ORGANIZATION AND MANAGEMENT OF A HEALTH CARE FACILITY
Hospitals are complex business structures in addition to complex medical organizations. The structure of the hospitals is very important to ensure that all departments are properly supervised and functioning.
Hospitals are sorted by bed count and on average a medium size hospital contains an inpatient unit of approximately 200 beds . Regardless of bed size all hospitals need certain departments functioning to be able to provide services and meet the overriding regulations that are required. The following organizational chart serves most hospitals well. Of course, larger hospitals may find that the departments need to be separated further and other managers and directors appointed.
The Administration Department includes the CEO, Vice Presidents, Accounting, Foundations, and all those departments that are concerned with the business side of the hospitals. Traditionally the qualifications do not require a medical degree although in some hospitals Doctors and Nursing assume administrative roles.
Hospital Information Services are centered on the patient information system. They are used by the patient accounting and patient medical records departments. Also the floors will use the information contained in the hospital information system to provide the patient medical care. The information system crosses over between the medical and business record keeping functions and is at the core of the services of the hospital. Human Resources are a part of this department and it works well to provide for proper certifications and qualifications for the medical personnel.
Therapeutic services are provided by a skilled team of health care professionals under the supervision of a licensed physician. Therapeutic services are comprised of rehabilitation, including ambulatory and cardiac, physical, speech, audiology therapy, and other services organized under the AVG payment methodology to bring the patient back to full functioning after a medical setback. The Therapeutic Department also offers the supervision of the Pharmacy and Nursing services. In larger hospitals these two services are separate departments.
Diagnostic Services include the outpatient and inpatient services that aid the healthcare professional to appropriately determine the physical ailments. The blood laboratories, X ray, and all other services used to help determine physical conditions are administered under this department. These services are also used in the inpatient and outpatient settings. Emergency Room services are administered from this division unless the hospital is larger and needs a separate division as the services are unique to the nature of the services.
Support Services are necessary and ancillary services to the running of the organization. Cleaning and maintenance is extremely important in the hospital industry. Nutrition includes a dietary program for all inpatients and onsite cafeterias for our patients and visitors. Central Supply provides all linens and vital materials for each floor in the inpatient side and all the materials except for the pharmaceutical supplies for the entire hospital.
(Alzona, 2012)
Mission and Value Statement for a Hospital
The mission of a hospital is to advance the health care needs of a community. High quality, professional health care services are available to all in the particular area. Beyond providing quality care, health care education of the community to help them achieve the best information possible to advance medicine for the future.
The mission statement supports the reasons for the hospital to be in service to the community that is to provide its residence with the needed medical professionals and treatments to maintain a healthy community. The role of providing the best services that a hospital can support takes many different members and services.
Many mission statements are more elaborate as the one from St Michael's Hospital in Ontario. In their mission statement that stresses the fact that each individual is deserving of exemplary care . That is assumed to be the case for every health care facility stated or implied. St Michael's makes a commitment to the community in their mission statement as the advance the health care needs of the poor along with all the community and create an environment that each person is valued. While not saying much about the actual physical needs the well being of each member of the community is important. This makes the mission of the hospital a social mission. The staff and all members of the hospital system realizes that the person matters so that in the hospital space the community members feel safe and well cared for.
Feasibility Study
A well staffed hospital has the appropriate number of nurses and licensed medical doctors to the number of patients. On the inpatient side the number of beds is used as the parameter to staff the facility. The formula is
Figure 1 Formula for ratio of beds to nurses
Nursing staffing varies though per level of care of the unit. For example, the Intensive Care Unit requires higher staffing than the Cardiac Care Unit. So in this hospital there are a total of 200 beds, with 10 in the intensive care unit. The formula itself has issues in that even though the hospital has 190 beds open for 24 hour care not all beds are occupied for 24 hours as some are for outpatient surgeries. But as a rule of thumb there is one nurse for every five patients. Most hospitals are structured with a team approach so that the nurses generally work in teams of three nurses for 15 patients. Depending on the discharge and admission policy then the team may have only ten patients but not usually more than fifteen.
