THE HOSPITAL

DEFINITION
 A hospital is a health care institution with an
organized medical and professional staff, and
with permanent facilities that include in-patient
beds.
 Provide medical, nursing and other health
related services to patients
 Hospital: Comes from the French word
“hospitale”. It is an institution in which the
sick or injured persons are treated.

 Steadman’s Medical Dictionary: It is an

institution for the care, cure and treatment of
the sick and wounded; for the study of diseases
and for the training of doctors and nurses
CONT,
 World Health Organization (WHO): It
is an integral part of a social and
medical organization, the function of
which is to provide for the population
complete health care, both curative and
preventive and whose output services
reach out to the family and its home
environment. The hospital is also a
center for the training of health workers
and for biosocial research.
FUNCTIONS OF THE
HOSPITAL
a) Preventive function
b) Curative function
c) Training function
d) Research function
PREVENTIVE FUNCTION
 It is an emerging secondary function for
the hospital and concerned with health
promotion.
 It is geared toward providing the
preventive services through a
community health centre.
 It takes an active role to improve the
health of the population.
CURATIVE FUNCTION
 It is the primary function of the hospital
and concerned with providing patient
care.
 It refers to any type of care given to the
patients by the health team members
e.g. physicians, nurses, dietitians….
 Also includes health education to
patients
TRAINING FUNCTION
 It is secondary function and concerned
with providing training and educational
courses for the professional and
technical personnel who provides health
services (e,g. physicians, nurses,
dentists, therapists….
RESEARCH FUNCTION
 It is a secondary function and concerned
with conducting the health related
researches that focus on the
improvement of the health and /or
prevention of diseases.
CLASSIFICATION OF
HOSPITALS
 Each hospital is distinct in its characteristics
as it differs in structure, functioning,
performance and the community it serves.
They are therefore classified according to:
1. Length of Stay of Patient
Short – term/acute care
Patient stays for a short term for treatment of
the disease, acute in nature e.g. pneumonia,
peptic ulcers
Long – term/chronic care
Treat diseases or conditions chronic in nature
e.g. TB, cancer
 2. Clinical Basis
They are licensed as general hospitals. Treat all
kinds of diseases but major focus on severe
medical conditions like heart diseases
3. Ownership
This category includes: Public, Voluntary,
Private, or Corporate – Public limited company ,
under companies act
4. Size
Classification is adopted according to bed
strength (capacity)
 5. Objectives
Teaching/Research
 It is a hospital to which a college is attached
for medical/nursing/dental/pharmacy
education. The main objective is to teach
based on research

General
 Provide treatment for common diseases and
conditions, provide active medical and nursing
care for more than one category of medical
discipline
Specialized Hospitals
 Provide medical/nursing care primarily for only
one discipline or specific diseases or
conditions of one system

Isolation Hospitals
 Admit patients suffering from infections or
communicable diseases requiring isolation
DEPARTMENTS OF
HOSPITALS

Hospital departments

Outpatient Inpatient
department(OPD) department (IPD)

MCH/FP/OUT DIAGNOSTI
PATIENT
CLINICS
C WARDS
CENTRES
HOSPITAL DEPARTMENTS
OUTPATIENT (OPD)/ CASUALTY
 It is the point of contact between hospital and
community. Its activities influence those of all
other departments
 Some space can be utilized for emergency
services (casualty)
 It is effective to have pharmacy, rehabilitation
center, injection room
 The number of clinics depends on the needs
of patients. It has the Ear, Nose and Throat
(ENT), Dental, Medical, Surgical, Obs/Gyn,
Pediatrics and Mental Health
MEDICAL UNIT
 In general hospitals, they are usually headed
by physicians and their associates whereas in
teaching hospitals by professors, assistant
professors, lecturers and clinical instructors
 They admit patients for treatment other than
surgery and certain exceptions.
 The services are further subdivided into
subspecialties e.g. cardiology, neurology,
nephrology, dermatology, thoracic
GYNECOLOGY UNIT
The following services are provided in this unit:
 Routine “well woman” exams. (Medical
examination of women’s reproductive organs,
looking out for abnormalities and possible
problems and ensuring overall wellness).

