MAMATA COLLEGE OF NURSINGKHAMMAM

SUBJECT: Nursing ManagementTOPIC: Planning and organization of hospitalGUIDED BY: Dr. Mrs. Ratna Philip, Principal DATE: PRESENTED BY: Mrs. Udaya Sree.G, M.Sc. (N) II year TIME:

SEMINAR ONPLANNING AND ORGANIZATION OF HOSPITAL

INTRODUCTIONThe picture regarding medical care services in developing countries including India can be described as chaotic. Hospital beds are inadequate, the hospital are located far away from the communities which need them most crowded in towns and cities and heavily biased in favors of urban populations.

MEANING OF HOSPITALThe English word “hospital” originates from the Latin word “HOSPICE” AND also some viewed that it comes from the French word “hospital” as do the words “hostel” and ‘hotel’.Now the term ‘hospital’ means an establishment temporary space occupied by the sick or injured.In other words the hospital is an institution in which sick or injured persons are treated.

DEFINITIONSHospital is an institution for the care cure and treatment of the sick and wounded for the study of disease and for the training of doctors and nurses

-Acc to Medical dictionary

Hospital is an integral part of a social 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 and its home environment the hospital is also a center for the training of health worker and for biosocial research.

-Acc to World health Organization

A modern hospital is an institution which processes adequate accommodation and well qualified and experienced personnel to provide service of duration restorative and preventive character of the highest quality possible to all people regardless of race color, creed or economic status, which conducts educational and training programs for the personnel particularly required for efficacious medical care and hospital services which conducts research assisting the advancement of medical service and hospital service as and which conducts programs in health education

-Acc to BT. Basavanthappa

PHILOSOPHY OF THE HOSPITALA philosophy is a statement of the values and beliefs that directs individuals or group in their attempts to achieve purposeEvery hospital needs to discuss refigure and write down its philosophy in clear terms. If may change according to changing needs and circumstances of the society at large.Some of the hospital philosophy statements are

Hospital authority Believes that hospital is to maintain the highest quality of service of curative,

restorative and preventive services. Irrespective of caste, creed, religion, color, race, origin or economic status through the excellence of medical practice, nursing practice and nursing service technical skills and management in an environment that is conductive to the protection and continuous improvement of total hospital health care system.

Believes that it is expected to render high standard of patient care in all functional areas of the hospital which include outpatient services in-patient services ambulatory care service emergency service home care services.

Believes that high quality of patient care is closely related of patient care is closely related to a dynamic stimulating educational settings will define its role and commitment to educational and training programs.

Believes that hospital may define its commitment to research in patient care, educational training and management for which it conducts research for assisting the advancement of medical service nursing services and hospital services as a whole.

Believes it defines its leadership role in the community and possible the depending up on its size, type and facilities and in relation to regional area planning for hospital

Believes that it would defines its commitments as screening and referred center for patient suffering from particularly complex health problem i.e., CCF, head injury kidney failure, psychiatric etc.

OBJECTIVE OF THE HOSPITAL To provide optimum health service to all people irrespective of race, color, caste

and creed and regardless of socio-economical status. To provide care, cure preventive service to all people irrespective of color, caste,

creed, religion, nationally and socio-economic status. To Protect the human rights of clients while taking care in its jurisdiction/in all

areas of its service To provide training for professionals, i.e., doctors, nurse, pharmacists, dentist

and other technical personnel. Who are involving in health care services To provide in-service/ continuing education in all discipline professional/

technical personnel involving health care. To Participate/ conduct research that will benefit patient care, improve the

community health status. To Define its leadership role in the community and possibly the region

depending up on its size, type and facilities in relation regional area planning of hospital

SCOPE OF HOSPITALObjective should be applied in personalized manner with full recognition and attention to personal dimensions in client needs and is carried out with in a frame work of social responsibility.The optimum health services consists of following elements

1. Team approach The care of the needy person will be taken by the team of professional members and paraprofessionals, technicians under the leadership of medically qualified persons with integration and co-ordination

2. Contents of service A spectrum of services that includes diagnosis, specific treatment, reliabilitation, education and prevention.

3. Co-ordination Clients care will cover the co-ordinate efforts of all agencies which have the required facilities at all levels

4. Continuity of care Continuity of clients care will be available and rendered by the particular agency with specific services whenever needed

5. Integration Organization of the hospital care both ambulatory and non ambulatory patients in to a continuum with common integrated services.

