36

Hospital Administration
and Management
Muhammad Irfanullah Siddiqui

Objectives
At the end of chapter students should be able to:
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z
z

Define hospital administration

Describe the history of hospital development
Enumerate the factors responsible for development of hospital
Classify hospitals using different criteria.
Describe the functions of hospital
Enumerate the factors affecting distribution of beds in hospital
Describe indices related to hospital and population.
Apply different indices to solve hospital issues.
Define hospital utilization.
Enumerate factors affecting hospital utilization
Describe the type of specialties available at various tiers of hospital.
Define administration
Describe role profile of administrator
Define management
Enumerate principals and functions of management
Describe the elements of personal management
Describe steps of personal management
Design and monitor budget
Define and concept of scalar principals
Describe importance of nosocomial infection

Introduction
Hospitals which utilize most of the health budget play a
very important role in the countrys health system1. Hospital
Administration can not be done on intuition. A hospital administrator must be well aware of the scientific methods to
run and evaluate the hospital functions and services in an
objective fashion.
All the doctors should be having a good understanding of
hospital organization and management for better care of their
patients. Moreover they should also have enough knowledge
for management of human, material and financial resources
in a cost effective way with optimum time approach.
Hospitals are among the most complex organizations in
modern society. The modern hospital itself is a universe,
with a variety of objectives, and a scalar division of labor to
achieve those objectives2.

Hospital Administration

It absorbs most of the (50% to 80 %) of health budget4. It is

not people oriented. Its procedure and style are inflexible. It
overlooks the cultural aspect of illness, treating the disease
without treating the patient i.e., directed to pathological agent
approach, rather than origin approach. It is intrinsically resistant to change. Fascinating for politician to spend money as
it is more tangible than expenditure on primary health care.
Comprehensive Health Care will remain dream as it eats
away most of the health budget.
WHO, UNICEF and NGOs worked together to change the
role of hospital working in isolation, to involve primary health
care. It started providing basic as well as referral services.
It integrated preventive and curative health care, through
primary health care centers.

History Of Hospital Development

Definition

The word hospital is an Italian word derived from hospitality

meaning to be guest.

Older concept of hospital for the provision of curative care

is not valid any more. A hospitals role is not only in the provision of curative care, but an equally important role is, the
provision of preventive & promotive health care.

It is represented by staff & serpent. Staff represents patient

while the serpent represents caring off (Figure 10-1).

A W.H.O. expert committee on organization of health care

defined Hospitals as follows;

Hospitals were not always taken in high esteem. The initial

hospitals were in alms houses in America, away from the city
and were used to keep the people of infectious diseases.

The hospital is an integral part of a social and medical

organization, the function of which is to provide for the population, complete health care, both curative and preventive,
and, whose out patient services reach out to the family and its
home environment; the hospital is also centre for the training
of health workers and for social research3.
Hospital without beds is the latest concept about hospitals. Preventive and promotive efforts should be so effective
that, the people should have optimum health with a minimum
need for curative consultation, and even less for hospital
admission.

Criticism Against Hospital

The public health physicians critically analyze the role of
hospitals in patient care. They argue;
Hospital exists in isolation and is beneficial to only one
component of community.

Figure 10-1
Generic Insignia for hospital

Hospital Administration
Only people without family and homes were housed in
them, any one, of means, was cared for in home by their
families.
In the United States, the first modern hospital was the
Pennsylvania Hospital, founded in Philadelphia in 1751.
Slowly throughout 1800s other large facilities were built, such
as Massachusetts General Hospital. It was not until middle of
1900, however, that modern hospital became common1.
Mayo Hospital Lahore is the oldest hospital in Pakistan .
5

Factors Responsible For Development Of

Hospitals
The following factors played important role in the development of hospitals.
z
z
z
z
z
z
z

Advances in Medical Sciences

Development of Technological Sophistication and Specialization
Development of Professional Nursing
Advances in Medical Education
Contribution by Industrialist
Support by Health Insurance
Role of Government

