UNIT 18 DEFINITION A

CLASSIFICATION OF
HOSPITALS
Structure
18.0 Objectives
18.1 Introduction
18.2 Definitio~lof Hospital
18.3 C1nssiSic;ition of Hospitals
18.3.1 According to Directory ol' I-lospitals
18.3.2 According to Ow~~ershilj al~cl('onlrol
18.3.3 According to the Systems ol' Mcdicinc
18.3.4 According to the Becl Slrcngth
18.3.5 According ~o Clinical Basis
18.3.6 According t o Length 01'Stay ol' l'alicnls
18.4 Hospital as System
18.3.1 Functions ol' Hospital
18.3.2 I-lospitul C)lgallogram
18.3.3 Role ol' Hospi~nlin l'rimary I Ic;~llh( ' i ~

18.5 Let Us Sum Up

18.6 Answcrs to Check Yoiir P~*ogi.css

88.0 OBJECTIVES
AHer con~pletingthis illlit, be ;II)Ic to ~~n~lcrstillld:
yoti shol~l~l
e defi~zitionof a hospital;

e the classification or the various typcs ol' I~ospitnls;and

the hospital as a sysjenn.

18.1 INTRODUCTION
You must be fully familiarized with the hohpitals as you are profcssionnlly
brought up in the hospital environnlcnt wllilt: i~nde~.going gl-adtiation cou~~scs.
You must know how thc llosj~italsarc organiscd ;~uclwhat ;u.c its expected
functions. To mlderstand these uspccts you lllust be knowlcdgcable that how the
I~ospitalsevolved from cnrly civilizntio11 to moclern cra and also the classification
of hospitals by various ways. 111 this ~lnit,you will l c m all about the above
lnentioned aspects, i.e., definition of hospitals, clnssificntion ot' huspitals 2nd
hospital as a system.

18.2 DEFIlNITION OF HOSPITAL

The I-Iospital is an organisation that inobiiiscs the skills and efforts ol' widely
divergent group of professionals, semi-professional and non-proressional
personnel to provide highly pcrsonalised scrvices to individz~:ilpatients. Like
Optometry Practice other large organisations, hospital is established and designed t o pursue certain
objectives through collaborative activity. The main objective of the hospita1 is.
' of
course, to provide adequate care and treatment to its patients (within the limits
that may be imposed by the scarce resources and by extra-organisalio~~al forces).
Its principal products is medical, surgical and nursing service t o the patient, and
'
its central concern is the life and health of the patient. A hospital may, of course,
have additional objectives, including is own maintenance and survival,
organisational stability and growth, financial solvency, inedical and nursing
education and research and various employee-related objectives. But. all these
are subsidiary to the key objectives of service to the patient, which coilstitutes
the bnsic principle that underlies all activities in a hospital.
Various literatures while describing the origin of hospitals stated that religious
forces and institutions was the main force behind the development of hospitals
rather than the development in the medical services. It is at times difficult and
complex task to dissociate development of hospitals from religion 21s in some
cases like early Roman or Greek civilization, tenlples of Gods were utili/ed as
hospitals. But in 400 BC Hippocrates made it possible to separate n~edicinefrom
religion on rational grounds.
Modern hospitals are very complex socio-economic, scientific and highly labour-
oriented organisations. Still they owe their origin to the sufferings and ail~nents
of people and to the compassion and zeal amongst sonic ~~~~~~~~~~~~~~~~s, to
relieve these sufferers from annoy of suffering and discomfort.
Today hospital means an institution in which sick or injured persons are treated,
A hospital is different from a dispensary becanse hospital being primarily an
a institution where in-patients are received and treated while the maill purpose of a
dispensary is'distribution of medicine and administration outdoor reliet
There are many definitions of hospital available in literature and dictionaries, but
not a single definition is perfect in defining a modern hospital and its
multifarious services. Even wjth WHO, there is no proper defiilition available.
The WHO expert group has defined the role of hospital as:
WHO Defirution of Hospital
Hospital is an integral part of a social and medical organisation, the functions of
which arc to provide the population complete health care both curative and
preventive with out-patient services reaches out to the family in its own
environment and also to carry out training of health workers/functioi~ariesand
the bio-social research.
Other than this WHO definition, the definition given in the "Directoly of
Hospitals in India, 1988" is to some extent simple and short. According to this
definition. "A hospital is an institution which is operated for the medical surgical
and/or obstetrical care of in-patients and which is treated as a hospital by the
CentraliState Government/Local bodies or licensed by the appropriate authority".
 Dcfinitio~iand
2) Write True (T) of False (F) Classificatio~lof Hospitals

i) The main objective of the hospital is to provide

adecluate care and treatment to its patients. (TlF)
ii) Modern hospitals are not labour oriented organisations. (TF)
iii) A l~osyitaland il dispensary serves the saume piurpose. (TIP)

