36

Hospital Administration
and Management
Muhammad Irfanullah
Muhammad Irfanullah Siddiqui
Siddiqui

Objectives
At the end of chapter students should be able to:
• 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
2
Hospital Administration

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

Introduction is not people oriented. Its procedure and style are
Hospitals which utilize most of the health budget play a inflexible. It overlooks the cultural aspect of illness, treating
very important role in the country’s health system1. Hospital the disease without treating the patient i.e., directed to
Administration can not be done on intuition. A hospital ad- pathological agent approach, rather than origin approach.
ministrator must be well aware of the scientific methods to It is intrinsically resis- tant to change. Fascinating for
run and evaluate the hospital functions and services in an politician to spend money as it is more tangible than
objective fashion. expenditure on primary health care. Comprehensive
All the doctors should be having a good understanding of Health Care will remain dream as it eats away most of the
hospital organization and management for better care of health budget.
their patients. Moreover they should also have enough WHO, UNICEF and NGOs worked together to change
knowledge for management of human, material and the role of hospital working in isolation, to involve primary
financial resources in a cost effective way with optimum health care. It started providing basic as well as referral
time approach. services. It integrated preventive and curative health care,
Hospitals are among the most complex organizations in through primary health care centers.
modern society. The modern hospital itself is a universe,
with a variety of objectives, and a scalar division of labor to History Of Hospital
achieve those objectives2. Development
Definition
Older concept of hospital for the provision of curative The word hospital is an Italian word derived from
care is not valid any more. A hospital’s role is not only in hospitality meaning to be guest.
the pro- vision of curative care, but an equally important It is represented by staff & serpent. Staff represents
role is, the provision of preventive & promotive health care. patient while the serpent represents caring off (Figure 10-
A W.H.O. expert committee on organization of health 1).
care defined Hospitals as follows; Hospitals were not always taken in high esteem. The
“The hospital is an integral part of a social and medical initial hospitals were in alms houses in America, away from
organization, the function of which is to provide for the the city and were used to keep the people of infectious
popu- lation, complete health care, both curative and diseases.
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
research”3.
“Hospital without beds” is the latest concept about hospi-
tals. 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;
Figure 10-1
Hospital exists in isolation and is beneficial to only one Generic Insignia for hospital
component of community.
Hospital Administration 3
Only people without family and homes were housed in revolution were primitive by today’s standards and were
them, any one, of means, was cared for in home by their physically very large. It made sense to provide a central
families. place, the hospital, where all physicians could have access
to this new technology. To this day, the hospital continues
In the United States, the first modern hospital was the
to serve a major role as the repository of technology for the
Pennsylvania Hospital, founded in Philadelphia in 1751.
community, although presently much is being done to
Slowly throughout 1800s other large facilities were built,
move this technology into non-institutional locations.
such as Massachusetts General Hospital. It was not until
middle of 1900, however, that modern hospital became A third major development occurred in the nursing profes-
common1. sion. Inmates provided what nursing care was available in
the early alms-houses. In the mid-1800s, during the
Mayo Hospital Lahore is the oldest hospital in Pakistan5.
Crimean War, Florence Nightingale demonstrated the
Factors Responsible For advantages of professional nursing services on reduction
of both mortality and morbidity. She later introduced nurse
Development Of Hospitals training programs in Britain and for hospitals in United
States. The availability of well-trained nursing personnel
The following factors played important role in the made hospitals much safer and more pleasant places.
develop- ment of hospitals.
The training of physicians also has changed dramatically,
• Advances in Medical Sciences and this has been an important factor in the development
• Development of Technological Sophistication and Spe- of hospitals. Before 1900, medical education in the United
cialization States was seriously deficient. Most physicians were
• trained in proprietary apprenticeships, with many lectures
Development of Professional Nursing
and little exposure to patients.
• Advances in Medical Education
• The development of professional licensure was important
Contribution by Industrialist
in the reformation of American Medical Education.
• Support by Health Insurance Licensing was based on an examination and graduation
• Role of Government from an ap- proved school. A second contributing factor
The first influence on the growth of the modern hospital was the Flexner Report. Flexner reported that the existing
was the ability to perform surgical procedures successfully. medical schools were grossly inadequate.
This was the result of two important scientific advances. One school, however, stood out. This school, Johns Hop-
The first was the discovery, in 1850s, of anesthesia. Before kins University, served as an example for others. The
anesthesia, the very best surgeon was the speediest one; positive features of this school were:
complicated procedures could not be performed because
• Students were required to have a college degree
of the pain associated with them. The advent of anesthesia
before they were admitted.
ushered in the golden age of surgery in the late 1800s.
• The medical curriculum was 4 years in duration, with 2
The second major advance was the discovery of asepsis. years dedicated to basic sciences and 2 years to work
Patients undergoing surgery frequently developed postop- with full-time clinical instructors.
erative infections. With the advent of asepsis the danger of
• The medical school was an integral part of a
postoperative infection was reduced substantially.
comprehen- sive university.
These advances allowed surgery to become a major • Faculty of the school was actively engaged in medical
force in the care of patients. Over 40% of total hospital research. Hospitals increasingly became the training
beds are surgical beds to understand the impact of these site for both medical students and residents, training
discoveries. The more recent advances in outpatient for a medical or surgical specialty.
surgical procedures probably represent another turning
Another development that was critical to the modern hos-
point in the influence of surgery on the system.
pital was the increasing health insurance coverage held by
The19th century, saw the emergence of the biological the population. Health insurance was relatively unknown
revo- lution. The discovery of the new sciences of until
the 1930s. During the 1940s, there was a rapid increase in
microbiology ushered in a new understanding of disease. the proportion of people who were covered.
The notion of the etiologic agent as the cause of disease
required fundamental rethinking of diagnosis and
treatment. New technology to as- sist in the diagnosis and Classification of Hospitals
treatment of patients developed rap- idly during that
period. The discovery of the electrocardiograph and the x- Hospital can be classified in any of the following way;
ray, illustrate the expanding role of technology. A. According to type of services provided
The early laboratories and machines of this technological B ccording to size or
number of beds
4 Hospital Administration

