HOSPITAL ADMINISTRATION

The 1998 edition of Hospital Statistics published by the

American Hospital Association reported that 6,021 hospitals
existed in the United States. These included acute care general
hospitals; federal, state, and local hospitals; psychiatric
hospitals; and specialty hospitals such as children's hospitals,
rehabilitation hospitals, and chronic disease hospitals. There
were 5,015 short-term, acute care general facilities. Short-term,
general hospitals are defined as those for which a patient stay
is thirty days or shorter and which provide general medical and
surgical care. General hospitals often provide additional
services including prevention, treatment, rehabilitation,
obstetrics, substance abuse, health education, and screening
for cancers and other diseases.
Modern hospitals derive historically from the monastic "hospes"
of tenth-century medieval England at which travelers stopped to
rest. Later, in the thirteenth century, the hospice became a
place for vagrants, invalids, and the infirm.
Benjamin Franklin founded the first hospital in the United
States, the Pennsylvania Hospital, which was chartered in
1757. Hospitals during this period provided refuge and homes
for the poor, ill, and infirm who had no other place to live.
Nineteenth- and early-twentieth-century hospitals in the United
States were primarily for the treatment of communicable
disease, such as tuberculosis or leprosy, for which people were
quarantined. Most people generally preferred to be treated for
acute illness at home. Before the discovery of germ theory, the
home was actually a healthier environment than the hospital.
Later, as scientific medical practice developed, hospitals
became more technical places of diagnosis and treatment for
those who could afford to be hospitalized and pay for the new
scientific technologies.
As a result of their increasing role in health care, hospitals
became important community resources. The community not-
for-profit hospital continued the role of providing charity care for
the poor. After World War II, the Hospital Survey and
Construction Act of 1946 (Hill-Burton Act) provided funding for
communities across the country to build not-for-profit
community hospitals and to modernize old ones. This legislation
was critical to locating hospitals in previously underserved rural
areas. Society has long viewed the hospital as a social service
organization. Public hospitals serve an important public
health function in caring for vulnerable and underserved
populations, including the poor, immigrants, and the uninsured.
TYPES OF HOSPITAL OWNERSHIP
Government hospitals at the federal, state, or local level
generally care for specified groups of individuals or diseases.
This includes the military, the mentally ill, or the uninsured,
among others. In addition, this includes educational or
academic hospitals where medical education is taught. Private
not-for-profit hospitals are usually owned by corporations, which
are founded by private organizations. For-profit or investor-
owned hospitals are those in which the shareholders receive
dividends or financial distributions based on the profits made by
the hospital or the hospital's corporation.
Regardless of ownership, most hospitals
are community hospitals, which provide care for a wide range of
acute episodes of illness. Acute episodes are serious short-term
illnesses for which patients require immediate care and are then
returned to their homes or community.
ORGANIZATION AND FUNCTION OF HOSPITALS
Hospital administration encompasses organizing and supporting
the patient's total medical care during an episode of illness in
the hospital, and is responsible for integrating the various
functions and services. 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. 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.
Board of Trustees. 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. 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. They ensure the quality of medical
care through the selection of qualified physicians and by
delegating quality assurance responsibilities to the medical
staff.
Executive Administration. The chief executive officer (CEO)
reports to the governing board and provides leadership in
implementing the strategic goals and decisions set by the
Board. 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. The
CEO delegates the clinical care and administrative duties to
highly trained individuals and teams.
The Medical Staff. 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.
The medical staff is a formally organized self-governing unit
within the hospital, primarily comprised of physicians, but may
also include other doctoral level health care professionals such
as dentists or psychologists. Responsibility for the quality of
medical care is exercised through the medical staff, whose
major purpose is to ensure the highest quality of medical care to
the patients. This is done through four functions: "Credentialing"
determines and assesses the qualifications of physicians
seeking to practice at the hospital. "Privileging" determines the
specific types of care that individual physicians will be allowed
to practice at the hospital. "Peer review" monitors how well a
physician is performing. "Reappointment" ascertains whether a
specific physician should be permitted to continue practicing at
the hospital.
Nursing Services. 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. It is also the largest health care
occupation in the United States. Nursing services provide
round-the-clock health maintenance, treatment, and support of
the patient. Important roles of nurses today also include those
of patient advocate and health educator.
Members of the nursing staff represent a wide range of training
and experience. A nurse manager has overall responsibility for
the care of patients on a particular unit, including supervising
other nursing and clerical staff, and for coordinating the services
of departments such as social work and discharge planning. A
nursing supervisor may have overall management responsibility
for several units. A clinical nurse-specialist has specific
expertise or competence in a particular field of nursing. These
nurses are helped by licensed practical nurses (LPNs) and
certified nurses aides (CNAs), who perform routine nursing
functions.
Allied Health Services. A number of departments perform
support functions that help with diagnosis and treatment. The
clinical laboratory is a diagnostic center that performs a variety
of functions, including autopsy, clinical cytology, and clinical
pathology. Medical technologists perform most of the work of
the laboratory under the supervision of a pathologist, who is a
physician.
The radiology department provides radiographs to aid with
diagnosis and performs radiation therapy for the treatment of
some medical disorders.
Rehabilitation services provides assistance in enhancing the
optimal physical, mental, and social functioning of the patient
following an episode of illness. Physical and occupational
therapy are the primary specialties in this service.
Clinical Support Services. 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. Clinical pharmacy consists of
communicating with patients, counseling patients and other
members of the health care team, and consulting with regard to
detailed drug information.
Social services integrates the patient, the medical team, and the
community. The primary objective is to ensure that all
environmental and emotional barriers to the patient's recovery
are mitigated. Social services helps coordinate needed
community-based services, and sometimes discharge planning.
Hospital dieticians play an important therapeutic role in
providing the patient with the appropriate food and nutrition,
consistent with the treatment plan prescribed by the physician.
Administrative Support Services. Nonmedical administrative
services are necessary to the hospital's business and physical
plant management. The CEO leads these administrative
services and is directly responsible for the day-to-day
operations of the facility.
Business services manages the hospital's admitting and
discharge functions, records charges to a patient's account, and
handles accounts receivables with third-party payers such as
insurance companies. The finance department advises the CEO
on financial policy and long-range planning, establishes
procedures for accounting functions, receives and deposits all
monies received by the hospital, and approves the payments of
salaries and other expenditures.
Accounting is central to the hospital's financial business.
Detailed and sound accounting practices are fundamental to
maintaining important organizational statistics for administrative
decision-making. The accounting department is responsible for
maintaining the general ledger and summarizing all the financial
transactions performed by the hospital, preparing and
dispensing the payroll, tracking and recording costs to enable
appropriate reimbursement for services from insurance
companies, and preparing the capital and operating budgets.
Admitting services is often where the patient first has contact
with the hospital. The sensitivity and efficiency of this
department can greatly influence the patient's perception of the
quality of care received.
Information services and medical record maintenance are core
functions of hospital management. Medical records have
recently been designated a source of revenue as they have a
direct bearing on reimbursement from insurance
companies. Medical records are maintained on all admitted
patients and they are indexed according to physician, disease,
and operation.
The human resources department interacts with all departments
in the hospital to ensure the quality and motivation of personnel
working at the hospital. Human resources performs job
analyses, develops job descriptions, and establishes
competitive compensation for specific positions, as well as
providing training to new employees and opportunities for
growth and self-actualization for all employees.
Other important administrative and business functions may
include marketing and planning, public relations, plant and
materials management, fund-raising, housekeeping, and
security.