For physicians and other than nursing care the ratio take into account the size of the community, the acuity level for the area, and the number of beds available in the community. Acuity level is important because some areas are inherently "sicker" such as areas with a high industrial community base. A high elderly population may use many hospital beds but the acuity or severity of the illness are not as high in that the elderly are more maintenance illness. So the number of doctors per day is not a complete view of the needs of the hospital.
The best way to take the acuity level and population into account for physicians is the following formula:
(PSA population x market share) / (1 – out-of-area draw)
or (200,000 x 0.5) / (1 – 0.2)
Figure 2 Physician Staffing Formula
In this formula, the population in this area is 200,000 residents and the hospital has a 50% market share and there is a 20% draw from the areas outside of the community. In this example the population if 200,000 the hospital has an effective service population of 200,000 x 0.06/ (1-0.25)=160,000 but in the specialties such as cardiac surgery the effective service population is smaller. So the formula would entail this difference, 200,000 x 0.04/(1-0.2) = 100,000 in general surgery.
Higher doctor numbers are usually associated with better patient outcomes. So simply put for every 1000 patient days there are three doctors. Teaching hospitals have different ratios. The number of doctors attending to patients is lowered due to the time that is involved in the teaching of the unlicensed health professionals.
Information Technology Services
Hospital Information systems include the hardware and software to effectively support clinical and accounting solutions. The information systems includes so much information that it is overwhelming that the data concerning the patients health care is the first and foremost priority of the system
With that concept in mind the Information Technology can be contoured to handle the long term of sustainability in the health care systems. Clinical education and leadership training is an integral part of the regulatory and accreditation reports that are necessary but in the past had been man-hour intensive. Another positive attribute of hospital information technology is that with the intensive amount of patient data that is accumulated on the information systems accurate facility and assets planning are achievable with pertinent data. The state of the art information systems can accommodate the diagnostic testing procedures. Financially by accurately preparing the correct assignment of DRGs and AVGs the hospital reimbursement is maximized and in the patient services the billing is done on a routine and payer sensitive time table.
Data security is of the utmost concern in hospital information systems. Backup and cloud storage scenarios are established along with a mirror image drives on an offsite location. This is important so that no breaches or the loss of data due to acts of nature are prevented as much as possible.
HIPA (Health Information Privacy Act) has certain privacy rules that govern who can use the hospital data. Since the information system contains sensitive information any unauthorized access can mean hefty fines along with a violation of patient confidence. A HIPAA breach was detected in Tennessee in 2014 and the theft included the identifying information of 4.5 million people . The institution of tight cyber security measures have been instituted since this attack, hospitals realized that they were vulnerable to attack.
References
Alzona, E. (2012). Business, Health, Medicine. Retrieved from Slide Share: [online]http://www.slideshare.net/ealzona/organizational-structure-ofahospital-13374694. Accessed February 2016
Cann, M. (2010). Medical Staffin Formulas. [online] www.managedcaredigest.com/DigitalDigests/2012html/page13.html. Accessed February 2016.
Dunn, L. (2012). 50 Things to Know about a Hospital. Becker's Hospital Review, [online]http://www.beckershospitalreview.com/hospital-management-administration/50-things-to-know-about-the-hospital-industry.html. Accessed February 2016.
Harper, C. (2009). Hospital Mission Statements. Retrieved from missionstatements.com: [online] http://www.missionstatements.com/hospital_mission_statements.html. Accessed Februay 2016
Knippa, P. (2014). What Healthcare Can Leanr fron CHS Data Breach. Healthcare Security and Privacy, pp. [online] http://www.informationweek.com/healthcare/security-and-privacy/what-healthcare-can-learn-from-chs-data-breach/a/d-id/1317696. Accessed February 2016.
Spetz, J. (2008). How many Nurses per Patient? Health Services Research , [online] doi: 10.1111/j.1475-6773.2008.00850.x. Accessed February 2016.
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