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II. Hospital Administration

1. Hospital objectives
● To furnish a safe and well maintained building and ground-- the ground must be
spacious, well drained and free from hazards that may cause injury to the user. It must be
located in an area where hygiene and sanitation can be observed and properly maintained
to ensure safety and aseptic conditions.
● To furnish adequate and safe equipment-- the selection of equipment must be based on
the purpose for which it is needed. It is not required that the instrument be the most
modern and sophisticated. In fact, it is more risky to use automatic apparatus as much as
the human element in their operation is eliminated. The equipment must be well
maintained and always functional.
● To exercise reasonable care in the-- governing board of the hospital must exercise care
and diligence in the selection of the hospital staff, otherwise, it will be held because
vicariously liable for the acts of the employees.

2. Types of hospitals
Classification of hospitals
● Ownership
● scope of services

Classification according to ownership

a. Government- hospital owned, established and created by law, facility
may be under the national government like the, the Department of Health (
DOH). Department of National Defense (DND). Philippine National
Police (PNP). Department of Justice (DOJ). State Universities and
Colleges (SUCs). Government Owned or Controlled Corporations
(GOCC) or Local Government Units (LGUs)
b. Private- hospital owned ,established or operated with funds through
donation, principal investment or other means by any individual, non-
government corporation, association or organization

Classification according to scope of services

a. General- a hospital that provides services for all kinds of illnesses,
diseases injuries or a general hospital shall provide medical and surgical
care to the sick and injured as well as maternity newborn and child care. It
shall be equipped with the service capabilities needed to support board
certified or eligible medical specialists and other licensed physicians
rendering service in, but not limited to, the following:
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I. Clinical services
1. family medicine
2. Pediatrics
3. internal medicine
4. obstetrics and gynecology
5. Surgery
II. Emergency services
III. outpatient services
IV. ancillary and support services, such as clinical laboratory, imaging
facility and pharmacy

Categories of general hospitals according functional capacity

Level 1 hospital
A Level 1 hospital shall have, as minimum, the following services and capacity:
● A staff of qualified medical, allied medical and administrative personnel headed
by a physician duly licensed by the professional regulation commission (PRC)
● Bed space for its authorized bed capacity in accordance with DOH guidelines in
the planning and designing of hospitals
● An operating room with a standard equipment and provision for sterilization of
equipment and supplies in accordance with the:
-DOH reference plan in the planning and designing of an operating room or
theatre
-DOH guidelines on cleaning, disinfection and sterilization of reusable medical
devices in hospital facilities in the Philippines
● A Post- operative recovery room;
● Maternity facilities, consisting of wards, rooms, and a delivery room exclusively
for maternity patients and newborns;
● Isolation facilities with proper procedures for the care and control of infectious
and communicable diseases as well as for the prevention of cross infection,
● a separate dental section or clinic
● a blood station
● A DOH- licensed secondary clinical laboratory with the services of consulting
pathologist,
● A DOH- licensed level 1 imaging facility with the services of a consulting
radiologist, and
● A DOH- licensed pharmacy

Level 2
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A Level 2 Hospital shall have as minimum, all of level 1 capacity, including ,but not limited to,
the following:
● An organized staff of qualified and competent personnel with chief of hospital or
medical director and appropriate board- certified clinical department heads:
● departmentalized and equipped with service capabilities needed to support board-
certified/ illegible medical specialists and other licensed physicians rendering services in
the specialties of medicine, pediatrics, obstetrics and gynecology, surgery, there sub-
specialties and ancillary services;
● a general intensive care unit (ICU) for critically ill patients;
● a neonatal intensive care unit (NICU)
● a high risk pregnancy unit (HRPU)
● provision of respiratory therapy services;
● A DOH- licensed tertiary clinical laboratory;and
● A DOH- licensed Level 2 imaging facility mobile x-ray inside the institution and with the
capability for contrast examinations

Level 3
A level 3 hospital have as minimum, all of level 2 capacity, including, but not limited to, the
following:
● Teaching and/ or train hospital with residency training program for physicians in the four
major specialties, namely: medicine, pediatrics, obstetrics and gynecology, and surgery;
● a physical medicine and rehabilitation unit;
● an ambulatory surgical clinic;
● a dialysis unit;
● a blood bank;
● A DOH-licensed Tertiary clinic laboratory with standard equipment/ reagents/ supplies
necessary for the performance of histopathology examinations; and
● A DOH- licensed level 3 imaging facility with interventional radiology

