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1 CHAPTER : 1 HOSPITAL MANAGEMENT - AN INTRODUCTION 2 Outline of the Chapter Page No. 1 Meaning of a Hospital 4 2 Meaning of Hospital Management 6 3 Evolution of Hospitals 8 History of Hospitals Changing Concept of Hospitals 4 Types of Hospital 14 5 Roles of Hospital Administrator 18 Role Towards Patients 19 Role Towards Hospital Organization 19 Role Towards Community 20 6 Functions of Hospital Management 20 7 Hospital Services 23 Medical Staff 23 Associated Medical Services 25 Number of Public Hospital and Bed in India 25 8 Numbers of Public Hospitals and Beds in India 25 9 Conclusion 28 CHAPTER : 1 HOSPITAL MANAGEMENT-AN INTRODUCTION 3 Health is an important factor in the formation of human resources development which will play a vital role in improving the qualities of human beings, who are the active agents of economic development. So any measure of development achievement in a nation must affect the state of personal wealth in the nation. Better wealth would contribute to improving the economic status of the poor and for expanding total output. This demands sound management of a hospital. Therefore in this chapter the researcher has made an attempt to discuss about the meaning of hospital and hospital management, evolution of hospitals, changing concept of hospital, role of hospital administrator, functions of hospital management, hospital services and to present a picture of number of public hospitals and beds in India. 4 1. Meaning of a hospital According to the World Health organization, Health is a State of complete physical, mental and social well being and not merely the absence of disease or deformility of the fundamental rights of every human being without distinction of race, religion, political belief, etc. is the enjoyment of the highest attainable standard of health 2. But, owing to a variety of factors like lack of health consciousness, low per capita income, lack of adequate education, on availability of proper sanitary condition and safe drinking water, unhealthy social taboos etc., the health status of the average Indian remains dissatisfactory. It has been the endeavor of successive Government in India to improve the situation. This is especially so after the Independence. The National Health Policy which was approved by the Parliament and announced by the Government in 1983 marked a beginning to the Quest for equity in health expressed as WHO s goal of Health For All by the year 2000 To achieve this goal massive inputs with restructuring of the organization setup and management has been achieved incurring huge amounts of revenue expenditure as well as capital expenditure financed from various sources- Central Government, State Government and externally aided projects. In views of this currently there have been many emphases on analytical study of hospital management pattern of health care expenditure and determination of costs of service. As the present research study is on a managerial appraisal of public hospital in Gujarat (Located at district head quarter), in this chapter the researcher has tried to present theoretical aspects of Hospital Management. Hospital first came into existence prior to 1000 4. 5 Grammar of the word differs slightly depending on the dialect. In the hospital usually requires an article, in Britain and elsewhere the word is normally used without an article when it is the object of a preposition and when referring to a patient ( into the hospital s ) in Canada, both usages are found 5. During the Middle ages the hospital could serve other functions, such as almshouse for the poor, or hostel for pilgrims The name comes from Latin hopes (host), which is also the root for the English words hotel, hostel and hospitality. The modern word hospital derives from the French word hostel, which featured a silent, which was eventually removed from the word; French for hospital is hospital 6. In the present time, a hospital is an institution for health care, often but not always provides large term patient stays. The hospital is an integral part of the social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whose outpatient services reach out to the family and its home environment. The hospital is also a centre for training of health workers and for biosocial research 7. The modern concept of the hospital visualizes it, as one of a comprehensive system of preventive and curative medicine and as an institution devoted not only to inpatient treatment, but also to ambulatory and domiciliary use 8. From above definition, it can be said that the hospital is a complex organization and an institute which provides health to peoples through complicated but specialized scientific equipment and a team of trained staff educated in the problems of modern medical science. They are all co-ordinate together for the common goal of restoring and maintaining a good health of the people who go there for relief from the pain, suffering and disease. 