NEHRU ARTS AND SCIENCE COLLEGE
PG DEPARTMENT OF SOCIAL WORK
SUBJECT: HOSPITAL ADMINISTRATION
HOSPITAL ADMINISTRATION(Spl. Paper – II)
UNIT I:
Meaning of hospital - Evolution of Hospitals from charity to modem hospital
classification of hospitals - General, special, public, private, Trust, Teaching –cum
Research Hospital - Small or Large Size Hospitals.
UNIT II:
Planning a Hospital - The Planning Process - Choosing a Site, Location and Access,
Building - Space Utilization, Physical Facilities - residential facilities requirements of
various types of Wards; out patient services and in-patient services, emergency services
in Hospital - Medico Legal cases - Different departments required in the hospital.
UNIT III:
Hospital Administration – Meaning, Nature and Scope Management of Hospitals principles of Management - need for Scientific management. Human resource
management in - Hospitals personnel policies - Conditions of Employment Promotions
and Transfers- Performance appraisal. Working hours - leave rules and benefits –safety
conditions - salary and wage policies, Training and development.
UNIT IV:
Staffing the hospital - selection and requirement of medical professional and technical
staff - social workers -physiotherapist and occupational therapist Pharmacist
-Radiographers - Lab technicians - dieticians - record officer -mechanics - electricians.
Role of Medical Records in Hospital Administration - Content and their needs in the
patient care system.
UNIT V:
Hospital Budget - departmental budget as a first step - specific elements of a department
al budget including staff salary - supply costs - projected replacement of equipment energy expenditures - contingency funds. Uses of computers in Hospital - purchase
centralization- Shared Building system purchase agreements.
UNIT I:
Meaning of hospital - Evolution of Hospitals from charity to modem hospital
classification of hospitals - General, special, public, private, Trust, Teaching –cum
Research Hospital - Small or Large Size Hospitals.
----------------------------------------------------------------------------------------------------------------PART A
1) The word hospital was derived from the latin word.........
A) Hospitium
2) The best-known type of hospital is the ...................
A) General hospital
3) The diseases like tuberculosis, infectious disease, heart,chest,child health, trauma,
psychiatry,cancer,leprosy are treated in..................hospitals
A) Specialised
PART B
1) Write the classification of hospital based on the ownership and mangement?
(Hint:Government,state and central; local bodies like jilla
Parishads,panchayats,municipalities and corporations; ESI Corporation, Non Governmentalprivate or voluntary organizations; individuals)
Classification of Hospitals
The Organisation of a hospital depends on the type of the hospital.

General: Acute care; long stay

Specialised : tuberculosis, infectious disease, heart,chest,child health, trauma,
psychiatry,cancer,leprosy and others

Teaching cum research hospitals: Large Hospitals provide both teaching as well as
health care service . the hospitals provide training to nursing and medical professionals.
Based on the treatment and the service provided by the hospital it also conducts research on the
origin ,treatment and the prognosis of particular diseases.

Small or Large size hospitals
Small hospitals ere those which have a low capacity and provide nearly 50 beds.
Such hospitals are usually single speciality hospitals or general Hospitals
Large Hospitals posssess a bed capacity of 100-500 [atients, usually multi speciality hospitals
The hospitals may be owned and managed by
1. Government,state and central; local bodies like Zilla Parishads,panchayats,municipalities
and corporations; ESI Corporation
2. Non Governmental- private or voluntary organizations; individuals
i.
non profit by philanthropic and charitable organisationslike religious orders,
congregations,service organizations like Diocesesand Philanthropic individuals.
ii.
Cooperatives by professionals, public and mixed
iii.
Large industries such as the Indian Telephone Industries, Bharat Electronics, etc
iv.
Or Profit: individuals,groups and public
Types
Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave
('outpatients') without staying overnight; while others are 'admitted' and stay overnight or for
several weeks or months ('inpatients'). Hospitals usually are distinguished from other types of
medical facilities by their ability to admit and care for inpatients and the others often are
described as a clinic.

General
The best-known type of hospital is the general hospital, which is set up to deal with many kinds
of disease and injury, and typically has an emergency department to deal with immediate and
urgent threats to health. A general hospital typically is the major health care facility in its region,
with large numbers of beds for intensive care and long-term care; and specialized facilities for
surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have
several hospitals of varying sizes and facilities. Some hospitals, especially in the United States,
have their own ambulance service.

Specialized
Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's
hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such
as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.
A hospital may be a single building or a number of buildings on a campus. Many hospitals with
pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals
are affiliated with universities for medical research and the training of medical personnel such as
physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a
nonprofit basis by governments or charities. Within the United States, most hospitals are
nonprofit.[citation needed]

Teaching
A teaching hospital combines assistance to patients with teaching to medical students and nurses
and often is linked to a medical school, nursing school or university.

Clinics
A medical facility smaller than a hospital is generally called a clinic, and often is run by a
government agency for health services or a private partnership of physicians (in nations where
private practice is allowed). Clinics generally provide only outpatient services.
2) List out the Distinguishing characteristics of Hospital.?
(Hint: personalized service of care and treatment , prominent values are humanitarian,
professional and social, diversity and variability in the nature and volume of Work..)
A hospital Organisation differs from other organizations in many ways.

A hospital renders mostly personalized service of care and treatment to the individual
patient. The prominent values are humanitarian, professional and social,. The patients
needs are of greatest importance

Hospitals are becoming increasingly responsive to the health needs of the surrounding
community.This response is often closely integrated with the needs of the patient

Much of the work in ahospital is of urgent nature and cannot be postponed.

There is a great diversity and variability in the nature and volume of Work

There is a mix of professionals( predominant group),skilled and semi skilled workers.
They work as a team with self discipline and informal adjustments if the members of
the team.
PART C
1.Describe the evolution of hospitals from charity to modern hospital?
(Hint: Earilest times, Greco Roman Era, Christian era, Medievel Era, Islamic Era)
Meaning of hospital - Evolution of Hospitals from charity to modem hospital
Public health was until relatively recently very low on the list of priorities in the Western world
— in fact, it only became a national objective in some countries in the late 18th century. This is,
however, not surprising when one considers all the forces working against it since the beginning
of Western civilisation, especially in Greece and Rome. Various factors prevented the early
development of an adequate health service, for instance ignorance, the unsympathetic attitude of
the Greeks and Romans towards the sick, superstition and religious beliefs. There were,
however, also positive measures taken by the Roman government in par ticular to promote public
health, like the appointment of state physicians and free medical services to the poor. The
provision of a relatively advanced infrastructure in the form of aqueducts to provide sufficient
fresh water for the population, a network of gigantic sewers underneath
the city for the disposal of sewage, and numerous public baths all over the city were further ways
of promoting hygiene. From a modern point of view, the most important and lasting contribution
of the ancients to public health was the establishment of the hospital in the modern sense of the
word, i.e. an institution where the sick and disabled could receive treatment for a period of time.
It is, strangely, not in Greece, the birthplace of rational medicine in the 4th century BC that one
finds the origin of the hospital, nor in the temples of Asclepius, or even the Roman military and
slave hospitals which can be traced back to the 1st century BC. It is to the Christians that we owe
the origin of the modern hospital — perhaps paradoxically, because in certain respects
Christianity had a rather negative effect on medicine: anatomy was denounced, human dissection
was prohibited because a man’s body is the temple of the Holy Spirit, the occurrence of miracles
advanced superstition, and diseases were regarded as a punishment for sin. However, Christian
contribution lay on another plain, namely compassion with and caring for the sick. Under their
control hospices built to shelter pilgrims and messengers between bishops developed into
hospitals in the modern sense of the word. Sir William Osler once said that Imhotep, grand vizier
to king
Zoser (Third Dynasty, c. 3 000 BC, and builder of the first pyramid at Sakkara), was “the first
figure of a physician to stand out clearly from the mists of antiquity” (Major 1954:39-40). If we
assume that our written records of medical endeavour do date back to that distant era of Egyptian
and Mesopotamian development, it is indeed surprising that hospitals as we know them today did
not appear until the 4th
century AD. However, evidence that forerunners of hospitals might have existed in the 2nd
millenium BC will be discussed.
DEFINITION OF TERMS
A hospital is defined as a room, rooms or building specifically employed for the investigation
and continued treatment of the diseased. For the purpose of this study, the Greek iatreion and
Roman taberna medica, comparable to the modern physician’s consulting room, are excluded
from consideration, but it is accepted that under special circumstances these rooms might well
have been put to shortterm
use as hospital equivalents The words hospital, hôtel, spital and hospice are all derived from the
Latin word hospitium meaning “a place of entertainment for strangers, a lodging, an inn, a guestchamber” In late Christian times such hospitia were often attached to a monastery and primarily
intended for accommodating pilgrims. Today a hospice usually indicates a home for the
terminally ill. The word hôtel is an early French term, and is a forerunner of the present word
which refers to a building offering accommodation to paying guests — with no connection to
illness
The word infirmary (from Latin infirmarium) originally referred to a room or rooms attached to a
monastery for the treatment of diseased monks (Aitken 1984:9-11). In the Roma n world a
valetudinarium referred to a hospital initially solely for the treatment of military personnel, but
the word was later also used to denote hospitals for the civic population (Scheider 1953:262264). In the monastic period the term nosocomium came into use to indicate a small Roman type
hospital, while the Greek word xenodochion which initially denoted a home for strangers and the
poor, eventually referred to charitable hospitals in the early Christian era
During the Golden Age of Islam (9th-13th centuries) the Persian word bimaristan denoted a
hospital, while maristan referred to an institution for the insane.

EARLIEST TIMES
There is some evidence that the earliest hospitals known to us may have been in ancient
Mesopotamia. Reiner (1964:544-549) presents evidence that royal physicians at Assyrian and
Babylonian courts to216
wards the end of the 2nd millennium BC, cared for ill court singers in what were probably
elementary hospitals or nursing homes. Classical sources also refer to possible hospitals in the
Hellenistic Age attached to the Egyptian temples for Saturn in places like Heliopolis, Memphis
and Thebes. However, this probably denoted sleeping accommodation in temple precincts, rather
like that associated with the Asclepian cult .
The Buddhist religion with its roots in 6th century BC India led to the creation of a monastic
system, which, as with subsequent Christianity, gave rise to institutionalised health care facilities
in and around
these monasteries as early as the 5th century BC. The nursing profession may also have
originated here (5th century BC), and we are told that Sri Lankan hospitals date back to 431 BC.
We know very little about the nature and function of these institutions, but the great Indian king,
Asoka, is credited with the construction of hospitals for humans and also for animals during the
3rd century BC (Aitken 1984:7; Haeger 1988:53-54). With the eastward spread of Buddhism, socalled hospitals, almshouses and convalescent homes also appeared in China (perhaps as early as
the 5th century BC) and South East Asia. The precise nature of these institutions is obscure
(Major 1984:100; Philips 1993:149;
Chrystal 2000:536). In antiquity the Mosaic laws covered health matters extensively, but the
Jewish nation is not associated with the founding of hospital systems (Major 1954:55-65). The
Bible does not mention such institutions, but we do know of persons treated for illness in private
homes, e.g. the child in Zarephath (I Kings 17:17-24), Lazarus (John 11:6-25), the centurion’s
child (Luke 7:1-9), the illness of king Ahaziah (2 Kings 1:1-16) and the Good Samaritan in the
parable (Luke 10:34, 35).

GRAECO-ROMAN ERA
Primitive health care associated with the temples of Asclepius are considered by many to have
been the forerunners of true hospitals Founded at Epidaurus in the 5th century BC , the
Asclepian cult revolved around temple complexes usually built at scenic, wooded sites with an
abundant water supply. Asclepiea were later built all over the Roman Empire, and flourished up
to 391 AD when as pagan temples, they were officially closed by the Christian emperor
Theodosius I. Their structure was fairly standardised, usually consisting of large rooms, closed
on three sides, orientated to the sun and opening to the south with a row of pillars in the form of
a Greek stoa (portico). Big Asclepiea like that at Pergamum included treatment halls, libraries, a
stadium, baths and latrines. Patients normally entered the temple for incubation sleep in the stoa .
Their dreams were then interpreted by priests, who also suggested the appropriate therapy . The
hypochondriacal Aelius Aristides for instance, relates how he spent considerable time as a
patient in the home of an Asclepian temple warden, and how in consultation with a physician he
was given a therapeutic medicament after his dreams had been interpreted.
Therapy was mainly of magico-mystic nature, and completely alien to the co-existing
Hippocratic medicine which was based on contemporary scientific knowledge and abhorred the
occult in medicine. There was, however, ironically, a famous Asclepieum on the island of Cos,
where Hippocrates taught. The Hippocratic doctors visited and treated patients at their homes
and performed the occasional surgical
procedure, but there is no evidence in Classical Greece of the use of hospitals in the modern
sense of the word, although there is suggestive evidence that rooms in private homes were
occasionally adapted for longer term medical treatment
The first official step taken by the Roman government in public health care — other than the
passing of various laws in this regard (Cilliers 1993) — was the establishment in 293 BC of a
temple of Aesculapius on the Tiber island in the aftermath of a disastrous epidemic. In the crisis
the Senate took the traditional step and consulted the prophetic Sibylline books; the
recommendation was to import the cult of Asclepius, the Greek god of medicine, from its main
centre at Epidaurus.

