LECTURE 2

HOSPITAL MANAGEMENT & ORGANIZATIONAL BEHAVIOR

HISTORY OF HOSPITALS
Medicine and surgery dae !ac" # $e !eginning #% ci&i'i(ai#n !ecause
diseases )receded $u*ans #n ear$+ Seri#us diseases ,ere #% )ri*ary
c#ncern # ear'y $u*ans a'$#ug$ $ey did n# $a&e $e "n#,'edge
needed # rea $eses i''nesses ade-uae'y+ Ear'y *edica' rea*en ,as
a',ays ideni%ied ,i$ $e re'igi#us ser&ices and cere*#nies+ Priess
,ere a's# )$ysicians #r *edicine *en. *inisering # s)iri. *ind and
!#dy/ )ries d#c#rs ,ere )ar #% $e ru'ing c'ass. ,i$ grea )#'iica'
in%'uence. and $e e*)'e $#s)ia' ,as a's# a *eeing )'ace+
In ear'y $is#ry. $#s)ia's ,ere &ie,ed as a )'ace %#r sic" )##r. ,eary
ra&e'ers. and desiue+ H#s)ia's ,ere c#nsidered danger#us as $ey
)r#&ided )ri*ii&e rea*en+ And $e e'ie c'ass s$unned g#ing #
$#s)ia' as $#*e care ,as c#nsidered # !e !es re*edy+ T$e diseases
,ere ari!ued # su)ernaura' %#rces and de*#ns+ S# $e diseases ,ere
y)ica''y reaed !y incanai#n. dancing. *agic e%%ecs. and a'is*ans
0an #!1ec $a is $#ug$ # $a&e *agic )#,ers and !ring g##d 'uc"2+ I%
$e de*#n *anaged # ener $e !#dy #% is &ici*. e%%#rs *ade $e
!#dy unin$a!ia!'e # $e de*#n !y !eaing. #ruring. and sar&ing $e
)aien+ T$e a'ien s)iri c#u'd a's# !e e3)e''ed !y )#i#ns 0a 'i-uid ,i$
*agic )#,ers2 $a caused &i#'en &#*iing. #r c#u'd !e dri&en #u
$r#ug$ a $#'e in $e s"u''+
In 4
$
cenury BC. Hi))#craes inr#duced $e c#nce) #% naura' causes
#% diseases. disregarding r#'e #% su)ernaura' %#rces in $e ei#'#gy #%
diseases+ S##n $is eac$ings ,ere %#rg#en. # !e re&i&ed during
Renaissance+
5#''#,ing $e !ir$ and s)read #% C$risianiy. *edicine ,as
re&ered # re'igi#n. $e nuns and *#n"s )racicing i+
Gradua''y. $ese C$risian $#s)ia's re)'aced $#se #% Greece
and R#*e+
C$risians ,ere enc#uraged # *a"e )i'gri*ages # $e *any $#'y
)'aces #% Midd'e Eas+ 5#r se&era' cenuries. ra&e'ers %r#*
6esern Eur#)e *ade $eir ,ay in# $is )ar #% $e ,#r'd+ Many
#% $ese )i'gri*s ra&e'ed ,i$#u *#ney. !e'ie&ing $a $ey
,#u'd recei&e assisance #n $eir ,ay %r#* #$er acc#**#daing
C$risians+ In #rder # $e') )i'gri*aging C$risians. *any $#s)ia's
,ere esa!'is$ed. )aricu'ar'y in re*#e and danger#us )'aces. ,i$
assisance %r#* C$risian )$i'an$r#)is+ H#s)ia's ,ere a's#
esa!'is$ed !y $e C$risian c$urc$ as insru*ens %#r $e
)r#)agai#n #% %ai$+