6 Thus, the hospital is a specialized body where the patient care is the focal point and about which all activities of the hospital revolve. The physician who examines and takes care of the patient is in the principal position and special facilities and trained personnel are provided to him to make his work easy and efficient, trained personnel includes technical staff of nurses, dieticians and pharmacists. From the organizational and administrative point of view, a hospital is virtually a city within a city. Within its four walls, it has an operation theatre, a hospital which is in the shape of the patients rooms, a dormitory for student nurses, residents and interns, a school for training of nurses, technicians, dietician, laboratories, a pharmacy, food vending operations, laundry and linen service, delivery service, a post office, massive internal and external communication system, blood bank, accounting and credit services, a public relation department, a motor service, and security patrols 9. In short the hospital is a healthcare Organization. 2. Meaning of hospital management : Hospital Management can have different meanings Management as a process: Often it is said that it is a professionally managed hospital; it is well managed hospital, meaning thereby the management is described as an activity, type of work. Management applies certain principles, techniques and activities which are performed by certain management the hospital Management does is Management. Hospital Management is a subject: A subject, a discipline taught in universities, colleges or institutes. It is an accumulated body of knowledge that can be learned, at some places the broad specialty is Health Management including Hospital degrees, diplomas, certificate courses are run by the institution/universities. 7 Hospital management as people: The Management of this hospital is very insensitive, the hospital management of this hospital is not responsive to society are the terms often used. While using these terms, we are referring to body of people responsible for management, the board of directors, director, medical superintendent and his team. Hospital management as career: News published in the national daily says that hospital management will be among top ten careers in the next decade. Such statements imply that hospital management is a career. The team management has been defined by different expects as below According to Hawalskantz, Management is the art of getting things done through and with the people in formally organized groups. 10 According to George Terry, Management is the process undertaken by one or more person to coordinate the activities of other persons to achieve results not attainable by any one person acting alone. 11 According to McFarland, Management is a distinct process consisting of activates of planning, organizing, actuating and controlling, performed to determine and accomplish stated objectives with the use of human beings and other resources. 12 From above discussion, the application of management in hospital can be defined as below. A. As a hospital administrator, he has to carry out management functions of planning, organizing, staffing, directing, controlling and coordinating. 8 B. Management applies to all kinds of organization, whether government or non government, small or big hospital, profit making hospitals or charitable hospitals. C. It applies to administrator at all organizational level, whether lower level or top level. D. The aim of all administrators is the same that is to maximize the output. E. It is concerned with productivity that implies effectiveness and efficiency. 3. Evolution of hospitals : Evolution of hospitals has been divided into two parts History of hospitals Changing concept of hospitals 9 History of hospitals : History of hospitals has been discussed under six heads as below Chart History of hospitals in ancient period Hotel Dieu,Paris 542 AD s Hospital, London 1123 AD Spanish Hospital,Mexico City 1524 AD Bellevue Hospital New York 1736 AD First General Hospital, North America (Pennsylvania Hospital) 1751 AD Massachusetts hospital 1811 AD (a) Early History: The word hospital originates from Latin word hospice 13. A place where a guest is received is called hospitable, an institution for the care of sick and injured. In the early period, during Greek and Roman Civilization the temples were used as hospitals and these hospitals were integral part of the temples. With the birth and spread of Christianity, the hospitals became an integral part of Church. Some of the notable hospitals established in Europe date back to ancient times. The earliest Hospital was founded at Hotel Dieu, 10 Paris in 542 AD. St Bartholomew`s hospital London dates back to 1123 AD. In 1524, Spanish built the first hospital in Mexico. The first general hospital opened in 1751 in North America as Pennsylvania hospital. Thereafter, Bellevue Hospital in New York in 1736 and Massachusetts Hospital in 1811 The advances in medical science in the field of microbiology, pharmacology, radiation, blood transfusion, anesthesiology, surgical techniques and computers all led to exponential growth in hospital services. (b) Ancient Asia: Sri Lankans are