CH-1: Hospital and their Organization

Syllabus: Hospital-Definition, Function, classifications based on various criteria, organization,

Management and health delivery system in India.
Q.1 Hospital- Definition****
Answer:
The hospital is complex organization utilizing specialized scientific equipment and functioning
through a group of trained people educated to the problems of modern medical sciences. All these are
co-ordinate together for the common purpose of restoration and maintenance of good health.
Q.2 Define modern hospital and write it functions.
Answer:
Modern Hospital: *** is an educational and social service institution with a single purpose of
restoration and maintenance of good health.
It provides special facilities (like accommodation, colleges and day night medical stores) with a
trained professional staff.
Functions of Hospital: ***
1. Patient care: It includes services for diagnosis, prophylaxis and treatment of diseases to the sick
or injured patients. It is a centre of community health and contributes a great deal to preventive and
social medicine.
2. Public health: The hospitals are required to support all the activities carried out by various public
health and voluntary agencies such as immunization programme, blood donation camps, social and
economics rehabilitation, health education etc. by providing facilities and advice.
3. Medical research: Research is an important activity in the hospital that helps in developing the
new methods of treatment and improving the hospital services. Some of the common areas of
research in the hospital are development of new techniques in surgery, laboratory diagnostic
procedures, evaluation of investigational drugs in diseases.
4. Educational training: - This facility, particularly for medical students, pharmacist, nursing,
medical technologist and allied health professional helps to fulfil their curriculum requirement.
Hospital also educates the general public through lectures and demonstrations on the preventive
aspects of common and serious diseases. Hospital provides the methods by which the persons can
work together in groups with the object of care of patient and community.
5. Counselling and patient advice: It is a modern concept adopted in big hospitals for the wellbeing
of the patients. During these counselling sessions pharmacist educate people on communicable
diseases, epidemics and family welfare etc.
Q.3 What is Elite hospital? ***
Answer:
 They are symbol of High-tech medical development.
 The hospital contains five-star hotel facilities.
 The deluxe rooms are equipped with fridge, TV and telephone excepting the medical care.
 Thus, the room charges are costly and the treatment cost is also high.
 But these hospitals reserve a particular percentage of their capacity for the poorer section and
subsidize a particular percentage of their accommodation.
 Jaslok has reserved 25% for the poorer sections and 30% at half the rates.
 Out of 680 beds of Mumbai Hospital, 315 are free and 112 are subsidized.
Q.4 Give classification of Hospitals. **
Answer:
1) Clinical Orientation as the basis of classification: (Major disease) **

Ms. Revati Deore 1

 CH-1: Hospital and their Organization

a. Psychiatric/ Mental hospital

b. T.B. hospital
c. Leprosy hospital
d. Cancer hospital
2) On basis of Anatomical- Physiological specialization***
a. EAR, Nose, Throat(ENT) hospital
b. Orthopaedic hospital (bones or muscles)
c. Eye hospital
d. Kidney hospital
3) On the basis of Client group**
a. Pediatric (children) hospital
b. Gynecological (Women) hospital
c. Maternity (Mothers) hospital
4) On basis of System of medicine***
a. Allopathic (Modern medicine) hospital
b. Ayurvedic (traditional) hospital
c. Homeopathic hospital
d. Unani hospital
e. Nature cure centres
f. Physio- therapy centres
5) On the basis of Non Clinical group******
On the basis of Ownership
Government and Private
a. Public Ownership: ****
They can be
i. Central government hospitals:
Like Railway hospital, Defense hospital, All India Institute of Medical sciences, Pondicherry
or Chandigarh.
ii. State Government hospitals:
Like Civil hospitals at district headquarters, Sassoon hospital- Pune, J.J. hospital Mumbai.
iii. Local Self- Government hospitals:
These are run by Municipalities or corporations.
Ex: BMC hospital like Bhagwati Hospital in Mumbai.
b. Private ownership- ***
i) Trust: They can be run by trust.
The board of trustees managed the Hospital affairs Bombay Hospital Mumbai, Jaslok Hospital.

