Hospital
Hospital word has been derived from the latin word ‘HOSPES’ as we know, which means ‘a host or guest’ or ‘hotel’, hostel.
Some also believe that the origin of the hospital from the word ‘HOSPITUM’ a rest house for travelers or night shelter showing ‘hospitality’ to the guests.
Hospital is a social organisation and logical combination of the activities of a number of persons with different level of knowledge and skills for achieving a common goal of patient care through a hierarchy of authority and responsibility
Organising is a process of grouping the activities in workable units and connected by authority, communication and control.
HOSPITAL
HOSPITALITY
Organization
DIFFINITION
Organization is the anatomy and Management is the physiology of the process.
Organization is the systemic bringing together of interdependent parts to form a unified whole through which authority, control and coordination may be exercised to achieve a given purpose.
Organisational structure represented by a basic organisational chart forming the skeleton of the organisation.
ORGANISATION STRUCTURE
CENTRALISATION
It implies standardisation, uniformity, and central authority. From one side it ensures better decision making, co-ordination.
Better authority of control and cost-effective due to less skilled administrators. But it blocks the carrier structure and requires strong administrative skills and leader ship.
DECENTRALISATION
It reduces burden on central authority. It brings decision making closer to people in local context.
Greater potential for multi sectoral approach Increases efficiency of staff due to their participation in decision making.
Decentralisation is exciting but may ruin the organisation if attention is not paid to:-
· Degree of decentralisation
· Skill and experience of local manager
· His leadership qualities and team
Centerlisation Dcenterlisation
MIXED (MATRIX)
Decentralisation should not be totally free from control of central authority. The degree and extent of de centralisation should match organisation function and objective.
Decentralisation should be within the policy frame work of each organisation and at where needed.
It is a diagrammatic representation of the administrative set up which easily shows the line of command, control and responsibility ,staff relation,job grouping and communication.
The structure of the organogram is like a pyramid, broader at base taper at appex. Hospital has got a Matrix type of Organogram.
Matrix organisation is a mix of product and function where people with similar skills are grouped together to execute activities to achieve organisational objective.
2. In a hospital some part of the organisation has scalar type of function while others are informally structured.
3. The hospital provides patient care with a multi functional team comprising of people with different level of knowledge and skill.
4. There are therefore dual reporting system at various levels.
5. It is structured in such a way that facilitates horizontal flow of authority in addition to its vertical control.
6. The matrix structure gets its name for its resemblance to a table which has both rows and columns .
7. The functional manager in the matrix work with the project manager to assess the resource requirement.
8. And their timely utilisation by the functional manager.
9. The general manager is at the top and outside the basic matrix net work
10. Information sharing is mandatory in such an organization
11. The basis for hospital to have a matrix organisational structure to create a synergism through shared responsibility between the administrative and functional departments in the hospital system.
Advantage of organogram
· It helps to identify in consistencies and complexities in the organisation structure.
· Helps to identify major line of decision making authority.
· It indicates the employees there position, status and role in the organisation.
· It is to identify the services (functional units), span of control, and crossed line authority.
· Chart needs to be modified with change of role and authority.
SUPERVISION AND AUTHORITY
a. Hierarchy
Hierarchy shows the tire of Superior- Sub-ordinate relation ship.
Extent to which it should be tall or short depends on the type and function of the organisation.
b. Span of control
It expresses the number of persons that a manager can directly control or supervise
This depends on type of sctivity,knowledge,skill leadership quality of supervisor.
c. Unity of command
The basic principle of span of control is unity of command.
The sub-ordinate should take direction from one authority only.
There by increases efficiency and effectiveness of the organization
Therefore grouping in the organisation is essential.
d. Grouping
Grouping depends on task and function. Hospital employs people with different skills and functions. More centrally it is associated with planning, decision making, and administration Peripheral implementation, monitoring and supervision. Hence functional grouping is ideal.
· Integration
Integration is the linking of line function to staff (group) function to make it a unified whole.
But the problem in the hospital is because of functional groups with different skills and job responsibility like doctors, nurses, technical and un-skilled group ‘D’ staff.
· Formalisation
Formalisation of the organisation is necessary to increase the efficiency and effectiveness by fitting into the organisational structure.
I. Participation
Participation provides a feeling of ownership leading to increase commitment, morale, and motivation. But participation should be restricted only to issues directly concerning the individual or group like carrier development, personal welfare, and their task and activities. If the suggestion is relevant should be accepted. The participant must have adequate knowledge of the subject in which participating.
II. Delegation
It is the most difficult part of formalization or job designing.