responsible for introducing the concept of dedicated hospitals to the world. The ancient Chronicle of Sinhalese Royalty written in 6th century , King Pandukabhaya had lying in homes and hospitals built in various parts of the country. Mihintale Hospital is perhaps the oldest one in the world. King Ashoks founded 18 hospitals in 230 were state supported hospitals. The first teaching hospital was the Academy of Gundishapur in the Persian Empire 15. (c) Modern Era: By the mid 19th Century most of the Europe and United States had established a number of public and privet hospital systems. In Continental Europe, the new hospitals were generally built and run by public funds. In the United Kingdom, the hospital sector is dominated by National Health Service. In the United States, the traditional hospital is a nonprofit hospital. In the late 20th Century, the concept of nonprofit hospital was switched over to chains of for profit hospital. (d) Period of Growth: The first hospital in USA was founded in 1751, the Pennsylvania Hospital. Rapid growth in the field of hospital occurred in between 1860 to 1920; however the number reached to its peak to 7370 in 1924. The main reason to the growth of the hospital can be 11 credited to the rapid advancement in the field of medicine. During 19th century, allopathic medicine was only one of many theories of the disease causation and cure. Before 1900, most of the hospital was proprietary, in a significant development. The john Hopkins University Medical School was founded. Emergence of nursing as a profession and change in society s attitude towards hospital shaped the role of hospital in patient care further. Florence Nightingale was instrumental in these changes. First three schools of Nursing in United States were established in 1973. Improvement in society s attitude towards acute care hospitals occurred slowly 16. (e) Consolidation ( 1920-1950 ) : The increasing average size of the hospitals improved the comprehensiveness and quality of medical care The American College of Surgeons (ACS) was constituted in 1913. The ACS developed standards for hospital Hospital standardization Program in 1918, for approval. Later on, this program was taken over by joint Commission on Accreditation of Healthcare Organization (JCAHO). The JCAHO is instrumental in development in application of structure, process and outcome criteria for hospitals another event effecting the growth and development of hospitals between the period 1920 to 1950 was introduction and operation of insurance section in the health care in United States. The general and acute care hospitals established during the period were mainly from private and voluntary action during Second World War. The number of hospital increased significantly. During 1970, hospitals were included under federal labor legislation in USA17. The hospital in the present era is now not only high-tech, but also operating from remote places like tale surgery and tale medicines. The hospital not only providing care and comfort to patient, but also to the visitors, attendants of patients. We are moving one step further to medical tourism The hospitals have grown 12 from the time of free treatment, fee for service to profit making organization, trying to compete with any corporate sector. (f) Hospitals after independence: India became free in 1947 and there were 7400 hospitals and dispensaries in India 18. There were 113000 beds with bed population ratio of 2/1000 population 19. There were 19 medical colleges and 19 medical schools 20. it was felt by Government of India that with the rising population and projected growth rate, it would not be possible to cope up with the health needs and demands of the community. Various committees were formed to suggest means and methods to reorganize the health care delivery system. Some of these important committees were Bhore Committee, Mudaliar Committee. Jain Committee, siddhu Committee, Rao Committee, Sri Vastava Committee and Bajaj Committee. As per Health information of India, we have 229 medical colleges, 189 dental colleges, 209 Ayurvedic medical colleges, 36 Unani, 6 siddha and 180 Homeopathic medical colleges, 36 Unani, 6 Siddha and 180 Homeopathic medical colleges 21. As on 1st January, 2002, India has 15393 hospitals with 914543 total beds and 89 beds/lakh population 22. India has 3043 CHCs, 22842 OHCs and 137311 Sub Centers as on 1st March, 2001 23. Since independence, lot of advancement has been made in health sector but still much remains to be done because still all these figures are far below the national target of at least 1 bed/1000 population as recommended by Mudaliar Committee in 1961 24. Changing concept of hospitals : The concept in the field of hospital is fast changing, The changing concept of hospitals is broadly divided into four periods. 13 1. Trusteeship Period Most of the hospitals were run and managed by the trustee s .The advances in technology were minimal during that period. This period lasted till 1920. The doctors and nurses are not working for money, the approach was only humanitarian. The objectives of the hospital remained to provide comfort to the patient. 