The first influence on the growth of the modern hospital

was the ability to perform surgical procedures successfully.
This was the result of two important scientific advances.
The first was the discovery, in 1850s, of anesthesia. Before
anesthesia, the very best surgeon was the speediest one;
complicated procedures could not be performed because
of the pain associated with them. The advent of anesthesia
ushered in the golden age of surgery in the late 1800s.
The second major advance was the discovery of asepsis.
Patients undergoing surgery frequently developed postoperative infections. With the advent of asepsis the danger of
postoperative infection was reduced substantially.
These advances allowed surgery to become a major force
in the care of patients. Over 40% of total hospital beds are
surgical beds to understand the impact of these discoveries.
The more recent advances in outpatient surgical procedures
probably represent another turning point in the influence of
surgery on the system.
The19th century, saw the emergence of the biological revolution. The discovery of the new sciences of microbiology
ushered in a new understanding of disease. The notion of the
etiologic agent as the cause of disease required fundamental
rethinking of diagnosis and treatment. New technology to assist in the diagnosis and treatment of patients developed rapidly during that period. The discovery of the electrocardiograph
and the x-ray, illustrate the expanding role of technology.
The early laboratories and machines of this technological

revolution were primitive by todays standards and were

physically very large. It made sense to provide a central
place, the hospital, where all physicians could have access
to this new technology. To this day, the hospital continues
to serve a major role as the repository of technology for the
community, although presently much is being done to move
this technology into non-institutional locations.
A third major development occurred in the nursing profession. Inmates provided what nursing care was available in
the early alms-houses. In the mid-1800s, during the Crimean
War, Florence Nightingale demonstrated the advantages of
professional nursing services on reduction of both mortality
and morbidity. She later introduced nurse training programs
in Britain and for hospitals in United States. The availability
of well-trained nursing personnel made hospitals much safer
and more pleasant places.
The training of physicians also has changed dramatically,
and this has been an important factor in the development
of hospitals. Before 1900, medical education in the United
States was seriously deficient. Most physicians were trained
in proprietary apprenticeships, with many lectures and little
exposure to patients.
The development of professional licensure was important
in the reformation of American Medical Education. Licensing
was based on an examination and graduation from an approved school. A second contributing factor was the Flexner
Report. Flexner reported that the existing medical schools
were grossly inadequate.
One school, however, stood out. This school, Johns Hopkins University, served as an example for others. The positive
features of this school were:
Students were required to have a college degree before
they were admitted.
z The medical curriculum was 4 years in duration, with 2
years dedicated to basic sciences and 2 years to work
with full-time clinical instructors.
z The medical school was an integral part of a comprehensive university.
z Faculty of the school was actively engaged in medical
research. Hospitals increasingly became the training site
for both medical students and residents, training for a
medical or surgical specialty.
Another development that was critical to the modern hospital was the increasing health insurance coverage held by
the population. Health insurance was relatively unknown until
the 1930s. During the 1940s, there was a rapid increase in
the proportion of people who were covered.
z

Classification of Hospitals
Hospital can be classified in any of the following way;
A. According to type of services provided
B ccording to size or number of beds

4
C. According to ownership
D. According to duration of stay

A. According to type of services provided6

General hospital

These are the type of hospitals where different specialist

services are provided to both adult and children under the
same roof including Medical, Surgery, Pediatrics Gynae &
Obs., Cardiology, Dermatology, Orthopedic and Ophthalmology etc.

Special hospitals

These hospitals deal with specific category of diseases

e.g. Eye hospital, hospital of cardiac disease, ENT hospital,
orthopedic hospital, kidney centre; or specific group of people
e.g. children hospital, maternity home; or specific disease
e.g. T.B Centre, Leprosy Centre.

Hospital Administration

D. According to duration of stay

Long duration hospital; Stay more than 30 days as in leprosy centre, orthopedic hospital etc.
Short duration hospital; Stay less than 30 days as in acute
diseases hospital. e.g. Eye hospital.

Functions of Hospitals
Following are the main functions of a hospital. It should be
kept in mind that all functions will not be carried out by every
hospital at all times.

a) Preventive & Promotive Care

B. According to size or number of beds7

This is the type of care which should be the main functions

of hospitals, for economic gain to the community in terms of
health benefit. It includes immunization against preventable
diseases, screening programs for detection of common health
problems & health education for personal hygiene, nutrition
and management of chronic diseases.

