Hospital

Organizational
Structures
By
MATHANKUMAR.S
CLASSIFICATIONS OF
HEALTH CARE

 Primary Care
 Secondary Care
 Tertiary Care
Primary 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 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)
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)
CLASSIFICATIONS OF
SERVICE
GENERAL HOSPITAL
SPECIALITY HOSPITAL
REHABILITATION HOSPITAL
LONG-TERM CARE HOSPITAL
(AUXILIARY)
NURSING HOME
GENERAL HOSPITAL
Provides primarily for the diagnosis and
short-term treatment of patients for a
wide range of diseases or injuries.
SPECIALITY HOSPITAL
Provides primarily for the diagnosis and
short-term treatment of patients for a
limited range of diseases or injuries.
REHABILITATION
HOSPITAL
Provides for the continuing assessment
and treatment of patients whose
condition is expected to improve
significantly.
 LONG-TERM CARE
HOSPITAL

Provides primarily for the continuing

treatment of patients with long-term
illness or with a low potential for
recovery.
NURSING HOME

Institution where residents are

accommodated who require nursing and
personal care on a continuing basis.
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
REGULATORY AGENCIES
Review committees within hospitals
Hospital administration and regulations
Canadian 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
most complex
organization in our society.
Clinical Engineer Must Understand
Roles and interaction between multiple
professional groups
Role of the hospital administration in
coordinating these groups
 WELL DEVELOPED
INTERPERSONAL SKILLS
ARE ESSENTIAL TO
CLINICAL ENGINEERING!
Impact of Technology
Advancements 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:
Professional Group
Cherished Role
Diversified Nomenclature
Self Image.
Professional Groups
Medical Specialties
Nursing Specialties
Clinical Technicians (i.e., Lab Techs, X-Ray
Techs, Respiratory Therapists, Physiotherapists,
etc.)

There are more than 200 health

occupations!
Administrative Challenges
Professionals typically cherish their "right"
to self-regulation.
Administrative Challenges
Group conflict is unavoidable.
Internal communications are impeded.
Consensus is more apt to be absent.
Administrative Challenges
Internal
◦ Medical Staff
◦ Competition Between Health Professions
◦ Unions
◦ Physical Resources
◦ Size and Complexity of Organization
External
◦ Government
◦ Funding
◦ Regulatory Agencies
◦ Public Demands
Hospital Administrators Require:
Interpersonal skills
Effective communications skills.
Leadership skills.
THE HOSPITAL AS A DELIVERY
SYSTEM
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 ORGANIZATION
GOVERNING BOARD

MEDICAL HOSPITAL
STAFF
ADMINISTRATOR
Hospital Management Model
Governing Board (government
appointed)
Chief Executive Officer (Hospital
Administrator)
Medical Staff Organization.
Functions 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 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 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
administrator places more of
a strain on character than on
intellect.
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.
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.
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
the services delivered during the past
year.
Advising the governing board on matters
of policy formulation.
THE MEDICAL STAFF
 Doctors represent the
initiators of every action that
results in the direct provision
of patient care services.
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.
 The doctor is not an
employee of the hospital,
he/she is outside of the
hospital organization.
Doctors control, yet are not
accountable, for nearly 90
percent of hospital
expenditures.
Medical Staff
Participationby the medical staff in the
decision-making process is in the best
interest of both the hospital and the
patients.

Physicianinvolvement leads to physician

accountability.
 The physician may view the
problems of medical practice
from a personal rather than
an organizational perspective.
 The administrator is
primarily concerned with the
maximum utilization of
available health resources and
personnel.
 Organization of medical
resources may require a
degree of control and
surveillance over the doctor's
work which maybe
unattractive to him/her.
Medical Staff
The 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 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
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 Staff
To 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
AMONG HEALTH
WORKERS
 The complex tasks of highly
skilled professionals demand a
participatory decision-making
structure while the repetitive
tasks performed by unskilled
workers require a more
formal hierarchical structure.
Organizational Structures
Highly 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.