THE HOSPITAL AS A SOCIAL SYSTEM AND BUREAUCRACY IN HEALTH CARE

Question 1

•In our previous lecture, we learnt the various social organisations and their characteristics
•The hospital is one such social organisation
•This is because the hospital and for that matter healthcare is part of the health system with similar characteristics
•However, any hospital has a distinct role to perform
True or false

Answer 1

True

Question 2

What is the history of the hospital

Answer 2

• The word Hospital has been derived from the Latin word ‘HOSPES’ meaning ‘a host or guest’ or ‘hotel’, hostel.
• Some also believe that the origin of the hospital from the word ‘HOSPITUM’ a rest house for travelers or night shelter showing ‘hospitality’ to the guests.

Question 3

Explain eight characteristics of the hospital

Answer 3

According to World Health Organization:
“The ‘hospital is an integral part of a social and medical organization, the function of which is to provide the population complete healthcare, both curative and preventive, and whose out‐patient services reach out to the family in its home environment; the hospital is also a centre for the training of health workers and for bio‐social research.”

• Hospital is a social organization and a rational combination of the activities of a number of persons with different level of knowledge and skills for achieving a common goal of patient care through a hierarchy of authority and responsibility.

Hospital is a social organization and logical combination of the activities of a number of persons with different level of knowledge and skill for achieving a common goal of patient care through a hierarchy of authority and responsibility.

• Hospital as a social organization process through grouping the activities in workable units and connected by authority, communication and control.

Hospital organization is very peculiar and differs from other organizations. Hence called a ‘MATRIX’ organization.

• Hospital as a ‘MATRIX’ organization is a mix of product and function where people of similar skills are grouped together to execute activities to achieve organizational objective.
• In a hospital some part of the organization has scalar type of function while others are informally structured.

As a social organization the hospital provides patient care with a multi‐functional team comprising of people with different level of knowledge and skill.

• Hospital, an institution that is built, staffed, and equipped for the diagnosis of disease; for the treatment, both medical and surgical, of the sick and the injured; and for their housing during this process. The modern hospital also often serves as a centre for investigation and for teaching

Question 4

State seven key assumptions in the social systems model

Answer 4

Social systems are open systems.
•Social systems consists of interdependent parts, which interact
with each other and the environment.
•Social systems are goal oriented.
•Social systems are peopled.
•Social systems have structure.
•Social systems are political.
•Social systems have cultures.
•Social systems have norms.
•Social systems are conceptual and relative.
•All formal organizations are social systems, but not all social systems
are organizations.

Question 5

State and explain nine key elements of the hospital as a social system

Answer 5

Hospitals are social systems with the following key parts:

Structure: roles are expectations of positions that are arranged in a hierarchy.(bureaucratic expectations)

Individual: the individual is a key unit in any social system; regardless of position,
people bring with them individual needs, beliefs, and a cognitive understandings of the job. (Cognition and Motivation)

Culture: represents the unwritten feeling part of the organizations:its shared values
(Shared orientation)

Politics: formal and informal power relations that develop spontaneously.
(Power relations)

Core: the teaching-learning process is the technical core of schools.

Environment: everything outside the organization; source of inputs.

Outputs: the products of the organizations, e. g. healthy/treated clients.

Feedback: communication that monitors healthy/unhealthy habits.

Effectiveness: the equivalence between expected and actual outcomes.

Question 6

State three structures under public sector,private sector, traditional sector

Answer 6

Public:
Ghana health sector(government hospitals,poly clinics,health centers)
Teaching hospital
Quasi Government Institution Hospital

Private:private hospitals and maternity homes boards(mission based providers and private medical and dental practitioners)

Traditional:Traditional medical providers
Alternative medicine
Faith healers

Question 7

Administratively Ghana health service is organized at 3 levels
Name them

Functionally Ghana health service is organized at 5 levels
Name them

Answer 7

Administratively GHS is organized at 3 levels:
•National level
• Regional level
• District Level

Functionally GHS is organised at Five (5) Levels:
•National Level
•Regional Level
• District Level
•Sub-district Level
•Community Level

Question 8

•GHS is governed by a 12-member Council-The Ghana Health Service Council.
True or false

What are its functions

Answer 8

True

functions are:
•Ensure the implementation of the functions of the Service
•Submit to the Minister recommendations for health care delivery policies and programmes
•Promote collaboration between the Ministry of Health, Teaching Hospitals and the Service
•Advise the Minister on posts in the Service and other matters that the Minister may request

Question 9

At the national level how is GHs administratively organized

At the regional level how is GHS administratively organized

At the district level how is GHS administratively organized

Answer 9

National Level
•Ghana Health Service Council
•Office of the Director General and Deputy Director General
•Eight National Divisional Directors

Regional Level
•Regions are headed by Regional Directors of Health Services
•Supported by Regional Health Management Teams
•Regional Health Committees

Districts Level
•All districts are headed by District Directors of Health Services
•Supported by the District Health Management Teams
•District Health Committees
•Sub District Health Management Teams

Question 10

What is the structure of delivery of services in the regional and district administration

Answer 10

Structure of Delivery of Services
•At the regional level, curative services are delivered at the regional hospitals and public health services by the District Health Management Team (DHMT) as well as the Public Health division of the regional hospital. The Regional Health Administration or Directorate (RHA) provides supervision and management support to the districts and sub-districts within each region.

