ARABEURO

Safety Engineering and Technology Solutions Pvt. Ltd.

Diploma in Hospital
Administration

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Element A2:

Role of Hospitals
in Health Care
Learning Outcome


2.1
Environmental Health Services:

Environmental health services are

considered as a component of public
health, with overlaps.

It covers the following:

1. Water supply
2. Pollution control
3. Sewage disposal
4. Food hygiene
5. Ecology and environmental pollution.
Public Health Services Public health
services are concerned with the
following.

1. Control of communicable diseases

2. Sanitation
3. Maternal and child health
4. Public health education
5. Vital statistics
6. Health planning
7. Occupational health and reduction
of health hazards.
Personal Health Services Personal
health services are the services
provided by hospitals, health centres
and nursing homes, apart from
privately practising physicians.
The care provided has been
traditionally classified into:

i. promotion of health,

ii. prevention of disease,

iii. early diagnosis and treatment,

and

iv. rehabilitation.
Promotion of health

Promotion of health is not directed

at any particular disease and is
generally considered the
responsibility of the individual.

Good health practices promote

health through adequate nutrition,
exercise, rest, personal hygiene,
health screening and health
education.
 Health promotion programmes aim
at physical and mental fitness, diet,
alcohol and drug abuse, recreation
and genetic counselling.

All concerned with medical care, i.e.

doctors, nurses and auxillary medical
staff are among the pepole actively
concerned with the promotion of
health.
Prevention of Disease

Primary prevention is a service

designed to protect against specific
diseases through immunisation, use
of specific nutrients and protection
against occupational hazards and
accidents.
Multiphasic health screening, annual
medical examinations and
surveillance of individuals and
groups with susceptibility to certain
diseases falls under secondary
prevention.

Prevention of disease and accidents,

e.g. refraining from smoking and
alcohol, wearing appropriate
protective clothing at work and
wearing helmets while driving are
matters of personal habits.
Primary, Secondary and Tertiary care:

Treatment services are categorised

as primary, secondary and tertiary
care.
Primary care is the entry point into
the health system and usually
obtained through family physicians
and through the hospital-based
ambulatory outpatients services—
besides the community health
workers and multipurpose workers at
the grass-roots level.
Secondary care services are at an
intermediate level in the chain of
hospitals.

The services of smaller peripheral

hospitals and general hospitals
would fit in this category.
Tertiary care refers to highly
specialised care in specialist
hospitals and speciality services
provided in superspeciality centres
and research centres.
Rehabilitation

WHO defines rehabilitation as “the

combined and coordinated use of
medical, social, educational and
vocational measures for training or
retraining the individual to the
highest possible level of functional
ability”.
Apart from restoration of function
(medical), rehabilitation medicine
involves disciplines such as physical
medicine, occupational therapy,
speech therapy, education,
vocational guidance.
Health Team

Achievement of health and medical

care can best be a joint function of
many professional groups of workers
like physicians, nurses, paramedical
workers, health educators, health
visitors, public health engineers and
many others who share a common,
unifying goal.
The health care team which consists
of all those who are involved in
improving health in a community
setting, without necessarily being in
active contact with patients.
The medical care team which
consists of those professionals and
paraprofessionals who provide
service for the patient generally in a
hospital setting, but without any
direct or personal contact with the
patient.
The patient care team which
comprises any group of professionals
and semiprofessionals in a hospital
setting who jointly provide service
that brings them into direct contact
with the patient
THE CHANGING ROLE OF HOSPITALS

With the wide coverage of every

aspect of human welfare as part of
health care—viz. physical, mental
and social wellbeing, a reachout to
the community, training of health
workers, biosocial research, etc.—the
health care services have undergone
a steady metamorphosis, and the
role of hospital has changed, with
the emphasis shifting from:
i. acute to chronic illness
ii. curative to preventive medicine
iii. restorative to comprehensive medicine
iv. inpatient care to outpatient and home
care
v. individual orientation to community
orientation
vi. isolated function to area-wise or
regional function
vii. tertiary and secondary to primary
health care
viii. episodic care to total care.
HOSPITAL VIEWED AS A SYSTEM

Management science defines a system as

“a collection of component subsystem
which, operating together, perform a set of
operations in accomplishment of defined
objectives.”

A system is viewed as anything formed of

parts placed together or adjusted into a
cohesive whole.

Every system is therefore a part of a large

system and has its own subsystem.
A system is construed as having inputs
which undergo certain processing and get
transformed into output, the output itself
in turn sending feeback to the input and
the process, which can be altered to
achieve still better output.