THE CHRISTIAN ERA
Even during the early phase of the Christian era when Christians suffered severe religious
persecution, their selfless dedication to relief of the suffering of the poor and ill, was remarked
on by historians (Cyprian, De mortalitate VI.1-2; Eusebius, Hist. Eccl. IX.7.15-8.3). The
Christians’ typical attitude towards the sick was based on Christ’s parable of the Good Samaritan
— mercy and compassion for anyone in need. This ethos of caring did however not translate into
action regarding hospitalisation
until Emperor Constantine promulgated his Edicts of Toleration in 311 and 313 granting
religious freedom. And then their charitable actions, concentrating on the needs of the wretched,
did not differentiate between assistance for paupers, pilgrims, orphans, the aged, insane and the
diseased

6. MEDIEVAL TIMES
By the middle of the 6th century the establishment of hospitals was securely anchored in the
Eastern as well as the Western parts of the Roman Empire, due also to the support of various
monarchs. Childebert, King of the Franks, founded the Hôtel Dieu in Lyons in 542, and
Theodoric the Great (493-526)
encouraged any Christian initiative concerned with
hospitalisation. Charlemagne (747-814) promulgated a decree that a school, monastery and
hospital be attached to every cathedral built in his territory . The term xenodochion now began to
give place to hospitalium — in a letter written in AD 796, the English scholar and ecclesiastic,
Alcuin, urged Eanbald II, Archbishop of York, to found in his diocese xenodochia, id est
hospitalia” With the founding of a monastery and hospital at Montecassino
in Italy in 529, St. Benedict of Nursia launched one of the most influential of all Medieval
initiatives in the field of hospitalisation. He insisted on excellence and dedication in the care of
illness, and in time
his Benedictine Order became the model for later monastic establishments. 3 In 742 a Church
Council decreed that all monks and nuns should run their lives, monasteries and hospitals
according to the
Benedictine Rule. Other famous monastic hospitals built at this time included those at Merida,
Spain (580), St. John’s Hospital at Ephesus (610), Pantokrator in Constantinople (7th century),
Hôtel Dieu at Paris (651), Montpellier (738), St. Albans in Engeland (794), St. Maria della Scala,
Siena (898), and St. Bernard’s Hospital in the Swiss Alps (962).
Gradually the driving force behind hospitalisation in Europe changed from almost exclusively
monastery-associated to greater participation by civil authorities. The monastic infirmaries
continued to expand, but in large centres the city fathers initiated hospitals driven by civil
support, whilst church authorities also opened public hospitals. And in addition specialised
institutions like leper hospitals made their ppearance
Monastic institutions gradually expanded their medical services, previously restricted to
infirmaries, to the community. Famous new hospitals appeared, like St. Bartholomew’s (1137),
St. Mary’s (1179)
and St. Thomas (1215) in London, the Holy Cross hospital in Winchester (1132) and St. John’s
in Canterbury (1118). During the 12th century a monastic order was founded by Pope Innocent
III, which
led to the establishment of a Hospital of the Holy Ghost in most major cities. It was said that
Islamic hospital design greatly influenced the construction of the first of these hospitals, the
Santa Spiritus in Rome (1198). The Holy Ghost hospital built at Montpellier (1145) became one
of Europe’s first great teaching hospitals.
The public hospital movement in large cities was financed by city authorities as well as the
Church and even private sources. Lay physicians played an increasingly important role,
especially after the Church
placed a ban on monks practising outside monasteries. The medical dogma, here and in monastic
institutions, was based mainly on the teachings of Galen and Hippocrates, which was also greatly
admired
by contemporary Islamic physicians ..
In Islamic Jerusalem the Order of the Hospital of St. John was founded by Brother Gerhard in the
13th century as a charitable organisation caring for sick pilgrims in the Holy Land. A warrior
element
developing from the order, took part in the Crusades, and when Acrefell (1291), the movement
was allowed to depart to Cyprus. From here it moved to Rhodos (1309), then settled in Malta
(1530) and eventually moved to Rome. They became known as the Hospitallers in view of their
intrepid and selfless record of charitable endeavours and hospital building in particular. The best
known of these were at Mont
pellier, Rhodos, Prussia and at various sites in Italy. The present day St. John’s Ambulance
evolved from the Hospitallers. The related Templars (Order of the Poor Knights of Christ and
Temple of Solomon, or the Teutonic Knights) remained involved in religious-military matters
rather than charity, and amassed great power and wealth but were suppressed by Pope Clement V
in 1312
Generally speaking, public hospitals (above) did not specialise, but in time certain specialised
institutions did arise. Although the Basilica in Caesarea (4th century) already had quarters for
lepers, it is probable
that leper houses (Lazar Houses; lazarettes; leprosaria) really originated during the 11th century
when Europe started experiencing an epidemic of leprosy. When this abated in the 15th century,
the leper houses were transformed by civic authorities into mainly mental asylums or infectious
diseases hospitals. During the 13th century there were 19 000 leper houses in Europe, mostly run
on a self-governing basis. During the early 14th century a maternity hospital was built at Metz.
There were also homes and hospitals for the aged, which partly evolved out of the monastic
infirmaries, but were later run as independent charity institutions. Relatively small and often
housing the apostolic number of 13 inmates, these homes were widespread and many large
hospitals, like Strasbourg’s St. Leonhardt’s and Nurnberg’s Holy Ghost Hospital, had sections
for the elderly. Larger Jewish communities e.g. in Cologne and Regensburg had their own
hospitals.

. ISLAM
With their eastern conquests consolidated and the western offensive decisively defeated at Tours
by a Frankish army under Charles Martel (723), the Islamic revolution, started by Muhammed in
632, consolidated its gains and moved into a period of remarkable stability and
Development — the Golden Age of Islam, which terminated in the 13th century. Whereas
Europe was experiencing an era of socio-scientific stagnation, eventually ended by the
Renaissance, Islam succeeded instimulating development and original thought. In spite of
medical science in Europe stagnating around the doctrines of Galen, hospitalisation did expand .
In Islamic countries foreign students were welcomed, and Greek medical dogma was greatly
admired, studied and translated into Arabic.4 Physicians like Rhazes (866-932), Albucasis (9361013), Avicenna (980-1037), Avenzoar (1091-1162), Averroes (1126-1198) and Maimonides
(1135-1204) made important contributions, and in the field of hospitalisation great strides were
taken (Major 1954:225-258). Taking their example from the Christian (Nestorian) teaching
hospital at Jundi-Shapur, Islam developed its own impressive hospitals (bimaristans) at Cordoba,
Baghdad, Damascus, Bokhara, Sevilla and Cairo. A total of 34 major ones have been identified.
Tudela, who visited Baghdad in 1160, wrote that there were 60 hospitals in that city and 50 in
Cordoba. The greatest and most magnificent was the Mansuri hospital in Cairo (completed in
1284). This self-contained institution had four great courts, each with a water fountain in the
centre, separate wards for men and women and for different diseases, a dispensary, lecture halls,
and an out-patient department (from where patients were visited at their homes), a chapel and
library. Fever wards were cooled by fountains. Musicians and storytellers entertained the sick,
and on discharge each patient received a sum of money sufficient to pay for immediate expenses
until he could resume work
Possibly the first mental hospital for the insane (a maristan) in Europe was built by Islam in
Granada in 1365 The hospitals at Cordoba, Baghdad, Damascus and Cairo in particular, also
served as centres of medical education, attracting students from Europe and the Far East,
spanning the void of Medieval scientific stagnation until the creation of Europe’s own fledgling
medical schools at Salerno (11th century), followed by Montpellier and Bologna (13th century),
Padua and Paris (14th century)

HOSPITALS AND MEDICAL EDUCATION
After the Renaissance when medical schools in cities like Padua, Bologna and Montpellier
initiated the blossoming of medical knowledge
invariably associated with great teaching
hospitals. This was indeed a
new development. Although the Renaissance cities mentioned above did have hospitals, the
primary initiative leading to scientific development originated in their universities rather than
their hospitals. With few exceptions, e.g. in the field of surgery (Ambroise Paré, Guy de
Chauliac) and women’s diseases, the advances were not in clinical medicine, but in anatomy
(e.g. Vesalius), physiology, herbalism and philosophical fields of study. Hospitals and clinical
medicine became an essential component of the doctors’ training only when physicians like
Sydenham (17th entury) and Boerhaave (18th century) made the patient pivotal in medical
education .
Hippocrates (5th century BC) did of course emphasise the importance of clinical contact and
expertise in medical practice, but neither he nor Galen nor any other Greek physician of status
had access to teaching
hospitals (which did not exist at the time). In the Roman era with the advent of hospitals
(valetudinaria initially) we have little evidence that these played a significant role in the
furthering of medical science. Harig (1971:188) makes the point that eminent doctors of the
quality of Galen were apparently never associated with valetudinaria, although he did treat
gladiators early in his career. The famous Alexandrian school of medicine (founded c.300 BC)
where human dissection was performed for the first time, was well known for its magnificent
library and museum, but not for a hospital of significance.
In the Christian era the Church progressively monop olised the predominantly monastic hospital
system, which for its time rendered an able service to the ill and the aged, but contributed little to
the dvancement
of medical science (Harig 1971:97). In fact, it is fair to say that through its strict and slavish
adherence to the dogma of Greek masters like Galen, the Church repressed original thought, and
left it to the doctors and hospitals of Islam to carry the flame of medical knowledge through the
dark Middle Ages to the new dawn of the Renaissance . The major Islamic hospitals served as
centres of medical education, and in that sense they were the true forerunners of the modern
medical teaching hospital.
UNIT II:
Planning a Hospital - The Planning Process - Choosing a Site, Location and Access,
Building - Space Utilization, Physical Facilities - residential facilities requirements of
various types of Wards; out patient services and in-patient services, emergency services
in Hospital - Medico Legal cases - Different departments required in the hospital.
-------------------------------------------------------------------------------------------------
PART A
1) The department which provides radiotherapy and a full range of chemotherapy
treatments for cancerous tumours and blood disorders is known as ............
A) Oncology
2) What ic MLC?
A) Medico Legal Cases
3) ...................department is known as the ambulatory acre dept.
A) Out patient dept.
PART B
1) Explain the planning process of a hospital ?
(Hint: Choosing a Site, Location and Access,Building - Space Utilization, Physical Facilities
- residential facilities requirements of various types of Wards; out patient services and inpatient services)
Hospital Planning
"A functional design can promote skill, economy, conveniences, and comforts; a non-functional
design can impede activities of all types, detract from quality of care, and raise costs to
intolerable levels." ... Hardy and Lammers
Hospitals are the most complex of building types. Each hospital is comprised of a wide range of
services and functional units. These include diagnostic and treatment functions, such as clinical
laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service
and housekeeping; and the fundamental inpatient care or bed-related function. This diversity is
reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital
construction and operations. Each of the wide-ranging and constantly evolving functions of a
hospital, including highly complicated mechanical, electrical, and telecommunications systems,
requires specialized knowledge and expertise. No one person can reasonably have complete
knowledge, which is why specialized consultants play an important role in hospital planning and
design. The functional units within the hospital can have competing needs and priorities.
Idealized scenarios and strongly-held individual preferences must be balanced against mandatory
requirements, actual functional needs (internal traffic and relationship to other departments), and
the financial status of the organization.
In addition to the wide range of services that must be accommodated, hospitals must serve and
support many different users and stakeholders. Ideally, the design process incorporates direct
input from the owner and from key hospital staff early on in the process. The designer also has to
be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not
generally have direct input into the design. Good hospital design integrates functional
requirements with the human needs of its varied users.
The basic form of a hospital is, ideally, based on its functions:

bed-related inpatient functions

outpatient-related functions

diagnostic and treatment functions

administrative functions

service functions (food, supply)

research and teaching functions
Physical relationships between these functions determine the configuration of the hospital.
Certain relationships between the various functions are required—as in the following flow
diagrams.
These flow diagrams show the movement and communication of people, materials, and waste.
Thus the physical configuration of a hospital and its transportation and logistic systems are
inextricably intertwined. The transportation systems are influenced by the building configuration,
and the configuration is heavily dependent on the transportation systems. The hospital
configuration is also influenced by site restraints and opportunities, climate, surrounding
facilities, budget, and available technology. New alternatives are generated by new medical
needs and new technology.
In a large hospital, the form of the typical nursing unit, since it may be repeated many times, is a
principal element of the overall configuration. Nursing units today tend to be more compact
shapes than the elongated rectangles of the past. Compact rectangles, modified triangles, or even
circles have been used in an attempt to shorten the distance between the nurse station and the
patient's bed. The chosen solution is heavily dependent on program issues such as organization
of the nursing program, number of beds to a nursing unit, and number of beds to a patient room.
(The trend, recently reinforced by HIPAA, is to all private rooms.)
Building Attributes
Regardless of their location, size, or budget, all hospitals should have certain common attributes.
Efficiency and Cost-Effectiveness
An efficient hospital layout should:

Promote staff efficiency by minimizing distance of necessary travel between frequently
used spaces

Allow easy visual supervision of patients by limited staff

Include all needed spaces, but no redundant ones. This requires careful pre-design
programming.

