Hospital

Administration
 Hospital
Administration

DC Joshi
MBBS, MD, PGDHHM, DNB (HA), MNAMS (HA),
MBA (Hosp. Management), MIPHA, MAHA, FISCD.
Chief Medical Officer (CHS)
Honorary Member Secretary Regional Chapter
Academy of Hospital Administration, Lucknow
Honorary Counsellor for PGDHHM Course, IGNOU
Guest Faculty for Hospital Administration Programmes SGPGIMS, Lucknow,
Department of Hospital Administration, CSMMU, Lucknow,
Guest Faculty for MHA, University of Lucknow, Lucknow, India

Mamta Joshi
MHA, PGDHA (Gold Medalist)
Guest Faculty for Community Medicine and Public Health
University of Lucknow, Lucknow, India

Foreword
Major General SK Biswas
AVSM, VSM

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Hospital Administration
© 2009, Jaypee Brothers Medical Publishers

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First Edition: 2009
ISBN 978-81-8448-676-6
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 To
Our Parents, Teachers
and
Academy of Hospital Administration
 Foreword
It is my proud privilege to write the foreword to the book Hospital Administration by Dr DC Joshi and
Ms Mamta Joshi. The hospitals are very complex organizations. The beneficiaries are the patients and
providers, who are still more complex, ranging from highly skilled doctors to illiterate or just literate
people. The needs of the organization, the beneficiaries, the providers and stake holders are different. At
one extreme; the hospital owners want to serve the humanity and at other, they want that the hospital as an
organization should be productive and self-supporting. How to strike the balance? This is a big challenge.
The Hospital Administration is an upcoming subject to prepare hospital administrators to meet the challenge.
In recent times, among the general population, there is an increased awareness of medical and technical
knowledge which has resulted in increased expectations. The hospitals of today are like big industries in
terms of the inputs required for hospital’s operations. Though the hospitals can be equated with production
industry in terms of the use of resources and quantum of resources, yet at the same time the nature of
hospital as a multidisciplinary organization is quite complex. The people who are successful managers in
production industry may not necessarily be effective in hospital organization. The authors have adopted a
holistic and unified approach in designing the book and including all the relevant aspects of the hospital
administration. Contracting in health care, effective media communication, health care financing, quality in
health care, medical tourism, telemedicine and role of health insurance in provision of health care to the
community, are newly emerged topics and have been given due importance. Various acts and laws relating
to the hospital administration have been grouped together in a separate section as Annexure, to facilitate
the readers for up-to-date and correct legal information in the field of hospital administration.
It would be the reader’s delight to find all the topics relating to hospital administration at one place and
more importantly in a concise and lucid manner. I am confident that the readers will appreciate the efforts
of the authors in bringing out the long-awaited book Hospital Administration. This book will definitely serve
the purpose of a textbook as well as reference book for the students and hospital administrators.
I congratulate the authors for their noteworthy achievement.

Major General SK Biswas

MBBS, MHA, FAHA
AVSM, VSM
Patron, Academy of Hospital Administration
C-56/43, Institutional Area, Sec-62, Noida
e-mail: ahaindia@ahainda.org
 Preface
This book Hospital Administration is based upon the felt need of the students pursuing various PG diploma
and degree courses on regular basis or through distance learning. When we were students, we also thought
of having a book, wherein we could find all the relevant topics at one place. It is a dream come true.
This book has been organized into nine sections. Each section deals with the topics of similar nature.
Section one deals with topics related to the introduction of hospital administration as a subject. Section two
has topics on management as relevant to hospital administration. Section three has been dedicated to hospital
planning keeping in mind the importance of hospital planning. The topic on hospital planning has been
simplified and made easy to understand to the beginners in the field of hospital administration. Sections
four, five and six have been organized for the hospital sub-systems, comprising clinical services, diagnostic,
and therapeutic services and support and utility services respectively. A separate section, i.e. section seven
is for risk management. This covers all the perceived risks and their management in the hospitals, from the
patient’s perspective as well as from the health care providers’ point of view. We have tried to cover all the
recent advances at one place in section eight. The law and medicine are very closely related in some aspects
of the hospital administration. The health care providers face great many difficulties due to ignorance of
law. To bridge this gap, in Section nine, we have Annexure.
We have no claim that much of the material in this book represents new or original thinking on our part.
The material was developed from various sources and from the works of the well-known authorities on the
subject. While preparing the book, references were taken from well-known literature, books, journals, and
websites. Wherever possible, we have cited the references at appropriate places. If inadvertently, we could
not cite the references, it is deeply regretted.
We have made our best possible efforts for preparation of the book, to make it user friendly. If there is
any error, the readers are requested to please bring to our notice, so that the same is rectified in the next
edition. Without active criticism and feedback, it would not be possible to continuously improve and update.

