introduction to hospital

INTRODUCTION TO HOSPITAL

APPROACH ADOPTED TO UNDERSTAND THE SUBJECT

UNDERSTAND HOSPITAL AS A FUNTUTIONAL INSTITUTION AND AS PART OF A SOCIAL SYSTEM

PURPOSE AND FUNCTIONS OF HOSPITAL MANAGEMENT

A MAN IN THE SOCIETY

Difference between Health care & Medical care ???

HEALTH CARE FACILITY AS A

SYSTEM MATRIX.

HOSPITAL

POLITICAL SYSTEM

BUREAUCRACY

CULTURE & RELIGION

INDUSTRY.

ECONOMY

MEDICAL TECHNOLOGY

APPLIED DISCIPLINES

HUMAN RESOURCES

HOSPITAL IS THE MOST VISIBLE FACE OF THE HEALTHCARE INDUSTRY

IT IS NOT JUST A BUILDING BUT A COMPLEX SOCIAL INSTITUTION COMPOSED OF

MANY SUBGROUPS REPRSENTING A VARIETY OF INTERESTS & DIVERSE NEEDS

IT HANDLES THE DYNAMICS OF LIFE & DEATH SITUATIONS

DURING THE PROCESS OF RENDERING HEALTHCARE

HOSPITALS ARE THE MOST COMPLEX HUMAN

ORGANISATION EVER DEVISED

Peter Drucker

TODAY

HOSPITAL BUILDINGS ARE THE MOST COMPLEX

BUILDING FORMS

INTEGRATION OF DEVELOPING TECHNOLOGIES INTO

HEALTHCARE DELIVERY

IS MAKING HOSPITALS MORE COMPLEX

HOSPITAL : DEFINED

Hospital (health care facility?) is an integral part of a social system and medical organization, the function of which is to provide for the population complete health care, 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

Practice of Medicine, as an organised entity, first appeared

5000 years ago in the ancient region of Southwest Asia known

as Mesopotamia. (Also known as cradle of civilisation) This

civilisation made its contribution in Political, Educational and

Healthcare fields to the later developed cultures in India,

Persia, Hebrew and Egypt.

The first recorded Doctor’s prescription came from Sumer in

ancient Babylon under the rule of dynasty of Hammurabi (1728

– 1686 BC).

Hammurabi’s code of law

provides the first record of regulation of Doctor’s practice as

well as regulation of their fees.

The ancient Greeks built temples and sanctuaries that were the

Hospitals of the time: a network of libraries, stadiums, baths,

theatres, gymnasiums, altars, sleeping rooms -- all were

included in the hospital experience.

Hippocrates (480 BC) is considered the first person who

developed the rational and non-religious approach to practice

of medicine. He started to use auscultation, perform surgical

operations and record detailed patient histories and

descriptions of various diseases ranging from Tuberculosis to

Ulcers. The temples of Saturn, Hygeia and Aesculapius were

the Hospitals and Medical schools in his time.

In ancient civilisations of Hindus, Greeks and China, one can

find mention of various natural systems of healing which are

being rediscovered today as Yoga or Acupuncture. There are

descriptions of large gathering houses, where these systems

were practised by groups of people. These places constituted

the ancient Hospitals or Sanatoriums.

The earliest dated hospitals are seen in excavations attributed

to Dravadian culture. These are big pavilions, where priests

cared for the sick. These are built close to water reservoirs.

There are descriptions relating to use of certain surgicaL

instruments for some invasive procedures. The presence of

separate rooms indicates departmentation.

Historical records show presence of efficient hospitals, akin to

present day Hospital in Indian continent around 600 BC. Later,

followers of Lord Buddha built a very large number of

Hospitals for infirm and destitute. The Buddhist Lamas were

trained as Doctors to work in these Hospitals. There are huge

libraries devoted to Medical knowledge in various monasteries

around the world. This knowledge is being reviewed now and

applied afresh as Tibetan Medicine.