Provide an efficient logistics system, which might include elevators, pneumatic tubes,
box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the
efficient handling of food and clean supplies and the removal of waste, recyclables, and
soiled material

Make efficient use of space by locating support spaces so that they may be shared by
adjacent functional areas, and by making prudent use of multi-purpose spaces

Consolidate outpatient functions for more efficient operation—on first floor, if
possible—for direct access by outpatients

Group or combine functional areas with similar system requirements

Provide optimal functional adjacencies, such as locating the surgical intensive care unit
adjacent to the operating suite. These adjacencies should be based on a detailed
functional program which describes the hospital's intended operations from the
standpoint of patients, staff, and supplies.
Flexibility and Expandability
Since medical needs and modes of treatment will continue to change, hospitals should:

Follow modular concepts of space planning and layout

Use generic room sizes and plans as much as possible, rather than highly specific ones

Be served by modular, easily accessed, and easily modified mechanical and electrical
systems

Where size and program allow, be designed on a modular system basis, such as the VA
Hospital Building System. This system also uses walk-through interstitial space between
occupied floors for mechanical, electrical, and plumbing distribution. For large projects,
this provides continuing adaptability to changing programs and needs, with no first-cost
premium, if properly planned, designed, and bid. The VA Hospital Building System also
allows vertical expansion without disruptions to floors below.

Be open-ended, with well planned directions for future expansion; for instance
positioning "soft spaces" such as administrative departments, adjacent to "hard spaces"
such as clinical laboratories.
Therapeutic Environment
Hospital patients are often fearful and confused and these feelings may impede recovery. Every
effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as
possible. The interior designer plays a major role in this effort to create a therapeutic
environment. A hospital's interior design should be based on a comprehensive understanding of
the facility's mission and its patient profile. The characteristics of the patient profile will
determine the degree to which the interior design should address aging, loss of visual acuity,
other physical and mental disabilities, and abusiveness. Some important aspects of creating a
therapeutic interior are:

Using familiar and culturally relevant materials wherever consistent with sanitation and
other functional needs

Using cheerful and varied colors and textures, keeping in mind that some colors are
inappropriate and can interfere with provider assessments of patients' pallor and skin
tones, disorient older or impaired patients, or agitate patients and staff, particularly some
psychiatric patients .

Admitting ample natural light wherever feasible and using color-corrected lighting in
interior spaces which closely approximates natural daylight

Providing views of the outdoors from every patient bed, and elsewhere wherever
possible; photo murals of nature scenes are helpful where outdoor views are not available

Designing a "way-finding" process into every project. Patients, visitors, and staff all need
to know where they are, what their destination is, and how to get there and return. A
patient's sense of competence is encouraged by making spaces easy to find, identify, and
use without asking for help. Building elements, color, texture, and pattern should all give
cues, as well as artwork and signage.
Cross-section showing interstitial space with deck above an occupied floor
Cleanliness and Sanitation
Hospitals must be easy to clean and maintain. This is facilitated by:

Appropriate, durable finishes for each functional space

Careful detailing of such features as doorframes, casework, and finish transitions to avoid
dirt-catching and hard-to-clean crevices and joints

Adequate and appropriately located housekeeping spaces

Special materials, finishes, and details for spaces which are to be kept sterile, such as
integral cove base. The new antimicrobial surfaces might be considered for appropriate
locations.

Incorporating O&M practices that stress indoor environmental quality (IEQ)
Accessibility
All areas, both inside and out, should:
Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if
federally funded or owned, the Uniform Federal Accessibility Standards (UFAS)

In addition to meeting minimum requirements of ADA and/or UFAS, be designed so as
to be easy to use by the many patients with temporary or permanent handicaps

Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are
wide enough for two wheelchairs to pass easily

Ensuring entrance areas are designed to accommodate patients with slower adaptation
rates to dark and light; marking glass walls and doors to make their presence obvious
Controlled Circulation
A hospital is a complex system of interrelated functions requiring constant movement of people
and goods. Much of this circulation should be controlled.

Outpatients visiting diagnostic and treatment areas should not travel through inpatient
functional areas nor encounter severely ill inpatients

Typical outpatient routes should be simple and clearly defined

Visitors should have a simple and direct route to each patient nursing unit without
penetrating other functional areas

Separate patients and visitors from industrial/logistical areas or floors

Outflow of trash, recyclables, and soiled materials should be separated from movement of
food and clean supplies, and both should be separated from routes of patients and visitors

Transfer of cadavers to and from the morgue should be out of the sight of patients and
visitors

Dedicated service elevators for deliveries, food and building maintenance services
Aesthetics
Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is
important in enhancing the hospital's public image and is thus an important marketing tool. A
better environment also contributes to better staff morale and patient care. Aesthetic
considerations include:

Increased use of natural light, natural materials, and textures

Use of artwork

Attention to proportions, color, scale, and detail

Bright, open, generously-scaled public spaces

Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices

Compatibility of exterior design with its physical surroundings
Security and Safety
In addition to the general safety concerns of all buildings, hospitals have several particular
security concerns:

Protection of hospital property and assets, including drugs

Protection of patients, including incapacitated patients, and staff

Safe control of violent or unstable patients

Vulnerability to damage from terrorism because of proximity to highvulnerability targets, or because they may be highly visible public buildings with
an important role in the public health system.
Sustainability
Hospitals are large public buildings that have a significant impact on the environment and
economy of the surrounding community. They are heavy users of energy and water and produce
large amounts of waste. Because hospitals place such demands on community resources they are
natural candidates for sustainable design.
Related Issues
The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address
security and privacy of "protected health information" (PHI). These regulations put emphasis on
acoustic and visual privacy, and may affect location and layout of workstations that handle
medical records and other patient information, paper and electronic, as well as patient
accommodations."
Emerging Issues
Among the many new developments and trends influencing hospital design are:

The decreasing numbers of general practitioners along with the increased use of
emergency facilities for primary care

The increasing introduction of highly sophisticated diagnostic and treatment
technology

Requirements to remain operational during and after disasters—see, for example,
VA's Physical Security Manuals

State laws requiring earthquake resistance, both in designing new buildings and
retrofitting existing structures

Preventative care versus sickness care; designing hospitals as all-inclusive
"wellness centers"

Use of hand-held computers and portable diagnostic equipment to allow more
mobile, decentralized patient care, and a general shift to computerized patient
information of all kinds. This might require computer alcoves and data ports in
corridors outside patient bedrooms. For more information, see WBDG Integrate
Technological Tools

Need to balance increasing attention to building security with openness to patients
and visitors

Emergence of palliative care as a specialty in many major medical centers

A growing interest in more holistic, patient-centered treatment and environments
such as promoted by Planetree. This might include providing mini-medical
libraries and computer terminals so patients can research their conditions and
treatments, and locating kitchens and dining areas on inpatient units so family
members can prepare food for patients and families to eat together.
Relevant Codes and Standards
Hospitals are among the most regulated of all building types. Like other buildings, they must
follow the local and/or state general building codes. However, federal facilities on federal
property generally need not comply with state and local codes, but follow federal regulations. To
be licensed by the state, design must comply with the individual state licensing regulations.
Many states adopt the FGI Guidelines for Design and Construction of Hospitals and Health
Care Facilities, listed below as a resource, and thus that volume often has regulatory status.
State and local building codes are based on the model International Building Code (IBC).
Federal agencies are usually in compliance with the IBC except NFPA 101 (Life Safety Code),
NFPA 70 (National Electric Code), and Architectural Barriers Act Accessibility Guidelines
(ABAAG) or Uniform Federal Accessibility Standards (UFAS) takes precedence."
Since hospitals treat patients who are reimbursed under Medicare, they must also meet federal
standards, and to be accredited, they must meet standards of the Joint Commission on the
Accreditation of Healthcare Organizations (JCAHO). Generally, the federal government and
JCAHO refer to the National Fire Protection Association (NFPA) model fire codes, including
Standards for Health Care Facilities (NFPA 99) and the Life Safety Code (NFPA 101).
The American with Disabilities Act (ADA) applies to all public facilities and greatly the building
design with its general and specific accessibility requirements. The Architectural Barriers Act
Accessibility Guidelines (ABAAG) or the Uniform Federal Accessibility Standards (UFAS)
apply to federal and federally funded facilities. The technical requirements do not differ greatly
from the ADA requirements. See WBDG Accessible
Regulations of the Occupational Safety and Health Administration (OSHA) also affect the design
of hospitals, particularly in laboratory areas.
Federal agencies that build and operate hospitals have developed detailed standards for the
programming, design, and construction of their facilities. Many of these standards are applicable
to the design of non-governmental facilities as well. Among them are:
Department of Veterans Affairs (VA), Office of Construction & Facilities Management
Technical Information Library contains many guides and standards, including:
Design Guides for planning many different departments and clinics, design manuals of technical
requirements, equipment lists, master specifications, room finishes, space planning criteria, and
standard details.
Hospital Building
In the words of office design consultant and author Francis Duffy, "The office building is one of
the great icons of the twentieth century. Office towers dominate the skylines of cities in every
continent… [As] the most visible index of economic activity, of social, technological, and
financial progress, they have come to symbolize much of what this century has been about."
This is true because the office building is the most tangible reflection of a profound change in
employment patterns that has occurred over the last one hundred years. In present-day America,
northern Europe, and Japan, at least 50 percent of the working population is employed in office
settings as compared to 5 percent of the population at the beginning of the 20th century.
Interestingly, the life-cycle cost distribution for a typical service organization is about 3 to 4
percent for the facility, 4 percent for operations, 1 percent for furniture, and 90 to 91 percent for
salaries. As such, if the office structure can leverage the 3 to 4 percent expenditure on facilities
to improve the productivity of the workplace, it can have a very dramatic effect on personnel
contributions representing the 90 to 91 percent of the service organization's costs.
To accomplish this impact, the buildings must benefit from an integrated design approach that
focuses on meeting a list of objectives. Through integrated design, a new generation of highperformance office buildings is beginning to emerge that offers owners and users increased
worker satisfaction and productivity, improved health, greater flexibility, and enhanced energy
and environmental performance. Typically, these projects apply life-cycle analysis to optimize
initial investments in architectural design, systems selection, and building construction.
Building Attributes
An office building must have flexible and technologically-advanced working environments that
are safe, healthy, comfortable, durable, aesthetically-pleasing, and accessible. It must be able to
accommodate the specific space and equipment needs of the tenant. Special attention should be
made to the selection of interior finishes and art installations, particularly in entry spaces,
conference rooms and other areas with public access.
A. Types of Spaces
An office building incorporates a number of space types to meet the needs of staff and visitors.
These may include:
Offices

Offices: May be private or semi-private acoustically and/or visually.

