Hospital administration role in quality patient care

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INTRODUCTION
1. Health administration or healthcare administration is the field relating to
leadership, management and administration of public health systems, health care
systems, hospitals, and hospital networks. Health care administrators are
considered health care professionals.
2. Hospital Administration describes the leadership and general
“administration” of hospitals, hospital networks, and/or a health care systems. In
international use, the term refers to “management” at all levels. In the United
States, management of a single institution (e.g. a hospital) is also referred to as
"medical and health services management", "healthcare management", or
"health administration".
3. Hospital administration ensures that specific outcomes are attained, that
departments of different health services are running smoothly, that the right
people are in the right jobs, that people know what is expected of them, that
resources are used efficiently and that all departments are working towards a
common goal. A common goal to provide quality patient care.
AIM
4. The aim of this paper to impart knowledge on Hospital Administration Role
in Quality Patient Care.
SCOPE
5. The topic will be unfolded on the following sequences:
a. Hospital & Its Organization
b. Hospital Administration
c. Elements of Hospital Administration
d. Quality Patient Care
e. Management
f. Policy & Consideration
g. Administrative Responsibility

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HOSPITAL
6. Hospital is a place for the diagnosis and treatment of human ills and
restoration of health and well-beings of those temporarily deprived of these.
7. Professionally & technically skilled people apply their knowledge and skill
with the help of complicated equipment and appliances - to provide quality care
for the patient.
8. Hospital is a combination of many processes. To the community it is a
place to receive medical care to the physician it is a place to treat patients to the
employees it is a place to work and to the hospital manager it is a multifaceted
organization.
ORGANIZATION
9. A hospital is a multifaceted organization comprising many committees,
departments, types of personnel, and services. It requires highly trained
employees, efficient systems and controls, necessary supplies, adequate
equipment and facilities, and of course, physicians and patients.
10. It is a business as well as a caring, people-oriented institution and it has a
similar structure and hierarchy of authority as any large business.
11. The "board of trustees," or governing board, operates the hospital in trust
for the community and has a fiduciary duty to protect the assets of the hospital
through efficient operation.
12. The trustees are responsible for establishing the hospital's mission and
establishing its bylaws and strategic policies. Trustees select the administrative
leader of the hospital and delegate the hospital's daily operations and budgeting
to the appointed executive.
13. The chief executive officer (CEO) reports to the governing board and
provides leadership in implementing the strategic goals and decisions set by the
Board.
14. The CEO also represents the hospital to the external environment and the
community. In these tasks, the CEO must coordinate the collective effort of the
hospital's personnel.
HOSPITAL ADMINISTRATION

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15. Sound administration is essential for the success of any public health
program whether on the national, intermediate or the local level.
16. We can define sound administration as “ The process of achieving defined
goals at a defined time through the guidance, leadership, and control of the
efforts of a group of individuals and the efficient utilization of non-human
resources bearing in mind adequacy, speed, and economy to the utmost possible
level.”
17. “Administration is the art and science of guidance, leadership, and control
of the efforts of a group of individuals towards some common goal.” A common
goal to “Quality Patient Care”
QUALITY PATIENT CARE
18. “The degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with
current professional knowledge.”
19. Some of the issues that need to be addressed to improve patient care are
listed below.
a. Access. Accessibility and availability of both the hospital and the
physician should be assured to all those who require health care.
b. Waiting. Waiting times for all services should be minimized. In most
developing countries, the high demand for services often makes this
a huge problem. Nevertheless, it has to be addressed effectively
through continual review of patient responses and other data and
using this feedback to make the necessary changes in systems.
c. Information. Patient information and instruction about all
procedures, both medical and administrative, should be made very
clear. Well trained patient counsellors form an effective link between
the patient
and the hospital staff and make the patient's experience better and
the physicians' task much easier.
d. Administration. Check-in and check-out procedures should be

