See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/259389319

hospital administration

Chapter · March 2016

DOI: 10.13140/RG.2.1.2566.6327

CITATIONS READS

0 40,261

1 author:

Muhammad Irfanullah Siddiqui

Umm Al-Qura University
74 PUBLICATIONS   274 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

School-based Strategies for Oral Health Education & Examination of Adolescents View project

Effectiveness of Feedback and Students’ Satisfaction During Objective Structured Clinical Examination (OSCE) View project

All content following this page was uploaded by Muhammad Irfanullah Siddiqui on 28 December 2013.

The user has requested enhancement of the downloaded file.

36
Hospital Administration
and Management
Muhammad Irfanullah Siddiqui

Objectives
At the end of chapter students should be able to:
z Define hospital administration
z Describe the history of hospital development
z Enumerate the factors responsible for development of hospital
z Classify hospitals using different criteria.
z Describe the functions of hospital
z Enumerate the factors affecting distribution of beds in hospital
z Describe indices related to hospital and population.
z Apply different indices to solve hospital issues.
z Define hospital utilization.
z Enumerate factors affecting hospital utilization
z Describe the type of specialties available at various tiers of hospital.
z Define administration
z Describe role profile of administrator
z Define management
z Enumerate principals and functions of management
z Describe the elements of personal management
z Describe steps of personal management
z Design and monitor budget
z Define and concept of scalar principals
z Describe importance of nosocomial infection
2 Hospital Administration

It absorbs most of the (50% to 80 %) of health budget4. It is

Introduction not people oriented. Its procedure and style are inflexible. It
Hospitals which utilize most of the health budget play a overlooks the cultural aspect of illness, treating the disease
very important role in the country’s health system1. Hospital without treating the patient i.e., directed to pathological agent
Administration can not be done on intuition. A hospital ad- approach, rather than origin approach. It is intrinsically resis-
ministrator must be well aware of the scientific methods to tant to change. Fascinating for politician to spend money as
run and evaluate the hospital functions and services in an it is more tangible than expenditure on primary health care.
objective fashion. Comprehensive Health Care will remain dream as it eats
All the doctors should be having a good understanding of away most of the health budget.
hospital organization and management for better care of their WHO, UNICEF and NGOs worked together to change the
patients. Moreover they should also have enough knowledge role of hospital working in isolation, to involve primary health
for management of human, material and financial resources care. It started providing basic as well as referral services.
in a cost effective way with optimum time approach. It integrated preventive and curative health care, through
Hospitals are among the most complex organizations in primary health care centers.
modern society. The modern hospital itself is a universe,
with a variety of objectives, and a scalar division of labor to
achieve those objectives2. History Of Hospital Development
The word hospital is an Italian word derived from hospitality
Definition meaning to be guest.
Older concept of hospital for the provision of curative care It is represented by staff & serpent. Staff represents patient
is not valid any more. A hospital’s role is not only in the pro- while the serpent represents caring off (Figure 10-1).
vision of curative care, but an equally important role is, the
provision of preventive & promotive health care. Hospitals were not always taken in high esteem. The initial
hospitals were in alms houses in America, away from the city
A W.H.O. expert committee on organization of health care
and were used to keep the people of infectious diseases.
defined Hospitals as follows;
“The hospital is an integral part of a social and medical
organization, the function of which is to provide for the popu-
lation, complete health care, both curative and preventive,
and, whose out patient services reach out to the family and its
home environment; the hospital is also centre for the training
of health workers and for social research”3.
“Hospital without beds” is the latest concept about hospi-
tals. Preventive and promotive efforts should be so effective
that, the people should have optimum health with a minimum
need for curative consultation, and even less for hospital
admission.