Conference Rooms
Employee/Visitor Support Spaces

Convenience Store, Kiosk, or Vending Machines

Lobby: Central location for building directory, schedules, and general information

Atria or Common Space: Informal, multi-purpose recreation and social gathering space

Cafeteria or Dining Hall

Private Toilets or Restrooms

Child Care Centers

Physical Fitness Area

Interior or Surface Parking Areas
Administrative Support Spaces

Administrative Offices: May be private or semi-private acoustically and/or visually.
Operation and Maintenance Spaces

General Storage: For items such as stationery, equipment, and instructional materials.

Food Preparation Area or Kitchen

Computer/Information Technology (IT) Closets. See WBDG Automated Data Processing
Center for PC System related information.

Maintenance Closets
B. Important Design Considerations
Typical features of Office Buildings include the list of applicable design objectives elements as
outlined below. For a complete list and definitions of the design objectives within the context of
whole building design, click on the titles below.
Cost-Effective
The high-performance office should be evaluated using life-cycle economic and material
evaluation models. In some cases, owners need to appreciate that optimizing building
performance will require a willingness to invest more initially to save on long-term operations
and maintenance.
To achieve the optimum performance for the investment in the facility, value engineering
provides a means for assessing the performance versus cost of each design element and building
component. In the design phase building development, properly applied value engineering
considers alternative design solutions to optimize the expected cost/worth ratio of projects at
completion. Value engineering elicits ideas on ways of maintaining or enhancing results while
reducing life cycle costs. In the construction phase, contractors are encouraged through shared
savings to draw on their special 'know-how' to propose changes that cut costs while maintaining
or enhancing quality, value, and functional performance. For more information on valueengineering, see WBDG Cost-Effective—Utilize Cost Management Throughout the Planning,
Design, and Development Process.
Functional/Operational
Tenant Requirements—The building design must consider the integrated requirements of the
intended tenants. This includes their desired image, degree of public access, operating hours,
growth demands, security issues and vulnerability assessment results, organization and group
sizes, growth potential, long-term consistency of need, group assembly requirements, electronic
equipment and technology requirements, acoustical requirements, special floor loading and
filing/storage requirements, special utility services, any material handling or operational process
flows, special health hazards, use of vehicles and types of vehicles used, and economic
objectives.
Flexibility
The high-performance office must easily and economically accommodate frequent renovation
and alteration, sometimes referred to as "churn." These modifications may be due to management
reorganization, personnel shifts, changes in business models, or the advent of technological
innovation, but the office infrastructure, interior systems, and furnishings must be up to the
challenge.

Consider raised floors to allow for easy access to cabling and power distribution, as well
as advanced air distribution capabilities to address individual occupant comfort.

Incorporate features such as plug-and-play floor boxes for power, data, voice and fiber,
modular and harnessed wiring and buses, and conferencing hubs to allow for daily
flexibility at work as well as future reorganization of office workstations.
Urban Planning
The concentration of a large number of workers within one building can have a significant
impact on neighborhoods. Office structures can vitalize neighborhoods with the retail, food
service, and interrelated business links the office brings to the neighborhood. Consideration of
transportation issues must also be given when developing office structures. Office buildings are
often impacted by urban planning and municipal zoning, which attempt to promote compatible
land use and vibrant neighborhoods.

Consideration should be given when selecting office locations to the distance the majority
of occupants will have to travel to reach the office. Studies including zip code origination
should be conducted to determine the best location of the office. The development of new
office locations will often necessitate relocation of employees, particularly if the office is
moved or opened in a new geographical area. Consideration of the municipal resources
should include housing costs and availability, traffic congestion, school system quality,
cultural resources such as museums, sports teams and institutions of higher education,
natural attractions such as coastal areas, mountains and public parks, availability of
educated labor, crime rate and law enforcement, and civic infrastructure capacity such as
water, waste water and waste processing.

Once a building has been constructed and occupied, it is critical that long-term
performance be confirmed through an aggressive process of metering, monitoring and
reporting. The results of this feedback should inform maintenance operations and be
available as input to new design efforts.
Productive

Worker Satisfaction, Health, and Comfort—In office environments, by far the single
greatest cost to employers is the salaries of the employees occupying the space. It
generally exceeds the lease and energy costs of a facility by a factor of ten on a square
foot basis. For this reason, the health, safety, and comfort of employees in a highperformance office are of paramount concern.

Utilize strategies such as increased fresh air ventilation rates, the specification of nontoxic and low-polluting materials and systems, and indoor air quality monitoring.

Provide individualized climate control that permits users to set their own, localized
temperature, ventilation rate, and air movement preferences.

While difficult to quantify, it is widely accepted that worker satisfaction and performance
is increased when office workers are provided stimulating, dynamic working
environments. Access to windows and view, opportunities for interaction, and control of
one's immediate environment are some of the factors that contribute to improved
workplace satisfaction. See also the Psychosocial Value of Space.

Natural light is important to the health and psychological well-being of office workers.
The design of office environments must place emphasis on providing each occupant with
access to natural light and views to the outside. A minimum of 30 foot candles per square
foot of diffused indirect natural light is desirable.

The acoustical environment of the office must be designed and integrated with the other
architectural systems and furnishings of the office. Special consideration must be given to
noise control in open office settings, with absorptive finish materials, masking white
noise, and sufficient separation of individual occupants.

Technical Connectivity
Technology has become an indispensable tool for business, industry, and education. Given that
technology is driving a variety of changes in the organizational and architectural forms of office
buildings, consider the following issues when incorporating it, particularly information
technology (IT), into an office:

Plan new office buildings to have a distributed, robust, and flexible IT infrastructure,
which would allow technological access in virtually all the spaces.

During the planning stage, identify all necessary technological systems (e.g.,
voice/cable/data systems such as audio/visual systems, speaker systems, Internet access,
and Local Area Networks [LAN] / Wide-Area Networks [WAN] / Wireless Fidelity [WIFI]), and provide adequate equipment rooms and conduit runs for them.

Consider and accommodate for wireless technologies, as appropriate.

For existing office buildings, consider improving access to the IT infrastructure as
renovations are undertaken.

