December 22, 2012

MH0052 [Hospital Organisation Operations & Planning] Set2 Q6

Q6. Ms. Margret is the executive secretary to the CEO . She is sending an e-mail to the following group of people for a meeting that is pre-scheduled. 
i. Dr. Narayanan N - CEO
ii. Mr. Krishnamurthy P.K. – Hospital Administrator
iii. Dr. Kiran Kumar – Medical Superintendent
iv. Mrs. Lilly Ivan - Nursing Superintendent
v. Ms. Ramya Kumari – Assistant Administrator
vi. Mr. Robert Antony – CFO
vii. Mr. Sathyanarayan Nair – HR Head

Answer the following questions, based on the details given above:


a. Find out the name of the committee that Ms. Margret is calling for. [2 Marks]

b. What is the purpose of this committee? [4 Marks]
c. What are the specific functions of this committee? [4 Marks]

Ans:


Hospital Organizational Structure

An organization is a coherent combination of functions of a group or groups of people, who are united by a common purpose, by division of labour and function and through a hierarchy of authority and responsibility. 

A hospital organization is a systematic medical, non-medical, administrative and human resources activity that would impact the satisfaction of all its stake holders. Therefore, organizing is a process of clustering the responsibilities and activities into workable units, determining the lines of authority and communication and developing patterns of coordination. And each of these workable units needs to have constant interaction for effective functioning of the hospital. 

Organization structure in a hospital refers to the levels of management within the hospital. These levels will allow the efficient management of the individual departments. The structure will enable one to understand the chain of command. The organizational structure may vary from one hospital to the other depending on the goals and objectives and size of the hospital. The collective functions of the various departments work towards the ultimate goal of the hospital. Authority responsibility relationships should be clearly spelled. Clarity in the organizational relationship may contribute to increased productivity and reduced internal conflicts.

Functional Authority 
Figure 1 represents a pyramidal organizational hierarchy. It is a traditional organizational structure that clearly depicts the flow of authority and responsibility which is essential for delegation and accountability. 

Fig. 1: Pyramidal Organizational Hierarchies

Top management consists of: The Governing Board, CEO, and Management Team
Middle management consists of: Sr. Administrative executives, Department heads, Consultants, Nursing head, Managers
Supervisors consist of: Section heads, senior doctors, Nursing supervisors, Ward-incharges
Line workers consist of: Junior doctors, Staff nurses, Clerical staff, Housekeeping staff, and maintenance staff

An outstanding characteristic of a hospital is that it does not have a clear line of authority. Unlike other organizations, hospitals do not have a single line of authority, hence, the clutter. Sometimes it is a single line and sometimes it is a double or multiple lines. Since, hospitals have a medical line of authority and an administrative line of authority, devising an organizational chart for a hospital is significant and utmost care needs to be given. The medical services are headed by a Medical Director or Medical Superintendent and the administrative services are headed by the CEO / Administrator / General Manager based on the size of the organization. However, the ultimate authority in devising policies rests with the governing board or the policy making body. The dual lines of authority is clearly depicted in the figure 2. 

Fig. 2: Lines of authority

The two important and distinct functions of the hospital are:
1. Provision of clinical care:

  • Treatment procedures
  • Diagnostic procedures
  • Nursing care
  • Clinical support services 


2. Provision of non-clinical care:

  • Administration
  • Sanitation
  • Security
  • Stay facilities


The organizational structure of a hospital may vary depending on the goals and objectives and size of the hospital. Figure 1.5 is a sample organization structure of a hospital.


The organizational chart of a hospital may vary from one hospital to another depending on the following factors:
1. Classification and nature of the hospital
2. Objectives and goals of the hospital
3. It depends on the professional competency of the administration head. It might be different based on the fact whether the General Manager or the CEO has a medical background or not
4. Local community demand and needs, trends. 

