Hospital and its organization

Hospital Pharmacy
2nd chapter
 Definition--hospital
• “The hospital is a complex organization
utilizing combination of intricate, specialize
scientific equipments and functioning through
a corps of trained people educated to the
problems of modern medical sciences. these
are all welded together in the common
purpose of restoration and maintenance of
good health.”
 Definition-contd

• “Hospital is an institution of community

health, where the functions of medical care,
prevention, diagnosis & therapy, rehabilitation
and education services (medical advices such
as AIDS, family planning) are carried out for
the purpose that people can regain health,
remain healthy and improve the quality of
life.” i.e. to attain and maintain health.
 Definitions-contd

• “when two or more individuals struggle for

common goals and objectives, it form an
organization. Organization is a formal relation,
co-ordination and co-operation between
various activities” OR
• “Organization is an institute through which we
reach the goals” i.e. Organization is not a goal
in itself, but it a source to reach the goal.
 PODSCoRB

• Core patterns of administration/Factors of

organization/ 7 functions of manager
that stand for: Planning, Organizing, Directing,
Staffing, Co-ordinating, Reporting and Budgeting
• Planning, that is working out in broad outline the
things that need to be done and the methods for
doing them to accomplish the purpose set for the
enterprise/project/activity;
• Organizing, that is the establishment of the formal
structure of authority through which work
subdivisions are arranged, defined, and coordinated
for the defined objective;
• Staffing, that is the whole personnel function of
bringing in and training the staff and
maintaining favorable conditions of work;
• Directing, that is the continuous task of making
decisions and embodying them in specific and
general orders and instructions and serving as
the leader of the enterprise;
• Coordinating, that is the all important duty of
interrelating the various parts of the work; OR
that means is a common thread that run
through all the activities of the organization.
• Reporting, that is keeping those to whom the
executive is responsible informed as to what is
going on, which thus includes keeping himself
and his subordinates informed through
records, research, and inspection;
• Budgeting, with all that goes with budgeting in
the form of planning, accounting and control.
 Definitions-contd

• Administration- it refers to the performance

or management of affairs.
• Administration is a functioning body (who
takes work from others) who gets things done
by other, by directing and supervising their
work.
 Definitions-contd

• Corporation may consist of large number of

people from a widely scattered area for achieving
a common objective. The representative group
among which is elected called “board of trustee”
, board of governors, board of managers, board
of directors or governing board.
• Single ownership (one individual)—partnership
(2-50 individuals)– corporation (more than 50
individuals)
 Classification of hospitals
• Based on system of medicine adopted for
treatment
-Allopathic H. -Homeopathic
-physiotherapy centers
• Based on clinical orientation
(a) on the basis of anatomical/physiological
specialization
-ENT -kidney -eye -dental
-orthopedic -heart and chest etc
(b) on the basis of pathological conditions
-TB -leprosy -cancer -diabetes
-psychiatry-infectious & communicable disease
© on the basis of type or group of people
-maternity hospital - pediatrics hospital
• Based on non-clinical orientation (ownership and
control basis)
(a) Govt: controlled
- Central Govt: /state/city Govt: hospital
- Military (army, Navy) hospital
(b) Non-Govt:
- private for profit
-non-profit e.g. community, church or trust
controlled hospitals
• Based on bed numbers
-large hospitals (having > 1000beds)
- medium hospitals(500-1000 beds)
- small hospitals (100-500 beds)
- very small hospitals (<100 beds)
• Based on cost
-costly hospitals
- low budget hospitals
- free hospitals
• Others based on length of stay, accreditation and teaching
hospitals
 definitions
• Teaching hospital- “a hospital that allocate a
substantial part of its resources to conduct, in
its own name or in formal association with a
college or courses of instruction in the health
discipline that lead to the granting of a
recognized certificate, diploma or degree, or
that are required for professional certification
or licensure, is a teaching hospital.”
• Rehabilitation- a treatment (or treatment
designed) to facilitate the process of recovery
from disease to as normal condition as possible
 Definitions-contd