A system is therefore a continuous and

dynamic phenomenon.
Peculiarities of a Hospital System

1. A hospital is a open system which

interacts with its environment.
2. Although a system generally has
boundary, the boundaries separating the
hospital system from other social systems
are not clear but rather fuzzy.
3. A system must produce enough outputs
through use of inputs. But the output of a
hospital system is not clearly measurable.
4. A hospital system has to be in a dynamic
equilibrium with the wider social system.
5. A hospital system is not an end in itself.
It must function, as a part of the larger
health care system.
6. A hospital system like other open social
systems tends towards elaboration and
differentiation, i.e. as it grows
 Table 1.5: Hospital as a system

Input Process – Transformation Output

People Communication: Between E
A. Staff F
• Physician • Physicians and patients F
• Nurses • Physicians and nurses I
• Paramedical • Physicians/nurses and paramedical staff C
• Supportive • Physicians and administrator I
• Administrator and community E
B. Patients, their attendents and relatives • Administrator and nursing/paramedical staff N
Material • Nursing/paramedical staff and patients T
• Drugs and chemicals
• Equipment P
• Diet Decision Making A
Money For T
• To maintain staff, facilities and • Cure: Diagnosis, treatment I
procure materials • Care: Creature comforts of patients, diet E
• Procurement of materials in right N
place at the right time T
Action
• Putting decisions into practice C
• Balanced mix of communication, decision- A
making and action R
E
Fig. 1.2: Components of a hospital system
INTRAMURAL AND EXTRAMURAL
FUNCTIONS OF HOSPITAL

The activities of the present day hospital

can be divided into two distinct types—
intramural and extramural.

Intramural activities are confined within

the walls of the hospital, whereas
extramural activities are the services which
radiate outside the hospital and to the
home environment and community
Intramural Functions of a Hospital

1. Restorative

a. Diagnostic : These comprise the inpatient

service involving medical, surgical and other
specialities, and special diagnostic
procedures.
b. Curative : Treatment of all ailments
c. Rehabilitative : Physical, mental and
social rehabilitation
d. Care of emergencies : Accidents as well as
diseases
2. Preventive

a. Supervision of normal pregnancies and

childbirth b. Supervision of normal growth
and development of children
c. Control of communicable diseases
d. Prevention of prolonged illness
e. Health education
f. Occupational health
3. Education

a. Medical undergraduates
b. Specialists and postgraduates
c. Nurses and midwives
d. Medical social workers
e. Paramedical staff f. Community (health
education)
4. Research

a. Physical, psychological and social aspects

of health and disease
b. Clinical medicine
c. Hospital practices and administration
Extramural Functions of a Hospital

1. Outpatient services
2. Home care services
3. Outreach services
4. Mobile clinics
5. Day care centre
6. Night hospital
7. Medical care camps
The Providers, Support Group and
Community

The hospital being a distinct, albeit integral,

part of the health service, is influenced by
all the above mentioned factors and the
health services in turn influence those
factors.

It has to deal with three different groups

which from the larger community.
1. The first group is the “providers” of
medical care, viz. the doctors, nurses,
technicians and paramedical personnel.
2. The second group is management,
administrative and support group
comprising of personnel dealing with
nonclinical functions of the hospitals, such
as diet, supplies, maintenance, accounts,
housekeeping, watch and ward, etc.
3. The third group and the most important
one for whose benefit the first two groups
exist in the first place, is that of the patients
who seek hospital service and their
attendants, relatives and associates who,
along with patient come in close contact of
the hospital.

This group is broadly termed as the

“community.”
PRIMARY HEALTH CARE (PHC) AND
HOSPITALS

Realisation of the importance of the role of

hospitals in primary health care (PHC) was
generated as a result of the International
conference on Primary Health Care held at
Alma Ata in the erstwhile USSR in 1978
jointly sponsored by WHO and UNICEF
PHC is a concept providing comprehensive
health care, i.e. promotive, preventive,
curative, and rehabilitative services covering
the main health problems in the community.

Hospitals have an important role in fostering

and encouraging the growth of primary
health care.
Elements of Primary Health Care Eight
essential elements of PHC as described by
the WHO are as follows.
1. Adequate nutrition
2. Safe and adequate water supply
3. Safe waste disposal
4. Maternal and child health and family
planning services
5. Prevention and control of locally endemic
diseases
6. Diagnosis and treatment of common
diseases and injuries
7. Provision of adequate drugs and supplies
8. Health education
Benefits to the Health Care System

Tremendous costs are incurred everytime a

patient is treated in a hospital who could
well be treated in an efficient PHC facility
which is inexpensive, avoiding the overuse
of the hospital by unnecessary patient self-
referral.
PHC as Entry Point into Hospitals

In large cities there is marked tendency to

bypass primary care facilities in preference
for the teaching hospital resulting in primary
and routine care workload on specialised
services, defeating the special role of such
hospitals.

