ACHARYA BANGALORE B-SCHOOL

MBA DEPARTMENT
HEALTH CARE MANAGEMENT
4.5.3: MANAGEMENT OF HOSPITAL SERVICES
FACULTY: Dr. Shalini H S
Module 1: Contents: Structure of Services: Uniqueness of Hospital Services-Differences
with Non-Hospital Forms of Healthcare, Services-Classification of Hospital Services based
on Ownership, Extent of specialization and Nature – Hospitals in India today, hospital as a
system.

Hospital: Meaning and Definition: A hospital is a healthcare facility that provides

specialized medical and nursing care as well as medical supplies to patients. The most well-
known form of the hospital is the general hospital, which usually carries an emergency
department to handle urgent health issues such as fire and accident victims, as well as
medical emergencies.

According to the hospital definition, a district hospital is usually the region's primary
healthcare facility, with a large number of intensive-care beds and extra beds for patients who
need long-term care. Trauma centers, children's hospitals, rehabilitation hospitals, hospitals,
and seniors' (geriatric) hospitals for coping with medical conditions such as psychiatric care
are also examples of specialized hospitals and several other disease categories. When
opposed to general hospitals, specialized hospitals can help save money on health care. Based
on the source of revenue, hospitals are categorized as general, specialized, or government.

A teaching hospital integrates patient care with medical students as well as nurse education. A
clinic is a care facility that is smaller than that of a hospital. A hospital's departments (such as
surgery and urgent care) and specialty units (such as cardiology) are diverse. Outpatient
departments and chronic care centers are available at certain hospitals. Pathology, pharmacy,
and radiology are examples of common support units.

Different Departments in Hospital (Various Departments in Hospital)

Below given are the details of different departments in the hospital: -

Outpatient department (OPD), Surgical department, Inpatient service (IP), Nursing

department, Physical medicine, Paramedical department, and Rehabilitation department,
Dietary department, Pharmacy department, Operation theater complex (OT), Radiology
department (X-ray), and Non-professional services are some of the departments located in
hospitals.

A nursing department, led by a director of nursing or a chief nursing officer, might exist in a
hospital. Such a department has the responsibility of overseeing the hospital's clinical nursing
practice, research, and regulation.

Numerous units also have nursing as well as a medical director who also acts as a supervisor
for their subject areas. A medical director, for instance, oversees doctors and medical
treatment in an intensive care nursery, whereas the nursing manager oversees both nurses and
nursing healthcare.

Health records, technical support, disclosure of information, facilities management, clinical

engineering, dining services, and plant operations, are examples of support units.

Hospital Services:

Hospital Services refers to the clinical services provided by the Hospital, as well as the
operational activities that support those clinical services, which are funded in whole or in part
by the LHIN, and includes the type, volume, frequency, and availability of Hospital Services;
HSAA Indicator Technical Specifications refers to the document titled "HSAA Indicator
Technical Specifications," as amended or replaced from time to time.

Hospital services are the foundation of a hospital's services. They are frequently influenced
by the demands or wishes of the hospital's key users, with the goal of making the hospital a
one-stop or core institution of the local community or medical network. Hospitals are
facilities with basic services and personnel—usually medicine and surgical departments—that
provide clinical and other services for specific diseases and ailments, as well as emergency
care. Hospital services include everything from basic health care to training and research for
major medical school centres, as well as services created by a network of industry-owned
institutions such as health maintenance organizations

Below mentioned are some of the hospital services: -

 Emergency room services

 Short-term hospitalization
 X-ray/radiology services
  General and specialty surgical services
 Blood services
 Laboratory services

Health maintenance organization hospitals supplement the basic list with a variety of
specialized and auxiliary services, such as:

 Pediatric specialty care

 Prescription services
 Good access to surgical specialists
 Rehabilitation services and physical therapy
 Home nursing services
 Mental health care
 Nutritional counseling
 Genetic testing and counseling
 Family support services
 Financial services
 Case management or social work services

Uniqueness of Hospital Services: A hospital can achieve uniqueness in the following key
success factors:

• Personalized and specialized Care for patients

• Ultra-modern technologies

• Quality Healthcare Services

Other factors include:

1. Providing Effective and Timely Communication to Patients:

In a typical clinical setting, especially in cases where there is a geriatric patient involved,
there are various clinicians attending the patient. Examples of such clinicians include
cardiologists, pulmonologists, endocrinologists, gastroenterologists, etc.

