HOSPITALS

Word hospital originated from latin word ‘hospitium’ which means the place
where the guests are received.

Ms. Priya Shaju

Lecturer
NCRD’s Institute of Pharmacy, Navi Mumbai
 Definition
❖ The hospital is a complex organisation containing specialised laboratories,
scientific equipments and team of professional people educated to the
problems concerning with health and hygiene. All these are united together
with a common goal of patient care. i.e. to restore and maintain good health
of public.
❖ Hospital can also be defined as an institution of community health where
diagnosis, therapy, organization, training and social services are provided.
 HISTORY
❖ Early hospitals by King Ashoka (273-232 B.C.) - Ayurvedic system of medicine (based
on teachings of Charaka and Sushrutha)
❖ From 10th century onwards - Unani system by Mughals
❖ From 17th century onwards - Allopathy by British European missionaries
❖ East India Company established first hospital in 1664 for their soldiers in Goa.
❖ Another hospital in 1684 for civilians in Madras.
❖ Next hospitals established in Bombay (1678), Calcutta (1707-1708) and Delhi (1874)
 FUNCTIONS
1. Patient care: Hospital raises quality of care and general standards of medical practices. It
acts as a centre of community health and contributes a great deal to preventive and social
medicine. It lowers incidence of diseases through early detection and treatment.
2. Public health: It provides facilities and advice to support all the activities carried out by
various public and voluntary agencies such as immunisation programme, blood donation
camps, health education, etc.
3. Educational training: It acts as a training centre for health professionals like doctors, nurses,
medical technologists, etc.
4. Medical research: Research is an important activity in the hospital that helps in developing
new methods of treatment and improving hospital services.
 Functions
5. Patient counseling: It is a modern concept adopted in big hospitals for the well-being of
the patients. During the counseling sessions, the pharmacist educates people on
communicable diseases, epidemics, family welfare, etc.

6. Coordination: It acts as a link between general public and policy makers.

 CLASSIFICATION
I) Clinical hospitals

a) On the basis of medicine(system) used

● Allopathic hospitals
● Ayurvedic hospitals
● Homeopathic hospitals
● Unani hospitals
● Physiotherapy centres
● Nature cure centres

b) On the basis of anatomy and physiology

● ENT hospitals
● Cardiac hospitals
● Eye hospitals
● Orthopaedic hospitals
c) On the basis of client group

● Paediatric hospitals
● Accident (trauma centres)
● Psychiatric hospitals
● Maternity hospitals

d) On the basis of disease

● TB hospitals
● Cancer hospitals
● AIDS hospitals
● Leprosy hospitals
 II) Non-clinical hospitals (ownership)
a) Government hospitals (public ownership run by government)
1. Central govt hospitals e.g. AIIMS hospitals, Central Railway hospital, military hospital
2. State government hospitals e.g. JJ hospital (Mumbai), Sassoon Hospital (Pune)
3. Municipal Corporation e.g. NMMC hospital, BMC hospital, KEM hospital

b) Non-government hospitals (private ownership)

1. Profit-oriented
● Owned by public limited company e.g Apollo hospitals, Wockhardt hospital
● Private hospitals e.g. Ambani hospital
2. Non-profit-oriented
● Private trust hospital e.g. Jaslok Hospital, Bombay hospital
● Run by religious bodies e.g. hindu mission hospital (Chennai), Christian medical college hospital
(Vellore)
III) On the basis of cost

a) Elite hospitals: Meant for privileged people. The patients will get value-added services with the
treatment. The deluxe rooms have refrigerator, TV, telephone and these hospitals are called
five-star hospitals. Room charges and treatments costs are high but these hospitals reserve a
particular percentage of their capacity for the poor. e.g. Lilavati hospital, Jaslok hospital
a) Low-budget hospitals: These are meant for moderate to low budget people. e.g. civil hospitals,
corporation hospitals.
b) Free or conventional cost hospitals

IV) On the basis of bed strength (bed size)

a) Large hospitals: Bed size more than 1000. e.g. J.J. hospital (1400 beds)
b) Medium hospitals: Bed size between 500 - 1000. e.g. Bombay hospital (700 beds)
c) Small hospitals: Bed size between 100 - 500. e.g. Hinduja hospital (175 beds)
d) Very small hospitals: Bed size less than 100. e.g. small private hospitals
V) On the basis of length of stay

a) Short term or acute hospitals: Average length of stay is is less than a month
b) Long term or chronic hospitals: Average length of stay is more than a month

VI) On the basis of accreditation

a) Accredited hospitals
b) Non-accredited hospitals

VII) Miscellaneous hospitals

Teaching hospitals - Hospitals attached to medical college. e .g. D.Y. Patil Hospital
 ORGANISATION OF HOSPITALS
The organisation and management of hospital differ with type of hospital and mainly
depends on ownership and control of hospital