2. Physician Period It was being utilized for medical. The hospitals were being utilized for medical practice. The laboratory medicine developed during the period 1940 to 1950. The political and economic environment started influencing the hospitals. 3. Administrative and Team Periods The hospital practice became a team approach. The advances in technology became more rapid. The use of computers and application of computers in patient s care and management of hospitals changed the scenario. People started thinking about professionally managing the hospital. 4. Growth of Corporate Sector With liberalization policy of the government all over the world lead to globalization. The rapid advancement in the field of information technology, with fast and safe air travel all over the world lead to the concepts of medical tourism, the concept of corporatization of the hospital. The hospital concept has changed from service approach to the profit making approach. The doctors have started thinking on management principles and functions for productivity. Telemedicine is a new addition. The patients can be treated and monitored by remote devices. The government all over the world has started thinking about easing the burden of financing the healthcare. The new emerging concept of contracting or public-private-partnership (PPP) is 14 growing very fast. The financing of health services though insurance sector has become need of the hour. 4Types of hospitals: There is wide range of hospitals Some hospitals are small, some are big, some imparting teaching and training facilities, some are owned by private bodies, some are special hospitals and so on. These hospitals can be categorized or classified in several manners. Some of the methods of classification of hospital are given below a. According to ownership and control. Chart Classification of hospital based up on ownership and control is present as below : Government Non -Government Public Hospitals Voluntary Nursing Corporate Hospitals Homes Hospitals Public hospitals: The hospitals run by central or state government, local bodies and public sector undertaking. The hospitals are purely service organizations and nonprofit making hospitals. Examples are civil hospitals. Voluntary Hospitals: These hospital are registered under the societies act or public trust act. They are run by trusts and on non commercial basis examples, charitable hospitals. Nursing Homes: Generally owned and, managed by individual doctors. These hospitals generally do not admit cases of medico legal 15 Homeopathy Hospital importance and the patient care services are usually provided in some of the specialties of medicine. Some of the nursing homes provide only maternity care. Some hospitals even provide tertiary care in some super specialties like cardiology, Nephrology. Example is Mayo medical centre. Awadh Hospital at Lucknow city, etc. Corporate Hospitals: These hospitals are run on the basis of profit-earning and are registered under companies act. Examples are Hinduja Hospital, Apollo Hospital, etc. b. According to Directory of Hospital Chart Classification of hospital based up on directory of hospital. General Hospital: These hospitals usually provide medical care in more than one broad specialty and there is no strict departmentation. Rural Hospitals :The hospitals located in rural areas. Specialty Hospitals : Hospital providing medical care usually in one or more specialty like TB Hospital, Eye Hospital, Cancer Hospital, heart centers etc . Teaching Hospital :Usually the hospitals attached to medical college Isolation Hospital :Hospitals providing patient care to communicable diseases. c. According to systems of medicine. Chart Classification of hospital based up on systems of medicine General Hospital Rural Hospital Speciality Hospital Teaching Hospital Isolation Hospital Allopathic Hospital Ayurvedic Hospital Unani Hospital Tibb Hospital 16 Various systems of medicines like Allopathic, Ayurvedic, Unani, Tibb, Homeopathy, have their own hospital. d. According to size of hospital. Chart Classification of hospital based up on size of hospital The hospitals can be classified as small, medium or large size depending upon the bed strength of the hospitals. Hospitals having more than 500 beds are usually called large hospitals. Hospitals having bed strength from 200 to 500 are called medium size hospitals and hospitals having less than 200 beds are small hospitals. e. According to clinical base. Chart Classification of hospital based up on clinical base The hospital can be classified as general hospital or specialized hospital. f. According to level of care. Chart Classification of hospital based up on according to level of care The hospital can be classified as primary care hospitals like PHCs, CHCs, secondary care hospitals like district hospitals and tertiary care Large HospitalBeds > Medium Hospital 200-500 Beds Small Hospital Beds < 200 General Hospital Specialty HospitalPrimary care Hospital Hospital and. CHCRegional Hospital, Secondary care Hospital Distt. Hospital