During 273 –232 BC, King Ashoka established a very large

number of Hospitals especially for the Mother and Child. These

hospitals followed the principals of sanitation – not much

different from what we see today. It is said that operations

similar to caesarean section was routinely carried out in these

Hospitals.

Ruins of an ancient hospital built in fifth decade of the 2nd century BC, at Mihintale in Sri Lankaby Mahinda, king Asoka’s son

Excavated Herbal Bath

EXCAVATED EDICTS

Stupa built next to hospital

DAKKHINAGIRI MONASTERY NEXT

TO HOSPITAL

The Romans, known for their talent for organisation

established infirmaries for the sick slaves. They also

established garrison Hospitals for their army. These garrison

Hospitals were equipped to treat all kinds of war injuries.

In 335 AD, a decree of Emperor Constantine closed the temples

of Aesculapius. This stimulated the growth of Christian

hospitals. The wealthy Romans converted to Christianity built

a large number of Hospitals. Over the years, especially during

the epidemics, the places of religious gathering all over the

world acquired the status of Hospitals. The Roman Catholic

Church played a big role in establishing such hospitals along

with the churches all over Europe and America.

PLAN OF A MEDIAVAL

HOSPITAL EXCAVATED IN

NORWICH IN UK SHOWING

PRESENCE OF THE

CHURCH

THE CHURCH

During the seventh century, Islamic civilisation provided

efficient and effective Hospitals, which were far superior to

Roman Hospitals. The Persian Hospital in Djoundisabour built

in 6th Century in Turkey is an excellent example of Islamic

Hospital. These Hospitals had department of pharmacy and

chemistry. They established separate asylums for insane

persons.

Some of the best known ancient hospitals are Medical School

of Damascus, Baghdad and Cairo. The Medical School of

Damascus had an extensive library. The patient history and

treatments were documented. There were different wards for

different diseases.

In 9th century, when the inter country trade got suppressed, the

religious communities assumed greater social significance

and started caring for the sick. Soon, the Hospitals started

degrading and only the hopeless and homeless went to

Hospital.

In 1155, first religious order devoted to Nursing – St. Augustine

Nuns was established. In 1198, First Pope Innocent III urged

wealthy Christians to build better Hospitals.

Hotels-Dieu in Lyons & Paris are the public hospitals built in

that era & are still in existence. Founded by Bishop Landry in

660 AD, the Hospital had grown over the years & in the year

1300, it was caring for nearly 1000 patients. Its capacity was

doubled in year 1500. Another building was added to the

complex in 1700 linked by Pont-au-Double. In 1880, these

buildings were replaced with present day structures.

Hotels-Dieu Paris

The Hotel-Dieu founded by Nicholas Rolin and his wife in 1443Funded by the income from 130 acres of Burgundy's finest vineyards, & salt production

It functioned as a hospital until 1971, when it was replaced by a modern hospital It's now a museum, it is well preserved because it has been used

28 Bedded Main Patient Room

Hotels-Dieu Paris

St. Bartholomew’s Hospital (London, 1123), Santo Spirito Hospital (Rome, 1204), St. John Hospital (Bruges, Belgium, 1200) are some other examples of Hospitals which have survived till date. The 2000 bed Knight of St. John Hospital in Jerusalem built in 12th century is another example of an efficient, well-organised Hospital, which has survived till date.

In England, the traditional role of the Catholic Church in healing and medicine declined as Herny VIII broke away from Rome. The closure of monasteries by him and the resulting loss of medical expertise was a spur to the development of the medical profession, which then developed outside it's religious origins. He encouraged and gave authority to physicians, granting the charter for Royal College of Physicians in 1528 and Royal College of Surgeons in 1506. This encouraged better management of Hospitals and scientific orientation to process of Healthcare.