Delegating authority must choose the level of delegation, extent of power and authority to be given.
Superior to chose sub-ordinate for delegation.
Territory of authority to be clearly defined.
There has to be mutual trust between delegator and delegant. Delegator must have full control over end result and give regular feedback to delegant.
III. Job enrichment
Enrichment depends on nature of job.
It is formalised to match the rules , job description and procedure manual.
High skilled persons like doctors, nurses, technical staff requires low job description while low skilled and un skilled staff need high job definition.
Job enrichment is required to make it interesting, attractive, interlocking and inter dependable.
Introduction
“an institution of community health/ a specialized complex organization, that makes use of physicians, surgeons & team of technical staff, in order to provide facilities for diagnosis, therapy, rehabilitation, prevention, education & research.
Classification is mainly based on :
· Clinical grounds
· Non-clinical grounds
· Size
· Cost
· System of medicine
Classification of hospitals based on clinical grounds: Medicine-based
· Pediatrics
· Psychiatric and other nervous diseases
· General medicine
Classification of hospitals based on Surgery
· Orthopedics
· Gynecology & obstetrics
· Maternity: - short-term - long-term
Classification of hospitals based on non-clinical grounds:
· Governmental hospitals:
· Army hospital - city hospital - navy hospital - civil hospital b.
· Non-governmental hospitals
· Private hospitals(for profit)
· Non-profit hospitals ( church hospital, community hospital, hospital, charitable hospital)
Classification of hospitals based on size:
· large hospitals: beds : 1000 and above b.
· medium hospitals: beds : 500-1000 c.
· small hospitals: beds : 100-500 d.
· very small hospitals: beds : less than 100
Classification of hospitals based on cost:
a. Elite hospitals
Consist of high technology & medical science advancements - comprise deluxe rooms, with t.v, telephones & refrigerator also known as “5-star hospitals”
example : apollo hospital .
b. Budget hospitals
Meant for moderate-low budget people (example: charitable & civil hospitals )
Classification of hospitals based on system of medicine:
· Allopathic hospitals
· Ayurvedic hospitals
· Homeopathic hospitals
· Unani hospitals
organization is defined as
“a dynamic process, in which various managerial activities bring on organization of hospitals & bind people together, for the achievement of common goals & consists of various eminent personalities in the field of :
· Medical education
· Administration
· Research
· Politics (optional)
Function of governing body is to frame all major policies, plans objectives”
Most important body of a hospital is the governing body/ board of directors/ board of trustees.
Governing body & programmes of hospital appoints a hospital administrator to get various functions performed like clinical services, nursing, pharmacy services, etc
Governing body have to give personal attention to patients - nurses are trained for prenatal care, observation, patient comfort during labour, etc. - nursing director is the in-charge of nursing services,assigned specific number of beds.
Services performed by hospital organization: include:
· Nursing services: - largest part of a hospital - functions all 24 hours - nurses
make a hospital an ideal community institution - hospital is duty-bound to provide diagnostic, preventive
· Out-patient services: - focus on comfort for out-patients, as the approach for major/minor illnesses - these services & curative measures to the out-patient.
· Assisted by various technicians - services include utilization of equipments like: a. Sonography b. X-ray c. Ecg d. Ct-scan, etc.
· Radiological services: - performed under direction of a competent radiologist - chief radiologist
· Central supply services: - refers to medical & surgical supply services - meant for diagnosis, treatment, prevention, education & research - involves their collection, processing, storage & issuance against proper indent form - qualified & skilled staff personnel are responsible for its maintenance.
· Hospital pharmacy services: - controls pharmacy operation in any hospital - fills prescription & no. Of necessities from wards - functions begin from drug procurement to distribution to i.p and o.p - responsible for :
a. Proper drug delivery
b. Manufacture
c. Information system
d. Sterilization
e. Drug storage
f. Advicing patient on drug use
· Medical record services: - valuable materials, as they help medical & para-medical staff for evaluation - also used for education, research & training - consists of :
a. Patient history
b. Physical examination details
c. Lab- test reports
d. Physican’s advice, etc. - it is mandatory to store medical records properly to facilitate easy access on requirement.
· Store services: - receive, store & issue materials against requisition forms of various departments & wards - hospital consists of:
a. Medical store
b. Store for general items
c. Surgical stores, etc - maintain a buffer stock of certain materials, including life-saving drugs.
· Miscellaneous services: - aimed at overall benefit & patient care - include:
a. Dietary services
b. Ambulatory services
c. Laundry services
d. Transport services
e. Mortuary services
f. Library
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