Services level 1 level 2 level 3

all level 1 plus: all level 2 plus:

clinical services for consulting departmentalized teaching or training

in- patients specialists in: clinical services services with
medicine pediatrics accredited
ob gyne residency training
surgery program in the four
major clinical
services
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emergency and respiratory unit Physical medicine

out-patients and rehabilitation
services unit

isolation facilities general icu

surgical or high risk ambulatory

maternity facilities pregnancy unit surgical clinic

Dental clinic NICU dialysis clinic

ancillary services secondary clinical tertiary clinical tertiary laboratory

laboratory laboratory with histopathology

blood station blood station Blood bank

first-level x-ray second level x-ray 3rd level x-ray

with mobile unit

pharmacy pharmacy pharmacy

3. Staffing
The staffing pattern of a hospital is determined based on:
- Assigned classification
- Bed Capacity
- Organizational structure of the Hospital

A. Medical Staff
- divided into general practitioners and specialists (surgeons, ENT specialist,
internist, obstetricians, radiologist, urologists, orthopedic, surgeons,
dermatologists and psychiatrists
-the number of general practitioners needed for each hospital is based on the ratio
of one general practitioner for every 1,000 population
-- The number and type of specialist required to staff a hospital are variable
depending on the services offered and the specialties and sub-specialties.

1. Medical Staff Positions

The Philippine hospitals’ standard for medical staffing is derived from the study entitled
“Developing Metrics for Hospital Medical Workforce Allocation” (Shannon, et al, 2007) which
is used internationally. DOH administrative Order No. 2012-0012 ( is added Rules and
regulations Governing New Classification of Hospitals and Health Facilities in the Philippines
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- In addition, the DOH Administrative Order No. 2012-0012 dated July 18,
2012 entitled “Rules and regulations Governing New Classification of
Hospitals and Health Facilities in the Philippines “ is used as reference.
- Based on the Shannon formula , DOH considered the last three years
average increase in in patient discharges and outpatient visits for each
level of hospital to determine the needed staff per level and bed capacity
of the hospitals.
- The total number of required medical staff on the sum of computer
number of medical specialists and medical officers . however , this does
not include the following :chief of medical service, had a head of the the
different department, medical specialist and medical officers of the
pathology department and medical specialists and medical officers of the
radiology department
2. Computation of additional medical staff for teaching and training hospital
● The number of resident physicians and interns will be governed by the
type of hospital or level of care delivered by a teaching and training
hospital; and the accreditations requirement of specialty societies
● the specialty requirements for because because training are the following:

Specialty Ratio

● Pediatrics

● Surgery

● Neurology

● Dermatology

● Nuclear medicine

● Anesthesiology

● Radiation oncology

● Obstetrics & gynecology

● Urology

● Otolangyngocology

B. Nursing Staff
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● Staffing of nurses is the largest and most crucial aspect of administration because the
quality of personnel and their performance will determine the degree of achieving the
goals of the Nursing Service.
● The goad of staffing is to provide the appropriate number and mix of nursing staff
(nursing care hours) The actual or projected care needs Comma average daily census and
hours of care provided For 24 hours a day , seven days a week.
● The nursing service staffing requirement shall adhere to the following staff-patient bed
ratio:

Unit Nurse to staff ratio

ward 1 supervising nurse ( nurse III): 50 beds per

shift

1 head nurse ( nurse II): 15 beds beds per shift

1 staff nurse (nurse i): 12 beds beds per shift

1 nursing attendant: 24 bed beds per shift

Critical care 1 supervising nurse ( nurse III): 30 beds per

shift

1 head nurse ( nurse II): 15 beds beds per shift

1 staff nurse (nurse i): 3 beds beds per shift

1 nursing attendant: 15 bed beds per shift

C. Other hospital professional personnel in indirect patient care services

● in general , units or sections needing 24 hours services will require a minimum of 5
personal to feel the 24 hours 7 days a week schedule following the 40 hour labor law
● with the operation of the DOH botikas, additional pharmacists are needed.
● In dispensing pharmacy , the ratio of pharmacists to administrative assistant ( pharmacy
assistant) is: 1 pharmacist: 2 administrative assistants.
● The requirement for other allied health personnel is determined based on the time and
motion study conducted by DOH’s National Center for Health Facility Development
(NCHFD). as the result of the study , the ratios of stuff to bed capacity in the following
units are indicated below:
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1. Pharmacy 1:25
2. nutritionist dietetics 1:60
3. medical social work 1:25
4. health information management 1:20
● in addition to the hospital administrator , there will be required assistance , clerks ,
bookkeepers, cooks , engineers , attendance , nursing aide , orderlies , janitor ,
maintenance crew and others so that the total hospital personnel will amount to
approximately two and one half for each occupied bed.
D. supplemental guidelines
1. the number and level of positions prescribed for each hospital category shall be the
maximum that will be allowed for the various organizational units. hospitals may adopt a
lesser number and lower levels of positions and/or merge different staff offices in the
internal management and support units , depending on their financial capability
2. hospital that qualify for the next higher category shell and of the corresponding
organizational structure and staffing pattern (OSSP) herein prescribed. however , the
hospital management has the option to adopt a leaner OSSP by merging the prescribed
organizational units or using lower level positions. if the authorized bed capacity of a
hospital falls between two of the specified bed capacities in the standard staffing pattern,
the higher set of standards shall be applied if the number of beds is in excess of one half
of their difference.
3. hospitals that are not qualified for upward categories may continue to adapt their existing
OSSP Provided that existing positions higher than those provided in the SP prescribed
for their appropriate category shall be abolished once vacated by their present
incumbents. hospitals may also be allowed to adopt the new OSSP prescribe for the
category that corresponds to their existing category approved by DOH
4. In the case of downward categorization, the hospital shall adopt the model OSSP for the
new category, provided that incumbents of positions higher than those prescribed shall
continue to retain their positions. Once vacated , the same will be abolished and replaced
by those appropriate under the new category.
5. the security , dietary and utility services may be contracted out in accordance with
pertinent guidelines.
6. The housekeeping , linen and laundry service may be contracted out but subject to
infection control mechanisms.
7. As an option , additional stopper approved specialty/ sub-specialty service may be
provided as part of the medical staff, contingent on the service capability of the
particular hospital and subject to the approval of the department of health. The number
of staff is not part of the regular staffing standards for level 3 hospitals.
● the standard is staffing pattern for each category of hospital and authorized bed capacity
are in shown below and in the succeeding pages
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4. Management and operation

Management
● Means to coordinate the effects of people to accomplish goals and objectives using
available resources efficiently and effectively.
● Comprises planning , organizing , staffing, leading or directing , and controlling an
organization or initiative to accomplish a goal.

LEVEL OF MANAGEMENT
● In organizations there are typically three levels of management; top level middle
level and first level.
● These three main levels of managers form a hierarchy, in which they are ranked
in order of importance.
● Most organizations, the number of managers at each level is such that the
hierarchy resembles a pyramid, with many more first level managers, fewer
middle managers, and the fewest managers at the top level.

TOP - LEVEL-MANAGERS
● They are also called senior management or executives.
● These individuals hold titles such as chief executive officer (CEO), Chief Financial
Officer,(CFO) Chief Operating Officer, Chief Information Officer, Chairman of the
Board, President, Vice President, and Corporate Head.
● Top-level managers make decisions affecting the entirety of the firm.
● They set goals for the organization and direct the company to achieve them.
● They are responsible for the performance of the organization and often these managers
have very visible jobS.