6. Evaluation and research Periodic evaluation programs and provision of conducting research included in the optimum health service for adequacy in meeting needs of the patients and community.

FUNCTIONS OF THE HOSPITAL

1. Patient care Care of the sick and injured and restoration of the health of a diseased person. With out any discrimination.

2. Diagnosis and treatment of disease Diagnosis and treatment services to in-patients. With in this broad function there are many subdivision of medical, surgical, gynecology, obstetrical, pediatric, psychiatry, orthopedics and other forms of care and rehabilitation.

3. Out-patient services These are services to out-patients with an equally wide range of specialties and technical modalities

4. Medical education and training Hospital provides professional and technical education for many classes of health personnel. They must work in hospital to receive proper training of their choice. Medical, nursing, pharmacy, dental, radiology etc.

5. Medical and nursing research The hospital the basis for scientific investigation into cause, diagnosis treatment and nursing management of disease and hospital administration in hospitals

6. Prevention of disease and promotion of health Hospital provides services to surrounding population that may be preventer care and promoting their health.

CLASSIFICATION OF HOSPITALSWe can classify the hospitals into different types depending upon different criteria.

I. Length of stay of patientII. Clinical basis

III. Ownership/control basisIV. ObjectivesV. Size

VI. ManagementVII. System of medicine

CLASSIFICATION ACCORDING TO LENGTH OF STAY OF PATIENTA patient stays for a short term in a hospital for treatment of disease that is acute in nature, such as pneumonia, peptic ulcer, gastroenteritis etcA patient may stay for a long-term in a hospital for treatment of diseases that chronic in nature such as tuberculosis, leprosy, cancer, psychosisThe hospital according to long-term and short term also known as chronic-care hospital and acute care hospitals respectively

CLASSIFICATION ACCORDING TO CLINICAL BASISThese are hospitals licensed as general hospital; treat all kinds of disease but major focus on treating special disease or conditions such as heart disease or cancer, or ophthalmic or maternity etc

CLASSIFICATION ACCORDING TO OWNERSHIP/CONTROLOn the basis of ownership or control, hospitals can be divided into four categories

a) Public hospitalsb) Voluntary hospitalsc) Private/ nursing homesd) Corporate hospitals

a) Public hospitals Public hospitals are those run by the central or state government or local bodies on non-commercial lines. These may be general hospital or specialized hospitals or both.

b) Voluntary hospitals Voluntary hospitals are those which are established and incorporated under the society’s registration Act 1860 or public trust Act 1882 or any other appropriate act of central or state governments. They are run with public or private funds on a non-commercial basis

c) Private nursing Hospitals/ nursing homes Private nursing hospitals/nursing homes are generally owned by an individual doctor or a group of doctorsThey run the hospital or nursing home on a commercial basis

They accept patient suffering from infirmity, advanced age, illness, injury, chronic, disability etc. but do not admit patient suffering from communicable disease, alcoholism, drug addiction or mental illness.

Usually they prefer patient from wealthy families.

d) Corporate hospitals Corporate hospitals are hospitals which are public limited companies formed under the companies act

They are normally run on commercial lines They can be either general or specialized or both

CLASSIFICATION ACCORDING TO THE OBJECTIVESAccording to the objective hospitals can be classified into three categories

a) Teaching-cum-research hospitalsb) General hospitalsc) Specialized hospitalsd) Isolation hospitals

a) Teaching-cum-research hospitals Teaching/cum/research hospitals is a hospital to which a college is attached for medical/nursing/dental/pharmacy educationThe main objective of these hospitals is teaching based on research and the provision of health care is secondary.Eg: JIPMER, Pondicherry, Victoria hospital Bangalore

b) General hospitals General hospitals are those which provide treatment for common disease and conditions.All establishments permanently staffed by at least two or more doctors, which can offer in-patient accommodation and provide active medical and nursing care for more than one category of medical discipline such as general medicine, general surgery, obstetrics and gynecology pediatrics etcThe main objective of these hospitals is to provide medical care to the people. While teaching and research is secondary and incidentalEg: All district and taluk or PHC or rural hospitals

c) Specializes hospitals Specialized hospitals are hospitals providing medical and nursing care primary for only one discipline or a specific disease or condition of one systemThese hospitals concentrate on a particular aspects or organ of the body and provide medical and nursing care in that fieldThe specialized department administration attached to a general hospital will not be considered as specialized hospitals

d) Isolation hospitals Isolation hospitals is a hospital in which the persons suffering from infections/ communicable disease requiring isolation of the patientsEg: Epidemic Disease Hospitals, Bangalore