This leaves the patient a little confused in terms of what is actually their main issue and what
ancillary issues are cropping up. So the net effect is that the patient does not get a holistic
picture of their health status.
Besides the patients’ family members would be even more anxious to know what are the
procedures being done, the report status, etc. So it is crucial to provide the patients and their
nominated family members effective and timely communication.

Aspects that need to be communicated include whether the diagnosis has been confirmed. Or
if the diagnosis is not confirmed then what is additionally being done to ascertain the root
cause of the illness being experienced. Or the line of treatment being provided, the period for
recuperation, what the patient is likely to feel like. Or information on the medicines being
given along with their side effects, if any, etc ought to be explained to the patients.

2. Sharing Steps they Can Take to Expedite the Discharge Process

Typically, the patient is asked to wait till the doctor visits the next day for their daily rounds
to get an understanding of their progress. Consider a scenario where the patient knows that if
he or she can do “x” number of things to get better faster. Also, this information is readily
available in an easy-to-access format.

That is exactly what is happening at Stanford today. “In the room, we have a flight path,
which includes the items that need to be accomplished in order for you to get discharged,”
Seyfried from Stanford Health Care explained. “It gives you daily and weekly goals so that
you can try to achieve those and get discharged more quickly.”

3. Enable Nurses to Focus on Clinical Care

According to a study conducted in the UK, during an average 8.5-hour shift, nurses spent
approximately 3.1 hours per 8-hour shift with patients. Even in the Indian scenario, nurses
spend a lot of time on activities other than patient care. In almost all healthcare settings,
nurses undertake roles that are not of their forte. Hence, they are left with minimal time to
carry out their actual roles and responsibilities.

They are spending more time than necessary doing non-nursing-related work, such as
coordinating for:

 Billing
 Record keeping
 Inventory management
 Laundry
 Diet
  Physiotherapy
 Insurance
 Housekeeping
 Electrical work

This reduces the time available for patient care. If at any instance, there is any fault in these
roles, the nurses have to bear the brunt of that.

The other reason for nurses not getting sufficient time for clinical care is the lack of sufficient
staff for administrative activities in the wards. So it becomes even more important to help the
nurses declutter and assign only important clinical work to them.

4. Allowing Patients the Ability to Self Care

Many times the nurse is the patient’s key contact point for any concerns. These include things
like an electrical fault in the room, food not reaching the patient on time, a glass of water, or a
bedpan. Patients also contact nurses for information on when they would be taken for
radiology and other tests etc.

To save time lost in coordinating these issues, it might make sense to empower the patients.
Hospitals should consider allowing themselves to directly make their tasks known on a
centralized hospital maintenance software for any such ancillary services.

In addition to empowering the patient, hospitals need a system to provide real-time updates to
the patient on what has happened to their hospital service management requests. Also, they
need to know within how much time they can expect the service. So, the nurses, in effect get
more time for clinical care, procedure explanation, updates on patient’s health status,
education, counseling, etc.

A case in point is that at both MUSC and Stanford Hospital, patients can control most of the
digital technologies in the room. Using a tablet, both hospitals are able to integrate multiple
operations, including the room lights, television, HVAC, the patient portal, and the education
platform displayed on the TV.

Patients and providers can bounce between different platforms and screens. The system
allows the provider to seamlessly pull up the EHR for both them and the patient to view. The
system even supports improving subtle aspects of patient experience such as letting a child
keep watching his program on the tablet while his clinician discusses charts with his parents.
5. Feedback/Grievance Redressal Mechanism

Patients need to have a mechanism to have their grievances voiced in a timely and efficient
manner. Many times, the feedback collection mechanism in corporate hospitals includes
having a Patient Relationship Officer making daily rounds to check on how the patient is
doing.

Alternatively, they provide feedback forms to patients. Though these are good first steps, they
might not be fully sufficient by themselves as superlative measures.

For example, it is common that patients did not like the food that was served to them for
lunch, and it is made known only by the next day. In such cases, the staff has already missed
the opportunity of getting the issue fixed immediately.