18.3 CILASSHFICATBON OP HOSPITALS

AS you h o w , there is no universally acccplccl method li,r clossificalion of
hospitals available. I n the yeiir I9X8 1.o~Lhc fir's1 lime an effort was made and it
was publislled in thc Directory of hosl:i':~ls in India. The Directory of Hospitals
in Illdia 1988 lists the vau-ious types ol hospilnls :und Lhc lypes of' management.
Based on this the hospilnls cun be classifictl in lnuny ways. They c;un be
classified accordillg to their ol?jcclivcs or aceorcling Lo the type of patient treatetl
01. accol.dirrg lo owncrsl~ip; u ~ t iconlrol. The variou5 comnlonly acccplcd criteria
for clasbification ol' the moderll hospitals iuc ;ls I'ollows:

18.3.1 According to Directory of I-lospitals

a) General Hospital: All cslublishn~cntspem~i~ncrltly sluf'fctl by at least two or
more medical officers, which can ol'l'ct in pi~tict~tnccommodutim and provide
active medical and nursing cau.c l'or nlorc rhan oruc culcgory oS rncdical
discipline (c.6.. gencl-ul mcdicinc, gclrclnl sir~.gc~+y,
obslctrics, palctliatrics elc.).

b) Rural Hospital: Hospihils locatcd in rur.ctl urcils (cla~ssificclhy Lhc Registsir

Gcne~.nlol' India) pcrm;u~entlysl:lSfcci by a1 Icilst ollc or more ~ ) h y s i ~ i i ~ ~ l s .
which offer in patients accommodatiorl ;inti pl3oviticmctlicul ant1 nursing cawc
for more thaun one caregory 01' nlcclicul cliscil)linc (c.g,, gcncri~lmcdicinc,
general surgery, okstelrics allti pactiialr.ics.).

c) Specialised Hospital: Hospiral provitlirlg rllcdical imd nursing c:u'e l x i ~ ~ ~ i ~ r i l y

fol- only orlc tlisciplinc or a specific tliscusclaf'l'cclion ol'onc S Y S ~ ~ I (c.g.,
II
tuberculosis, KNrI', eye, Icpl.osy, orthopi~ctlic,pilcdintsic, ~ i ~ ~ d ~ncnlnl,
ii~c,
cancel; inl'cctious disease, vcnel.cnl tliscnscs, motclnity, etc.). The spccialiseci
depxtments, i~drnillistrntivclyut~uclicclto ;I gcncrnl hospitol imd some lirncs
located in an annexu~cor scparalc w:ll-cl, m;uy hc cxcludccl il11tl thcir beds
shoi~ldnot be Considclcd in this cotcgolnyof spccialised hospitals.

cl) Teaching Hospital: A hospital to wllich n college is attachcd for medici~ll

dental education.

e) Isolation Hospital: This is a hoslilol for the curc ol' person sul'l'ering frorn
infectious disease rccluiring isolation oT 111c patients.

18.3.2 According to Ownership and Control

Hospitals can also be classified on the btusis 01' ownership and control. The
hospitals classified according to this zlre shown in Fig. 18.1. Few of' these types
are discilssed below:

a) Public Hospitals: Public hospitals ~lrclhosc run by the Central Govcmmcnl,

Stale Governments, Local Bodies and public sector undes1:lkings elc., on non
commercial lines. The hospitals may bc gcncral hospital or' specialised
hospitals or both. General hospilnls are those [hilt provide treatment for
comrnon diseases, whereas spccialiscd hospitals provide treatinent for specific
Optonletry Practice

Sector e.g e.g L.N.J.P Oriented

NTPC, Hospital
SAL, Coat Delhi State Hospital

Under Under

of Home

Army
Hosplal

Fig. 18.1: ~lassificatiunof hospilals on ownersliip co~itrolbasis

diseases like infectious diseases, cancer, cye diseases, psychiatric ailments.

etc., General hospitills can diagnose patients suffering from infectious
diseases, but refer tbein to infectious disease hospitals Tor hospitalisntioll as
general hospitals are not hlly equipped to treat infectious disease patients.

