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Health administration

Health administration, healthcare administration, healthcare management or hospital management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals,and hospital networks in all the primary, secondary, and tertiary sectors.

Terminology

Health systems management or health care systems management describes the leadership and general management of hospitals, hospital networks, and/or health care systems. In international use, the term refers to management at all levels.

In the United States, management of a single institution (e.g. a hospital) is also referred to as "medical and health services management", "healthcare management", or "health administration".

Health systems management ensures that specific outcomes are attained, that departments within a health facility are running smoothly, that the right people are in the right jobs, that people know what is expected of them, that resources are used efficiently and that all departments are working towards a common goal for mutual development and growth.

Hospital administrators

Hospital administrators are individuals or groups of people who act as the central point of control within hospitals. These individuals may be previous or current clinicians, or individuals with other healthcare backgrounds. There are two types of administrators, generalists and specialists. Generalists are individuals who are responsible for managing or helping to manage an entire facility. Specialists are individuals who are responsible for the efficient and effective operations of a specific department such as policy analysis, finance, accounting, budgeting, human resources, or marketing.

It was reported in September 2014, that the United States spends roughly $218 billion per year on hospital's administration costs, which is equivalent to 1.43 percent of the total U.S. economy. Hospital administration has grown as a percent of the U.S. economy from .9 percent in 2000 to 1.43 percent in 2012, according to Health Affairs. In 11 different countries, hospitals allocate approximately 12 percent of their budget toward administrative costs. In the United States, hospitals spend 25 percent on administrative costs.

Competencies

NCHL competencies that require to engage with credibility, creativity, and motivation in complex and dynamic health care environments.

Accountability
Achievement orientation
Change leadership
Collaboration
Communication skills
Financial Skills
Impact and influence
Innovative thinking
Organizational awareness
Professionalism
Self-confidence
Strategic orientation
Talent development
Team leadership
Training and organizations
Associated qualifications

Health care management is usually studied through healthcare administration or healthcare management programs in a business school or, in some institutions, in a school of public health.

North America

Although many colleges and universities are offering a bachelor's degree in healthcare administration or human resources,[6] a master's degree is considered the "standard credential"[8] for most health administrators in the United States. Research and academic-based doctorate level degrees, such as the Doctor of Philosophy (PhD) in Health Administration and the Doctor of Health Administration (DHA) degree, prepare health care professionals to turn their clinical or administrative experiences into opportunities to develop new knowledge and practice, teach, shape public policy and/or lead complex organizations. There are multiple recognized degree types that are considered equivalent from the perspective of professional preparation.

The Commission on the Accreditation of Healthcare Management Education (CAHME) is the accrediting body overseeing master's-level programs in the United States and Canada on behalf of the United States Department of Education. It accredits several degree program types, including Master of Hospital Administration (MHA), Master of Health Services Administration (MHSA), Master of Business Administration in Hospital Management (MBA-HM), Master of Health Administration (MHA), Master of Public Health (MPH, MSPH, MSHPM), Master of Science (MS-HSM, MS-HA), and Master of Public Administration (MPA).(Master of Hospital Management) (MHM)

Professional organizations

There are a variety of different professional associations related to health systems management, which can be subcategorized as either personal or institutional membership groups. Personal membership groups are joined by individuals, and typically have individual skills and career development as their focus. Larger personal membership groups include the Healthcare Financial Management Association, and the Healthcare Information and Management Systems Society. Institutional membership groups are joined by organizations; whereas they typically focus on organizational effectiveness, and may also include data sharing agreements and other medical related or administrative practice sharing vehicles for member organizations. Prominent examples include the American Hospital Association and the University Healthsystems Consortium.

History

Early hospital administrators were called patient directors or superintendents. At the time, many were nurses who had taken on administrative responsibilities. Over half of the members of the American Hospital Association were graduate nurses in 1916. Other superintendents were medical doctors, laymen and members of the clergy. In the United States, the first degree granting program in the United States was established at Marquette University in Milwaukee, Wisconsin. By 1927, the first two students received their degrees. The original idea is credited to Father Moulinier, associated with the Catholic Hospital Association.
The first modern health systems management program was established in 1934 at the University of Chicago.
At the time, programs were completed in two years – one year of formal graduate study and one year of practicing internship. In 1958, the Sloan program at Cornell University began offering a special program requiring two years of formal study,which remains the dominant structure in the United States and Canada today (see also "Academic Preparation").

Health systems management has been described as a "hidden" health profession because of the relatively low-profile role managers take in health systems, in comparison to direct-care professions such as nursing and medicine. However the visibility of the management profession within healthcare has been rising in recent years, due largely to the widespread problems developed countries are having in balancing cost, access, and quality in their hospitals and health systems.

Master of Health Administration

The Master of Health Administration (MHA or M.H.A.), or Master of Healthcare Administration, is a master's-level professional degree granted to students who complete a course of study in the knowledge and competencies needed for careers in health administration, involving the management of hospitals and other health services organizations, as well as public health infrastructure and consulting. Programs can differ according to setting; although practitioner-teacher model programs are typically found in colleges of medicine, health professions, or allied health, classroom-based programs can be found in colleges of business or public health.

Accredited programs of study typically require students to complete applied experiences as well as course work in areas such as population health, healthcare economics, health policy, organizational behavior, management of healthcare organizations, healthcare marketing and communications, human resource management, information systems management and assessment, operations assessment and improvement, governance, leadership, statistical analysis and application, financial analysis and management, and strategy formulation and implementation. The degree program is designed to give graduates of health disciplines (in particular) greater understanding of management issues and prepare them for senior management roles, and is awarded by many American, European, Australian, Indian and Sri Lankan (Post Graduate Institute of Medicine – University of Colombo)[1] universities. The degree traditionally focuses on health administration at the local, state, and federal level as well as in the nonprofit sector. This contrasts with the general Master of Business Administration or the Master of Public Administration degrees.

General

MHA programs are intended to provide students with the essential knowledge required for senior managerial and planning work in the health services and systems sectors. The objectives of the program are to develop graduates who are: competent general and financial managers, competent planners, knowledgeable about public health and the structure, organization and financing of health care systems, knowledgeable about society, law and ethics, and competent in quantitative skills. "Health care is a labor intensive industry, no doubt about it and it’s not likely to change in the near future. Leadership of this human capital is uniquely challenging because of the diversity of both the workforce and the customer base and because of the life and death nature of our work." - Dr. RuthAnn Althaus.

In most countries, applicants are required to hold, at minimum, a four year undergraduate degree and have a minimum period of professional experience in the health system. The curriculum, however, varies between universities.

United States

Although many colleges of business, public health, and/or health sciences in the United States have degrees with health administration content, only a minority have been accredited through the Commission on the Accreditation of Healthcare Management Education (CAHME), which is the only accreditor recognized by the United States Department of Education for these programs. In the same way the AACSB evaluates accreditation for MBA programs; CAHME accreditation requires programs to meet a set of standards related to areas such as program resources, faculty preparation, curriculum content, and post-graduation career success, and also helps to ensure that the programs are well integrated with the practice communities their graduates will work within.

Applicants to accredited programs are required to hold a four-year undergraduate degree prior to enrolling. Some universities offer dual MBA/MHA degrees with AACSB accreditation, or MBA/HOM degree programs, which may be completed concurrently or sequentially.