• Allopathy- a system of medical practice that

aims to combat disease by the use of remedies
producing effect different from (or incompatible
with) those produce by the disease being
treated.
• Homeopathy- a system of medical practice that
aims to treat a disease by the administration of
minute doses of remedy that would in healthy
person produce symptoms similar to those of
the disease.
 Organizational pattern

• Organogram for a teaching hospital

(p.16, H.Pharm by Nadeem I.B.)
• Organogram for a private hospital (p.17,…..)
• Departmrntal organization in a Military
Hospital (p.17,…………………………)
 Administration
• The active management of hospital is delegated
by “B. of trustee” to an administrator and his staff
of associates, assistants, supervisors and
departmental heads.
• Responsibilities of administrator
-entire operations of the institution
-assuring institutional staff and patients of
highest possible standards of services
-promoting economy by planning, directing and
coordinating of the activities
• Functions of administrator
-enforce trustee policies
-establish organizational structure to carry out
programs of the hospital and to meet the
patients need
-implement the governing body’s policy on the
financial management of the hospital
-develop and implement a comprehensive
management reporting system through the
hospital
- provide, maintain and safeguard appropriate
physical resources in the institution
- look at the weakness influencing any aspect
of the institution
- link between institutional staff and B.O.T
- play role in community public relations
 Clinical departments
• The extent of departmentalization of clinical services
in a hospital depend upon the degree of
specialization of the medical staff
• In small hospitals, only two departments provide all
clinical services.
- other significant services either offered on a limited
basis or sought externally from outside facility
-supportive services such as radiology and pathology
are usually acquired externally
• In large hospitals, staff is highly specialized
and a greater subdivision within clinical
department exist.
-clinical departments is broadly divided into
medicine and surgery
• Generally, the medicine department include
the following subdivisions:
- cardiology -dermatology -geriatrics
-pediatrics - neurology -pulmonary Dis
-infectious dis - endocrinology -immunology
-Nephrology - psychiatry -rheumatology
-allergy/internal medicine
-gastroenterology
• Surgery departments
-General surgery-neurologic surgery
- ophthalmology-orthopedic surgery
- dental & oral s.-obstetric & gynecology
-otolaryngology -thoracic s.
-proctology -plastic s.
-urology
 Nursing
• Nursing and other supportive departments –
on separate doc
 Nursing--cont
• Nursing process– it is a goal oriented method of caring
that provide a frame work to nursing care. It involve 6
major steps:
- assessment (what data is collected)
-diagnose (what is the problem)
-outcomes identification
- plan (how to manage the problem)
-implementation (putting plan into action)
-Rationale (scientific reasons of the implementation)
(assessment, diagnosis, planning, implementation and
evaluation are commonly in practice)
 Role of pharmacy in hospital
• The hospital play a role like a “city within a city”
which operate
• The pharmacy as one of the subdivision of the
hospital play great influence w.r.t. Professional
position and total operational cost, becasue of its
interrelation with and the interdependency of
other services upon it
• In a hospital setting, the physician diagnose and
prescribe, the pharmacist dispense medication
and the nurse administer the drug to the patient
(unless the patient is on self medication regimen)
• The pharmacist is aware of physician-patient-
pharmacist triad and the forces operating around
him, so pharmacist must have to understand them
and assist in marshalling them toward the
ultimate goal of better patient care
 Hospital finances
• The hospital pharmacist may lack a thorough
knowledge of the ways and means by which
the operation of a hospital is financed
• This situation may be due to lack of interest of
pharmacist or his belief that this matter does
not concerned him or his department
• BUT, in fact , the finances of the hospital affect
every patient, employee, staff member,
trustee and the community at large
• The sources from which income may be
derived to meet the operating expenses is the
billing of patient for services rendered
• The patient may pay the bill in full by himself
or he may have third party coverage/ “third
party payor” which may pay the bill in full or
pay a specified portion
• The hospital finance department is supervised
by a well trained and qualified individual and
staffed by financial personnel and accountants
• This department is responsible for financing
of all operations of a hospital and delivery of
salaries to the institutional employees