Introduction

A hospital can be variously described as a factory, an office building, a hotel, an eating establishment, a medical care agency, a social service institution and a business organization. In fact, it is all of these in one, and more. Sometimes it is run by business means but not necessarily for business ends. This complex character of the hospital has social scientists as well as lay people.

Management science defines a system as “a collection of component subsystem which, operating together performs a set of operations in accomplishment of defined objectives.” 

A system is viewed as anything formed of parts placed together or adjusted into a cohesive whole. Every system is therefore a part of a large system and has its own subsystem.

A system is constructed as having inputs which undergo certain processing and get transformed into output. The output itself in turn sending feedback to the input and the process, which can be altered to achieve still better output. A system is therefore a continuous and dynamic phenomenon.

Different perspectives of hospital as a system are as follows:

1. Client oriented perspective 

a. access to service, 

b. use of service, 

c. quality of care, 

d. maintenance of client autonomy and dignity, 

e. responsiveness to client needs, 

f. wishes and freedom of choice

2. Provider-oriented perspective 

a. the physician, nurses and other professionals working for the hospital 

b. freedom of professional judgment and activities 

c. maintenance of proficiency and quality of care

d. adequate compensation 

e. control over traditions and terms of practice  

f. maintenance of professional norms.

3. Organization-oriented perspective 

a. cost control, 

b. control of quality, 

c. efficiency, 

d. ability to attract clients, 

e. ability to attract employee and staff, and 

f. mobilization of community support.

4. Collective orientation perspective 

a. Proper allocation of resources among competing needs, 

b. Political representation, 

c. representation of interests affected by the organization, 

d. coordination with other agencies.

Hospital as a Social System

Sociologists have considered hospital as a social system based on bureaucracy, hierarchy and super ordination and subordination. A hospital manifests characteristics of a bureaucratic organisation with dual lines of authority, viz. Administrative and Professional. In teaching hospitals and in some others, many professionals at the lower and middle level (junior resident, senior residents, registrar) and transitory while as in others, all medical professionals are permanent with tenured positions and nontransferable jobs. In order to continue in a orderly fashion, every social system has to fulfil the functional needs of that system, viz. the need for pattern maintenance, the need for adaptation, for goal attainment and integration.

In a hospital system, the patients’ needs determine the interactions within the system. When a patient is cured and discharged, in his or her place a new patient is admitted. This new patient also demands all the attention and skills of doctors, nurses and others, thus, forcing the essential and separative components into immediate action, repeatedly as each patient is admitted. Free upward and lateral communication is an important characteristic of any system.

The two lines of authority (viz, administrative and professional) come into conflict, because each group has a different set of values. One is concerned with the maintenance of organization and the other with providing medical expertise. This leads to interpersonal stress. A system that operates through multiple subordination subjects the subordinates to multiple orders which are often inconsistent with one another.

Peculiarities of a Hospital System

In spite of the simple definition of a system, a hospital system is more than the sum of its parts. The peculiarities of a hospital system are as follows:

1. A hospital is an open system which interacts with its environment.

2. Although a system generally has boundary, the boundaries separating the hospital system from other social systems are not clear and fuzzy.

3. A system must produce enough outputs through the use of inputs. But the output of a hospital system is not clearly measurable.

4. A hospital system has to be in a dynamic equilibrium with the wider social system.

5. A hospital system is not an end in itself. It must function, as a part of the larger heath care system.

6. A hospital system like other open social systems tends towards elaboration and differentiation, i.e. as it grows, the hospital system tends  to become more specialized in its elements and elaborate its structure, manifesting in the creation of more and more specialized departments, acquisition of new technology, expansion of  the “product lines” and scope of services.