ORGANIZATIONAL STRUCTURE of a HOSPITAL and MEDICAL STAFF
Organizational Structure of a Hospital
There is no doubt that modern day hospitals, in particular large teaching hospitals, are complex organizational structures. They are operated similar to large business corporations, albeit not for profit in most cases. A typical hospital is comprised of three elements that must be effectively integrated to ensure optimal patient care, they are; a well functioning governing body, and both highly trained and competent medical staff and hospital staff members.
Governing Body
The Board of Trustees or Board of Directors is the executive body that governs hospital organization. Members are carefully selected from the community. Although members often have a business or health background, a wide range of skills and talent are sought to fulfill the requirements of the Board. The Board is responsible for the establishment of the hospital’s by-laws and policies, enforcement of the Public Hospitals Act, according to the Regulations 729 and 965 concerning the management of a hospital. In a nutshell, the Board is ethically, financially and legally responsible for ‘everything’ in the day-to-day operations of a hospital.
The Board organizes itself into a variety of committees, including those that encompass financial activities, community relations, planning, quality assurance and personnel. It is also responsible for organizing medical, dental and midwife staff hospital privileges and duties. Board By-Laws provide details on the organization of the hospital management and administration, an occupational health and safety program, a health surveillance program, avenues for staff participation, organ and tissue donation policies and procedures and a fiscal advisory committee which offers recommendations on monies allocated to the operation of the hospital including staffing. Information regarding the London Health Sciences Centre's (LHSC) Administrative By-Law can be found here.
Hospital Administration
The organizational structure of a hospital generally consists of several layers. The Hospital Administrator or President is at the top of the hierarchy (directly under the Board) followed by a second level of department managers often designated as Vice-Presidents. Larger hospitals, such as LHSC, will include a third level of managers referred as Directors or Coordinators of various departments throughout the hospital.
The Hospital Administrator, also referred to as the Hospital Director, Executive Director, President, or Chief Executive Officer (CEO), is responsible for creating a vision and mission statement for the hospital and its day to day management. The Administrator also ensures that a budget is in place, maintains medical staff relations, reports to the Board of Trustees and carries out the directives set out by the Board of Trustees. The Administrator is the person who is ultimately responsibility for the staffing and operations of the hospital.
Second level managers typically include a minimum of three, including a COO, a CFO and a Director of Nursing who report directly to the Administrator. The Chief Operating Officer (COO) may instead be referred to as the Vice-President of Operations or Assistant Executive Director of Operations. The COO is the person who is responsible for daily the operations of the hospital. The Chief Financial Officer (CFO) may be referred to as the Vice-President of Finance or the Assistant Executive Director of Finance. The CFO is responsible for the financial management of hospital funds. The Director of Nursing (DON)may instead be given the title Associate Director of Nursing, Vice-President of Nursing, or Assistant Executive Director of Nursing. This person is in charge of supervising all patient care in the hospital. In some hospitals the DON reports to the COO or CFO instead of the Administrator.
Management/Structure
The number of additional levels of management at the second and third level is based on the size of the hospital, and the number and scope of services within it. The administrative structure has changed dramatically over the years. Hospitals today are organized in a variety of ways. The organizational structure is now tailored to the activities of the hospital and the capabilities of its individual departments. Although all have common elements, there is no longer one dominant organizational structure. Recent mergers of several hospitals in a geographical area (e.g. MHA) has added to the changes in management. It is critical to understand the importance of communication and collaboration among the various departments and sites.
Theory of Management
The two main types of management used in hospitals are Matrix Management and Product Line Management.
Matrix Management involves the emphasis of overlapping areas of responsibility and common areas of decision making amongst departments. This type of management helps to break down information "silos" and allows different departments, usually via committees, to communicate and work together on common goals.
Product Line Management is a theory that focuses on the end product or category of service provided. Individual managers are responsible for the entire "start to finish" process in their departments. This includes motivating employees to accomplish hospital wide goals.
Medical Staff Overview
The medical staff includes physicians (General Practitioners), dentists, psychologists, psychiatrists, podiatrists and specialty/sub-specialty physicians (e.g. Cardiologists). New medical staff are appointed by the Board of Trustees upon recommendation by the Medical Advisory Committee (MAC). The medical staff are organized into departments (e.g. internal medicine, surgery, family practice, obstetrics and gynecology, pediatrics). Clinical departments have a department head who oversees functioning of its department.