Some MHA programs do not require professional experience prior to enrollment; however, most programs require work experience, such as internships or fellowships, as part of their graduation requirements. Some MHA programs use a blended lecture and online format, allowing people to continue working while they pursue the MHA degree. There are also a few universities, including many for-profit universities, that offer Master of Healthcare Administration programs completely online; however, these programs are not currently eligible for CAHME accreditation because of concerns about the effectiveness of online programs as an analog for developing interpersonal and team-based skills which are more typically face-to-face in their use in post-graduation professional roles.

Most Master of Healthcare Administration-equivalent graduate programs in the United States are offered by schools of public health, business, allied health, or, less frequently, by schools of medicine. Programs in schools of public health or business tend to have a more 'traditional' structure; courses are typically taught by academicians and have a focus on theory as well as analysis. In the United States, the official academic honor society for Master of Healthcare Administration graduates is Upsilon Phi Delta.

Australia

In Australia the Master of Health Administration may be divided in two parts; the first part awards a graduate diploma of Health Service Management, and, depending on the outcome, diplomates may be permitted to continue to the second part which culminates in the Master of Healthcare Administration degree. Course structures, and be either research or coursework based. The Master of Health Administration is considered the benchmark qualification by the Australasian College of Health Services Management and the Royal Australasian College of Medical Administrators. Unlike elsewhere, the Master of Healthcare Administration is not intended primarily for medical practitioners (who have courses provided by their professional organisations) but is open to graduates of any discipline wishing to pursue a career in health administration. Owing to the wide variety of course nomenclature in Australia, some universities offer the course as a Master of Business(Health Administration), abbreviated to MBus(Hlth).

Healthcare Education

1.Upsilon Phi Delta

Upsilon Phi Delta (ΥΦΔ) is the national academic honor society for students in healthcare administration in the United States. The organization was formed in 1965 to further the profession of health administration and the professional competence and dedication of its members. It is administered by the Association of University Programs in Health Administration.

The name of the society is derived from the Greek words for "health," "care," and "administration." Its official colors are crimson red and cobalt blue and its official flower is the rose.

2.Professional degrees of public health

The Master of Public Health (M.P.H.), Master of Science in Public Health (MSPH), Master of Medical Science in Public Health (MMSPH) and the Doctor of Public Health (Dr.P.H.), International Masters for Health Leadership (IMHL) are interdisciplinary professional degrees awarded for studies in areas related to public health. The MPH degree focuses on public health practice, as opposed to research or teaching. Master of Public Health programs are available throughout the world in Schools of Public Health, Programs in Public Health, Medical Schools, and Schools of Public Affairs. MPH degrees, in addition to including a core curriculum, will usually also let students pursue a specialization in a specific field, such as epidemiology, biostatistics, or health management.

General

A professional degree is one that, based on its learning objectives and types of positions its graduates pursue, prepares students with a broad mastery of the subject matter and methods necessary in a field of practice; it typically requires students to develop the capacity to organize, analyze, interpret and communicate knowledge in an applied manner.

Master's degrees

In some countries the MPH program is only available for physician graduates (MBBS, MD, DO, or equivalent). In those countries, individuals without a medical degree may enter a Master of Science in Public Health (MSPH) or Master of Medical Science in Public Health (MMSPH) programs.

Doctorate degrees

The DrPH degree is for those who intend to pursue or advance a professional practice career in public health and for leaders and future leaders in public health practice. They face the particular challenge of understanding and adapting scientific knowledge in order to achieve health gain and results. This degree leads to a career in high-level administration, teaching, or practice, where advanced analytical and conceptual capabilities are required. The usual requirement for entry into this program is a master's degree in Public Health (MPH). The DrPH program develops in its candidates all competencies included in MPH programs, with increased emphasis on high level skills in problem-solving and the application of public health concepts.

India

In India, the MPH degree course is a two-year Post graduate course or a post graduate diploma of one year (DPH), approved by the Medical council of India, which is open to candidates with a bachelor's degree in any discipline from a recognized university, with at least 50% marks. But preference is given to applicants having a bachelor's degree in any of the health related fields - Medical, dental, pharmacy, physiotherapy, nursing, AYUSH and paramedical sciences; veterinary sciences and from management; natural sciences (incl. biology); social sciences and social work; statistics; engineering; law; commerce or accounting, communication etc. In some institutions preference will be given to MBBS doctors. Relevant work experience in health or development sector will be an advantage but not mandatory. In India, job opportunities for MPH graduates with a medical degree is generally good, but for others (non medical MPH graduates) it is not clear.

Specialization

The MPH degree in India is covers all major disciplines of public health including Environment and Health, Gender issues, Public Health Nutrition, Sexual and Reproductive Health but some institutes offer specialization such as Social epidemiology, Health Policy, Health and Development, Health System Management, Economics or Finance. .

Subjects

Topics covered during the course include Social Epidemiology including Chronic and Infectious disease Epidemiology, Biostatistics, Environmental and Occupational Health, Gender Issues in Health, Health Policy Analysis and Health Administration, Social and behavioral sciences, Health System Management, Sexual and Reproductive Health, Health and Development, Health Economics, Public Health Nutrition, National Health Programs, Medical Anthropology, Research Methodology, Public Health Ethics and Law.

Doctor of Health Administration

The Doctor of Health Administration (D.H.A.) is a research doctoral degree focused with the development of theoretical knowledge in health administration and on the applied application of the said knowledge in the field of health administration. The D.H.A. requires significant coursework beyond the masters level and a dissertation that contributes to knowledge or practice.

Description

The Doctor of Health Administration is a research degree, and is equivalent to the PhD in Health Administration. The only difference being that the DHA allows for either an applied application approach or a theoretical approach.

History

The Doctor of Health Administration was first introduced in the U.S. in the late 1990s at the Medical University of South Carolina as an advanced professional doctorate in health leadership.Prior to this the only D.H.A. degrees awarded were in Canada and Europe. The American version of this doctoral degree focuses on advanced professional knowledge and applied research in health administration, policy, and leadership.

New programs have been instituted at other universities providing substantial amounts of online coursework. Most D.H.A. students are working health professionals who seek doctoral education. Admission to the three year degree typically requires two years of coursework beyond the Masters Degree (i.e. M.H.A., M.P.A., M.S.A., or M.P.H.) and an applied or theoretical dissertation to be completed in the third year.

Program structure

Most D.H.A. programs require about 70 credit hours beyond the master's degree. Students are expected to take a number of core classes, electives, research/method classes, and dissertation credits. Candidates typically work with a committee and advisors throughout the process and the dissertation eventually requires an oral defense to the student's committee. Curricula may be offered on a full-time or part-time basis. The normal duration of a doctorate should correspond to 3–5 years of full-time graduate study or 7–10 years of sustained part-time graduate study.

Purpose

The Doctor of Health Administration program prepares health professionals to become innovative leaders and problem solvers within the healthcare industry. By blending the theoretical with the practical, the coursework of this advanced doctorate of health administration degree program provides students with the holistic knowledge needed to transition into careers that improve and influence healthcare administration systems.

Schools offering this degree
Schools of medicine & health sciences
A.T. Still University of Health Sciences
Medical University of South Carolina
University of Mississippi Medical Center
Non-medical & health sciences schools
Capella University
Central Michigan University
University of Phoenix
Walden University
Franklin University

Master of Public Administration

The Master of Public Administration (M.P.Adm., M.P.A., or MPA) is a professional graduate degree in public administration, similar to the Master of Business Administration but with an emphasis on the issues of governance.

