Hospital Management

UNIT I - OVERVIEW OF HOSPITAL ADMINISTRATION

1
 Hospital Management?
Hospital Management can have different meanings

•Management as a process: Often it is said that it is a professionally managed hospital; it is well managed hospital,
meaning thereby the management is described as an activity, type of work. Management applies certain principles,
techniques and activities which are performed by certain management functions.What the hospital Management
does is Management.

•Hospital Management is a subject: A subject, a discipline taught in universities, colleges or institutes. It is an

accumulated body of knowledge that can be learned, at some places the broad specialty is Health Management
including Hospital Management.Various degrees, diplomas, certificate courses are run by the institution/universities.

• Hospital management as people: The Management of this hospital is very insensitive, the hospital management of
employees such as doctors, nurses, accountants, receptionists and house keeping staff etc.
 Overview of Hospital
Administration
● Distinction between hospital and other
Industries

● Challenges in Hospital Administration

● Hospital planning

● Equipment Planning

● Functional Planning
 Evolution of the Hospital
● During Akbar’s period the Unani medicine system spread all the way through the greater part of India..
● During his period, there were a good number of government hospitals, as well as private clinics run by many physicians.
● The modern system of medicine in India was introduced in the 17th century with the arrival of Christian missionaries in South India.

● Organized medical training was started with the first medical college opening in Calcutta in 1835, two in Delhi in 1835 and 1836,

followed by Mumbai in 1845 and Chennai in 1850.

● The oldest college of Asia was established in Calcutta on JAN 28 1835 followed by Madras Medical College .
● AIIMS was established in 1956 which is leading hospital
 Changing concept of hospitals
Trusteeship Period

Most of the hospitals were run and managed by the trustee’s .The advances in technology were minimal during that
period. This period lasted till 1920.The doctors and nurses are not working for money, the approach was only
humanitarian. The objectives of the hospital remained to provide comfort to the patient.

Physician Period It was being utilized for medical. The hospitals were being utilized for medical practice. The laboratory
medicine developed during the period 1940 to 1950. The political and economic environment started influencing the
hospitals

Administrative and Team Periods The hospital practice became a team approach. The advances in technology became
more rapid. The use of computers and application of computers in patient’s care and management of hospitals changed
the scenario. People started thinking about professionally managing the hospital.
 Hospital Administration
Hospital has become a highly scientific and complex medical institution as against the age
old concept of a poor house where people left their patients for hope of cure.

To keep space with the changing environment and demands of the people, the
administrator has to strike a balance between internal management and community
expectations maintaining positive relation with the staff and patients on one side and
other health related community organization on the other side
Hospital Classification
 Healthcare Market Overview
Healthcare has become one of India's largest sector,
both in terms of revenue and employment. The
industry is growing at a tremendous pace owing to its
strengthening coverage, service and increasing
expenditure by public as well private players

During 2016-22, the market is expected to record a

CAGR of 17.69 per cent.

Total health industry size is estimated to touch US$

372 billion by 2022.
Shift from communicable to Currently, about 50 percent of spending on in-patient beds is for lifestyle diseases – this has increased the demand
lifestyle diseases for specialised care. In India, lifestyle diseases have replaced traditional health
problems.

Lifestyle diseases are caused by high cholesterol, high blood pressure, obesity, poor diet and alcohol.

Expansion to tier II and tier Vaatsalya Healthcare is one of the first hospital chains to start focus on tier II and tier III for expansion.
III cities The private sector to establish hospitals in these cities, the Government has relaxed taxes on these hospitals for
the first five years.

Emergence of telemedicine Telemedicine is a fast-emerging sector in India. Major hospitals (Apollo, AIIMS, Narayana Hrudayalaya) have
adopted telemedicine services and entered into a number of PPPs.

Telemedicine market in India is expected to rise at a CAGR of 20 per cent during FY16-20, reaching US$ 32 million
by 2020.

Telemedicine can bridge the rural-urban divide in terms of medical facilities, extending low-cost consultation and
diagnosis facilities to the remotest of areas via high-speed internet and telecommunication.