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

D. According to duration of stay Long duration hospital; Stay more than 30 days as in
lep- rosy centre, orthopedic hospital etc.
A. According to type of services Short duration hospital; Stay less than 30 days as in
provided6 acute diseases hospital. e.g. Eye hospital.

General hospital Functions of Hospitals

These are the type of hospitals where different specialist
services are provided to both adult and children under the Following are the main functions of a hospital. It should
same roof including Medical, Surgery, Pediatrics Gynae & be kept in mind that all functions will not be carried out by
every hospital at all times.
Obs., Cardiology, Dermatology, Orthopedic and
Special
Ophthalmol-hospitals
ogy etc.
These hospitals deal with specific category of diseases a) Preventive & Promotive Care
e.g. Eye hospital, hospital of cardiac disease, ENT hospital, This is the type of care which should be the main
orthopedic hospital, kidney centre; or specific group of functions of hospitals, for economic gain to the community
people in terms of health benefit. It includes immunization against
e.g. children hospital, maternity home; or specific disease preventable diseases, screening programs for detection of
e.g. T.B Centre, Leprosy Centre. common health problems & health education for personal
B. According to size or number of hygiene, nutrition and management of chronic diseases.

beds7
b) Domiciliary Service
This is another important service provided by hospitals. It
Regional/Teaching hospital means “Treating the patient at home”. This helps not only
These hospitals have more than 500 beds. They are at- in decreasing the work load at hospital services, but,
tached to medical colleges and have all types of specialties conser- vation of resources which are already scarce. The
and subspecialties e.g. radiotherapy, neurosurgery. hospital administrator should create liaison with the private
clinic existing in catchment area.
Example of this type of hospital is Jinnah Postgraduate
District Hospitals
Medical Centre, Karachi & Mayo Hospital Lahore.
Provide about fifteen specialties including Medical, c) Training
Surgery, Gynae & Obs. , ENT, Eye, anesthesia and Hospitals are the most suitable places for, both, medical
& paramedical personnel. Theoretical lectures
dermatology and have a range of beds from 100-600,
supplemented by practical demonstration on patient will
example include Civil Hospital, Thatta, Jacobabad, Attock add to skill of the trainee both at undergraduate and
etc. postgraduate level.
Rural Hospital
It has capacity of 20 – 100 beds. It provides medical, d) Research
surgi- cal & obstetrical care only, e.g. Rural Health Centre Research is an integral part of hospital services. It is by
Gharoo, Rural Health Centre, Murad Memon Goth, Malir. this means that most of the advances in the medical
sciences have been achieved. A good training regarding
C. According to ownership research principals followed by the application of the same
in the real life situation helps in new discoveries.
Public Hospital
These hospitals are owned and managed by government e) Health Education
and/or autonomous bodies e.g. Civil Hospital, Sargodha, Health education means providing information to the
Pakistan Institute of Medical Sciences, National Institute of people to change their behavior in the positive direction.
This is the most neglected service, though most important
Child Health etc.
one. This is the most effective way of preventing disease
Private Hospital and promoting health in the community when a patient and
his attendants seek care, they are very receptive to the
Owned by private people or entrepreneur, can be further
information about the problem. Useful information can be
classified into. provided through well baby clinic, asthma clinic, diabetes
a) Commercial centre and vaccination canter, etc.
b) Non-profit
Hospital Administration 5
