Hospital and its

Organizational Structure
 Hospital
 The hospital is a complex organization utilizing combination
of intricate, specialized scientific equipment, and functioning
through a corps of trained people educated to the problem of
modern medical science. These all work in a team for the
common purpose of restoration and maintenance of good
health
 WHO---- Integral part of society that provides diagnostic,
curative and preventive health care to population
 CLASSIFICATIONS OF
HEALTH CARE
 Primary Care
 Secondary Care
 Tertiary Care
 Primary Care
 Consists of basic curative care,
including simple diagnosis and
treatment, provided at the point of
entry into the health care system.
(Example: walk-in-clinic)
 Secondary Care
 Consists of specialized care requiring more sophisticated
and complicated diagnosis and treatment than is provided
at the primary health care level. Normally involves
hospitalization. (Example: Patient ward in general
hospital)
 Tertiary Care
 Consists of highly specialized diagnostic and therapeutic
services which can usually only be provided in centers
specifically designed staffed and equipped for this
purpose. (Example: Neonatal intensive care unit)
 Classification of hospital
 Based on Services
 i. General hospitals
 ii. Speciality hospitals
– Medicine Surgery
– Psychiatric and nervous disorder, Orthopaedic
– TB ENT
– Communicable disease Gynae/Obs
– Paediatrics Cardiology
 Based on ownership and
control
 i. Government/public hospital
– Armed forces
– Fedral Governmental, Provincial
Governmental (Disstt. Head Quarter, Agency
Head Quarter, Civil Dispensary, Social
Security, RHC, BHU
– Teaching Hospitals
 ii. Private Hospitals
– Trust based, Religion based, limited based,
private personnel, charity
On the basis of Size
–Large (upto 500 beds)
–Medium (upto 100 beds)
–Small (upto 25 beds)
 GENERAL HOSPITAL
 Provides primarily for the diagnosis and
treatment of patients for a wide range of
diseases or injuries.
 SPECIALITY HOSPITAL
 Provides primarily for the diagnosis and
treatment of patients for a limited range of
diseases or injuries.
 Organizational Structure
 Refers to levels of management
within a hospital.
 Levels allow efficient management of
hospital departments.
 The structure helps one understand
the hospital’s chain of command.
Organizational structure varies
from hospital to hospital.
 Large hospitals have complex
organizational structures. And Smaller
hospitals tend to have much simpler
organizational structures.
 Hospital departments are grouped in
order to promote efficiency of facility.
 Grouping is generally done according to
similarity of duties.
 Common Categorical
Grouping:
 Administrative Services
 Informational Services
 Therapeutic Services
 Diagnostic Services
 Support Services
 Administrative Services
Hospital Administrators
CEO, Vice President(s), Executive
Assistants, Department Heads
 Business people who “run the hospital”
 Oversee budgeting and finance
 Implement hospital policies and procedures
 Often perform public relation duties
 Informational Services
 Document and process information
Includes:
1. Admissions
2. Billing & Collection
3. Medical Records
4. Computer Information Systems
5. Health Education
 Provides treatment to patients
Includes following departments:
Wards, OPD, OT, ICU, CCU….
1. Physical Therapy - treatment to improve large muscle
mobility
2. Occupational Therapy - treatment goal is to help patient
regain fine motor skills (help with barriers that affect a
person's emotional, social, and physical needs)

3. Speech/Language Pathology - identify, evaluate, treat

speech/language disorders
4. Respiratory Therapy - treat patients with heart
& lung disease
5. Medical Psychology - concerned with mental
well-being of patients
6. Social Services - connect patients with
community resources (financial aid, etc.)
7. Pharmacy - dispense medications
8. Dietary - maintain nutritionally sound
diets for patients
9. Sports Medicine - provide rehabilitative
services to athletes
10. Nursing - provide care for patients
 Diagnostic Services
 Determines the cause(s) of illness or
injury
Includes:
1. Medical Laboratory - studies body tissues
2. Medical Imaging - radiology, MRI, CT,
Ultra Sound
 Support Services
 Provides support for entire hospital
Includes:
1. Central Supply - orders, receives, stocks &
distributes equipment & supplies
2. Biomedical Technology - design, build repair,
medical equipment
3. Housekeeping & Maintenance - maintain
safe, clean environment
 Board

Administration

Information Therapeutic Diagnostic Support

Services Services Services Services

Admissions PT, OT Med. Lab Central Supply

Billing, etc. Speech/Lang. Radiology Biomedical
Med. Records Resp. Therapy Nuclear Med Housekeeping
Computer Info. Pharmacy Cardiology Maintenance
Health Ed. Nursing Neurology Transportation
Human Resour. Dietary
 Management
 Governmental Hospitals----- MS
 Military---------------------- Commanding
officer
 Private Hospitals---- Governing Body
– Board of trustees
– Board of governors
– Board of directors
Functions of the Management
Responsible to
Provide the overall mission and goals of the
hospital
Evaluate its progress toward achieving the mission
and goals
Ensure that the hospital serves its community
Ensure financial appropriateness.
 THE HOSPITAL
ADMINISTRATOR
 Function is identical to that of the president
of any corporation.
 Individual styles are judged to be successful
if the determined results progress the
organization toward its goals.
 Administrative Challenges
 Internal
– Medical Staff
– Competition Between Health Professions
– Unions
– Physical Resources
– Size and Complexity of Organization
 External
– Government
– Funding
– Regulatory Agencies
– Public Demands
 Hospital Administrators
Require:
 Interpersonal skills
 Effective communications skills.
 Leadership skills.
 Functions of the Hospital Administrator

 Safeguarding the operating funds of the enterprise.