Artificial Rising adoption of AI-based applications has enabled people to talk directly to doctors, physician, and expertise for
Intelligence(AI) the best treatment.

Home healthcare Development in information technology (IT) and integration with medical electronics has made it possible to provide
high quality medical care at home at affordable prices. It enables the customers to save up to 20-50 per cent of the
cost.healthcare market is estimated to reach US$ 6.21 billion by 2020 from US$ 4.46 billion at the end of 2018.
Hospitals Of Tomorrow

Smart
Hospitals
Distinction Between hospital &
Other Industries
➔ Complexity – Hospitals tend to have very complex organizational structures compared to their overall size. A 400-

bed hospital might have over 1,000 different job titles.

➔ Highly trained professionals – A large portion of the workforce- physicians, nurses, allied health and many

technical positions, are highly trained and have a high level of autonomy. Many have performance criteria

defined by the profession and by state and national testing and licensing bodies.

➔ A fragmented organization structure – An auto manufacturer designs the entire workforce around production of

the car. Hospitals, only recently, have begun to take a service line or patient-centered approach to organizational

structure, built around the patient experience. Historically, a hospital is built around relatively independent

departments, each with a great deal of autonomy.

Distinction Between hospital &
Other Industries
● De-centralized and disparate hiring processes – This autonomy often fosters a decentralized and inconsistent

approach to recruiting and hiring. Nursing has its approach, other departments do something else, and physician hiring

is informally controlled by the C-suite. Inconsistency between hospitals in a system, or even hiring managers

within the same hospital, make standardization difficult and create unnecessary legal risk.

● Customer Service is no longer a 'nice to have' – Every company wants to improve customer service but with the

new HCAHPS requirements, patient satisfaction scores are a critical success metric for hospitals.

● The nature of the Services – Poor quality in a manufacturing plant means a poor product and a weakened
competitive

advantage. Poor quality in a hospital means harm to patients and the hospital’s ability to fulfill its mission.
 Distinction Between hospital &
●
Other Industries
Healthcare-specific solutions – Basic, off the shelf personality tests that might be fine for other industries don’t work
in

healthcare. Nurses, physicians, and other care providers are unique and assessments must incorporate an understanding

of the work and the competencies that lead to success.

● A multi-level approach – Creating a patient and family focused environment means you can’t just improve the level of

customer service provided by the nursing staff. Even housekeeping impacts the patient experience, and if you don’t

hire better managers, hiring better front line workers is futile.

● Consider the 'future-state' – Healthcare is changing – rapidly. Our traditional better performers may not be what we

need moving forward. It takes a thorough understanding of the new challenges and of the vision of the organization, in

order to build the workforce for the future.

 Why challenges?

● Rapid development in Med. Tech. ● Increased Political interference

● Increase Health awareness of people ● Better and quick communication facilities
● Rapid Urbanization ● Competitive private health care facilities
● Increase demand for better facilities ● Increase in NCD
● Active participation of Media ● Higher level of consumers expectations
● Legal involvements in hospital affair ● Marketing of hospital services
● Maintaining peaceful internal environment
 A Changing Healthcare Industry - Challenges

Internal Factors - External factors

-

Lack of motivation of staff Legal issues

Lack of adequate Pollution control board

manpower
Financial constraints Statutory requirements

Logistic management Lack of standardization

Apathy of doctors/nurses Accreditations - NABH/JCI

Union activities Consumer’s forum

Challenges Faced By HR
Professionals
Unlike baby boomers and Gen Xers who primarily sought competitive compensation, millennials value benefits and
advancement opportunities far more than their predecessors. This means that employers looking to hire the next batch
of medical professionals need to make changes now to appeal to their young candidates.