Hospitals should provide patients with a system where patients are allowed to provide
feedback by themselves. Also, there should be a notification system to send alerts to the
concerned department/ personnel to enable quick intervention measures. This can lead to
faster issue resolution and improved patient satisfaction.

Function of Hospital:

Below mentioned are some of the functions of hospital/hospital use: -

Medical hospital - medical hospital includes the treatment and management of patients by a
team of doctors.

Patient Support provides nursing, nutritional diagnostic, counseling, pharmacy, and medical
supplies, all of which are directly related to patient care.

Administrative responsibilities include carrying out the hospital's guidelines and directives
regulating the release of support services in the areas of finance, staff, housekeeping,
materials and property, laundry, protection, transportation, engineering, and board as well as
several other maintenances.

The hospital's financial activities must be planned, guided, and coordinated for

Patients in a hospital as well as the employees working there.

Prepare a job and financial plan for services and initiatives, as well as funding projections.

To keep track of cash receipts and disbursements.

To manage personnel development plans, procedures, and standards; to provide guidance on
policy, implementation, and administration of laws, rules, and regulations.

The quality, efficacy, and outcomes of health services for various groups and populations are
shaped by the structure and dynamics of healthcare organizations; the policy repercussions
for future health care reform initiatives and patients in the hospital.

Hospital operation is another major benefit of hospitals.

Non-Hospital Forms of Healthcare: 14 Types of healthcare facilities commonly found in

the U.S.

1. Ambulatory surgical centers

Ambulatory surgical centers, also called outpatient surgical facilities, allow patients to
receive certain surgical procedures outside a hospital environment. These environments often
offer surgeries at a lower cost than hospitals while also reducing the risk of exposure to
infection—since patients are there for surgery, not to recover from sickness and disease.

Ambulatory surgical centers don’t provide diagnostic services or clinic hours. Instead, they
take patients who have been referred for surgery by a hospital or physician—they’re designed
to be “all business” when it comes to surgical care.

2. Birth centers

A birth center is a healthcare facility for childbirth that focuses on the midwifery model,
according to the American Association of Birth Centers. They aim to create a birth
environment that feels more comfortable to the mother and allows for a cost-effective,
family-inclusive birth.

Birth centers are not typically equipped with the same contingency equipment and staff as a
hospital, such as surgeons in case of a C-section or a neonatal intensive care unit. As a result,
birth centers accommodate only healthy pregnancies without any known risk or complication
factors.

These facilities are guided by principles of prevention, sensitivity, safety, cost-effectiveness

and appropriate medical intervention when needed.

3. Blood banks
Blood banks allow donors to donate blood and platelets while also storing and sorting blood
into components that can be used most effectively by patients.

“Red blood cells carry oxygen, platelets help the blood clot and plasma has specific proteins
that allows proper regulation of coagulation and healing,” writes the American Society of
Hematology. Sometimes patients need these particular components specifically, and
sometimes they just need lots of blood. For example, a single car accident victim could
require as many as 100 pints of blood.

Blood is essential for human life, and it can’t be manufactured—only donated. So these
facilities work to build the supply for patients who need it.

4. Clinics and medical offices

The definition of a clinic is “a facility for diagnosis and treatment of outpatients.” There are
many healthcare facilities that fit that definition across a wide variety of treatment specialties.

Many people go to a clinic for routine doctor’s appointments and checkups. These healthcare
facilities can be a physician’s private practice, a group practice setting or a corporately owned
clinic that may be connected to a larger healthcare system or hospital.

Clinics cover a lot of ground in healthcare. For example, you could visit a dental clinic to
have a toothache investigated, a physical therapy clinic to recover from an athletic injury or a
pediatric speech therapy clinic to help your child overcome an articulation disorder.

If there is a specialized health area you need to see an expert for, then odds are that there’s a
clinic somewhere to accommodate you. The goal of these clinics is to give people
preventative care and important diagnoses with as much convenience as possible.

That goal has also led to “walk-in” clinics becoming situated in grocery and convenience
stores, malls and even airports. These clinics allow patients to get a flu shot or receive a
prescription without making an appointment at their physician’s office. While many medical
providers believe that a continued relationship with a provider is better for patients’ long-term
health, the speed, convenience and sometimes lower cost of a walk-in clinic can be ideal for a
quick need.