 Maintaining all physical properties (plant and
equipment) in safe operating condition.
 Representing the hospital in its relationships with
the community and other health agencies.
 Serving as liaison between the board or its
committees and the medical staff.
 Functions of the Hospital Administrator

 Submitting for board approval a plan of

organization and recommending changes when
necessary.
 Preparing a plan for accomplishing the
institutional objectives as approved by the board
and periodically reviewing and evaluating it.
 Selecting, employing, controlling, and discharging
employees.
 Submitting for board approval an annual budget.
 Functions of the Hospital Administrator

 Assisting the medical staff with its

organizational and administrative
responsibilities.
 Submitting to the board annual reports
which describe the nature and volume of the
services delivered during the past year.
 Advising the governing board on matters of
policy formulation.
 Medical Staff
 Licensed to Practice medicine or dentistry
 Backbone of healthcare institution
– active medical staff
– Associate medical staff
– Consulting medical staff (having recognised
professional abilities)
– Courtesy medical staff (given right to admit
patient occasionally)
– Honorary medical Staff (former, Retired, others)
 Doctors represent the
initiators of every action
that results in the direct
provision of patient care
services.
 Doctors determine:
 Who Will Be Admitted
 When
 Where
 What Medical Services Are to Be Provided,
in What Sequence, in What Dosage, With
What Equipment and Supplies When,
Where and by Whom
 Who Is Discharged and When.
 Pakistan Health Care Delivery
System
 Pakistan has a mixed health system that
includes public, parastatal, private, civil
society, philanthropic contributors, and donor
agencies.
 health care delivery to the consumers is
systematized through four modes of
preventive, promotive, curative, and
rehabilitative services
 The private sector attends 70% of the
population
 Public sector health care system
 Deliver healthcare through a three level healthcare
delivery system and a range of public health interventions.
 The first level includes Basic Health Units (BHUs) and
Rural Health Centers (RHCs) founding the fundamental of
the primary healthcare model,
 Secondary care encompassed first and second referral
facilities providing acute, ambulatory and inpatient care
through Tehsil Headquarter Hospitals (THQs) and District
Headquarter Hospitals (DHQs) and AHQs
 and tertiary care including teaching hospitals.
 Some government/ semi government
organizations like the armed forces,
parastatals such as Sui Gas, WAPDA,
Railways, Fauji Foundation and the
Employees Social Security Institution
provide health service to their employees
and their dependents through their own
system, however, these collectively cover
about 10% of the population.
 The major strength of HCDS of Pakistan is an
outreach primary health care services delivered at
the community level by Lady Health Workers
(LHWs), Lady Health Visitors (LHVs), and
Community Midwives (CMWs) who have earned
success and trust in the communities
 under article 18th amendment the health care
services are the obligations of provisional
government except for the federal area.
 Key Health Issue
 High population growth rate, infant and
maternal mortality rates, and burden of
communicable and non-communicable
diseases
 Human Resources
the number of public sector hospitals has increased to 1,279, Basic Health

Units (BHUs) improved to 5,527, Rural Health Centers (RHCs) were

increased to 686 and dispensaries to 5,671

 Medical Products
 Currently, a pharmaceutical industry of Pakistan is
rapidly developing and has 411 registered
manufacturing divisions and 30 multinational
companies across the country. It meets
approximately 80% of country’s demand and 20%
are being imported. The Drug Regulatory Authority
of Pakistan (DRAP) is the authority that set policies,
rules, and control pharmaceutical companies.
 The primary objective of the authority is to ensure
the quality, effectiveness, drug safety, implementing
the policies and guidelines.
 Information, Research, and
Technology
 Pakistan health system has an extensive
infrastructure spanning the country but has
inadequate resource i.e. drugs, instruments,
supplies, and technologies
 the limited use of information technology,
record maintenance, and unfitting
infrastructure can be observed in the health
system of Pakistan
 It lacks Health Management Information System
(HMIS) in public sector and has no well-defined
policy and plans for technology implementation,
telemedicine, and infrastructure development.
Moreover, most of the health care educational
institutions have limited tools and technology to
prepare the health professionals.
 At the national level the legislative framework for
health information that covers vital registration and
notable diseases reporting do not exist