Criticism Against Hospital

The public health physicians critically analyze the role of
hospitals in patient care. They argue;
Figure 10-1
Hospital exists in isolation and is beneficial to only one Generic Insignia for hospital
component of community.
Hospital Administration
Only people without family and homes were housed in
them, any one, of means, was cared for in home by their
families.
In the United States, the first modern hospital was the
Pennsylvania Hospital, founded in Philadelphia in 1751.
Slowly throughout 1800s other large facilities were built, such
as Massachusetts General Hospital. It was not until middle of
1900, however, that modern hospital became common1.
Mayo Hospital Lahore is the oldest hospital in Pakistan . 5
Factors Responsible For Development Of
Hospitals
The following factors played important role in the develop-
ment of hospitals.
z Advances in Medical Sciences
z Development of Technological Sophistication and Spe-
cialization
z Development of Professional Nursing
z Advances in Medical Education
z Contribution by Industrialist
z Support by Health Insurance
z Role of Government
The first influence on the growth of the modern hospital
was the ability to perform surgical procedures successfully.
This was the result of two important scientific advances.
The first was the discovery, in 1850s, of anesthesia. Before
anesthesia, the very best surgeon was the speediest one;
complicated procedures could not be performed because
of the pain associated with them. The advent of anesthesia
ushered in the golden age of surgery in the late 1800s.
The second major advance was the discovery of asepsis.
Patients undergoing surgery frequently developed postop-
erative infections. With the advent of asepsis the danger of
postoperative infection was reduced substantially.
These advances allowed surgery to become a major force
in the care of patients. Over 40% of total hospital beds are
surgical beds to understand the impact of these discoveries.
The more recent advances in outpatient surgical procedures
probably represent another turning point in the influence of
surgery on the system.
The19th century, saw the emergence of the biological revo-
lution. The discovery of the new sciences of microbiology
ushered in a new understanding of disease. The notion of the
etiologic agent as the cause of disease required fundamental
rethinking of diagnosis and treatment. New technology to as-
sist in the diagnosis and treatment of patients developed rap-
idly during that period. The discovery of the electrocardiograph
and the x-ray, illustrate the expanding role of technology.
The early laboratories and machines of this technological
3
revolution were primitive by today’s standards and were
physically very large. It made sense to provide a central
place, the hospital, where all physicians could have access
to this new technology. To this day, the hospital continues
to serve a major role as the repository of technology for the
community, although presently much is being done to move
this technology into non-institutional locations.
A third major development occurred in the nursing profes-
sion. Inmates provided what nursing care was available in
the early alms-houses. In the mid-1800s, during the Crimean
War, Florence Nightingale demonstrated the advantages of
professional nursing services on reduction of both mortality
and morbidity. She later introduced nurse training programs
in Britain and for hospitals in United States. The availability
of well-trained nursing personnel made hospitals much safer
and more pleasant places.
The training of physicians also has changed dramatically,
and this has been an important factor in the development
of hospitals. Before 1900, medical education in the United
States was seriously deficient. Most physicians were trained
in proprietary apprenticeships, with many lectures and little
exposure to patients.
The development of professional licensure was important
in the reformation of American Medical Education. Licensing
was based on an examination and graduation from an ap-
proved school. A second contributing factor was the Flexner
Report. Flexner reported that the existing medical schools
were grossly inadequate.
One school, however, stood out. This school, Johns Hop-
kins University, served as an example for others. The positive
features of this school were:
z Students were required to have a college degree before
they were admitted.
z The medical curriculum was 4 years in duration, with 2
years dedicated to basic sciences and 2 years to work
with full-time clinical instructors.
z The medical school was an integral part of a comprehen-
sive university.
z Faculty of the school was actively engaged in medical
research. Hospitals increasingly became the training site
for both medical students and residents, training for a
medical or surgical specialty.
Another development that was critical to the modern hos-
pital was the increasing health insurance coverage held by
the population. Health insurance was relatively unknown until
the 1930s. During the 1940s, there was a rapid increase in
the proportion of people who were covered.
Classification of Hospitals
Hospital can be classified in any of the following way;
A. According to type of services provided
B ccording to size or number of beds
4 Hospital Administration
C. According to ownership
D. According to duration of stay
A. According to type of services provided6
General hospital
These are the type of hospitals where different specialist
services are provided to both adult and children under the
same roof including Medical, Surgery, Pediatrics Gynae &
Obs., Cardiology, Dermatology, Orthopedic and Ophthalmol-
ogy etc.
Special hospitals
These hospitals deal with specific category of diseases
e.g. Eye hospital, hospital of cardiac disease, ENT hospital,
orthopedic hospital, kidney centre; or specific group of people
e.g. children hospital, maternity home; or specific disease
e.g. T.B Centre, Leprosy Centre.
B. According to size or number of beds7
Regional/Teaching hospital
These hospitals have more than 500 beds. They are at-
tached to medical colleges and have all types of specialties
and subspecialties e.g. radiotherapy, neurosurgery. Example
of this type of hospital is Jinnah Postgraduate Medical Centre,
Karachi & Mayo Hospital Lahore.
District Hospitals
Provide about fifteen specialties including Medical, Surgery,
Gynae & Obs. , ENT, Eye, anesthesia and dermatology and
have a range of beds from 100-600, example include Civil
Hospital, Thatta, Jacobabad, Attock etc.
Rural Hospital
It has capacity of 20 – 100 beds. It provides medical, surgi-
cal & obstetrical care only, e.g. Rural Health Centre Gharoo,
Rural Health Centre, Murad Memon Goth, Malir.
C. According to ownership
Public Hospital
