1. Organizational Structures

2. CLASSIFICATIONS OF HEALTH CARE
Primary Care
Secondary Care
Tertiary Care

3. Primary Care
Consists of basic curative care, including simple diagnosis and treatment, provided at the point of entry into the health care system. (Example: walk-in-clinic)

4. Secondary Care
Consists of specialized care requiring more sophisticated and complicated diagnosis and treatment than is provided at the primary health care level. Normally involves hospitalization. (Example: Patient ward in general hospital)

5. Tertiary Care
Consists of highly specialized diagnostic and therapeutic services which can usually only be provided in centers specifically designed staffed and equipped for this purpose. (Example: Neonatal intensive care unit)

6. CLASSIFICATIONS OF SERVICE
GENERAL HOSPITAL
SPECIALITY HOSPITAL
REHABILITATION HOSPITAL
LONG-TERM CARE HOSPITAL (AUXILIARY)
NURSING HOME

7. GENERAL HOSPITAL
Provides primarily for the diagnosis and short-term treatment of patients for a wide range of diseases or injuries.

8. SPECIALITY HOSPITAL
Provides primarily for the diagnosis and short-term treatment of patients for a limited range of diseases or injuries.

9. REHABILITATION HOSPITAL
Provides for the continuing assessment and treatment of patients whose condition is expected to improve significantly.

10. LONG-TERM CARE HOSPITAL
Provides primarily for the continuing treatment of patients with long-term illness or with a low potential for recovery.

11. NURSING HOME
Institution where residents are accommodated who require nursing and personal care on a continuing basis.

12. REGULATORY AGENCIES Provincial hospital authorities responsible for:
Approving hospital budgets
Licensing and inspecting hospitals
Health and safety of hospital workers
Agencies regulating the various health professions
Agencies approving various hospital based training programs

13. REGULATORY AGENCIES Review committees within hospitals
Hospital administration and regulations
Canadian Council on Healthcare Facility Accreditation (CCHFA), representing:
Canadian Hospital Association
Canadian Medical Association
Royal College of Physicians and Surgeons of Canada
L'Association des Medecins de Langue Francaise du Canada
The Canadian Nurses Association

14. A hospital is perhaps the most complex organization in our society.

15. Clinical Engineer Must Understand
Roles and interaction between multiple professional groups
Role of the hospital administration in coordinating these groups

16. WELL DEVELOPED INTERPERSONAL SKILLS ARE ESSENTIAL TO CLINICAL ENGINEERING!

17. Impact of Technology
Advancements 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, MRI
Lithotrity
Nuclear Medicine
Laser Surgery
Laparoscopic Surgery

18. Each technology has its own:
Professional Group
Cherished Role
Diversified Nomenclature
Self Image.

19. Professional Groups There are more than 200 health occupations!
Medical Specialties
Nursing Specialties
Clinical Technicians (i.e., Lab Techs, X-Ray Techs, Respiratory Therapists, Physiotherapists, etc.)
There are more than 200 health occupations!

20. Administrative Challenges
Professionals typically cherish their "right" to self-regulation.

21. Administrative Challenges
Group conflict is unavoidable.
Internal communications are impeded.
Consensus is more apt to be absent.

22. Administrative Challenges
Internal
Medical Staff
Competition Between Health Professions
Unions
Physical Resources
Size and Complexity of Organization
External
Government
Funding
Regulatory Agencies
Public Demands

23. Hospital Administrators Require:
Interpersonal skills
Effective communications skills.
Leadership skills.

24. THE 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.

25. THE HOSPITAL AS AN OPERATING ENTERPRISE

26. HOSPITAL ORGANIZATION
GOVERNING BOARD
MEDICAL HOSPITAL
STAFF ADMINISTRATOR

27. Hospital Management Model
Governing Board (government appointed)
Chief Executive Officer (Hospital Administrator)
Medical Staff Organization.

28. Functions 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.

29. Functions of the Governing Board
To provide adequate financing by securing sufficient income and by enforcing business like control of expenditures.
To provide for the safe administration of funds given in trust, (e.g., gifts and contributions).
To maintain accurate records of its finances and activities.
To surround the patient with a safe environment.

30. THE 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.

31. Being a hospital administrator places more of a strain on character than on intellect.

32. Functions of the Hospital Administrator
Submitting for board approval a plan of organization and recommending changes when necessary.
Preparing a plan for accomplishing the institutional objectives as approved by the board and periodically reviewing and evaluating it.
Selecting, employing, controlling, and discharging employees.
Submitting for board approval an annual budget.

33. Functions 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.

34. Functions 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.

35. THE MEDICAL STAFF

36. Doctors represent the initiators of every action that results in the direct provision of patient care services.

37. Doctors determine: Who Will Be Admitted When Where
What Medical Services Are to Be Provided, in What Sequence, in What Dosage, With What Equipment and Supplies When, Where and by Whom
Who Is Discharged and When.

38. The doctor is not an employee of the hospital, he/she is outside of the hospital organization.

39. Doctors control, yet are not accountable, for nearly 90 percent of hospital expenditures.

40. Medical Staff
Participation by the medical staff in the decision-making process is in the best interest of both the hospital and the patients.
Physician involvement leads to physician accountability.

41. The physician may view the problems of medical practice from a personal rather than an organizational perspective.

42. The administrator is primarily concerned with the maximum utilization of available health resources and personnel.

43. Organization of medical resources may require a degree of control and surveillance over the doctor's work which maybe unattractive to him/her.

44. Medical Staff
The 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.

45. Functions of the Medical Staff
To advise the governing body on medical affairs.
To accept accountability for the quality of care rendered to patients in the hospital.
To request, review and act upon reports of 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.

46. Functions 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.

47. INTERRELATIONSHIPS AMONG HEALTH WORKERS

48. The 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.

49. Organizational 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.