DC Joshi
Mamta Joshi
 Acknowledgments
We express our sincere thanks to Major General SK Biswas for writing the Foreword of this book and
showering his blessings on us. He provided the platform like Academy of Hospital Administration to us.
We also express our sincere thanks to Dr Hem Chandra, Medical Superintendent, SGPGIMS, Lucknow, for
his encouragement.
We are thankful to Dr K Jamaluddin, APRO, SGPGIMS, for his help. Our sincere thanks are due to Major
Gen A Chakravarty, Maj Gen M Srivastava, Surg Capt NA Khan, Surg Rear Admiral VK Singh, Col Pawan
Kapoor, Col Mishra, HOD, Hosp. Admin., AFMC, Pune, Col Basu, Dr Shakti Kumar Gupta, HOD, Hospital
Administration, AIIMS, Dr AK Gupta, HOD, Hospital Administration, PGIMER, Chandigarh, Dr Vipin
Kaushal, MS, Govt Medical College Hospital Chandigarh, Col T Dayakar, Hyderabad, Dr VK Srivastava,
HOD, Hospital Administration, CSMMU, Lucknow, Dr Udai Mohan, Professor of Community Medicine,
CSMMU, Lucknow, Dr Shiraj Ahmad, Dr Raveesh Kumar, Dr Manoj Dixit, University of Lucknow, Dr HS
Kukreja, President, Delhi Medical Association has been of great help and guided us from time to time in
preparation of the book from the point of view of the Nursing Home Administrators. Dr Ashok Kumar Dy
Medical Superintendent, PGIMER, Chandigarh, provided great academic support and guided us in
preparation of this project, we are indebted to him.
We heartily extend our sincere thanks to Sri R Ganesan Ex-Director General, Department of Post for his
good wishes, who has been a role model for us. We also extend our gratitude to Sri SP Ojha, Ex-PCPMG,
UP, for his ever-encouraging attitude. We are grateful to Mrs Neelam Srivastava, Chief Postmaster General,
UP Circle, Lucknow, for granting permission to publish this book. We avail this opportunity to pay regards
to Mrs Nirmla Pant, Director, Lucknow Cancer Institute, and Padmashree Dr MC Pant for their love and
affection.
We have special place in our hearts for our elder brother Dr VP Joshi and Mrs Basudha Joshi for their
contribution in making our lives comfortable and socially and economically productive. Mrs and Mr AK
Goel, Mrs and Mr Harshwardhan Mishra, Dr Vinita and Mr DC Bhatt, Dr Mrs Tara and Dr Nitin Bhatt, Dr
Mrs Anshu and Dr Charu, Mrs Vartika and Mr Abhinav, Vidhi and Shristi have shown their genuine concern
from the inception to the final stage of this book. Our children Dr Ankit, Dr Anumeha and Dr Arjuna have
given us the friendly guidance and have projected their ideas from the student’s perspective.
We also take this opportunity to thank Mr Siddqui and Mr Sanjay Mishra for their genuine concern and
providing secretarial support whenever required during the preparation of the book. We also extend our
gratitude to all other family members, relatives, colleagues and friends for their good wishes.
We are extremely grateful to M/s Jaypee Brothers Medical Publishers (P) Ltd. for their kind cooperation
in bringing out the publication of this book Hospital Administration in record time. The credit goes to our
publishers for giving practical shape to our dreams, and making it a reality.
 Contents
SECTION ONE: INTRODUCTION TO HOSPITAL ADMINISTRATION

1. Hospital Administration—the Beginning .......................................................................................................... 1