Regional/Teaching hospital

b) Domiciliary Service

These hospitals have more than 500 beds. They are attached to medical colleges and have all types of specialties
and subspecialties e.g. radiotherapy, neurosurgery. Example
of this type of hospital is Jinnah Postgraduate Medical Centre,
Karachi & Mayo Hospital Lahore.

District Hospitals

Provide about fifteen specialties including Medical, Surgery,

Gynae & Obs. , ENT, Eye, anesthesia and dermatology and
have a range of beds from 100-600, example include Civil
Hospital, Thatta, Jacobabad, Attock etc.

Rural Hospital

It has capacity of 20 100 beds. It provides medical, surgical & obstetrical care only, e.g. Rural Health Centre Gharoo,
Rural Health Centre, Murad Memon Goth, Malir.

C. According to ownership
Public Hospital

These hospitals are owned and managed by government

and/or autonomous bodies e.g. Civil Hospital, Sargodha,
Pakistan Institute of Medical Sciences, National Institute of
Child Health etc.

Private Hospital

Owned by private people or entrepreneur, can be further

classified into.
a) Commercial
b) Non-profit

This is another important service provided by hospitals. It

means Treating the patient at home. This helps not only in
decreasing the work load at hospital services, but, conservation of resources which are already scarce. The hospital
administrator should create liaison with the private clinic
existing in catchment area.

c) Training
Hospitals are the most suitable places for, both, medical &
paramedical personnel. Theoretical lectures supplemented
by practical demonstration on patient will add to skill of the
trainee both at undergraduate and postgraduate level.

d) Research
Research is an integral part of hospital services. It is by this
means that most of the advances in the medical sciences
have been achieved. A good training regarding research
principals followed by the application of the same in the real
life situation helps in new discoveries.

e) Health Education
Health education means providing information to the people
to change their behavior in the positive direction. This is the
most neglected service, though most important one. This is
the most effective way of preventing disease and promoting
health in the community when a patient and his attendants
seek care, they are very receptive to the information about
the problem. Useful information can be provided through well
baby clinic, asthma clinic, diabetes centre and vaccination
canter, etc.

Hospital Administration

f) Curative Care

with problems of old age people.

This is the service for which the hospitals are known to the
community since very long. It includes both outpatient and
inpatient care.

j) Physiotherapy

Outpatient: The focus of attention in hospital has gradually

shifted from the inpatient to the outdoor, i.e. the OPDs. The
diagnostic procedures which previously required hospitalization have become outpatient facilities and can be performed
there. This is also one of the major means of keeping the
patients out of the hospital. As outpatients are the first point
of contact between the patients and the hospital, it should
be well organized, well staffed and well equipped. Facilities
like laboratory, X-ray and pharmacy should be located near,
to avoid patient discomfort.
Filter Clinics are mandatory for outpatients departments;
now these are clinics where bulk of patients are seen and
those requiring special consultation are referred to the consultants clinics.
Inpatient services: Previously the role of hospital was confined to inpatient department only. All the inpatient departments should be in one block with free communication with
the supplies. The nursing station should be rightly placed
and sufficient numbers of nurses should be available for the
present number of beds. The general nurse to patient ratio
is 1:10. The desirable number of patients per ward is 10-20,
with one nursing unit. The ward could be divided into 2 rooms
with capacity of 10 beds each, or rooms with single, double
or four bed capacity. In all cases, adequate floor space per
patient is needed to prevent cross infection. There should be
adequate toilet facilities.

g) Accident & Emergency Services

This is an important component of hospital services. Hospitals should be well equipped and staff should be properly
trained to meet the emergencies.

h) Disaster Management
This is another component of health services. Though disasters are rare events, every hospital should have a disaster
management protocol, for the various types of disasters, and
staff should always be prepared through regular mock exercises to deal with such situations. Types of disasters depend
on the catchment region of the hospital, for example, a hospital in Baluchistan could prepare a earthquake management
protocol, whereas an hospital in the Punjab plains would lay
more emphasis on management of flood affected morbidity,
and in NWFP, for a sudden influx of refugees.

i) Geriatric Services
Census in 1998 shows a significant increase in the geriatric
population. Currently more that 1.5 million people are found
in 75 years + group and more will be added during the next
decade. Special arrangements should also be there to deal