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 j) Physiotherapy
and inpatient care. This is an important service and sufficient trained man
Outpatient: The focus of attention in hospital has gradually power should be there to deal with patients with chronic
shifted from the inpatient to the outdoor, i.e. the OPD’s. diseases such as CVA(cerebrovascular accidents).
The diagnostic procedures which previously required
hospitaliza- tion have become outpatient facilities and can k) Ambulance Services
be performed there. This is also one of the major means of
An effective ambulance service is a part and parcel of
keeping the patients out of the hospital. As outpatients are
hospital services to deal with emergency problem and
the first point of contact between the patients and the
hence provision of timely care.
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. l) Laboratory Services
Filter Clinics are mandatory for outpatients departments; An efficient laboratory’s with all necessary reagent and
now these are clinics where bulk of patients are seen and effective blood transfusion service, is a prerequisite of good
those requiring special consultation are referred to the con- functioning hospital.
sultants’ clinics.
Inpatient services: Previously the role of hospital was m) Social Medical Services
con- fined to inpatient department only. All the inpatient This is another neglected service. An effective social
depart- ments should be in one block with free medi- cal service will help in preventing the disease,
communication with the supplies. The nursing station promoting the health in the community and thus preventing
should be rightly placed and sufficient numbers of nurses the load on hospital services.
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 n) Medical Record Keeping
unit. The ward could be divided into 2 rooms with capacity It is also a very important component of health services.
of 10 beds each, or rooms with single, double or four bed No effective planning can be done if the record keeping is
capacity. In all cases, adequate floor space per patient is poor. This is one of the reasons why health conditions of
needed to prevent cross infection. There should be the communities have not improved.
adequate toilet facilities.
g) Accident & Emergency o) Others
The support services provided by hospitals include;
Services
This is an important component of hospital services. Hos- • House Keeping
pitals should be well equipped and staff should be properly • Kitchen
trained to meet the emergencies. • Medical Store
h) Disaster Management • Laundry
This is another component of health services. Though di-
• Library
sasters are rare events, every hospital should have a
disaster management protocol, for the various types of • Security
disasters, and staff should always be prepared through
regular mock exer- cises to deal with such situations. Factors Affecting Distribution
Types of disasters depend on the catchment region of the
hospital, for example, a hos- pital in Baluchistan could of Beds
prepare a earthquake management protocol, whereas an
hospital in the Punjab plains would lay more emphasis on A hospital administrator has always to face the problem
management of flood affected morbidity, and in NWFP, for of scarcity of beds as complained by various heads of
a sudden influx of refugees. depart- ment. He should be well aware of the technique of
justifica- tion of distribution of beds for the various
i) Geriatric Services departments of hospitals. Some of the factors effecting the
Census in 1998 shows a significant increase in the distribution of beds are as under and they should always
geriatric population. Currently more that 1.5 million people be considered before allocation of beds.
are found in 75 years + group and more will be added
during the next decade. Special arrangements should also • Type of Hospital.
be there to deal • Availability of Resources
6 Hospital Administration