Ms. Revati Deore 2

 CH-1: Hospital and their Organization

ii)Religious bodies: and other- Ramakrishna Hospital Kolkata and Christian medical college hospital
(Bangalore).
iii)Limited company hospital- They can be incorporated as public Ltd company where public
subscribes to the share capital. Apollo Hospital Ltd (Madras), Medinova (Baroda).
iv) Other Private hospital or nursing home – Run by single or group of private practitioner or
husband wife team. They are proprietary or partnership concern and general nursing home.
6) On the basis of Cost:
a) Elite Hospital: Like Jaslok and Hinduja are meant for the privileged.
b) Budget Hospitals: These are meant for moderate budget and low budget users
Ex: Civil hospitals, corporation hospitals.
Miscellaneous:
 Teaching hospitals where medical college is attached.
 Research centres.
 Integrated hospitals, where many medical and surgical departments are integrated or
alternative systems of medicine are integrated.
 These are in-plant hospitals, run as a part of business organisation for the benefit of its
employees and immediate community surrounding it.
 There is no system of accreditation for hospitals here in India, as it prevails in other advanced
countries.
 The time has come now to take steps for the rating of hospitals on the criteria of service
quality, service availability, patient satisfaction and perceived image.
Q.5 Describe functions of Hospital administrator**
Answer:
Selected by Board to run the hospital. Board acts as guide to administrator.
1. Implementing the policies, procedure & guidelines frame by GB (Governing Bodies) in the daily
management of hospital laid down by GB.
2) Attend meeting of GB as well as medical staff & paramedical staffs (Head of various department).
3) Incharge of admission & discharge of the patient.
4) Link between GB & medical staff. Also link between GB & all other employees.
5) Prepare a hospital budget for approval by the GB.
6) Oversees the training of the students, nurses, volunteer etc.
7) Ensure smooth functioning of the OPD.
8) Provide facilities, equipment, & assistance so that improve quality of patient care.
9) He has power of staffing & directing in consultation with the dept. of heads.
10) Modify internal organization of hospital in response to current operating condition.
Q.6 Explain health delivery system in India at Central government level. *
Answer:
In the central government there is “Union Ministry of Health and Family Welfare” which formulates
and plans the overall health schemes.

Ms. Revati Deore 3

 CH-1: Hospital and their Organization

It also offers financial assistance to the state governments.

The following chart explains the organization of health delivery system at central government level.

Q.7 Write purpose, principles and contents of medical record.

1) Purpose-
 To serve as a basis for planning & for continuity of patient’s care.
 It assists in protecting legal interest of the patient hospital & physician.
 It helps for communication among the physician & any professional contributing to
the patient’s care.
 It acts as a evidence for the patients illness & treatment during each hospital stay.
 It provides data for use in research and education.
 It serves as a basis for review study of the patient & evaluation of health care given to
the patient.
2) Principle-
 It must be accurately prepared.
 It must be properly stored & readily available.
 It must be easily accessible.
3) Contents-
 It must contain all important clinical information which should give immediate
knowledge to another physician who takes care of patient at any time in emergency
complete medical record is one which contain personal family history, history of
patient’s present illness.
 The physical examination, clinical laboratory data, X-ray and other examinations,
medical and surgical treatment, pathological findings of patient progress notes, final
diagnosis, condition on discharge, regular follow up of the patient.
 If the death of patient has occurred the medical record also contains autopsy findings.
Q.8 Write about nursing services in a hospital. *
 Nursing is the vital prime need of the health care system.