7uring renaissance8$e )eri#d in Eur#)ean $is#ry %r#* 9:
$
#
9;
$
cenury8$ea'ing ars re<disc#&ered a scieni%ic and rai#na'
a))r#ac$+
T$e era #% *#dern *edicine !egan ,i$ $e disc#&ery #%
circu'ai#n #% !'##d. *icr#!es. ase)sis. e$er. &accinai#n. surgica'
ec$ni-ues. and ani!i#ics+
MESOPOTAMIAN HOSPITALS
Mes#)#a*ia re%ers # $e regi#n #ccu)ied !y *#dern Ira-. easern
Syria. & s#u$easern Tur"ey+ I is an area !e,een ,# ri&ers8
Eu)$raes & Tigris+ T$ese ri&ers $a&e $eir #rigin in Asia Min#r
and *erge # %'#, in# $e Persian Gu'%+ T$is %eri'e 'and $as !een
ca''ed $e crad'e #% ci&i'i(ai#n+
In Mes#)#a*ia 0=>>>BC2. ear'y $ea'$ care ,as )r#&ided !y
)riess rained in $ea'ing s"i''s+ T$e diseases ,ere #%en !'a*ed #n
)re<e3ising s)iris? g#ds. g$#ss. & eac$ s)iri ,as res)#nsi!'e %#r
#n'y #ne disease in any #ne )ar #% $e !#dy+ I ,as a's#
rec#gni(ed $a &ari#us #rgans c#u'd si*)'y *a'%unci#n causing
@
i''ness+ Medicina' re*edies used as cure ,ere s)eci%ica''y used #
rea $e sy*)#*s #% $e disease. and ,ere c'ear'y disinguis$ed
%r#* *i3es #r )'ans used as #%%ering # suc$ s)iris+
T$e )ri*ary cenre %#r $ea'$ care ,as $e $#*e+ T$e *a1#riy #%
$ea'$care ,as )r#&ided a $e )aienAs $#use. ,i$ $e %a*i'y
acing as care gi&ers+ Ouside $#*e. #$er i*)#ran sies %#r
re'igi#us $ea'ing ,ere near!y ri&ers+ T$ese )e#)'e !e'ie&ed $a
$e ri&er $ad $e )#,er # e'i*inae e&i' su!sances and %#rces $a
,ere causing i''ness+ S#*ei*es a s*a'' $u ,as se u) ei$er near
$e $#*e #r ri&er # aid $e )aien+
T$e radii#na' $ea'ers disse*inaed *edica' "n#,'edge $r#ug$
$eir ,riings+ Medica' rec#rd ,as ,rien #n c'ay a!'es and
)a)yrus 'ea&es+
T$e %irs rec#rded d#c#rAs )rescri)i#n ca*e %r#* Su*er in
ancien Ba!y'#n under $e ru'e #% $e dynasy #% Ha**ura!i
09B@C<9;C; BC2+ Ha**ura!iAs c#de #% 'a,s )r#&ides $e %irs
rec#rd #% $e regu'ai#n #% d#c#rAs )racices. as ,e'' as $e
regu'ai#n #% $eir %ees+ T$e Mes#)#a*ian ci&i'i(ai#n *ade
)#'iica'. educai#na'. and *edica' c#nri!ui#n # $e 'aer
de&e'#)*en #% Egy)ian. He!re,. Persian. and e&en Indian
cu'ures+
GREED HOSPITALS
5#r $undreds #% years. $e Gree"s en1#yed $e !ene%is #% c#nac
and cr#ss<%eri'i(ai#n #% ideas ,i$ nu*er#us #$er ancien
)e#)'es. es)ecia''y $e Egy)ians+ A'$#ug$ )aiens ,ere reaed
!y *agic riua's and cures ,ere re'aed # *irac'es and di&ine
iner&eni#n. $e Gree"s rec#gni(ed $e naura' causes #% disease.