5. Diabetes education centers

Diabetes is a very serious illness in the United States. Over 30 million people have diabetes
and many of them don’t know it, reports the Centers for Disease Control (CDC).
Additionally, over a third of the national population is highly at risk for diabetes, in a
condition called prediabetes.

Patients with diabetes need to manage the disease and typically make lifestyle adjustments to
keep it from becoming life-threatening. Since diabetes is so widespread, diabetes education
centers rose up to help patients manage their disease and to help people at risk for diabetes to
avoid it, if possible.

Diabetes education centers typically offer classes, education, support groups and a variety of
resources to help patients manage their diabetes and live as complication-free as possible.

6. Dialysis Centers

Patients with kidney disease often need regular treatments of dialysis. Dialysis is a process
that filters and cleans the blood artificially—the work functioning kidneys normally take on.
About 14 percent of Americans have chronic kidney disease. When kidneys aren’t able to
filter the blood the way they are supposed to, patients might need dialysis as often as three
times a week to avoid serious complications. With such high demand, dialysis facilities rose
up to meet patient needs and avoid undue strain on hospitals.

7. Hospice homes

Hospice can be a particularly confusing title. It represents a package of insurance benefits

that deals with an end-of-life trajectory. It also represents a philosophy of care provision for
dying patients as well as official networks that offer hospice care. Hospice is also a
designation for specific healthcare facilities that specialize in end-of-life care.

Hospice care is a model that provides not only medical support, but also emotional and even
spiritual support for patients and their families. According to the National Hospice and
Palliative Care organization, a patient with hospice care has a team of care providers made up
of the patient's personal physician, a hospice physician, nurses, home health aides, social
workers, clergy or other counselors and physical or occupational therapists, if needed.

Though patients can receive hospice care at home, if their medical needs are significant, they
might live in a nursing home with hospice care, or a specified hospice home.

8. Hospitals
Hospitals are the ultimate “catch-all” healthcare facility. Their services can vary greatly
depending on their size and location, but a hospital’s goal is to save lives. Hospitals typically
have a wide range of units that can be loosely broken into intensive care and non-intensive
care units.

Intensive care units deal with emergencies and the most serious illnesses and injuries.
Patients with imminently life-threatening problems go here.

Non-intensive care units include things like childbirth, surgeries, rehabilitation, step-down
units for patients who have just been treated in intensive care and many others. Typically,
most hospital beds could be classified as non-intensive care.

9. Imaging and radiology centers

These facilities, much like their hospital counterparts, offer diagnostic imaging services to
patients. Diagnostic imaging includes CT scans, ultrasounds, X-rays, MRIs and more. While
hospitals and even clinics have imaging centers, outpatient facilities help keep costs lower
and allow more convenient scheduling for patients.

Hospital facilities will likely handle imaging for urgent cases, such as an MRI for a brain
injury. But any imaging that can be scheduled in advance, such as ultrasounds to monitor a
pregnancy, could take place at an imaging center.

10. Mental health and addiction treatment centers

This type of healthcare facility is a grouping for many different types of facilities. Specialty
treatment centers exist all across America for specified mental health issues and addictions.

Mental health treatment facilities sometimes exist as a general institution for any mental
health issue and are sometimes specialized. Examples of these kinds of facilities are suicidal
thoughts (or suicidal ideation) treatment, depression treatment, trauma and post-traumatic
stress disorder (PTSD) treatment, treatment for anxiety disorders, behavioral disorders and
more.

You can find inpatient or outpatient versions of many mental health facilities, designed to
assist patients through different stages of their healing processes. At the acute-care level, you
can find mental health wards in hospitals—as well as hospitals specifically devoted to mental
health and long-term care facilities.
Addiction treatment centers typically deal with drug and alcohol addictions, as well as
problematic behavioral addictions like gambling, work, shopping or the internet.

11. Nursing homes

Nursing homes offer a living situation for patients whose medical needs aren’t severe enough
for hospitalization, but are too serious to manage at home. Some nursing homes offer services
for heavier medical needs, such as speech and occupational therapy. Other nursing homes try
to create a homier atmosphere, and might operate like an apartment complex with medical
staff on hand.

According to the National Care Planning Council (NCPC), nursing homes enable patients
with injuries, acute illnesses or postoperative care needs to recover in an environment outside
the hospital. These facilities offer long-term medical care ranging from simple to complex
levels of need in an environment built for residents to live in long term instead of just staying
a few weeks or months.