These hospitals are owned and managed by government
and/or autonomous bodies e.g. Civil Hospital, Sargodha,
Pakistan Institute of Medical Sciences, National Institute of
Child Health etc.
Private Hospital
Owned by private people or entrepreneur, can be further
classified into.
a) Commercial
b) Non-profit
D. According to duration of stay
Long duration hospital; Stay more than 30 days as in lep-
rosy centre, orthopedic hospital etc.
Short duration hospital; Stay less than 30 days as in acute
diseases hospital. e.g. Eye hospital.
Functions of Hospitals
Following are the main functions of a hospital. It should be
kept in mind that all functions will not be carried out by every
hospital at all times.
a) Preventive & Promotive Care
This is the type of care which should be the main functions
of hospitals, for economic gain to the community in terms of
health benefit. It includes immunization against preventable
diseases, screening programs for detection of common health
problems & health education for personal hygiene, nutrition
and management of chronic diseases.
b) Domiciliary Service
This is another important service provided by hospitals. It
means “Treating the patient at home”. This helps not only in
decreasing the work load at hospital services, but, conser-
vation of resources which are already scarce. The hospital
administrator should create liaison with the private clinic
existing in catchment area.
c) Training
Hospitals are the most suitable places for, both, medical &
paramedical personnel. Theoretical lectures supplemented
by practical demonstration on patient will add to skill of the
trainee both at undergraduate and postgraduate level.
d) Research
Research is an integral part of hospital services. It is by this
means that most of the advances in the medical sciences
have been achieved. A good training regarding research
principals followed by the application of the same in the real
life situation helps in new discoveries.
e) Health Education
Health education means providing information to the people
to change their behavior in the positive direction. This is the
most neglected service, though most important one. This is
the most effective way of preventing disease and promoting
health in the community when a patient and his attendants
seek care, they are very receptive to the information about
the problem. Useful information can be provided through well
baby clinic, asthma clinic, diabetes centre and vaccination
canter, etc.
Hospital Administration
f) Curative Care
This is the service for which the hospitals are known to the
community since very long. It includes both outpatient and
inpatient care.
Outpatient: The focus of attention in hospital has gradually
shifted from the inpatient to the outdoor, i.e. the OPD’s. The
diagnostic procedures which previously required hospitaliza-
tion have become outpatient facilities and can be performed
there. This is also one of the major means of keeping the
patients out of the hospital. As outpatients are the first point
of contact between the patients and the hospital, it should
be well organized, well staffed and well equipped. Facilities
like laboratory, X-ray and pharmacy should be located near,
to avoid patient discomfort.
Filter Clinics are mandatory for outpatients departments;
now these are clinics where bulk of patients are seen and
those requiring special consultation are referred to the con-
sultants’ clinics.
Inpatient services: Previously the role of hospital was con-
fined to inpatient department only. All the inpatient depart-
ments should be in one block with free communication with
the supplies. The nursing station should be rightly placed
and sufficient numbers of nurses should be available for the
present number of beds. The general nurse to patient ratio
is 1:10. The desirable number of patients per ward is 10-20,
with one nursing unit. The ward could be divided into 2 rooms
with capacity of 10 beds each, or rooms with single, double
or four bed capacity. In all cases, adequate floor space per
patient is needed to prevent cross infection. There should be
adequate toilet facilities.
g) Accident & Emergency Services
This is an important component of hospital services. Hos-
pitals should be well equipped and staff should be properly
trained to meet the emergencies.
h) Disaster Management
This is another component of health services. Though di-
sasters are rare events, every hospital should have a disaster
management protocol, for the various types of disasters, and
staff should always be prepared through regular mock exer-
cises to deal with such situations. Types of disasters depend
on the catchment region of the hospital, for example, a hos-
pital in Baluchistan could prepare a earthquake management
protocol, whereas an hospital in the Punjab plains would lay
more emphasis on management of flood affected morbidity,
and in NWFP, for a sudden influx of refugees.
i) Geriatric Services
Census in 1998 shows a significant increase in the geriatric
population. Currently more that 1.5 million people are found
in 75 years + group and more will be added during the next
decade. Special arrangements should also be there to deal
5
with problems of old age people.
j) Physiotherapy
This is an important service and sufficient trained man
power should be there to deal with patients with chronic
diseases such as CVA(cerebrovascular accidents).
k) Ambulance Services
An effective ambulance service is a part and parcel of
hospital services to deal with emergency problem and hence
provision of timely care.
l) Laboratory Services
An efficient laboratory’s with all necessary reagent and
effective blood transfusion service, is a prerequisite of good
functioning hospital.
m) Social Medical Services
This is another neglected service. An effective social medi-
cal service will help in preventing the disease, promoting the
health in the community and thus preventing the load on
hospital services.
n) Medical Record Keeping
It is also a very important component of health services.
No effective planning can be done if the record keeping is
poor. This is one of the reasons why health conditions of the
communities have not improved.
o) Others
The support services provided by hospitals include;
z House Keeping
z Kitchen
z Medical Store
z Laundry
z Library
z Security
Factors Affecting Distribution of Beds
A hospital administrator has always to face the problem of
scarcity of beds as complained by various heads of depart-
ment. He should be well aware of the technique of justifica-
tion of distribution of beds for the various departments of
hospitals. Some of the factors effecting the distribution of
beds are as under and they should always be considered
before allocation of beds.
z Type of Hospital.
z Availability of Resources
6 Hospital Administration