HOSPITAL OF ST. BARTHOLOMEW

First Royal Charter granted in 1133 by King Henry I to set up a hospital

This charter was accompanied by a deed and a seal

The oddest feature of medieval hospitals to the modern

mind is that not all of them cared for the sick. Those that

did might be selective. At Bridgwater, there was this

written directive displayed:

No lepers, lunatics, or persons having the falling sickness or other contagious disease, and no pregnant women, or sucking infants, and no intolerable persons, even though they be poor and infirm, are to be admitted to the house; and if any such be admitted by mistake,they are to be expelled as soon as possible.

And when the other poor and infirm persons have recovered they are to be let out without delay.

This last rule has a pleasingly optimistic ring

Treatment was limited and many who entered a hospital would leave it only for the grave

Yet recovery was envisaged

In America, first Hospital was set up by Columbus in village La

Isabella in Hispaniola (Santo Domingo).

In Mexico, Conception Hospital was established in 1524, which

is still active today.

The Pennsylvania Hospital founded in 1751 was the first

Hospital to charge fees from its patients.

New York Hospital founded in 1771 was the first Hospital built

by private citizens by forming a society.

The first woman doctor of United States, Elizabeth Blackwell

and her sister started the New York Infirmary for Women &

Children in 1853. This was a privately owned Hospital.

The United States Marine Hospital service act, 1798 is the first

federal act providing for Health insurance. The premium for

Healthcare was deducted from the seamen wages. This led to

fast growth of marine hospitals and there were 30 Marine

Hospitals built in 63 years. These very hospitals later became

Veterans Affairs Hospitals from 1926, which later became the

foundation for third party payment provisions in Hospitals.

They also provided for tax trade-off and rebates for serving the

poor.

The earlier hospitals required that poor patients to do

housekeeping works and assist hospital staff in their routine

work while full paying patients were given amenities like a

Hotel room and were served as guests.

These provisions led to competition amongst Hospitals.

Discoveries in Medical Science Technology started having

their impact on Hospitals during the early eighteenth century.

The hospital grew in number, consolidated their hold on

delivering effective Healthcare and systematised their working.

The fruits of all medical discoveries were being made available

in shorter time span. The rich were willing to pay for

experimentation, which was usually carried out on poor

patients, and once results were assured, the rich accepted the

treatments.

This trend brought the much-needed capital required for

experimentation and growth of Healthcare technology.

The history of Hospital planning acquired a status of its own

during the life of Florence Nightingale.

PENCIL SKETCH OF FLORENCE NIGHTINGALE BY SIR GEORGE SCHARF (1857)

In 1893, Florence Nightingale said, “I look to the day when

there are no nurses to the sick but only nurses to the well”

Her vision was far ahead of its time. Now everyone is talking

about wellness centres, prevention, and health promotion.

Nightingale was also quite an expert in hospital design, and it

is said that administrators at Johns Hopkins had to send their

plans to her to be approved before they could build their

hospital. She founded the first nursing school (in 1860).

Her 1859 book, Notes on Nursing, outlines how the environment

impacts a patient & how it should be used as a tool to further the

healing process.

Her chapters on the “Health of Houses,” “Noise,” “Bed and bedding,”

“Light,” “Cleanliness,” & “Variety” illustrate how she advocated

using the environment as a healing tool.

She wrote, “In watching disease, both in private houses and public

hospitals, the thing which strikes the experienced observer most

forcibly is this, that the symptoms or the sufferings generally

considered to be inevitable and incident to the disease are very often

not symptoms of the disease at all, but of something quite different --

of the want of fresh air, or of light, or of warmth, or of quiet, or of

cleanliness, or of punctuality and care in the administration of diet, of

each or all of these.”

About lighting, she wrote, “A dark house is always an unhealthy

house, always an ill-aired house, always a dirty house. Want of light

stops growth and promotes scrofula, rickets, etc., among children.

People lose their health in a dark house and if they get ill, they cannot

get well in it again.”

She wrote about noise, “Unnecessary noise, then, is the most crucial

absence of care, which can be inflicted either on sick or well....

Unnecessary (although slight) noise injures a sick person much more

than necessary noise (of a much greater amount).”