Clinical Department: Functions
The clinical departments of a hospital are responsible for establishing the standards of practice for their specialty, as well as providing continuing education, monitoring individual physicians’ performance, and providing a forum for the exchange of ideas and new techniques. The medical staff have a unique relationship with hospital in that most are not hospital employees but rather they are in private practice and therefore self-employed. The medical staff may be faculty members at a school of medicine (e.g. Western University). Those who are employees tend to be the Emergency Room doctors, Pathologists, Radiologists and physicians in charge of Infection Control.
Medical Staff: Organizational Structure
The medical staff are directly linked to the hospital organization. An elected Chief of (Medical) Staff serves as a liaison to hospital Administrator. The Administrator and Chief of Staff work together to resolve issues, achieve mutual goals and most importantly to provide optimal patient care.
Medical Staff: Designations
Members of the medical staff are given various titles dependent upon their education, hospital privileges and duties. For instance, Honorary Staff are physicians who have provided an exemplary or long-standing service to the hospital. However, they do not have attendance or voting privileges at committee (e.g. MAC) meetings. Consulting Staff do have attendance and voting privileges at committee meetings. They are also specialists (e.g. Surgeons) who are in good standing within their field. Active Staff comprise the main body of physicians in a hospital and are responsible for committee work and the administrative duties on behalf of the medical staff. Active Staff attend and treat their private patients as well as patients in clinics at the hospital. They have committee attendance and voting privileges. Associate Staff are newly appointed physicians for a set period of time. Their status will be changed to Active once their commitment to patient care is proven. Courtesy Staff are physicians, typically Family Practitioners, who are given the opportunity to attend to their own patients who have been hospitalized. They are able to attend committee meetings but may not vote or hold office. Residents are physicians who are completing post-graduate training (3-4 years) in a specific field of medicine (e.g. oncology, neurology, dermatology).
CHECKPOINT Question ONE: Visit the LHSC website ("About Us"). Search for the following: Who is the Hospital Administrator? What title is used for the Administrator at LHSC? How do you become a member of the Board of Directors? What are the Mission and Vision Statements of the hospital?
Organizational Structure of a Hospital
There is no doubt that modern day hospitals, in particular large teaching hospitals, are complex organizational structures. They are operated similar to large business corporations, albeit not for profit in most cases. A typical hospital is comprised of three elements that must be effectively integrated to ensure optimal patient care, they are; a well functioning governing body, and both highly trained and competent medical staff and hospital staff members.
Governing Body
The Board of Trustees or Board of Directors is the executive body that governs hospital organization. Members are carefully selected from the community. Although members often have a business or health background, a wide range of skills and talent are sought to fulfill the requirements of the Board. The Board is responsible for the establishment of the hospital’s by-laws and policies, enforcement of the Public Hospitals Act, according to the Regulations 729 and 965 concerning the management of a hospital. In a nutshell, the Board is ethically, financially and legally responsible for ‘everything’ in the day-to-day operations of a hospital.
The Board organizes itself into a variety of committees, including those that encompass financial activities, community relations, planning, quality assurance and personnel. It is also responsible for organizing medical, dental and midwife staff hospital privileges and duties. Board By-Laws provide details on the organization of the hospital management and administration, an occupational health and safety program, a health surveillance program, avenues for staff participation, organ and tissue donation policies and procedures and a fiscal advisory committee which offers recommendations on monies allocated to the operation of the hospital including staffing. Information regarding the London Health Sciences Centre's (LHSC) Administrative By-Law can be found here.
Hospital Administration
The organizational structure of a hospital generally consists of several layers. The Hospital Administrator or President is at the top of the hierarchy (directly under the Board) followed by a second level of department managers often designated as Vice-Presidents. Larger hospitals, such as LHSC, will include a third level of managers referred as Directors or Coordinators of various departments throughout the hospital.
The Hospital Administrator, also referred to as the Hospital Director, Executive Director, President, or Chief Executive Officer (CEO), is responsible for creating a vision and mission statement for the hospital and its day to day management. The Administrator also ensures that a budget is in place, maintains medical staff relations, reports to the Board of Trustees and carries out the directives set out by the Board of Trustees. The Administrator is the person who is ultimately responsibility for the staffing and operations of the hospital.