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‘patient friendly’. For example, for in-patients, we have instituted a
system of discharging patients in their rooms, eliminating the need
for the patient or the family to go to another office or counter in
the hospital and waiting there for a long time. This has been
favourably received by patients.
e. Communication. Communicating with the patient and the family
about possible delays is a factor that can avoid a lot of frustration
and anxiety. The creation of a special ‘Patient Care Department’ with
a full time Administrator has helped our institution significantly and
has enhanced our interactions with patients and their families.
f. Ancillary Services. Other services such as communication, food, etc.
should be accessible both to patients and to attending families.
ADMINISTRATIVE ELEMENTS
20. The basic elements of administration are as follows:
a. Planning
b. Organization
c. Staffing
d. Directing
e. Coordinating
f. Reporting
g. Budgeting
h. Supervising
i. Evaluation

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21. Planning needs knowledge, experience, foresight, reasoning and the
mastering of special skills and techniques. Its must be
a) Futuristic
b) Decision Making Process
c) Dynamic
d) Flexible
22. The Organizational process is classified into:
a) Structural organization
b) Functional organization
& there must be a good co-ordination.
23. Staffing is the process of “personalizing” the organization, by hiring
the right type and adequate number of workers to each unit for the time
required through the following steps:
a) Identifying the type and number of personnel
b) Recruitment
c) Selection and appointment
d) Orientation
23. Budgeting is the financial administration. About 60 percent of total
budget is spent in wages & salaries of the staff in a hospital. reviews will be
needed to allow ideal budget
a) Population changes

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b) Input price inflation
c) Technological advances
d) Relative needs of population
e) System efficiencies
24. Regular Auditing process seeks to identify areas for service improvement,
develop & carry out action plans to rectify or improve service provision and then
to re-audit to ensure that these changes have an effect. Clinical audit can be
described as a cycle or a spiral, see figure. Within the cycle there are stages that
follow the systematic process of: establishing best practice; measuring against
criteria; taking action to improve care; and monitoring to sustain improvement. As
the process continues, each cycle aspires to a higher level of quality.
25. Purchasing of modern equipments and maintaining. To maintain
compliance, hospital administrators must overhaul old medical equipment
maintenance plans, compile full inventories, follow manufacturer maintenance

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recommendations to the letter, identify high-risk equipment, revise policies and
procedures and closely monitor the credentials of those who maintain the
equipment. Hospital administrator must:
a) Maintain an inventory of all medical equipment used in their facilities,
regardless of ownership. Because many hospitals use equipment owned
by physicians, loaned or rented, this will likely increase hospital
inventories significantly.
b) Follow medical equipment manufacturer recommendations regarding
maintenance procedures and frequency, particularly if the equipment is
diagnostic or therapeutic radiologic, laser oriented.
c) Obtain actual manufacturers' maintenance recommendations for all
medical equipment, rather than relying upon general industry guidelines
and practices for their equipment maintenance methods.
d) Identify critical or high-risk medical equipment in their inventory,
broadening the number of equipment categories for which 100 percent
compliance is expected.
e) Maintain and monitor the credentials of all individuals providing
maintenance on medical equipment, including in-house staff, vendors and
manufacturers' staff, as well as all those overseeing the hospital's medical
equipment maintenance program.
26. Supervision of both work & workers by the Executive. The focus of the
hospital administration and management is to assure that the facility is running
efficiently and in compliance within the realm of hospital policies and state
regulations. The stress, hours, and workload associated with hospital
administration fluctuate depending upon the issues of the day. However, the day-
to-day operations of the facility are crucial to its success. The administrative team
must stay focused on the delivery of state-of-the-art healthcare while looking to
improve future technology at the facility.
27. Evaluation of activities, characteristics, outcome of the health care
process to improve effectiveness & make decision for efficient planning.
LEVELS OF ADMINISTRATION

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28. There are 03 levels of providing health care.
a) Central level. e.g. Ministry of Health
b) Intermediate level. e.g. Directorates of Health
c) Local level. e.g. Health office, Hospital, Health care unit
ADMINISTRATION STRUCTURE