z Prevalence / incidence of diseases 2. Average Length of Stay (ALOS)

z Accident and injury It is calculated by summing the bed days occupied by
z Male / Female ratio patients for a particular month and then dividing this figure
by separation.
z Level of Expertise
z Intensive Care Problems Separation may be defined as bed available due to the
following reasons:
z Community Program (Pressure)
z Premises / wards / theatre / kitchen z Deaths
z Financial Resources z Discharges
z Statistical Figure z Transfers
„ Average Length of Stay
Example:
„ Turn over period In a particular unit average bed days’ occupancy (ABO) by
„ % Bed occupancy patients of a particular month was 900 while separation was
„ Throughput 60. Work out ALOS.

ABO = 900 = 15
Hospital Utilization And Statistics ALOS =
Separation 60

The term “hospital utilization” denotes the manner in which

the community uses its hospital resources8. 3. Turn over period (TOP)
It is the statistical test which provides you the information
Since the modern concepts of hospital include curative, about the difference between the BED DAYS AVAILABLE
preventive, promotive, educational, domiciliary, in patient and BED DAYS OCCUPIED during a month with respect to
and ambulatory services, indices should be developed to separation.
evaluate all these components. The best known indices are
only for the in patient care so we will discuss only the indices It is calculated as following:
for in patient care.
ABA - ABO
TOP =
Some of the common indices used by hospital administrator (S)
to evaluate the in - patient care.
Example:
A. Indices related to hospitals In a hospital ABA=600, ABO is 400, while separation is 35,
calculate the TOP:
Basically there are three indices related to inpatient care
in hospitals. These are: 600 - 400 =
TOP = 5.7 Days
Bed Capacity (BC) which is defined as the average number 35
of beds during a specified period, Average Bed Availability
(ABA) which is the average number of beds available for
patients to be admitted, and, Average Bed Occupancy
4. Throughput (THROP)
It is calculated by dividing Separation with ABA/DAY
(ABO), which is the proportion of beds which are filled during
a specified period. The indices given below are derived from
these basic values: Example:
In a hospital separation was 50 during a month and avail-
z Bed occupancy rate (BOR) able no. of beds is 30/day. Calculate throughput.
z Average length of stay (ALOS)
S = 50 = 1.66
z Turn over period (TOP) Throughput =
ABA DAY 30
z Throughput (THROP)