This is an important service and sufficient trained man

power should be there to deal with patients with chronic
diseases such as CVA(cerebrovascular accidents).

k) Ambulance Services
An effective ambulance service is a part and parcel of
hospital services to deal with emergency problem and hence
provision of timely care.

l) Laboratory Services
An efficient laboratorys with all necessary reagent and
effective blood transfusion service, is a prerequisite of good
functioning hospital.

m) Social Medical Services

This is another neglected service. An effective social medical service will help in preventing the disease, promoting the
health in the community and thus preventing the load on
hospital services.

n) Medical Record Keeping

It is also a very important component of health services.
No effective planning can be done if the record keeping is
poor. This is one of the reasons why health conditions of the
communities have not improved.

o) Others
The support services provided by hospitals include;
z
z
z
z
z
z

House Keeping
Kitchen
Medical Store
Laundry
Library
Security

Factors Affecting Distribution of Beds

A hospital administrator has always to face the problem of
scarcity of beds as complained by various heads of department. He should be well aware of the technique of justification of distribution of beds for the various departments of
hospitals. Some of the factors effecting the distribution of
beds are as under and they should always be considered
before allocation of beds.
z
z

Type of Hospital.
Availability of Resources

6
z
z
z
z
z
z
z
z
z

Hospital Administration
Prevalence / incidence of diseases
Accident and injury
Male / Female ratio
Level of Expertise
Intensive Care Problems
Community Program (Pressure)
Premises / wards / theatre / kitchen
Financial Resources
Statistical Figure
Average Length of Stay
Turn over period
% Bed occupancy
Throughput

Hospital Utilization And Statistics

The term hospital utilization denotes the manner in which
the community uses its hospital resources8.
Since the modern concepts of hospital include curative,
preventive, promotive, educational, domiciliary, in patient
and ambulatory services, indices should be developed to
evaluate all these components. The best known indices are
only for the in patient care so we will discuss only the indices
for in patient care.
Some of the common indices used by hospital administrator
to evaluate the in - patient care.

A. Indices related to hospitals

Basically there are three indices related to inpatient care
in hospitals. These are:
Bed Capacity (BC) which is defined as the average number
of beds during a specified period, Average Bed Availability
(ABA) which is the average number of beds available for
patients to be admitted, and, Average Bed Occupancy
(ABO), which is the proportion of beds which are filled during
a specified period. The indices given below are derived from
these basic values:
z
z
z
z

Bed occupancy rate (BOR)

Average length of stay (ALOS)
Turn over period (TOP)
Throughput (THROP)

1. Bed Occupancy Rate (BOR)

It is calculated by dividing ABO and ABA

Example:
In a hospital ABO is 600 and ABA is 800 calculate BOR.
BOR =

ABO # 100 = 600 # 100 =

75%
ABA
800

2. Average Length of Stay (ALOS)

It is calculated by summing the bed days occupied by

patients for a particular month and then dividing this figure
by separation.
Separation may be defined as bed available due to the
following reasons:
z
z
z

Deaths
Discharges
Transfers

Example:
In a particular unit average bed days occupancy (ABO) by
patients of a particular month was 900 while separation was
60. Work out ALOS.
ALOS =

ABO
= 900 = 15
Separation
60

3. Turn over period (TOP)

It is the statistical test which provides you the information

about the difference between the BED DAYS AVAILABLE
and BED DAYS OCCUPIED during a month with respect to
separation.
It is calculated as following:
TOP =

ABA - ABO
(S)

Example:
In a hospital ABA=600, ABO is 400, while separation is 35,
calculate the TOP:
TOP =

600 - 400 =
5.7 Days
35

4. Throughput (THROP)

It is calculated by dividing Separation with ABA/DAY

Example:
In a hospital separation was 50 during a month and available no. of beds is 30/day. Calculate throughput.
Throughput =

S
= 50 = 1.66
ABA DAY 30

B. Indices related to Population at Risk

a) Admission rate

Also known as hospital frequentation rate (Fh), is usually

compared as no. of hospital admission (A) per thousand
population (P) per year however rate per person or per 100
persons may also be used.

