Hospital Administration - Introduction & Overview

HOSPITAL MANAGEMENT – INTRODUCTION &
OVERVIEW
Brigadier General Dr Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
North South University (NSU), Bangladesh

What is Hospital?
The English words hospital, hostel, hotel, and hospice are all
etymologically related to the Latin noun hospes—a word having the
diametric meanings "a guest or visitor" and "one who provides
lodging or entertainment for a guest or visitor."
The word ‘patient’ comes from ‘patior’, which is to suffer. Hence a
hospital can be interpreted etymologically as a place where
strangers who suffer come to be cared for.
Patior Who suffer Patient

Definition of Hospital
WHO Expert Committee, 1963:
‘A hospital is a residential establishment which provides short-term
and long-term medical care consisting of observational, diagnostic,
therapeutic and rehabilitative services for persons suffering or
suspected to be suffering from a disease or injury and for
parturients. It may or may not also provide services for ambulatory
patients on an out-patient basis’.

WHO expert committee, 1956:
‘The hospital is an integral part of a social and medical organization,
the function of which is to provide for the population complete
healthcare, both curative and preventive, and whose out-patient
services reach out to the family in its home environment; the
hospital is also a centre for the training of health workers and for
bio-social research’.

Society is a group of people with common values and culture in a
defined geographical territory. Society consists of the people and
institutions around us, our shared beliefs, and our cultural ideas.
Social Organizations are the institutes who promote the welfare of
the society, and facilitate the needs of it.
Common examples include Colleges, businesses, political parties,
police, universities, hospitals, mosques/temples, families, and any
people or groups that have social interactions.
Why Hospital is called Social Organization?
Society
People Social Inst
Common
values &
Culture
Together
serve their
needs

Criteria of Social Institute:
• Is part of the society
• Takes input from society (Resources, manpower etc)
• Gives output to the society (Healthcare)
• Involves members of the society in its activities (Local authority,
local politicians, patients)
• Serve the needs and welfare of the society
To be
Social
Institute
Part of
Society
Takes
input
from
Society
Gives
output
to
society
Involves
society
in its
affairs
Serves
interest
of
society

Because of these interconnectivity, interactions with people and other
institutions and its contributions to meet the health need of the
society; hospital is called a Social Organization.
Hospital
Input
(Patients,
Manpower,
Resources)
Involvement
(Local authority,
population)
Aim is to fulfill
healthcare needs
of the
population
Output
(Healthcare
Service)

EVOLUTION OF HOSPITAL
Historically, hospital as a organization has passed through different
phases:
1. Centre of religious practice (Antiquity to Franco-Roman period-
3rd Century): The history of hospitals began in antiquity with
hospitals in Greece, the Roman Empire, Indian subcontinent, ancient
Mesopotamia and China. Hospices, initially built to shelter pilgrims
and messengers of various bishops. Priests treated their patients
mainly in temples by religious dictates and prayers.

2. Poor-houses (Upto 10th century): By putting the sick and the poor
in homes, they were taken out of public view. The idea was that in
that way they would not constitute a danger for the rest of society. It
aimed primarily at offering a place to stay, food, and perhaps some
medical treatment like cleaning wounds, applying some plant
medicines etc for sick travelers.

3. Knights Hospitals (War Hospital )(10th-13th Century)
From 10th-13th century, hospitals were built to treat the wounded
and sick crusaders marching from Europe to Jerusalem. Treatments
mostly consist of amputation, wound cleaning, blood-letting and
religious rituals. Example: St John Hospital

4. Arab Hospitals (7th-15th Century)
During this time the contributions of the Arabs in medicine was
significant. Hunayn (809–873 A D) wrote more than 100 medical
books. Ar-Razi wrote 200 books. Ibn Sina (980–1037 A D), is perhaps
the best known physician from medieval times. Cairo Hospital, Al-
Mansuri Hospital in Cairo, Al-Nuri Hospital, Syria were famous. Arabic
treatment consisted of therapy by exercises, baths, diet, remedies
like herbs, their extracts, organic salts, surgery, music therapy, story
telling, dancing etc.

5. Death houses: During 17th century, early hospitals in Europe were
breeding grounds for infection and provided only the most primitive
facilities for the sick and dying, many of whom were housed on
wards with little ventilation or access to clean water. As a result of
this squalor, these places became known as 'Houses of Death‘.

