Classification of Hospital

Classification of Hospital: Hospital is an institution of community health organization comprised of dedicated staff consisting of physicians, surgeons, and a team of technical staff. Hospitals can provide the facilities for the prevention, diagnosis, and treatment, rehabilitation as well as providing health education and research facilities. 

As per the WHO expert committee of 1963, Hospital is a residential establishment, which strives to provide short-term and long-term medical care facilities comprised of diagnostic, therapeutic, and rehabilitation services for the suspected patient who is suffering from disease or injury. Sometimes, such hospitals may or may not be able to provide the services for the ambulatory patient or an outside patient. 

As per the WHO expert committee of 1956, Hospital is an essential part of a social and medical organization that can provide the services for the complete healthcare facilities which include; both curative and preventive measures. Hospital is also able to provide services to the outpatient. Hospital is a center for health education and training to health care workers and a center for biomedical and social research.

General Classification of Hospital

Following are different classifications of hospitals as per their objectives, functions, and service provides: 

1. Objectives: 

  1. General Hospitals
  2. Special Hospitals 
  3. Teaching cum Research Hospitals 

2. Administration, Ownership, Control, or Financial Income: 

  1. Governmental or public Hospitals
  2. Non-governmental or private Hospitals 
  3. Semi government Hospitals
  4. Voluntary Agency Hospitals 

3. Length of Stay: 

  1. Short-stay hospitals; also called short-term Hospitals and can accommodate and provide the services for less than 30 days. 
  2. Long-stay hospitals also called long-term Hospitals and can accommodate and provide the services for more than 30 days.

4. Medical Staff: 

  1. Open-staff Hospitals
  2. Closed-staff Hospitals 

5. Bed Capacity: 

  1. Small Hospitals, which can accommodate and provide the facility up to 100 beds. 
  2. Medium Hospitals, which can accommodate and provide the facility for more than 100 while less than 300 beds. 
  3. Large Hospitals, which can accommodate and provide the facility for more than 300 beds.

6. Type of care: 

  1. Primary Care Hospitals
  2. Secondary Care Hospitals 
  3. Tertiary Care Hospitals 

7. Teaching affiliation: 

  1. Teaching Hospitals
  2. Non-teaching Hospitals 

8. System of Medicine: 

  1. Allopathic Hospitals
  2. Ayurvedic Hospitals 
  3. Homeopathic Hospitals
  4. Unani Hospitals 
  5. Hospitals of other systems of medicine 

9. Region dependant: 

  1. Regional Hospitals
  2. Upazilha Health Complex 
  3. District Hospitals
  4. Union Health and Family Welfare Centres 
  5. Community Clinics 

10. Medicine System: 

  1. Allopathic Hospitals
  2. Ayurvedic Hospitals 
  3. Homeopathy Hospitals
  4. Unani Hospitals

11. As per WHO Classification: 

  1. Regional Hospitals
  2. Intermediate/ District Hospitals 
  3. Rural Hospitals 

Classification of Hospital-Based on Clinical and Non-Clinical Basis 

General Hospitals: The purpose of general hospitals meant to provide a wide range of various categories of healthcare facilities in limited numbers. The general hospital provides health care services to various kinds of diseases for both sexes to cover all ages. Such hospitals provide facilities for general medical, ENT, surgical, pediatrics, obstetrics and gynecology, etc. while general hospitals are devoid of super-specialty medical care facilities.

Special Hospitals: Special hospitals have limited services to a particular condition such as; maternity, pediatrics, geriatric, orthopedics, cardiac, diabetic, oncology, etc. 

Teaching cum Research Hospitals: Such type of hospital is attached with research institute such as; medical college/nursing college/dental college or Pharmacy College. The rationale behind the attachment of such type of educational institution is to provide medical care education and research facilities for budding research students. For example;  Christian Medical College Vellore, PGIMER Chandigarh, AIIMS, Seth G.S. Medical College  Mumbai, etc.

Governmental or Public Hospitals: Such types of hospitals are owned and controlled by the government. These hospitals provide free-of-cost medical care services to particular patients/ at a very low cost compared to others. The government hospitals are owned by the  Ministry of Health, The University, the Municipal Corporation, or other government corporations and sectors. 

Such a type of hospital receives government funding for the organization and maintenance of the hospital. Examples: AIIMS, Tata memorial hospital Mumbai, Ram Manohar Lohiya hospital  New Delhi, Lokmanya Tilak Municipal general hospital Mumbai, K.E.M Hospital Mumbai, etc. 

Private Hospitals: Private hospitals are owned and controlled by an individual or group of physicians or citizens or by a private organization. The medical care facilities which are provided by such hospitals are comparatively costly. 

Semi-Government Hospitals: Such types of hospitals are run by both the government and private entities. Example: Cantonment Board Hospital. 

Corporate Hospitals: Such types of hospitals are operated by public limited companies and it formed under the companies act. Such hospitals are run under commercial lines.  Example: Apollo Hospital. 

Voluntary Agency Hospitals: Such types of hospitals are run by a voluntary organization or charitable trust on not profit basis. 

Short-stay Hospitals: Short-stay hospitals are also called short-term hospitals and such types of hospitals can accommodate and provide the services for less than 30 days.

Long-stay Hospitals: Long-stay hospitals are also called long-term hospitals and such hospitals can accommodate and provide the services for more than 30 days. 

Closed-staff Hospitals: In such types of hospitals, the physicians are responsible for all medical activities including the diagnosis and treatment on a fee-paying basis. 