Many people picture elderly patients in a nursing home. For the most part that’s true—over
80 percent of patients are over the age of 65. But there are also younger patients in nursing
homes who may have serious long-term illnesses and need care beyond what their families
can provide.

12. Orthopedic and other rehabilitation centers

Orthopedic medicine deals with muscles and bones. Physical therapists are typically the
practitioner patients see for problems in these areas of the body. If you are experiencing
chronic lower back pain, for example, you might see a physical therapist at an orthopedic
center or clinic to get a diagnosis and a plan of treatment.

Orthopedic centers deal in everything from athletic injuries to therapy for patients with
disabilities. They typically offer evaluation and diagnosis of the problem, as well as
prevention, treatment and rehabilitation work involving bone, tendon, ligament, muscle and
joint conditions.

These healthcare facilities have a variety of names depending on their specialization. They
might simple be called outpatient physical therapy centers. Or you could find pediatric
physical therapy clinics, sports medicine centers or geriatric physical therapy clinics.
There are also rehabilitation centers where patients can receive various therapies to help
restore their abilities after an illness or injury. Physical therapy, occupational therapy and
speech therapy are all processes that help people gain or regain skills they need to move
around, work or speak in daily life.

Practitioners at rehabilitation centers work with people to help them recover as much of their
mobility and independence as possible. Outpatient rehab centers can relieve the strain on
hospital rehabilitation floors.

13. Urgent care

Urgent care (UR) facilities exist for on-demand healthcare needs that aren’t severe enough for
the emergency room, but are too severe or concerning to wait for a scheduled appointment at
the doctor’s office. Urgent care is a common choice when children get sick, for example, and
need an immediate diagnosis or relief from symptoms.

Providers in the UR are experts in acute care. They can set broken bones and treat limb
fractures; diagnose a viral illness; run strep tests, blood tests and urine labs and provide
treatment for injuries. If a problem is too severe, then urgent care practitioners will call an
ambulance or refer patients to a hospital or specialist.

14. Telehealth

While telehealth isn’t really a type of healthcare facility, it is worth mentioning in its potential
for serious growth in the coming years. Telehealth, telemedicine and remote healthcare can
represent a digital type of healthcare facility.

Telehealth refers to the use of electronic communication technology to facilitate long-distance

health care and health education, according to the federal Health Resources and Services
Administration (HRSA). Many people lack easy access to physicians and specialty clinics.
Whether through their physical location, physical ability, living situation or transportation
choices, many patients have a hard time getting to a medical practitioner face to face.

Those patient limitations, the push to lower costs in healthcare, and new technological
capabilities have all come together to motivate telehealth applications. This might look like
live video conferencing between patient and physician. Or a patient with an illness might
wear a device to allow remote monitoring from their medical team.
For quick consultations, telehealth can be an ideal option even for patients with easy access to
their doctors. “When you log into a web-based service, the doctor or nurse practitioner can
prescribe medications, suggest home care strategies or recommend additional medical care,”
the Mayo Clinic writes.

Classification of Hospital Services based on Ownership:

Hospitals categorized based on this criteria are general hospitals that cure all types of
diseases. However, they are mainly focused on curing heart disease, cancer, ophthalmic,
maternity, etc. conditions. Hospitals are classified as follows based on their anatomical-
physiological specialization:

 ENT (Ear, Nose, and Throat) hospitals,

 Eye hospitals,
 Orthopedic hospitals, and
 Kidney hospitals.
 Hospitals are classified as follows based on the client group they serve:
 Pediatric hospitals for children,
 Gynecological hospitals for women, and
 Maternity hospitals for mothers.

Hospitals are classified as follows based on the system of medicine adopted for treatment:

 Allopathic hospitals,
 Ayurvedic hospitals,
 Homeopathic hospitals,
 Unani hospitals, and
 Hospitals of other systems of medicine.
 Classification Based on Non-Clinical Basis

Hospitals on a non-clinical basis are classified as follows:

Classification Based on Ownership/Control Basis: Hospitals categorized based on this

criterion are of the following types:

Public Hospitals: These hospitals are under the control of Central or State Governments or
local bodies on non -commercial lines. They can be general hospitals or specialized hospitals
or both.
Voluntary Hospitals: These hospitals are recognized and combined under the Societies
Registration Act 1860 or Public Trust Act 1882 or any other act of Central or State
Governments. They are supported by public or private funds on a non-commercial basis.