1. Bed Occupancy Rate (BOR) B. Indices related to Population at Risk

It is calculated by dividing ABO and ABA
a) Admission rate
Example: Also known as hospital frequentation rate “(Fh)”, is usually
In a hospital ABO is 600 and ABA is 800 calculate BOR. compared as no. of hospital admission (‘A’) per thousand
population (P) per year however rate per person or per 100
ABO # 100 = 600 # 100 = persons may also be used.
BOR = 75%
ABA 800
Hospital Administration 7
A z Existence of proprietary hospital
Fh = # 1000
P z Housing
z Morbidity
b) Hospitalization rate per person (Hc) z Internal organization
This index represents the volume of hospitalization in terms
of number of hospitalization days per person per year. Specialties in a Hospital
It is calculated by dividing the total number of hospitalization
days in a year “H” by the mean population in that year “P”. A frequently asked question is, what specialties should be
available at Teaching Hospital (Regional Hospital), District
HC =
H Hospital (DHO), Tehsil Hospital (THO), and Rural Health
P Centre (RHC).
Following is the distribution of specialties.
c) Bed Occupancy Ratio
Bed occupancy ratio (Bc) is the average daily number of
persons hospitalized per unit of population. It is obtained by
At Teaching Hospitals
dividing the average daily number of beds occupied “N” by All specialties including subspecialties should be available.
the mean population “P” in the same year.

N # 1000
At District Headquarter Hospital (DHQ)
BC = At least following specialists should be available.
P
z Physician One
Factors Influencing Hospital Utilization z Surgeon “
While evaluating the hospital services, a hospital adminis- z Gynecologist “
trator must consider the various factors effecting the hospital z Pediatrician “
utilization. z Ophthalmologist “
The manner in which a certain community utilizes the z E.N.T. Specialist “
hospital bed and the extent of such utilization are influenced z Dermatologist “
by many factors that depend on the social, economic, edu-
z Pathologist “
cational, and cultural characteristics of the people and on
the attitudes and special habits of the medical profession. z Radiologist “
With regard to the latter, it may be presumed that the doctor z Anesthetist Two
orders or advise admission to a hospital primarily for medical z Chest Physician One
reasons; however, this is not always the case. Very often the z Cardiologist “
people themselves influence the decision for or against hos-
pital admission. Thus, in less developed communities, fear of z Orthopedic Surgeon “
the hospital or unwillingness to separate from the family may z Urologist “
be strong arguments against hospital admission, whereas in z Psychiatrist “
more sophisticated communities the hospital “habit” may be
such that a person may bring pressure to bear on the attend-
ing physician for admission to the hospital, even though there
At Tehsil Headquarter Hospital (THQ)
may not be objective reasons for this course of action. The At least 10 specialties should be available which are also
main factors which affect hospital utilization are as under; available to DHQ excluding Chest Physician, Cardiology,
Orthopedic, Urology and Psychiatry.
z Availability of Hospital beds
z Methods of payment of hospital services
At Rural Health Center (RHC)
z Age of the population
Medicine, Surgery, Gynecology and Obstetrics and prefer-
z Services coverage & bed distribution ably pediatric facilities should be available.
z Availability of extramural medical services
z
z
Hospital bottle necks
Medical custom and social patterns
Administration
z Supply of physician Administration includes the following activities termed as
z Research and training POSD CORB (Guillick).
8 Hospital Administration
Planning, organizing, staffing, directing, coordinating,
reporting and budgeting.
The term “hospital administration” covers a large number
of activities which may roughly be classified into three cat-
egories.
z Preparation of hospital legislation, planning of the hospital
system as a whole, determination of international policy,
regulation for the operation of hospitals, establishment
of architectural control and standards.
z Application of hospital legislation and of social assis-
