Hospital Planning &

Administration
Introduction & Overview

Session 1
 Hospital
WHO defines Hospital as:

“A hospital is an integrated 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 outpatient services
reach out to the family and its home
environment; the hospital is also a center for
the training of health workers and biosocial
research”.
The Word “HOSPITAL” is self explanatory as it is
given below:

• H - HEALING
• O - OBSERVATION
• S - SUPERVISION
• P - PERSUATION
• I - INVESTIGATION
• T - TREATMENT
• A - ASSURANCE
• L - LIESURE
 Changing role of hospitals

Due to its gradual evolution through the 18th and 19th

centuries, the hospital-both in the eastern and the western
world, the role of hospitals have changed due to the factors
which include;
 Expansion of the clientele from the dying, the destitute, the
poor and the needy to all classes of people.
 Improved economic and social status of the community.
 Control of communicable disease and increase in chronic
degenerative diseases.
 Progress in the means of communications and transport.
 Political obligations of the government to provide
comprehensive health care
 Increasing health awareness.
• Rising standard of living (especially in urban areas)
and sociopolitical awareness (especially in semi-urban
and rural areas) with the result that people expect better
services and facilities in health care institutions.
• Control and promotion of quality of care by statuary
and professional associations.
• Increase in specialization where need for team
approach to health and disease is now required
• Rapid advances in medical sciences and technology
• Increase in population requiring more number of
hospital beds.
• Sophisticated instrumentation, equipment and better
diagnostic and therapeutic tools.
• Advances in administrative procedures and management
techniques
• Reorientation of the healthcare delivery system with
emphasis on delivery of primary healthcare
• Awareness of the community
 Hospital as a System
A hospital system is more than the sum of its parts.
The peculiarities of a hospital system are as follows:
• A hospital is an open system which interacts with its environment.
• Although a system generally has boundary, the boundaries separating
the hospital system from other social systems are not clear bur
rather fuzzy.
• A system must produce enough outputs through series of inputs. but the
output of a hospital system is not clearly measurable. (mostly intangible
services)
• A hospital system has to be in a dynamic equilibrium with the wider
social system.
• A hospital system is not an end in itself. It must function as a part of the
larger healthcare systems.
• A hospital system like other open social systems tends towards
elaboration and differentiation, i.e. as it grows, the hospital system
tends to become more specialized in its elements and elaborated in its
structure, manifesting in the creation of more and more specialized
departments, acquisition of new technology, expansion of the
product lines and scope of services.
INPUT PROCESS-TRANSFORMATION OUTP
Hospital as a System UT

People Communication: Between E

• Staff • Physicians & Patients F
• Physicians • Physicians & Nurses F
E
• Nurses • Physicians/ Nurses & Paramedical Staff
C
• Pharmaceuticals • Physicians & Administrator T
• Supportive • Administrator & Community I
• Patients, their • Administrator/ Nurse & Paramedical Staff V
attendants & • Nurses/Paramedical & Patients E
relatives
P
A
Material Decision Making:
T
• Drugs & Chemicals For: I
• Equipment • Cure: Diagnosis, Treatment E
• Diet • Care: Creature comfort of Patients & Diet N
• Procurement of material in Right place & T
Right time
C
A
Money Action: R
E
• To maintain staff, • Putting decision into practice
facilities & procure • Balanced mix of communication, decision
material making & actions
 Hospital
System

Cure Care Minor

Subsystem Subsystem Subsystem

Diagnostic Therapeutic Nursing Supportive Administrativ

Subsystem Subsystem Subsystem Subsystem e

Circulation

Environmenta
l

Components of a Social
Hospital System
Technical
 Functions of a hospital
• The activities of a present day hospital are
divided into two distinct types-intramural and
extramural functions
• Intramural: Intramural activities are
confined within the walls of the hospital.
• Extramural: Extramural activities are the
services which radiate outside the hospital
and to the home environment and community.
 Intramural Functions

