Reality of Hospital Administration D Rambabu
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Organization of Hospitals/Healthcare ServicesCHAPTER 1

Hospital organization is today an essential part of the medical care scheme. Owing to the increasing complexity of the medical sciences, it is very necessary for medical practioners and specialists to rely on sound hospital services. Furthermore, there is general agreement on the active role the modern hospital has to play in health and social welfare programs, and its influence on economic development of the country.
The hospital has been defined in Stedman's Medical Dictionary as:
“Hospital is an institution for the care, cure, and treatment of sick and wounded, for the study of diseases and for the training of doctors and nurses”.
“Hospital is an institution for medical facility primarily intended, appropriately staffed, and equipped to provide diagnostic and therapeutic service in general medicine and surgery or in circumscribed field or fields of restorative medical care, together with bed-care, nursing care, and dietic service to the patients requiring such care and treatment” (Blakiston's New Gould Medical Dictionary Page 560).
“Hospital is an integral part of social and medical organization, the function of which is to provide for the population complete heath care, both curative and preventive, and whose outpatient services reach out to the family and its home environment, the hospital is also a center for the training of health worker and for biosocial research” (World Health Organization).
The healthcare delivery system is vast and complex. There are a number of agencies or operators to provide healthcare facilities and services to the people. They may be broadly divided into:
  1. Private agencies
  2. Voluntary agencies
  3. Government agencies.
  1. Private agencies are the agencies where care is provided on the basis of fee-for services in a one-to-one relationship like private-practioners, nursing homes, etc.
  2. Voluntary agencies are the traditional, nonofficial organizations established by groups of philanthropic and civic-minded individuals in response to the health and social needs within the community. They exist for unselfish and humanitarian purposes, with emphasis on ‘service to the community’ and as such, they play an essential role in the public health system in the country.
    Voluntary health agencies are supported by voluntary contributors, and hence are accountable to them. They offer free service and also involve in voluntary experimentation and research.
  3. Government agencies are official health agencies operating at the local, state, federal and international levels. They are tax supported, their functions are mandated by law, and they emphasize health promotion and disease prevention. Official health agencies are accountable to the citizens and the government through an official appointed or elected to the board of the agency.
Hospitals have many functions to perform, which involve enhancement of health status, health promotion, prevention and treatment of injury and disease; the immediate and ongoing care and rehabilitation of patients. Other functions involve the education of health professionals, patients and community. All these activities must be conducted keeping the values and dignity of patients in mind.
A modern hospital is an institution which possesses adequate accommodation and well-qualified and experienced personnel to provide various services. These services are the cure of diseases, restoration of health and prevention from future illness to all the needy irrespective of their race, color, creed and socioeconomic background. Educational and 3training programs are also conducted in such institutions required for efficacious medical care and hospital service. Research to assist advancement of medical and hospital services programs in health education are some of the services that are taken up.
Thus, hospital is an institution provides healthcare in the modern world, by offering considerable benefits to the individual and the society at large. From the point of an individual point of view, the sick and injured person has accessibility to centralized medical knowledge and technology that render thorough and efficient treatment. A large number of professionally and technically skilled personnel apply their knowledge and skill with the help of sophisticated equipments and appliances to provide qualitative care to the patients. From the point of view of the society, hospitalization of a patient meant to cure him/her with the help of highly professional medical care, which is otherwise not possible at home.
Indian healthcare service has evolved over the past six decades after independence. The role of private sector has played an important role in providing medical care services. Though public sector provisions dominated healthcare delivery in the first few decades, economic and political changes in the last few decades propelled the growth of private sector. Other factors that have aided the Indian healthcare delivery market are the changing consumer perception, increasing awareness about the quality of medical care, greater penetration of insurance, increase in purchasing power and the changing demographic structure. The recent innovations include focus on ambulatory and retail health care that are designed to focus on non communicable diseases. Inherent factors like improved efficiency, better quality, greater reliability and transparency have also aided tremendous changes in health care. With the incorporation of medical professionals under the Consumer Protection Act, 1986, there was an increased realization of the importance of quality in the provision of medical care services. With various initiatives of the Quality Council of India, efforts are underway to promote standardization of medical care services and thereby to enhance the quality of medical care that is provided.