tance provision by the authorities responsible for the
management of hospital services whether they be local
or regional, public or private.
z Daily running of the hospital by the administrative staff
concerned with personnel, finance accounts and techni-
cal services.
Role Profile of Administrator
z Ability to see ahead and plan accordingly: planning for
the future while managing the present.
z Ability to produce and accept new and creative ideas,
being an agent of change.
z Willingness to take risks to get the new ideas accepted
and implemented.
z Ability to co-ordinate, bringing about harmony, collabora-
tion, organizing, allocating resources and controlling.
z Ability to analyze, synthesize and integrate diverse infor-
mation.
z Sense of equity, fairness and social justice, in all dealings
within and outside the hospital.
z Knowledge, skills and experience.
z Ability to delegate, making effective use of own time and
that of others.
z Good personal motivation and ability to motivate the
people working in the hospital.
z Ability to review and evaluate, making adjustments as
necessary.
Role of Administrators
The Administrator reports to the Governing Body (or other
higher authority such as Director of Health Services, Secre-
tary to Government, etc).
Persons Reporting Directly to Administrator
z Medical Superintendent
z Nursing Superintendent
z Associate Assistant Administrators
z Coordinator, Community Health Programs
z Principal, School of Nursing, where there is a school of
Nursing.
Management
Management is an old process and has existed ever since
man has been organized into communities. It is sometimes
thought to be a process of 20th Century but this is not so.
Where and whenever people have worked together in-groups
to grow crops, to buy and sell, to wage wars, to build a temple,
there was management.
The most comprehensive way to define management is:
Management is a key process. The function of management
is to enable our patient/doctor/nurse team to do their job as
easily, efficiently, economically, effectively and as humanly
as possible so that they can develop and maintain a caring
environment within the Hospital. OR
It is the process of organizing, using and controlling human
activities and other resources towards special end9; OR
Management is a process whereby resources in term of
people, finances, equipment and facilities are mobilized, ide-
ally in an efficient and effective manner to serve the purposes
of an institution.
Resources are;
Men
Money
Materials
Machinery
Methods
Principles of Management
The major principles are:
z Unity of Command
z Span of Control
z Homogenous Assignment
z Delegation of Authority
Functions of Management
The main functions of management include the following:
z Planning
z Organizing
z Staffing
z Leading
z Controlling
Planning
Planning involves selecting the mission, goals, objectives
and actions required. It is defined as setting objectives, deter-
mining resources and selecting courses and requires decision
making i.e. choosing future courses of action from among
alternatives. It can be defined as “deciding what is to be done
and how it is to be done”. Planning must aim at the fulfillment
Hospital Administration 9
of the hospital’s role in terms of the appropriateness, quality, Recruitment and Selection
quantity and cost of the health care provided. The aim of recruitment is to ensure that the organization’s
demand for manpower is met by attracting potential employ-
ees in a cost-effective and timely manner.
Organizing
This includes the identification and classification of the
required activities. The activities are then grouped together Steps in Recruitment
and each group of activities is assigned to a manager, through Job Analysis
the process of delegation both horizontally, among the dif- It has two components;
ferent managers on the same level, and vertically from the
superiors to subordinates. Job specification
This is that part of Management that involves establishing It is a summary of the knowledge, skills and personal char-
an international roles for the people. acteristics required of the job holder to carry out the job to an
acceptable standard of performance.