Some organizations are already doing this by offering training, development and advancement, and competitive
benefits packages, including tuition reimbursement.
 Hospital Planning
● Planning is the forecasting and organizing the
activities required to achieve the desired goals.
● All successful hospitals, without exception are built
on a triad of good planning, good design &
construction and good administration.
● To be successful, a hospital requires a great deal
of preliminary study and planning.
● It must be designed to serve people.
● It must be staffed with competent and adequate
number of efficient doctors, nurses, and other
professionals.
● A strong management essential for the daily
functioning of a facility; must be included in the
plans of a new hospital.
 STRATEGIC ESSENTIALS
● Regionalization

• Pre- planning consideration

• Need assessment

• Plot ratio

• Design for flexibility and expandability

• Fulfill the demand functions

• Emphasize on patient focused hospital

• Focus on energy conservation

• Intelligent buildings
 Steps in planning
● Need assessment
● Feasibility report
● Architects brief
● Request for proposal
● Appointment of consultant
● Detailed project report
● Notice inviting tender
● Allocation of work
● Construction of building, services and
facilities,
● Equipment purchase
● Manpower selection and recruitment
● Stage of commissioning
● Review process
 Hospital planning
I. Planning, design and construction.
The planning, design and construction phase is the one of the most important phases in setting up
a super-specialty hospital. This phase lays the basis for an operationally efficient hospital
capable of serving patients in the most optimal way.

1.Workflow and medical space planning.

(a) Review of the hospital design prepared
(b) Review the medical space planning for adequacy and suggest changes necessitated by
workflow dependencies and medical equipment requirements
(c) Suggest necessary changes to align the design
 Hospital planning
3. Architectural & MEP design.
The scope of services under this head would include:

a) Schematic design stage

●Review of architectural plans for adequacy and for provisioning of support services
●Propose design concepts in line with the project brief
●Ensure adequate space provision for accommodation of allied services and support functions
●Review final schematic drawings with recommendation for final approval
 Hospital planning
4. Design development stage

a) Coordinate with the promoter, architects, structural and MEP consultants for coordinated design development
drawings
b) Review and recommend for approval, the design development drawings and specifications including
building
elevations, incorporating all building elements such as doors, windows, shafts, materials, signage’s
etc.
c) Structural design report indicating type of structure, loading patterns and design
parameters
d) preliminary engineering design report for all engineering disciplines indicating type of system proposed along
with
justifications (technical and financial), basic engineering scheme, preliminary costs, suggested vendors
etc.
e) Architectural finishes including flooring material, wall dado, false ceiling, furniture selection
etc.
f) Specialist services like, IT, laundry, kitchen, CSSD, medical graphics & signage, medical gas systems and
medical
equipments.
 Hospital planning
5. Tender stage

a)Review drawings, tender specifications and bill of quantities (BOQ).

b)Review comprehensive detailed design report along with detailed cost estimates.

c)Recommend to promoter for approval to issue of tenders to contractors.

d)Suggest qualified contractors who are capable of executing the work and meeting the expectations
in terms of quality, cost and time.
 Hospital planning
6. Construction stage

(a) Pre-Construction Phase

(i) Assess the scope of development, which may be required for planning the total
development of site.

(ii)At completion of schematic design phase verify & confirm the budgeted cost of
construction of the project as prepared by the Architect/Design Consultants.

(iii)Conduct pre-bid conferences to familiarize the Vendors with the Tender Documents,
management techniques and with any special systems, materials and methods.

(iv)Evaluate the quotes received and facilitate contract negotiations leading to selection
of contractor(s) for the various tender packages and make recommendations for award
of contracts.
 Hospital planning
(b) Construction Phase
Recommend course of actions when the contractual requirements are not being met and co-ordinate the work
with the activities and responsibilities of the promoter, Architect/Design Consultants to complete the project in
accordance with the promoter’s objectives of cost, time and quality.

1. Develop the procedure for the review and processing of applications for payment by the

contractors for progress and final payments, in consultation with the promoter.

1.Review drawings (as may be required), co-ordinate with the Architect/Design Consultants with comments for their
approval.
2.Review mock-ups and samples as submitted by contractors / suppliers
3.Determine when a project is substantially complete, and take necessary steps that arerequired before the certificate to
this effect can be issued.
 Hospital planning
(C) Post Construction Phase

(i) Review maintenance manual containing 'As-Built drawings’ prepared by the

Architect/Design Consultants/Contractors (as applicable) lists.

(ii) Recommend rectification of defects (if any) by the contractor during defect liability

period.
 Hospital planning
III. Medical furniture planning and procurement.
Plan the bill of quantity and finalise the stainless steel furniture such as medicine trolleys, crash

carts, OT furniture, CSSD furniture etc.