6. Modern Hospital (18th century): In the Age of Enlightenment (18th
century), the modern hospital began to appear, serving only medical
needs and staffed with trained physicians, surgeons and nurses. The
development of medical knowledge and technology spurred a
change in the way hospitals operated and a rising role for physicians
within them. By new scientific discoveries, innovations and most
modern machineries have changed hospital industry in to a
technology and knowledge-based institution. From mere treatment,
there was paradigm shift of care to consumer satisfaction.

In the slide, there is a group of people working on some puzzles
together and fixing the problem to attain success. Whenever there
are group of people, having a common goal to attain, there has to be
a plan, that plan has to be organized, works have to be identified and
distributed, coordination has to be established among them, and
direct the group efforts with resources to attain success.
Management is manage people and their works.
Concept of Management

Why and when Management is important?
40,000 years before, a group of people called Neanderthal habited
our planet earth. They had unique pattern of living. They lived a
lonely life confined in the boundary of family. So, there was no social
effort in any activities, and there was no exchange of skill among
themselves.
Australopithecus Homo Habilis Home Erectus Cromagnun
Neanderthal Homo Sapiens

Nearly, 10,000 years before, another group of people called the Cro-
magnan came to our earth. They were social, got involved in any
activities in group. In doing so, there evolved a pattern of
‘management’ among themselves to organize the collective action
with hiererchy. When, Neanderthal and Cromagnan faced each other
in the race for limited food resources, Cromagnan better organized by
their group ability and management strength eliminated the
Neanderthal.

Importance of Hospital Management
• Helps to set and achieve goals
• Provides a sense of focus and direction
• For optimum utilization of resources
• To maintain responsibility and order
• To get the most qualified personnel for the job
• To reduce workload and get things done
• Helps facilitate good communication
• Helps to initiate action and keep the organization moving
• To monitor progress and chart a way forward
• To hold individuals accountable

What is Management?
Management is the art and science of getting things done with and
through people, in a formally organized group.

Management is the process of creating and maintaining an
environment in which individuals working together in groups,
efficiently accomplish selected aims.

Science vs Art
SCIENCE ART
Objective Subjective
It has theories and hypothesis It is abstract
Phenomena can be explained
by science
Can not be explained by theory
It is scientifically established
fact
It is philosophical
Logical Rational imaginative
Advances by knowledge Advances by practice
It proves It feels like

Management process is how inputs are systematically processed by
management functions to make an output. Feedback is taken to
adjust or correct inputs for desired quality or quantity of output.
Management Process

Hospital Administration - Introduction & Overview

Level of Management
First-line manager
First-line managers are managers who perform on-the-ground
management duties in the closest contact with the non-managerial
employees. They are directly responsible for making sure that
organizational objectives and plans are implemented effectively. In
hospital: Ward Master, Nurse Incharge etc.

Mid Level Manager
Middle managers have titles like department head, and chief
supervisor. They are links between the top managers and the first-
line managers. Middle managers receive broad strategic plans from
top managers and turn them into operational plans for first-line
managers. In hospital: Head of the Dept, Manager CSSD, Manager
ICU, Manager OPD, Manager Linen and Laundry Service etc.

Top Level Manager
Top-level managers are the “bosses” of the organization.
These top managers are responsible for setting the overall direction
of a company, lay down organizational goals, policies and strategy,
responsible for resource allocation, approval of budget. Typical titles
of top managers are Director Hospital, Chief Executive Officer,
President and Vice president.

Functions of Various level of Managers

Administration
Administration and management are sometimes synonymous in
vocabulary.
But, technically, Administration is defined as an act of administering
policies within an organization. Administration mainly focuses on
formulation of plans, policies, procedures, setting up of goals,
objectives, rules and regulations.
Management focuses on execution of plan, by managing people and
their works in line with given policies.

Administration is the strategic part of management, is the act of
making policies and plans, and management is the operational part
of management, is the act of executing the strategic plan.

Management Functions- Admin vs Management

• Operations Management.
• Financial Management.
• Human Resource Management.
• Legal Responsibilities.
• Communications.
• Material Management.
• Hospital Waste Management.
• Quality Control.
• Public Relations.
• Conflicts Resolution.
Managerial Responsibilities of Hospital Manager

Operations Management
It is concerned with converting materials and labor into goods and
services as efficiently as possible.
The function of operation management is basically concerned with
daily routine operations of an organization.

Financial Management
Financial management is concerned with procurement and
distribution of money to attain organizational goals.
Financial management often accounts for approximately a quarter of
the healthcare administrator’s major responsibilities.