Staffing Job description

This involves filling and keeping filled the positions in the The job description describes information about the job
organizational structure. concerned viz title of job, overall purpose of the job, principle
responsibilities, location of job, grade/salary level of job etc.
Leading/Directing The purpose of job description is to define exactly for a
This is influencing people, so that they will contribute to the worker, fellow worker and supervisor:-
organization and group goals in an effective manner.
z How much is his authority?
z What is his responsibility?
Controlling z What the worker is expected to do?
This is the measuring and correcting the activities of the
subordinates in order to ensure that the events conform to z What standards he is expected to reach?
the plans. z To whom he is responsible?
All the above activities need to be backed up by the process z Whose work he supervises?
of coordination by the manager/administrator at all levels. Job description helps each worker to know clearly and with-
out doubt what his duties are and what he is expected to do.
Elements of Management Such job descriptions should be interpreted flexibly, as per
guidelines.
The following are elements of management.
Attracting the Application
A. Personal Management
By advertisement
B. Financial management The aim of job advertisement is to attract sufficient numbers
C. Material Management of the right kind of candidates. It should include details about
D. Time Management the position of the job, employing organization, candidate
requirements-essential/desirable, the salary indicator etc.
A. Personal Management Evaluating Applicants
The function of caring for staff in the organization is known It is a process of scrutiny of the applicant for their qualification
as “Personnel management”. In the hospital services with and experience for the required post.
very few specialists, the effective management of staff lies
on the shoulders of departmental heads. Selection
The aim of selection is to identify applicants most likely to
Steps of Personal Management fulfill the requirements of the organization. The initial selec-
z Human Resources Planning tion of candidates on the basis of their application form is
called short-listing.
z Recruitment and Selection
Placement and Development
Human Resource Planning After selection of personnel a very important task for the
This is information decision making process designed to
management is assigning proper duties and responsibilities
ensure that enough competent people and appropriate skills
according to the skills and qualification of the person.
are available to perform jobs where and when needed.
10
B. Financial Management
Financial management is one of the very important tasks of
management and deals with how to spend money and get
maximum benefit for the organization.
Budget
“Budget is formal financial statements of policies, plans
and goals that are designed to assure that actions are taken
within boundaries laid down by top management”.10
OR
“It is numerical statements of program showing the pro-
posed or estimated schedule of expenditure in coming years
keeping in view the estimated income of next year”.
Budget may be;
Developmental
This part of budget used for a new process of expenditure
usually for a limited period usually prepared according to
annual developmental program and called Annual Develop-
mental Budget.
Non Developmental (Recurrent)
This is that part of budget which an organization needs for
its non-developmental activities. e.g.,
z Salaries
z Travelling
z Other daily expenditure e.g., bills
Monitoring of Budget
Monitoring means keeping an eye on expenditure of budget
to see if expenses are according to the schedule or not, and
to avoid inappropriate use of funds.
Tools for Monitoring
z Monthly statements
z Excess statements
z Accounting
z Auditing
Auditing
This is an analysis of proposed or past expenditure with
respect not only to their legality but also to their desirability.
This is of 2 types.
Pre Audit
Audit taking place prior to payment.
Post Audit
Audit done after payment has been made.
Audit Objection
If the auditors are not satisfied with any transactions, they
Hospital Administration
discuss it with the managers and if manager fails to satisfy
them, an audit objection is submitted to Public Accounts
Committee.
C. Material Management
It is the planning, purchasing and maintaining of different
items used in the hospitals. The job of a hospital administra-
tor is to ensure;
“The supply of right thing at the right place, at the right
time and at right cost”11.
It involves:-
z Correct planning
z Sticking to time needs
z Correct purchasing procedures
z Standardization
z Stock control tools
z Documentation for audit
D. Time Management
Time is one of the most important resources. Time is like
central nervous system i.e. it cannot be regenerated once
destroyed or wasted.
Hospital administrator should be able to control and use-
fully consume the time of his subordinates for the welfare of
the patients.
This can be done by making correct duty rosters for the
organizations and see to it that everything is done according
to schedule.
The management of time is an issue, which is fundamental
to job performance.
The Scalar Principle
This implies delegation of authority to the various staff
members in responsible positions. The principle is applicable
not only in hospital administration but also in other areas of
Health Sector. The power to execute the functions may be in
the context of financial requirements, but also in connection
with leave sanctions, disciplinary action and job performance
as well as complaints.
If an Administrator or a Director has to be approached by a
lower sanctioning officer, he should follow a series of steps, as
for example: If the Resident MO has to approach the Direc-
tor, he is required to go through the scale, while the reverse,
Director to Summon the residents he is also required to fol-
low the channel down the scale. However this depends on
the nature of event. In an emergency, the resident may have
to establish contact with the director without going through
the ladder. Likewise the director may, depending upon the
circumstances, call for a lower ranking staff member directly
Hospital Administration 11
without following the channel. This principle equally holds
good in financial sanctions and other areas.