Central Billing Department 

Introduction
The Central billing department plays an important role, as liaison office between the management and the patients, in addition to its prime duty of billing. The immense patience, human relations and hospitality is the need of the hour to alleviate the problems of patients who are in distress, as the words spoken and deeds undertaken by the staff working at this department project the theme of humanity. One of the commonest problems faced by the discharged patients at all hospitals is the delay in discharge due to slow bill generation. The same can be overcome or reduced to a great extent by computerization of billing system and having a user friendly hospital information system (HIS) in place.

Admission records of patients
The admission records with complete details pertaining to the patients admitted are sent to the Billing Office from the Central Admission Office, which are filed alphabetically to serve as information to the patients party to locate their patients easily at the enquiry counter.

Volume of work
On an average, 120 to 140 patients are discharged in a tertiary care referral hospital with bed occupancy of 80 percent. The bills generated by the billing department per day are approximately 120 to 140.

Organization of billing department
The overall administration of the hospital is the responsibility of the Medical Superintendent. For the effective and smooth functioning, the Billing Office has been placed under the Finance Executive, who looks after the financial matters and accounts of the hospital.

Documentation Procedure
Compilation of Billing Data
The Billing Office receives statement of investigation charges from various wards, laboratories, operation theatre and other departments every day at a set time every day. The charges are immediately fed into the computers in the respective patient files. This system enables the Billing Office to issue interim bills and weekly reminders to patients so as to initiate payment.

Discharge procedure for inpatients
Ward Patient is advised discharge
File moves from billing section to the receiving counter
Discharge procedure initiated at billing office.
Print out of checklist generated
Checking and coding of charges which are not entered
Final entry of charges
Generation of Bills
Final Scrutiny and Re-entry if necessary
Cash collection
Patient is discharged
Dispatch of bills to accounts department

Procedure of Billing
The files of the discharged patients are received from the wards at the Billing Office after proper scrutiny and are entered in the daily discharge register. The file along with a print out of a check list of charges is made available for coding after recording the date, time and the condition of the patient in the computer, as indicated in the files.

Coding of Investigation / Procedure / Operation Charges
The patients bills are prepared according to the rate list provided by the management. With the help of a check list and inpatient file, proper coding of the charges are carried out to find out the discrepancies in charges and also for appropriateness of the charges as it is the most essential aspect in billing procedure. After codification of charges the files are passed on for final entry and then the bills are generated.

Scrutiny of the Bills
Bills are scrutinized thoroughly for accuracy of the charges to avoid short billing and omission of charges by referring the files and clarifying the doubts from the concerned department. The bills are then sorted out and distributed to the respective counters for the completion of the assigned job of discharging the cases admitted under free ward, camp case, family planning and corporate referral companies etc.

Paying Inpatient Bill
For the convenience of the general and special ward patients cash counters are functioning separately where the payments can be made according to the status of the ward.

Remittance of the Cash
The cash collected against the bills is remitted to the bank once/twice in a day. This depends on the policy adopted.

Dispatching of the Bills
The bills after payment are assembled serially and dispatched to the Accounts Section, usually on the following day, to enable the hospital to maintain the accounts and to preserve the bills. This is subject to the policy adopted by the organization.

Procedure of Billing of Investigations / Procedures
The bills of the outpatient are generated in computers on the basis of the investigations/procedure prescribed by the doctors. The charges are levied as per the rate list provided by the management.

Billing of Procedures at Various Outpatient Departments
In large hospitals for the purpose of convenience to the patients billing counters may be located floor wise, though this is not advisable. Cash memo raised by the concerned OPD against the procedures and the special consultation is sent to the outpatient cash counter for payment.

Ascertaining of the X-ray Bill
The x-ray bill along with investigation slip should be produced by the patient at the x-ray counter which is scrutinized by the technician for appropriateness of the charges before taking x-ray. For any discrepancies in charges the bill should be redirected to the Central Cash Counter by the Radiology department for ascertaining and rectification of the charges.

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