and rai#na' *e$#ds #% $ea'ing ,ere c#nsidered i*)#ran+ In
addii#n. ,$a ,as "n#,n #% $u*an ana#*y and )$ysi#'#gy ,as
*#re #% rai#na' $an su)ersii#us #r re'igi#us naure+
=
In addii#n # rai#na' *edicine. a re'igi#us $ea'ing sc$e*e ,as
a's# g#ing #n? $e cu' #% Aescu'a)ius. $e Gree" g#d #% $ea'ing+
T$e sic" ra&e'ed # s$rines and )arici)aed in a nu*!er #% riua's
and cere*#nies+ Per$a)s $e *#s rudi*enary %#r* #% $#s)ia'
,ere $e $ea'ing e*)'es #% Greece+ Hea'ing e*)'es ,ere sacred
sies creaed %#r $e sic" # recei&e di&ine aid+ T$ey ,ere #%en
ass#ciaed ,i$ )u!'ic !a$s and s)a<y)e %aci'iies ,$#se )ries<
)$ysicians ad*inisered riua's #% $ea'ing. *assage. and $er!a'
*edicine+
Hi))#craes ,as $e %irs )$ysician ,$# re1eced $e &ie, #% $is
i*e $a c#nsidered i''ness # !e caused !y )#ssessi#n #% e&i'
s)iris and !y dis%a&#ur #% g#ds+ He $e'd $e &ie, $a i''ness $ad a
)$ysica' and rai#na' e3)'anai#n+ He *ainained $a disease ,as
caused !y dise-ui'i!riu* #% !#dy %'uids+ S# $e cure 'ies in
re*#&ing $e %'uid in e3cess+ He !e'ie&ed in $e naura' )r#cess #%
res. a g##d die. %res$ air. and c'ean'iness+ Hi))#craic d#c#rs
)aid $#use<ca''s+
Hi))#craes is usua''y c#nsidered # !e %irs )$ysician # $#'d
rai#na' n#nre'igi#us a))r#ac$ # *edicine+ In :C> BC. $e sared
# use auscu'ai#n. )er%#r* surgica' #)erai#ns. and )r#&ide
$is#rians ,i$ deai'ed rec#rds #% $is )aiens and descri)i#n #%
diseases ranging %r#* u!ercu'#sis # u'cers+ T$e e*)'es #%
Saurn. Hygeia. and Aescu'a)ius. $e Gree" g#d #% *edicine. a''
ser&ed as !#$ *edica' sc$##'s %#r )racii#ners and resing )'aces
%#r )aiens under #!ser&ai#n #r rea*en+
ROMAN HOSPITALS
6i$ $e e*ergence #% R#*an E*)ire. $e cu' #% Aescu'a)ius
reac$ed is $ig$es 'e&e' #% di%%usi#n and )#)u'ariy+ T# aain cure.
*any R#*ans re'ied #n su)ersii#n and s)e''s. ,$i'e #$ers
:
)er%#r*ed re'igi#us riua's+ T$ey !e'ie&ed $a Aescu'a)ius $ad
s)ecia' )#,ers # $ea' i''nesses+ In #rder # re*edy $e siuai#n.
Ga'en ried # creae a cadre #% 'earned and e3)erienced
)$ysicians+
R#*e a's# )r#&ided $e %irs c'ear e3a*)'e #% sae< s)#ns#red
*edica' care %#r a )ri&i'eged sec#r #% $e )#)u'ai#n/ is s#'diers+
A,ay %r#* $e *a"e<s$i% en %aci'iies near $e !a'e%ie'd. $e
R#*ans esa!'is$ed regi#na' military hospitals %#r $e care #% $e
,#unded and sic" s#'diers+
R#*an Ci&i' ,ar resu'ed in $ig$ 'e&e' #% in1uries. c#*)e''ing
E*)er#r Augusus # %#r* a )r#%essi#na' *edica' c#r)s+ Rea'i(ing
$eir i*)#rance. $e ga&e a'' )$ysicians $a 1#ined $is ne,
*edica' c#r)s digni%ied i'es. 'and grans. and s)ecia' reire*en
!ene%is+ T$e )r#%essi#n '#s is s$#ddy as)ec & !eca*e
res)eca!'e+ T$is )r#%essi#na' gr#u) su))#red !y $e )#,ers $a
!e. ad&anced $e sudy & )racice #% *edicine # a 'e&e' n# seen
uni' 'ae in $e nineeen$ cenury+
Ancien R#*an *edicine ,as s)'i a*#ng different specialties.