 Treatment of conditions or problems that

involve the female reproductive system.
SURGERY UNIT
 This has various subspecialties: orthopedics,
urology, ENT, neurosurgery, gynecology and
thoracic surgery
 Operation theatre has the following facilities:
receiving room, anesthesia room, lay up room,
wash room and scrubbing room
MATERNITY/ OBSTETRIC UNIT
Serves to provide care for the expectant mother
and her newborn. It has the following departments:
 Ante – natal – Provides systematic medical
supervision of women during pregnancy.
 Labor ward/delivery unit
 Post natal – Provides care for the mother who has
just delivered
PEDIATRIC UNIT
 The clients in this unit are aged between 1
day old and 15 years
 New Born Unit (NBU) is part of this unit. The
basic need of children are best met when they
are grouped and located in quiet area of the
hospital
 There is need for large play rooms and school
room
 There should be an isolation room and
facilities for mothers
DENTAL UNIT
 It is concerned with the dental welfare of the
clients. The services of hospital dental specialists
are needed for collaboration with the orthopedic
or general surgeon in treatment of fracture of
elbow
RADIOLOGY/ X –RAY
 It provides diagnostic services for inpatient,
outpatient and casualties.
PATHOLOGY/LABORATORY
 Primary function is assisting in diagnosis of
diseases and treatment. Specimen examined
include stool, urine, sputum, blood, cerebrospinal
fluid, tissues and bone marrow
PSYCHIATRY/MENTAL HEALTH
 It should have the following services:
outpatient, liaison services for contact with
mental hospitals, day and night treatment
services, inpatient units and psychiatry
communication services
PHARMACY
 The functions include stocking of drugs and
medical supplies, distribution of drugs to
departments
LAUNDRY
 Ensures availability of microbe – free washed
linen
DIETARY
 Preparation of nutritionally adequate meals

CENTRAL STERILE SUPPLY SERVICES

DEPARTMENT
 It stores, sterilizes, maintains and issues
instruments, materials and garments which
are required to be sterilized. Air condition in
this department is essential to avoid
contamination through air
NURSING DEPARTMENT
 Major force in health and in medical team
which is so essential for providing services to
the hospital
 Nursing personnel consist of professional
ORGANIZATIONAL
STRUCTURE
ORGANIZATIONAL STRUCTURE

►Creation of various levels of management

within any organization
►Breakdown of the organization into various
levels allows for more efficient management
of individual departments
 Manager of each level delegates authority
and responsibility in order to accomplish
departmental goals and to accomplish
overall organizational goals
►Visualization of the structure helps
employees understand the organizations
chain of command who is responsible for a
particular area
►Structure will vary from health facility to
another depending on many variables such
as:
►size
►type of hospital
►geographic location
►other variables

►Large hospitals tend to have very complex

structures
►Smaller hospitals tend to have much more
simple structures
►hospital grouping of departments are
normally set up according the
similarities in job goals which promotes
efficiency in accomplishing the overall
goals of the health facility.
MEDICAL ORGANIZATIONS

 Organizations large and small will have

some type of structure to help the
organization run more efficiently
 We will be looking at the largest of
healthcare organizations --- the hospital
COMMON CATEGORICAL GROUPING

►Administrative Services
►Informational Services
►Therapeutic Services
►Diagnostic Services
►Support Services
ADMINISTRATIVE SERVICES

►Hospital Administrators
 Chief Executive Officer (CEO)
 Ultimate responsibility for the operation
of the entire organization
 Responsible for ANY decisions made by
ANY persons associated with the
organization
 This person usually answers to the
“Board” made up of persons specializing
in certain business areas.
 Responsibilities:
 ►Business people who “run the hospital”
 ►Oversee budgeting and finances
 ►Establish hospital policies and
procedures
 ►Often perform public relation duties
INFORMATIONAL SERVICES