Ms. Revati Deore 4

 CH-1: Hospital and their Organization

 The primary aim of the nursing service is to provide nursing care to patients.
 Nursing constituted single largest group of employees in the hospital.
 Nursing director is the in charge of Nursing service.
 Nursing director is responsible to administrator.
 Nursing department consist of nursing units such as operating room, recovery room, labour room,
central supplies room etc. Each area has a in charge called Head Nurse.
It has following roles in the hospital- *
 Nursing department gives general assistance to outpatients, inpatient area and wards.
 It gives assistance to the labour wards and Operation Theatre.
 It is the integral part of the hospital which keeps coordination with all other departments of the
hospital
 Maintaining Nursing records and record of quality of service given to the patient.
 Arranging training programmes for staff of the Nursing department.
 Nursing department encompasses health promotion, patients care, prevention of disease,
rehabilitation, teaching, counselling and emotional support.
 Nursing department respect individuality, dignity and rights of every person regardless of race,
colour and social and economic status.
Early Hospitals:
 The early hospitals were primarily almshouses (house founded by charity, offering
accommodation for poor people).
 These provides lodgings for the poor and needy peoples
 Another motivating factor to establish hospitals was to accommodate leprosy patients.
 Throughout the middle ages, the hospitals were run by monastic orders.
 The first hospital in the New World were founded by Spanish in Mexico City (1524) and
French in Canada.
Roles of Modern Hospitals: *
o Improved standard of living, rise in income and social status.
o Public education.
o Professional education.
o Advances in medicine.
o Patterns of medical practice.
o Improved diagnosis and therapy.
o Financing pattern.
o Attitude of community.
o Governments approach.
o Managerial orientation to hospitals.
o Public Health
o Medical care early this century
o Institutional care
o Prevention
o Diagnosis
o Treatment
o Rehabilitation** (Rehabilitation: The process of helping a person who has suffered an illness
or injury restore lost skills and so regain maximum self-sufficiency. For
example, rehabilitation work after a stroke may help the patient walk and speak clearly
again.)
o Education

Ms. Revati Deore 5

 CH-1: Hospital and their Organization

o Research

Organisation of Hospitals:
 A successful hospital is based on a triad – good community- oriented planning, good design and
construction and good administration.
 A progressive hospital builds its services on specific knowledge of the community it is to serve.
 Organisation is not viewed merely as a structure these days.
 It is a process of achieving the objectives by grouping people in order to get the work done.
 The ultimate aim of the hospital is to provide optimum health care, and as such its organisation is
based upon the following principles:
a. Team Approach: A patient here is under the care of a professional team of medical/
paramedical staff. The services are integrated and coordinated.
b. Spectrum of services:
The well-known management Guru observes, “activities analysis is an important criterion to
shape the organisation”.
Hospital, as an organisation, has to undertake a number of activities-
diagnosis, treatment or therapy, rehabilitation, education and prevention.
These activities are further sub-classified, and groups and sub-groups are formed to carry out
these activities.
The whole workload is divided into manageable units of health services.
Each unit contributes to the total spectrum of health services.
Each unit contributes to the total spectrum of health services that are possible in terms of the
type of community it serves, and the overall pattern of health facilities of the region in which
it exists.
c. Authority- responsibility: The various people must be allotted carefully spelled out tasks in
a hospital. Responsibility should be assigned appropriately. Once responsibility is assigned,
accountability to report the superior regarding performance, is a natural corollary. This is
necessary to ensure a high quality of patient care.
d. Talent Search: A good hospital organisation should be staffed by competent medical and
non-medical personnel. The organisation should formulate a programme to attract good
physicians/ surgical specialists to maintain optimum occupancy of inpatients facilities and
full utilization of outpatient facilities.
e. Budgeting and Financing: Large hospitals like KEM Mumbai treat almost 15 lacs patient
per year, and perform 18 thousand major surgeries and 33 thousand minor ones. The yearly
budget for KEM is Rs. 16-18 crores. Many other hospitals face a resource crunch. They
should therefore design an effective organisation, and use proven management techniques to
optimize their resources. There should be scientific budgeting and a planned programme for
capital financing.
f. Continuum (band): A hospital provides to both ambulatory and non-ambulatory patients
(outpatients and inpatients). The organisation should form a band with common or integrated
services.
g. Evaluation and Research: Services provided by the hospital should be rated in terms of
quality and adequacy for meeting the patients and community’s needs.
h. No Stereotypic Organisation chart: There is no standardized organizational chart which
will be suitable for every hospital.
The organisation should evolve considering the objectives, the tasks and their possibility of
the specific hospital
i. Governing Body: Each hospital has its top management, which directs its course of action,
and which provides policy guidelines and exercises overall supervision and control.
It assumes the legal and moral responsibility for the conduct of the hospitals staff as an
institution.
It is responsible to the patient, the community and the sponsoring organisation.
Typical Hospital Organisation:

Ms. Revati Deore 6

 CH-1: Hospital and their Organization

Governing Board:
 The legal status of hospital is due to character or the parent body a society, a trust, a
company.
 The powers derived from its legal status are exercised through a body called the governing
body.
 Synonyms- board of trustees, board of governors, board of directives, commissioners.
 The board assumes complete authority over, and responsibility for, the conduct of hospital
staff and is responsible to the community or the beneficiaries it serves, either directly or
indirectly through the parent body by which it was created.
Composition: **
 Physician member: gives interpretation on medical matters.
 Board members and members of medical staff have a symbiotic relationship.
 They learn much from each other.
Functions of Governing Board: *
1. Executive committee:
 Takes decision to form ad- hoc committees and task committees.
 It exercises authority in emergencies.

Ms. Revati Deore 7

 CH-1: Hospital and their Organization

 It reviews specific and board reports before final rectification by the full board.
 It also reviews specific and board reports before final ratification by the full board.
 It also reviews specific and board reports before final ratification by the full board.
 It also reviews other committee reports.
2. Joint Conference committee:
 It is a combination of the representative of the board and the clinical services, with the
administrator acting as its secretary.
 It is a liaison committee.
 It means communication of cooperation between people or organisation.
3. Professional committee:
 It is responsible to the executive committee.
 It is made up of select Board members who study and make the medical staff and
administration.
 Their aim is to upgrade the quality of health care.
4. Finance committee:
 It reviews the budget, financial statements and related problems.
5. Other Committee:
 Some are temporary, and some are permanent. They are formed depending upon the need and
situation. These include buildings, public relations(PR) and others.
 The administration usually serves as an ex-office member of all committees of the Board and
should attend all the meetings.
Services of Hospital:
A) Clinical Services: *
 Works surrounding to the patients
 It involves the mobilization and concentration of professional and scientific resources
dedicated to the restoration of the patient’s health.
 Serves role for prevention, diagnosis, therapeutic and restorative.
 Covers: Medical, Surgical, Obstetrical (relating to childbirth and the processes associated
with it), pathology and laboratory, radiological, dental, medical records, dietary and
outpatients.
General Medical services: works for
General diagnosis, Therapy, General medical and nursing care, Pediatrics Psychiatry, Neurology,
Cardiology, Dermatology, Pathology, Enterology (intestinal tract), Blood bank, Physical medicine
(physical medicine and rehabilitation (PM&R), also known as physiatry or rehabilitation medicine,
aims to enhance and restore functional ability and quality of life to those with physical impairments
or disabilities affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and
tendons.), Urology, Communicable diseases, Epidemiology (the branch of medicine which deals with
the incidence, distribution, and possible control of diseases and other factors relating to health),
Many aspects of related diagnosis, Tropical diseases (any disease that is indigenous to tropical or
subtropical areas of the world or that occurs principally in those areas. Examples of tropical diseases

Ms. Revati Deore 8

 CH-1: Hospital and their Organization

include malaria, cholera, yellow fever, and dengue.) Therapy and complications of surgery,
Obstetrics, gynecology, ENT and orthopedics, Allergy, Gland, Respiratory, GI Geriatrics, Chronic
diseases (defined broadly as conditions that last 1 year or more and require ongoing medical attention
or limit activities of daily living or both. Chronic diseases such as heart disease, cancer, and diabetes
are the leading causes of death and disability in the united states) Clinical diseases, Clinical research
are also parts of general medical services.