MIDDLE - LEVEL MANAGERS

● Are those in the levels below top managers

● Middle managers’ job titles includes: General manager, Plant Manager , Regions
manager and divisional managers
● They are responsible for carrying out the goals set by top management.
● They can motivate and assist first-line managers to achieve business objectives
● Middle managers may also communicate upward, by offering suggestions and feedback
to top managers
● They are more involved in the day-to-day workings of a company, they may provide
valuable information to top managers to help improve the organization bottom line
FIRST LEVEL MANAGERS
● Also called as low level managers, first line managers or supervisor
● These managers are responsible for the daily management of line workers- the
employees who actually produce the product or offer the service.
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● These managers have job titles such as; office manager ,shift supervisor, department
manager , foreperson, crew leader , and store manager
● although first level managers typically do not set goals for the organization , they have a
very strong influence on the company
● these are the managers that most employees interact with on a daily basis , and if the
managers perform poorly , employees may also perform poorly , may lack motivation , or
may leave the company

Operations management is the overall coordination of processes required for the

creation and distribution of products and services. For example, in the case of healthcare,
managing costs while delivering quality services is a major component of healthcare operations
management.

Understanding Operations Management in Healthcare

Healthcare is a diverse industry that includes institutions and practitioners that provide
services for the diagnosis, treatment, and prevention of injury, illness, disease, and other physical
and mental impairments. There is a wide variety of specialties that focus on specific treatments.

Healthcare is composed of primary, secondary, and tertiary care. Social and economic
conditions largely affect access to health care as do the policies and management of services. For
a healthcare system to function efficiently, necessary aspects include generous financing, a well-
trained and well-paid workforce, credible information on which policies can be structured, and
health facilities that are well-maintained and reliably managed.

Operations Managers and Cost Controls

One of the first areas of focus for operations managers is cost control. The current health-
care system overuses expensive, technological, and emergency-based treatment. High costs from
care often remain uncompensated due to uninsured patients. A prevalence of services in
expensive settings creates a burden on taxpayers, health insurance holders, and health-care
institutions themselves.

The goal for operations managers is to strike a balance between necessary high-tech
treatment and community centers that offer preventative services. Primary care institutions help
to avoid the need for expensive emergency services.

Cost controls affect the levels and quality of services provided to clients. Inefficiently
managed costs usurp budgets, limiting the technology and equipment that can be purchased and
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used to provide necessary services. Operations managers attempt to streamline costs and raise the
necessary funding to maintain adequate levels of care and quality of services.

5. Liabilities of hospitals
● Corporate liabilities and
● vicarious liabilities

Corporate liabilities- those arising from failure of the hospital to furnish accommodations and
facilities necessary to carry out its purpose or to follow in a given situation, the established
standard of conduct to which the corporation conform. Its corporate liabilities may arise from :
● Failure to furnish safe and well- maintained buildings and ground.
● failure to furnish safe and reliable equipment.
● recent decision of courts extends hospital liability for its failure to make selection of its
medical and nursing staff but also in granting special privileges in the use of the hospital
facilities by private physicians.
Vicarious liabilities ( for the acts of hospital employees)
a. nursing staff- a hospital is not only required to have qualified and reliable nurses but also
sufficient in number to maintain adequate services to the patient.
b. medical staff
● Interns- after completion of clinical clerkship, internship in any of the hospitals
approved by the board of medical education, is required before a person may be
qualified to take the final board examination. the quantity and quality of facilities
will determine the number of interns who may be allowed to undergo clinical
training in a hospital.
● resident physicians- resident physicians are medical graduates And juliana raised
to practice medicine. residency is usually training in a specific service or field of
medicine, like surgery, pediatrics obstetrics, etc. and a stepping stone to
specialization or general practice with special emphasis on a certain line of
medicine.
-Ordinarily, resident physicians are employees of the hospital. they are appointed
by the administration of the hospital, they are receiving their regular salary, they
are part of the staff of a specific department of a hospital and they are enjoying all
the social security benefits accruing to an employee.
- for any negligent act committed by them during the performance of their duties
and within the scope of the authority granted them during the performance of their
duties and within the scope of the authority granted them, the hospital maybe
vicariously liable. The principal and the consequences of “ borrowed servant”
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shall be applied in the negligent act was done when the resident physician was
under the supervision and control of another physician.

● Consultant- the code of ethics provides that “ in serious case which is

difficult to diagnose and treat, the attending physician should seek the
assistance of his colleagues in consultation”
- as a general rule, deafening position is not legally responsible for
the acts of the facilities he calls in to assist him in the management
of his patient. the specialist is an independent contractor and the
attending physician only acted as an agent of the patient, expressly
and impliedly in soliciting the service of the specialist.