• Prevalence / incidence of diseases

2. Average Length of Stay (ALOS)
• Accident and injury
It is calculated by summing the bed days occupied by
• Male / Female ratio
patients for a particular month and then dividing this figure
• Level of Expertise
by separation.
• Intensive Care Problems
Separation may be defined as bed available due to the
• Community Program (Pressure)
following reasons:
• Premises / wards / theatre / kitchen
• Deaths
• Financial Resources
• Discharges
• Statistical Figure
• Transfers
■ Average Length of Stay
■ Turn over period
Example:
In a particular unit average bed days’ occupancy (ABO)
■ % Bed occupancy
by patients of a particular month was 900 while separation
■ Throughput
was
60. Work out ALOS.
Hospital Utilization And ALOS = Separation ABO
60
= 900 = 15
Statistics
3. Turn over period (TOP)
The term “hospital utilization” denotes the manner in It is the statistical test which provides you the information
which the community uses its hospital resources8.
about the difference between the BED DAYS AVAILABLE
Since the modern concepts of hospital include curative, and BED DAYS OCCUPIED during a month with respect to
preventive, promotive, educational, domiciliary, in patient
separation.
and ambulatory services, indices should be developed to
evaluate all these components. The best known indices are It is calculated as following:
only for the in patient care so we will discuss only the -
TOP = ABA (S) ABO
indices for in patient care.
Some of the common indices used by hospital
administrator to evaluate the in - patient care. Example:
A. Indices related to hospitals In a hospital ABA=600, ABO is 400, while separation is
Basically there are three indices related to inpatient care 35, calculate the TOP:
in hospitals. These are:
Bed Capacity (BC) which is defined as the average TOP = 600 35
- 400
= 5.7 Days
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 4. Throughput (THROP)
Occupancy (ABO), which is the proportion of beds which It is calculated by dividing Separation with ABA/DAY
are filled during a specified period. The indices given
below are derived from these basic values: Example:
• Bed occupancy rate (BOR) In a hospital separation was 50 during a month and avail-
• able no. of beds is 30/day. Calculate throughput.
Average length of stay (ALOS)
• Turn over period (TOP) Throughput = ABA
S DAY = 30 = 1.66
• Throughput (THROP)
50
1. Bed Occupancy Rate B. Indices related to
(BOR) Population at Risk
It is calculated by dividing ABO and ABA
Example:
In a hospital ABO is 600 and ABA is 800 calculate BOR. a) Admission rate
# # Also known as hospital frequentation rate “(Fh)”, is usually
BOR = ABO 100 = 600 100 = 75%
ABA 800 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 7
• Existence of proprietary hospital
Fh= AP# 1000 • Housing
• Morbidity
• Internal organization
b) Hospitalization rate per person (Hc)
This index represents the volume of hospitalization in terms
of number of hospitalization days per person per year.
Specialties in a Hospital
It is calculated by dividing the total number of A frequently asked question is, what specialties should
hospitalization days in a year “H” by the mean population be available at Teaching Hospital (Regional Hospital),
in that H
year “P”. District Hospital (DHO), Tehsil Hospital (THO), and Rural
HC = P Health Centre (RHC).
Following is the distribution of specialties.
c) Bed Occupancy Ratio
Bed occupancy ratio (Bc) is the average daily number of At Teaching Hospitals
persons hospitalized per unit of population. It is obtained by All specialties including subspecialties should be available.
dividing the average daily number of beds occupied “N” by
the mean population “P” in the same year.
#
At District Headquarter
BC = N 1000
P Hospital (DHQ)
• AtPhysician
least following specialistsOne
should be available.
Factors Influencing Hospital • Surgeon “
• Gynecologist “
Utilization • Pediatrician “
While evaluating the hospital services, a hospital
• Ophthalmologist “
adminis- trator must consider the various factors effecting
the hospital utilization. • E.N.T. Specialist “
• Dermatologist “
The manner in which a certain community utilizes the
hospital bed and the extent of such utilization are • Pathologist “
influenced by many factors that depend on the social, • Radiologist “
economic, edu- cational, and cultural characteristics of the • Anesthetist Two
people and on the attitudes and special habits of the
• Chest Physician
medical profession. With regard to the latter, it may be
presumed that the doctor orders or advise admission to a • Cardiologist One
hospital primarily for medical reasons; however, this is not • Orthopedic Surgeon “
always the case. Very often the people themselves • Urologist “
influence the decision for or against hos- pital admission.
• Psychiatrist “
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 At Tehsil Headquarter Hospital
sophisticated communities the hospital “habit” may be
such that a person may bring pressure to bear on the
(THQ)
attend- ing physician for admission to the hospital, even At least 10 specialties should be available which are also
though there may not be objective reasons for this course available to DHQ excluding Chest Physician, Cardiology,
of action. The main factors which affect hospital utilization Orthopedic, Urology and Psychiatry.
are as under; At Rural Health Center (RHC)
Medicine, Surgery, Gynecology and Obstetrics and
• Availability of Hospital beds prefer- ably pediatric facilities should be available.
• Methods of payment of hospital services
• Age of the population
• Services coverage & bed distribution
Administration
• Availability of extramural medical services Administration includes the following activities termed as
• Hospital bottle necks POSD CORB (Guillick).
• Medical custom and social patterns
• Supply of physician
• Research and training
8 Hospital Administration