IV. CSSD set-up planning and commissioning.

Identify the sterilization department equipments and also in staffing the CSSD and establishing
standard protocols for operation of the CSSD.
 Hospital planning
V. Contractual services finalization
1. Food & beverage services: planning, design, preparation of patient menu and identifying F&B
vendors

2. Laundry services: evaluating the laundry load and negotiating best possible rates for the various
types of hospital laundry such as OT linen, soiled linen, patient linen etc.

3. House-keeping services: assist in negotiating & finalizing house-keeping vendors

4. Maintenance: evaluate various facility management providers for the expertise in operating
equipments like chiller, DG sets, AHUs, transformers, electrical panels, cooling towers etc.,
review man power deployment chart etc.

5. Security: evaluate the security agencies and prepare the security personnel deployment
requirement
 Hospital planning
VI. Essential requirements finalization.
1. Stationery, formats and administrative items

2. Patient & staff uniforms and linen

3. Nurse call system

4. Central medical gas system

5. OT cleaning, fumigation and setting up

6. ICU cleaning and setting up

 Hospital planning
VII. Regulatory and licensing requirements.
A super-specialty hospital requires almost 60 licenses to comply with the various Central and State
Legislative requirements, such as:

1. Documentation and comprehensive file preparation

2. Staffing requirement

3. Prepare requisite documents for licenses such as medical registration certificates etc.

4. Submit the files and interact with the Government officials and provide clarification wherever
possible on queries raised by authorities

Ensure site presence during inspection by various authorities

 Hospital planning
VIII. Medical professionals’
recruitment
1. HR planning for staffing.

2. Obtain approvals for recruitment

3. Identify the right medical talent, interviewing and final selection of doctors, nurses, technicians,
para-medical personnel etc.
 Hospital planning
. IX Pre-commissioning Testing the readiness of the following:
1.The electrical system

2.Utilities (including power generators, if applicable, to be used in case of a blackout)

3.Telephone lines and cable and wireless telecommunications connections

4.Plumbing and sewerage structures

5.Flowed-mechanical and acclimatization systems (for various gases, air-conditioning, and

vapors)

6.Medical equipment

7.Medical gas systems (with outlet-by-outlet testing of type of gas, pressure, and flow rate)
 Hospital planning
X. Sourcing and supply chain management
1. Ensure procurement of all consumables and medicines required by the hospital at the pre-
negotiated rates.

2. Availability of material at preferential schedules enjoyed lowering inventory holding costs

significantly.

XI. Operating Licenses and Permits.

Pertaining to medical practice, emergency care, utilities, waste treatment and disposal, and so on,

but also various legal documents necessary for running the hospital as a business.
 Hospital planning
XII. Insurance

Relevant to the hospital during the pre-opening and post-opening stages.

XIII.Project Costs and Financing Plan

1. Financial Projection Model - Market Parameters and Capacity Assumptions

2. Key Assumptions for Operation

3. Revenue Assumptions

XIV.Marketing Plan

1. Market analysis

2. Competition analysis
 Hospital planning
XV. Standards, protocols and processes.
1. Prepare and put in place standard operating protocols and medical risk management procedures,
to ensure quality medical outcomes and lower risk to patients.

2. Train nursing and para-medical personnel in standard operating procedures and protocols for
patient care.

XVI Accreditations
1. Prepare the hospital for obtaining nationally recognized accreditation such as NABH, NABL,
blood bank accreditation etc.

2. Extend life and reduce cost of ownership of medical equipments.

3. Tie up with reputed company for maintaining specialized equipments.

 Hospital planning
Information Technology
1.Hospital Information System (HIS)

2.Laboratory Information System (LIS)

3.ERP system for better planning of resources and operations

Post Commencement of Operations

1.Day to Day Management of the Hospital

2.Clinical and Technological Adequacy

3.Assess Supplier Reliability

Equipment Planning

● Health care equipment planning is a specialised process and requires not only a clear understanding of the
clinical need but also an intricate knowledge of budgeting, architectural design and building process.