Hospital Administration
A
Fh = # 1000
P

z
z
z

b) Hospitalization rate per person (Hc)

This index represents the volume of hospitalization in terms

of number of hospitalization days per person per year.
It is calculated by dividing the total number of hospitalization
days in a year H by the mean population in that year P.
HC =

H
P

c) Bed Occupancy Ratio

Bed occupancy ratio (Bc) is the average daily number of

persons hospitalized per unit of population. It is obtained by
dividing the average daily number of beds occupied N by
the mean population P in the same year.
BC =

N # 1000
P

Specialties in a Hospital
A frequently asked question is, what specialties should be
available at Teaching Hospital (Regional Hospital), District
Hospital (DHO), Tehsil Hospital (THO), and Rural Health
Centre (RHC).
Following is the distribution of specialties.

At Teaching Hospitals
All specialties including subspecialties should be available.

At District Headquarter Hospital (DHQ)

At least following specialists should be available.
z

Factors Influencing Hospital Utilization

While evaluating the hospital services, a hospital administrator must consider the various factors effecting the hospital
utilization.

The manner in which a certain community utilizes the

hospital bed and the extent of such utilization are influenced
by many factors that depend on the social, economic, educational, and cultural characteristics of the people and on
the attitudes and special habits of the medical profession.
With regard to the latter, it may be presumed that the doctor
orders or advise admission to a hospital primarily for medical
reasons; however, this is not always the case. Very often the
people themselves influence the decision for or against hospital admission. Thus, in less developed communities, fear of
the hospital or unwillingness to separate from the family may
be strong arguments against hospital admission, whereas in
more sophisticated communities the hospital habit may be
such that a person may bring pressure to bear on the attending physician for admission to the hospital, even though there
may not be objective reasons for this course of action. The
main factors which affect hospital utilization are as under;

z
z
z
z
z
z
z
z
z

Availability of Hospital beds

Methods of payment of hospital services
Age of the population
Services coverage & bed distribution
Availability of extramural medical services
Hospital bottle necks
Medical custom and social patterns
Supply of physician
Research and training

Existence of proprietary hospital

Housing
Morbidity
Internal organization

z
z

z
z
z
z
z
z
z
z
z

Physician
Surgeon
Gynecologist
Pediatrician
Ophthalmologist
E.N.T. Specialist
Dermatologist
Pathologist
Radiologist
Anesthetist
Chest Physician
Cardiologist
Orthopedic Surgeon
Urologist
Psychiatrist

One

Two
One

At Tehsil Headquarter Hospital (THQ)

At least 10 specialties should be available which are also
available to DHQ excluding Chest Physician, Cardiology,
Orthopedic, Urology and Psychiatry.

At Rural Health Center (RHC)

Medicine, Surgery, Gynecology and Obstetrics and preferably pediatric facilities should be available.

Administration
Administration includes the following activities termed as
POSD CORB (Guillick).

Hospital Administration

Planning, organizing, staffing, directing, coordinating,

reporting and budgeting.

Management

The term hospital administration covers a large number

of activities which may roughly be classified into three categories.

Management is an old process and has existed ever since

man has been organized into communities. It is sometimes
thought to be a process of 20th Century but this is not so.
Where and whenever people have worked together in-groups
to grow crops, to buy and sell, to wage wars, to build a temple,
there was management.

Preparation of hospital legislation, planning of the hospital

system as a whole, determination of international policy,
regulation for the operation of hospitals, establishment
of architectural control and standards.
Application of hospital legislation and of social assistance provision by the authorities responsible for the
management of hospital services whether they be local
or regional, public or private.
Daily running of the hospital by the administrative staff
concerned with personnel, finance accounts and technical services.

Role Profile of Administrator

z
z
z
z
z
z
z
z
z
z

Ability to see ahead and plan accordingly: planning for

the future while managing the present.
Ability to produce and accept new and creative ideas,
being an agent of change.
Willingness to take risks to get the new ideas accepted
and implemented.
Ability to co-ordinate, bringing about harmony, collaboration, organizing, allocating resources and controlling.
Ability to analyze, synthesize and integrate diverse information.
Sense of equity, fairness and social justice, in all dealings
within and outside the hospital.
Knowledge, skills and experience.
Ability to delegate, making effective use of own time and
that of others.
Good personal motivation and ability to motivate the
people working in the hospital.
Ability to review and evaluate, making adjustments as
necessary.