Second level managers typically include a minimum of three, including a COO, a CFO and a Director of Nursing who report directly to the Administrator. The Chief Operating Officer (COO) may instead be referred to as the Vice-President of Operations or Assistant Executive Director of Operations. The COO is the person who is responsible for daily the operations of the hospital. The Chief Financial Officer (CFO) may be referred to as the Vice-President of Finance or the Assistant Executive Director of Finance. The CFO is responsible for the financial management of hospital funds. The Director of Nursing (DON)may instead be given the title Associate Director of Nursing, Vice-President of Nursing, or Assistant Executive Director of Nursing. This person is in charge of supervising all patient care in the hospital. In some hospitals the DON reports to the COO or CFO instead of the Administrator.
Management/Structure
The number of additional levels of management at the second and third level is based on the size of the hospital, and the number and scope of services within it. The administrative structure has changed dramatically over the years. Hospitals today are organized in a variety of ways. The organizational structure is now tailored to the activities of the hospital and the capabilities of its individual departments. Although all have common elements, there is no longer one dominant organizational structure. Recent mergers of several hospitals in a geographical area (e.g. MHA) has added to the changes in management. It is critical to understand the importance of communication and collaboration among the various departments and sites.
Theory of Management
The two main types of management used in hospitals are Matrix Management and Product Line Management.
Matrix Management involves the emphasis of overlapping areas of responsibility and common areas of decision making amongst departments. This type of management helps to break down information "silos" and allows different departments, usually via committees, to communicate and work together on common goals.
Product Line Management is a theory that focuses on the end product or category of service provided. Individual managers are responsible for the entire "start to finish" process in their departments. This includes motivating employees to accomplish hospital wide goals.
Medical Staff Overview
The medical staff includes physicians (General Practitioners), dentists, psychologists, psychiatrists, podiatrists and specialty/sub-specialty physicians (e.g. Cardiologists). New medical staff are appointed by the Board of Trustees upon recommendation by the Medical Advisory Committee (MAC). The medical staff are organized into departments (e.g. internal medicine, surgery, family practice, obstetrics and gynecology, pediatrics). Clinical departments have a department head who oversees functioning of its department.
Clinical Department: Functions
The clinical departments of a hospital are responsible for establishing the standards of practice for their specialty, as well as providing continuing education, monitoring individual physicians’ performance, and providing a forum for the exchange of ideas and new techniques. The medical staff have a unique relationship with hospital in that most are not hospital employees but rather they are in private practice and therefore self-employed. The medical staff may be faculty members at a school of medicine (e.g. Western University). Those who are employees tend to be the Emergency Room doctors, Pathologists, Radiologists and physicians in charge of Infection Control.
Medical Staff: Organizational Structure
The medical staff are directly linked to the hospital organization. An elected Chief of (Medical) Staff serves as a liaison to hospital Administrator. The Administrator and Chief of Staff work together to resolve issues, achieve mutual goals and most importantly to provide optimal patient care.
Medical Staff: Designations
Members of the medical staff are given various titles dependent upon their education, hospital privileges and duties. For instance, Honorary Staff are physicians who have provided an exemplary or long-standing service to the hospital. However, they do not have attendance or voting privileges at committee (e.g. MAC) meetings. Consulting Staff do have attendance and voting privileges at committee meetings. They are also specialists (e.g. Surgeons) who are in good standing within their field. Active Staff comprise the main body of physicians in a hospital and are responsible for committee work and the administrative duties on behalf of the medical staff. Active Staff attend and treat their private patients as well as patients in clinics at the hospital. They have committee attendance and voting privileges. Associate Staff are newly appointed physicians for a set period of time. Their status will be changed to Active once their commitment to patient care is proven. Courtesy Staff are physicians, typically Family Practitioners, who are given the opportunity to attend to their own patients who have been hospitalized. They are able to attend committee meetings but may not vote or hold office. Residents are physicians who are completing post-graduate training (3-4 years) in a specific field of medicine (e.g. oncology, neurology, dermatology).
CHECKPOINT Question ONE: Visit the LHSC website ("About Us"). Search for the following: Who is the Hospital Administrator? What title is used for the Administrator at LHSC? How do you become a member of the Board of Directors? What are the Mission and Vision Statements of the hospital?