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HOSPITAL, , 1

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Definition of Hospital, WHO Expert Committee, 1963:, 'A hospital is a residential establishment which, provides short-term and long-term medical care, consisting of observational, diagnostic, therapeutic, and rehabilitative services for persons suffering or, suspected to be suffering from a disease or injury and, for parturients. It may or may not also provide, services for ambulatory patients on an out-patient, basis'., 2

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Classification of Hospital, 1. Basing on Objective, a. General hospitals, b. Special hospitals, c. Teaching cum Research Hospital, 2. Basing on Administration, ownership, control or financial income, a. Governmental or public, b. Non-governmental or private, c. Semi Govt Hospital, d. Voluntary Agency Hospitals, 3.Basing on Length of Stay, a. Short-term or short-stay hospitals (Stay less than 30 days), b. Long-term or long-stay hospitals: (Stay more than 30 days), 3

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4.Depending on Type of Medical Staff, a. Closed-staff hospital:, b. Open-staff hospital, 5.Basing on bed capacity (Size), a. Small hospital (between 100-500 beds), b. Medium hospital ( between 500 -1000), c. Large hospital (posses beds 1000 and more)., 6.Basing on type of care:, a. Primary Care, b. Secondary Care, C. Tertiary Care, 7.By teaching affiliation, a. Teaching hospital, b. Non-teaching hospital, , 4

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8.Basing on system of medicine, a. Allopathic hospital, b. Ayurvedic hospital, c. Homeopathic hospital, d. Unani hospital, e. Hospitals of other system of medicine, 9.Basing on regionality, a.Regional, b.District, c.Primary health centres, d. Union Health and Family Welfare Centres, e. Community Clinics, As per WHO Classification:, a. Regional Hospital, b. Intermediate/ District Hospital, c. Rural hospital, , 5

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General hospitals:, General Hospitals are meant to provide wide-range of various types, of healthcare, but with limited capacity. They care for patients with, various-disease conditions for both sexes to all ages, medical,, surgical, paediatrics, obstetrics, eye and ear etc. Usually, General, hospitals are devoid of super-specialist medical care., Special hospitals:, They limit their service to a particular condition, orthopedics,, maternity, paediatrics, geriatrics, oncology etc., Teaching cum Research Hospital:, College is attached for medical/ nursing/ dental/ pharmacy, education. Main objective is to provide medical care, teaching and, research is secondary, 6

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Governmental or public hospital: They are owned, administered and, controlled by the government. They provide free care for patients. The, governmental hospitals are owned by:, The Ministry of Health., The University, Others, A public hospital or government hospital is a hospital which is owned by a, government and receives government funding. In some countries, this type, of hospital provides medical care free of charge, the cost of which is, covered by government reimbursement., Private hospital, Privately owned or controlled by an individual or group of physicians or, citizens or by private organization. eg, Square Hospital., Purpose is to provide services for profit making., Semi Govt Hospital:, Hospitals run both by the govt and private entity. eg Cantt Board Hospital., , 7

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Corporate Hospital, Hospitals which are public limited companies formed under, the companies act. Run on commercial lines., eg, Apollo, Voluntary Agency Hospital:, Not for profit hospitals by the Voluntary Organizations., eg, HOPE Foundation Fistula Hospital, Short-term or short-stay hospitals: These are hospitals where, over 90% of all patients admitted stay less than 30 days., Long-term or long-stay hospitals: These are hospitals where, over 90% of all patients admitted stay 30 days or more, i.e., mental hospital, 8

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On the Basis of Cost:, (1)Elite hospital: These are called five star, hospital. In this, some high technical service is, provided,, eg., escort heart institute, deluxe rooms are, equipped with TV; telephones and refrigerator., The room rates are quite high and generally it is, included in the package., (ii) Budget Hospitals. These are meant for, moderate budget and low budget persons, e.g.,, civil hospital and charitable hospital., 9