• Restorative
 Diagnostic
 Curative
 Rehabilitative
 Care of emergencies
• Preventive
• Education
• Research
 Restorative function
• Diagnostic: These comprise both the in-
patient/out-patient service involving medical,
surgical and other specialties and special
diagnostic procedures.
• Curative: Treatment of all ailments.
• Rehabilitative: Physical, mental and social
rehabilitation
• Care of emergencies: Accidents as well as
diseases
 Preventive Function

Following are the preventive services of a

hospital:
• Supervision of normal pregnancies and childbirth
• Supervision of normal growth and development
of children
• Control of communicable diseases
• Prevention of prolonged illness
• Health education
• Occupational health
 Education

• Medical undergraduates
• Specialists and postgraduates
• Nurses and mid-wives
• Medical social workers
• Paramedical staff
• Community health educators
 Research

• Physical, psychological and social

aspects of health and diseases
• Clinical medicine
• Hospital practices and administration
 Extramural Functions

Following are the extramural functions:

• Outpatient services
• Home care services
• Outreach services
• Mobile clinics
• Day care centers
• Night hospital
• Medical care camps
 Types of hospitals
• Public hospitals
A public hospital or government hospital is a hospital which is owned by a
Government and receives government funding. This type of hospital provides
medical care free of charge, the cost of which is covered by the funding the
hospital receives. most hospitals worldwide are public.

• Private hospitals
A private hospital is a hospital owned by a for-profit company or a non-profit
organization and privately funded through payment for medical services by
patients themselves, by insurers, or by foreign embassies. This practice is very
common in the United States and Australia.

In the United Kingdom, private hospitals are distinguished from the far more
prevalent National Health Service institutions.
 Types of hospitals
Specialized Hospitals:
• Cardiac Care Centers
• Infertility Centers
• Trauma centers
• Rehabilitation hospitals
• Children Hospitals
• Seniors' hospitals, Geriatric Services
• Hospitals for dealing with specific medical needs
such as Psychiatric problems.
Super-Specialty Hospitals
• Organ Transplant Centers (Liver, Kidney)
• Specialized orthopedic centers for Joint replacements
e.g. Hip Replacement , Knee replacement etc.
Teaching & Training Hospitals
• Some hospitals are affiliated with universities for
medical research and the training of medical
personnel such as physicians and nurses, often called
teaching hospitals.
• A teaching hospital combines assistance to patients
with teaching to medical students and nurses and
often is linked to a medical school or nursing school.
some of these are associated with universities
Clinics
• A medical facility smaller than a hospital is generally
called a clinic, and often is run by a government
agency for health services
• A private partnership of physicians (in nations where
private practice is allowed). clinics generally provide
only outpatient services.
 It must be a size which the people can
afford to build and operate.

It must be designed to meet all the

needs of people it is to serve.

It must be well-staffed with a sufficient number of physicians,

nurses and other trained personnel to give adequate and
efficient service.
 The Health Professional is a
manager in a health services
organization
&
Management or administration, on a
planned and scientific basis, is
necessary for the smooth running of
every institution, including hospitals.
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Hospital personnel, medical staff, para-
medical or general employees, must all
be concerned with one goal:

Providing the best

possible
patient care.
 Many aspects of health organizations are managed

several

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hundred fellow
as
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many activities

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Hospital administration should be entrusted on
those who have the necessary training and the
right kind of attitude to perform this vital task.
 ADMINISTRATION
Administration is a process by which
the potentials of men and material are
synthesized and activated for
achievement of defined goals
 Health
Administration

Sound administration is
essential for the success of
any public health program
whether on the national,
intermediate or the local
level.
Definition of Sound Administration
We can define sound administration
as:

“ The process of achieving defined goals at a

defined time
Through the guidance, leadership, and control
of the efforts of a group of individuals and the
efficient utilization of non-human resources
bearing in mind adequacy, speed, and
economy to the utmost possible level.”
 Elements of
Administration
• Planning • Reporting
• Organization • Budgeting
• Staffing • Supervising
• Directing • Evaluation
• Coordinating
 Levels of
Administration