suc$ as inernis. #)$$a'*#'#giss. and ur#'#giss+ A'' surgica'
as"s ,ere )er%#r*ed !y a))r#)riae s)ecia'iss+ Ancien R#*an
surge#ns $ad a ,ide &ariey #% )ain"i''ers and sedai&es # $e') in
surgery. e3racs #% #)iu* )#))ies & $en!ane 0sc#)#'a*ine2+ T$ey
!#i'ed $eir ##'s !e%#re use & ,#u'd n# use $e sa*e ##' #n a
)aien !e%#re re!#i'ing+ T$ey used di%%eren y)es #% surgica'
insru*ens. suc$ as sca')e's !#ne $##"s & !#ne dri''s+
T$ey in&ened s#)$isicaed )er*anen $#s)ia's. ,i$ s)ecia'i(ed
r##*s %#r di%%eren as"s. and ,i$ is#'ai#n #% s#*e )aiens %r#*
#$ers # reduce $e s)read #% disease+ Cenra' $eaing & g##d
&eni'ai#n a's# $e')ed )aiens+
4
R#*an Medics sudied e3 !y Hi))#craes+ 6riings #% Ga'en
,ere a's# inc'uded in $e curricu'u*+ He c#*)i'ed in%#r*ai&e
*edica' e3s and *anua's+ Ga'en ,as )er$a)s $e *#s ,e''<
"n#,n #% $e R#*an *edics. ,$# 'e% deai'ed ,riing a!#u
)$ysi#'#gy and surgica' )r#cesses. inc'uding $e &ari#us *edica'
and surgica' insru*ens $en in use+ His $e#ries d#*inaed $e
6esern *edica' science %#r #&er a *i''enniu*+ He )er%#r*ed
*any audaci#us #)erai#ns E inc'uding !rain and eye surgeries+ He
a's# )er%#r*ed caarac surgery+ In #rder # sudy $e %unci#n #%
"idneys and s)ina' c#rd. $e )er%#r*ed &i&iseci#n #% nu*er#us
ani*a's+ He 'ecured. ,r#e e3ensi&e'y. and )er%#r*ed )u!'ic
de*#nsrai#n #% ana#*ica' "n#,'edge+
T$e decree #% E*)er#r C#nsanine in ==4 A7 c'#sed $e
Aescu'a)ia and si*u'aed $e !ui'ding #% C$risian $#s)ia's+
H#,e&er. i ,as n# uni' =;FA7 $a $e ,ea'$y R#*ans.
c#n&ered # C$risianiy. sared # !ui'd $#s)ia's+
ISLAMIC HOSPITALS
T$e !#dy #% "n#,'edge in$eried !y Mus'i*s ,as *#s'y %r#*
Gree" s#urces+ 7#c#rs in Is'a*ic $#s)ia's ,ere rained acc#rding
# $e ideas #% Hi))#craes+ Mslims re!introdced the idea of
rational medicine" 6$en Eur#)e ,as in $e gri) #% 7ar" Ages.
Mus'i* science. ar and *edicine %'#uris$ed+ T$us. n# #n'y curing
$e ai'*ens #% *asses !u increasing $eir sandard #% $ea'$+
6i$ $e )ar#nage #% U*ayyad and A!!asid ca'i)$s. Mus'i*
)$ysicians translated the #ree$ medicine and science+ In
addii#n. $ey )reser&ed and rans*ied ancien Gree" "n#,'edge
$a *ay ,e'' $a&e !een '#s #$er,ise+ Mus'i* )$ysicians suc$ as
A&icenna and A'<Ra(i a's# *ade i*)#ran c#nri!ui#ns # $e
"n#,'edge $ey in$eried %r#* $e Gree"s+ H#,e&er. i is )erinen
# *eni#n $a Mus'i*s ,$# e3ce''ed in *edicine and science
,ere n#n<Ara!s ,i$ rare e3ce)i#ns and $eir re'igi#us &ie,s
;
,ere n# acce)ed !y $e #r$#d#3 $e#'#gians+ 5#r e3a*)'e. A'<
Ra(i ,as a nai&e #% Rayy 0near Te$ran2+
H#s)ia's ,ere #ne #% $e greaes ac$ie&e*ens #% Mus'i*s during
$e Midd'e Ages+ H#s)ia's ,ere !ui' a'' #&er $e Mus'i* 6#r'd
,i$ $ig$ sandard #% $ea'$ care+
In Is'a* $ere ,as genera''y a *#ra' i*)erai&e # rea a'' $e i''
regard'ess #% $eir %inancia' saus+ Many #% $e $#s)ia's ,ere
#)en # a''. *a'e and %e*a'e. ci&i'ian & *i'iary. adu' & c$i'd.