CLASSIFICATION ACCORDING TO SIZEOn the basis of health committee report it is recommended that the following pattern of developments of hospitals to bead opted according to size i.e., bed strength

a) Teaching hospitals 00(bed to be increased according to the number of students)b) District hospital 200(may be raised up to 300 beds depending upon populationc) Taluk hospitals 50(may be raised depending upon population to be served)d) Primary health centers 6(may be increased up to 10 depending upon needs).

CLASSIFICATION ACCORDING TO MANAGEMENTa) Union government/ government of India

All hospitals administered by the government of India e.g. Hospitals run by the railways, militaries/defense public sector undertaking of the central government.

b) State government All hospitals administered by the state/union territory. Government authority and public sector undertaking operated by the state/union territories including the police, prison, irrigation department etc

c) Local bodies All hospitals administered by local bodies i.e. Municipal Corporation, municipality zila parishad panchyat

d) Autonomous bodies All hospitals establishing under special act of parliament or state legislation and founded by the central/state government union territoryEg: AIIMS, New Delhi, NIMHANS Bangalore

e) Private All private hospitals owned by an individual or by a private organization Eg: Manipal Hospital, Bangalore, Hinduja hospital, Mumbai

f) Voluntary agencies All hospitals operated by a voluntary body a trust charitable society registered or recognized by the appropriate authority under central/state government laws.Eg: CMC, Vellore

CLASSIFICATION ACCORDING TO SYSTEMAccording to the system of medicine we can classify the hospitals as follows

a) Allopathic Hospitalsb) Ayurvedic Hospitalsc) Homoeopathic Hospitalsd) Unani Hospitalse) Hospitals Of Other System Of Medicine

HOSPITAL UTILIZATIONThe term “hospital utilization denotes the manner in which a certain community makes use of its resources or the manner in which certain community utilizes the hospitals

Factors influencing hospitals utilizationFactors influencing hospitals utilization can be classified into either extra-mural factor i.e. without the hospital or intra-mural factor i.e. within the hospital

Extra-mural factors1. availability of hospitals beds2. service coverage and bed distribution3. age of the population4. means of communication5. morbidity and mortality ratio6. availability of extra-mural medical service 7. supply of physicians

Intra-mural factor1. hospitals physical layout/internal organization2. methods of payments for hospitals services3. medical customers and social patterns 4. research and training

Today a hospital is a place for the diagnosis and treatment of human ills and restoration of health and well-being of those temporary deprived of these a large number of professionally and technically skilled people apply their knowledge and skills with the help of complicated equipment and appliances to produce quality care for patient

Indices for measuring the efficiency of the hospital

1. Average length of stay Average period in hospital per patient admitted.

a. Total number of bed days in the year divided by the number of admission in the same year

H/Ab. Total number of bed days in the year divided by the number of discharges and

deaths in the same year.H/D+d

c. Total number of bed days in the year divided by half of the sum of admissions and discharges (including deaths in the same year)

L=Hx1 /1/2(A+D+d)=2xH/A+D+d.

2. Bed occupancy ratio The average percentage occupancy of hospitals bedsIt is calculating by dividing the daily average numbers of beds occupied (N) obtained from daily census of occupied beds) by the bed clement (B) i.e. nominal number of beds in the institution and multiplying by 100O=N/B*100=H/365+B*100

Number of patient days during year 0 = ------------------------------------------------ x100 Number of bed days during the year

3. Turn over interval (T) The total vacant bed days during the years----------------------------------------------------------- The number of admissions during the yearT=B*365-H/D+d

4. Average duration of illness

The total number of in-patient days during the year-------------------------------------------------------------------Total number of in-patients admission during the year

5. The average out-patient admission

Total number of out-patients during the year------------------------------------------------------------------------Total number of out-patients admission during the year

6. Average daily out-patient admission

Total number of new out-patients admission during the year-------------------------------------------------------------------------------The number of workings days during the year

