HOSPITAL DESIGNING

Hospital viewed as a system: 2. Extramural functions

“A Collection of component subsystem which, INTRAMURAL EXTRAMURAL

operating together, perform a set of operations in FUNCTIONS OF A FUNCTIONS OF A
accomplishment of defined objectives.” HOSPITAL HOSPITAL
1. Restorative 1. Outpatient service
a) Diagnostic: these comprise 2. Home care service
Hospital as a Social System: the inpatient service 3. Outreach service
Socialists have considered hospital as a social system based on involving medical, surgical 4. Mobile clinics
and other speciality 5. Day care centre
bureaucracy, hierarchy and super-ordination subordination. It manifests
6. Night hospital
characteristics of a bureaucratic organisation with dual lines of authority 7. Medical care camps
that is; Administrative and Professional. b) Curative: Treatment of all
ailments
Components of a hospital system: c) Rehabilitative: Physical
mental and
Social
rehabilitation
d) Care of emergencies:
Accident as well as
disease

8. Preventive
a) Supervision of normal
pregnancies and child birth
b) Supervision of normal
growth and development of
children
c) Control of communicable
disease
d) Prevention of prolonged
illness
e) Health education
f) Occupational health
9. Educational
FUNCTIONS OF HOSPITALS 10.Research
The activities of the present day hospital can be divided into two distinct
types:

1. Intramural functions
 HOSPITAL DESIGNING
Determination of size of hospital A/C Bed capacity:
Levels of medical care: The size of a district hospital is a function of the hospital bed requirement,
which in turn is
Level of Medical facility a function of the size of the population served.
The groupings of populations around health facilities vary. A survey of
care
the Member States of
Primary Dispensary, primary health centre or
the Western Pacific Region revealed that primary health care facilities
subcentre generally serve communities
secondary District hospital (intermediate) or equivalent of 5000-10 000 people, and first-level referral hospitals generally serve
communities to 50 000-
500 000. In some countries, an intermediate level of primary health care
Tertiary Provincial or similar hospital (regional) facility exists, serving
populations of 10 000-50 000.
quaternary Institute of research and higher training One method that can be used to determine the number of beds is based on
superspecialist the expected patient load, as shown in the following
example:
CONCEPT OF REGINALISATION: Data collected:
Regionalisation is a system of technical and administrative Population of district
Average length of stay in hospital
decentralisation by establishment of “level of care”. The hospital would Annual rate of admissions
be strategically located in the region so that patient in need of its highly Computations:
specialised services could be readily referred to it. 150 000
5 days
I per 20 population
(I) Total number of admissions per year:
'" district population X rate of admission per year
'" 150 000 X 1120 '" 7500
(2) Bed-days per year:
'" total number of admissions per year x average length of stay in hospital
'" 7500 X 5 '" 37 500
The district hospital
(3) Total number of beds required when occupancy is 100%:
bed-days per year + 365 days
= 37 500 + 365 = 102.74
(4) Total number of beds required when occupancy is 80%:
bed-days per year + (365 X 80%)
= 128.42, say 130 beds

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WHO Regional Publications. Western Pacific Series No.4
DISTRICT HOSPITALS:
GUIDELINES FOR DEVELOPMENT
Second Edition