In addition, Nightingale wrote, “The effect in sickness of beautiful objects, of a variety of objects, and especially of brilliancy of colour is hardly at all appreciated. Such cravings are usually called the 'fancies' of patients .… but much more often, their (so-called) 'fancies' are the most valuable indications of what is necessary for their recovery. And it would be well if nurses could watch these (so-called) 'fancies' closely.”

For the first time since Florence Nightingale, healing environments have become an important factor in the design of spaces for the ill. Much has been written about it; research is beginning to validate its worth; and, bottom line administrators are starting to desire it.

The importance of Nightingale's concept itself was twofold.

One that she made a synthesis of the European, French and British knowledge at that time. Undoubtedly, she knew and appreciated the tremendous efforts made in

France in the late 17th century, after the burning of the Paris' Hotel Dieu, fully documented in literature.

Two - She added the profession of nursing to the new hospital.

WARD 4, LINCOLN HOSPITAL, PAVILION TYPE WARD MODEL PICTURE COURTESY, NATIONAL LIBRARY OF MEDICINE

WARD 4, LINCOLN HOSPITAL, PAVILION TYPE WARD COURTESY, NATIONAL LIBRARY OF MEDICINE

TYPES OR CLASSIFICATION OF HOSPITALS

SPECIALITIES BASED

GENERALSUPER

SPECIALITIESSPECIALITY

SPECIAL

Ownership/User Based

Government

Public

Central Govt.

State Govt.

Local Bodies

InstitutionalGovt

Organizations

Eg: Defence

Railway

CRPF

BSF

ESI Hospital

Public underta

kings

Under the act of legislatio

n(Autonom

ous)

Non Government

Profit making

Corporate

Private nursing Homes

Non Profit making

Charitable

NGOs

Directory of Hospital Based

General Hospital

Rural Hospital

Speciality Hospital

Teaching Hospital

Isolation Hospital

System of Medicine Based

Allopathic Hospital

Ayurvedic Hospital

UnaniHospital

TIBB Hospital

Homeopathic

Hospital

Size Based

Large Hospital(Beds> 500)

Medium Hospital(Beds 200-500)

Small Hospital(Beds<200)

Level of Care Based

Primary CareEg: PHC

Secondary CareEg: District

Hospital

Tertiary HospitalEg: Medical

College Hospital

Teaching Based

Teaching Hospital Non-Teaching Hospital

Accreditation Based

Accreditated Non-Accreditated

Gender Based

Male Female

Age Based

Paediatric Hospital Geriatric Hospital

Length of Stay Based

Acute Care HospitalChronic Care

Hospital

CLASSIFICATIONOFHOSPITAL SERVICES

CLASSIFICATION OF HOSPITAL SERVICES(CONTD.)

THERAPEUTICOR

MEDICAL TREATEMENTSERVICES


DIAGNOSTIC SERVICES


NURSING SERVICES

CLASSIFICATION OF HOSPITAL SERVICES (CONTD.)

SUPPORT SERVICES CSSD MEDICAL RECORDS MEDICAL STORES

BULKRETAIL

GENERAL STORES BIOMEDICAL ENGINEERING WORKSHOP TRADESMAN WORK SHOP AMBULANCE SERVICES PROFESSIONAL AND GOODS TRANSPORT SERVICES MORTUARY AND HERSE SERVICES


HOSPITALITY SERVICES FRONT OFFICE PUBLIC RELATION / COUNSELLING HOUSE KEEPING LINEN & LAUNDRY PATIENT FOOD SERVICES AMENITIES STORE/STALL SPIRITUAL SERVICES HOSPITAL WASTE DISPOSAL SERVICES VEHICLE PARKING


