Organizational Structures

CLASSIFICATIONS OF HEALTH CARE

Primary CareSecondary CareTertiary 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)

CLASSIFICATIONS OF SERVICE

GENERAL HOSPITALSPECIALITY HOSPITALREHABILITATION HOSPITALLONG-TERM CARE HOSPITAL

(AUXILIARY)NURSING HOME

GENERAL HOSPITALProvides primarily for the diagnosis and

short-term treatment of patients for a wide range of diseases or injuries.

SPECIALITY HOSPITAL

Provides primarily for the diagnosis and short-term treatment of patients for a limited range of diseases or injuries.

REHABILITATION HOSPITAL

Provides for the continuing assessment and treatment of patients whose condition is expected to improve significantly.

LONG-TERM CARE HOSPITAL

Provides primarily for the continuing treatment of patients with long-term illness or with a low potential for recovery.

NURSING HOME

Institution where residents are accommodated who require nursing and personal care on a continuing basis.

REGULATORY AGENCIES

Provincial hospital authorities responsible for:– Approving hospital budgets– Licensing and inspecting hospitals– Health and safety of hospital workers

Agencies regulating the various health professions Agencies approving various hospital based

training programs

REGULATORY AGENCIES

Review committees within hospitals Hospital administration and regulations Canadian Council on Healthcare Facility

Accreditation (CCHFA), representing:– Canadian Hospital Association– Canadian Medical Association– Royal College of Physicians and Surgeons of Canada– L'Association des Medecins de Langue Francaise du

Canada– The Canadian Nurses Association

A hospital is perhaps the most complex organization in our

society.

Clinical Engineer Must Understand

Roles and interaction between multiple professional groups

Role of the hospital administration in coordinating these groups

WELL DEVELOPED INTERPERSONAL SKILLS

ARE ESSENTIAL TO CLINICAL ENGINEERING!

Impact of Technology

Advancements in medical technology have had an enormous impact on hospital management.

Each new development has given birth to another discrete body of knowledge.– Ultrasound, CT, MRI– Lithotrity– Nuclear Medicine– Laser Surgery– Laparoscopic Surgery

Each technology has its own:

Professional GroupCherished RoleDiversified NomenclatureSelf Image.

Professional Groups

Medical Specialties Nursing Specialties Clinical Technicians (i.e., Lab Techs, X-Ray

Techs, Respiratory Therapists, Physiotherapists, etc.)

There are more than 200 health occupations!

Administrative Challenges

Professionals typically cherish their "right" to self-regulation.

Administrative Challenges Group conflict is unavoidable. Internal communications are impeded. Consensus is more apt to be absent.

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 skillsEffective communications skills.Leadership skills.

THE HOSPITAL AS A DELIVERY SYSTEM

Primarily a non-profit system. A third party (government) financed system. Demand for services can bear no direct

relationship to societal needs or the available supply of necessary resources.

The rate of hospital admissions has increased, but the average length of stay has decreased.

The health care system is presently undergoing rapid, radical change.

THE HOSPITAL AS AN OPERATING ENTERPRISE

HOSPITAL ORGANIZATION

GOVERNING BOARD

MEDICAL HOSPITAL

STAFF ADMINISTRATOR

Hospital Management Model

Governing Board (government appointed)Chief Executive Officer (Hospital

Administrator)Medical Staff Organization.

Functions of the Governing Board

To determine the policies of the institution within the context of community needs.

To provide equipment and facilities to conduct patient care programs.

To see that proper professional standards are defined and maintained.

To co-ordinate professional interests with administrative, financial and community needs.

Functions of the Governing Board

To provide adequate financing by securing sufficient income and by enforcing business like control of expenditures.

To provide for the safe administration of funds given in trust, (e.g., gifts and contributions).

To maintain accurate records of its finances and activities.

To surround the patient with a safe environment.

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 further the organization toward its goals.

Being a hospital administrator places more of a strain on character than on

intellect.

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

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

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.

THE MEDICAL STAFF

Doctors represent the initiators of every action that results in the direct provision of patient care

services.

Doctors determine:

Who Will Be AdmittedWhenWhereWhat 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.

The doctor is not an employee of the hospital, he/she is outside of the hospital organization.

Doctors control, yet are not accountable, for nearly 90 percent of

hospital expenditures.

Medical Staff

Participation by the medical staff in the decision-making process is in the best interest of both the hospital and the patients.

Physician involvement leads to physician accountability.

The physician may view the problems of medical practice from a personal

rather than an organizational perspective.

The administrator is primarily concerned with the maximum utilization

of available health resources and personnel.

Organization of medical resources may require a

degree of control and surveillance over the doctor's work which

maybe unattractive to him/her.

Medical Staff

The chief of medical staff is the elected representative of the medical staff.

The chief of staff appoints all of the committees other than the executive committee whose members are elected by the staff or appointed by the board administrator.

Functions of the Medical Staff To advise the governing body on medical affairs. To accept accountability for the quality of care

rendered to patients in the hospital. To request, review and act upon reports of medical

staff committees. To scrutinize the professional ethics of its

members and to initiate corrective action as indicated.

To develop, implement, and review medical staff policies.

Functions of the Medical Staff

To recommend action to the administrator on all medical-administrative matters.

To assure that the standards of the Canadian Council on Healthcare Facility Accreditation (CCHFA) are followed as a basic guideline for standards of care.

INTERRELATIONSHIPS AMONG HEALTH WORKERS

The complex tasks of highly skilled professionals demand a participatory decision-making structure while the repetitive tasks performed by unskilled

workers require a more formal hierarchical structure.

Organizational Structures

Highly structured and routine tasks can lead to worker alienation and boredom.

Loosely knit, associational activities of highly skilled professionals results in personal gratification to the individual employee but works against the centralized control and co-ordination needs of management.