Role of Administrators
The Administrator reports to the Governing Body (or other
higher authority such as Director of Health Services, Secretary to Government, etc).

The most comprehensive way to define management is:

Management is a key process. The function of management
is to enable our patient/doctor/nurse team to do their job as
easily, efficiently, economically, effectively and as humanly
as possible so that they can develop and maintain a caring
environment within the Hospital. OR
It is the process of organizing, using and controlling human
activities and other resources towards special end9; OR
Management is a process whereby resources in term of
people, finances, equipment and facilities are mobilized, ideally in an efficient and effective manner to serve the purposes
of an institution.
Resources are;
Men
Money
Materials
Machinery
Methods

Principles of Management
The major principles are:
z
z
z
z

Functions of Management
The main functions of management include the following:
z
z
z
z

Persons Reporting Directly to Administrator

z
z
z
z
z

Medical Superintendent
Nursing Superintendent
Associate Assistant Administrators
Coordinator, Community Health Programs
Principal, School of Nursing, where there is a school of
Nursing.

Unity of Command
Span of Control
Homogenous Assignment
Delegation of Authority

Planning
Organizing
Staffing
Leading
Controlling

Planning

Planning involves selecting the mission, goals, objectives

and actions required. It is defined as setting objectives, determining resources and selecting courses and requires decision
making i.e. choosing future courses of action from among
alternatives. It can be defined as deciding what is to be done
and how it is to be done. Planning must aim at the fulfillment

Hospital Administration
of the hospitals role in terms of the appropriateness, quality,
quantity and cost of the health care provided.

Organizing

This includes the identification and classification of the

required activities. The activities are then grouped together
and each group of activities is assigned to a manager, through
the process of delegation both horizontally, among the different managers on the same level, and vertically from the
superiors to subordinates.
This is that part of Management that involves establishing
an international roles for the people.

Staffing

This involves filling and keeping filled the positions in the

organizational structure.

Leading/Directing

This is influencing people, so that they will contribute to the

organization and group goals in an effective manner.

Controlling

This is the measuring and correcting the activities of the

subordinates in order to ensure that the events conform to
the plans.
All the above activities need to be backed up by the process
of coordination by the manager/administrator at all levels.

Elements of Management
The following are elements of management.
A.
B.
C.
D.

Personal Management
Financial management
Material Management
Time Management

A. Personal Management
The function of caring for staff in the organization is known
as Personnel management. In the hospital services with
very few specialists, the effective management of staff lies
on the shoulders of departmental heads.

Steps of Personal Management

z
z

Human Resources Planning

Recruitment and Selection

Human Resource Planning

This is information decision making process designed to
ensure that enough competent people and appropriate skills
are available to perform jobs where and when needed.

Recruitment and Selection

The aim of recruitment is to ensure that the organizations
demand for manpower is met by attracting potential employees in a cost-effective and timely manner.

Steps in Recruitment
Job Analysis
It has two components;
Job specification
It is a summary of the knowledge, skills and personal characteristics required of the job holder to carry out the job to an
acceptable standard of performance.
Job description
The job description describes information about the job
concerned viz title of job, overall purpose of the job, principle
responsibilities, location of job, grade/salary level of job etc.
The purpose of job description is to define exactly for a
worker, fellow worker and supervisor:z
z
z
z
z
z

How much is his authority?

What is his responsibility?
What the worker is expected to do?
What standards he is expected to reach?
To whom he is responsible?
Whose work he supervises?

Job description helps each worker to know clearly and without doubt what his duties are and what he is expected to do.
Such job descriptions should be interpreted flexibly, as per
guidelines.

Attracting the Application

By advertisement
The aim of job advertisement is to attract sufficient numbers
of the right kind of candidates. It should include details about
the position of the job, employing organization, candidate
requirements-essential/desirable, the salary indicator etc.
Evaluating Applicants
It is a process of scrutiny of the applicant for their qualification
and experience for the required post.
Selection
The aim of selection is to identify applicants most likely to
fulfill the requirements of the organization. The initial selection of candidates on the basis of their application form is
called short-listing.
Placement and Development
After selection of personnel a very important task for the
management is assigning proper duties and responsibilities
according to the skills and qualification of the person.