Organization chart
 GOVERNING BODY/BOARD OF DIRECTORS
Functions:

❖ Selection of competent personnel including medical staff

❖ Control of hospital funds
❖ Overall supervision of staff
❖ The governing body after consultation with chief administrative officer must establish
● Working hours
● Salary schedule
● Schedule of room rent and other charges of the hospital for inpatients and outpatients.
● Methods of investing funds from which interest is to be paid for operations and other expenses of
hospital
● Methods of obtaining grants which will supplement income from paying patients and helps to balance
the hospital budget
● The need for additional or replacement construction of the hospital
● Appoints certain committees such as finance committee, public relations committee, legal advisory
committee, etc.
 ADMINISTRATOR
The dean or chief administrative officer or chairman is the administrator of the hospital. He is a person selected
by the governing body to run the hospital. He should be specialised in administration, an educator and a
community advisor.

Functions/Duties:

1. An administrator acts a link between board of directors and hospital staff.

2. He is responsible for implementing policies laid down by the governing body.
3. He coordinates the work of various heads of departments. He is often the secretary of governing body and needs
to report all the essential facts concerning with operations of hospital.
4. He is responsible for planning the expansion and modernization of hospital. He also ensures compliance of legal
formalities.
5. He also looks after the training of interns, nurses and other health workers.
6. He also ensures smooth running of outpatient department (OPD).
7. He should provide all required facilities, equipments and assistance so that the patients will be satisfied with the
treatment and services.
8. He should provide the employees good and supportive working environment.
9. He prepares the budget for approval by governing body.
10. The administrator attends the meetings of governing body and frames overall administrative policies.
 MEDICAL STAFF
DUTIES AND FUNCTIONS

● The medical staff is responsible for quality of medical care provided to

patients and for ethical conduct and professional services.
● Audit their own professional work.
● To participate in educational programmes of hospital.
● To advise and assist the administrator and governing body regarding medical
policies.
 GROUPS (TYPES) OF MEDICAL STAFF
❖ Honorary medical staff: It is composed of physicians who have been active in the
hospital but are retired from whom it is desired to do honour because of their
outstanding experience.
❖ Consulting medical staff: It consists of specialists from various fields who are specialty
board members or belong to national organisation.
❖ Active or attending medical staff: This group is most actively involved in the hospital
concerned with patient care.
❖ Associate medical staff: Group of junior or less experienced members.
❖ Courtesy medical staff: Group of physicians who desire privilege of attending private
patients but refuse the active staff membership.
❖ Resident medical staff: Group of physicians who are employees of hospital residing in
the campus.
 CLINICAL SERVICES
● Related to patient care
● Can be diagnostic, preventive, therapeutic or rehabilitation

❖ General medical services: It includes general diagnosis, therapy, general

medical care, psychiatry, neurology, dermatology, etc.
❖ Surgical services: Professionally trained and experienced surgeons have full
responsibility of these services. Qualified physicians act as first assistants
while nurses and other helpers serve as second and third assistants.
 SUPPORTIVE SERVICES
Anaesthesia department: Usually administered by anesthesiologist. He/She is responsible for the
quality of anesthesia and availability of equipments required for the administration for the anesthetic
drug.

Central sterile services department (CSSD): Operations require careful planning and equipping. CSSD
is responsible for processing, sterilising and dispensing all surgical equipments, and supplies such as
needles, syringes, surgical dressings, etc.

Pathology department: The practice of medicine depends on lab examination to facilitate correct
diagnosis and treatment. Blood, urine, sputum, semen, etc. are analysed for the presence of
microorganisms and abnormal constituents.The lab works under a qualified pathologist who is assisted
by medical technologists.

Radiology department: This dept. is useful for diagnostic and therapeutic purpose. The dept. Works
under qualified radiologist who is assisted by technologists. These services are performed only on the
receipt of written order of medical staff.
Blood bank: This is operational on most of the big hospitals. This service is generally under the
supervision of a person with MD in Pathology, Hematology or Transfusion medicine. The main
functions of this dept. Include collecting blood, processing, testing, storing as whole human blood
or components and provide whenever needed.

Dietary services: This occupies an important place in the hospital. These services are headed by
dietician who is well versed with principles of nutritional science.

Functions of dietician:

● Menu planning for general patients and special diet depending upon the requirement.
● Selection and purchase of food.
● Maintain relationship with food vendors.
● Supervision of preparation and storage of food.
● Maintain cleanliness and safety in the dept.
Nursing department: The primary aim of this dept. is to give nursing care. The dept. is headed by
HOD or superintendent of nursing.