Philosophy is an abstract system of thought or belief that is concerned with the conduct of man's endeavors. As hospital organization is an essential 4part of medical care, it should have its own philosophy to deal with the day-to-day and future objectives. Philosophy is a statement of the value and beliefs that direct individual or groups in their attempts to achieve a purpose. Many hospitals in their definition of philosophy set their objectives and goals based on their vision, which may change with the needs of the society. Their philosophy also directs the organization in achieving their objectives and purposes. A purpose is a reason for an organization's existence; it is the ‘why’ of the organization.
However, every hospital needs to discuss critique and write down its philosophy in clear terms. No statement of philosophy of an institution is a permanent document; it may change according to the changing needs and circumstances of the society at large. The philosophy of the hospital is presented in its statement of definition.
Classification of hospitals based on the controlling board with change in times, hospitals fall under various categories based on their board of control. Some of them are as follows:
  1. Union Government/Government of India: All the hospitals administered by the Government of India, e.g. hospital run by railways, military/defense, mining, etc. or public sector undertakings of the central government fall under this category.
  2. State governments: All the hospitals administered by the State/Union territory, government authorities and public sector undertaking operated by the State/Union territories, including the police, prison, irrigation department, etc. fall under this category.
  3. Local bodies: All the hospitals administered by local bodies, like Corporation, Municipality, Zilla Parishad, Panchayat like Corporation Maternity homes fall under this category.
  4. Autonomous bodies: All the hospitals established under the special Act of Parliament State Legislation and funded by the central/state government/Union territory fall under this category. AIIMS (New Delhi). PGI (Chandigarh) NIMHANS (Bengaluru), KMIO (Bengaluru) are some examples.
  5. Private bodies: All the private hospitals owned by an individual, trusts or by a private organization, fall under this category. MAHE, Manipal (Manipal) hospital (Bengaluru), Hinduja hospital (Mumbai), and Vijaya hospitals (Chennai) are some examples.
  6. Voluntary agencies: All the hospitals operated by a voluntary body/a trust/a charitable society registered or recognized by the appropriate 5authority under central/state government laws fall under this category. This includes hospitals run by missionary bodies and cooperatives like the CMC (Vellore).
According to systems of medicine hospitals can be classified as follows:
  1. Allopathic hospitals
  2. Ayurvedic hospitals
  3. Homeopathic hospitals
  4. Unani hospitals and hospitals of other systems of medicine.
  1. Anesthesiology
  2. Biochemistry
  3. Burns
  4. Cardiology
  5. Cardiothoracic surgery
  6. Clinical apheresis
  7. Cosmetic surgery
  8. Dental surgery
  9. Dermatology
  10. Diabetology
  11. Endocrinology
  12. ENT
  13. Gastroenterology
  14. General surgery
  15. Geriatrics
  16. Gynecology
  17. Hematology
  18. Immunology
  19. Internal medicine
  20. Interventional radiology
  21. Medical oncology
  22. Microbiology
  23. Microsurgery
  24. Multiorgan transplant program
  25. Neonatology
  26. Nephrology
  27. Neurosurgery
  28. Neurology
  29. Neuroradiology
  30. Nuclear medicine
  31. Obstetrics
  32. Ophthalmology
  33. Orthopedics
  34. Pediatric surgery
  35. Pediatrics
  36. Physiotherapy
  37. Plastic and cosmetic surgery
  38. Psychiatry
  39. Radiology
  40. Respiratory medicine
  41. Rheumatology
  42. Serology
  43. Sleep disorder laboratory
  44. Surgical oncology
  45. Transfusion medicine
  46. Trauma and emergency
  47. Urology
  48. Vascular surgery.