(For more Details see Chapter 08 National Healthcare Administration)

Hospitals and other Custodian Care Organisations (collectively called Hospitals) are administered as Matrix Organisations with Dual Authority Structure. In Hospitals, the Functional Authority is clearly defined and separated from the Administrative Authority. The Multi-disciplinary Functional Authority for the Medical Staff is vested in the Medical Director of the Hospital, and the Functional Authority for the Nursing Staff is vested in the Director of Nursing. The Superintending & Administrative Authority is vested in the Medical Superintendent of the Hospital.

Hospitals are complex Organisations and essentially deal with matters of Life and Death. To provide all embracing governance to navigate the complexities of the Healthcare environment. 

All Hospitals, Public or Private, should have a Hospital Board, also called Board of Governors or Hospital Management Committee. By leveraging their collective expertise, members of the Hospital Board provide essential Governance and Administrative Leadership. 

The Medical Director has absolute authority for Functional Administration and makes all Clinical Decisions for Healthcare Delivery. His decision making is evaluated internally by His Subordinate Departmental Heads of Clinical Services and externally by Departmental Heads of Clinical Services of other Hospitals. The process is called “Peer Review”. 

Similarly, The Director of Nursing (called Chief Matron in UK) has absolute authority for Functional Administration and makes all decisions relating to Nursing Care Services, as part of the Healthcare Delivery Services. These decisions are evaluated internally by Head Nurses of various Clinical Departments and externally by Matrons and Head Nurses of other Hospitals. The process is called “Peer Review” of Nursing Care Services.

National Health Policy must facilitate these processes of Peer Review in all its Healthcare Services and Custodian Care Institutions.

To provide overall Governance and Strategic Guidance in the Public or Private Hospitals, individual Hospital Boards are established by the hospital’s parent organisation. The Parent Organisation can be the Government, a not-for-profit Organisation or a for-profit Organisation. Specifically, Hospital Boards have overall authority to provide the Safety of Patients under Hospital’s Custodian Care, the Safety of Hospital Staff and the Safety of all Visitors to the Hospital, with or without support of country specific Police Organisations.

Hospital Boards also ensure the Quality of Patient Care being provided. It includes the responsibility of employing certified, licensed and adequately shilled Medical and Technical Staff to deliver Healthcare. It also includes facilitating Continuing Medical Education, Skilling the Hospital Staff and integrating Developing Technologies. Hospital Boards generally incorporate the Medical Director of the Hospital and the Director of Nursing of the Hospital, in the Board.

In addition, Hospital Boards provide overall Superintending Management, which primarily facilitates delivery of Healthcare Services. It includes maintaining In-hospital Discipline, developing and implementing policies for Day-to-Day Operations, Financial Management, Personnel Management, compliance with Country Specific Legal & Ethical Regulations and compliance with International Regulations. It also includes the duty to maintain the Accreditation Requirements, keep the Physical Facility of the Hospital and its Equipment in a state of full repair to provide Healthcare Delivery.

Hospital Boards appoint a Medical Superintendent (also called the Chief Executive Officer) and delegate to him or her, most of their Superintending Powers & Executive Powers including being the prime cosignatory for implementing Day-to-Day Operations.

The position of Medical Superintendent is considered to be that of a Custodian who takes charge of all Patients admitted in the Hospital and who manages all matters relating to control of all Hospital Staff, their discipline, Internal and External disasters, interaction with statutory authorities and addressing the grievances of the Hospital Staff to maintain Continuity of Healthcare being provided. He or She is assisted by a team of Functional Heads in various administrative departments like Man Management, Financial Management, Supply Chain Management, Engineering Services, Biomedical Engineering Services, etc. The Medical Superintendent is also the custodian of all assets of the Hospital including its Buildings, Medical Equipment and Allied Equipment.

The Medical Superintendent must be a Medical Doctor with adequate experience in administering a complex organisation like the Hospital and meet the challenges of transient nature of the Patient Population.

The appointment of Medical Superintendent is always notified by a Hospital Order. In some countries the appointment of Medical Superintendent of a Public Hospital is always notified in the Government Gazette. The Medical Superintendent is vested with adequate supervisory authority to operate the Hospital. This authority is transferred in the name of the newly appointed Medical Superintendent, whenever this changeover happens.

In order to maintain the Continuity of Custodian Charge and to maintain the Continuity of Healthcare being provided, the Medical Superintendent of a Hospital always has a Hospital Duty Officer who performs the assigned duties of the Medical Superintendent during his physical absence from the Hospital during notified Holidays and during designated “After-Workhours”, every day. The Medical Superintendent will always be provided with an officiating Medical Superintendent during his Leave of absence, as per the Hospital Policy. The officiating Medical Superintendent and the Hospital Duty Officer can exercise only limited supervisory authority of the Medical Superintendent, as per the Hospital Policy.

The Medical Superintendent is also the custodian of all data, including the Patient Data and all routine Administrative Data, as generated in the Hospital. The Medical Superintendent provides all statutory reports and publishes the annual report of the Hospital. All regulatory permissions and licenses, etc. are provided in the name of current Medical Superintendent of the Hospital.

The Medical Superintendent provides leadership and administrative oversight to operate the entire Hospital and ensures effective collaboration with the Medical Staff and other Healthcare Providers for delivering Quality Care to the Patients.