Overview

The MPA program is a professional degree and a graduate degree for the public sector and it prepares individuals to serve as managers, executives and policy analysts in the executive arm of local, state/provincial, and federal/national government, and increasingly in non-governmental organization (NGO) and nonprofit sectors; it places a focus on the systematic investigation of executive organization and management. Instruction includes the roles, development, and principles of public administration; public policy management and implementation.

Through its history, the MPA degree has become more interdisciplinary by drawing from fields such as economics, sociology, law, anthropology, political science, and regional planning in order to equip MPA graduates with skills and knowledge covering a broad range of topics and disciplines relevant to the public sector. A core curriculum of a typical MPA program usually includes courses on microeconomics, public finance, research methods, statistics, policy analysis, managerial accounting, ethics, public management, geographic information systems (GIS), and program evaluation. MPA students may focus their studies on public sector fields such as urban planning, emergency management, transportation, health care (especially public health), economic development, community development, non-profit management, environmental policy, cultural policy, international affairs, and criminal justice.

MPA graduates currently serve in some important positions within the public sector including Prime Minister of Singapore Lee Hsien Loong, former UN Secretary General Ban Ki-Moon, former CIA Director David Petraeus, former president of Liberia Ellen Johnson Sirleaf, former president of Mexico Felipe Calderón, Foreign Minister of Serbia Vuk Jeremić, Chairman of the World Toilet Organization Jack Sim, former New York City Police Commissioner Raymond Kelly, former Secretary of Health and Human Services Kathleen Sebelius, current Treasurer of Australia Josh Frydenberg. Other notable MPA graduates include U.S. Representative Dan Crenshaw, Bill O'Reilly and pilot Chesley Sullenberger.

Master of Business Administration

The Master of Business Administration (MBA or M.B.A.) degree originated in the United States in the early 20th century when the country industrialized and companies sought scientific management.

The core courses in an MBA program cover various areas of business administration such as accounting, applied statistics, human resources, business communication, business ethics, business law, business strategy, finance, managerial economics, management, entrepreneurship, marketing, supply-chain management, and operations management in a manner most relevant to management analysis and strategy.

Most programs also include elective courses and concentrations for further study in a particular area, for example accounting, finance, and marketing. MBA programs in the United States typically require completing about forty to sixty credits (sixty to ninety in a quarter system), much higher than the thirty credits (thirty-six to forty-five in a quarter system) typically required for degrees that cover some of the same material such as the Master of Economics, Master of Finance, Master of Accountancy, Master of Science in Marketing and Master of Science in Management.

The MBA is a terminal degree and a professional degree. Accreditation bodies specifically for MBA programs ensure consistency and quality of education. Business schools in many countries offer programs tailored to full-time, part-time, executive (abridged coursework typically occurring on nights or weekends) and distance learning students, many with specialized concentrations.

Programs

Full-time MBA programs normally take place over two academic years (i.e. approximately 18 months of term time). For example, in the Northern Hemisphere they often begin in late August or early September of year one and continue until May or June of year two, with a three to four month summer break in between years one and two. Students enter with a reasonable amount of prior real-world work experience and take classes during weekdays like other university students. A typical full-time, accelerated, part-time, or modular MBA requires 60 credits (600 class hours) of graduate work.

Accelerated MBA programs are a variation of the two-year programs. They involve a higher course load with more intense class and examination schedules and are usually condensed into one year. They usually have less down time during the program and between semesters. For example, there is no three to four-month summer break, and between semesters there might be seven to ten days off rather than three to five weeks vacation. Accelerated programs typically have a lower cost than full-time two-year programs.

Part-time MBA programs normally hold classes on weekday evenings after normal working hours, or on weekends. Part-time programs normally last three years or more. The students in these programs typically consist of working professionals, who take a light course load for a longer period of time until the graduation requirements are met.

Evening (second shift) MBA programs are full-time programs that normally hold classes on weekday evenings, after normal working hours, or on weekends for a duration of two years. The students in these programs typically consist of working professionals, who can not leave their work to pursue a full-time regular shift MBA. Most second shift programs are offered at universities in India.

Modular MBA programs are similar to part-time programs, although typically employing a lock-step curriculum with classes packaged together in blocks lasting from one to three weeks.

Executive (part-time) MBA (EMBA) programs developed to meet the educational needs of managers and executives, allowing students to earn an MBA (or another business-related graduate degree) in two years or less while working full-time. Participants come from every type and size of organization – profit, nonprofit, government – representing a variety of industries. EMBA students typically have a higher level of work experience, often 10 years or more, compared to other MBA students. In response to the increasing number of EMBA programs offered, The Executive MBA Council was formed in 1981 to advance executive education.

Full-time executive MBA programs are a new category of full-time 1 year MBA programs aimed at professionals with approx. 5 years or more. They are primarily offered in countries like India where the 2-year MBA program is targeted at fresh graduates with no experience or minimal experience. These full-time executive MBA programs are similar to 1 year MBA programs offered by schools like Insead and IMD.

Distance learning MBA programs hold classes off-campus. These programs can be offered in a number of different formats: correspondence courses by postal mail or email, non-interactive broadcast video, pre-recorded video, live teleconference or videoconference, offline or online computer courses. Many schools offer these programs.

Blended learning programs combine distance learning with face-to-face instruction. These programs typically target working professionals who are unable to attend traditional part-time programs.

MBA dual degree programs combine an MBA with others (such as an MS, MA, MEng, or a JD, etc.) to let students cut costs (dual programs usually cost less than pursuing 2 degrees separately), save time on education and to tailor the business education courses to their needs. This is generally achieved by allowing core courses of one program count as electives in the other. Some business schools offer programs in which students can earn both a bachelor's degree in business administration and an MBA in five years.

Mini-MBA is a term used by many non-profit and for-profit institutions to describe a training regimen focused on the fundamentals of business. In the past, Mini-MBA programs have typically been offered as non-credit bearing courses that require less than 100 hours of total learning. However, due to the criticisms of these certificates, many schools have now shifted their programs to offer courses for full credit so that they may be applied towards a complete traditional MBA degree. This is to allow students to verify business related coursework for employment purposes and still allow the option to complete a full-time MBA degree program at a later period, if they elect to do so.

Admissions criteria

Many programs base their admission decisions on a combination of undergraduate grade point average, academic transcripts, entrance exam scores, a résumé containing significant work experience, essays, letters of recommendation, and personal interviews. Some schools are also interested in extracurricular activities, community service activities or volunteer work and how the student can improve the school's diversity and contribute to the student body as a whole.

The Graduate Management Admission Test (GMAT) is the most prominently used entrance exam for admissions into MBA programs. The Graduate Record Examination (GRE) is also accepted by almost all MBA programs in order to fulfill any entrance exam requirement they may have. Some schools do not weigh entrance exam scores as heavily as other criteria, and some programs do not require entrance exam scores for admission. In order to achieve a diverse class, business schools also consider the target male-female ratio and local-international student ratios. In rare cases, some MBA degrees do not require students to have an undergraduate degree and will accept significant management experience in lieu of an undergraduate degree. In the UK, for example an HND (Higher National Diploma) or even HNC (Higher National Certificate) is acceptable in some programs.