ric$ and )##r. Mus'i*s and n#n<Mus'i*s+ T$ey ended # !e 'arge
ur!an srucures+
T$e Is'a*ic $#s)ia's ser&ed se&era' )ur)#ses/ a cenre #% *edica'
rea*en. a c#n&a'escen $#*e %#r $#se rec#&ering %r#* i''ness #r
accidens. an insane asy'u* and a reire*en $#*e gi&ing !asic
*ainenance needs %#r $e aged B #$ers ,$# 'ac"ed a %a*i'y #
care %#r $e*+
An Is'a*ic $#s)ia' ,as ca''ed a bimaristan. #%en c#nraced #
maristan. %r#* $e Persian ,#rd bimar. i'' )ers#n. and stan. )'ace+
Asy'u*s %#r $e insane ,ere %#unded 9> cenuries !e%#re $ey %irs
a))eared in Eur#)e+ In addii#n. Is'a*ic )$ysicians ,ere
res)#nsi!'e %#r $e esa!'is$*en #% )$ar*acy. and c$e*isry as
sciences+
T$e Mus'i*s esa!'is$ed $eir %irs $#s)ia' during $e )eri#d #%
6a'eed. ,$# ru'ed %r#* ;C4 # B>4 A+7+ I ,as *ean %#r 'e)r#sy
)aiens+ T$e )$ysicians ,$# ,#r"ed in $is $#s)ia' ,ere graned
'arge )r#)eries and sa'aries+ T$e )aiens a $is $#s)ia' $ad
#rders # say )er*anen'y a $e $#s)ia' & in addii#n # %##d &
s$e'er ,ere gi&en s#*e *#ney+ T$e &i(ier # $e ca'i)$ Harun a'<
Ras$id !ui' a 'arge $#s)ia' in F
$
cenury in Bag$dad+
B
In 'i'e *#re $an a $undred years. 4 addii#na' $#s)ia's $ad !een
!ui' in Bag$dad+ T$e *#s i*)#ran #% Bag$dad $#s)ia's ,as
esa!'is$ed in FC@ !y $e ru'er Adud a'<7a,'a$+ 6$en i ,as
%#unded i $ad @4 d#c#rs. inc'uding #cu'iss. surge#ns. and
!#neseers+
T$ere ,ere @ "inds #% $#s)ia's/ *#!i'e & )er*anen+ M#!i'e
$#s)ia's *#&ed %r#* &i''age # &i''age ,$ere $ere n# )er*anen
$#s)ia's+ Medica' care ,as a's# )r#&ided # $e in*aes #%
)ris#ns+
In $e Ara!ic $#s)ia's. se)arae ,ards ,ere se aside %#r di%%eren
diseases. suc$ as %e&er. eye c#ndii#ns. diarr$ea. ,#unds. and
gynec#'#gica' dis#rders+ C#n&a'escing )aiens ,ere se)araed
%r#* sic"er )aiens and )r#&isi#n ,ere *ade %#r a*!u'a#ry
)aiens+ C'inica' re)#rs #% cases ,ere c#''eced and used %#r
eac$ing+
T$ere ,ere a's# $#s)ia's %#r *any di%%eren gr#u)s #% )e#)'e+
S#*e ,ere %#r $e ar*y and $ey $ad $eir #,n s)ecia' d#c#rs+
T$ere ,ere s)ecia' d#c#rs aending # $e ca'i)$s. *i'iary
c#**anders. and n#!'es+ T$ere ,ere se)arae $#s)ia's %#r
)ris#ners+ T$ere e&en ceners # )r#&ide %ree %irs aid. ,$ic$ ,ere
'#caed a !usy )u!'ic )'aces 'i"e $e !ig *#s-ues+
T$ere ,ere a's# $#s)ia's %#r ,#*en run !y rained *id,i%es and
,#*en d#c#rs+
In Egy). $e %irs $#s)ia' ,as !ui' in Cair# in CB@ !y A$*ad i!n
Tu'un. $e A!!asid G#&ern#r+ I a's# )r#&ided care # $e insane+
In $e 9@ $ cenury. Sa'adin %#unded $e Nasiri $#s)ia' in Cair#+
T$e Mansuri. c#*)'eed in 9@C:. re*ained $e )ri*ary *edica'