Duties/Role:

1. Nursing dept. gives general assistance to outpatients in outpatient area and wards.
2. It gives assistance to labour wards and operation theatres.
3. It coordinates with other departments of the hospital.
4. It maintains nursing records and records of quality of service given to patients.
5. It arranges training programs for nursing staff.
6. This department encompasses health promotion, patient care, prevention of diseases,
rehabilitation, teaching, counseling and emotional support.
7. The department respects, individuality, dignity and rights of every person regardless of race,
colour, and social and economic status.
Pharmacy department: The hospital pharmacist fills in thousands of prescriptions and dispenses
the same which are coming from wards. It maintains the inventory of drugs.

Functions of hospital pharmacy deals with procurement of drugs and ends with distribution of
drugs. It performs other functions of preparation of IV fluids, sterilisation and quality control. He is
a member of Pharmacy and Therapeutics Committee which adopts a suitable hospital formulary.

Medical Record Services: Every hospital is required by law to maintain adequate medical records
of their patients. This dept. is useful for patients as well as hospital.

Purpose of medical records:

● To serve as basis for planning and for continuous patient care.

● Means of communication between physicians and other professionals contributing to patient care.
● Providing data which is used in research and education.
● Serves as documentary evidence for the course of patient illness and subsequent treatment in the
hospital.
● Medical record serves as a valuable reference material clinically and legally.
 Principles of medical record:

❖ They must be accurate.

❖ Properly filed and stored.
❖ Easily accessible.

Contents: Complete medical record includes:

❖ Brief sheet for identification and sociological data.

❖ Medical history form which includes history of family and patient and present illness of patient.
❖ Physical examination data: Initial findings are recorded and abnormal findings are highlighted.
❖ Special examination data: This includes X-ray reports, lab reports, tissue examination reports.
❖ Provisional diagnosis.
❖ Medical or surgical treatment.
❖ Progress report.
❖ Final diagnosis.
❖ Discharge card of autopsy findings or death report.
Importance of medical records:

❏ Facilitate good care.

❏ Allows subsequent caregiver to understand patient’s condition and basis for current
investigation and treatment.
❏ Provides a method of communicating with other team members.
❏ Satisfy legal and ethical obligations.
❏ Act as evidence; if your care is later questioned it shows events as they happened.
 ADMINISTRATIVE SERVICES
Financial services: Hospitals have huge capital costs at the time of setting up of hospital. This capital cost
is utilized for construction, infrastructure, and purchase of medical equipments. The capital cost is
generated by donations, govt. allocations or by loans from banks. Operational cost is managed by the
charges received from patients against hospital bills. Teaching hospitals earn through research projects.
Hospital can have some form of investment which can act as a source of income.

Housekeeping department: Good housekeeping is an invaluable part of any hospital. The head of the
dept. should be well versed with principles of home science and physical science. He should handle
many unskilled persons who are continuously trained.

Some of the important aspects of housekeeping are:

● Cleaning and dusting.

● Mopping
● Removal of waste
● Window or wall washing
● General sanitisation
● Bed making for vacated rooms for occupancy by other patients
 HEALTH DELIVERY SYSTEMS

At central govt. level, there is Union Ministry of Health and Family Welfare.

At state govt. level, there is Ministry of Health.

The central govt. formulates overall health policies and plans new health
schemes. It also offers financial assistance to the state govts.
 Organisation of health at central level
Union Ministry of Health and Family Welfare

Ministry of State for Health Ministry of Health and Family Welfare

Secretary Secretary

Joint Secretary Commissioner

Deputy Secretary 2 deputy commissioners

2 Director Generals of Health Services (DGHS) Joint Secretary

Deputy Directors of Health Services (DHS) Deputy Secretary

DHS for medical care DHS for DHS for general administration Regional directors

and hospital public health

 Organisation of health at state level
Ministry of State for Health

Deputy Minister

Secretary

Deputy Secretary

Director of Health Services

Deputy Director of Health Services

Public health School health Medical health Health education Nursing Family welfare Nutrition
 Chief Medical Officer
❖ Responsible for health administration and community health.
❖ Responsible for all govt. hospitals, taluka hospitals, jail hospitals in the district.
❖ Sometimes separate officer district officer is appointed by state govt for public
health centre, city hospital by corporation and town hospital
❖ Primary health centre provides health care needs of rural areas.
 PRIMARY HEALTH CENTRES
These centres provide health care needs of rural areas. They are not self-sufficient
but depend on facilities provided by civil or taluka hospitals. Different family welfare
centres doing family welfare services are also linked to primary health centres.

The staff includes:

❏ 1 medical officer
❏ 1 block extension educator
❏ 1 pharmacist
❏ 3 family welfare field workers
❏ 1 accountant cum clerk
❏ 4 auxiliary nurses or midwives
❏ 1 health visitor
❏ 7 female assistants