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According to Level of Care:, , Primary Care Hospital Primary care is the day-to-day healthcare, given by a health care provider. Typically this provider acts as, the first contact and principal point of continuing care for, patients within a healthcare system, and coordinates other, specialist care that the patient may need. Provides mostly, basic health care. It is generally regarded as the 'gateway' to, receiving more specialist care., eg, Upazila Health Complex, , 10

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Secondary health care:, , In Bangladesh, this level of services are provided, in District hospitals.This is the first level of referral, services, and more complicated services are, dealt with which is beyond the scope and, capacity of the primary level. This level is, assigned to provide some specialist services, particularly in Internal Medicine, General Surgery,, Obstetrics and Gynaecology, and Paediatrics., 11

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Tertiary level:, , ■ This level deals with highly specialized services provided at regional or, central level hospitals,, ▪ Such as teaching hospitals. Super specialized hospitals like NICVD, NIO,, BIRDEM, Cancer Hospital, Chest Hospital, Infectious Disease Hospital,, Mental Disease Hospital are also included in this level, .■ These institutions provide referral support to primary and secondary, level health care. This also includes Divisional and National Level, Hospitals, , 12

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WHO Classification (Expert Committee 1957), Regional Hospital: Provides complex range of treatment and highly, specialized services. Serves a larger area than a local hospital., Example- Govt Medical College Hospital, Intermediate/ District Hospital: A district hospital typically is the, major health care facility in its locality . Specialty services in major, disciplines, (eg, Medicine, Surgery, Gynae etc), Rural Hospital: Remote hospitals with small number of beds and, limited service capacity. It should have 20-100 beds., Upazila Health Complex in Bangladesh, 13

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Hospital Function, 1.Intramural: Services hospital within the wall of, hospital, 2. Extramural: Services outside the wall of hospital., eg, OPD, Outreach services, Medical Camps,, Immunization Program, , 15

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FUNCTIONS OF A HOSPITAL, 1. INTRA-MURAL FUNCTIONS, i. Therapeutic,  Diagnostic,  Curative,  Rehabilitative,  Care of emergencies, ii. Preventive,  Antenatal and postnatal services.,  Well baby clinics and immunisation schedule.,  Family welfare services.,  Control of communicable diseases,  Health education, , 16

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iii. Education,  Medical : Under graduate, post-graduate and post doctoral.,  Nursing education :Undergraduate, post-graduate and doctoral.,  Speciality,  Paramedical,  Community health, iv. Research,  Clinical medicine,  Hospital administration, , 17

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EXTRA-MURAL FUNCTIONS, • Outpatient services, • Home care/outreach/domiciliary services., , 18

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Hospital functions, , 1) Preventive function:,  it is an emerging secondary function for the, hospital and concerned with health promotion,  It is geared toward providing the preventive, services through a community health center .It, takes an active role to improve the health of the, population, 19

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2) Curative function:,  it is the primary function of the hospital, and concerned with providing patient care,  It refers to any type of care given to the, patient by the health team members, e.g physicians, nurse,dietitiants,  Also includes health education to the, patients, 20

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3.Research function:, •, , It is a secondary function and concerned, with conducting the health related, researches that focus on the improvement, of health and or prevention of diseases., , 21

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4.Rehabilitative function:, The Rehabilitation Services are dedicated to providing, high qualified individualized effective interventions, aimed at promoting both patient safety and a return to, independent function. Services include Physical, Therapy, Occupational Therapy, and Speech-Language, therapy etc with compassion and empathy in a patient, and family centered care environment., , 22

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ORGANIZATION OF HOSPITALS :, 1. ORGANIZATION is defined as "A DYNAMIC PROCESS, in, which various MANAGERIAL ACTIVITIES bring & bind, people together, for the ACHIEVEMENT of COMMON, GOALS & OBJECTIVES", 2. Most important BODY of a hospital is the GOVERNING, BODY/ BOARD OFDIRECTORS/BOARD OF TRUSTEES, 3. GOVERNING BODY → Consists of various eminent, personalities in the field of, a. MEDICAL EDUCATION, b. RESEARCH, c. ADMINISTRATION d. POLITICS, (Optional), 23