Opening PHC units within the premises as

the first entry point to the hospital for such
routine direct cases will reduce avoidable
routine workload for specialised outpatient
departments (OPD).
Development of a PHC Policy by Each
Hospital

To decide the scope and extent of the PHC to

be provided by it, every hospital will have
first to prepare a PHC policy and strategy.

The policy statement should outline the

essential points to be included and then list
the actions needed ensure putting the policy
into effect.
1. Organising a two way referral system
from mobile and outreach clinics to the
hospital and referral back with reports for
follow-up
2. Backing up the referral system with
medical records
3. Organising visits of hospital specialists to
outreach clinics
4. Carry out training and reinforcing skills at
PHC workers by visiting specialists
5. Giving preferences to patients referred
from PHC centres for specialist clinics and
for admissions.
Support Function

1. Providing logistics support in respect of

equipment, materials, drugs and other
supplies

2. Reinforcing diagnostic capabilities of PHC

workers and outreach clinics

3. Providing transport for referrals and

outreach services

4. Making hospitals facilities available for

training and retraining of PHC workers.
The technological advances in the field of
medical sciences have provided clinicians
with more esoteric aids to diagnose and
treat illnesses.

Clinics and communities will continue to

pressure hospital management to provide
such advances even though they will be very
costly.

Not only pressures will increase for

providing newer technological capabilities,
but there will be growing demands for such
care
Hospitals will be catering more and more to
the needs of patients in fragments, which:

i. will lead to more and more specialised

hospitals in place of general hospitals which
provided medical, surgical, obstetric and
gynaecological, ENT, paediatrics, etc. under
one roof
ii. people will medical care
iii. hospitals will require more and more
management skills as administrators at each
level
iv. will lead to growth of corporate hospitals
and modern management concepts
v. will be capital intensive
vi. will be technology intensive
vii. ascendancy of technical expectations
over human values.
Preventive Medicine, Health Promotion and
Hospitals

The scope of medical examination and

treatment is being extended gradually to
take care of the post-sickness conditions and
the importance of rehabilitation of sick and
disabled people is being emphasised.

The scope of medicine is also expanding to

include “pre-sick” conditions of human
beings.
Rising Mental Illness, Heart Disease and
Cancer

The myth that underdeveloped or developing

countries are not as much susceptible to
degenerative, mental or cardiovascular
disorders and cancer has been recently
exploded.

India now faces the unenviable task of not

only curbing the high incidence of
communicable diseases but also checking
the rapid rise of noncommunicable diseases
like mental illness, heart disease and cancer.
Geriatric Care

A national Sample Survey had revealed that

45 per cent of the elderly population (viz.
about 27 million) sufferes from chronic
diseases.

Old age is associated with growing incidence

of heart disease, high blood pressure,
osteoarthrosis, cognitive disorders, prostate
enlargement and cancer and urinary tract
infections.
Development of New Management
Practices

Exchange of knowledge pertaining to

hospital practices by consultation and
coordination among hospitals, and on the
same lines consultation and guidance in
administrative matters including costs,
purchasing, personnel and other phases of
hospital administration would promote
efficient utilisation of personnel and
finances.
MARKETING OF HOSPITALS

Marketing can be a useful function that

should not be rejected summarily because of
the sanctimony attached to health care
activities.

Promotion, including advertising is not

inherently bad but is an important
communication activity

The word “customer” is not a dirty word.

Strategic Planning

Diligent promotion of the marketing concept

is changing professional attitudes as it
challenges the institution to provide services
that consumers want and will pay for.

Strategic planning is that set of decisions

and actions which lead to the development
of an effective strategy to achieve the basic
objectives of the hospitals, viz. quality
patient care at a reasonable cost and
achieving excess revenue over costs.
Marketing of Medical Services

Hospitals will have to be more receptive to

marketing management philosophy which
involves many conceptually new approaches
within the framework of strategic planning.

With increasing health insurance coverage,

price competition becomes an appealing
marketing tool.
We can anticipate competitive pricing
schemes, use of incentive premiums, new
attitude towards admissions, discharge, food
service, “package pricing” obstetrical family
participation programmes, and similar other
changes designed to attract and service
patients and his or her family members.

A competitive health care industry, with

carefully devised marketing strategies for
market product combinations is an emerging
alternative to a heavily regulated and
socialised system.
Specialty Hospitals

Medical science has expanded laterally to

include the conditions surrounding sick
people.

Specialised hospitals are coming up in many

places in recent years, e.g. those for cancer
and cardiovascular diseases, geriatric
hospitals, paediatric hospitals and perinatal
hospitals.
Proliferation of specialty
hospitals
End of Element A1:

Role of Hospitals
in Health Care
ARABEURO
Safety Engineering and Technology Solutions Pvt. Ltd.

International Diploma in
Occupational Health and Safety

This is the sole property of A 65