Medical college Hospital Tertiary care17 hospitals like regional hospitals or hospital associated with medical college. g. According to teaching facilities. Chart Classification of hospital based up on teaching facilities The hospital can be classified as teaching hospital or non teaching hospital. h. According to accreditation. Chart Classification of hospital according to accreditation Now on time to come, the hospital will be classified as accredited hospitals and non accredited hospitals. In USA and Europe, this lassification is more relevant, as far as the quality of medical care is concerned. In India also the steps are being taken in this regard. i. According to gender. Chart Classification of hospital based up on gender Some of the hospital is also classified on the basis of male hospital and female hospital, particularly in the public sectors, at district level. j. According to length of stay. Teaching Hospital Non-teaching Hospital Accredited Hospital Non-accredited Hospital Male Hospital Female Hospital Male Hospital Female Hospital 18 Chart Classification of hospital based up on length of stay Hospitals can also be classified on the basis of length of stay of patients. The hospitals may be under the category of short term or long term or acute or chronic hospital respectively. 5. Roles of hospital Administrator: By virtue of serving a health care organization, the hospital administrator performs some specific roles which are described below. The hospital administrator ensures that hospital runs effectively and efficiently. The role of hospital administrator varies, depending up on the nature and complexity of hospital, various roles can be grouped as role towards patients, towards hospital organization, towards community. Role Towards Patients, Role Towards Hospital Organization, Role Towards Community, Role Towards Patients: The hospital administrator has a great responsibility to understand and appreciate the emotional aspects of the patient care, his responsibility is to understand the specific needs of certain groups of patients, patients on wheelchairs, stretchers, geriatric group of patients, pediatric patients, neonates, serious cases, foreign nationals etc. Some of the aspects of patients are given below. i. Creation of friendly environment, ii. Understanding patient s physical needs, iii. Patient s emotional needs, AcuteHospital Chronic Hospital 19 iv. Patient s clinical needs, v. Patient s satisfaction, vi. Patient s education, vii. Patient s communication needs, Role Towards Hospital Organization: To handle the hospital resources for maximizing the output is one of the fundamental roles of the administrator. Hospital is a complex organization it is a labor intensive organization working for day and night and without break; expectations of the workers are very high and unity of direction and unity of command are often violated. The role of administrator is more of coordination in nature instead of controlling he is coordinating officer. Under the role a hospital administrator performs following function. i. Strategic planning, ii. Environmental influence on the hospital, iii. Operational management, iv. Management of hospital staff, v. Materials management, vi. Financial management, vii. Hospital information, viii. Communication, ix. Public relation, x. Risk management, xi. Law, Ethics and Code of Conduct, xii. Marketing of health services, xiii. Quality management, Role Towards Community: Hospital is a community organization; it receives inputs from the community in the form of manpower, material, money, machines, 20 land, building, environment, information and gives output to the community. Community participation is must for the success of any health program. The utilization of health facility is also an important behavior of the community. Hospital may provide State of the art Care, but if community does not utilize it; it will go to waste. Hospital must fulfill the felt needs of the community. There should be social responsiveness and social responsibility of the hospital administrator. This can be achieved by: i. Integrating with primary health care, ii. Integrating hospital with other health care organizations, iii. Community participation in planning of services and also for utilization of hospital services, iv. Outreach program: Outreach program like health camps, camp surgery, swarthy melas, immunization camps, etc. 6. Functions of hospital management: The hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive and whose outpatient services reach out to the family and its home environment; the hospital is also a centre for the training of health worker and for biosocial research (WHO) 25. Management is the process of designing and maintaining an environment in which individuals, working together in groups, efficiently accomplish selected aims management functions remain the same in all types of the organizations, whether production industry or the service industry like hospital. The organizational structure of hospital as given in chart is different from the structure of the production industry. The