Private Nursing Homes: These are regulated by an individual doctor or a group of doctors
on a commercial basis. Patients suffering from infirmity, advanced age, illness, injury,
chronic disease, disability, etc. are admitted here. However, patients having communicable
diseases, alcoholism, drug addiction, or mental illness are not treated.

Corporate Hospitals: These hospitals are public limited companies running on commercial
lines and formed under the Companies Act. They can be general or specialized or both.

Classification Based on the Objectives: Hospitals based on these criteria can be subdivided
as follows:

Teaching-cum-Research Hospitals: These are the hospitals having a college for the
education of medical, nursing, dental, or pharmacy. Teaching is the major aim of these
hospitals and the provision of healthcare is secondary. AIIMS (New Delhi), PGIMER
(Chandigarh), JIPMER, (Pondicherry), KR Hospital (Mysore), Victoria Hospital (Bangalore),
etc. are some examples of teaching-cum-research hospitals.

General Hospitals: These hospitals help for curing common diseases. They have at least two
or more doctors, who can offer in-patient accommodation and provide medical and nursing
care for more than one category of medical disciplines, such as general medicine, general
surgery, obstetrics, gynecology, pediatrics, etc. Their primary aim is to provide medical
support to the people, and teaching and research are secondary. Examples of these hospitals
are all districts and Taluk or PHC or rural hospitals.

Specialized Hospitals: These hospitals provide medical and nursing care for one discipline
or a disease or a condition of one system. They concentrate on a particular aspect of the body
organ and give medical and nursing care in the particular field, e.g., tuberculosis, ENT,
ophthalmology, leprosy, orthopedics, pediatrics, cardiology, mental health/psychiatric,
oncology, STDs, maternal, etc.

Isolation Hospitals: These hospitals treat patients who are suffering from infections and
communicable diseases and need to be isolated. Epidemic diseases hospital (Bangalore) is an
example of an isolation hospital.
Classification Based on Size (Bed Strength): According to the Health Committee Report,
the following pattern of development of hospitals should be accepted on the basis of size:

Teaching Hospitals: These hospitals have 500 beds and can be increased depending on the
number of students.

District Hospitals: These hospitals have 200 beds and can be increased up to 300 depending
on the population.

Taluk Hospitals: These hospitals have 50 beds and can be increased depending on the
population.

Primary Health Centres: These hospitals have 6 beds and can be increased up to 10
depending on the needs.

Classification Based on Management: Hospitals based on this criterion can be subdivided

as follows:

Union Government/Government of India: These hospitals are controlled by the

Government of India. Hospitals run by the railways, military/defense, mining or public sector
activities of Central Government are examples of such hospitals.

State Governments: These hospitals are controlled by the state or union territory.
Government authorities and public sector activities running through the state or union
territories comprising the police, prison, irrigation department, etc. are the examples of such
hospitals.

Local Bodies: These hospitals are managed by the local bodies, such as municipal
corporation, municipality, Zila Parishad, Panchayat e.g., corporation maternity homes.

Autonomous Bodies: These hospitals are formed under a special act of parliament or state
legislation. They are financially supported by the Central/State Government/Union territory.
AIIMS (New Delhi), PGIMER (Chandigarh), NIMHANS (Bangalore), KMIO (Bangalore),
etc. are some examples of such hospitals.

Classification Based on Cost: Hospitals based on this criterion can be subdivided as

follows:

Elite Hospitals: These hospitals are a symbol of high-tech medical development. The per-
day room rates vary between 300-1200. The deluxe rooms have a fridge, television, and
telephone. Excluding the medical care, they are similar to five-star hotels, thus, are also
called five-star hospitals. These institutions reserve a particular percentage of their capacity
for poorer sections and also support a particular percentage of their accommodation cost. For
example, Jaslok has reserved 25% for the poorer sections and 30% at half the rates. In
Mumbai hospital, 315 beds out of 680 are free and 112 beds are funded.

Budget Hospitals: These hospitals are for moderate budget and low budget users, e.g., civil
hospitals, corporation hospitals, etc.

Hospital as a system-Refer PPTs

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