Central Ministry of health

level

Intermediate Directorates of health

level

E.G. Health office,

Local Level Hospital, health
Care unit
HOSPITAL ADMINISTRATION
• Hospital has become a highly scientific and
complex medical institution as against the old
concept of poor house where people left their
patients for hope of cure.
• To keep pace with changing environment and
demands of the people, the administrator has
to strike a balance between internal
management and community expectations
maintaining a positive relation with the staff
and patients on one side and other health
elated community organizations on the other
side.
Ideal hospital administrator
Attributes Management Skills

Administrative skills

HOSPITAL
ADMINISTRATOR
 In addition to the care provided to the patients by
the physicians and nurses, most medical facilities
require a significant amount of behind-the-scene
administrative support. Hospital administrators are
the professionals responsible for managing
hospitals.
hospital administrator
plays a vital a role in saving lives,
without having to take scalpel in hand.

Hospital administrators manage

hospitals, outpatient clinics, hospices, and
drug-abuse treatment centers.
 “The doctors strive to keep the blood
flowing and the heart beating,”

BUT
“The hospital administrator is doing his job
in keeping the hospital alive and
healthy.”
 Health
Manager/Administrator
• Health managers are sometimes called health
care administrators or medical managers.
• A health manager helps to plan, coordinate
and supervise the delivery of health care
services in clinics, hospitals and military and
civil agencies.
• Though a health manager mainly works
outside of a health care facility, there is not
much difference between the roles and
responsibilities of a health manager versus a
medical administrator.
 Administration

Type of Skills
HIGH LEVEL
Conceptual Skills

MID LEVEL
Humane Skills

LOWER LEVEL
Technical Skills

Successful administration is based on three basic

managerial skills
 Administrative skills for hospital administration

• Planning &
Human
• Leadership Skills • Managerial Skills
Decision Making • Interpersonal skills • Marketing Skills
Skills • Conflict Management • Business Skills
• Innovative skill Skills • Finance &
• Research Oriented • Negotiating Skills Budgeting

