INTRODUCTION

TO HOSPITAL
& ITS
CHALLENGES
INTRODUCTION
 Hospitals are the institution providing medical &
surgical treatment and nursing care for any ill or
injured people.

 It is an integral part of social and medical

organization, the function of which is to provide
complete health care to the needy one, both
curative and preventive. It is also a center for
providing training to health workers & center for
biosocial research(WHO)
Hospitals are the part of social system which again
have subsystem like:
 Clinical services,
 Diagnostic services,
 Therapeutic Services,
 Supportive and Utility services
with heterogeneous group of people like Doctors, Nurse,
Paramedics, Administrative staffs all working together
to provide medical care to patients.
HISTORY
The word “Hospital” originated from
Latin word “Hospice”, meaning of
which is guest. The medieval Latin
word “Hospitale” means the place for
reception of guest which have mainly
six types of institutional meanings,
one of which is
“An institution that care for sick,
injured and wounded”

In early period during Greek and

roman civilizations, Temples were
used as hospitals. With birth of
Christianity, Churches were also used
as hospitals.
  The Earliest noted Hospital was

HOTEL DIEU,PARIS 542 AD

St.BARTHOLOMEU’S HOSPITAL, LONDON

1123AD

SPANISH HOSPITAL,MEXICO CITY,1524 AD

FIRST GENERAL HOSPITAL,NORTH

AMERICA(PENNSYLVANIA HOSPITAL)
1715AD

MASSACHUSETTS HOSPITAL 1811 AD

The advance in all field of medical science led to experimental growth in
hospital service.
 Under Clinical Establishment Act, 2010 the Allopathic Hospitals
will be broadly defined under following four levels:
 Hospital Level 1 (A) –
General Medical services with indoor admission facility provided
by recognized allopathic medical graduate(s) and may also include
general dentistry services provided by recognized BDS graduates.
 Example: PHC, Government and Private Hospitals and Nursing
Homes run by MBBS Doctors etc.

 Hospital Level 1 (B) –

This level of hospital shall include all the general medical
services provided at level 1(A) above and specialist medical
services provided by Doctors from one or more basic
specialties namely General Medicine, General Surgery,
Pediatrics, Obstetrics & Gynecology and Dentistry,
providing indoor and OPD services.
 Level 1(A) and Level 1(B) Hospitals shall also include support
systems required for the respective services like Pharmacy,
Laboratory, etc.
 Example: General Hospital, Single/Multiple basic medical
Specialties provided at Community Health Centre, Sub Divisional
Hospital, and Private Hospital of similar scope, Nursing Home,
Civil/District Hospital in few placed etc.
 Hospital Level 2 (Non-Teaching)
This level may include all the services provided at level 1(A)
and 1(B) and services through other medical specialties given
as under, in addition to basic medical specialty given under 1
(B) like:-
a. Orthopedics
b. ENT
c. Ophthalmology
d. Dental
e. Emergency with or without ICU
f. Anesthesia
g. Psychiatry
h. Skin Pulmonary Medicine
i. Rehabilitation, etc.
 And support systems required for the above services like
Pharmacy, Laboratory, Imaging facilities, Operation Theatre
etc.
 Example: District Hospital, Corporate Hospitals, Referral
Hospital, Regional/State Hospital, Nursing Home and
Private Hospital of similar scope etc.
 Hospital Level 3 (Non-Teaching) Super-specialty
services –
This level may include all the services provided at
level1(A), 1(B) and 2 and services of one or more or
the super specialty with distinct department and/or
also Dentistry if available. It will have other support
systems required for services like pharmacy,
laboratory, and Imaging facility, Operation Theatre
etc.
 Example: Corporate Hospitals, Referral Hospitals,
Regional/State Hospital, Nursing Home and Private
Hospital of similar scope etc.
 Hospital Level 4 (Teaching)
This level will include all the services provided at level 2
and may also have Level 3 facilities. It will however
have the distinction of being teaching/training
institution and it may or may not have super specialties.
Tertiary healthcare services at this level can be
provided through specialists and may be super
specialists (if available). It will have other support
systems required for these services. It shall also include
the requirement of MCI/other registering body for
teaching hospitals and will be governed by their rules.
However registration of teaching Hospitals will also be
required under Clinical Establishment Act for purpose
other than those covered under MCI such as, records
maintenance and reporting of information and
statistics, and compliance to range of rates for Medical
and Surgical procedures, etc.
LEGAL STATUS OF HOSPITAL