2. Hospital Administration—Introduction ............................................................................................................. 3
3. Rationale of Hospital Administration .............................................................................................................. 13
4. Role of Hospitals ................................................................................................................................................ 23
5. Evolution of Hospitals ........................................................................................................................................ 25
6. Types and Classification of Hospitals ............................................................................................................... 34
7. Problem Solving in Hospital .............................................................................................................................. 38
8. Hospital Statistics ............................................................................................................................................... 41
9. Research in Hospital Administration ............................................................................................................... 49
10. Legal Aspects of Hospital Administration ....................................................................................................... 55
11. Role of Hospitals in New Millennium ............................................................................................................... 62

SECTION TWO: INTRODUCTION TO MANAGEMENT

12. Approaches to Management .............................................................................................................................. 70

13. Planning ............................................................................................................................................................... 72
14. Decision Making ................................................................................................................................................. 78
15. Organizing ........................................................................................................................................................... 84
16. Staffing ................................................................................................................................................................ 92
17. Job Designing ...................................................................................................................................................... 95
18. Directing .............................................................................................................................................................. 97
19. Motivating ........................................................................................................................................................... 99
20. Leadership ......................................................................................................................................................... 104
21. Communication ................................................................................................................................................ 108
22. Controlling ......................................................................................................................................................... 111
23. Organizational Behavior .................................................................................................................................. 114
24. Materials Management ..................................................................................................................................... 119
 xiv Hospital Administration

25. Financial Management .................................................................................................................................... 146

26. Management Techniques in Hospitals ........................................................................................................... 164
27. Industrial Relations in Hospitals .................................................................................................................... 182

SECTION THREE: HOSPITAL PLANNING

28. Hospital Planning ............................................................................................................................................. 186

SECTION FOUR: CLINICAL SERVICES

29. Outpatient Department Services ................................................................................................................... 209

30. Emergency Services Department ................................................................................................................... 217
31. Inpatient Department ...................................................................................................................................... 224
32. Operation Theater ............................................................................................................................................ 249
33. Intensive Care Unit ......................................................................................................................................... 257
34. PMR Services .................................................................................................................................................... 261

SECTION FIVE: DIAGNOSTIC AND THERAPEUTIC SERVICES

35. Laboratory Services ......................................................................................................................................... 266

36. Radiology Services ........................................................................................................................................... 276
37. Pharmacy Services ........................................................................................................................................... 286
38. Transfusion Services ........................................................................................................................................ 292

SECTION SIX: SUPPORT AND UTILITY SERVICES

39. Medical Records Department .......................................................................................................................... 308

40. Central Sterile Supply Department ............................................................................................................... 318
41. Linen and Laundry Services ........................................................................................................................... 326
42. Dietary Services ............................................................................................................................................... 333
43. Hospital Housekeeping Services .................................................................................................................... 339
44. Hospital Engineering Services ........................................................................................................................ 345
45. Hospital Transportation System ..................................................................................................................... 348
46. Hospital Equipments Management ................................................................................................................ 352
47. Public Relations in Hospital ............................................................................................................................ 363
48. Mortuary Services of Hospital ........................................................................................................................ 369
 Contents xv

SECTION SEVEN: RISK MANAGEMENT

49. Hospital Waste Management .......................................................................................................................... 375

50. Nosocomial Infections ...................................................................................................................................... 386

51. Disaster Management ...................................................................................................................................... 395

52. Hospital Security Services ............................................................................................................................... 405

53. Occupational Safety in Hospitals .................................................................................................................... 410

SECTION EIGHT: RECENT ADVANCES IN HOSPITAL ADMINISTRATION

54. Contracting in Health Care .......................................................................................................................... 421

55. Health Care Financing .................................................................................................................................. 428

56. Role of Health Insurance .............................................................................................................................. 442

57. Quality in Health Care Organizations ...................................................................................................... 449

58. Effective Media Communication ................................................................................................................ 474

59. Telemedicine ................................................................................................................................................... 480

60. Medical Tourism ............................................................................................................................................. 487

SECTION NINE: ANNEXURE

A-1 Code of Medical Ethics ................................................................................................................................. 493

A-2 The Consumer Protection Act, 1986 ........................................................................................................... 505

A-3 Tender Document ........................................................................................................................................... 524

A-4 Biomedical Waste Disposal Rules .............................................................................................................. 536

A-5 The Prenatal Diagnostic Techniques Act and Rules ............................................................................. 545

A-6 Human Organ Transplantation Act ........................................................................................................... 555

Index ............................................................................................................................................................................ 565