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ADMINISTRATOR
29. By virtue of serving a healthcare organization the hospital administrator
performs some specific roles which are described below. The hospital
administrator ensures that hospital runs effectively and efficiently. The role of
hospital administrator varies, depending upon the nature and complexity of
hospital. Various roles can be grouped as role towards patients, towards hospital
organization, towards community.
a) Role towards patient :
The hospital administrator has a great responsibility to understand and
appreciate the emotional aspects of the patient care, his responsibility
is to understand the specific needs of certain groups of patients, i.e.
patients on wheelchairs, stretchers, geriatric group of patients,
pediatric patients, neonates, serious cases, foreign nationals etc. some
of the aspects of patients are given below:
i. Creation of friendly environment
ii. Understanding patient’s physical needs
iii. Patient’s emotional needs
iv. Patient’s clinical needs

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v. Patient’s satisfaction
vi. Patient’s education
b) Role towards hospital organization:
To handle the hospital resources for maximizing the output is one of
the fundamental roles of the administrator. The role of administrator is
more of coordination in nature instead of controlling, he is coordinating
officer.
THE MEDICAL STAFF
30. The physician is the leader of the clinical team and the major agent
working on behalf of the patient. The physician's responsibility is to diagnose the
patient's condition accurately and to prescribe the best and most cost-effective
treatment plan.
NURSING SERVICE
31. Nurses are one of the few blessings of being. Nursing services employees
are responsible for carrying out the treatment plan developed by the physician.
Nursing services, also called patient care services, is the largest component of
the hospital.
CLINICAL SUPPORT SERVICE
32. The hospital pharmacy purchases and dispenses all the medications used
to treat patients in the hospital. The pharmacist works directly with the medical
staff in establishing a formulary, the listing of drugs chosen to be included in the
pharmacy.
LINE SERVICE
32. Emergency services to diagnosis & treatment of illness of an urgent nature
& injuries from accidents. Out-Patient services for provision of diagnostic,
curative, preventive and rehabilitative services. In-patient services (Wards).
Intensive care unit fort those who need acute, multidisciplinary and intensive
observation and treatment. Operation theatres should have a pre-anaesthesia
room and sterilization room and a scrub room for doctors and nurses.

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PUBLIC AREA(ENTRANCE ZONE)
33. Public area should have following criteria:
a) Entrance wide ramps and steps
b) Modernized reception and information system
c) Registration counter
d) Drinking water
e) Toilet and washroom
f) Snack bar
g) Porter service
h) Waiting area (0.1sq mt/patient visited)
CLINICAL AREA
34. To provide complete health care an administrator should consider about
followings:
a) Different OPDs
b) Sub waiting area
c) Consultation room
d) Special exam room
e) Specialist room
ANCILLARY AREA
35. Administrator should supervise following areas:
a) Injection room
b) Dressing room
c) Family planning immunization
d) Pharmacy
AXILLARY AREA
36. For effective and quick patient care providing following area should well
functional, up to date and have enough manpower.
a) Central collection

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b) X-ray/Ultra-sound
c) ECG room
d) Health education and counseling
e) Physiotherapy
f) Medical social worker
g) Diet counseling and nutrition
CIRCULATION AREA
37. It should be 30 percent of total hospital area.
a) Stairs, lifts and ramps
b) Corridors (1.8M wide)
c) Security guard
d) Telephone
EQUIPMENTS
38. Hospital administrator should make sure of the following equipments are
in good number and well condition.
a) Trolleys and wheel chairs
b) PA system
c) Porters
d) Examination equipments
e) Television in waiting area
f) Wall clock
g) Furnished consultation room
HOSPITAL MANAGEMENT SYSTEM
39. Hospital management is the operational part of administration. It can
define as:
“Hospital Management is a continuing and dynamic application of
managerial functions for providing comprehensive health care to the
community ”
40. In countries with large population to ensure the most cost-effective means
of improving delivery of service hospital management system should be up to
date and managers are functioning efficiently & effective.