Sustainable
Energy Efficiency—Depending on the office's size, local climate, use profile, and utility rates,
strategies for minimizing energy consumption involve: 1) reducing the load (by integrating the
building with the site, optimizing the building envelope [decreasing infiltration, increasing
insulation], etc.); 2) correctly sizing the heating, ventilating, and air-conditioning systems; and 3)
installing high-efficiency equipment, lighting, and appliances.
Consideration should be given to the application of renewable energy systems such as buildingintegrated photovoltaic systems that generate building electricity, solar thermal systems that
produce hot water for domestic hot water (DHW) or space conditioning, or geothermal heat
pump systems that draw on the thermal capacitance of the earth to improve HVAC system
performance.
Hospitals vary widely in the services they offer and therefore, in the departments they have.
They may have acute services such as an emergency department or specialist trauma centre, burn
unit, surgery, or urgent care. These may then be backed up by more specialist units such as
cardiology or coronary care unit, intensive care unit, neurology, cancer center, and obstetrics and
gynecology.
Some hospitals will have outpatient departments and some will have chronic treatment units such
as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services,
and physical therapy.
Common support units include a dispensary or pharmacy, pathology, and radiology, and on the
non-medical side, there often are medical records departments and/or release of information
department.
2.Write about in patient and out patient wards?
Outpatients and inpatients
An outpatient is a patient who is not hospitalized overnight but who visits a hospital, clinic, or
associated facility for diagnosis or treatment. Treatment provided in this fashion is called
ambulatory care. Outpatient surgery eliminates inpatient hospital admission, reduces the amount
of medication prescribed, and uses a doctor's time more efficiently. More procedures are now
being performed in a surgeon's office, termed office-based surgery, rather than in an operating
room. Outpatient surgery is suited best for healthy people undergoing minor or intermediate
procedures (limited urologic, ophthalmologic, or ear, nose, and throat procedures and procedures
involving the extremities).
An inpatient on the other hand is "admitted" to the hospital and stays overnight or for an
indeterminate time, usually several days or weeks (though some cases, like coma patients, have
been in hospitals for years).
Emergency services
An Emergency Department (ED), also known as Accident & Emergency (A&E), Emergency
Room (ER), Emergency Ward (EW), or Casualty Department is a medical treatment facility,
specialising in acute care of patients who present without prior appointment, either by their own
means or by ambulance. The emergency department is usually found in a hospital or other
primary care centre.
Due to the unplanned nature of patient attendance, the department must provide initial treatment
for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require
immediate attention. In some countries, emergency departments have become important entry
points for those without other means of access to medical care.
The emergency departments of most hospitals operate around the clock, although staffing levels
may be varied in an attempt to mirror patient volume
3. What all are the Cases that are to be treated as medico-legal?
(Hint:
All
cases
of
injuries
and
burns,sucide,drownint
ito
water,
sexual
assault,accidents..)
Medico- legal cases
Every medical practitioner, at any time during the practice
of his profession, whether in a government setting or a private one, will encounter/ would have
encountered certain cases, which at that given time or subsequently, would be labeled as
“medico-legal”. Many a practitioners are usually apprehensive in dealing with these, for,
according to them, an MLC (Medico-legal Case) implies—‘rough speaking’ police officials,
‘inordinate hours’ in the court, ‘unrelenting’ defense counsels, etc. Because of this “fear-factor”,
they either try to avoid the cases or try to ‘get done with’ them as soon as possible. Both ways,
because they did not properly understand the implications of the case, they may make mistakes,
which may land them in trouble. The best way to deal with these cases is to understand them
clearly, analyze them thoroughly, and then act accordingly.
What actually is a medico-legal case?
A medico-legal case is a case of injury/ illness where the attending doctor, after eliciting history
and examining the patient, thinks that some investigation by law enforcement agencies is
essential to establish and fix responsibility for the case in accordance with the law of the land.1 It
can also be defined as a case of injury or ailment, etc., in which investigations by the lawenforcing agencies are essential to fix the responsibility regarding the causation of the said injury
or ailment.2 Simply put, it is a medical case with legal implications or a legal case requiring
medical expertise. Accordingly, a medico-legal report is one, which is prepared for the purpose
of litigation – imminent or prospective. The responsibility to label any case as an MLC rests
solely with the attending medical practitioner.
Receiving an MLC
A doctor can receive a medico-legal case in any of the three ways –
1. A case is brought by the police for examination and reporting,
2. The person in question was already attended to by a doctor and a medico-legal case was
registered in the previous hospital, and the person is now referred for expert management/
advice.
3. In the other instances, after history taking and thorough examination, if the doctor feels that
the circumstances/ findings of the case are such that registration of the case as an MLC is
warranted, he should immediately inform the patient of the same and take his consent for
converting the case into MLC. At that given time, the patient may refuse consent, withdraw the
consent already given or may even leave the hospital. The doctor has no right to force anything
on the patient. The best that should, in his own interest, be done is to carefully document all the
BVFpolice station regarding the same, giving reasons for his actions. At times, the decision may
be made easier by the patient himself expressing his intention to register a case against the
alleged accused.
The decision is easy in the first two instances but the doctor has to use his judgment when the
person comes on his own and the history is not completely revealed, either by the patient or his
relatives/ friends, due to some motive. When a person has been referred from another hospital,
which has already registered a medico-legal case, the same may be informed to the nearest police
station; however, a fresh medico-legal case need not be registered. When a patient is to be
referred to another hospital for further management, he should be issued a referral letter detailing
the treatment given and whether the case was registered as an MLC or not.
Request by the patient or the persons accompanying, not to register a medico-legal case, should
not be acceded to, by the medical practitioner. He should use his judgment and experience. If he
thinks that the case needs to be reported to the police, he should do so without fail and without
any delay. Not informing the police of such cases may invite trouble to the doctor u/s 39 CrPC
[Criminal Procedure Code (cases wherein public is duty-bound to inform the police)] and S.177
& 201, IPC [Indian Penal Code (giving false information & causing disappearance of evidence)].
Procedure of registering a medico-legal case
In the casualty, while attending to an emergency, the doctor should understand that his first
priority is to save the life of the patient. He should do everything possible to resuscitate the
patient and ensure that he is out of danger. All legal formalities stand suspended till this is
achieved. This has been clearly exemplified by the Hon’ble Supreme Court of India in
Parmananda Katara Vs Union of India3: “Every doctor is bound to provide medical aid to the
victims irrespective of the cause of injury; he cannot take any excuse of allowing law to take its
course”. In the same case, the MCI (Medical Council of India) filed an affidavit stating that ”the
MCI expects that all registered medical practitioners must attend to the sick and the injured
immediately and it is the duty of the medical practitioner to make immediate and timely medical
care available to every injured person, whether he is injured in an accident or otherwise…..Life
of a person is far more important than the legal formalities” Again, in Pattipati Venkaiah Vs
State of AP4, the Hon’ble High Court of Andhra Pradesh decreed that “doctor’s duty is to attend
to the injuries of the person produced before him. His primary effort should be to save the life of
the patient and then inform the police/ document clearly all the injuries observed by him in
medicolegal cases”. This means that the duty of the doctor to provide medical aid, even in
MLCs, has been extended to the private doctors also.
The next important duty is to identify, after carefully analyzing the injuries on the person of the
patient, the history given, and the other circumstances of the case; whether the said case falls
under the category of an MLC or not. If it does fall in this category, then he must register the
case as an MLC and/ or intimate the same to the nearest police station, either by telephone or in
writing. An acknowledgement of receipt of such a message should be taken for future reference.
If the intimation is given orally or on phone, the diary number (DD or the Daily Docket number)
should be taken down as proof of intimation and should be properly documented in the patient’s
records. According to the Hon’ble Supreme Court, “whenever any medico-legal case comes to
the hospital, the medical officer on duty should inform the Duty Constable, giving the name, age,
sex of the patient and the place of occurrence of the incident and should start the treatment of the
patient. It will be the duty of the said Constable to inform the nearest concerned police station or
higher police functionaries for further action”.3 Every big hospital usually has either a police
post at the casualty or has a police official posted there for this purpose. Police should also be
informed regarding the discharge/ death of the said patient in the Casualty/ any other department
of the hospital.
A medico-legal register should be maintained in the casualty of every hospital and details of all
medico-legal cases should be entered in this register, including the time and date of examination
and the name of the doctor who is dealing with the case. This would be of immense help for
future reference, when the patient through the court/ the police, requests for a copy of the
medicolegal report.
Cases that are to be treated as medico-legal
The following cases should be considered as medico-legal and as such the medical officer is
“duty-bound” to intimate to the police regarding such cases:
1. All cases of injuries and burns –the circumstances of which suggest commission of an offence
by somebody. (irrespective of suspicion of foul play)
2. All vehicular, factory or other unnatural accident cases specially when there is a likelihood of
patient’s death or grievous hurt.
3. Cases of suspected or evident sexual assault.
4. Cases of suspected or evident criminal abortion.
5. Cases of unconsciousness where its cause is not natural or not clear.
6. All cases of suspected or evident poisoning or intoxication.
7. Cases referred from court or otherwise for age estimation.
8. Cases brought dead with improper history creating suspicion of an offence.
9. Cases of suspected self-infliction of injuries or attempted suicide.
10. Any other case not falling under the above categories but has legal implications.
Time limit for registering a medico-legal case
A medico-legal case should be registered as soon as a doctor suspects foul play or feels it
necessary to inform the police, at any time after admission. There should not be any unnecessary
delay in doing so. A case may be registered as an MLC even if it is brought several days after the
incident.
4. What is MLC and explain the precautions to be taken while preparing MLCs
(Hint: Consent,confidentiality, Collection and preservation of samples..)
Precautions to be taken
a. Consent
A valid consent to medical procedures is fundamental to the interaction between all doctors and
patients. Accordingly, consent of the patient or the legal guardian is mandatory for examination.
To be valid, the consent must be competent, freely given, informed, and specific to the procedure
being performed. In medicolegal cases, an informed consent includes information that: a) the
examination to be conducted would be a medicolegal one and would culminate in the preparation
of a medico-legal injury report, b) all relevant investigations needed for the said purpose would
be done, and c) (the most important) the findings of the report may go against the patient if they
do not tally with the history given.
A person arrested as accused in a criminal offence may however, be medically examined without
his consent on the request of a police officer or on the orders of the court, if there are sufficient
grounds to believe that such examination will provide evidence of the commission of the
offence. Moreover, a reasonable amount of force may be used to medically examine the person
in such cases (Sec 53 CrPC). To invoke Sec 53 of CrPC,6 certain criteria need to be fulfilled,
namely: a) the person should have been arrested on charge of committing an offence punishable
under law, b) there are reasonable grounds for believing that an examination of his person will
afford evidence as to the commission of the offence, and c) the requisition for medicolegal
examination is from an officer of the rank of a sub-inspector of police or above.
Whenever examining a woman, it is preferable that a lady doctor should examine her, or,
wherever this is not possible, a female disinterested attendant (nurse, etc) should be present
during the examination.7 The Hon’ble High Court of Punjab and Haryana has now ruled that
only a lady doctor can examine a woman who is an alleged victim of sexual offence.
In civil cases, however, no examination should be done without the consent of the person to be
medically examined.
b. Confidentiality
A doctor is required to keep secret all information regarding the patient that he comes across
during the course of his treatment. Medico-legal reports are no exception and are to be treated as
strictly confidential. They should not be issued directly to the patient. They have to be handed
over to the police official, after getting them duly received on the carbon copy of the same.
Copies of the MLR can be handed over to the patient/ his relatives, as per the prevailing rules of
the doctor’s hospital, and after the requisite fee has been paid by the patient.
c. Collection and preservation of samples
All relevant specimens should be collected and after proper labeling, are to be sealed under the
doctor’s supervision. These should be handed over to the police official concerned, along with
the medico-legal report and a proper requisition letter detailing the tests to be conducted on such
samples. If the samples have been collected on the request of the police, the fact is to be
mentioned in the report and no requisition is necessary.
Medico-legal Reports
Medico-legal reports (MLR) are to be prepared immediately after the examination is done. They
should be prepared in duplicate, preferably with a ball-point-pen, in a clear and legible hand.
Cutting/ overwriting, etc should be avoided as much as possible and all corrections should be
properly initialed. Abbreviations of any sort should be avoided.
An MLR comprises of three parts, namely:
a) Pre-amble—includes the date, time and place of examination, name of the patient, his
residential address, occupation; name of the person(s)/police official accompanying, DDR/FIR
No., informed consent of the person being examined, two marks of identification, etc, wherever
applicable.
b) Body (Findings/Observations)—includes a complete description of the injuries/any other
findings present; any investigations/referrals, etc, asked for.
c) Post-amble (Opinion)—includes the

Nature of the injury—whether simple or grievous.

Weapon/Force used—whether blunt or sharp or fire-arms or burns, etc.

Duration of the injuries—based on the characteristics of the external injuries.
Here, it would be pertinent to add that when giving the duration of the injuries, the most common
mistake that is committed is that undue/complete reliance is placed on the history given; while
the doctor’s own observations regarding the features of the injuries are often not taken into
consideration. This again, may prove disastrous, as far as the courts are concerned. As regards
the accuracy of estimating the duration of the injuries, the Hon’ble Supreme Court, in
Ramswaroop v State of UP8, said that “It is well known that a doctor can never be absolutely
certain on the point of the time so far as duration of injuries is concerned”.

Any other information that may prove to be helpful to the police.

If for any reason, the opinion is to be kept ‘pending’, the same is to be documented properly in
the appropriate column.
The Officer/CMO issuing the MLR register to any doctor should ensure that it is properly
numbered and a certificate regarding the same (giving the number of forms contained there-in)
should be given by him on the first page of the said register.
All investigation forms, X-rays, Case file, etc should bear the label “MLC” on the top, so that
necessary precautions can be taken by all concerned.
Custody of the Records
The records should be kept under lock and key, in the custody of the doctor concerned or may be
kept in a Central Record Room, in hospitals where such facility is available; as per the
institution’s rules.
Most hospitals have a policy of maintaining all medico-legal records for variable periods.
However, as per law, there is no specified time limit after which the MLRs can be destroyed.
Hence, they have to be preserved. In view of the multitude of cases against the doctors under the
Consumer Protection Act, it is advisable to preserve all the in-patient records for a period of at
least 5 years and OPD records for 3 years.9
Admission and discharge
Whenever a medico-legal case is admitted or discharged, the same should be intimated to the
nearest police station at the earliest. It is always better to inform the police through the casualty
of the hospital where the medico-legal register is usually maintained and necessary entries can be
made in it. While discharging or referring the patient, care should be taken to see that he receives
the Discharge Card/Referral Letter, complete with the summary of admission, the treatment
given in the hospital and the instructions to the patient to be followed after discharge. Failure to
do so renders the doctor liable for “negligence” and “deficiency of service”. In N. K. Kohli v
Bajaj Nursing Home,10 the Madhya Pradesh State Consumer Disputes Redressal Commission
said that “issuance of the discharge certificate is the mandatory duty of the treating doctor and
the Nursing Home/ Hospital and the non-issuance of the same amounts to grave negligence and
deficiency (in service) on the part of the doctor and the hospital”.
If the patient is not serious and can take care of himself, he may be discharged on his own
request, after taking in writing from him that he has been explained the possible outcome of such
a discharge and that he is going on his own against medical advice. Police have to be informed
before the said patient leaves the hospital. Sometimes the patient, registered as a medico-legal
case, may abscond from the hospital. Police have to be immediately informed, the moment such
an instance comes to the notice of the doctor/ hospital staff.
Death of a person admitted as a medico-legal case
The following are the do's and dont's in case a person admitted as a medico-legal case expires.

Inform the police immediately.

Send the body to the hospital mortuary for preservation, till the legal formalities are completed
and the police releases the body to the lawful heirs.

Request a medico-legal postmortem examination.

Do not issue a death certificate – even if the patient was admitted.
The dead body should never be released to the relatives; it should only be handed over to the
police.
Conclusion
Medico-legal cases have to be dealt with properly, following the institution’s prevailing
guidelines. Usually, all the big hospitals and the teaching institutions have an ‘institutional
medico-legal manual’ which gives, in a step-wise detail, the correct procedure of dealing with
the various kinds of MLCs. Even if such manuals are not available, these cases pose no problem
if one uses proper caution and due care and attention, while dealing with them. Proper
documentation, timely information, a methodical and thorough examination—including all
relevant investigations and referrals, etc, are all that are necessary to see such cases through,
successfully.
PART C
1.List out the varioud departements departments and it’s functions in a hospital.?
(Hint: OP,IP,cardiology,oncology,general
medicine,ENT,nephrology,orthopaedics,gynaecology,dermatology,urology...)
Different departments in a hospital
There are many hospital departments, staffed by a wide variety of healthcare professionals, with
some crossover between departments.
For example, physiotherapists often work in different departments and doctors often do the same,
working on a general medical ward as well as an intensive or coronary care unit.
Below is a list of the main departments you'll come across when you visit a hospital. Some of
these units work very closely together, and may even be combined into one larger department.
Each department tends to be overseen by consultants in that speciality with a team of junior
medical staff under them who are also interested in that speciality.

Accident and emergency (A&E)
This department (sometimes called Casualty) is where you're likely to be taken if you've called
an ambulance in an emergency.It's also where you should come if you've had an accident, but
can make your own way to hospital. These departments operate 24 hours a day, every day and
are staffed and equipped to deal with all emergencies. Patients are assessed and seen in order of
need, usually with a separate minor injuries area supported by nurses.

Anaesthetics
Doctors in this department give anaesthetic for operations.
They are responsible for the provision of:

acute pain services (pain relief after an operation)

chronic pain services (pain relief in long-term conditions such as arthritis)

critical care services (pain relief for those who have had a serious accident or trauma)

obstetric anaesthesia and analgesia (epidurals in childbirth and anaesthetic for Caesarean
sections).

Breast screening
This unit screens women for breast cancer, either through routine mammogram examinations or
at the request of doctors. It's usually linked to an X-ray departmen

Cardiology
This department provides medical care to patients who have problems with their heart or
circulation. It treats people on an inpatient and outpatient basis.Typical procedures performed
include:

electrocardiogram (ECG) and exercise tests to measure heart function

echocardiograms (ultrasound scan of the heart)

scans of the carotid artery in your neck to determine stroke risk

24-hour blood pressure tests

insertion of pacemakers

cardiac catheterisation (coronary angiography) to see if there are any blocks in your
arteries.

Chaplaincy
Chaplains promote the spiritual and pastoral wellbeing of patients, relatives and staff. They are
available to all members of staff for confidential counsel and support irrespective of religion or
race. A hospital chapel is also usually available.