organizational structure is more like a matrix organization. There is no clear cut chain of commands and lack of departmentations. The clinical and service 21 departments of the hospitals are entirely different in structure and reporting relationship in comparison to the production industry. In production industry, there is rigid departmentation, line of reporting relationship, clear demarcation between the line and staff authorities. These things make the hospital organization a very peculiar organization. Chart Organization structure of hospital Production Sales Personnel Finance Unit-I Unit-II Unit-I Unit-II Unit-I Unit-II Unit-I Unit-II Management process in general: The functions of the management in all types of the organization remains the same and revolves round the following management functions. These are summarized below: Planning : Objectives of the individual Objectives of the organization Policy and strategy of the hospital Rules and procedures of hospital Various health programs of the hospital Priorities of the hospital Organizing : Span of control Delegation of authority CMD 22 Use of staff and service groups Informal groups of hospital Integration of structural activities Staffing : Recruitment procedure Developmental schemes of hospital in relation to human resource Maintenance of staff Utilization of staff Directing : Leading the staff Motivating the staff Communication channels and methods Job satisfaction Job enrichment and job enlargement schemes Supervising of staff Controlling : Establishing standards of performance Methods of measurement of performance Comparison of performance with standards Improving rate of return on investment Developing effective budgeting Employing better cost control and quality control Coordinating Synergy among different units of the hospital The combined and coordinated efforts make one plus one eleven 7. Hospital services: Hospital services are emerging issues, so far as public sector hospital are concerned. Hospital services can be summarized as below. 23 Medical staff: Every hospital must have medical staff responsible for all medical care to be provided to the patients as per the ethical conduct and professional practices of their membership. The frame-work of the medical staff varies from hospital to hospital. However, in big hospital, staff may be divided into residential medical staff, associate medical staff, consulting medical staff and honorary medical staff. The residential medical staff is available on 24 hour service basis and is available round the clock to attend the patients. They are also involved in organizational and administrative duties pertaining to the medical staff. The Associate medical staffs are the practitioners appointed and assigned to the various services in the same manner as members of the active medical staff. They may be advanced to as the residential medical staff. Consulting medical staff consists of medical practitioners of recognized professional ability and are not members of other preceding categories of the medical staff. The honorary medical staff is like part-time consulting medical staff. The personnel s of this group may be retired or emeritus physicians or those practitioners who have their own clinic but provide honorary services to the hospital. The above mentioned medical staff may be further subdivided into staff of different clinical divisions based on the degree of specialization. Some of the divisions are as follows: A. Medicine Division Internal Medicine Cardiology Gastroenterology Nephrology Pulmonary Psychiatry and Neurology 24 Infectious diseases Allergy Skin and Venereal diseases Endocrinology Geriatrics Immunology Pediatrics B. Surgery Division General surgery Obstetrics and Gynecology Orthopedic surgery Ophthalmology Otolaryngology Dental and Oral Surgery Nephrology Neurologic surgery Cardiothoracic surgery Plastic surgery Anesthetics medical services: In addition to the medical staff involved in diagnosis and treatment of the diseases, there are some other medical services where in, medical staff is the chief and help main medical staff for the diagnostic and associated medical services are as below. A. Pathology and Clinical Biochemistry Services B. Radiology C. Blood Bank D. Medical-Social Service Department E. Anesthesia Services 25 SupportiveParamedical Services : A hospital is not only a clinical department but provide also a number of supportive paramedical services. such as the nursing department, dietary services, laboratory services, medical records department, the blood bank, the central sterile, pharmaceutical services and social services. Actually,the clinical departments cannot finction without them. Some of the other important non clinical services include maintenance and engineering department workshops. 