Planning, organizing, staffing,

coordinating, reporting and budgeting.
directing,
Management
The term “hospital administration” covers a large number Management is an old process and has existed ever
of activities which may roughly be classified into three cat- since man has been organized into communities. It is
egories. sometimes thought to be a process of 20th Century but this
is not so. Where and whenever people have worked
• Preparation of hospital legislation, planning of the
together in-groups to grow crops, to buy and sell, to wage
hospital system as a whole, determination of
wars, to build a temple, there was management.
international policy, regulation for the operation of
hospitals, establishment of architectural control and The most comprehensive way to define management is:
standards.
Management is a key process. The function of
• Application of hospital legislation and of social assis- management is to enable our patient/doctor/nurse team to
tance provision by the authorities responsible for the do their job as easily, efficiently, economically, effectively
management of hospital services whether they be local and as humanly as possible so that they can develop and
or regional, public or private. maintain a caring environment within the Hospital. OR
• Daily running of the hospital by the administrative staff
It is the process of organizing, using and controlling
concerned with personnel, finance accounts and
human activities and other resources towards special end9;
techni- cal services.
OR
Role Profile of Management is a process whereby resources in term of
Administrator
• Ability to see ahead and plan accordingly: planning for
the future while managing the present.
people, finances, equipment and facilities are mobilized,
ide- ally in an efficient and effective manner to serve the
• Ability to produce and accept new and creative ideas, purposes of an institution.
being an agent of change.
Resources are;
• Willingness to take risks to get the new ideas accepted
and implemented. Men
• Ability to co-ordinate, bringing about harmony, Money
collabora- tion, organizing, allocating resources and Materials
controlling. Machinery
• Ability to analyze, synthesize and integrate diverse Methods
infor- mation.
Principles of
• Sense of equity, fairness and social justice, in all
dealings within and outside the hospital. Management
• Knowledge, skills and experience. • The
Unity of Command
major principles are:
• Ability to delegate, making effective use of own time • Span of Control
and that of others. • Homogenous Assignment
• Good personal motivation and ability to motivate the • Delegation of Authority
people working in the hospital.
• Ability to review and evaluate, making adjustments as Functions of Management
necessary. The main functions of management include the following:
Role of Administrators • Planning
The Administrator reports to the Governing Body (or • Organizing
other higher authority such as Director of Health Services,
• Staffing
Secre- tary to Government, etc).
• Leading
• Controlling
Persons Reporting Directly to
Administrator Planning
• Medical Superintendent
Planning involves selecting the mission, goals, objectives
• Nursing Superintendent
and actions required. It is defined as setting objectives,
• Associate Assistant Administrators
deter- mining resources and selecting courses and
• Coordinator, Community Health Programs
requires decision making i.e. choosing future courses of
• Principal, School of Nursing, where there is a school of action from among alternatives. It can be defined as
Nursing.
“deciding what is to be done and how it is to be done”.
Planning must aim at the fulfillment
Hospital Administration 9
of the hospital’s role in terms of the appropriateness, Recruitment and Selection
quality, quantity and cost of the health care provided.
The aim of recruitment is to ensure that the organization’s
demand for manpower is met by attracting potential
Organizing employ- ees in a cost-effective and timely manner.
This includes the identification and classification of the Steps in
required activities. The activities are then grouped together
Recruitment
and each group of activities is assigned to a manager,
through the process of delegation both horizontally, among Job Analysis
the dif- ferent managers on the same level, and vertically It has
Job two components;
specification
from the superiors to subordinates. It is a summary of the knowledge, skills and personal
char- acteristics required of the job holder to carry out the
This is that part of Management that involves establishing job to an acceptable standard of performance.
an international roles for the people.
Staffing Job description
This involves filling and keeping filled the positions in the The job description describes information about the job
concerned viz title of job, overall purpose of the job,
organizational structure.
principle responsibilities, location of job, grade/salary level
of job etc.
Leading/Directing
This is influencing people, so that they will contribute to The purpose of job description is to define exactly for a
worker, fellow worker and supervisor:-
the organization and group goals in an effective manner. • How much is his authority?
• What is his responsibility?
Controlling • What the worker is expected to do?
This is the measuring and correcting the activities of the • What standards he is expected to reach?
subordinates in order to ensure that the events conform to • To whom he is responsible?
the plans. • Whose work he supervises?
All the above activities need to be backed up by the Job description helps each worker to know clearly and
process of coordination by the manager/administrator at all with- out doubt what his duties are and what he is
levels.
Elements of expected to do. Such job descriptions should be
interpreted flexibly, as per guidelines.
Management
Attracting the Application
[Link]
Personal Management
following are elements of management. By advertisement
B. Financial management The aim of job advertisement is to attract sufficient
C. Material Management numbers of the right kind of candidates. It should include
D. Time Management details about the position of the job, employing
organization, candidate requirements-essential/desirable,
A. Personal Management the salary indicator etc.
Evaluating Applicants
The function of caring for staff in the organization is It is a process of scrutiny of the applicant for their
known as “Personnel management”. In the hospital qualification and experience for the required post.
services with very few specialists, the effective
management of staff lies on the shoulders of departmental Selection
heads. The aim of selection is to identify applicants most likely to
fulfill the requirements of the organization. The initial selec-
Steps of Personal Management tion of candidates on the basis of their application form is
• Human Resources Planning called short-listing.
• Recruitment and Selection
Placement and Development
Human Resource Planning After selection of personnel a very important task for the
This is information decision making process designed to management is assigning proper duties and responsibilities
according to the skills and qualification of the person.
ensure that enough competent people and appropriate
skills are available to perform jobs where and when
needed.
10 Hospital Administration