Critical care
Sometimes called intensive care, this unit is for the most seriously ill patients. It has a relatively
small number of beds and is manned by specialist doctors and nurses, as well as by consultant
anaesthetists, physiotherapists and dietitians. Patients requiring intensive care are often
transferred from other hospitals or from other departments in the same hospital.

Diagnostic imaging
Formerly known as X-ray, this department provides a full range of diagnostic imaging services
including:

general radiography (X-ray scans)

scans for A&E

mammography (breast scans)

ultrasound scans

angiography (X-ray of blood vessels)

interventional radiology (minimally invasive procedures, eg to treat narrowed arteries)

CT scanning (scans that show cross sections of the body)

MRI scanning (3D scans using magnetic and radio waves).

Discharge lounge
Many hospitals now have discharge lounges to help your final day in hospital go smoothly.
Patients who don't need to stay on the ward are transferred to the lounge on the day of discharge.
Staff will inform the pharmacy, transport and relatives of your transfer. To help pass the time,
there are usually facilities such as a TV, radio, magazines, puzzles, books and newspapers.
If someone feels unwell while waiting, nurses contact a doctor to come and see you before
discharge.

Ear nose and throat (ENT)
The ENT department provides care for patients with a variety of problems, including:

general ear, nose and throat diseases

neck lumps

cancers of the head and neck area

tear duct problems

facial skin lesions

balance and hearing disorders

snoring and sleep apnoea

ENT allergy problems

salivary gland diseases

voice disorders.

Elderly services department
Led by consultant physicians specialising in geriatric medicine, this department looks after a
wide range of problems associated with the elderly. This includes:

stroke medicine

gastroenterology

diabetes

locomotor (movement) problems

continence problems

syncope (fainting)

bone disease.
It provides a range of services such as home visits, day hospitals and outpatient clinics. The
department often has close links with other community services for the elderly.

Gastroenterology
Run by consultants specialising in bowel-related medicine, this department investigates and
treats upper and lower gastrointestinal disease, as well as diseases of the pancreas and bile duct
system. This includes endoscopy and nutritional services. Sub-specialities include colerectal
surgery, inflammatory bowel disease and swallowing problems. There are often endoscopy nurse
specialists linked to a gastroenterology unit who are able to perform a wide range of bowel
investigations.

General surgery
The general surgery ward covers a wide range of surgery and includes:

day surgery

thyroid surgery

kidney transplants

colon surgery

laparoscopic cholecystectomy (gallbladder removal)

endoscopy

breast surgery.
Day surgery units have a high turnover of patients who attend for minor surgical procedures such
as hernia repairs.

Gynaecology
These departments investigate and treat problems of the female urinary tract and reproductive
organs, such as endometritis, infertility and incontinence.
They also provide a range of care for cervical smear screening and post-menopausal bleeding
checks.
They usually have:

a specialist ward

day surgery unit

emergency gynaecology assessment unit

outpatient clinics.

Haematology
Haematology services work closely with the hospital laboratory. These doctors treat blood
diseases and malignancies linked to the blood, with both new referrals and emergency
admissions being seen.

Maternity departments
Women now have a choice of who leads their maternity care and where they give birth. Care can
be led by a consultant, a GP or a midwife. Maternity wards provide antenatal care, care during
childbirth and postnatal support. Antenatal clinics provide monitoring for both routine and
complicated pregnancies. High-dependency units can offer one-to-one care for women who need
close monitoring when there are complications in pregnancy or childbirth.

Microbiology
The microbiology department looks at all aspects of microbiology, such as bacterial and viral
infections. They have become increasingly high profile following the rise of hospital-acquired
infections such as MRSA and C. difficile. A head microbiology consultant and team of
microbiologists test patient samples sent to them by medical staff from the hospital and from
doctors' surgeries.

Neonatal unit
Neonatal units have a number of cots that are used for intensive, high-dependency and special
care for newborn babies. It always maintains close links with the hospital maternity department,
in the interest of babies and their families. Neonatal units have the philosophy that, whenever
possible, mother and baby should be together.

Nephrology
This department monitors and assesses patients with kidney (renal) problems. Nephrologists
(kidney specialists) will liaise with the transplant team in cases of kidney transplants. They also
supervise the dialysis day unit for people who are waiting for a kidney transplant or who are
unable to have a transplant for any reason.

Neurology
This unit deals with disorders of the nervous system, including the brain and spinal cord. It's run
by doctors who specialise in this area (neurologists) and their staff.There are also paediatric
neurologists who treat children. Neurologists may also be involved in clinical research and
clinical trials. Specialist nurses (epilepsy, multiple sclerosis) liaise with patients, consultants and
GPs to help with any problems that may occur between outpatient appointments.

Nutrition and dietetics
Trained dieticians and nutritionists provide specialist advice on diet for hospital wards and
outpatient clinics, forming part of a multidisciplinary team. The department works across a wide
range of specialities such as:

diabetes

cancer

kidney problems

paediatrics

elderly care

surgery and critical care

gastroenterology.
They also provide group education to patients with diabetes, heart disease and osteoarthritis, and
work closely with weight management groups.

Obstetrics and gynaecology units
These units provide maternity services such as:

antenatal and postnatal care

prenatal diagnosis unit

maternal and foetal surveillance.
Overseen by consultant obstetricians and gynaecologists, there is a wide range of attached staff
linked to them, including specialist nurses, midwives and imaging technicians.
Care can include:

general inpatient and outpatient treatment

colposcopy, laser therapy or hysteroscopy for abnormal cervical cells

psychosexual counselling

recurrent miscarriage unit

early pregnancy unit.

Occupational therapy
This profession helps people who are physically or mentally impaired, including temporary
disability after medical treatment. It practices in the fields of both healthcare and social care. The
aim of occupational therapy is to restore physical and mental functioning to help people
participate in life to the fullest.
Occupational therapy assessments often guide hospital discharge planning, with the majority of
patients given a home assessment to understand their support needs. Staff also arrange provision
of essential equipment and adaptations that are essential for discharge from hospital.

Oncology
This department provides radiotherapy and a full range of chemotherapy treatments for
cancerous tumours and blood disorders. Staffed by specialist doctors and nurses trained in
oncology (cancer care), it has close links with surgical and medical teams in other departments.

Ophthalmology
Eye departments provide a range of ophthalmic services for adults and children, including:

general eye clinic appointments

laser treatments

optometry (sight testing)

orthoptics (non-surgical treatments, eg for squints)

prosthetic eye services

ophthalmic imaging (eye scans).

Orthopaedics
Orthopaedic departments treat problems that affect your musculoskeletal system. That's your
muscles, joints, bones, ligaments, tendons and nerves.
The doctors and nurses who run this department deal with everything from setting bone fractures
to carrying out surgery to correct problems such as torn ligaments and hip replacements.
Orthopaedic trauma includes fractures and dislocations as well as musculoskeletal injuries to soft
tissues.

Pain management clinics
Usually run by consultant anaesthetists, these clinics aim to help treat patients with severe longterm pain that appears resistant to normal treatments. Depending on the hospital, a wide range of
options are available, such as acupuncture, nerve blocks and drug treatment.

Pharmacy
The hospital pharmacy is run by pharmacists, pharmacy technicians and attached staff. It's
responsible for drug-based services in the hospital, including:

the purchasing, supply and distribution of medication and pharmaceuticals

inpatient and outpatient dispensing

clinical and ward pharmacy

the use of drugs.
A pharmacy will provide a drug formulary for hospital doctors to use as a guide. It will also help
supervise any clinical trial management and ward drug-use review.

Physiotherapy
Physiotherapists promote body healing, for example after surgery, through therapies such as
exercise and manipulation. This means they assess, treat and advise patients with a wide range of
medical conditions. They also provide health education to patients and staff on how to do things
more easily. Their services are provided to patients on the wards, in the physiotherapy
department itself and in rehabilitation units. Physiotherapists often work closely with orthopaedic
teams.

Radiotherapy
Run by a combination of consultant doctors and specially trained radiotherapists, this department
provides radiotherapy (X-ray) treatment for conditions such as malignant tumours and cancer.

Renal unit
Closely linked with nephrology teams at hospitals, these units provide haemodialysis treatment
for patients with kidney failure. Many of these patients are on waiting lists for a kidney
transplant. They also provide facilities for peritoneal dialysis and help facilitate home
haemodialysis.

Rheumatology
Specialist doctors called rheumatologists run the unit and are experts in the field of
musculoskeletal disorders (bones, joints, ligaments, tendons, muscles and nerves). Their role is
to diagnose conditions and recommend appropriate treatment, if necessary from the orthopaedic
department. The rheumatologist may need to review you regularly, either in person or via one of
the rheumatology team. Alternatively, your condition may be one your GP can manage in the
community. Many conditions are managed jointly between the GP and the hospital care team.

Sexual health (genitourinary medicine)
This department provides a free and confidential service offering:

advice, testing and treatment for all sexually transmitted infections (STIs)

family planning care (including emergency contraception and free condoms)

pregnancy testing and advice.
It also provides care and support for other sexual and genital problems.
Patients are usually able to phone the department directly for an appointment and don't need a
referral letter from their GP.

Urology
The urology department is run by consultant urology surgeons and their surgical teams. It
investigates all areas linked to kidney and bladder-based problems.
The department performs:

flexible cystoscopy bladder checks

urodynamic studies (eg for incontinence)

prostate assessments and biopsies

shockwave lithotripsy to break up kidney stones
UNIT III:
Hospital Administration – Meaning, Nature and Scope Management of Hospitals principles of Management - need for Scientific management. Human resource
management in - Hospitals personnel policies - Conditions of Employment Promotions
and Transfers- Performance appraisal. Working hours - leave rules and benefits –safety
conditions - salary and wage policies, Training and development.
Questions :
PART A
1) Performance reviews of the employees are checked and varified by ........
A) HR Manager
2) ..................are integral to any human resource planning process.
Performannce reviews
3) Salary and wage policies are administerd by ........dept
A) HRM(Human Resource Management)
PART B
1) Define hospital administration and it’s scope .
( Hint : international level, education level,....|)
Hospital Administration
The burgeoning health care industry ecosystem comprising hospitals, specialty clinics, medical
centers, private health care facilities and the need for 24/7 patient care has raised the profile and
overall responsibilities of administrators. A hospital administrator functions like a de facto CEO
or business manager and is fully responsible for the smooth, efficient and day-to-day running and
operations of a hospital. He or she interacts and coordinates with varied audiences and
stakeholders on a regular basis.Hospitals are now run like small- or medium-sized businesses and
involve all conventional business operations, practices and procedures. A hospital administrator
has to manage the business side of the hospital to ensure smooth running of the hospital on all
fronts. The business aspects encompass management of human resources and personnel,
establishing policies and procedures, maintaining of computer systems and databases, allocation
of budgets, tracking accounts and finance, and other organizational systems. He or she
coordinates with professionals, staff members and other employees and assigns their duties and
tasks.
A hospital administrator has to interact, engage and coordinate with doctors, physicians,
surgeons, nurses, health care technicians, other medical staff members and health care
professionals involved with the primary care, treatment and rehabilitation of patients. A hospital
administrator has to draw up schedules for resident doctors and allied medical staff, address their
specific needs and ensure that they are able to perform their primary duties of looking after
patients, professionally and ethically. A hospital administrator also coordinates with external
specialists

and
consultants
in
case
of
emergencies
and
specialized
operations.
Patients' Medical Care and Well-Being
administrator. He or she has to ensure the availability and deliverability of quality facilities and
amenities for all patients. The administrator has to motivate the medical teams and allied staff
members to perform their roles, tasks and functions to the best of their abilities to make the
patients feel comfortable at all times. He or she takes rounds of all rooms and centers where
patients are housed or recuperating and, if necessary, makes quick, informed decisions to
alleviate or improve patient care.