Depending on the program, type and duration of work experience can be a critical admissions component for many MBA programs.[30] Many top-tier programs require five or more years of work experience for admission.

MBA admissions consulting services exist to counsel MBA applicants to improve their chances of getting admission to their desired Business Schools. These services range from evaluating a candidate's profile, GMAT preparation, suggesting the schools to which they can apply, writing and editing essay, conducting mock interviews as preparation for MBA admission interviews, as well as post-MBA career counseling.

Nosokinetics

Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems. Nosokinetics brings together the Greek words for noso: disease and kinetics: movement.

Black box models are currently used to plan changes in health and social care systems. These input-output models overlook the process of inpatient care, as a result suboptimal decisions are made. Nosokinetics, (analogous to Pharmacokinetics), seeks to develop dynamic methods which measure and model the process of inpatient care. The aim is to develop a scientific base to underpin the planning of sustainable health and social care systems.

Establishment

Nosokinetics is a new science that was established in the UK in the early 1990s by Prof Peter H Millard after publishing his PhD thesis. In 2004 Nosokinetics group newsletter was established.

Origin

Prof Peter H Millard writes about Nosokinetics : "If the random forces of wind and tide can make such a beautiful statue (referring to an iceberg), how much better could mankind do if a new science was developed which explains the complex processes of health and social care. Until new methods of planning health and social care services to meet the needs of an ageing population are introduced, service delivery will stumble on from crisis to crisis. The world population is ageing and sustainable systems of health care need to be developed..

He has established the nosokinetics group of interested researchers. The group collaborates to organize conferences and disseminates news of nosokinetics and other researchers' research and practical use of modelling to enhance decision making in health and social care systems.

Network

The Nosokinetics Group has succeeded in attracting a lot of researchers. Nosokinetics interested people are present in many countries including Australia, UK & Egypt. They are from different disciplines ranging from health care providers to management scientists. The news related to nosokinetics is shared to the network through the bimonthly newsletter Nosokinetics News[3] which helps to communicate papers, conferences and events of interest to the Nosokinetics network.

Hospital

A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment.

The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care. Specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric treatment (see psychiatric hospital) and certain disease categories. Specialized hospitals can help reduce health care costs compared to general hospitals. Hospitals are classified as general, specialty, or government depending on the sources of income received.

Hospital in New York City is one of the world's busiest hospitals. Pictured is the Weill Cornell facility (white complex at the centre).

A teaching hospital combines assistance to people with teaching to medical students and nurses. A medical facility smaller than a hospital is generally called a clinic. Hospitals have a range of departments (e.g. surgery and urgent care) and specialist units such as cardiology. Some hospitals have outpatient departments and some have chronic treatment units. Common support units include a pharmacy, pathology, and radiology.

Hospitals are usually funded by the public sector, health organisations (for profit or nonprofit), health insurance companies, or charities, including direct charitable donations. Historically, hospitals were often founded and funded by religious orders, or by charitable individuals and leaders..

Currently, hospitals are largely staffed by professional physicians, surgeons, nurses, and allied health practitioners, whereas in the past, this work was usually performed by the members of founding religious orders or by volunteers. However, there are various Catholic religious orders, such as the Alexians and the Bon Secours Sisters that still focus on hospital ministry in the late 1990s, as well as several other Christian denominations, including the Methodists and Lutherans, which run hospitals.

In accordance with the original meaning of the word, hospitals were originally "places of hospitality", and this meaning is still preserved in the names of some institutions such as the Royal Hospital Chelsea, established in 1681 as a retirement and nursing home for veteran soldiers.

Etymology

The first five hospitals in world were built in Bagdad, Iraq. During the Middle Ages, hospitals served different functions from modern institutions. Hospitals in the Middle Ages were almshouses for the poor, hostels for pilgrims, or hospital schools. The word "hospital" comes from the Latin hospes, signifying a stranger or foreigner, hence a guest. Another noun derived from this, hospitium came to signify hospitality, that is the relation between guest and shelterer, hospitality, friendliness, and hospitable reception. By metonymy the Latin word then came to mean a guest-chamber, guest's lodging, an inn.

Hospes is thus the root for the English words host (where the p was dropped for convenience of pronunciation) hospitality, hospice, hostel and hotel. The latter modern word derives from Latin via the ancient French romance word hostel, which developed a silent s, which letter was eventually removed from the word, the loss of which is signified by a circumflex in the modern French word hôtel. The German word 'Spital' shares similar roots.

The grammar of the word differs slightly depending on the dialect. In the United States, hospital usually requires an article; in the United Kingdom and elsewhere, the word normally is used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both uses are found.

Type

Some patients go to a hospital just for diagnosis, treatment, or therapy and then leave ("outpatients") without staying overnight; while others are "admitted" and stay overnight or for several days or weeks or months ("inpatients"). Hospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others, which are smaller, are often described as clinics.

General and acute care

The best-known type of hospital is the general hospital, also known as an acute-care hospital. These facilities handle many kinds of disease and injury, and normally have an emergency department (sometimes known as "accident & emergency") or trauma center to deal with immediate and urgent threats to health. Larger cities may have several hospitals of varying sizes and facilities. Some hospitals, especially in the United States and Canada, have their own ambulance service.

District

A district hospital typically is the major health care facility in its region, with large numbers of beds for intensive care, critical care, and long-term care.

In California, "district hospital" refers specifically to a class of healthcare facility created shortly after World War II to address a shortage of hospital beds in many local communities.

Even today, district hospitals are the sole public hospitals in 19 of California's counties, and are the sole locally-accessible hospital within nine additional counties in which one or more other hospitals are present at substantial distance from a local community.

Twenty-eight of California's rural hospitals and 20 of its critical-access hospitals are district hospitals.
They are formed by local municipalities, have boards that are individually elected by their local communities, and exist to serve local needs.

They are a particularly important provider of healthcare to uninsured patients and patients with Medi-Cal (which is California's Medicaid program, serving low-income persons, some senior citizens, persons with disabilities, children in foster care, and pregnant women). In 2012, district hospitals provided $54 million in uncompensated care in California.

Specialized

Types of specialized hospitals include rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, long-term acute care facilities and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopedic problems, and so forth. In Germany specialised hospitals are called Fachkrankenhaus; an example is Fachkrankenhaus Coswig (thoracic surgery).

A hospital may be a single building or a number of buildings on a campus. Many hospitals with pre-twentieth-century origins began as one building and evolved into campuses. Some hospitals are affiliated with universities for medical research and the training of medical personnel such as physicians and nurses, often called teaching hospitals. Worldwide, most hospitals are run on a nonprofit basis by governments or charities. There are however a few exceptions, e.g. China, where government funding only constitutes 10% of income of hospitals. (need citation here. Chinese sources seem conflicted about the for-profit/non-profit ratio of hospitals in China)

Specialised hospitals can help reduce health care costs compared to general hospitals. For example, Narayana Health's Bangalore cardiac unit, which is specialised in cardiac surgery, allows for significantly greater number of patients. It has 3000 beds (more than 20 times the average American hospital) and in pediatric heart surgery alone, it performs 3000 heart operations annually, making it by far the largest such facility in the world. Surgeons are paid on a fixed salary instead of per operation; thus, the costs to the hospital drops when the number of procedures increases, taking advantage of economies of scale. Additionally, it is argued that costs go down as all its specialists become efficient by working on one "production line" procedure.