Responsibilities:
►Documentation and processing of all
information within the organization
Admissions
►Responsible for the collection of
demographic information, payor
information, assessing the type of
services the patient is there for and
seeing that the patient gets sent to the
proper area or facility for completion of
the patient’s care
INFORMATIONAL
SERVICES
Billing & Collection
►Once service has been rendered, billing
of the patient or their insurance
company must be done thus providing
funds to pay employees, obtain supplies
and equipment, and extend additional
services in the future
Medical Records
►Transcription, maintenance, and storage
of ALL patient medical records.
►Copying services for those patients
wanting a copy of medical records or
copies to be sent to another medical
provider.
Computer Information Systems
►Maintenance and repair of ALL
computerized informational and
diagnostic testing systems within the
organization
Health Education
 ►Patient education on treatment and
prevention Diabetes and other areas of
medical treatment, maintaining the
medical library, storage of statistical
information regarding disease conditions
and treatments
Human Resources
►Responsible for obtaining qualified
personnel to fill job positions in the
organization
►Handling of ALL employee benefits such
as insurance, retirement, and other
benefits
THERAPEUTIC SERVICES

Responsibilities:
 ►Providing treatment to patients
 ►Physical Therapy
 ►treatment to improve large muscle
mobility
 ►Occupational Therapy -treatment goal
is to help patient regain fine motor skills
 ►Speech/Language Pathology
 ► identify, evaluate, treat
speech/language disorders
 ►Providing treatment to patients
 ►Respiratory Therapy
 ►treat patients with heart & lung
disease
 ►Medical Psychology
 ►concerned with mental well-being of
patients
►Social Services
►connect patients with community
resources such as financial aid, Long-
Term Care, etc.)
►Pharmacy -Composition of and
dispensing of medications
Dietary
►maintain nutritionally sound diets for
patients
Sports Medicine
►provide rehabilitative services to
athletes
Nursing
 ►provide care for patients
DIAGNOSTIC SERVICES
Responsibilities
►Assistance in determining the cause(s)
of illness or injury
 Medical Laboratory -Study of body
tissues
 Medical Imaging
 Radiology, MRI, CT, Ultra Sound
 Emergency Medicine -provides
emergency diagnoses & treatment
SUPPORT SERVICES

Responsibilities
Provides support services for the entire
hospital
 Central Supply -orders, receives, stocks
& distributes equipment & supplies
►Biomedical Technology -design, build,
repair, medical equipment
►Environmental/Physical Maintenance -
maintain safe, clean environment
LEVELS OF HEALTH
FACILITIES
 Level 6: KNH,MTRH,MATHARI MENTAL
HOSP
 Level 5: county hospitals
 Level 4: formal district hospitals
 Level 3: health centres
 Level 2 :dispensaries
 Level 1: community
 COMMUNITY LEVEL 1
 Form TBAs, VHCs and CHWs
 Preventive interventions
 Recognize illness
 Timely referral
 Record keeping
 Nursing care
 Promotion of awareness
 Health messages on important health
matters
DISPENSARY LEVEL 2

 These facilities are run by nurses.

 The dispensaries does not have in-patient
facilities.
 These are some of the services offered at this
level

 Health education
 Preventive interventions
 Basic curative care(out patient and laboratory)
 Supervise VHCs, CHWs, TBAs and Traditional
healers
 Record keeping
 Referral to other facilities.
HEALTH CENTRES LEVEL 3
 These are small hospitals with minimal
facilities, they are run by clinical officers
and nurses.
 Health education
 Preventive interventions
 Inter-sectoral collaboration
 Early diagnosis and treatment/prompt
referral
 Supervise VHCs, TBAs and CHWs
 Record keeping

DISTRICT LEVEL 4
 These are hospitals that offer holistic
services and are ran by director who is a
medic and at the best doctor by profession
 Develop control strategies
 Develop and implement District specific
cost effective packages
 Mobilise resources
 Inter- sectoral collaboration
 Surveillance
 Specialized treatment
 Referral to other facilities
PROVINCIAL LEVEL 5
 These are county referral hospitals
formerly the provincial hospitals.They
are run by chief executive officer who
are medic by profession and have over
100 beds capacity.
 Supervision and monitoring
 Integrated surveillance
 Operational research
 Mobile resources
 Referral to other facilities
 Training
NATIONAL LEVEL 6
There range of function is as of level 5, but
they also offer specialised treatments and its
not only accessible by Kenyans but also
serve East and Central Africa.
The national government manages these
hospitals