•At the district level, curative services are provided by district hospitals many of which are mission or faith based. Public health services are provided by the DHMT and the Public Health unit of the district hospitals. The District Health Administration (DHA) provides supervision and management support to their sub-districts.

Question 11

What are the functions and roles of district hospitals

Answer 11

Functions and Roles
•District hospitals are the facilities for clinical care at the district level. District hospitals serve an average population of 100,000–200,000 people in a clearly defined geographical area. The number of beds in a district hospital is usually between 50 and 60. It is the first referral hospital and forms and integral part of the district health system.
•A District Hospital should provide the following:
•Curative care, preventive care, and promotion of heath of the people in the district

Functions and Roles
•Quality clinical care by a more skilled and competent staff than those of the health centers and polyclinics
•Treatment techniques, such as surgery not available at health centers
•Laboratory and other diagnostic techniques appropriate to the medical, surgical, and outpatient activities of the district hospital
•Out patient and in-patient

Question 12

What’s re the functions and roles of polyclinic Centre’s

Answer 12

• They augment their service coverage with outreach services and refer severe and complicated conditions to appropriate levels.
• The polyclinic is the urban version of the rural health center.
• Polyclinics are usually larger, offer a more comprehensive array of services, are manned by physicians, and can offer complicated surgical services.
• They are mainly in metropolitan areas.

Question 13

What re the functions and roles at the sub district levels

Answer 13

At the sub-district level both preventive and curative services are provided by the health centers as well as out-reach services to the communities within their catchment areas.
•Basic preventive and curative services for minor ailments are being addressed at the community and household level with the introduction of the Community-based Health Planning and Services (CHPS).
•The role played by the traditional birth attendants (TBAs) and the traditional healers is also receiving national recognition.

Question 14

What re the functions and roles at the health centers

Answer 14

Health Centres
Functions and Roles
•The health center has traditionally been the first point of contact between the formal health delivery system and the client.
•It is headed by a Physician Assistant and staffed with program heads in the areas of midwifery, laboratory services, public health, environmental, and nutrition.
•Each health center serves a population of approximately 20,000.
•They provide basic curative and preventive medicine for adults and children as well as reproductive health services.

Question 15

State five role of the Physician Assistant in the healthcare delivery

Answer 15

Conduct complete physical examination

2. Take medical history
3. Diagnose and treat illnesses
4. Order and interprete diagnotic tests
5. Develop treatement plan
6. Educate and counsel patients on preventive care
7. Assess and record patients progress
8. Write prescriptions
9. Assist in surgery
10. Conduct or participate in outreach programme and many more!!

Question 16

Who developed the Bureaucratic theory
What does that theory say
What is bureaucracy

Answer 16

Bureaucratic Theory was developed by a German Sociologist and political economist Max Weber(1864-1920).
•According to him, bureaucracy is the most efficient form of organization. The organization has a well- defined line of authority.
•Bureaucracy simply means a rational form of organization.

Question 17

What was the world view of max weber

How many types of legitimate authority did he find and state em

Answer 17

His Worldview
•A social liberal
•nationalism based on classical republicanism
•capitalism where workers are educated and given political responsibility

• In his analysis of organisations, he identified three basic types of legitimate authority:
• Traditional
• Charismatic and
• Rational-legal authority

Question 18

What is legitimate authority

Answer 18

The concept of authority is distinguished from power.
•Power is a unilateral thing – it enables one person to force another to behave in a certain way, whether by means of strength or by rewards.
•Authority on the other hand, implies acceptance of rule by those over whom it is to be exercised.
•It implies that power may only be exercised within limits agreeable to subordinates.

Question 19

Explain the types of legitimate authority

Answer 19

Traditional - this is where acceptance of those in authority arises from tradition and customs (monarchies and tribal hierarchies)
•Charismatic – this is where acceptance arises from loyalty to and confidence in, the personal qualities of the ruler
•Rational-legal - this is where acceptance arises out of the office or position of the person in authority to bounded by the rules and procedures of the organisation.

Question 20

What are the principles of bureaucracy

Answer 20

Hierarchy
•Division of Labor
•Consistency
•Qualification
•Professional–Private Separation
•Devotion to Purpose
•Advancement / Seniority

Question 21

Explain hierarchy and division of labor as a principle of bureaucracy

Answer 21

• Authority and its flow
• subordination
• “Such a system offers the governed the possibility of appealing the decision of a lower office to its higher authority”

Specialization
•Separation of roles and duties
•“’higher’ authority [is not] authorized to take over the business of the ‘lower’”

Question 22

Explain consistency and qualification as a principle of bureaucracy

Answer 22

Rules regulate all matters “abstractly.”
•i.e. no one is special
•Management
•Duties
•The “Governed”

Training and qualification is the number one requisite.
•How to manage
•How to carry out duties
•Knowledge of the rules

Question 23

Explain separation of professional and private ,devotion to purpose and duty ,advancement and seniority as a principle of bureaucracy

Answer 23

The bureau is separate from the “private domicile of the official” (p. 51).
•resources
•time

Devotion is to your work and role, not to person above you.
•“[official] is not considered the personal servant of a ruler”

The unspoken agreement...
•you hang around
•you climb the ladder
•you get taken care of
•Salary and Pension

Question 24

What are the contributions of Max weber

Answer 24

Championed anti-positivism in sociology and study of public administration.
•Laid the descriptive groundwork for bureaucracy
•and the position/role of the state in government, politics and people’s lives
•Ever since then, public administration has studied what actually happens when you stick human beings into a bureaucracy.