Generally 3 types of legal status

 Public hospital
 NGO run Hospital

 Private hospital
 Public Hospital: They are directly under
governmental control. They can be categorized as
 Sole government hospital

 Semi-Autonomous hospital

 Autonomous hospital

Sole Government Hospital are managed by civil

servant. The fee /Income directly goes to
government treasury and have direct control of
government.
 Semi Autonomous Hospital- Run and managed
under Development committee Act. Government
constitutes a development committee according
to the act and committee is responsible for
managing hospital, fix fees, appointing staffs
(under dev. Committee only) . Government also
send civil servants to manage semi-autonomous
hospital. Eg- Kanti Children Hospital, Maternity
Hospital etc.
 Autonomous Hospital –These kinds of hospitals
are established, run and managed under
separate act for individual hospital. The
governing body is the apex body to manage and
run hospital. Eg. BPKIHS, Gangalal Heart center
2. NGO run hospital :
 They are non profit and social organization and are
part of social service. These hospitals must be
registered in concerned District administration office
and social welfare council for legal validity.
 They also must take permission from Ministry of
Health to establish and run hospital

 Eg-Mission hospital, Palpa. Scheer Memorial

Hospital etc.
3. Private Hospital- These Hospitals are run by
private sectors and must be registered under
company act in the company Registrant's office.
 They may be Proprietary Hospital or Private
Limited Hospital or Limited Hospital.
 They must take permission from Ministry of
Health to establish run and manage hospitals.
 TYPES AND CLASSIFICATIONS OF
HOSPITAL

 According to the definition given by WHO , all

hospital will not qualify to be called as Hospital.
Because there are wide range of Hospital. Some
are big, some small, some imparting teaching &
training activities and some with mixed facilities.
So Hospitals can be categorized and classified in
different manners.
1. According to Ownership:
 Public Hospital
 NGO run hospital
 Private Hospital

2. According to Objectives:
 General Hospital
 Specialty Hospital
 Teaching –cum- research Hospital
3. According to System of Medicine
 Allopathic Hospital
 Ayurvedic Hospital
 Homeopathic Hospital
 Unani Hospital

4. According to Level of Care

 Sub Centers
 Primary care Hospital eg.PHC
 Community Health Centers
 Sub District/Sub Divisional Hospitals
 District Hospitals
5. According to size of Hospital
 50-100 Bedded Hospital

 200 Bedded Hospital

 300 Bedded Hospital

 500 Bedded Hospital

 750 Bedded Hospital

 1000 Bedded Hospital

6. According to Teaching facility

 Teaching Hospital

 Non-Teaching Hospital
FUNCTION OF HOSPITAL
 Curative or medical care
 Preventive care

 Promotive care

 Rehabitative care

 Education and training

 Research
HOSPITALS IN 21ST CENTURY
 The hospitals have travelled a long journey from
a time when hospitals were used to be synonym
to temples or home where people go to take
complete rest and wait till death.

 Today hospital are a hi-tech organizations, If a

patient recalls his hospital stay he will have
memory of being surrounded by electronic
gadgets, hi tech equipments, doctors, nurse with
computer, notebook, pen drives and every thing
being processed with computers.
 In past, the aim of hospital was to provide care,
comfort and assurance to the patient with team
of dedicated doctors, nurses and other staffs
whose aim was never upon to earn money but to
serve the poor, helpless and destitute.

 The doctors were treated as god and patient were

treated as guest or angels of god.
 Due to rapid development and advancement of
technology, influence of money in lives of people,
policy of government, Health insurance, medical
tourism etc have changed total scenario of
hospital in new millennium.

 The shift is from care of sick and treating the

patient as an agent of god to treating patient as
customer and providing quality care which is
need based as developing the hospitals as center
of excellence and profit making organizations.
CHALLENGES TO HOSPITALS
 Changes in Pay Structure i.e high costs
 Quality Services

 Management by clinicians in Bureaucratic way

 Lack of trained and professional manpower

 Awareness of clients to rights and obligations

 Patient Satisfaction

 Legislation in the health care.