Liaise with External Vendors
s and
other partners on a regular basis. Keeping the hospital stocked with drugs, medicines, food items,
hospital equipment, systems, allied hospital gadgets and machinery is a priority item.This is a
critical responsibility so as to ensure that the primary and tertiary care of patients and the
specialized needs of doctors and surgeons are not compromised. The administrator has to have
sound negotiation skills to draw up the right contracts, follow-up on orders and maximize
purchasing power with vendors and suppliers.
Other Responsibilities

A hospital administrator interacts with a governing board or trustees or other ownermanagement professionals of the hospital to undertake review of policies and
frameworks. Experienced administrators also train trainee doctors, newly inducted nurses
and assistant staff and other assistant administrators. Depending on budget allocation and
resources, the hospital administrator establishes programs for medical research,
preventive medicine and community welfare. He or she is also involved in various public
awareness health care campaigns and social advocacy activities. The administrator
attends fundraising events, local health council meetings and professional industry
conferences.
PART C
1) Explain the role of dept. Of HRM in a hospital
(Hint: administation, salary,wages, policies, perfomance appraisal...)
Human Resource Management
Human resources, when pertaining to health care, can be defined as the different kinds of clinical
and non-clinical staff responsible for public and individual health intervention [1]. As arguably
the most important of the health system inputs, the performance and the benefits the system can
deliver depend largely upon the knowledge, skills and motivation of those individuals
responsible for delivering health services
As well as the balance between the human and physical resources, it is also essential to maintain
an appropriate mix between the different types of health promoters and caregivers to ensure the
system's success . Due to their obvious and important differences, it is imperative that human
capital is handled and managed very differently from physical capittal. The relationship between
human resources and health care is very complex, and it merits further examination and study.
Both the number and cost of health care consumables (drugs, prostheses and disposable
equipment) are rising astronomically, which in turn can drastically increase the costs of health
care. In publicly-funded systems, expenditures in this area can affect the ability to hire and
sustain effective practitioners. In both government-funded and employer-paid systems, HRM
practices must be developed in order to find the appropriate balance of workforce supply and the
ability of those practitioners to practise effectively and efficiently. A practitioner without
adequate tools is as inefficient as having the tools without the practitioner.
Human resource (HR) planning is perhaps the most vital business practice in an organization or
business. The set of processes and initiatives pertaining to recruiting, selecting and hiring of new
candidates, managing of employees, analyzing current and future workforce requirements and
training the workforce and new inductees are all integral to the human resource planning process.
Strategic and focused HR planning helps organizations to handle long-term human resource
needs, address organizational goals and achieve business-defined goals.
Skills Improvement
-term profitability of an organization is the consistent
performance of its employees. Training and development initiatives and workforce and staffbased programs form an integral part of the continuous process of skills development. HR also
plays a role in ensuring employee buy-in and acceptance of such a crucial workforce
improvement metric. This process involves developing better teamwork and work ethics,
learning new skills, refreshing technologies and acquiring new certifications and educational
qualifications,
if
needed.
Performance Reviews
performance reviews reflects the commitment of employers to acknowledge the role and
importance of employees in the success of an organization. A rigorous, accurate and periodic
performance review of workers and staff members, detailed assessment of performance and
subsequent rewards recognitions and benefits keeps employees enthused and motivated toward
meeting organizational goals. These reviews are also initiated and planned by the HR department
and executed by managers and supervisors.
Mentorship and Informal Management
management and HR personnel in order to stay enthused and motivated to perform their assigned
roles and responsibilities. Human resource planning is also about managing employees and their
aspirations, needs and specific requirements at all levels. HR personnel and managers should
mentor newly inducted hires, encourage and empathize with veteran employees and generally act
as
a
vital
resource
and
informal
sounding
board
for
all
workers
and
staff
In addition to the care provided to patients by physicians and nurses, most medical facilities
require a significant amount of behind-the-scenes administrative support. Hospital administrators
are the professional administrators responsible for managing hospitals. While the specific duties
of a hospital administrator will vary according to hospital policy, there are a number of duties
standard to most positions
Hospital administrators or CEOs are responsible for all hospital operations. It is the top position
one can acquire in a medical setting, and thus, years of work experience and education are
required. While salaries are high, administrators put in long hours and have heavy responsibility.
Administrators may often be called at off hours to handle emergencies relating to the hospital.
Duties
1. Administrators have the largest role in a hospital. One role is directing staff. Administrators
meet with department heads to make sure hospital goals are being carried out correctly.
Additionally, they control the day-to-day operations of the hospital, making sure patient care
is being met in compliance with state standards and hospital policies. Administrators oversee
and approve all budget and financial information for the facility and continually seek to
improve procedures for patient care. They must possess strong leadership, mediator and
multitasking skills to be successful.
Work Environment
2. Whether the facility is a large or small hospital, much of an administrator's work takes place
in the office. However, administrators also meet several times a week with department
managers, board of directors and patients, which often takes place in hospital conference
rooms. Typically, administrators will do periodic walk-throughs of the facility to observe and
direct staff and may make site visits to outside facilities.
Salaries
3. Salaries for hospital administrators vary depending on the size of the facility, location,
hospital budget and other factors; however, administrators can expect annual salaries ranging
from $87,000 to $170,000. Administrators for small hospitals, nonprofits and rural areas can
expect salaries in the lower end of the range. Experienced administrators at large hospitals in
urban areas will see salaries at the top of the range.
Education and Training
4. Administrators typically need a master's degree in medical services administration, business
administration or something similar. For small hospitals, a bachelor's degree in a similar field
combined with extensive work experience may be sufficient. Typically, hospital
administrators have at least 5 to 7 years of experience as department managers or care
providers before receiving such a promotion.
Licensing
5. In every state, administrators must have a bachelor's degree and take continuing education
courses throughout their career. The position also requires the passing of a license
examination and, in most cases, a state-approved training program. Those seeking positions
in specialized hospitals, such as nursing home facilities, may require additional licensing
depending on the state.
UNIT IV
Staffing the hospital- selection and requirement of Medical professional and technical staff,
social workers, Physiotherapist and occupational therapist, pharmacist, radiographers, lab
technicians, dieticians, record officers, mechanic, electricians, Role of medical records in
Hospital management- content and their needs in patient care system.
----------------------------------------------------------------------------------------------------------------
PART A
1) The advent of ..........has not only changed the format of medical records but has
increased accessibility of files.
A) electronic medical records
2) ........ is a sub-discipline of social work
A) Medical social work
3) What is QAP?
A) Quality Assurance Process
PART B
1) List out the medical professionals and their duties.....?
(Hint : Doctor,nurses,radiographers,physiotherapists,lab technicians..)
Medical Professional
Doctors and nurses can be found in hospitals, clinics and other medical facilities designed to
diagnose and treat the sick and the injured. Doctors and nurses share many similar skills but
function differently. A doctor examines a patient's health and finds a cause and solution for the
illness while the nurse assists in the records, equipment and application of medicines. There are
many types of doctors and nurses, but all help treat the sick and injured in some way.
Doctor
1. A doctor is a medical professional who examines the sick and tries to find a way to help
them. Doctors can prescribe medicines, different treatments, and can give health advice. A
doctor will usually make observations first, then make a list of possible causes and perform
tests to find the right treatment. Most doctors have a doctor of medicine, or an M.D.
Role of Doctors
2. Family doctors or general practitioners are often the doctors we would go see when we are
sick. These doctors treat common problems and perform general checkups. When a more
serious problem is present, these doctors can send their patient to other doctors who are
specialists. Specialists include pediatricians, neurologists and gynecologists, among others.
Doctors often work long hours and may have to rush to a hospital in cases of emergencies.
Nurse
3. Nurses, or registered nurses, help doctors and specialist take care of ill and injured people.
Good nurses not only treat wounds and handle medicine, but also provide emotional support
to their patients. Because nurses handle many sick people on a daily basis, they have to avoid
the risk of infection.
Role of Nurses
4. Nurses usually assist doctors when dealing with patients. Nurses are usually in charge of
handling information and records pertaining to patients and help with testing and lab work.
Nurses can also teach patients how to care for themselves. Some nurses can specialize like
doctors, and focus on children, surgery or intensive care. Some nurses do office work. Nurses
may also work long hours like doctors, and may work more irregular hours. Office nurses
usually have regular hours while part-time nurses work selected shifts.
2) Listout the functions of physiotherapists.?
(Hint: outpatients,intensive care,womens health,care of the elderly,stroke patients,
orthopaedics,mental
illness,learning
difficulties,occupational
health,terminally
ill,
paediatrics)
Physiotherapist
Physiotherapists help and treat people of all ages with physical problems caused by illness,
accident
or
ageing.
Physiotherapy is a healthcare profession which sees human movement as central to the health
and well-being of individuals. Physiotherapists identify and maximise movement potential
through
health
promotion,
preventive
healthcare,
treatment
and
rehabilitation.
The core skills used by physiotherapists include manual therapy, therapeutic exercise and the
application of electro-physical modalities. Physiotherapists also have an appreciation of
psychological,
cultural
and
social
factors
which
The following are just a few of the areas physiotherapists work:

outpatients

intensive care

womens health
influence
their
clients.

care of the elderly

stroke patients

orthopaedics

mental illness

learning difficulties

occupational health

terminally ill

paediatrics
Many physiotherapists work within hospitals. Here they are needed in virtually every
department, from general out-patients to intensive care, where round-the-clock chest
physiotherapy can be vital to keep unconscious patients breathing.
Hospitals often have physiotherapy gyms, hydrotherapy and high-tech equipment so that
specialist therapy can be carried out.
Today's physiotherapist is just as likely to work in the local community as within a hospital.
There is also a need for physiotherapists in many other places.
These places are:

industry

special schools

the private sector (for example, private practice)