10
B. Financial Management
Financial management is one of the very important tasks of
management and deals with how to spend money and get
maximum benefit for the organization.

Budget

Budget is formal financial statements of policies, plans

and goals that are designed to assure that actions are taken
within boundaries laid down by top management.10
OR
It is numerical statements of program showing the proposed or estimated schedule of expenditure in coming years
keeping in view the estimated income of next year.
Budget may be;

Developmental

Hospital Administration
discuss it with the managers and if manager fails to satisfy
them, an audit objection is submitted to Public Accounts
Committee.

C. Material Management
It is the planning, purchasing and maintaining of different
items used in the hospitals. The job of a hospital administrator is to ensure;
The supply of right thing at the right place, at the right
time and at right cost11.
It involves:z
z
z
z

Correct planning
Sticking to time needs
Correct purchasing procedures
Standardization
Stock control tools
Documentation for audit

This part of budget used for a new process of expenditure

usually for a limited period usually prepared according to
annual developmental program and called Annual Developmental Budget.

Non Developmental (Recurrent)

Time is one of the most important resources. Time is like

central nervous system i.e. it cannot be regenerated once
destroyed or wasted.

This is that part of budget which an organization needs for

its non-developmental activities. e.g.,
z
z
z

Salaries
Travelling
Other daily expenditure e.g., bills

Monitoring of Budget

D. Time Management

Hospital administrator should be able to control and usefully consume the time of his subordinates for the welfare of
the patients.
This can be done by making correct duty rosters for the
organizations and see to it that everything is done according
to schedule.

Monitoring means keeping an eye on expenditure of budget

to see if expenses are according to the schedule or not, and
to avoid inappropriate use of funds.

The management of time is an issue, which is fundamental

to job performance.

Tools for Monitoring

The Scalar Principle

z
z
z
z

Monthly statements
Excess statements
Accounting
Auditing

Auditing

This is an analysis of proposed or past expenditure with

respect not only to their legality but also to their desirability.
This is of 2 types.

Pre Audit
Audit taking place prior to payment.

Post Audit
Audit done after payment has been made.

Audit Objection
If the auditors are not satisfied with any transactions, they

This implies delegation of authority to the various staff

members in responsible positions. The principle is applicable
not only in hospital administration but also in other areas of
Health Sector. The power to execute the functions may be in
the context of financial requirements, but also in connection
with leave sanctions, disciplinary action and job performance
as well as complaints.
If an Administrator or a Director has to be approached by a
lower sanctioning officer, he should follow a series of steps, as
for example: If the Resident MO has to approach the Director, he is required to go through the scale, while the reverse,
Director to Summon the residents he is also required to follow the channel down the scale. However this depends on
the nature of event. In an emergency, the resident may have
to establish contact with the director without going through
the ladder. Likewise the director may, depending upon the
circumstances, call for a lower ranking staff member directly

11

Hospital Administration
without following the channel. This principle equally holds
good in financial sanctions and other areas.

References
1.

Nosocomial Infection
Nosocomial infections, i.e. infections acquired by patients
in the hospital have become more of a problem in human
medicine, because of increase in drug-resistant microbial
strains as well as increases in the use of invasive procedures
for patient support and monitoring. Nosocomial infections
are also expected to become a more serious problem in
veterinary medicine for similar reasons.

Last JM, Wallace RB (editor) Maxcy Rosenaue-Last public health and

preventive medicine- 13th ed. Connecticut Appleton & Lange 1992 page
1066-8
2. Willson RN. The social structure of a general hospital in medicine and
society. The annals of the American Academy of Political and social
sciences. 1963;346:67
3. WHO technical report series No 261, 1963
4. Park K Parks text book of preventive and social medicine 20th ed.
Jabalpur, Banarsidas Bhanot. 2009
5. http://en.wikipedia.org/wiki/Mayo_Hospital
6. Davies RL, Macaulay HC.(ed) Hospital planning and administration.
Geneva. WHO. 1966.
7. WHO Technical report series 1957 122, 17
8. Smith BA. Hospital costs and utilization. In: Davies RL, Macaulay
HC.(ed) Hospital planning and administration. Geneva. WHO. 1966.
9. Rhea JC, Ott JS, Shafritz JM. The dictionary of health care management.
New York. Facts On File. 1988
10. D o t y P , L i u K , Wi e n e r J . . A n o v e r o f l o n g - t e r m c a r e
H e a l t h C a r e F i n a n c i n g R e v i e w. 1 9 8 5 ; 6 ( 3 ) : 6 9 - 7 8 .
abs.sagepub.com/cgi/content/refs/30/2/143
11. Sand R, Parnell RW. Ed. The Advance to Social Medicine; Eng. trans.
by Rita Bradshaw. New York-London: Staples Press, 1952. 655 pp.
http://www.sciencemag.org/cgi/content/citation/117/3027/19-a

