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HOSPITATS AND HEATTH.SYSTEMS

Health System is collection of organizations and institutions whose mission is to
positively impact health outcomes
o interdependent and unified
o provide enhanced levels of patient-care continuity through access to medical
records and patient care providers

flEALTrr\ SYSTFMS

1.

LONG TERM HEALTH CARE FACILITY

institutions, such as nursing homes and skilled nursing facilities that

provide healthcare t.o people who are unable to manage independently in
the community
mdy represent custodial or chronic care rnelnilgement or short-tcrm
rehabll ltatll'e services
Camillus MedHaven Nursing Home, [,iltle Sisters ol'the Poclt'

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2.
.

RESIDENT TREATMENT FACILI'IY

provide safe, hygienic living arrangements for residents
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.

3. CLINIC
. ambulatory

patients are seen by appointment, treated by a group of

physicians practicing together, and where the patient is not confined

4. AMBULATORY

5.

SURGERY CENTER

patients are admitted, surgical procedures are performed and patients

are discharged follor,r'ing assessment

HOSPICE

o
.

provides end-of-life care

help people who are dying have peace, comfort, and dignity

6,

CORRECTIONAL FACILITIES
place used for confinement of convicted criminal

7.

HOSPITALS

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HISTORICAT.PERSPECTIVES OF HOSPITALS : DEVELOPMENT AND

EXPANSION
Hospitals have emerged over the years from almshouses for the sick poor,
asylums for the care and confinement of orphans and the mentally ill, sanatoriums

for long-term care of tuberculosis patients and victims of other chronic diseases,
hospices for the terminally ill, and infirmaries for short-term acute care.

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Early examples of healing centers where the god were implored, physicians
praeticed medicine, and apprentices learned the arts of healing,

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Temple of Aesculapius (Greek god of Medicine) existed in 1.134 BC

Temple at the lsland of Kos, Greece was where Hippoerates (born ahout 460
BC), the t'enowned Iather of Medicine, practiced Medicine arrd Pharmacy.
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Patients w'lto came to these temples were diagnosecl, treated, ancl cared fbr
until they were able to return home, Services available from these templos include
herbal remedies, mineral baths, exercise, fresh sea air, and sunshine. Admission
records and other medical records are inscribed in the columns of these temples.

Hospitals were often endowed by citizens who frequently cared

volunteers.

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1.
2.

Fabiola, a wealthy Roman woman, donated her(place)for the care of the sick
and injured and personally cared of their needs.
The spread of Christianity brought the teachings of Jesus to the care of the
sick and infirm. During the 4tl,century A.D., bishops were required to provide
a shelter for the care of the sick in each diocese.
Maimonides, famous rabbi, inf'luenced health care by his teachings and
'ruorks.

Prayers of Maimonides - for many years completed the pledge of service

made by pharmacists as they completed school and began professional
practice.
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Middle Ages
Medical advancement came close to a standstill. A church edict in 1163
forbade clerics from performirrg any surgery that causes a loss of blood. Monks are
the primary health care practitioners during this time, so surgical procedures were
eliminated

The Black Plague {-L347-1.350) killed almost one-third of the inhabitants of

Europe. Although most people were cared for and/or died in their own
homes, many eithel died on the street or were brought to overcrowded
hospitals. Hotel Dieu, one of the finest hospitals in Europe at that time, was
reported to dismiss up to 500 bodies a day to be buried during the height of
ihe plague.

Renaissance period
Hospitals were beginning to emerge from Dark Ages, Hospitals begin to take
shape into military hospitals which functioned during the revolufiona.y War ln New
York (Manhattan), Pennsylvania (Lilitz), Massachusetts, and other aieas of batt[e.
Nonmilitary hcspitals came into existence in New Amsterdam, New york, Salem,
Massachusetts and Philadelphia, Pennsylvania.

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The Hospital of the Holy Spirit vras founded in 71.7 and was one of the
Iargest hospitals in Europe.
o provided personal care for the patients with special attention to diet
o soon became a major site for the educa tion of lay physicians
o contained an impressive library of medical literature

2.

The Hospital of the Immaculate Conception in Mexico Cit was the flrst
hospital on the American continent builr by the Spaniards (led by Cortez) in

t524

3.

the name was changed to The Hospital of Jesus of Nazareth in 1663

The Philadelphia General Hospital started in 17L3 as an almshouse to give

relief to the sick, the incurables, the poor, and orphans and abandoned
infants.
fonathan Roberts r,vas recruited as the pharmacist and enjoys the
reputation of being the first American hospital pharmacist.

4.

The Pennsylvania Hospital established in 1.751 was the first incorporated

hospital in the united States through the efforts of Dr. Thomas Bond.

5.

The Massachusetts General Hospital was founded in Boston, and was the
first hospital to use general anesthesia in surgery.
. Dr. Crawford Long performed the first operation with anesthesia.
. soon chloroform and ether became standard anesthetic agents which
allowed for more frequent,less painful surgery

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The Union Hospital in Georgetown, Virginia was described in detail by

Louisa May Alcott in her published book Hospital Sketches as having
conditions of poor sanitation and depressing environment.

