Is the healthcare delivery providers part of the Healthcare Marketplace Specialization. This is Module 2.1.2, How are Hospitals Organized? Learning Outcomes of this lecture will be to review the organizational structure of a typical community based hospital and then discuss some of the external linkages that the hospital has with the rest of its community. Doctors of medicine or physicians, registered nurses. So, let's look at a typical hospital organizational structure and we'll start at typically with the board of directors at the top that has ultimate authority and responsibility. Under that comes, of course, the chief executive officer and under the chief executive officer is a layer of other senior leaders. So a chief medical officer, chief nursing officer, chief operations officer, chief financial officer. Sometimes, there are quality improvement folks. There's typically, a chief information technology officer and so on and so forth. Now under each of these folks, the physician structure would be various specialty physicians and departments would report up into the chief medical officer. The chief nursing officer would be responsible for all of the nursing departments, nursing education and the like. Chief operations officer is responsible for all of the various divisions within the hospital, the environmental services, the volunteers, sometimes therapy's and pharmacy, case management, social worker could be jointly owned here. Chief financial officer is responsible for everything to do with financials, accounting, coding, billing. Quality improvement, sometimes can be on it's own or sometimes can be jointly owned between the clinical leaders here. So typically, there is a quality reporting arm, there's a quality improvement arm. The chief information officer has everything to do with IT Information technology, information services, electronic health record. So typically, the org structure is aligned vertically with these various divisions, medical officer, nursing officer, operations, finance, quality improvement, information system and may more. For example, legal, compliance, legislative, lobbyists and many other. Let's take a little bit of a deep dive into the physician organization structure, because there are some nuances here. So the physicians can interact with the hospital, either by being employed by the hospital or by being independent. So the structure would change, depending upon if the physician is employed directly by the hospital and health system. So in that case, the chief medical officer would have line responsibility for all of the departments of the physicians. So, here will be a medical director for the emergency department and then underneath would be the all of the physicians. Medical director for lung respiratory and then all the physicians, and then so on, and so forth. In case the physicians are independent, then there is again, let's say, a lung physician here that would come to the hospital, to provide services, but reporting up into their own group or independent practice. And that's where the concept of a Medical Executive Committee becomes very important, because that is the committee that reports up into the board of directors. So if our reports up into the board of directors and its made up of all of these physicians, and the independent physicians, and that particular Medical Executive Committee is responsible to the board of directors. And also, responsible for the quality of care for continuous quality improvement and also for oversight of all of the physicians that practice at that particular hospital. Let's take a short quiz. Let's transition to thinking about how the services in hospital are laid out? So let's start with the typical gateway to a hospital, which is the emergency department. So Harland Reeves, for example, would enter the hospital, maybe be brought in through the ambulance. I would enter the hospital through the emergency department and inside the emergency department, our beds where patients are evaluated and treated. Some of the patients can be discharged out, some of the patients are admitted into the hospital. So let's say, the patient is admitted. So they become an inpatient, then they could go to many, many different places. So up on the unit, they're organized by units. Let's say, this patient needs surgery right away. So, they go into the operating room. And in here, they would have a surgeon, nurses, technicians that would perform surgery. So, there would be a lot of different operating rooms that would be working at the same time in a large hospital. After the surgery, the patient is then sent to another area of the hospital called the medical and surgical unit. If the patient was not sick to begin with, they could directly go and did not need surgery. So sick enough to be in the hospital, but not needing surgery. They would go directly into the medical surgical unit. And again, here they would beds and different units where the patients would be emitted. Let's say, after the surgery or in the ED, the patient is extremely sick and needs continuous monitoring, they would go into what's called the intensive care unit. So here, there would be a lot of nurses and other pharmacist and other physicians and technicians surrounding the patient. And so, these are typically how a particular hospital is laid out. There might be other services that are segregated. For example, psychiatry. For example, pediatrics or children's services. So, that's how patients flow through a typical hospital. After the patient gets better, then it is time to be discharged and that's the gate out. So that's the discharge time, the patient is able to go out and back into the community. Let's look at a couple of other services outside of the clinical areas that typically hospitals have. So as I said, there are many different units, ICU, ED, medical surgical units. But outside of that, there typically right next to the emergency department would be a radiology radiology department with x-ray, MRI and other radiology equipment. Also, typically, there is a lab where all of the specimens, blood tests from either the ED or inside the hospital can be sent. Also, there are a department, such as a physical therapy, respiratory therapy. There, typically is a pharmacy where medications are monitored and then dispensed. There's a decentralization of pharmacy now where medications that are evaluated here, but then they actually are sent back to the unit to be kept in the unit in a machine where nurses can come in and take them out and dispense them. So again, this is a typical layout of a typical a community based short-term acute care hospital. So, let's think about how the hospital is linked outside in the community. So, here is the hospital that we looked at. It would be linked to an ambulance division, either owned by the same system or serving the local area. Some of the hospitals are owned and controlled by counties and districts. The hospitals typically have connectivity with other hospitals. If they are smaller hospitals, they can send patients to the hospital or there are systems, for example, a State Trauma system where it's very hard wired. If a patient comes in here to the small hospital has had a lot of trauma would be transferred to a appropriate hospital or if the patient comes in here and needs more, might be transferred into a tertiary care hospitals. So again, there are dedicated linkages between various hospitals and systems. There are linkages between the ambulance. Sometimes, there are linkages with security and police. So again, the hospital is extremely well-connected with the community and the structures in the community that surround it. Another way of looking at the linkages would be thinking back to the accountable care organizations topic. So here's a hospital that is linked to the primary care clinics and there could be many of those, could be linked to home healthcare, would be linked to skilled nursing facility by virtue of being employed and owned and controlled by the same healthcare system. So again, this view of vertical integration. So, the system is getting vertically integrated. Sometimes, there's also horizontal integration. So, there's a couple of different hospitals in here. Maybe this one is a general hospital and maybe this one is a psych hospital or there might be other hospitals in the region that combine together and form a network of hospitals through mergers and acquisitions. So again, there could be vertical integration or there could be horizontal integration across services. In summary, hospitals have very complex organizational structures, both for human beings and also for the services they offer. And the hospitals are very well-connected and connected in different ways with their external environment, their communities and also the rest of the system that owns and employs them.