 Develop cost effective packages

 Mobilise resources
 Conduct and disseminate research findings
 Facilitate consultation with stakeholders
 Technical support
THEATRE LAYOUT
Definition
Its an operating room within hospital
which surgical operations are carried
out.
The patient is the centre point of
functioning in theatre complex,efforts
are directed to maintain vital functions,
prevent infection and promote healing
with safety, comfort and economy.
CONT,
 An operating theater, also known as an ,
operating room (OR) or operating suite,
is a facility within a hospital where
surgical operations are carried out in a
sterile environment. Historically, the
term “operating theatre” referred to a
non-sterile, tiered theater or
amphitheater in which students and
other spectators could watch surgeons
perform surgery.
ZONES OF AN OPERATING
THEATRE
 The location and flow of patients, the
staff and materials from and in theatre
must be considered during all stages of
the operating theatre design.
 There are four zones in an operating
theatre based on varying degrees of
cleanliness in which the bacteriological
count progressively diminishes from the
outer to the inner zones (operating
areas) and is maintained by a differential
decreasing positive pressure ventilation
gradient from the inner to outer zone.
I. Protective zone(non restricted area)
it includes the changing room for all medical and
paramedical staff ,transfer bay for patient ,materials
and equipments, room for administrative staff, stores
and records , pre and post operative rooms ,intensive
care unit and sterile stores.
11.Clean zone (semi restricted area)
This connects protective zone to aseptic zone and has
other areas also like stores and clean
room,equipment store room , maintenance workshop,
kitchenette,fire fighting devices room, emergency
exits room and service room for staffs.
111.Aseptic zone(restricted area) -includes the sterile
operation room
1v. Disposal zone –disposal areas from each operation
room and corridor heading to disposal area.
PHYSICAL LAYOUT OF OPERATION
THEATER

1. The location should allow accessibility

to and from supportive department like
ICU
2. Independent from all traffic and air
movement within the hospital
3. There should be minimum noise
4. Well ventilated and well lit
5. Changing room for staff both male and
female with bathrooms and toilets
SUB AREAS
 Pre- operative check-in areas this is
important with respect to maintaining
privacy, for changing from street
clothes to gown and provide lockers and
lavatories for staff.
 Anaesthetics rooms- it should have all
facilities as in operating theatre.
 Staff room- should have washrooms and
hand wash basin.
 Rest room-there should be a pleasant
room for staffs to rest.
HOSPITAL SERVICE
CHARTER
 In general, a service charter may be
defined as a public document that sets
out basic information on
the services provided, the standards
of service that customers can expect
from an organisation, and how to make
complaints or suggestions for
improvement.
ELEMENTS OF TOTAL
PATIENT CARE
 Total patient care refers to the provision
of services catering for all the needs of
the patient including physical,
psychological, social and spiritual needs.
 It means managing the patient as a
whole
 Sometimes this approach is referred to
as the practise of “holistic medication”
 To put the concept into practise requires
clear objectives, strategies and
approaches.
COMPONENTS OF ELEMENTS
OF PATIENT CARE
 The provision of care involves the
primary acts of caring as well as other
services that facilitate this activity.
 Patient care activities can be
categorized into
I. Clinical patient care
II. Hospitality service
III. Administrative and communication
CLINICAL PATIENT CARE
 Clinical patient care covers a range of
processes that include.
a) Generation ,gathering and collection of
data about a patient and his/her disease.
b) Analysing and interpretation of data to
determine the diagnosis and needs of the
patient.
c) Planning the case management.
d) Treatment
e) Review of the progress of the patient
f) Continuation of care.
PHYSICAL ELEMENTS OF
PATIENT CARE
 There have been many attempts to define the
attributes of patient-centered care However, there
are gray areas even in the most experiences:
 The Eight Principles of Patient-Centered Care

