
Government
Funding
Regulatory Agencies
Public Demands
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Hospital Administrators
Require: Interpersonal skills
Effective communications skills.
Leadership skills.
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THE HOSPITAL AS A
DELIVERY SYSTEM Primarily a non-profit system.
A third party (government) financed system.
Demand for services can bear no directrelationship to societal needs or the availablesupply 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.
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THE HOSPITAL AS AN
OPERATING ENTERPRISE
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HOSPITAL ORGANIZATION
GOVERNING BOARD
MEDICAL HOSPITAL
STAFF ADMINISTRATOR
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Hospital Management Model
Governing Board (government appointed)
Chief Executive Officer (Hospital
Administrator)
Medical Staff Organization.
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Functions of the Governing
Board To determine the policies of the institution within
the context of community needs.
To provide equipment and facilities to conductpatient care programs.
To see that proper professional standards are
defined and maintained.
To co-ordinate professional interests with
administrative, financial and community needs.
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Functions 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.
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THE HOSPITAL
ADMINISTRATOR Function is identical to that of the president
of any corporation.
Individual styles are judged to be successfulif the determined results further the
organization toward its goals.
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Being a hospitaladministrator placesmore of a strain oncharacter than on
intellect.
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Functions of the Hospital
Administrator Submitting 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.
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Functions of the Hospital
Administrator Safeguarding 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.
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Functions of the Hospital
Administrator Assisting the medical staff with its
organizational and administrative
responsibilities. Submitting to the board annual reports
which describe the nature and volume of theservices delivered during the past year.
Advising the governing board on matters ofpolicy formulation.
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THE MEDICAL STAFF
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Doctors represent theinitiators of every action
that results in the directprovision of patient care
services.
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Doctors determine:
Who Will Be Admitted
When
Where What 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.
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The doctor is not an
employee of the hospital,he/she is outside of thehospital organization.
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Doctors control, yet are
not accountable, fornearly 90 percent of
hospital expenditures.
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Medical Staff
Participation 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.
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The physician may viewthe problems of medical
practice from a personalrather than anorganizationalperspective.
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The administrator isprimarily concerned with
the maximum utilizationof available healthresources and personnel.
O i ti f di l
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Organization of medicalresources may require a
degree of control andsurveillance over the
doctor's work whichmaybe unattractive to
him/her.
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Medical Staff
The chief of medical staff is the elected
representative of the medical staff.
The chief of staff appoints all of thecommittees other than the executive
committee whose members are elected by
the staff or appointed by the boardadministrator.
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Functions of the Medical Staff
To 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 medicalstaff committees.
To scrutinize the professional ethics of its
members and to initiate corrective action as
indicated.
To develop, implement, and review medical staff
policies.
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Functions of the Medical Staff
To recommend action to the administrator
on all medical-administrative matters.
To assure that the standards of the CanadianCouncil on Healthcare Facility
Accreditation (CCHFA) are followed as a
basic guideline for standards of care.
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INTERRELATIONSHIPS
AMONG HEALTH WORKERS
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The complex tasks of highlyskilled professionals demand aparticipatory decision-making
structure while the repetitivetasks performed by unskilled
workers require a more formalhierarchical structure.
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Organizational Structures
Highly structured and routine tasks can lead
to worker alienation and boredom.
Loosely knit, associational activities ofhighly skilled professionals results in
personal gratification to the individual
employee but works against the centralizedcontrol and co-ordination needs of
management.