Human Resource Management
The healthcare administrator is responsible for recruitment of
employees, training and development, placement, retention,
motivation, compensations and benefit, reward and punishment,
maintaining discipline, performance management, dealing with
labour union, negotiation etc.

Legal Responsibilities
Legal issues loom large in the medical profession. So keeping current
on laws and regulations is one of the health administrator’s most
important responsibilities. Managers should create a safe working
environment, maintain a compliance program for laws and
regulations, deal with adverse events, torts related to medical
treatment, healthcare ethics, comply with accreditation and licensure
requirements, have up-to-date knowledge on health related
regulations. SOPs to deal with Brought in Death Case, Sexual Assault,
death investigations, certifying the cause and manner of unnatural
and unexplained deaths, issuance of certificate of wound etc.

Legal Issues in Healthcare
Organ Transplantation Law 2018
Mental Health Law 2018
Foreign specialist doctor, nurse policy 2018

Communications
The exchange of information, ideas or thought from one person to
the other is communication. Managers must be able to receive
accurate information to determine plans, and they must be able to
send accurate information for the plans to be implemented.
Communication thus helps understand people better, removing
misunderstanding and creating clarity of thoughts and expression. It
also educates people.

Quality Management
Quality management is the act of overseeing all activities and tasks
needed to maintain a desired level of excellence. It is management
activities and functions involved in determination of quality policy
and its implementation. Example: Quality assurance, quality control,
Medical Audit, TQM etc.

Material Management
Material Management is the coordinated function responsible to
plan, acquire, store, move and control materials to provide customer
service in accordance with organizational goals.
Materials constitute 60 to 70% of the expenses in a hospital, hence
the efficient buying and utilization is desired.

Hospital Waste Management
Hospital Waste Management means the management of waste
produced by hospitals using such techniques that will help to check
the spread of diseases. In developing countries, every patient
generate 1-2 kg of hospital wastes everyday.

Conflict Management
Conflict management is the practice of being able to identify and
handle organizational conflicts sensibly, fairly, and efficiently. It is the
process of dealing with disagreements arising from, for example,
diverging opinions, objectives, and needs.

Public Relations
Public Relations (PR) is the practice of managing and disseminating
information from an organization to the public in order to affect the
public perception. Public Relations builds and maintains a positive
public image for an organization. They create press releases and
messages, that shape public opinion of the company or organization
and increase awareness of its brand.

Leadership vs Management
In any organization or group setting, there are individuals that other
people seem to just gravitate toward. These people tend to have
great motivation, a clear and positive vision and are very good at
communicating. They have the ability to influence people for a
purpose., and inspire trust and confidence in other members.
There is a common quote about the difference between manager
and leader; “Managers have subordinates, leaders have followers”.

Leaders s Manager
Basis for
Comparison
Leader Manager
Management
function
Performs only one
function - direction.
Performs all five
functions - planning,
organizing, staffing,
directing, and controlling.
Authority Informal authority by
virtue of his/her
personal qualities
Formal authority due to
his/her positional role.
Approach Proactive Reactive
Key Attribute Foresightedness Prompt decision making
and coordination
Subordinate Followers Sub Ordinates
Aims at Motivating and
inspiring people
Driving and Controlling
employees

Hospital Administration is getting quite popular as a career option,
and more and more people are going for it. Hospital Administrator
is in a unique position to help create an environment for the doctor
and other healthcare force to work conveniently, with satisfaction,
in an equipped and adequately staffed premise.
Without the leadership role of a competent Hospital Administrator,
a hospital is like ‘a ship in the vast ocean without a compass’.
CONCLUSION

References
1. Hospital Administration. DC Joshi, Mamta Joshi. Jaypee Brothers
Publishers
2. Hospital and Healthcare Administration. Shakti Gupta, Sunil Kant.
Jaypee Brothers Publishers
3. Principles of Hospital Adminsitration & Planning. BM Sakharkar.
Jaypee Brothers Publishers
4. Hospital Administration. CM Francis, Mario C De Souza. Jaypee
Brothers Publishers
5. Managing a Modern Hospital. AV Srinivasan. SAGE Publications
6. Management- A Global Perspective. Heinz Weihrich, Harold
Koontz. Mc Graw Hill Inc

Class Assignment
.
Mr Abdur Rahmen is the incharge of a pharmacy of a hospital. Dr
Parvez Faisal instructed him to reduce the price of pharmacy items.
What are their levels in the hierarchy of management? Differentiate
their functions and skills.

Hospital Administration - Introduction & Overview

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