b) Voluntary Hospitals: Volui~taryhospitals are those which arc estnblishcd and

incorporated under the Societies ~egistrationAct, 1860 or Public Trust Act.
1882 or any other appropriate Acts of the Central or Stale Govemmcnts. Thcy
are run with public or piivate funds on a non-comnlercial basis. No part of the
profit of the voluntary hospital goes to the benefit of any member, truslee or to
any other individuals. Similarly, no member, tlustee or any other individual is
entitled to a share in the distribution of any of the corporate assets on
dissolution of the registered society, A board of trustees, usually comprising
prominent members of the community and retired senior officials of thc
government, manages such hospitals. The board appoints ,an administrator and
a medical director Lo lull such voluntay hospitals. These hospitals spend more
on patient care than what they receive from the patients. There is of late, a
trend among voluntay hospitals to charge reasonably high fees from'iich
patients and very little from poor patients. Whatever they earn from the iich
patients of the private wards is spend on the patients of general wards.
However, the main source of their revenue are public and private donations,
and grants-in-aid from the Central Government, the State Govewme~lts,and
from philanthropic organisations, both national and international. Thus,
voluntary hospitals run on a 'no profit no loss' basis.
c) Private Nursing Homes: Private nursing homes are generally owned by an
individual doctor or a group of doctors. They accept patients suffering from
infirnGty, advanced age, illness, injury, chronic disability, etc., or those who
are convalescing. They do not admit patients suffering from communicable
diseases, dtug-addiction or mental illness. These is, howevel; no uniform
'definition for nursing homes. The pkgase may refer to out-of home care
facilities that offer a range or services similar to many found in a hospital.
 These ~lursinghomes are run on a commercial basis. Naturally, the orclinary Defiriitioli and
citizens Lsually cannot :~TTordedLo get lnedical treatment there. However, Classificiptio~lof Hospitals
these nursing homes are becoming Inore and more popular due to the shortage
of government and volunlary hospitals. Secondly, wealthy patients do not
want to get Lreatl~ientat public l~ospitalsdue to long queues of patients and the
shortage of medical as well :IS nursing staff leading to lack of ~neclicaland
nursing care.

d) Corporate Hospitals: The latest concepl is of corlwrnte hospitals which are

public limited comp;unies lilrmecl under the Companies Act. They a1.e nol-mally
run of conimercinl lines. They can he cillicl. pcner:ll 01.!;pccialil;ccl o r both.

18.3.3 Accordilng to the Systenas of Mcdicilae

The hospitals in very broad terms may also he clussii'ictl accortling to tile syslclll
of medicine that is been praclicetl thcrc. lIcncc lhe Iiosl>itals:ire n:imccl ns
"Allopathic", "Homoeupathic". "Ay~irvcdic", "Natiiropathic", "Ununr. untl
"Siddha" etc.

118.3.4 According to the Bed Strength

Arbitrarily the hospitals can be cl:~ssilicd inlo I;\rgc, tncdium i11ill sn~nll,
depending upon the tlu~nberof hecls uv;~il:lhlc in thal hospital. Roughly any
hospital liaving more than 500 beds is a large h ~ h l ~ i l ione
~ l , having Lhc hcd
strength between 200 Lo 500 is u nlcdiu~nliospilal, :mil a hospilal having less
than 200 beds is a small liospilal.

18.3.5 According to Clinical Basis

A clinical classification of ho~piliilis iu1oL11cr. hnsis Ibr clossil'icution. Son~e
hospitals arc ternled as "General Hospitals" wl~crcusothc14s:\re "Spccinlisetl
Hospitals" according to the specialily it is tlcaling with, In n gcncral hospilal.
patients are treated for all kind of diseases hut in n'sneciulised hospili~l,patients
are treated only for those dise:wes for which hospitol l~ushcen set-up, such as
heart disease, cancer, eye, maternity, gaslro-mltcrology, neurology, psychiol~yetc.