● Effective project planning can only be achieved by a successful team process.

● This cohesive team generally consists of user groups, project managers, architects and other associated

healthcare planners such as equipment planners, whose responsibility is to balance the requirements of the

clinical users and the clients against available healthcare technology, budgetary targets and the realities of the

design and construction process.

Equipment Planning Planning
Team
●Hospital Administrator
●Specialists from various clinical
branches
●Nursing advisor
●HR Manager
●Civil and electrical engineers
●Representative of local body
●Senior architect
 Objectives and outcomes of the equipment planning

● Undertake current FF&FE inventory process (if required)

● Ascertain types and complexity of medical equipment technology intended to be used to meet the project
requirements
● Establish and finalise FF&E Schedules
● Develop budget information for all agreed FF&FE

● Provide expert assistance with the selection of fit for purpose FF&E Provided support and assistance to both
the architectural and engineering teams to ensure all selected equipment can be effectively placed and
operated within the building design and fit Manage or assist with the procurement and delivery process of
new items Assist with the process and planning of any FF&FE that needs to be relocated from an existing
facility
● Manage the delivery, installation and sign off of new equipment
 MASTER PLAN
• Overall site

• Departmental boundaries

• Major entry and exit points

• Vertical transport

• Inter - departmental corridors

• Location of critical zones

• Energy conservation

• Future site development

• Appropriate way finding

• Services master plan

Space Planning
 Equipment planning ➢
● What is Equipment? What is Planning? Common Equipment Procurement Methods
➢ Process of Equipment Planning
➢ Coordination with Key Stakeholders
● Equipment versus Furniture, Fittings and ➢ Client Service and Technical briefs
Fixture Fixed Equipment versus Loose ➢ Service Brief
Equipment ➢ Technical Brief
● Exemptions in FF&FE for Equipment ➢ Obtain or Create Schedule of Accommodation
Planners ➢ Development of a Schedule of Equipment
(SOE)
● Stakeholder Engagement
➢ Assess the Need for Equipment
● Responsibility Matrix
➢ Development of a Services Package
● Education and Training of Clinical Staff ➢ Supplier Site Planning Guides/ Cut Sheets
➢ Define Builders Work in Conjunction with
● Greenfield versus Brownfield Sites Equipment
➢ Supply and Installation
● Project Delivery Phases ➢ Strategic Program Dates for Equipment
Definition, Delivery & Installation
● Design Phase
➢ Development and Implementation of the
● Schematic Design Procurement Project Timeline
● Design Development ➢ Equipment Specifications
● Construction Documentation
● Construction Phase
● Occupancy/ Commissioning Phase
 Functional Planning
“Form follows function”, is a principle associated with modernist architecture and
industrial design in the 20th century. The principle is that the shape of a building or
object should be primarily based upon its intended function or purpose.

1. As in planning of any other specialised service, persons with expertise and experience in the field are needed
to work as a team with the administrator and the architect, to develop a written programme.
2. Development of the functional programme depends mainly on the current and projected number of
services
required to be carried out, which in turn will depend on the number and types of patients to be served.
3. This input is translated into effective floor plans, areas, spaces, equipment, organisation and staffing.
 Functional Planning
4.Determining the number of workstations in each functional unit/division and deciding the linear bench space allotted for
each workstation.

5.Determining the major equipment and appliances in each unit. This is generally classified into:

i. Technical equipment peculiar to certain workstations

ii.Other equipment and appliances e.g. (refrigerators, hot air ovens, centrifuges) that can be jointly used by different
workstations or units.

6. Determining the functional location of each section in relation to one another, from the point of view of flow of work and
technical work considerations.

.
 Functional Planning
7.Identifying the electrical and plumbing requirements for each area/work station. Independent electric circuits are required for
electronic equipment items. Location of sinks and wash areas are vital for efficient performance of work stations.

8.Considering utilities, viz. lighting, ventilation (forced or normal exhaust, air-conditioning and air hygiene) and isolation of
equipment or work stations.

9.Working out the most suitable laboratory space unit, which is a standard module for work areas. A standard module
facilitates rearrangement of work units with least disruption and minimal structural changes