B. Financial Management discuss it with the managers and if manager fails to satisfy
them, an audit objection is submitted to Public Accounts
Financial management is one of the very important tasks of Committee.
management and deals with how to spend money and get
maximum benefit for the organization.
C. Material Management
It is the planning, purchasing and maintaining of different
Budget items used in the hospitals. The job of a hospital
“Budget is formal financial statements of policies, plans administra- tor is to ensure;
and goals that are designed to assure that actions are
“The supply of right thing at the right place, at the right
taken within boundaries laid down by top management”.10 time and at right cost”11.
OR It involves:-
“It is numerical statements of program showing the pro- • Correct planning
posed or estimated schedule of expenditure in coming
years keeping in view the estimated income of next year”. • Sticking to time needs
• Correct purchasing procedures
Budget may be;
• Standardization
Developmental • Stock control tools
This part of budget used for a new process of
• Documentation for audit
expenditure usually for a limited period usually prepared
according to annual developmental program and called D. Time Management
Annual Develop- mental Budget.
Time is one of the most important resources. Time is like
Non Developmental (Recurrent) central nervous system i.e. it cannot be regenerated once
This is that part of budget which an organization needs destroyed or wasted.
for its non-developmental activities. e.g., Hospital administrator should be able to control and use-
• Salaries fully consume the time of his subordinates for the welfare of
• Travelling the patients.
• Other daily expenditure e.g., bills This can be done by making correct duty rosters for the
organizations and see to it that everything is done
Monitoring of Budget according to schedule.
Monitoring means keeping an eye on expenditure of The management of time is an issue, which is
budget to see if expenses are according to the schedule or fundamental to job performance.
not, and to avoid inappropriate use of funds.
Tools for The Scalar Principle
Monitoring
This implies delegation of authority to the various staff
• Monthly statements members in responsible positions. The principle is
• Excess statements applicable not only in hospital administration but also in
• Accounting other areas of Health Sector. The power to execute the
• Auditing functions may be in the context of financial requirements,
Auditing but also in connection with leave sanctions, disciplinary
This is an analysis of proposed or past expenditure with action and job performance as well as complaints.
respect not only to their legality but also to their desirability. If an Administrator or a Director has to be approached by
This is of 2 types. a lower sanctioning officer, he should follow a series of
steps, as for example: If the Resident MO has to approach
Pre Audit the Direc- tor, he is required to go through the scale, while
Audit taking place prior to payment. the reverse, Director to Summon the residents he is also
required to fol- low the channel down the scale. However
Post Audit this depends on the nature of event. In an emergency, the
Audit done after payment has been made. resident may have to establish contact with the director
without going through the ladder. Likewise the director
Audit Objection may, depending upon the circumstances, call for a lower
If the auditors are not satisfied with any transactions, they ranking staff member directly
Hospital Administration 11
without following the channel. This principle equally holds
good in financial sanctions and other areas.