18.3.6 According to Length of Stay of Patients

Hospitals can also be classified according to the length of stay of palients. A
patient may stay for a short-lenn in :l hospital in ~ h ccliseilses like gaslro-
enteritis, lever etc., or may stay Tor long-tesln Ihr thc trentment of diseascs snch
as tuberculosis, cancer, schizophrenia, etc. 'Sheref'c~re,a hospital may [all eitbcr
under the category of short-term or long-term (now known as acute and chronic-
care hospitals ~*espectively):wording to the period of stay in the hospital.
' Check Your Progress 2 i

1) Enumerate types of hospitals in India according to Direclaty of 1-1

India 1988.
Optometry Praclice a) Restorative or Curative

This includes diagnosis, treatment, rehabilitation and to provide emergency

medical care.

b) Prevention of Diseases and Promotion of Wealth

Supervision of MCH and fanlily welfare includes irnrnunisation, control of

various communicable and non-communicable diseases, health education.
Also liospital is a ceqtre where the health e&cation activity for the
community can be done very effectively. As the patients and their relatives are
in a right frame mind to accept and subsequently practice the preventive and
health promotive measures for the diseases from which they are suffering.
I

C) Surveillance Centre

Surveillance centrc for both communicable and non-communicable diseases

can also generate most reliable mortality and morbidity data for the area or
community 10 which this hospital is rendering its service.

d) Education and Resear&

Basic education, various inductions and in-service training programmes for

graduate and post-graduate doctors, nurses and other paramedical staff.

e) Professional Support

Intellectual and professional support need to be provided to medical -

practitioners at stipulated cost.

f) Early Detection Epidemics

Hospitals particularly the outpatient departments play a very important role in

early detection of the epidemic along with the definite geographical mapping
of that area and the population at risk. As the OPDs are the places where the
first patient of the potential epidemics usually anives well before the epidemic
is actually breaking out.

. g) Primary Heath Curb (PHC) Programme

To become a part of primary health care (PHC) programme, every hospital

need to take some role such as:

i) To provide support to PMC.

ii) To promote cornrnonity health development action.

iii) Basic and continuing education to workers engaged in PHC.

iv) Research on PHC (How to remove various socio-cultural barriers) etc.

The hospital should regard health as a value and focus on prevention, use of
appropriate technology, community involvement and multi-sectoral approach.
The strengthening of co-ordination through improved exchange of information
collected through passive surveillance by the hospital is an important aspect. The
value of information feedback with regard to referrals and coinrnunicable
diseases from the held to hospital and hospital to held is essential. Moreover it is.
,important foi undertaking epldemiologienl measure and saving the community
from lots of serious disease.
 Definition and
Classification of Haspitals
Hospital organisation is unique because of the various comp1exitic.s involved
therein. These complexities have been vxying with increasing interest of all
sections of society within the hospital. The complexity of the modern hospital
results from a number of attributes:

1) There is a wide diversity of objectives and goals for different personnel and
sub-system.

2) The diversity of personnel ranges from highly qualified and skilled physicians
to u~lslulledand uneducated employees. Enabling then1 to work as a team is a
challenge.

3) In many areas of hospital operation, there are dual lilies of au:hority.

Administrators arc responsible for solving 1: wide viu.iety of management
problems and physici:ms :re responsible for patient care education and
research. Often, these two secrningly distinct areas of activity overlap, and,
infact, some elllployees may have two or more persons to whom they are
responsible.

4) The problenls of life and death put wemendous pressure on administration and
functioning of hospitals.

5) The patient care rendered in the hospital has elutlcd precise measurements.

6) Simple management principles lilcc unity ol' command, order unity 01

objectives etc., become difficult t ~ i ~ p p in
l yclifl'elcnt situi~tions.

All these factors coupled with the special impostant of hospital, make it din'icult
to fit it into any of 1he tradifionnl organisation structures like line, line :~lldst;ifS
or functi&lal orga11is:ltions. In vicw ol' the fact that Ilospital l'unctioniuies cannot
avoid duality of controls at difl'erenl lcvcls ant1 the fact that simultaneously
vertical and horizontal controls :KC ncces5:uy li)r achieving the ol~.jectivcsof the
hospitals.
In the following pages the terlus 01' selscnccs ant1 rccomnlcndatims about 11cnlt11
care, nledical care and hospital m:unugenient spccirically contaillcd in thc reports
of some significant comnlittees are dcsc~.it)cdbsicHy.

18.4.3 Role i f Hospital in ~ r i r n a ;Health

~ Care
Hospital can play and should play a very iluportant and vital role Ihr providing
primary health case to the community. Even to the extent, it can give a leatlillg
role for providing primary health ciuc in ii give11area. T11c role of hospital in
primary health case could be better understood by knowing the health systems
operating in the 'area. It is based o n the li~llowingfactors:

I) The extznt to which population scrved by that hospital is well demurc:lted.

2) The number and size of other hospitnls availahlc in the area.

3) The type of ownership ofthe hospitals ilnd the intci.a.action between thcnl.

4) of hospital services in relation to cotnn~unityhealth

The level of develop~~letlt
needs and comprehensiveness oS the services.