Teaching

A teaching hospital combines assistance to people with teaching to medical students and nurses and often is linked to a medical school, nursing school or university. In some countries like UK exists the clinical attachment system that is defined as a period of time when a doctor is attached to a named supervisor in a clinical unit, with the broad aims of observing clinical practice in the UK and the role of doctors and other healthcare professionals in the National Health Service (NHS).

Clinics

The medical facility smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

Departments or wards

Hospitals consist of departments, traditionally called wards, especially when they have beds for inpatients, when they are sometimes also called inpatient wards. Hospitals may have acute services such as an emergency department or specialist trauma center, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as the following:

Emergency department
Cardiology
Intensive care unit
Paediatric intensive care unit
Neonatal intensive care unit
Cardiovascular intensive care unit
Neurology
Oncology
Obstetrics and gynaecology, colloquially, maternity ward

In addition, there is the department of nursing, often headed by a chief nursing officer or director of nursing. This department is responsible for the administration of professional nursing practice, research, and policy for the hospital. Nursing permeates every part of a hospital. Many units or wards have both a nursing and a medical director that serve as administrators for their respective disciplines within that specialty. For example, in an intensive care nursery, the director of neonatology is responsible for the medical staff and medical care while the nursing manager/director for the intensive care nursery is responsible for all of the nurses and nursing care in that unit/ward.

Some hospitals have outpatient departments and some have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.

Common support units include a dispensary or pharmacy, pathology, and radiology. Hospitals also have a mortuary, where the dead are stored. On the non-medical side, there often are medical records departments, release of information departments, information management (a.k.a. IM, IT or IS), clinical engineering (a.k.a. biomed), facilities management, plant ops (operations, also known as maintenance), dining services, and security departments.

Funding

Modern hospitals are either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals also are still supported by the historical type of charitable or religious associations).

In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents, although free emergency care is available to anyone, regardless of nationality or status. As hospitals prioritise their limited resources, there is a tendency for 'waiting lists' for non-crucial treatment in countries with such systems, as opposed to letting higher-payers get treated first, so sometimes those who can afford it take out private health care to get treatment more quickly.

In some countries such as the US, hospitals typically operate privately and in some cases on a for-profit basis; for example, the multinational corporation Hospital Corporation of America operates hospitals across the country.

The list of procedures and their prices is called a chargemaster; however, these prices don't reflect the typical cost of the procedure, which is typically lower due to in-network negotiation.

Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after Hurricane Katrina in the USA), they incur direct financial losses, ensuring that there is a clear disincentive to admit such patients. In the United States, laws exist to ensure patients receive care in life-threatening emergency situations regardless of the patient's ability to pay.

Quality and safety

As the quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this matter. Independent external assessment of quality is one of the most powerful ways to assess this aspect of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international healthcare accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the US, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.

The World Health Organization noted in 2011 that going into hospital was far riskier than flying. Globally the chance of a patient being subject to an error was about 10% and the chance of death resulting from an error was about 1 in 300 according to Liam Donaldson. 7% of hospitalised patients in developed countries, and 10% in developing countries, acquire at least one health care-associated infection. In the USA 1.7 million infections are acquired in hospital each year, leading to 100,000 deaths, figures much worse than in Europe where there were 4.5 million infections and 37,000 deaths.

Architecture

The medical center at the University of Virginia shows the growing trend for modern architecture in hospitals.

The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian architecture of many modern hospitals

Hospital chapel at Fawcett Memorial Hospital (Port Charlotte, Florida)

Modern hospital buildings are designed to minimise the effort of medical personnel and the possibility of contamination while maximising the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimised. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.

However, many hospitals, even those considered "modern", are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:

"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."

Some newer hospitals now try to re-establish design that takes the patient's psychological needs into account, such as providing more fresh air, better views and more pleasant colour schemes. These ideas harken back to the late eighteenth century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.

The research of British Medical Association is showing that good hospital design can reduce patient's recovery time. Exposure to daylight is effective in reducing depression. Single-sex accommodation help ensure that patients are treated in privacy and with dignity. Exposure to nature and hospital gardens is also important – looking out windows improves patients' moods and reduces blood pressure and stress level. Open windows in patient rooms have also demonstrated some evidence of beneficial outcomes by improving airflow and increased microbial diversity. Eliminating long corridors can reduce nurses' fatigue and stress.

Another ongoing major development is the change from a ward-based system (where patients are accommodated in communal rooms, separated by movable partitions) to one in which they are accommodated in individual rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital; this causes some hospitals to charge for private rooms.

Burn center

A burn center, burn unit or burns unit is a hospital specializing in the treatment of burns.
Burn centers are often used for the treatment and recovery of patients with more severe burns.

The severity of a burn, and therefore whether a referral will be made after the patient is treated and stabilized, differs depending upon many factors, among them: the age of the victim (burns to infants and toddlers or to those over age 65 are generally more serious, particularly if the face, head, respiratory system, chest, abdomen, groin, or extremities are burned; those who are not in these age groups can be more affected if they are or were already ill, injured, or immunocompromised), the total body surface area that is burned (the rule of nines), if proper treatment and referrals are delayed or the wrong treatments are given, if the burns are of the 2nd, 3rd, or 4th degree (the bigger and deeper, the worse it is), the source (if it was due to a chemical, or from a scald, or fire, or radiation, the treatment regimen has to be modified appropriately), or if skin grafting is not feasible and/or important organs are harmed.

Burn centers need a team approach for the management of critically burnt patient. Usually the burns management team consists of plastic surgeon, intensivist, chest physician, general surgeon, pediatrician, nurses and technicians, microbiologist, psychiatrist, nutritionist, physiotherapist and a social worker. Early burn wound excision and immediate wound cover can improve the chances of survival in major burn cases.

Hospital information system

A hospital information system (HIS) is an element of health informatics that focuses mainly on the administrational needs of hospitals. In many implementations, an HIS is a comprehensive, integrated information system designed to manage all the aspects of a hospital's operation, such as medical, administrative, financial, and legal issues and the corresponding processing of services. Hospital information system is also known as hospital management software (HMS) or hospital management system.

Hospital information systems provide a common source of information about a patient's health history.
The system has to keep data in a secure place and controls who can reach the data in certain circumstances. These systems enhance the ability of health care professionals to coordinate care by providing a patient's health information and visit history at the place and time that it is needed. Patient's laboratory test information also includes visual results such as X-ray, which may be reachable by professionals. HIS provide internal and external communication among health care providers.

Portable devices such as smartphones and tablet computers may be used at the bedside.

Hospital information systems are often composed of one or several software components with specialty-specific extensions, as well as of a large variety of sub-systems in medical specialties from a multi-vendor market. Specialized implementations name for example laboratory information system (LIS), Policy and Procedure Management System, radiology information system (RIS) or picture archiving and communication system (PACS).

Potential benefits of hospital information systems include:

Efficient and accurate administration of finance, diet of patient, engineering, and distribution of medical aid. It helps to view a broad picture of hospital growth.
Improved monitoring of drug usage, and study of effectiveness. This leads to the reduction of adverse drug interactions while promoting more appropriate pharmaceutical utilization.
Enhances information integrity, reduces transcription errors, and reduces duplication of information entries.
Hospital software is easy to use and eliminates error caused by handwriting. New technology computer systems give perfect performance to pull up information from server or cloud servers.