Conceptu Technical
al Skills Skills

A modern hospital administrator has to acquire above

administrative skills to successfully manage a hospital
 Attribute to hospital
administration
• A man with lot of experience and post graduate qualification
in Hospital Management.
• Successful past record of efficient and effective
management.
• Professional par excellence, committed to task.
• Possess high degree of conceptual skills & creative mind.
• Ability to direct the subordinates in goal achievement.
• Possess mental robustness & adequate tactfulness.
• Have an attitude to change in changing circumstance and
time situation.
• Demonstrates a code of ethics within the organization.
• Can withstand the adverse criticism and able to take
appropriate measures.
• Clear & realistic goal setting & keen in professional growth.
 Policy for Administration
• To make sure that hospitals are operating
efficiently & providing adequate medical care to
the patients.
• To act as a liaison between Governing Board,
Medical staff & Department Heads.
• To integrate the activities of all departments so
they function as a whole.
• To plan, organize, direct, control & co-ordinate
medical & health services following policies set
by a governing board of trustees.
• To recruit, hire and sometimes train doctors,
nurses, interns & assistant administrators to
develop a stable staff.
• To develop strengths and neutralize workers’
weaknesses.
• To develop procedures for medical treatments (in
collaboration with consultants), quality assurance,
patient services, and public relations activities such
as community health.
• To attend staff meetings & participate in health
planning councils.
• The Administrators need to keep up with advances in:
- Medicine
- Computerized diagnostic & treatment equipment
- Government regulations
- Health Insurance Changes
- Financing options
 objectives
• Directing hospital activities according to governing boar’s
overall objective & policies.
• Reviewing departments reports and activities
• Settling patients’ complaints
• Assembling competent workers to direct & undertake
given activities & to develop them useful environmental &
medical teams.
• Preparing & operating sound financial structure and
effective control & safety of funds
• Submitting a long term plan for hospital and growth & a
periodic, annual financial budget to Governing Board for its
approval or otherwise.
• Studying advances in hospital practices in order to advise
the Governing Board.
• Studying the means to meet the community’s changing
hospital needs
• DRRSSSA
 procedures
• Written proposals for government grants.
• Preparing periodic budgets
• Allocating scarce funds & other resources
• Determining patients’ fee schedule
• Determining space, equipment, materials &
human resource needed to provide services.
• Convening conferences
• Determining on-duty schedule for
Administration Department
• Making a formal inspection “round”
• PPADDCM
 Programs
• Fire prevention & fighting: Prevention of fire by documented
regular inspections of facility, fire fighting equipment and drills
• Disaster Management: Care of mass casualties, maintenance of
services during disrupted utility supplies, city riots and
providing the workforce in strikes etc.
• Safety: Documents periodic inspections of facility & job
procedures to prevent accidents, loss of time and lowered
morale.
• Noise: Reviews outside unwelcome sounds & inside excessive TV
volume, door slamming, equipment & wheel chair squeaking etc.
• Time conservation: Involves prompt & accurate information,
delegation of routine tasks & orderly arrangements of items at
workplace to prevent searching.
• Quality patient care: Documents periodic review of Patients;
needs for good care & evaluation of coordinated activities &
resources to meet such needs
• Patients’ suggestions: Invitation, acknowledgment & acceptance
of patients’ suggestion for service importance.
 Standards
• For the • For Quality of Care:
Administrator’s - No. of clinical tests
periodic report: performed
- To ensure uniform • Resources Used:
presentations - Staff man-hours paid
- Pounds of soiled linen
- Prevent omission and
processed
duplications
• For Quality of Resources
- Facilitate comparison Used
with previous reports - By worker’s qualifications
• For the quantity of and secretaries shorthand
patient care: & typing speed
- Total patient’s day
- Outpatient attendances
- Social service visit
 Duties & responsibilities
There are many duties of the administrator, but
regardless, they are as just as vital to patient’s lives as
regular doctors & nurses are.

• Supervision • Managing Patients’

• Communication Records
• Staff Hiring • Employee Evaluation
• Co-ordination of • Public Relations
Business Functions • Program
• Policy Development Development
& Implementation • Budget
• Logistics
• Policies
 Role of Hospital
Role
towards

Administrator
Patients

ROLE

Role
Role towards
Organization
towards
Community
 Role towards patient
Clinical Needs

Physical Needs

Safety Needs
PATIEN
Emotional Needs

Staff Attitude towards

Patient
patients, attendants &
Satisfaction
Relatives
Educational
Needs
 Role towards Community Supporting
Primary Health
Care

COMMUNITY Community
Health Needs

Outreach
Services
Integration
with other
Healthcare
Institutions
(Pvt. Hospitals,
Practitioners &
Community
Public Health
Care
Deptt.
(Surveillance
System &
Community
Education
Role towards organization-PULSE MASTER HQ

• Patient Care • Maintenance

Services Services
• Legal & Statutory • Logistics & Supplies
Responsibility • Ethics & Code of
• Public Relations Ethics
• Marketing • Quality Management
Management • Planning & Decision
• Management Making
Information System • Finance &
• Staff Management Budgeting
 Patient care
• Developing Patient • Organizational
Care Services Structure
• Investigation Facilities • Functional
• Patient Safety Development
Measures • Formation of Policies
• Physical Facilities • Rules & Regulation
 Personnel
management
• Staff
Recruitment Selection
• Rewards & • Manpower Planning
Promotions • Wages & Salaries
• Training • Disciplinary
• Performance Procedure
Appraisal
• Grievance Redressed
 Material
management
• Quality Assessment • Materials
• Storage • Material Planning
• Inventory Control • Specification
• Distribution • Procurement
• Disposal of Scrap • Transportation
• Receipt
• Inspection
 Recurrent
Financial management Capital