education

leisure & sport
In fact wherever people are at risk of injury from their occupation or activity.
Nowadays, more and more physiotherapists work outside the hospital setting, in the community
where a growing number are employed by GP fund holders. Treatment and advice for patients
and carers take place in their own homes, in nursing homes or day centres, in schools and in
health
centres.
Being a physiotherapist in any setting is all about teamwork. As well as being able to build up a
rapport with your patients, it is equally important to maintain communication with their relatives
or carers as well as occupational therapists, GPs, health visitors, district nurses and social
workers.
Physiotherapy is a ''hands on'', physical career in every sense. The personal qualities needed for
this rewarding role are tolerance, patience and compassion, you will also need to be levelheaded, practical and have good communication skills
3) Explain the Role of medical records in hospitals?
(Hint: basis for planning patient care, documenting communication between the health
care provider and any other health professional contributing to the patient's care, assisting
in protecting the legal interest of the patient and the health care providers responsible for
the patient's care)
Role of medical records in hospitals
A medical record, health record, or medical chart is a systematic documentation of a patient's
individual medical history and care. The term 'Medical record' is used both for the physical
folder for each individual patient and for the body of information which comprises the total of
each patient's health history. Medical records are intensely personal documents and there are
many ethical and legal issues surrounding them such as the degree of third-party access and
appropriate storage and disposal. Although medical records are traditionally compiled and stored
by health care providers, personal health records maintained by individual patients have become
more popular in recent years.
Purpose
The information contained in the medical record allows health care providers to provide
continuity of care to individual patients. The medical record also serves as a basis for planning
patient care, documenting communication between the health care provider and any other health
professional contributing to the patient's care, assisting in protecting the legal interest of the
patient and the health care providers responsible for the patient's care, and documenting the care
and services provided to the patient. In addition, the medical record may serve as a document to
educate medical students/resident physicians, to provide data for internal hospital auditing and
quality assurance, and to provide data for medical research. Personal health records combine
many of the above features with portability, thus allowing a patient to share medical records
across providers and health care systems.[2].
Contents
Basically a patient's individual medical record shall identitfy the patient and shall contain the
information obtained with a certain case and shall refer to past cases with the very same patient.
The information recorded with a personal health record could start with
* Name, birth date, residence and emergency contact
* Sex, Blood type
* Date of last physical examination
* Dates and results of tests and screenings
* Major illnesses and surgeries, with dates
* List of medication, dosages and duration of prescription
* Any allergies
* Any chronic diseases
* Any history of illnesses in the family
Although the specific content of the medical record may vary depending upon specialty and
location, it usually contains the patient's identification information, the patient's health history
(what the patient tells the health-care providers about his or her past and present health status),
and the patient's medical examination findings (what the health-care providers observe when the
patient is examined). Other information may include lab test results; medications prescribed;
referrals ordered to health-care providers; educational materials provided; and what plans there
are for further care, including patient instruction for self-care and return visits. In some places,
billing information is considered to be part of the medical record.
Format
Traditionally, medical records have been written on paper and kept in folders. These folders are
typically divided into useful sections, with new information added to each section
chronologically as the patient experiences new medical issues. Active records are usually housed
at the clinical site, but older records (e.g., those of the deceased) are often kept in separate
facilities.
The advent of electronic medical records has not only changed the format of medical records but
has increased accessibility of files. The use of an individual dossier style medical record, where
records are kept on each patient by name and illness type originated at the Mayo Clinic out of a
desire to simplify patient tracking and to allow for medical research.
Administrative issues
Medical records are legal documents and are subject to the laws of the country/state in which
they are produced. As such, there is great variability in rule governing production, ownership,
accessibility, and destruction
PART C
1. Explain the role of medical social workers and dieticians in a hospital ?
(Hint: Interventions may include connecting patients and families to necessary resources and
supports in the community; providing psychotherapy, supportive counseling, or grief counseling;
or helping a patient to expand and strengthen their network of social supports.)
Social workers
Medical social work is a sub-discipline of social work, also known as Hospital social work.
Medical social workers typically work in a hospital, skilled nursing facility or hospice, have a
graduate degree in the field, and work with patients and their families in need of psychosocial
help. Medical social workers assess the psychosocial functioning of patients and families and
intervene as necessary. Interventions may include connecting patients and families to necessary
resources and supports in the community; providing psychotherapy, supportive counseling, or
grief counseling; or helping a patient to expand and strengthen their network of social supports.
Medical social workers typically work on an interdisciplinary team with professionals of other
disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy,
etc.).
Role and required skills
The medical social worker has a critical role in the area of discharge planning. It is the medical
social worker's responsibility to ensure that the services the patient requires are in place in order
to facilitate a timely discharge and prevent delays in discharge that can cost the hospital
thousands of dollars per day.
For example, the medical doctor may inform the medical social worker that a patient will soon
be cleared for discharge (a term that means that the patient no longer requires hospitalization)
and will need home care services. It is the medical social worker's job to then arrange for the
home care service to be in place so that the patient can be discharged. If the medical social
worker fails to arrange for the home care service, the patient may not leave the hospital resulting
in a delay in discharge. In such situations the treating physician is ultimately held responsible for
the delay. Nevertheless the medical social worker often bears the brunt of the blame for the delay
in discharge and his or her failure to perform often attracts the attention of management.
Other skills required of the medical social worker is an ability to work cooperatively with other
health care staff as part of a multidisciplinary treatment team. They need to have good analytical
and assessment skills, an ability to communicate clearly with both patients and staff, and an
ability to quickly engage the patient in a therapeutic relationship. The Medical Social Worker
will inevitably have to be able to process almost a never-ending flow of paperwork, whilst
retaining a willingness to advocate for the patient, especially in situations where the medical
social worker has identified a problem that may compromise the discharge and put the patient at
risk in the community.
For example, the medical doctor reports that a frail elderly patient is medically cleared for
discharge and plans to discharge the patient home with home care services. However, after
assessing the patient's psychosocial needs, the medical social worker determines that the patient
does not have the requisite ability to direct a home care worker and recommends that the
discharge be deferred pending further assessment of this problem. In such a case, it is the
medical social worker's ethical duty to inform the medical doctor that the discharge may place
the patient at risk and advocate for another, more appropriate discharge even if it means that the
patient's discharge has to be postponed. It is precisely in such cases that the medical social
worker proves his or her worth - by placing the needs of the patient above all other
considerations.
Dieticians
A dietitian works in a wide variety of medical and non-medical facilities. According to the U.S.
Bureau of Labor and Statistics, a dietitian is mostly employed in nursing homes, doctor's offices,
hospitals and outpatient facilities. Some of the non-medical facilities that a dietitian works in are
schools and private wellness centers that offer nutritional, educational and fitness services. The
role of a dietitian is determined by what kind of facility she works in. However, there are some
overlapping responsibilities.
Nursing Homes
1. Nursing homes may contract with a company that oversees a dietitian pool to provide
nutritional services on an as-needed basis. Nursing homes may also hire a dietitian as a staff
member to provide ongoing services on a full- or part-time basis. A contracted dietitian may
be called in to assess new arrivals to a nursing home and to make nutritional care plans. A
dietitian may also be called in to address any emergent needs of a current nursing home
resident if his condition worsens or changes. Since a staff dietitian is on site on an ongoing
basis, she oversees all the facility's nutrition services while assuring that the site maintains
the licensing requirements set forth by the state.
Hospitals
2. A dietitian's role in a hospital is similar to the role in a nursing home. In a hospital, a dietitian
may interact with a larger group of healthcare team members, especially when the patient is
in a critical care unit. For non-critical care patients, a dietitian may be called in for consults
as needed to do one-on-one patient education for newly diagnosed chronic disease patients.
For instance, if a child is newly diagnosed with diabetes, the nurse or physician may request
a consult with the dietitian to draft a short- and long-term care plan for their diet and
medications. The dietitian will then spend time educating the family and the child about the
condition, making specific recommendations for dietary changes.
Outpatient Clinics
3. A dietitian in an outpatient clinic may meet regularly with the established patients of
physicians from that office or with patients referred there for long-term nutritional
counseling from a hospital. However, in some cases of outpatient care, a dietitian may have
the job of working with a person before a chronic condition is diagnosed or as a prerequisite
for a medical procedure. In these cases, the dietitian's role may be to help a person prevent
the development of a chronic disease through nutritional counseling and weight management
interventions. For people seeking bariatric (weight loss) surgery, some insurance companies
and physicians require consultations with a dietitian before and after the procedure. In this
case, the dietitian will assess the current eating habits and dietary needs of the person,
explain how these will change after the procedure and schedule regular follow-ups on a longterm basis.
Wellness Center
4. The role of a dietitian in a wellness center is different from the role in a medical facility
primarily because she works with a healthier population. Many wellness center services are
contracted out by private corporations or by individuals. In this case, a dietitian may staff a
health fair, provide employee wellness education or do one-on-one weight management
counseling. In a private wellness center, the dietitian's role varies and depends on what the
center was hired to do and by whom (large company or one family). In a private wellness
center, some dietitians do double-duty as personal trainers, providing fitness and nutrition
services since these so often go hand-in-hand. As these centers look for ways to cut costs, the
dietitian is trained to do a variety of duties which lessens the strain on the center's budget.
Other duties of a dietitian in a private wellness center involves contacting physicians offices
that see chronic disease patients, such as cardiologists. In this case, the role is to educate the
doctors about services and request that they refer their patients for nutritional counseling
UNIT V
Hospital Budget - departmental budget as a first step - specific elements of a department
al budget including staff salary - supply costs - projected replacement of equipment energy expenditures - contingency funds. Uses of computers in Hospital - purchase
centralization- Shared Building system purchase agreements.
PART A
1) A .............is a list of all planned expenses and revenues.
A) Budget
2) What is contingency funds?
A) An amount kept in reserve to guard against possible losses.
3) ..............are the excellent means for storage of patient related data
A) Computers
PART B
1) Define budgets and planning?
Budgeting and Planning
A budget is a plan expressed in quantitiative, usually monetary, terms covering a specified
period, typically one year. In a budget formulation process, a program is translated into terms
that correspond to the responsibilities of those who are charged with executing them.
The result of these negotiations between department managers and supervisors is a statement of
outputs expected during the budget year and the resources to be used to achieve these outputs.
Managers new to the budget process tend to focus on the mechanics of budgeting and overlook
the fact that budgeting is an extension of the planning process. This book demonstrates that
preparing a budget really is a fine-tuning of long-range planning. The budget formulation process
enables healthcare financial managers to quantify their strategic objectives.
Managing a human resources department involves budget planning and execution like any other
company department. Steps include preparing a forecast, developing your personnel, analyzing
jobs, and preparing a short- and long-term plan to execute your vision. By accurately assessing
what work needs to be done and who can do it most efficiently, managers can ensure an
organization's success.
Preparing a Forecast
minimal or global in nature. Anticipating how to staff the operation with accuracy improves the
longer a company has been in business. Using previous results or by comparing a business with
similar companies to get the needed data, a manager can predict the growth pattern and the type
of personnel needed to maintain or expand the business.
Developing Employees
employees (including executive leadership) requires budget planning and execution. Workshops,
seminars, self-paced courses and formal education degrees typically cost money, so assessing
company needs carefully requires thought. Ensuring the return on investment---in the form of
improved skills in professional development or technical expertise---typically warrants the
expenditure. Companies should be prepared for any employee turnover and have applications
and resumes on file, ready to act upon should the company need to replace or expand the
workforce.
Analyzing Work Flow
policies and procedures
to utilize in
order to complete the work in a timely and cost effective manner. By accurately defining each
job's scope, responsibilities, required experience, skills and knowledge, managers can plan to
develop, retrain or hire personnel to accomplish each task. Providing training for professional or
technical development motivates employees to utilize their skills on the job to execute the
company's strategic goals. Gaps in company expertise should result in recruitment activities as
quickly as possible.
Creating a Comprehensive Plan
for wages, training and recruitment programs for current and future fiscal years. Tracking and
monitoring actual expenditures should influence future planning strategies. Any issues
encountered during execution should be examined during post-project review sessions, and any
lessons learned should be incorporated into future Human Resources budget planning and
execution activities. Typically, three to six months planning results in successful execution of
advertising, interviewing, hiring, assessing and training company personnel.
PART C
1.Explain the application of computers in hospitals ?
(Hint: Precise 'tests' and medical examinations,Faster medical alerts, which are more accurate
time-wise,Enhanced data about a patients medical history,Precision in diagnosis,Precision in
billing,Automated updating of medical history)
Uses of computers in hospitals
Computers play a key role in almost every sphere of life. They facilitate storage of huge amounts
of data, they enable speedy processing of information and they possess an inbuilt intelligence.
Owing to these unique capabilities, computers function on levels close to that of a human brain.
Computers can hence be employed in a wide variety of fields like engineering, data processing
and storage, planning and scheduling, networking, education as well as health and medicine. You
might
want
to
take
a
look
at
the
various
uses
of
computers.
Computers are the excellent means for storage of patient related data. Big hospitals employ
computer systems to maintain patient records. It is often necessary to maintain detailed records
of the medical history of patients. Doctors often require the information about a patient’s family
history, physical ailments, already diagnosed diseases and prescribed medicines. This
information
can
be
effectively
stored
in
a
computer
database.
Computers can keep track of prescriptions and billing information. They can be used to store the
information about the medicines prescribed to a patient as well as those, which cannot be
prescribed to him/her. Computers enable an efficient storage of huge amounts of medical data.
Medicine comprises vast base of knowledge. Computer storage can serve as the best means of
housing this information. Medical journals, research and diagnosis papers, important medical
documents
and
reference
books
can
best
be
stored
in
an
electronic
format.
Many of the modern-day medical equipment have small, programmed computers. Many of the
medical appliances of today work on pre-programmed instructions. The circuitry and logic in
most of the medical equipment is basically a computer. The functioning of hospital-bed beeping
systems, emergency alarm systems, X-ray machines and several such medical appliances is
based
on
computer
logic.
Computer software is used for diagnosis of diseases. It can be used for the examination of
internal organs of the body. Advanced computer-based systems are used to examine delicate
organs of the body. Some of the complex surgeries can be performed with the aid of computers.
The different types of monitoring equipment in hospitals are often based on computer
programming.
Medical imaging is a vast field that deals with the techniques to create images of the human body
for medical purposes. Many of the modern methods of scanning and imaging are largely based
on the computer technology. We have been able to implement many of the advanced medical
imaging techniques, thanks to the developments in computer science. Magnetic resonance
imaging employs computer software. Computed tomography makes use of digital geometry
processing techniques to obtain 3-D images. Sophisticated computers and infrared cameras are
used for obtaining high-resolution images. Computers are widely used for the generation of 3-D
images
in
medicine.
Computer networking enables quicker communication. Computers and Internet have proved to
be a boon in all the spheres of life. In the field of medicine, computers allow for faster
communication between a patient and a doctor. Doctors can collaborate better over the Internet.
Today, it is possible to obtain experts’ opinions within seconds by means of the Internet. Medical
professionals sitting on opposite sides of the globe can communicate within minutes by means of
the Internet. It is due to computer networking technology that network communication has
become easy. Medical practitioners can discuss medical issues in medical forums. They can
exchange images and messages in seconds and derive conclusions speedily. They can seek
advice
and
share
knowledge
in
a
convenient
manner
over
the
Internet.
The importance of computers cannot be stressed enough as computer technology has
revolutionized the field of medicine.