CIVIL, MECHANICAL AND ENGINEERING SERVICES

WATER SUPPLYBUILDING MAINTENANCEHVAC SERVICESELECTRICAL SERVICESHOT WATER AND STEAM SUPPLY SERVICES


ADMINISTRATIVE SERVICES MEDICAL, TECHNICAL AND ADMINISTRATIVE

COMMAND AND CONTROL NURSING ADMINISTRATION GENERAL ADMINISTRATION HUMAN RESOURCE MANAGEMENT FINANCIAL MANAGEMENT MATERIAL MANAGEMNET SECURITY AND INTELLIGENCE PUBLIC RELATIONS MAINTENANCE HOSPITAL MANAGEMENT INFORMATION SYSTEM HOSPITAL SERVICES MARKETING

STORY # 1It's a fine sunny day in the forest and a lion is sitting outside his cave, lying lazily in the sun. Along comes a fox, out on a walk.

Fox: "Do you know the time, because my watch is broken"

Lion: "Oh, I can easily fix the watch for you"

Fox: "Hmm... But it's a very complicated mechanism, and your big claws will only destroy it even more“

Lion: "Oh no, give it to me, and it will be fixed"

Fox: "That's ridiculous! Any fool knows that lazy lions with great claws cannot fix complicated watches"

Lion: "Sure they do, give it to me and it will be fixed"

The lion disappears into his cave, and after a while he comes back with the watch which is running perfectly. The fox is impressed, and the lion continues to lie lazily in the sun, looking very pleased with himself.

Soon a wolf comes along and stops to watch the lazy lion in the sun.

Wolf: "Can I come and watch TV tonight with you, because mine is broken"

Lion: "Oh, I can easily fix your TV for you"Wolf: "You don't expect me to believe such rubbish, do you? There is no way that a lazy lion with big claws can fix a complicated TV“

Lion: "No problem. Do you want to try it?"

The lion goes into his cave, and after a while comes back with a perfectly fixed TV. The wolf goes away happily and amazed.

: SCENE :

Inside the lion's cave. In one corner are half a dozen small and intelligent looking rabbits who are busily doing very complicated work with very detailed instruments. In the other corner lies a huge lion looking very pleased with himself.

: MORAL :

IF YOU WANT TO KNOW WHY A MANAGER IS FAMOUS; LOOK AT THE WORK OF HIS SUBORDINATES.

MANAGEMENT LESSON IN THE CONTEXT OF THE WORKING WORLD :

IF YOU WANT TO KNOW WHY SOMEONE UNDESERVED IS PROMOTED; LOOK AT THE WORK OF HIS SUBORDINATES.

STORY # 2It's a fine sunny day in the forest and a rabbit is sitting outside his burrow, tippy-tapping on his typewriter. Along comes a fox, out for a walk.

Fox: "What are you working on?"Rabbit: "My thesis."Fox: "Hmm... What is it about?"Rabbit: "Oh, I'm writing about how rabbits eat foxes."

Fox: "That's ridiculous ! Any fool knows that rabbits don't eat foxes!"

Rabbit: "Come with me and I'll show you!"

They both disappear into the rabbit's burrow. After few minutes, gnawing on a fox bone, the rabbit returns to his typewriter and resumes typing.

Soon a wolf comes along and stops to watch the hardworking rabbit.

Wolf: "What's that you are writing?"Rabbit: "I'm doing a thesis on how rabbits eat wolves."

Wolf: "you don't expect to get such rubbish published, do you?"

Rabbit: "No problem. Do you want to see why?"

The rabbit and the wolf go into the burrow and again the rabbit returns by himself, after a few minutes, and goes back to typing.

Finally a bear comes along and asks, "What are you doing?

Rabbit: "I'm doing a thesis on how rabbits eat bears."

Bear: "Well that's absurd ! "

Rabbit: "Come into my home and I'll show you"

: SCENE :

As they enter the burrow, the rabbit introduces the bear to the lion.

:MORAL:

IT DOESN'T MATTER HOW SILLY YOUR THESIS TOPIC IS; WHAT MATTERS IS WHOM YOU HAVE AS A SUPERVISOR.

THANK YOU..

introduction to hospital

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