Health informatics

Health informatics (also called health care informatics, healthcare informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics) is information engineering applied to the field of health care, essentially the management and use of patient health care information. It is a multidisciplinary field that uses health information technology (HIT) to improve health care via any combination of higher quality, higher efficiency (spurring lower cost and thus greater availability), and new opportunities. The disciplines involved include information science, computer science, social science, behavioral science, management science, and others. The United States National Library of Medicine (NLM) defines health informatics as "the interdisciplinary study of the design, development, adoption and application of IT-based innovations in health care services delivery, management and planning".

It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and bio-medicine. Health informatics tools include computers, clinical guidelines, formal medical terminologies, and information and communication systems, among others.

It is applied to the areas of nursing, clinical medicine, dentistry, pharmacy, public health, occupational therapy, physical therapy, biomedical research, and alternative medicine,all of which are designed to improve the overall effectiveness of patient care delivery by ensuring that the data generated is of a high quality.

The international standards on the subject are covered by ICS 35.240.80 in which ISO 27799:2008 is one of the core components.

Subspecialities

Health care informatics includes sub-fields of clinical informatics, such as pathology informatics, clinical research informatics (see section below), imaging informatics, public health informatics, community health informatics, home health informatics, nursing informatics, medical informatics, consumer health informatics, clinical bioinformatics, and informatics for education and research in health and medicine, pharmacy informatics.

Computational health informatics

Computational health informatics is a branch of computer science that deals specifically with computational techniques that are relevant in health care. Computational health informatics is also a branch of health informatics, but is orthogonal to much of the work going on in health informatics because computer scientists' interest is mainly in understanding fundamental properties of computation. Health informatics, on the other hand, is primarily concerned with understanding fundamental properties of medicine that allow for the intervention of computers. The health domain provides an extremely wide variety of problems that can be tackled using computational techniques, and computer scientists are attempting to make a difference in medicine by studying the underlying principles of computer science that will allow for meaningful (to medicine) algorithms and systems to be developed. Thus, computer scientists working in computational health informatics and health scientists working in medical health informatics combine to develop the next generation of health care technologies.

Using computers to analyze health data has been around since the 1950s, but it wasn't until the 1990s that the first sturdy models appeared. The development of the Internet has helped develop computational health informatics over the past decade. Computer models are used to examine various topics such as how exercise affects obesity, health care costs, and many more.

Examples of projects in computational health informatics include the COACH project.

Informatics for education and research in health and medicine

Clinical research informatics

Clinical research informatics (CRI) is an amalgamation of clinical and research informatics. Featuring both clinical and research informatics, CRI has a vital role in clinical research, patient care, and the building of health care system (Katzan & Rudick, 2012). CRI is one of the rapidly growing subdivisions of biomedical informatics which plays an important role in developing new informatics theories, tools, and solutions to accelerate the full transitional continuum (Kahn & Weng, 2012). Evolution of CRI was extremely important in Informatics as there was an extraordinary increase in the scope and pace of clinical and translational science advancements (Katzan & Rudick, 2012). Clinical research informatics takes the core foundations, principles, and technologies related to Health Informatics, and applies these to clinical research contexts.

As such, CRI is a sub-discipline of health informatics, and interest and activities in CRI have increased greatly in recent years given the overwhelming problems associated with the explosive growth of clinical research data and information.

There are a number of activities within clinical research that CRI supports, including:

more efficient and effective data collection and acquisition.
improved recruitment into clinical trials.
optimal protocol design and efficient management.
patient recruitment and management.
adverse event reporting.
regulatory compliance.
data storage, transfer, processing and analysis.
repositories of data from completed clinical trials (for secondary analyses).

Law

Health informatics law deals with evolving and sometimes complex legal principles as they apply to information technology in health-related fields. It addresses the privacy, ethical and operational issues that invariably arise when electronic tools, information and media are used in health care delivery. Health Informatics Law also applies to all matters that involve information technology, health care and the interaction of information. It deals with the circumstances under which data and records are shared with other fields or areas that support and enhance patient care.

As many health care systems are making an effort to have patient records more readily available to them via the internet, it is important that providers implement security standards in order to ensure that the patients' information is safe. They have to be able to assure confidentiality, integrity, and security of the people, process, and technology. Since there is also the possibility of payments being made through this system, it is vital that this aspect of their private information will also be protected through cryptography.

The use of technology in health care settings has become popular and this trend is expected to continue. Various health care facilities had instigated different kinds of health information technology systems in the provision of patient care, such as electronic health records (EHRs), computerized charting, etc.

The growing popularity of health information technology systems and the escalation in the amount of health information that can be exchanged and transferred electronically increased the risk of potential infringement in patients' privacy and confidentiality.

This concern triggered the establishment of strict measures by both policymakers and individual facility to ensure patient privacy and confidentiality.

One of the federal laws enacted to safeguard patient's health information (medical record, billing information, treatment plan, etc.) and to guarantee patient's privacy is the Health Insurance Portability and Accountability Act of 1996 or HIPAA.

HIPAA gives patients the autonomy and control over their own health records.

Furthermore, according to the U.S. Department of Health & Human Services (n.d.), this law enables patients to:

view their own health records.
request a copy of their own medical records.
request correction to any incorrect health information.
know who has access to their health record.
request who can and cannot view/access their health information.
Health and medical informatics journals

Computers and Biomedical Research, published in 1967, was one of the first dedicated journals to health informatics. Other early journals included Computers and Medicine, published by the American Medical Association; Journal of Clinical Computing, published by Gallagher Printing; Journal of Medical Systems, published by Plenum Press; and MD Computing, published by Springer-Verlag. In 1984, Lippincott published the first nursing-specific journal, titled Journal Computers in Nursing, which is now known as Computers Informatics Nursing (CIN).

As of September 7, 2016, there are roughly 235 informatics journals listed in the National Library of Medicine (NLM) catalog of journals.

The Journal Citation Reports for 2018 gives the top three journals in medical informatics as the Journal of Medical Internet Research (impact factor of 4.945), JMIR mHealth and uHealth (4.301) and the Journal of the American Medical Informatics Association (4.292).

Information system

An information system (IS) is a formal, sociotechnical, organizational system designed to collect, process, store, and distribute information.
In a sociotechnical perspective, information systems are composed by four components: task, people, structure (or roles), and technology.

A computer information system is a system composed of people and computers that processes or interprets information.

The term is also sometimes used in more restricted senses to refer to only the software used to run a computerized database or to refer to only a computer system.

Information Systems is an academic study of systems with a specific reference to information and the complementary networks of hardware and software that people and organizations use to collect, filter, process, create and also distribute data. An emphasis is placed on an information system having a definitive boundary, users, processors, storage, inputs, outputs and the aforementioned communication networks.

Any specific information system aims to support operations, management and decision-making.
An information system is the information and communication technology (ICT) that an organization uses, and also the way in which people interact with this technology in support of business processes.

Some authors make a clear distinction between information systems, computer systems, and business processes. Information systems typically include an ICT component but are not purely concerned with ICT, focusing instead on the end use of information technology. Information systems are also different from business processes. Information systems help to control the performance of business processes.