The exact prevalence of the nosocomial infections is not

known, but there are reasons to believe that this is a significant public health problem, particularly in the developing
countries where sanitary conditions fall short of the required
standards.
Studies carried out in hospitals of the US showed, urinary
tract infections, surgical wound infections, lower respiratory
and blood stream infections in varying degrees.
The mode of infection is either through direct contact or
through fomites. Vehicular transmission through food, water
and vectors has also been noted. The hospital administration
has the responsibility of hand washing provision for the hospital staff of all categories and the patients and maintenance
of sanitary standards at all levels, as preventive measures.

Acknowledgment
Part of this chapter has been taken from the previous
chapter 4th ed. written by A Sattar Tabani, Aamir Waseem
Khan, Sabiha Khurshid Ahmed, Aamir Omair. For this we are
thankful to authors.

Index
A
Accident & Emergency Services 5
Administration 7
Persons Reporting Directly to Administrator 8
Role Profile of Administrator 8
Ambulance Services 5
Auditing 10
Average Bed Availability 6
Average Bed Occupancy 6
Average length of stay 6
Average Length of Stay (ALOS) 6

B
Bed Capacity 6
Average Bed Availability 6
Average Bed Occupancy 6
Bed occupancy rate 6
Bed Occupancy Rate (BOR) 6
Budget 10
Monitoring of Budget 10
Tools for Monitoring 10

12

Hospital Administration

CRITICISM AGAINST HOSPITAL 2

Curative Care 5

Management 8
Controlling 9
Elements of Management 9
Financial Management 10
Function of Management 8
Human Resource Planning 9
Job description 9
Job specification 9
Leading/Directing 9
Material Management 10
Organizing 9
Personal Management 9
Planning 8
Principles of Management 8
Recruitment and Selection 9
Staffing 9
Time Management 10
Medical Record Keeping 5

D
Disaster Management 5
District Hospitals 4
Domiciliary Service 4

F
Factors Affecting Distribution of Beds 5
Factors Responsible for Development Of Hospitals 3
Factors Responsible For Development Of Hospitals
Advances in Medical Education 3
Advances in Medical Sciences 3
Contribution by Industrialist 3
Development of Professional Nursing 3
Development of Technological Sophistication and Specialization 3
Role of Government 3
Support by Health Insurance 3
Financial Management 10
Budget 10

G
General hospital 4
Geriatric Services 5

H
Health Education 4
History Of Hospital Development 2
Hospital Administration 2
Definition 2
Hospital Administration and Management 1
Hospitals 2
Administration 7
Classification of Hospitals 3
Factors Influencing Hospital Utilization 7
Functions of Hospitals 4
Hospital Utilization and Statistics 6
Management 8
oldest hospital 3
Specialties in a Hospital 7
Hospital without beds 2

I
Indices related to hospitals 6
Indices related to Population at Risk 6
Admission rate 6
Bed Occupancy Ratio 7
Hospitalization rate per person 7

L
Laboratory Services 5

N
Nosocomial Infection 11

P
Physiotherapy 5
Preventive & Promotive Care 4
Private Hospital 4
Public Hospital 4

R
Regional/Teaching hospital 4
Research 4
Rural Hospital 4

S
Scalar Principle 10
Social Medical Services 5
Special hospitals 4
Specialties in a Hospital
At Teaching Hospitals 7
At Tehsil Headquarter Hospital 7

T
Throughput 6
Throughput (THROP) 6
Training 4
Turn over period 6
Turn over period (TOP) 6