Throughout the centuries, persons afflicted with mental heatth problems

were often secluded from society in confined custodial care. These are reflected in
the story of Bethlehem Hospital in London, where it was called Bedlam ('l'he word
continues in the English language to convey the idea of confusion and disorders).

L. In Arab

Countries, the attitudes were more humane and compassionate,

Asylums for psychiatric patients were built to provide gardens, fountains,
pleasant music, and a healthy setting where drugs, baths, and good nutrition
were given to lhe patients.

2. In ltaly, mental hospitals were built in which patients are treated in

humanistic way,

3. ln Belgium,

Saint Dymphna was murdered by her deranged father who was

the King ol'lreland and pursued hrs daughter in rage after she had f'led his
abuse. She was the
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4.

In the Uttited States, Benjamin Rush, a physician, introduced new methods of

treetment for psychiarrlcs patients based on moral prlnetples.
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Nineteenth Century
There is the continuecl manner of dealing with mental patients by separating
them from family and society, still that time the term asylum is still substituted for
the term hospital. The grcwth in the number and size of mental hospitals were
tremendous and half of the hospital beds in the United States were occupied by
mentalpatients.

Middle of the Twentieth Ccntury

The use of psychiatric drugs and various psychiatric treatment methods

allowed many patients to leave custodial care and assume the activities of daily
living in society.

Norar

Deinstitutionalization - large number of persons were discharged to

communicate and in some cases fend for themselves in the streets,
supported b1' civil liberty group. State governments were only too
t"'illing to unlturden themselves of the financial responsibilities
involved in institutional care, what seemed to be a humane approach
only increasecl the number of homeless in society

sffelts are bcirrg made of professionals to develop srnall

facilities for their care.

housing

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Period ofChange

Wars of the 20th centuryhave seen significant changes in hospitats and healrh
care delivery systems.

W'orld War I

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brought about the need to care for patients suffering from major trauma,
burns, pol*on gai, and lnfectlons of all klnds
hospitai designs reflected these needs in dealing with the masses of injured,
maimed, and sick
ships designed as floating hospitals were in great demand to handled large
number of casualties away from the battlefield; they were also used to
transport the sick under treatment to land based institutions

World War II

major advances

in

trauma surgery, the introduction

of

systemic

sulfbnamides, penicillin, and the wide use of blood and plasma for
transfusion
volume of injured itrcreased and very large hospitals were built to provide
the services needed
cadet Nurse Corps were employed during the early 1940s to answer the
need for large numbers of professionally trained people to nurse the sick
new forms of treatment of war injuries were developed
PT's and OT's came into being
emotional problems rcsulting from the war gave new impetus for hospital
facilities to dealwith war-related psychiatric patients

Other factors that influenced the development and expansion of hospital

include:
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The Flexner report ott rtedical education (1910), which caused revolutionary
developments in medical education per se and in medical internship training,
which helped the devclopment of minimum standards for patient care in
hospital surroundings.

2.

The activities of Florr':tce Nightingale during and after the Crimean War,
which served as the brsis for revolutionizing the quality of nursing care in
hospitals and for thc, , , ,,,slopment of schools of nursing.

3' The public interest in hospitals

through the greater dependence and

improved confidence in hospital care.

Modern Health Care

Tuberculosis sanatoriums a1d poliomyelitis facilities are examples of

treatment centers that are outmoded by new therapy. The famed William parker
Hospital of New York was declared obsolete after drug and antibiotic treatments
reduced contagion and the need for isolation in hospital buildings.
More recently, ambulatory treatment of childhood disease has caused
dramatic reduction for the need for pediatric hospital beds.
One

of the most significant

governmental programs that affected the

development and expansion of hospital facilities was the adoption (in t9a6) by the
Congress of the Hospital Survel' and Construction Act. Commonly known as the HillBurton program, this act provided federal funds for hospital construcLion on a
matching basis with local communities. In addition, the Social Security Amendments
of 1965 (Medicare) had a long-range impact on the development and erpansion of
hospitals because funds are made available to pay services of medically indigent
patients.
Technology continues at an accelerated pace, making real what only few
years ago appeared to be science fiction. New technology has resulted in shorter
hospitalization and has given rise to home health care. For example, cataract
surgery in the 1930's and 1940's was followed by a long postoperative recovery.
The patient was housed in a darkened room and the head immobilized between
sandbags. Now surgery is performed on an ambulatory basis with the patient going
home the same day, once surgery is completed.

As the 20th century closed, the demand for service, the method of
reimburserrLent for health care services, and the practice of medicine will greatly
infltrenced hospitals. Most assuredly the awesome specter of AIDS will have a great
impact in the remaining years of the century. Hospitals will continue to clrange and
grow or diminish as medical biotechnology, scienre, economics, politics,;ind putrlic
concerns assert their influence. As a result of these factors hospitals will continue to
develop these own special character.

Beyond the three basic essentials of human existence (ie, food, clothllg,
shelter), the hospital has become a necessary instrument for providing the fourrh
basic element of survival - health. tlealth care has come to be defined ai a right fbr
all, rather than a luxury for a few. The hospital serves as a major instrument through
which health professions are able to provide health care to the people of the
community.