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41. Hospital healthcare managers juggle several responsibilities. They plan,
direct, and coordinate other practitioners, departments, and groups. Because of
the diversity of the role, healthcare managers must have strong skills in:
a) Communication, problem solving, and decision-making
b) Collaborating with other disciplines
c) Personnel or Talent development
d) Budgeting and finance
42. Managers can improve healthcare delivery by operating hospitals that
deliver reliable, adaptable services. Importantly, managers must not only
understand but also be able to coordinate and direct the following forces
impacting innovation:
a) Employees such as doctors, insurance companies, technology
distributers, patient advocates etc. have personal interests in hospital
policy and operations. A manager's aim is to coordinate these groups and
guide them to focus on a common goal.
b) Funding innovation is important, and managers are needed to direct the
flow of funds from the various resources such as third-party investors,
long-term investors, and insurers to the appropriate areas.
c) Policy impacting innovation is in constant flux with new federal-wide
regulations requiring rigid compliance cascading throughout the
organization. Managers must not only be aware of policy updates, but they
must also be able to communicate them to staff and implement them in
the hospital.
d) Technology innovation requires managers to exercise solid timing skills
given that a hospital's infrastructure must be in place to adapt to new
technologies but technologies must also be adopted before any
competitive advantage in doing so is lost.
e) Patients invest financially and intellectually in their own healthcare;
empowered by the knowledge they can glean from the Internet pertaining
to their own circumstances. Innovative managers make it a point to
address the empowered patient's concerns, recognizing that savvy
patients are not complacent to just take the doctor's word at face value if
that conflicts with their existing knowledge.
f) Accountability impacts innovation in that managers have to in addition to
overseeing the areas listed above to demonstrate effectiveness, safety,

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and other regulatory principles to accrediting organizations.
POLICY AND GUIDELINES
43. Healthcare managers of all levels and specializations are critical to
guarantee a hospital functions in a competitive, effective, profitable and
satisfactory manner.
a) Sustained and continuity of high standard patient care
b) Modern technology and methods
c) Obtain total patient satisfaction
d) Highly motivated and trained, skilled hospital staff
e) Manual of procedures for hospital staff
f) Periodic training and review system
g) System of appointment
h) Morning and afternoon clinics
i) Proper singe system
ADMINISTRATIVE RESPONSIBILITIES
44. There's no doubt a hospital administrator's job is difficult and demanding,
and it's only getting tougher. As competition and expenses increase, hospital
executives must prepare administrators to effectively lead during a time of
transformational change in our healthcare system. Here are five challenges they
must overcome in order to successfully improve patient care while maintaining
fiscal responsibility.
a) Procedure manual of patient care at various areas of health care
b) Advisory responsibility, planning and budgeting
c) Nursing training and research in services
d) Recruitment, promotion and development of nursing staff
e) Staff meetings, monitoring and evaluation of service
f) Maintenance of discipline, reward and punishment
g) Welfare measures, residential accommodation, health promotion,
recreation and other utility service like canteen, bank etc.
CONCLUSION
45. History has shown a clear necessity for the healthcare administrator, and
the job itself requires a diverse set of job responsibilities. Through a variety of
healthcare systems, administrators lead and manage staff and work with
administrative personnel to assure the organization runs smoothly operationally,
legally, and professionally. Administrators work as either generalists (manage
entire facilities) or specialists (operate a specific department, such as human

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resources or accounting).
46. In the ever-changing field of healthcare role, such as the hospital care
administrator, have begun to take prominence in medical institution settings.
While some believe that any role in healthcare deals directly with medical
procedures or patient care, but the role of the hospital administration
encompasses a much wider range of duties and positions.
46. Regardless of the position or the tasks involved, the role of the hospital
administration is vital to the growth and success of a hospital to provide a quality
health care.
25 February 2016 CAPT.
SHAHARUL
Roster-52
REFERENCE
1. WWW.MEDSCAPE.COM

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2. WWW.BLOGSPOT.COM
3. WHO
4. Mike Freel, PhD, Director of Healthcare Programs, Bellevue University's
College of Arts and Sciences
5. Bowles, Roger "Techcareers: Biomedical Equipment Technicians" TSTC
Publishing
6. www.publichealthonline.org
7. https://en.wikipedia.org/wiki/Health_administration
8. www.hospitalmanagement.net
9. www medicinenet.com