Hospital – Evolution, Types & Structure

Hospital – Evolution, Types & Structure

HOSPITAL

• A hospital is an institution providing medical, surgical, or psychiatric care and treatment for the sick or injured.
• WHO Definition: “A 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.”
• Modern hospitals are also involved in teaching and research activities.

HISTORICAL DEVELOPMENT OF HOSPITALS

a) Ancient Period

• India: Ayurveda-based care in ashrams and temples (e.g., Charaka and Sushruta period).
• Egypt & Greece: Temples served healing purposes.
• Rome: Military hospitals known as "valetudinaria".

b) Medieval Period

• Hospitals run by religious groups (churches, monasteries).
• Hospitals were often poorhouses or almshouses.

c) Modern Period

• Hospitals became more scientific post-18th century.
• Introduction of antiseptics, anesthesia, and diagnostic tools.
• Transition from religious to professional medical institutions.

d) Post-Independence Growth in India

• Bhore Committee Report (1946) laid the foundation of health infrastructure.
• Establishment of AIIMS (1956) and regional medical colleges.
• Expansion under National Health Mission (NHM).

GROWTH OF HOSPITALS IN INDIA

• Massive expansion post-1947.
• Increase in both public and private hospitals.
• Growth in multi-specialty, super-specialty, and corporate hospitals.
• Emphasis on medical education, healthcare quality, and public health programs.

PRESENT STATUS

• Over 70,000 hospitals and healthcare institutions across the country.
• Diverse ownership: government, trust-based, corporate.
• Increasing technology integration (telemedicine, EHR).
• Challenges include overcrowding, shortage of staff, health disparities.

ROLE OF HOSPITALS

1. Curative Care – Diagnosis and treatment.
2. Preventive Care – Immunization, health education.
3. Promotive Care – Nutrition, sanitation, lifestyle modifications.
4. Rehabilitative Care – Physiotherapy, mental health support.
5. Training and Education – For doctors, nurses, and allied health professionals.
6. Research and Innovation – New treatments, epidemiology studies.
7. Support to Public Health System – Surveillance, outbreak control.

ILL HEALTH FACTORS IN HOSPITALS

• Nosocomial (Hospital-acquired) Infections
• Iatrogenic diseases (illness caused by treatment).
• Psychological stress among patients due to environment.
• Medical errors and medication-related issues.
• Overcrowding and resource constraints.
• Staff burnout and absenteeism.

TYPES & CLASSIFICATION OF HOSPITALS

A) By Ownership

• Public Hospitals – Government funded (e.g., AIIMS).
• Private Hospitals – Owned by individuals/corporations.
• Voluntary/Charitable Hospitals – Trusts or NGOs.

B) By Objective/Function

• Teaching Hospitals – Linked to medical colleges.
• General Hospitals – Provide broad range of care.
• Specialty Hospitals – Focus on a single specialty (e.g., cancer, eye).

C) By Size

• Primary Level – PHCs, Community Health Centres.
• Secondary Level – District and Sub-district hospitals.
• Tertiary Level – AIIMS, PGIMER, etc.

D) By Length of Stay

• Short-Term/Acute Care – <30 days (e.g., surgery).
• Long-Term/Chronic Care – >30 days (e.g., rehabilitation).

E) By Management

• Central/State Government Hospitals
• Railway/ESIC/Defence Hospitals
• Corporate Hospitals (Apollo, Fortis, etc.)

HOSPITAL AS A SOCIAL SYSTEM

• A hospital is not just a medical unit, but a complex social system with interrelated components.

Features:

• Multiple interacting roles: doctors, nurses, administrators, patients.
• System governed by formal (rules) and informal (culture) structures.
• Influenced by external environment: community, politics, economy.
• Hospitals reflect social values and norms.
• Patient-centric culture and team dynamics play a key role.

PECULIARITIES OF HOSPITAL SYSTEM

1. Complex Structure: Multidisciplinary and hierarchical.
2. High Level of Specialization: Departments operate semi-independently.
3. Unpredictability of Workload: Emergency and seasonal variation.
4. Emotional Environment: Associated with illness, birth, death.
5. Dual Role: Patient care and academic/research work.
6. 24x7 Functioning: No closure, continuous operations.
7. High Accountability: Clinical, ethical, legal responsibilities.
8. Multiple Stakeholders: Government, society, insurance, patients, staff.

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