5) The level of adequacy of scf'e~~:ll

arrangements.
Opto~netrgPractice The situation in the country is 4uch. that so far development of othcr health care
sub-systems are wenlier ~hanthe hospitals. This situation, to some extent, is
universal in all systems. The hospitals are too dominant, secondly too little
altention is p a d to thc links belwcen hospitals ancl primary health case and its
workerh in the fieltl. The institutions still lack co-ordinalion and clearly defined
sole boundarieh.
The situation is fur the^. cornplicatcd because most of the hospitals in Governnlent
sector are f'tcing the nlost severe fin;mcial and manpower problems, whereas the
hospitals in private sector though by and large are not having any such problelns
LO a greal extent, still they are not comlllitted for providing primary health care.
Hence, the question. for the Government hospitals, who we the milin providers
for primary health care, is not how thcy take newer roles but rather how they call
contain the cost and quality of scrvices and survive in their prcsent crisis.
Howcvel; the experiences or ditfercnt countries of the world can prov~decertain
insights into the possible roles which hospilals lilic to purslle lo t'~~ll'ill
the goals
of Health For All through primary health are. Tl~oscexperiences have shown
that.

I) Hospitals have played their part in heulth educalion and health promotion and
their exa~nplewill be of significance to heal111 promoters.

2) Commu~lityinvolverller~tis fundamental to thc primary health cnrc and il

applies to hospitals as much a:, to any other parts of the heallh system. But the
Icey issues ofcor~~munity participation are:

a) The kind of pmicipation to achicve the speciSic goals.

b) Who should participate from community?

c) The type and method of participation.

It requires radical change in the thinking of the medical professionals in the

hospital and close interaction with health care providers in non-
governmental and private voluntary organisations loo.

3) Hospitals can play a role in planning, co-ordination and even implementation

of at least such health programmes as:

a) Mother and child at risk.

b) Programnles requiring surgical assistance,

c) Single disease care programnles throwing cases for hospitalisatioii.

I
d) Referral load of cases detected during follow-up.

e) Diagnostic back-up services.

!
f) Specialist back-up services,

g) Sentinelle centre for imrnunisation programmes.

I

h) Passive surveillance centre for many diseases.

I

i) Logistic support for dmgs and other equipment.

II
4) In developing referral system as an integral part of the district health care i
system, referral is a critical problem. The movement of patients between the I
 different levels of health care is one of the aspects that effect the popula~ion Dennition iind
CItlssifici~tio~~
of Hospitals
most directly. The effectiveness of the systcm will depend on people's
confidence in the hospital system and in other levels of the system and tlle
persollnel working therein.

5) Providing technological supporl to dilferent levels of health care.

6) Extellding specialist consultation services to out-reach itreas i l l order 10

ullderstalld and prioiilise cornlnunity hoalth problcms iuld screen cases for
future health camps and referral.

~ h u s hospital
, as an institution might hcncl'it from being redefined as a
commullity health-orientcd institution which means that il is not only disease-
oricnled but has responsibilities in the field ol' henlth prevcnlion iund 17ronlolicjn
as well as acquires skull and pcrspcctivc aboul mol.e tlcvclopmcnt:~l asprcts of
prinlary heallh care and its miulag~mc~ll.
Check Your Progress 3
1) Enu~lieratethe five ~ n a j ol'unctions
~' of the hospit;~ls.

2). List the role of Hospivals ill Prirnwy Health Care.

18.5 LET US SUM UP

In this unit you have learnt about thc classil'ication of the hospitals. Towards the
end of this unit yo11 have leanlt about hospital us a syslem, its function, hospital
organogram and role the hospilals can play in p r i ~ n a ~hcalth
y case. In ncxt unil
you will Ieun about hospital organisation.

18.6 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
1) i) "HOSPITUM'"
ii) Medical, Social

Check Your Progress 2

1) General Hospital, Rural Hospital, Speciczlised Hospital, Teaching Hospitd,
Teaching Hospital, Isolation Hospital.
Optometry Practice 2) Central Government, Stale Governments, Local Bodies, Private, Autonomous
Body, Voluntary organisation.

3) Allopathic, Homoeopathic, Ayurvedic, Naturopathic, Unani and Siddha.

4) Large, medium and small.

5) General Hospitals and specialised Hospitals.

Check Your Progress 3

1) Curative, preventive and promotion, education and research, professional

support, surveillance centre.

2) Health Education, Specialist support, Diagnostic support. Logistic support,

Referral support, Surveillance centre.