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4. Function of GOVERNING BODY is to FRAME all major, POLICIES, PLANS & PROGRAMMES of hospital, 5. GOVERNING BODY→→ Appoints a HOSPITAL, ADMINISTRATOR to get various functions performed like, CLINICAL SERVICES, NURSING, PHARMACY SERVICES, etc, , 24

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SERVICES PERFORMED BY HOSPITAL ORGANIZATION:, Include:, A. NURSING SERVICES:LARGEST part of a hospital - Functions all 24 hoursNurses → assigned specific number of beds → have to give, personal attention to patients, Nurses are trained for PRENATAL CARE, OBSERVATION,, PATIENTCOMFORT DURING LABOUR, etc, .NURSING DIRECTOR is the in-charge of NURSING SERVICES.........., , 25

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B. OUT-PATIENT SERVICES:, Focus on COMFORT for OUT-PATIENTS, as the, approach for major/minor illnesses,  These services → make a hospital an IDEAL, COMMUNITY INSTITUTION,  Hospital is duty-bound to provide DIAGNOSTIC,, PREVENTIVE & CURATIVE measures to the OUTPATIENTS., , 26

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3. RADIOLOGICAL, , , , , , , , , SERVICES:, Performed under direction of a competent, RADIOLOGIST CHIEF RADIOLOGIST → assisted by, various TECHNICIANS Services include UTILIZATION of, EQUIPMENTS like:, a SONOGRAPHY, b. X-RAY, C. ECG, d. CT-SCAN, etc, 27

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4. CENTRAL SUPPLY SERVICES:, Refers to MEDICAL & SURGICAL SUPPLY, SERVICES Meant for DIAGNOSIS, TREATMENT,, PREVENTION, EDUCATION & RESEARCH Involves, their COLLECTION, PROCESSING, STORAGE &, ISSUANCE against proper INDENT FORM, Qualified & skilled staff personnel are responsible, for its maintenance, 28

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5.HOSPITAL PHARMACY SERVICES:, • Controls PHARMACY OPERATION in any hospital, • FILLS PRESCRIPTION & no. of NECESSITIES from, wards, • Functions begin from DRUG PROCUREMENT to, DISTRIBUTION to I.P and O.P, • Responsible for:, a PROPER DRUG DELIVERY, b. INFORMATION SYSTEM, c. MANUFACTURE, d. STERILIZATION, c.DRUG STORAGE, f. ADVICING PATIENT ON DRUG USE, , 29

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6. MEDICAL RECORD SERVICES:, VALUABLE MATERIALS, as they help MEDICAL &, PARA-MEDICAL STAFF for EVALUATION,  Also used for EDUCATION, RESEARCH &, TRAINING- Consists of:, a. PATIENT HISTORY, b. LAB-TEST REPORTS, c. PHYSICAL EXAMINATION DETAILS, d. PHYSICAN'S ADVICE, etc. It is mandatory to store medical records, properly to FACILITATE EASY ACCESS on, requirement......................, , 30

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7. STORE SERVICES:, RECEIVE, STORE & ISSUE materials against REQUISITION, FORMS of various DEPARTMENTS & WARDS Hospital, consists of, a. MEDICAL STORE, b. STORE FOR GENERAL ITEMS, c. SURGICAL STORES, etcMaintain a BUFFER STOCK of certain materials, including, LIFE-SAVINGDRUGS, 31

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8. MISCELLANEOUS SERVICES:, Aimed at overall BENEFIT & PATIENT CARE Include, a. DIETARY SERVICES, b. AMBULATORY SERVICES, c. LAUNDRY SERVICES, d. TRANSPORT SERVICES, e. MORTUARY SERVICES, f. LIBRARY SERVICES., , 32

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Thank you, , 33