B) Surgical services:
 Almost half of admitted patients to the hospital undergo on operation.
 Function: Prevention, Diagnosis, Therapy, Restoration, Research and education
 Qualified physicians serve as first assistants during surgery, while nurses and aides serve as
second and third assistants.
 Operating room nursing supervisor directs the nursing staff and is responsible to the director
of nursing services functionally and to chief of the surgical staff administratively.
 Anesthesiology dept. is controlled by chief of surgery and maternity.
 The physical facilities for operating room requires careful planning and equipping.
1. Maternity services:
 Good planning for no. of maternity beds.
 Maternity departments include: nursing staff, maternity unit procedures, delivery unit
procedures, hospital records, new born infant care, identification of infants, premature infant
services, infant feeding, infant records.
2. Pathology & Clinical laboratory services:
 To facilitate correct diagnosis, treatment and prevention of diseases.
 Some diseases diagnosed on the basis of lab records.
 Ex: Diabetes, syphilis (a chronic bacterial disease), blood diseases.
 Some diseases can be diagnosed earlier due to lab facilities.
 Ex: TB, cancer.
 The control and treatment of some diseases are aided by the laboratory.
 Ex: Anemia, infectious diseases.
 The lab reports help surgical practice.
 Ex: Urine analysis, Rh- typing (blood protein- hemolytic disease of the newborn), blood
typing, post-operative tests.
2. Pathology & Clinical laboratory services:
 Lab works under a qualified pathologist who is assisted by no. of medical technologists.
 Certain factors like workload, staff and routine tests considered.
 Blood bank managed by hospital committee where pathologist is a member (to supervise the
proper use of blood and its derivatives in hospital).
Units in Pathology lab:
 Hematology (the branch of medicine involving study and treatment of the blood)/ blood bank
unit.

Ms. Revati Deore 9

 CH-1: Hospital and their Organization

 Urine analysis unit.

 Biochemistry unit (study of living organisms).
 Histology unit (the microscopic structure of tissues).
 Serology- Bacteriology unit (the scientific study or diagnostic examination of blood serum,
especially with regard to the response of the immune system to pathogens or introduced
substances).
Administrative area provides:
 Waiting room
 Venipuncture cubicle for drawing blood specimens.
 Specimen toilet
 Basal- metabolism/ ECG room
 Pathologist’s office
 Auxiliary services:
 Glass washing and sterilizing unit
 Morgue (cold section)
3. Radiological services:
 It is the diagnostic and therapeutic arm of the hospital.
 Play under the direction of competent radiologist.
 This department uses radiography and fluoroscopy.
 The radiologist is responsible to Chief of staff for clinical policies and activities.
 The administrator for administrative aspects.
 He is assisted by technologists (Facilities are well planned).
4. Dental services: Every hospital having same for emergencies.
 Sections/ services like:
 Dentistry for children.
 Dental X-rays.
 Oral hygiene and Oral pathology.
 Oral surgery.
 Periodontics (the branch of dentistry concerned with the structures surrounding and
supporting the teeth.).
 Restorative dentistry (the study, diagnosis and integrated management of diseases of the teeth
and their supporting structures and the rehabilitation of the dentition to functional and
aesthetic requirements of the individual)
 Cosmetic dentistry.
4. Medical records: ****
 It serves as a valuable reference material clinically and legally.
 Used for training, education and research.
 Purpose of Medical records:

Ms. Revati Deore 10

 CH-1: Hospital and their Organization

 Patient care
 Medical and allied education
 Research
 Legal protection
 Administrative planning and control
 Three Basic principles of medical records:
 They must be accurate.
 They must be properly stored(filed)
 The must be easily accessible.
 Have record committee.
Brief Sheet: It is a summary of the patients stay in hospital.
 It is used to admit the patient and becomes the face sheet of the clinical chart.
 It also provides non- medical information about the patient.
 It is signed by the patient or by another person on his behalf.
 The date and hour of admission and discharge are entered on this form, together with total
number of hospital days.
 The lower half of the page has space allocated for final diagnosis, operation performed and
condition of the patient on discharge.
 The responsibility of recording this data is of the attending physician who signs it.

Rehabilitation** Definition:
The process of helping a person who has suffered an illness or injury restore lost skills and so regain
maximum self-sufficiency. For example, rehabilitation work after a stroke may help the patient walk
and speak clearly again.

Reference:
 Dr. A.R. Paradkar and S.A. Chunawala, “Hospital and Clinical Pharmacy”, Nirali
Prakashan, 22nd Edition- July2019, Page No.-1.1 -1.21.

Ms. Revati Deore 11