What are hospitals?

Organization and Functions

Hospitals are run both privately and under public auspices, such as a local, state, or federal government. In general, they can be classified in three ways: nonprofit versus for-profit, general versus specialty, and short-term versus long-term care. Typically, they are organized in a hierarchical fashion: A governing body, such as a board of directors and its committees, oversees an administrator who, in turn, oversees a variety of departmental managers. While the governing body is responsible for defining and fostering the hospital’s mission, the administrator guides the implementation of the mission, and the managers enact it. As such, hospitals have feedback mechanisms from the departments and chief administrator back to the board to ensure quality and progress.

Staff and Services

Most hospitals have five primary departments for service management: financial, support, nursing, medical, and ancillary. The first two, financial and support, provide nonmedical services, while the remaining departments provide direct and indirect medical services. The financial department relies on office personnel and manages business functions such as admissions, data management, accounting, and collections. In contrast, the support department manages administrative functions (such as volunteer services, medical records, purchasing, personnel), environmental concerns (such as maintenance and housekeeping), and nonmedical patient services (such as dietary needs and social services). This department hosts a diverse service staff ranging from janitors to dietitians to social workers.

As patients, individuals typically enter hospitals through admissions, the emergency room, a hospital clinic, or via referral from a private doctor. Thus, depending on a patient’s route of admission, his or her interaction with different departmental service staff may vary considerably. In any hospital, however, the nursing service has perhaps the greatest visibility with nursing functions in the emergency and operating rooms, outpatient clinics, and inpatient units. In fact, nurses may perform any of the following duties, depending on their level of training and where they work within a hospital: triage, charting, medical room preparation, medication administration, vital signs monitoring, assistance of patients with meals and hygiene, and staff training. In addition, the nursing service typically dominates short-term special care units, such as intensive care and the emergency room, and nonacute care units, such as renal dialysis centers, psychiatric and substance abuse units, and long-term care centers for chronic illnesses.

Equally well known is the medical service, consisting of physicians, osteopathic physicians, podiatrists, dentists, and psychologists. Typically, this service manages the delivery of care for general medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry. While the nursing service historically has dominated the emergency room, more recently medical staff are leading in this service area. Many different classes of emergency rooms exist, however, ranging from those highly staffed by physicians and specialists (on-site twenty-four hours a day) to minimally staffed (an on-call emergency nurse or technician who transfers patients to hospitals with life support equipment). Consequently, this balance between nursing and medical services may vary considerably among hospital emergency rooms.

Finally, ancillary service professionals assist the medical service staff in rendering diagnoses and treating patients. These staff members are highly trained and commonly use sophisticated equipment and methods. Subdepartments composing this service include the laboratory, pharmacy, anesthesiology, physical therapy, electrocardiography (ECG or EKG), electroencephalography (EEG), magnetic resonance imaging (MRI), and inhalation therapy departments. Radiology is also included and has three divisions: diagnostic radiology, therapeutic radiology, and nuclear medicine.

Perspective and Prospects

The word “hospital” was derived from the Greek word hospitum, meaning a place for the reception of pilgrims, and the Latin word hospes, meaning “guest” or “host.” Originally, hospitals existed as temples or churches in ancient Greece and Rome, where priest-physicians performed healing miracles on the mind, body, and spirit. Later, hospitals were run by Christians and church bishops in Europe and served primarily as places of refuge and service for travelers. It was not until around 600 ce. that European hospitals specifically began caring for the sick. Similarly, in America, hospitals were not established until the eighteenth century—and then, only in larger cities. At that time, they primarily functioned as places where the urban poor could receive care and where individuals with contagious diseases could be confined during epidemics. With the advent of modern medicine and developments such as anesthesia and antibiotic drugs, hospitals were seen less as places to be sick and more as places to get well. As a result, they began to take in patients from all sectors of society and with a broader diversity of medical needs.

Today, hospitals are large, financially driven institutions that focus not only on the provision of emergency medical services and healing the very sick but also on the prevention of illness. Increasingly, specialty hospitals are addressing specific groups of patients, such as children, women, elders, and individuals with particular illnesses, such as cancer. In addition, specialty hospitals are taking on identities as centers for research and teaching as they improve treatment methods and strategies. With improved drug therapies and medical procedures, there is also a trend in general hospitals toward outpatient and day care for chronic illnesses replacing a long history of inpatient services. In the future, these trends toward service specialization and outpatient service are expected to continue, with hospitals increasing their use of illness prevention strategies, as well as continuing to improve their delivery of critical care and emergency services for diverse groups of patients.

Bibliography

Birenbaum, Aaron. Wounded Profession: American Medicine Enters the Age of Managed Care. Westport, Conn.: Greenwood Press, 2002. Print.

Clifford, Joyce C. Restructuring: The Impact of Hospital Organization on Nursing Leadership. Chicago: AHA Press, 1998. Print.

Dranove, David. The Economic Evolution of American Health Care: From Marcus Welby to Managed Care. Princeton, N.J.: Princeton University Press, 2002. Print.

Griffin, Donald J. Hospitals: What They Are and How They Work. 4th ed. Sudbury, Mass.: Jones & Bartlett, 2012. Print.

McKean, Sylvia C., et al. Principles and Practice of Hospital Medicine. New York: McGraw-Hill Medical, 2012. Print.