References
1. Last JM, Wallace RB (editor) Maxcy Rosenaue-Last public health and
preventive medicine- 13th ed. Connecticut Appleton & Lange 1992 page
1066-8
2. Willson RN. The social structure of a general hospital in medicine and
society. The annals of the American Academy of Political and social
sciences. 1963;346:67
3. WHO technical report series No 261, 1963
4. Park K Park’s text book of preventive and social medicine 20th ed.
Jabalpur, Banarsidas Bhanot. 2009
5. http://en.wikipedia.org/wiki/Mayo_Hospital
6. Davies RL, Macaulay HC.(ed) Hospital planning and administration.
Geneva. WHO. 1966.
7. WHO Technical report series 1957 122, 17
8. Smith BA. Hospital costs and utilization. In: Davies RL, Macaulay
HC.(ed) Hospital planning and administration. Geneva. WHO. 1966.
Nosocomial Infection 9. Rhea JC, Ott JS, Shafritz JM. The dictionary of health care management.
New York. Facts On File. 1988
Nosocomial infections, i.e. infections acquired by patients 10. D o t y P , L i u K , Wi e n e r J . . A n o v e r o f l o n g - t e r m c a r e
H e a l t h C a r e F i n a n c i n g R e v i e w. 1 9 8 5 ; 6 ( 3 ) : 6 9 - 7 8 .
in the hospital have become more of a problem in human abs.sagepub.com/cgi/content/refs/30/2/143
medicine, because of increase in drug-resistant microbial 11. Sand R, Parnell RW. Ed. The Advance to Social Medicine; Eng. trans.
strains as well as increases in the use of invasive procedures by Rita Bradshaw. New York-London: Staples Press, 1952. 655 pp.
for patient support and monitoring. Nosocomial infections http://www.sciencemag.org/cgi/content/citation/117/3027/19-a
are also expected to become a more serious problem in
veterinary medicine for similar reasons.
The exact prevalence of the nosocomial infections is not
known, but there are reasons to believe that this is a sig-
nificant public health problem, particularly in the developing
countries where sanitary conditions fall short of the required
standards.
Studies carried out in hospitals of the US showed, urinary
Index
tract infections, surgical wound infections, lower respiratory
and blood stream infections in varying degrees.
A
The mode of infection is either through direct contact or
through fomites. Vehicular transmission through food, water Accident & Emergency Services 5
and vectors has also been noted. The hospital administration Administration 7
has the responsibility of hand washing provision for the hos- Persons Reporting Directly to Administrator 8
pital staff of all categories and the patients and maintenance Role Profile of Administrator 8
of sanitary standards at all levels, as preventive measures. Ambulance Services 5
Auditing 10
Acknowledgment Average Bed Availability 6
Average Bed Occupancy 6
Part of this chapter has been taken from the previous Average length of stay 6
chapter 4th ed. written by A Sattar Tabani, Aamir Waseem Average Length of Stay (ALOS) 6
Khan, Sabiha Khurshid Ahmed, Aamir Omair. For this we are
thankful to authors. B
Bed Capacity 6
Average Bed Availability 6
Average Bed Occupancy 6
Bed occupancy rate 6
Bed Occupancy Rate (BOR) 6
Budget 10
Monitoring of Budget 10
Tools for Monitoring 10
12 Hospital Administration

C M
CRITICISM AGAINST HOSPITAL 2 Management 8
Curative Care 5 Controlling 9
Elements of Management 9
D Financial Management 10
Disaster Management 5 Function of Management 8
District Hospitals 4 Human Resource Planning 9
Domiciliary Service 4 Job description 9
Job specification 9
F Leading/Directing 9
Material Management 10
Factors Affecting Distribution of Beds 5 Organizing 9
Factors Responsible for Development Of Hospitals 3 Personal Management 9
Factors Responsible For Development Of Hospitals Planning 8
Advances in Medical Education 3 Principles of Management 8
Advances in Medical Sciences 3 Recruitment and Selection 9
Contribution by Industrialist 3 Staffing 9
Development of Professional Nursing 3 Time Management 10
Development of Technological Sophistication and Specializa- Medical Record Keeping 5
tion 3
Role of Government 3 N
Support by Health Insurance 3
Financial Management 10 Nosocomial Infection 11
Budget 10 P
G Physiotherapy 5
General hospital 4 Preventive & Promotive Care 4
Geriatric Services 5 Private Hospital 4
Public Hospital 4
H
R
Health Education 4
History Of Hospital Development 2 Regional/Teaching hospital 4
Hospital Administration 2 Research 4
Definition 2 Rural Hospital 4
Hospital Administration and Management 1 S
Hospitals 2
Administration 7 Scalar Principle 10
Classification of Hospitals 3 Social Medical Services 5
Factors Influencing Hospital Utilization 7 Special hospitals 4
Functions of Hospitals 4 Specialties in a Hospital
Hospital Utilization and Statistics 6 At Teaching Hospitals 7
Management 8 At Tehsil Headquarter Hospital 7
oldest hospital 3
Specialties in a Hospital 7 T
Hospital without beds 2 Throughput 6
I Throughput (THROP) 6
Training 4
Indices related to hospitals 6 Turn over period 6
Indices related to Population at Risk 6 Turn over period (TOP) 6
Admission rate 6
Bed Occupancy Ratio 7
Hospitalization rate per person 7

L
Laboratory Services 5

View publication stats