2CLASSIFICATIONS OF HEALTH CARE Primary CareSecondary CareTertiary Care
3Primary CareConsists of basic curative care, including simple diagnosis and treatment, provided at the point of entry into the health care system. (Example: walk-in-clinic)
4Secondary CareConsists of specialized care requiring more sophisticated and complicated diagnosis and treatment than is provided at the primary health care level. Normally involves hospitalization. (Example: Patient ward in general hospital)
5Tertiary CareConsists of highly specialized diagnostic and therapeutic services which can usually only be provided in centers specifically designed staffed and equipped for this purpose. (Example: Neonatal intensive care unit)
6CLASSIFICATIONS OF SERVICE GENERAL HOSPITALSPECIALITY HOSPITALREHABILITATION HOSPITALLONG-TERM CARE HOSPITAL (AUXILIARY)NURSING HOME
7GENERAL HOSPITALProvides primarily for the diagnosis and short-term treatment of patients for a wide range of diseases or injuries.
8SPECIALITY HOSPITALProvides primarily for the diagnosis and short-term treatment of patients for a limited range of diseases or injuries.
9REHABILITATION HOSPITAL Provides for the continuing assessment and treatment of patients whose condition is expected to improve significantly.
10LONG-TERM CARE HOSPITAL Provides primarily for the continuing treatment of patients with long-term illness or with a low potential for recovery.
11NURSING HOMEInstitution where residents are accommodated who require nursing and personal care on a continuing basis.
12REGULATORY AGENCIES Provincial hospital authorities responsible for: Approving hospital budgetsLicensing and inspecting hospitalsHealth and safety of hospital workersAgencies regulating the various health professionsAgencies approving various hospital based training programs
13REGULATORY AGENCIES Review committees within hospitals Hospital administration and regulationsCanadian Council on Healthcare Facility Accreditation (CCHFA), representing:Canadian Hospital AssociationCanadian Medical AssociationRoyal College of Physicians and Surgeons of CanadaL'Association des Medecins de Langue Francaise du CanadaThe Canadian Nurses Association
14A hospital is perhaps the most complex organization in our society.
15Clinical Engineer Must Understand Roles and interaction between multiple professional groupsRole of the hospital administration in coordinating these groups
16WELL DEVELOPED INTERPERSONAL SKILLS ARE ESSENTIAL TO CLINICAL ENGINEERING!
17Impact of TechnologyAdvancements in medical technology have had an enormous impact on hospital management.Each new development has given birth to another discrete body of knowledge.Ultrasound, CT, MRILithotrityNuclear MedicineLaser SurgeryLaparoscopic Surgery
18Each technology has its own: Professional GroupCherished RoleDiversified NomenclatureSelf Image.
19Professional Groups There are more than 200 health occupations! Medical SpecialtiesNursing SpecialtiesClinical Technicians (i.e., Lab Techs, X-Ray Techs, Respiratory Therapists, Physiotherapists, etc.)There are more than 200 health occupations!
20Administrative Challenges Professionals typically cherish their "right" to self-regulation.
21Administrative Challenges Group conflict is unavoidable.Internal communications are impeded.Consensus is more apt to be absent.
22Administrative Challenges InternalMedical StaffCompetition Between Health ProfessionsUnionsPhysical ResourcesSize and Complexity of OrganizationExternalGovernmentFundingRegulatory AgenciesPublic Demands
24THE HOSPITAL AS A DELIVERY SYSTEM Primarily a non-profit system.A third party (government) financed system.Demand for services can bear no direct relationship to societal needs or the available supply of necessary resources.The rate of hospital admissions has increased, but the average length of stay has decreased.The health care system is presently undergoing rapid, radical change.
28Functions of the Governing Board To determine the policies of the institution within the context of community needs.To provide equipment and facilities to conduct patient care programs.To see that proper professional standards are defined and maintained.To co-ordinate professional interests with administrative, financial and community needs.
29Functions of the Governing Board To provide adequate financing by securing sufficient income and by enforcing business like control of expenditures.To provide for the safe administration of funds given in trust, (e.g., gifts and contributions).To maintain accurate records of its finances and activities.To surround the patient with a safe environment.
30THE HOSPITAL ADMINISTRATOR Function is identical to that of the president of any corporation.Individual styles are judged to be successful if the determined results further the organization toward its goals.
31Being a hospital administrator places more of a strain on character than on intellect.
32Functions of the Hospital Administrator Submitting for board approval a plan of organization and recommending changes when necessary.Preparing a plan for accomplishing the institutional objectives as approved by the board and periodically reviewing and evaluating it.Selecting, employing, controlling, and discharging employees.Submitting for board approval an annual budget.
33Functions of the Hospital Administrator Safeguarding the operating funds of the enterprise.Maintaining all physical properties (plant and equipment) in safe operating condition.Representing the hospital in its relationships with the community and other health agencies.Serving as liaison between the board or its committees and the medical staff.
34Functions of the Hospital Administrator Assisting the medical staff with its organizational and administrative responsibilities.Submitting to the board annual reports which describe the nature and volume of the services delivered during the past year.Advising the governing board on matters of policy formulation.
36Doctors represent the initiators of every action that results in the direct provision of patient care services.
37Doctors determine: Who Will Be Admitted When Where What Medical Services Are to Be Provided, in What Sequence, in What Dosage, With What Equipment and Supplies When, Where and by WhomWho Is Discharged and When.
38The doctor is not an employee of the hospital, he/she is outside of the hospital organization.
39Doctors control, yet are not accountable, for nearly 90 percent of hospital expenditures.
40Medical StaffParticipation by the medical staff in the decision-making process is in the best interest of both the hospital and the patients.Physician involvement leads to physician accountability.
41The physician may view the problems of medical practice from a personal rather than an organizational perspective.
42The administrator is primarily concerned with the maximum utilization of available health resources and personnel.
43Organization of medical resources may require a degree of control and surveillance over the doctor's work which maybe unattractive to him/her.
44Medical StaffThe chief of medical staff is the elected representative of the medical staff.The chief of staff appoints all of the committees other than the executive committee whose members are elected by the staff or appointed by the board administrator.
45Functions of the Medical Staff To advise the governing body on medical affairs.To accept accountability for the quality of care rendered to patients in the hospital.To request, review and act upon reports of medical staff committees.To scrutinize the professional ethics of its members and to initiate corrective action as indicated.To develop, implement, and review medical staff policies.
46Functions of the Medical Staff To recommend action to the administrator on all medical-administrative matters.To assure that the standards of the Canadian Council on Healthcare Facility Accreditation (CCHFA) are followed as a basic guideline for standards of care.
48The complex tasks of highly skilled professionals demand a participatory decision-making structure while the repetitive tasks performed by unskilled workers require a more formal hierarchical structure.
49Organizational Structures Highly structured and routine tasks can lead to worker alienation and boredom.Loosely knit, associational activities of highly skilled professionals results in personal gratification to the individual employee but works against the centralized control and co-ordination needs of management.