Alter argues for advantages of viewing an information system as a special type of work system. A work system is a system in which humans or machines perform processes and activities using resources to produce specific products or services for customers. An information system is a work system whose activities are devoted to capturing, transmitting, storing, retrieving, manipulating and displaying information.

As such, information systems inter-relate with data systems on the one hand and activity systems on the other. An information system is a form of communication system in which data represent and are processed as a form of social memory. An information system can also be considered a semi-formal language which supports human decision making and action.

Information systems are the primary focus of study for organizational informatics.

Career pathways

Information Systems workers enter a number of different careers:

Information System Strategy

Management Information Systems –
A management information system (MIS) is an information system used for decision-making, and for the coordination, control, analysis, and visualization of information in an organization.

Project Management – Project management is the practice of initiating, planning, executing, controlling, and closing the work of a team to achieve specific goals and meet specific success criteria at the specified time.

Enterprise Architecture – Enterprise architecture (EA) is "a well-defined practice for conducting enterprise analysis, design, planning, and implementation, using a comprehensive approach at all times, for the successful development and execution of strategy.

IS Development
IS Organization
IS Consulting
IS Security
IS Auditor

There is a wide variety of career paths in the information systems discipline. "Workers with specialized technical knowledge and strong communications skills will have the best prospects. Workers with management skills and an understanding of business practices and principles will have excellent opportunities, as companies are increasingly looking to technology to drive their revenue."

Information technology is important to the operation of contemporary businesses, it offers many employment opportunities. The information systems field includes the people in organizations who design and build information systems, the people who use those systems, and the people responsible for managing those systems. The demand for traditional IT staff such as programmers, business analysts, systems analysts, and designer is significant. Many well-paid jobs exist in areas of Information technology. At the top of the list is the chief information officer (CIO).

The CIO is the executive who is in charge of the IS function. In most organizations, the CIO works with the chief executive officer (CEO), the chief financial officer (CFO), and other senior executives. Therefore, he or she actively participates in the organization's strategic planning process.

Types of information system

The "classic" view of Information systems found in textbooks in the 1980's was a pyramid of systems that reflected the hierarchy of the organization, usually transaction processing systems at the bottom of the pyramid, followed by management information systems, decision support systems, and ending with executive information systems at the top. Although the pyramid model remains useful since it was first formulated, a number of new technologies have been developed and new categories of information systems have emerged, some of which no longer fit easily into the original pyramid model.

Some examples of such systems are:

data warehouses
enterprise resource planning
enterprise systems
expert systems
search engines
geographic information system
global information system
office automation.

A computer(-based) information system is essentially an IS using computer technology to carry out some or all of its planned tasks. The basic components of computer-based information systems are:

Hardware- these are the devices like the monitor, processor, printer and keyboard, all of which work together to accept, process, show data and information.
Software- are the programs that allow the hardware to process the data.
Databases- are the gathering of associated files or tables containing related data.
Networks- are a connecting system that allows diverse computers to distribute resources.
Procedures- are the commands for combining the components above to process information and produce the preferred output.

The first four components (hardware, software, database, and network) make up what is known as the information technology platform. Information technology workers could then use these components to create information systems that watch over safety measures, risk and the management of data. These actions are known as information technology services.

Certain information systems support parts of organizations, others support entire organizations, and still others, support groups of organizations. Recall that each department or functional area within an organization has its own collection of application programs or information systems. These functional area information systems (FAIS) are supporting pillars for more general IS namely, business intelligence systems and dashboards[citation needed]. As the name suggests, each FAIS support a particular function within the organization, e.g.: accounting IS, finance IS, production-operation management (POM) IS, marketing IS, and human resources IS. In finance and accounting, managers use IT systems to forecast revenues and business activity, to determine the best sources and uses of funds, and to perform audits to ensure that the organization is fundamentally sound and that all financial reports and documents are accurate. Other types of organizational information systems are FAIS, Transaction processing systems, enterprise resource planning, office automation system, management information system, decision support system, expert system, executive dashboard, supply chain management system, and electronic commerce system.

Dashboards are a special form of IS that support all managers of the organization. They provide rapid access to timely information and direct access to structured information in the form of reports. Expert systems attempt to duplicate the work of human experts by applying reasoning capabilities, knowledge, and expertise within a specific domain.

Trauma center

A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department (also known as a "casualty department" or "accident and emergency") without the presence of specialized services to care for victims of major trauma.

In the United States, a hospital can receive trauma center status by meeting specific criteria established by the American College of Surgeons (ACS) and passing a site review by the Verification Review Committee.

Official designation as a trauma center is determined by individual state law provisions. Trauma centers vary in their specific capabilities and are identified by "Level" designation: Level I (Level-1) being the highest and Level III (Level-3) being the lowest (some states have five designated levels, in which case Level V (Level-5) is the lowest).

The highest levels of trauma centers have access to specialist medical and nursing care, including emergency medicine, trauma surgery, critical care, neurosurgery, orthopedic surgery, anesthesiology, and radiology, as well as a wide variety of highly specialized and sophisticated surgical and diagnostic equipment.

Lower levels of trauma centers may only be able to provide initial care and stabilization of a traumatic injury and arrange for transfer of the victim to a higher level of trauma care.

The operation of a trauma center is extremely expensive. Some areas, especially rural regions, are underserved by trauma centers because of that expense. As there is no way to schedule the need for emergency services, patient traffic at trauma centers can vary widely. A variety of methods have been developed for dealing with that.

A trauma center will often have a helipad for receiving patients that have been airlifted to the hospital. In many cases, persons injured in remote areas and transported to a distant trauma center by helicopter can receive faster and better medical care than if they had been transported by ground ambulance to a closer hospital that does not have a designated trauma center. The trauma level certification can directly affect the patient's outcome and determine if the patient needs to be transferred to a higher-level trauma center.

The Waiting Room (2012 film)

The Waiting Room is a 2012 documentary film and social media project directed by Peter Nicks that follows the life and times of patients, doctors, and staff at Highland Hospital, a safety-net hospital in Oakland, California.

The project includes a blog which features stories and conversations from the waiting room as well as behind-the-scenes information about the project. Frequent video updates from the project are posted on the blog.

These videos examine what life is like in an American public hospital caring for a community of largely uninsured patients.

The project involves placing interactive storytelling booths in hospital waiting rooms.
These kiosks will include the live-blogged reports from people living without health insurance, and a unique online portal that will distribute these stories and become an archive for the testimonials that will highlight the urgency of the national dialogue around health care.

The Waiting Room is funded by the MacArthur Foundation, Independent Television Service, The Fledgling Fund, The San Francisco Foundation, California Council for the Humanities, the Pacific Pioneer Find, and the San Francisco Film Society. Its key partners include the Bay Area Video Coalition, Active Voice, Pentagram, and The Takeaway. The Waiting Room has also been featured on the New York Times Lens Blog as Videos Worth Watching.

Critical reception

Both The Washington Post and the San Francisco Chronicle named the film on the 10 Best of the Year lists.

Critic Ann Hornaday of The Washington Post named The Waiting Room the third best film of 2012. Wrote Hornaday: "This subtle, compassionate tableau lifts the veil on a world often described in terms of squalor and despair, finding the inherent dignity and perseverance therein."
The movie holds a "fresh" rating of 100% on Rotten Tomatoes based on 34 reviews, with a weighted average of 8.41/10.