 1. Respect for patient’s values, preferences and

expressed needs. This dimension is best expressed
through the phrase, “Through the Patient’s Eyes” and
the book of the same title, and leads to shared
responsibility and decision-making.
 2. Coordination and integration of care. This
dimension addresses team medicine and giving
patients support as they move through different care
settings for prevention as well as treatment.
 3. Information, communication and education. This
includes advances in information and social technologies
that support patients and providers, as well as the
cultural shifts needed for healthy relationships.
 4. Physical comfort. This dimension addresses individual,
institutional and system design (i.e. pain management,
hospital design, and type and accessibility of services).
 5. Emotional support. Empathy and emotional well-being
are as important as evidence-based medicine in a
holistic approach.
 6. Involvement of family and friends. Care giving
includes more than patients and health professionals so
that the larger community of caregivers are considered.
 7. Transition and continuity. Delivery systems provide for
caring hand-offs between different providers and phases
of care
8. Access to care
 Patients need to know they can access care when
it is needed. Focusing mainly on ambulatory care,
the following areas are of importance to the
patient:
 Access to the location of hospitals, clinics and
physician offices
 Availability of transportation
 Ease of scheduling appointments
 Availability of appointments when needed
 Accessibility to specialists or specialty services
when a referral is made
 Clear instructions provided on when and how to
get referrals
OBJECTIVES AND CONTENT OF CARE

CARE OBJECTIVES
 It is important to determine the care objectives at the start of
patient management and review them at subsequent phases.
While definitive treatment preferably should be started only when
an accurate diagnosis is made, much can be offered to the
patient in the meantime.
 A wide variety of strategies, methods and modalities are available
to the care provider. Their selection depends on the treatment
objectives and may include any or all of the following:
A. Remove or minimize effects of illness
B. Maintain, restore or improve the health status
C. Avoid or minimize complications of treatment
D. Prevent deterioration or recurrence
 Depending on the nature of the disease and the objectives, the
treatment strategy can be one of three categories:
 Curative
 Restriction of effects and prevention of deterioration
 Palliative
 When there is potential for cure or cessation of the
disease processes, a concerted attempt is made to
achieve it. However, even when there is no possibility for
complete resolution of the illness many different
therapeutic interventions can be offered.
 Each of the three categories has several common

components or content i.e.:

a. Symptomatic therapy
b. Supportive therapy
c. Preventive therapy
d. Rehabilitative therapy
e. Health Promotion
The priority and sequence of treatment will depend very
much on the type, severity and effects of the illness.
“…to cure sometimes,to relief often,to comfort always
”Ambroise Pare’ (French surgeon 1510-1590)
PHASES OF CARE

 The period within which care is given to a patient

with a particular health problem or disease is
termed as the care episode. This can be divided
further into sequential phases of care which vary
according to the stages of the natural history of
the disease (or disease episode) such as:
 The disease onset and progression:
 whether acute, sub-acute or chronic
 The optimal target (end-point) that can be
achieved:
 cure
 arrest of progression (modify, moderate, ameliorate)
 prevention of further complications
 recovery of lost function
 palliation
 Each phase has its own objectives an
content depending on the needs of the
patient.
 The care in each phase may comprise
one or more care visits and encounters
with the relevant care providers in the
appropriate care setting (in-patient, day
care, out-patient, or home visit
services).
 Schematic representation of examples
of Phases of Care are shown below:
IMPLEMENTING THE TOTAL PATIENT
CARE CONCEPT

 Adoption and implementation of Total patient care

requires applying the concept in all aspects of health
care delivery.
 Optimal benefits of health care can be achieved
through teamwork. Policies and procedures that
enable and value the contributions from all health
care professionals, the patient and relatives need to
be created.
 This concept can be translated into practice using the
following strategy:
 use a combination of approaches,
 involvement of a team of care providers,
 enabling integration,
 facilitating co-ordination,
 providing for continuous assessment.