Budgeting Distribution
Plan Heads

Revised
Accounting
Estimate FINANCE

Surplus
Expenditure
Deficit
 Inventory Patient
Hospital information system
Medical
Records
Controlling
Function
Managemen Feedback
t System

Operational
Two way
Planning &
Communication
Budgeting

Hospital Information
System
 Responsibility
LEGISLATIONS
Notification
of Disease,
Constitutional Role (Ethics)Death & C.P.A
IPC
Birth
Medico-legal
Cases
PNDT Transplantation
RTI BMW Act MCI Act MTP Act
Act
 Medical audit
Management
lapses
Adverse
Reactions

Safety
Operations
Compromises

Deaths AUDIT Accidents

 Market responsibility
Incenti
ves
Advertise
Conces
ment
Product sions

Paymen Marketi
Billing
t Mode ng

Promoti
Place
on
Price
Ethics & code of conduct
For Staff

For Patients

For Relatives
& Attendants

Personnel
Protection

Drug trial &

Research
 ORGANOGRAM CEO/Administrator

Department
Secretary

Chief Operational Chief Financial Officer Human Resource

Officer

Assit. Manager
Assistant Manager Manager Recruitment
Manager Nursing Chief Medical Officer Income
Operation

Assit. Manager
Dietary Services Maintenance Expense Manager Appraisal

Accountant Manager Training

House Keeping Social Services

Pharmacy Laboratory

Radiology
Distinction between Hospital
& Industrial Organization:
The difference between administrative work in
hospital and in other organizations can be
attributed to the existence of some conditions
peculiar to hospitals.
 Condition N0. 1
 The consumers of the
services provided in a
hospital (the patients) are
physically or mentally ill
and are rendered services
within the four wall of the
hospital.

 As compared with most

other institutions of
business, government and
education, this is an
unusual situation and
present quite different
problems of management.
 Condition no. 2
 The customers of the
hospital (the patients)
have individual needs
and require highly
personalized and custom-
made services.

 The diagnostic,
therapeutic and
preventive services
provided by physicians,
nurses and technicians,
and the aid of expensive
and specialized
equipment and
medication are tailored
to the need of each
individual consumer.
 Condition N0. 3
The hospital provides a wide
range of scientific and
technical services such as:
• Nursing, diet therapy,
anesthesiology, pharmacy,
radiology, clinical
laboratory, physical
therapy and medical
social work.
• Many of its services are
provided continuously,
round the clock, every day
of the year.
 Condition N0. 4

 Nurses and certain other

personnel must accept
direction from both the
matron and the physicians
under whom they work
closely every day.
 They also have to fulfill the
emotional, physical, mental
and medical needs of the
patients.
 The human relations
problems in such situations
of dual authority are much
more frequent, delicate,
varies and complex than in
organization where this
situation does not exist.
 Condition N0. 5
 Handicapped by low
wages, rigid discipline
and some apprehension
of exposure to disease,
hospital personnel are
expected to:

Maintain a very high

level of efficiency,
as their functioning
affects the lives of
patients.
 Condition N0. 6
 The amount and the variety of training
programmers that the hospital has to
provide.
 Training is provided for medical interns
and residents (6 months to 1 year),
technicians (2 years), medical
laboratory technicians (2 years),
physical therapists, pharmacists,
medical social workers, dieticians and
nurses. Classrooms, clinical and
different training methods are used in
varying combinations.
 The administrator is responsible for
planning and operating these various
training programmers.
 Very few other types of institutions
combine such major educational
responsibilities with other operating
activities.
 Condition N0. 7
 The efficiency and quality of
health care services in any
hospital is directly dependent on
the use of bio-medical equipment
in diagnosis, surgery and
therapeutic process.
 These equipment employ
sophisticated technology made of
complex systems. The problem of
maintenance and management of
these bio-medical equipment is
complex because there is acute
shortage of technical hands who
have suitable and adequate
training in the maintenance and
repairing of these specialized hi-
tech equipment.