cenre in Cair# $r#ug$ $e 94
$
cenury+ T$e Nuri $#s)ia' in
C
7a*ascus ,as a *a1#r #ne %r#* $e i*e #% %#undai#n in $e
*idd'e #% 9@
$
cenury ,e'' in# $e 94
$
cenury+
Besides $#se in Bag$dad. 7a*ascus. and Cair#. $#s)ia's ,ere
!ui' $r#ug$#u Is'a*ic 'ands+ Iran $ad se&era'. and $e #ne a ray
,as $eaded !y a'<Ra(i )ri#r # $is *#&ing # Bag$dad+ Oa*an
$#s)ia's %'#uris$ed in Tur"ey in $e 9=
$
cenury+ H#s)ia's ,ere
'ae in !eing esa!'is$ed in Is'a*ic S)ain. $e ear'ies )#ssi!'y
!eing !ui' in 9=FB in Granada+
IN7IAN HOSPITALS
Ear'y Indian ru'ers c#nsidered $e )r#&isi#n #% insiui#na' care #
$e sic" as $eir s)iriua' and e*)#ra' res)#nsi!i'iy+ T$e
%#rerunners #% $e )resen $#s)ia's can !e raced # $e i*es #%
Budd$a. %#''#,ed !y As$#"a+ India c#u'd !#as #% a &ery ,e''<
#rgani(ed $#s)ia' and *edica' care syse* e&en in $e ancien
i*es+ T$e ,riings #% Sus$rua 0 ;
$
cenury BC2 and C$ara"a 0@>>
A72. $e %a*#us surge#n and )$ysician res)eci&e'y. ,ere
c#nsidered sandard ,#r"s %#r *any cenuries ,i$ insruci#ns %#r
esa!'is$*en #% $#s)ia's. %#r seri'i(ing !ed 'inen ,i$ sea* and
%u*igai#n. and use #% syringes and #$er *edica' a))'iances+
Medicine !ased #n $e Indian syse* ,as aug$ in $e ancien
uni&ersiy #% Ta3i''a+
T$e *#s n#a!'e #% $e ear'y $#s)ia's ,ere $#se !ui' !y Ding
As$#" 0@B=<@=@ BC2+ T$ere ,ere riua's 'aid d#,n %#r $e
aendans and )$ysicians ,$# ,ere en1#ined # ,ear ,$ie c'#$es
and )r#*ise # "ee) $e c#n%idence #% $e )aiens+ H#s)ia's
%#''#,ed $e )rinci)'es #% saniai#n. and caesarian seci#ns ,ere
)er%#r*ed ,i$ c'#se aeni#n # ec$ni-ue in #rder # sa&e !#$
*#$er and in%an+ P$ysicians ,ere a))#ined <<<#ne %#r e&ery 9>
&i''ages8# ser&e care needs #% $e )#)u'ai#n. and regi#na'
$#s)ia's %#r $e in%ir*+
F
6$en M#ng#'s ra&aged Persian and Cenra' Asian ciies.
)$ysicians %'ed # India+ T$ey %#''#,ed $e Gree" syse* #%
*edicine ,$ic$ ca*e # !e "n#,n as GYunaniH+ T$is syse*
%'#uris$ed ,i$ a dec'ine #% radii#na' Ayu&edic syse*+ H#,e&er.
$e in%'uence #% Ayu&eda c#ninued in $e S#u$+
T$e modern system of medicine in India ,as inr#duced in $e
9B
$
cenury ,i$ $e arri&a' #% Eur#)ean C$risian *issi#naries in
S#u$ India+ In $e 9B
$
cenury. $e Eas India C#*)any8$e
%#rerunner #% $e Briis$ E*)ire in India8esa!'is$ed is %irs
$#s)ia' in 9;;: a C$nnai %#r is s#'diers and in 9;;C %#r ci&i'ian
)#)u'ai#n+ Eur#)ean d#c#rs sared geing )#)u'ar and $e 'aer
)ar #% 9C
$
and ear'y 9F
$
cenury. $ere ,as a seady gr#,$ #%
*#dern syse* #% *edica' )racice and $#s)ia's. )us$ing $e
Iunani and Ayu&edic syse*s # $e !ac"gr#und+
9>
99