7. Cost of daily diet

Total expenditure on diet during the year-----------------------------------------------------Total number of in-patient days

8. Average cost of medicine

Total cost of medicine for in-patient for the year------------------------------------------------------------------Total number of in-patient admissions

ASPECTS OF HOSPITAL SERVICESThe service provided in a hospital differ from one hospital to anotherIt is very different to discuss all services these services classified into three

Line serviceEmergency service

The emergency department provides round the clock, immediate diagnosis and treatment for illness for emergent nature and injuries from accident.Simple cases after administering preliminary treatment are dismerged with instructions to attend OPD as a follow-up measure. Cases of serious nature are admitted in casualty wards to provide immediate care, after keeping them in required period, they will be discharged and transfer to in-patient wards

Out-patient servicethe outpatient department is a distinct and important part of the hospitalIn modern planning, these facilities are no longer separatedThe OPD should be within the main body of the hospital. The department should be located close to public entrance to OPD there should be a reception and enquiry counters, with proper communication facilities like telephone etcIt is also effective to have clinics of different specialty, x-ray, laboratory, pharmacy, rehabilitation centre, injection room and other facilities depending on the type of facilitiesIn modern days we have number of clinic, conducted in the OPD such as eye, ear, nose, throat, dental, medical, surgical, obstetric and gynaec, also mental health clinics, pediatrics etcHospital should have specialized clinics like orthopedics, genitor-urinary, neurosurgical, cardiovascular, diabetics etc

In-patient serviceThe persons who needs acutely care, moderately and mild care are admitted in the wards

Intensive care unitsThe cases of serious in nature and needs life support, supervised care

Operational theatresThe operating room consist of OT tablesA lay-up room which connects directly with operating room is used to prepare trolleys with all the equipment needful for an operation. Wash-up room contains sinks Scrubbing up room in which the surgeons and nurses scrub up and put on sterilized gowns, gloves and masks.In addition the operation theatre should be equipped with necessary, equipments, supplies which includes linen, surgical instruments, OT tables, bolys apparatus, o2 N2 and other gases, anesthetic ether and other gases drugs etcOT also should have recovery room for the reception of patients immediately following surgery- patients remains in the recovery room for varying length of time depending on their condition and on hospital policy

Supportive services

1. Central sterile supply service management The CSSD is supply department is supposed to store, sterilize, maintain and issue those instructions, materials and garments which are required to be sterilizedThe CSSD should have direct lines of communication with all wards, operation theatres, out-patient and casualty departments and to a lesser extent with x-ray and pathology department

2. Diet management The purpose of the dietary service department in every hospital is the preparation of nutritionally adequate, attractive meals

3. Pharmacy service management The main function of this department will include the stocking of drugs and other medical supplies and equipment, and distribution of drugs and others to different departmentsIn some hospitals, purchasing and charging of pharmaceutical are handled by the chief of the pharmacy department in collaboration with the medical superintendents and resident medical officer of the hospital

4. Laundry All hospitals are concerned with the dangers of cross infections and the need for using only sanitary, germ-free washed linenSurgical linen are autoclaved in the surgical area to ensure sterility and further safeguard the patients

5. Laboratory facilities The primary function of pathology services is to give assistance to the attending doctor in the diagnosis and treatment of patientsInvestigations made by this service reveals normality or degree of deviation from normalTissues, blood, bone marrow, CSF and other body fluids, excretions (urine, stool, sputum etc)Postmortem examination are conducted to determine the causes of death and to study disease processes

6. Radiology The department of radiology deals with radio diagnosis and radiotherapyThe x-ray department’s needs to provide services for in-patients, out-patients, causalities and patient referred for x-ray by general practitionersIn modern hospital much scientific progress being made and the use of diagnostic and therapeutic radiation procedures

7. Nursing services Nursing is provided in large portion of the total services to patients in hospital. Nursing personnel composed of professional nurses, nurses as practitioner, and nursing assistants of various types, constitutes the largest single body of personnel in hospitals and the nursing department of the hospitalIt is a department which interrelates with more other department

Auxiliary services1. Registration and indoor case records2. Stores3. Transport4. Mortuary5. Engineering and maintenance service6. Hospital security

PLANNING A NURSING UNIT OF A HOSPITAL AND PUBLIC HEALTH NURSINGNeed and functions

The nursing unity is an integral part of the hospital complex the hospital is divided into blocks and each block is divided into wards.