8. Number of public hospital and beds in India : As the present research work is on management issues in public hospital, the researcher has tried to present about number of public hospital and beds in India, which is shown in below 26 Table State/ Ut wise number of Govt. Hospital and beds in Rural and Urban Areas (including CHCs) In India as on 31-3-2012. No State/Ut Rural Hospital Urban Hospital Total Hospital Particular No of hospitals No of beds No of hospitals No of beds No of hospitals No of beds India 6955 154031 3021 328491 9976 6955 1 Andhra Pradesh 167 6220 192 28113 359 167 2 Arunachal Pradesh 36 379 30 1674 66 36 3 Assam 100 3000 NR NR 100 100 4 Bihar 101 3030 NR NR 101 101 5 Chhatisgarh 116 3514 22 2051 138 5565 6 Goa 9 452 11 2127 20 2579 7 Gujarat 1483 18832 229 22200 1712 41032 8 Haryana 56 1178 93 6484 149 7662 9 Himachal Pradesh 94 2146 55 5963 149 8109 10(a) Jammu Division 28 830 8 870 36 1700 10(b) Kashmir Division 33 990 23 1255 56 2245 11 Jharkhand 47 1410 NR NR 47 1410 12 Karnataka 444 7290 424 35301 868 42591 13 Kerala 173 12450 77 15945 250 28395 14 Madhya Pradesh 275 8179 102 11739 377 19918 15 Maharashtra 424 15380 242 30593 868 42591 16 Manipur 24 669 4 1251 28 1920 Table 27 Table No State/Ut Rural Hospital Urban Hospital Total Hospital Particular No of hospitals No of beds No of hospitals No of beds No of hospitals No of beds 17 Meghalaya 26 780 8 1839 34 2619 18 Mizoram 10 320 10 904 20 1224 19 Nagaland 123 1962 12 790 135 2752 20 Orissa 1623 5882 84 8668 1707 14550 21 Punjab 77 2100 172 8927 249 11027 22 Rajasthan 347 11850 128 20217 475 32067 23 Sikkam 29 700 3 820 32 1520 24 Tamil nadu 533 25078 48 22120 581 47198 25 Tripura 16 500 15 1762 31 2262 26 Uttar Pradesh 397 11910 528 20550 925 32460 28 West Bengal 99 5171 284 44510 383 49681 29 A and N Island 6 355 1 450 7 805 30 Chandigarh 2 50 5 2150 7 2200 31 D and N Haveli 1 30 1 130 2 160 31 Daman and Diu 2 52 2 140 4 192 32 Delhi 21 972 102 20220 123 21192 32 Delhi 21 972 102 20220 123 21192 33 Lakshadweep 5 160 NR NR 5 160 34 Pondicherry 4 110 12 3315 16 3425 Source: Note: Government hospitals include central government staff and local government bodies. Table shows that 1. Number of rural hospitals are highest in Orissa, 2. Number of urban hospitals are highest in Karnataka, 3. Number of beds in rural hospital are highest in Tamilnadu, 4. Number of beds in urban hospitals are highest in West Bengal, 28 5. Total Number of beds in rural and urban hospital are highest in West Bengal, 6. With regard to total number of beds in rural and urban hospitals, Gujarat stands fifth rank 7. It can be said that number of rural and urban hospitals andnumber of beds in rural and urban hospitals are varying significantly in different states of Gujarat, 9 Conclusion : India is a signatory to the Alma Ata declaration on Health for All by the year 2000 Here the government of India is committed to take all the necessary steps to achieve this goal therefore much more emphasis is given on analytical study of hospital management pattern of public care expenditure and determination of costs of expenditure. Hence hospital management concept should be properly understood, Hospital in a health care organization, where patient care is focal point and about which all activities of the hospital revolve. Application of management functions in a hospital is regarded as hospital management. Hospital management is a great concern to all because health is wealth. The concept of hospital is rapidly changing. In the present scenario, hospital is considered a corporate sector. There is wide range of hospitals, so hospitals can be classified in several manners. The hospital administrator like any other manager performs various roles, like role towards patients, role towards hospital organization and role towards community. So far as public hospitals are concerned, hospital services are emerging issues. Today`s hospitals are hi-tech organizations, furnished with hi-tech gadgets, as soon as the patients enter the main gate of the hospitals, there are modern sophisticated electronic devices for security check till he leaves the organization with electronic check out system. There is a sea change in the hospital scenario of new millennium. 29 References : 1. Dr. Mohammad Akbar Ali Khan, Hospital management , APH Publication Corporation New India, 1999, p 1 2. Ibid. 3. Family welfare programme in India, Ministry of Health and family welfare, New Delhi. 4. DC Joshi and Mamta Joshi, Hospital Administration, Jypee Brother Medical Publisher (p ) Ltd. Ahmedabad 2000,p 3. 5. Chandra Ballabh, Hospital Administration, Alfa Publication, 2007, New Delhi, p 1. 6. Ibid. 7. Ibid. 8. Ibid. 9. Opp, cit, Dr. Mohammad Akbar Ali Khan. 10. Hawalskantz, Esspatials of Management, 6th Edition M,grow, New Delhi,1999, p15 11. Prasad Principal and Practitioner of Management, S, chand& co, new Delhi,2006,p6. 12. Ibid. 13. Oppcit, Chandra ballabh, p 28. 14. Opp, Cit, Joshi and Mamta Joshi, p 26. 15. http:// 16. Opp, Cit, Joshi and Mamta Joshi, p 26 17. MustadHany An Intention Public Health, Mac Millan India Ltd, New Delhi, 1992 p 48. 18. Buero of Health Intelligence, DGHS, Govt. of India. 19. Ibid. 20. Ibid. 21. Ibid. 30 22. Ibid. 23. Ibid. 24. Ibid. 25. Sreenivas Tallas, Management of Hospital, Aph Publishing Corporation, New Delhi, 200. P 48. 26. Opp cit. Hawalskantz.

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