Open-staff Hospitals: In such hospitals, other physicians in the community have permission to admit the patient to the hospital and provide the treatment to them.

Classification of Hospital-based on Level of Care 

Primary Care Hospitals:  Primary care hospitals provide the services of the day-to-day healthcare facilities by health care practitioners. In such hospitals, the health care provider act as the principal and main point of contactors for continuing care of the patient and may co-ordinate other specialists for the care of the patient if need. This type of hospital provides mostly basic health care facilities and consider as a gateway to receive more specialty care facilities for example: Upazilha Health Complex.

Secondary Health Care:  This type of hospital provides the first level of recommendation services which are more complicated and beyond the scope and capacity of the primary level. This level is allocated to provide some specialist care services mostly in Internal Medicine, General Surgery, Obstetrics and Gynaecology, and Paediatrics. Such level of a hospital usually provides 50-200 bedded capacity. 

Tertiary Level:  Such a level of hospitals deals to provide highly specialized care services at regional or central-level hospitals. Like teaching hospitals, super-specialized hospitals like; Cancer hospitals, Chest hospitals, Infectious Disease hospitals, and Mental Disease hospitals are also included in this level of care. 

These institutions provide recommendation support to primary and secondary level health care. This also includes Divisional and National Level Hospitals.

Classification of Hospital as per WHO (Expert Committee 1957) 

1. Regional Hospitals: Provide a complex range of treatment and highly specialized services. Serve a larger area than local hospitals. For example: Government Medical  College Hospitals. 

2. Intermediate/District Hospitals: District hospital typically is the major health care facility in their locality. 

3. Rural Hospitals: These are remote hospitals with a small number of beds and limited service capacity. It should have 20-100 beds. For example: Upazilha Health  Centre.

Organizational Structure of Hospital 

Every hospital has an organizational structure for efficient management to allow and provide a different kinds of services. A hospital is a multilayered organization consisting of many committees, departments, types of staff, and services. 

It is divided as follows:

Organizational Structure of a Hospital
Fig.1: Organizational Structure of a Hospital

Board of Trustees/Governing Board: 

  • The “board of trustees,” controls the hospital in the belief of the community health care and has obligatory duty to protect the resources of the hospital through efficient operation.
  • The guardians or trustees are accountable for founding the hospital’s mission and launching its regulations and strategic policies.
  • Trustees appoint the administrative leader called Chief Executive Officer (CEO) for the hospital and delegate the hospital’s daily procedures and budgeting.

Executive Administration: 

  • The chief executive officer (CEO) reports to the board of trustees and delivers leadership services for the implementation of the strategic plan, goals, and decisions established by the board of trustees.
  • The CEO also symbolizes the hospital to the community and the external environment for its growth.
  • The CEO should also coordinate effectively with the hospital’s staff.
  • The CEO is also responsible to participate in the establishment of hospital policies and procedures as well as involves in the performing of public relations duties.

Informational Services: 

There are various departments under informational services to perform the following duties,  responsibilities and provide the information: 

  • Admissions-related information of patients which includes full information and history of patients.
  • Billing and Collection: There is a separate department that provides the responsibilities for billing the service provided.
  • Medical Records: These are responsible for maintaining the medical record of all patients.
  • Computer Information Systems: In this, the personnel is responsible for maintenance of computer and hospital network.
  • Health Education: The personnel involved in these services are responsible for health education to staff and patients.
  • Human Resources: The personnel involved in this service is responsible for recruiting employees and looking towards to benefits of employees.

Therapeutic Services: 

Provides treatment to patients which include following departments: 

  • Physical Therapy: Associated with various treatments to improve large muscle mobility.
  • Occupational Therapy: In this, the treatment goal is to help the patient to regain fine motor skills.
  • Speech/ Language Pathology/therapy- It is associated with identifying, evaluating, and providing treatment for speech/language disorders.

Diagnostic Services 

Determines the cause(s) of illness or injury includes:

  • Medical Laboratory – dealing with studies on body tissues.
  • Medical Imaging – dealing with providing the services related to radiology, MRI, CT,  Ultra Sound.
  • Emergency Medicine – dealing with providing the services related to emergency diagnoses and treatment. 

Administrative Support Services: 

  • Administrative support services are essential for the business of hospitals and physical plant management.
  • The CEO is responsible for the implantation of various administrative support services and day-to-day operations activities of the facility.
  • The non-medical staff is involved in the manages of admitting and discharging of patients, record maintenance, handling of the accounts related to third-party payers such as insurance companies.
  • The finance section is central to the hospital’s financial business and performs the fundamental practices in the administrative decision-making process. They regularly advise the CEO on the various financial policies and long-range financial arrangements, establish procedures for the functioning of the account section. The finance section of the hospital has also a major responsibility to receive and deposit all kinds of monies received by the hospital, as well as to approve the expenditures and payments of salaries.
  • Admitting service is provided by the hospital. Such type of service is given by a particular hospital staff/department to which the patient first has to contact. This department efficiently and greatly influences the perception of the patient regarding the quality care services received.
  • The hospital management department has a core responsibility to provide information services and to maintain the medical record of patients.
  • The human resources department interacts with all departments in the hospital to ensure the provision of quality service to patients. They also motivate staffs who are working at the hospital.
  • Other important administrative and business roles in hospital management may include; marketing and planning strategies, public relations, maintenance and management of hospital building, rising of funds of a hospital, provision of housekeeping, and security services.
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