In each ward there is a nursing unit to take care of the patient for all the 24 hours.The efficient planning of this unit would ensure maximum care of the patient.The broad categories of functions that should be discharged by the nursing unit are

a) Meeting personnel needs of the patients

b) Efficient ward managementc) Proper maintenance of records of the patientsd) Provision of basic institutional servicese) Availability of diagnostic and treatment equipmentf) Arranging formal and informal health education of the patient and their relatives

Planning a nursing unitPlanning is preparation for action the proper advance planning would ensures

best patient care The aspects of planning a ward include space planning location of nursing unit

material planning personnel planning etc The planning here must be practical and operational and not theoretical Planning is the process of determining the objectives of administrative effort of

devising the calculated to achieve them -Millet

In each nursing unit planning may be done to provide the following basic facilities

a) Patient rooms with attached or separate toilets and bathing facilitiesb) Nurses duty roomc) Treatment aread) Waiting room for the relativese) Storage of liner and other supplies and equipment.

Beside there is a need of manpower planningIdentification of actions which personnel have to take in order to perform activities and identification of positions by which personnel requirements may be grouped to determine types number and qualifications

Administration of a nursing unitThe following steps to administer to wards

1. Assisting the patient with those physical service necessary for his well-being and comport which he cannot do for himself cannot do unaided and planning such services to meet his individual needs as they are affected by physical conditions and his emotional reactions

2. Observing recording and reporting to the physician for the 24 hours period the physical emotional and mental symptoms which may have significance in diagnosis and in the direction of therapy.

3. Preparing the necessary equipment for and assisting the physician with diagnostic test and therapeutic measures

4. Giving medication and carrying out treatment prescribed by the physician5. Observing the patient for reactions which may follow treatment and taking the

necessary measures to combat them should they occur

6. Assisting in providing a clean orderly well-ventilated environment for the patient and protecting from infections accidents and fire hazards

7. Helping the patient to feel secure in his new environment and to adjust himself to condition and to any limitations he may have as a results of his illness

8. Teaching the patient how to maintain and improve his health and to carry out his treatment when he goes home

9. Establishing good rapport with the patient’s family and his friends.10. Meeting emergency situations and unforeseen situations with promptness

and good judgment11. Making concerned for the patient with others concerned with his care such

as the medical social worker the dietician the occupational therapist or the clergy or nursing agencies. When he leaves the hospital

Problem of patient care1. Defective construction of the ward2. Big size of ward3. Luck of effective inter-personnel relationships4. Defective materials management5. Pilferage of goods and poor maintenance of equipments6. Low morale among nursing personnel7. Unsatisfactory nurse/patient ratio8. Non-nursing Duties by nursing personnel9. Favoritism in the allotment of Bed-room in the wards10. Non-courteous attitude of employees in the wards11. Corrupt practices in the wards12. Food arrangements not satisfactory

NURSING SERVICESIn hospitals nursing origination is the most important ingredient of hospital

administration.According to Mooney organization is the form of every human associate for the

attainment of a common purpose”

BASIC NURSING MANAGEMENT SERVICES IN HOSPITAL AND COMMUNITY1. Authority and responsibility- Development of team nursing2. Delegation and decentralization3. Public relations4. Communication5. Co-ordination with in a nursing unit and co-ordination with the entire hospitals

system6. Supervision and control7. Personnel management

SUMMARYHospital is an institution for the care cure and treatment of the sick and wounded

for the study of diseases and for the training of doctors and nurses. Planning of hospitals and patient care important aspects in providing effort care.

BIBLIOGRAPHY BT. Basavanthappa (2008) “The text book of nursing administration”, 1st edition,

New Delhi, Jaypee brother publication, page no:354-385

BT. Basavanthappa (2008) “The text book of nursing administration”, 3st edition, New Delhi, Jaypee brother publications

Neelam Kumari(2009) “The text book of management of nursing service and education” Jalandhar, S.Vikas, P V publications, page no: 88-139

DC. Joshi (2009) “The text book of hospital administration”, 1st edition, New Delhi, Jaypee publication, page no:26-32

AG. Chandorkar (2010) “The text book of hospital administration and planning”, 2nd edition, New Delhi page no:18-27

AK (2010) “Text book of management of nursing service in the hospital and education” 1st edition, page no:133-139