References
1. 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 Park’s text book of preventive and social medicine 20 th ed.
Jabalpur, Banarsidas Bhanot. 2009
5. [Link]
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.
Nosocomial Infection 9. Rhea JC, Ott JS, Shafritz JM. The dictionary of health care
management. New York. Facts On File. 1988
Nosocomial infections, i.e. infections acquired by patients 10. Doty P , Liu K , Wiener J .. An over of long - term care Health Care
Financing Review. 1985; 6(3): 69 - 78 .
in the hospital have become more of a problem in human [Link]/cgi/content/refs/30/2/143
medicine, because of increase in drug-resistant microbial 11. Sand R, Parnell RW. Ed. The Advance to Social Medicine; Eng.
strains as well as increases in the use of invasive trans. by Rita Bradshaw. New York-London: Staples Press, 1952.
procedures for patient support and monitoring. Nosocomial 655 pp. [Link]
infections are also expected to become a more serious
problem in veterinary medicine for similar reasons.
The exact prevalence of the nosocomial infections is not
known, but there are reasons to believe that this is a sig-
nificant 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
Index
tract infections, surgical wound infections, lower respiratory
and blood stream infections in varying degrees.
A
The mode of infection is either through direct contact or
through fomites. Vehicular transmission through food, water Accident & Emergency Services 5
and vectors has also been noted. The hospital Administration 7
administration has the responsibility of hand washing Persons Reporting Directly to Administrator 8
provision for the hos- pital staff of all categories and the Role Profile of Administrator 8
patients and maintenance of sanitary standards at all Ambulance Services 5
levels, as preventive measures. Auditing 10
Average Bed Availability 6
Acknowledgment Average Bed Occupancy 6
Part of this chapter has been taken from the previous Average length of stay 6
chapter 4th ed. written by A Sattar Tabani, Aamir Waseem Average Length of Stay (ALOS) 6
Khan, Sabiha Khurshid Ahmed, Aamir Omair. For this we
are thankful to authors. 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

C M
CRITICISM AGAINST HOSPITAL 2 Management 8
Curative Care 5 Controlling 9
Elements of Management 9
D Financial Management 10
Disaster Management 5 Function of Management 8
District Hospitals 4 Human Resource Planning 9
Domiciliary Service 4 Job description 9
Job specification 9
F Leading/Directing 9
Material Management 10
Factors Affecting Distribution of Beds 5 Organizing 9
Factors Responsible for Development Of Hospitals 3 Personal Management 9
Factors Responsible For Development Of Hospitals Planning 8
Advances in Medical Education 3 Principles of Management 8
Advances in Medical Sciences 3 Recruitment and Selection 9
Contribution by Industrialist 3 Staffing 9
Development of Professional Nursing 3 Time Management 10
Development of Technological Sophistication and Specializa- Medical Record Keeping 5
tion 3
Role of Government 3 N
Support by Health Insurance 3
Financial Management 10 Nosocomial Infection 11
Budget 10 P
G Physiotherapy 5
General hospital 4 Preventive & Promotive Care 4
Geriatric Services 5 Private Hospital 4
Public Hospital 4
H
R
Health Education 4
History Of Hospital Development 2 Regional/Teaching hospital 4
Hospital Administration 2 Research 4
Definition 2 Rural Hospital 4
Hospital Administration and Management 1 S
Hospitals 2
Administration 7 Scalar Principle 10 Social
Classification of Hospitals 3 Medical Services 5
Factors Influencing Hospital Utilization 7 Special hospitals 4
Functions of Hospitals 4 Specialties in a Hospital
Hospital Utilization and Statistics 6 At Teaching Hospitals 7
Management 8 At Tehsil Headquarter Hospital 7
oldest hospital 3
Specialties in a Hospital 7 T
Hospital without beds 2 Throughput 6
I Throughput (THROP) 6
Training 4
Indices related to hospitals 6 Turn over period 6
Indices related to Population at Risk 6 Turn over period (TOP) 6
Admission rate 6
Bed Occupancy Ratio 7
Hospitalization rate per person 7

L
Laboratory Services 5

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