01 Organizational Structures

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Organizational Structures


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CLASSIFICATIONS OF

HEALTH CARE

Primary Care

Secondary Care

Tertiary Care


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Primary Care

Consists of basic

curative care,

including simplediagnosis and

treatment, provided at

the point of entry into

the health care system.(Example: walk-in-

clinic)


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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)


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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)


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CLASSIFICATIONS OF

SERVICE GENERAL HOSPITAL

SPECIALITY HOSPITAL

REHABILITATION HOSPITAL

LONG-TERM CARE HOSPITAL

(AUXILIARY)

NURSING HOME


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GENERAL HOSPITAL

Provides primarily for the diagnosis and

short-term treatment of patients for a

wide range of diseases or injuries.


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SPECIALITY HOSPITAL

Provides primarily for the diagnosis and

short-term treatment of patients for a

limited range of diseases or injuries.


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REHABILITATION HOSPITAL

Provides for the continuing assessment and

treatment of patients whose condition is

expected to improve significantly.


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LONG-TERM CARE

HOSPITAL

Provides primarily for the continuing

treatment of patients with long-term illnessor with a low potential for recovery.


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NURSING HOME

Institution where residents are

accommodated who require nursing and

personal care on a continuing basis.


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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


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REGULATORY AGENCIES

Review committees within hospitals

Hospital administration and regulations

Canadian Council on Healthcare FacilityAccreditation (CCHFA), representing:

Canadian Hospital Association

Canadian Medical Association

Royal College of Physicians and Surgeons of Canada

L'Association des Medecins de Langue Francaise duCanada

The Canadian Nurses Association


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A hospital is perhaps

the most complexorganization in our

society.


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Clinical Engineer Must

Understand Roles and interaction between multiple

professional groups

Role of the hospital administration in

coordinating these groups


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WELL DEVELOPED

INTERPERSONAL SKILLSARE ESSENTIAL TO

CLINICAL ENGINEERING!


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Impact of Technology

Advancements in medical technology have had an

enormous impact on hospital management.

Each new development has given birth to anotherdiscrete body of knowledge.

Ultrasound, CT, MRI

Lithotrity

Nuclear Medicine

Laser Surgery

Laparoscopic Surgery


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Each technology has its own:

Professional Group

Cherished Role

Diversified Nomenclature

Self Image.


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Professional Groups

Medical Specialties

Nursing Specialties

Clinical Technicians (i.e., Lab Techs, X-RayTechs, Respiratory Therapists, Physiotherapists,etc.)

There are more than 200 healthoccupations!


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Administrative Challenges

Professionals typically cherish their "right"

to self-regulation.


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Administrative Challenges

Group conflict is unavoidable.

Internal communications are impeded.

Consensus is more apt to be absent.


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Administrative Challenges Internal

Medical Staff

Competition Between Health Professions

Unions

Physical Resources

Size and Complexity of Organization

External

Government

Funding

Regulatory Agencies

Public Demands


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Hospital Administrators

Require: Interpersonal skills

Effective communications skills.

Leadership skills.


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THE HOSPITAL AS A

DELIVERY SYSTEM Primarily a non-profit system.

A third party (government) financed system.

Demand for services can bear no directrelationship to societal needs or the availablesupply 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.


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THE HOSPITAL AS AN

OPERATING ENTERPRISE


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HOSPITAL ORGANIZATION

GOVERNING BOARD

MEDICAL HOSPITAL

STAFF ADMINISTRATOR


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Hospital Management Model

Governing Board (government appointed)

Chief Executive Officer (Hospital

Administrator)

Medical Staff Organization.


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Functions of the Governing

Board To determine the policies of the institution within

the context of community needs.

To provide equipment and facilities to conductpatient care programs.

To see that proper professional standards are

defined and maintained.

To co-ordinate professional interests with

administrative, financial and community needs.


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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.


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THE HOSPITAL

ADMINISTRATOR Function is identical to that of the president

of any corporation.

Individual styles are judged to be successfulif the determined results further the

organization toward its goals.


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Being a hospitaladministrator placesmore of a strain oncharacter than on

intellect.


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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.


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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.


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Administrator Assisting the medical staff with its

organizational and administrative

responsibilities. Submitting to the board annual reports

which describe the nature and volume of theservices delivered during the past year.

Advising the governing board on matters ofpolicy formulation.


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THE MEDICAL STAFF


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Doctors represent theinitiators of every action

that results in the directprovision of patient care

services.


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Doctors determine:

Who Will Be Admitted

When

Where What 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.


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The doctor is not an

employee of the hospital,he/she is outside of thehospital organization.


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Doctors control, yet are

not accountable, fornearly 90 percent of

hospital expenditures.


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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.


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The physician may viewthe problems of medical

practice from a personalrather than anorganizationalperspective.


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The administrator isprimarily concerned with

the maximum utilizationof available healthresources and personnel.

O i ti f di l


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Organization of medicalresources may require a

degree of control andsurveillance over the

doctor's work whichmaybe unattractive to

him/her.


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Medical Staff

The chief of medical staff is the elected

representative of the medical staff.

The chief of staff appoints all of thecommittees other than the executive

committee whose members are elected by

the staff or appointed by the boardadministrator.


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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 medicalstaff committees.

To scrutinize the professional ethics of its

members and to initiate corrective action as

indicated.

To develop, implement, and review medical staff

policies.


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Functions of the Medical Staff

To recommend action to the administrator

on all medical-administrative matters.

To assure that the standards of the CanadianCouncil on Healthcare Facility

Accreditation (CCHFA) are followed as a

basic guideline for standards of care.


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INTERRELATIONSHIPS

AMONG HEALTH WORKERS


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The complex tasks of highlyskilled professionals demand aparticipatory decision-making

structure while the repetitivetasks performed by unskilled

workers require a more formalhierarchical structure.


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Organizational Structures

Highly structured and routine tasks can lead

to worker alienation and boredom.

Loosely knit, associational activities ofhighly skilled professionals results in

personal gratification to the individual

employee but works against the centralizedcontrol and co-ordination needs of

management.

01 Organizational Structures

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