Walk-in clinic

A Walk-In Clinic (also known as a Walk-In Centre) describes a very broad category of medical facilities loosely defined as those that accept patients on a walk-in basis and with no appointment required. A number of healthcare service providers fall under the walk-in clinic umbrella including urgent care centers, retail clinics and even many free clinics or community health clinics. Walk-in clinics offer the advantages of being accessible and often inexpensive.

It is estimated that there are nearly 11,000 walk-in clinics in America, although it is impossible to calculate an exact number given the variable and ill-defined nature of the category. Urgent care centers make up the largest percentage of walk-in clinics in America with an estimated 9,000 locations nationwide. In fact, consumers often erroneously refer to all walk-in clinics as urgent care centers, and vice versa. Retail clinics are the next most prevalent in the industry with 1,443 locations as of July 1, 2013.
However, amongst the negative aspects are that walk-in clinics provide poor quality healthcare as opposed to professional care such as regular doctors and hospitals.

Other disadvantages may include the urgency to make the patient's visit as quick as possible in order to reduce the long waiting list of walk-ins at the clinic, which may fail to fulfill the purpose of the visit.

Services

Urgent care clinics are usually led by physicians. The much smaller category of retail clinics, which are stand-alone clinics located inside large retail stores or shopping malls, tend to be headed by nurse practitioners. The significantly higher price for an urgent care visit compared to a retail clinic visit is largely attributed to this difference in staffing.

All types of walk-in clinics provide basic medical services, such as routine vaccinations, evaluation of cold and flu symptoms, and treatment for less severe physical injuries. Urgent care centers normally provide more services, such as X-ray testing for suspected pneumonia or broken bones.

Access to the patient's regular medical records depends on the agreements that the clinic has with other organizations. For example, a walk-in clinic that is part of or affiliated with a hospital or larger clinic may have full access to all the medical records belonging to the larger institution, while an independent walk-in clinic may not have access any patient records except those related to previous visits to that walk-in clinic. This lack of access can prevent healthcare providers from recognizing chronic problems.

Controversies

The existence of walk-in clinics has had some controversy. Doctors acknowledge that Minute Clinics and other retail-based clinics are convenient. Primary care doctors say they are trying to build a relationship with their patients, meet them regularly, and follow up on problems. These clinics interfere with that relationship and can potentially fragment health care. There is also the concern that the urgent care clinics fail to provide the primary care providers documents about the visit for the minor emergency. This can further fragment a patient's care. Claire McCarthy, pediatrician, addressed the lack of shared medical records, "Sometimes a minor thing isn't so minor." The American Academy of Pediatrics has recommended that parents do not use retail-based clinics for primary care for their children.

History of medicine

The history of medicine shows how societies have changed in their approach to illness and disease from ancient times to the present. Early medical traditions include those of Babylon, China, Egypt and India. Sushruta, from India, introduced the concepts of medical diagnosis and prognosis. The Hippocratic Oath was written in ancient Greece in the 5th century BCE, and is a direct inspiration for oaths of office that physicians swear upon entry into the profession today. In the Middle Ages, surgical practices inherited from the ancient masters were improved and then systematized in Rogerius's The Practice of Surgery. Universities began systematic training of physicians around 1220 CE in Italy.

Invention of the microscope was a consequence of improved understanding, during the Renaissance. Prior to the 19th century, humorism (also known as humoralism) was thought to explain the cause of disease but it was gradually replaced by the germ theory of disease, leading to effective treatments and even cures for many infectious diseases. Military doctors advanced the methods of trauma treatment and surgery. Public health measures were developed especially in the 19th century as the rapid growth of cities required systematic sanitary measures. Advanced research centers opened in the early 20th century, often connected with major hospitals. The mid-20th century was characterized by new biological treatments, such as antibiotics. These advancements, along with developments in chemistry, genetics, and radiography led to modern medicine. Medicine was heavily professionalized in the 20th century, and new careers opened to women as nurses (from the 1870s) and as physicians (especially after 1970).

Prehistoric medicine

Although there is little record to establish when plants were first used for medicinal purposes (herbalism), the use of plants as healing agents, as well as clays and soils is ancient. Over time, through emulation of the behavior of fauna, a medicinal knowledge base developed and passed between generations. Even earlier, Neanderthals may have engaged in medical practices.
As tribal culture specialized specific castes, shamans and apothecaries fulfilled the role of healer. The first known dentistry dates to c. 7000 BC in Baluchistan where Neolithic dentists used flint-tipped drills and bowstrings.

The first known trepanning operation was carried out c. 5000 BC in Ensisheim, France.
A possible amputation was carried out c. 4,900 BC in Buthiers-Bulancourt, France.

Early Civilization in India

The Atharvaveda, a sacred text of Hinduism dating from the Early Iron Age, is one of the first Indian texts dealing with medicine. The Atharvaveda also contains prescriptions of herbs for various ailments. The use of herbs to treat ailments would later form a large part of Ayurveda.

Ayurveda, meaning the "complete knowledge for long life" is another medical system of India. Its two most famous texts belong to the schools of Charaka and Sushruta. The earliest foundations of Ayurveda were built on a synthesis of traditional herbal practices together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 600 BCE onwards, and coming out of the communities of thinkers which included the Buddha and others.

According to the compendium of Charaka, the Charakasamhitā, health and disease are not predetermined and life may be prolonged by human effort. The compendium of Suśruta, the Suśrutasamhitā defines the purpose of medicine to cure the diseases of the sick, protect the healthy, and to prolong life. Both these ancient compendia include details of the examination, diagnosis, treatment, and prognosis of numerous ailments. The Suśrutasamhitā is notable for describing procedures on various forms of surgery, including rhinoplasty, the repair of torn ear lobes, perineal lithotomy, cataract surgery, and several other excisions and other surgical procedures. Most remarkable is Sushruta's penchant for scientific classification: His medical treatise consists of 184 chapters, 1,120 conditions are listed, including injuries and illnesses relating to aging and mental illness.

The Ayurvedic classics mention eight branches of medicine: kāyācikitsā (internal medicine), śalyacikitsā (surgery including anatomy), śālākyacikitsā (eye, ear, nose, and throat diseases), kaumārabhṛtya (pediatrics with obstetrics and gynaecology), bhūtavidyā (spirit and psychiatric medicine), agada tantra (toxicology with treatments of stings and bites), rasāyana (science of rejuvenation), and vājīkaraṇa (aphrodisiac and fertility). Apart from learning these, the student of Āyurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The teaching of various subjects was done during the instruction of relevant clinical subjects. For example, the teaching of anatomy was a part of the teaching of surgery, embryology was a part of training in pediatrics and obstetrics, and the knowledge of physiology and pathology was interwoven in the teaching of all the clinical disciplines. The normal length of the student's training appears to have been seven years. But the physician was to continue to learn.

As an alternative form of medicine in India, Unani medicine found deep roots and royal patronage during medieval times. It progressed during the Indian sultanate and mughal periods. Unani medicine is very close to Ayurveda. Both are based on the theory of the presence of the elements (in Unani, they are considered to be fire, water, earth, and air) in the human body. According to followers of Unani medicine, these elements are present in different fluids and their balance leads to health and their imbalance leads to illness.

By the 18th century CE, Sanskrit medical wisdom still dominated. Muslim rulers built large hospitals in 1595 in Hyderabad, and in Delhi in 1719, and numerous commentaries on ancient texts were written.

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