CLASSIFICATION OF HOSPITAL

Hospitals
Public Hospitals Act / Loi sur les hôpitaux publics
Regulation 964 - Amended to O. Reg. 321/01
Classification Of Hospitals

(This Regulation is made in English only.)

1. (1) Hospitals are classified as general hospitals, convalescent hospitals, hospitals for chronic
patients, active treatment teaching psychiatric hospitals, active treatment hospitals for alcoholism and
drug addiction and regional rehabilitation hospitals, and are graded as,

(a) Group A hospitals, being general hospitals providing facilities for giving instruction to medical
students of any university, as evidenced by a written agreement between the hospital and the university
with which it is affiliated, and hospitals approved in writing by the Royal College of Physicians and
Surgeons for providing post-graduate education leading to certification or a fellowship in one or more of
the specialties recognized by the Royal College of Physicians and Surgeons;

(b) Group B hospitals, being general hospitals having not fewer than 100 beds;

(c) Group C hospitals, being general hospitals having fewer than 100 beds;

(d) Group D hospitals, being hospitals that treat patients suffering from cancer, that undertake
research with respect to the causes and treatment of cancer and that provide facilities for the
instruction of medical students;

(e) Group E hospitals, being general rehabilitation hospitals;

(f) Group F hospitals, being hospitals for chronic patients having not fewer than 200 beds but not
including Group R hospitals;

(g) Group G hospitals, being hospitals for chronic patients having fewer than 200 beds but not
including Group R hospitals;

(h) Group H hospitals, being psychiatric hospitals providing facilities for giving instruction to medical
students of any university;

(i) Group I hospitals, being hospitals for the treatment of patients suffering from alcoholism and drug
addiction;

(j) Group J hospitals, being hospitals designated by the Minister to provide special rehabilitation
services for disabled persons in a region of Ontario specified by the Minister for each hospital;

(k) Group K hospitals, being separate organized facilities approved as such by the Minister, to provide
local diagnostic and treatment services in a community or district to handicapped or disabled individuals
requiring restorative and adjustive services in an integrated and co-ordinated program;
 (l) Group L hospitals, being hospitals for the treatment of patients suffering from alcoholism and drug
addiction and providing facilities for giving instruction to medical students of any university as evidenced
by a written agreement between the hospital and the university with which it is affiliated;

(m) Group M hospitals, being hospitals that may charge and accept payment from other hospitals for
the performance of computerized axial tomography scans;

(n) Group N hospitals, being hospitals that may acquire and operate magnetic resonance imaging
equipment and may charge and accept payment from other hospitals for the performance of magnetic
resonance imaging;

(o) Group O hospitals, being hospitals used as transplantation centres;

(p) Group P hospitals, being hospitals that may acquire and operate extra corporeal shock wave
lithotripsy equipment;

(q) Group Q hospitals, being hospitals that may provide in vitro fertilization services;

(r) Group R hospitals, being facilities for chronic patients that are called continuing care centres;

(s) Group S hospitals, being hospitals that provide biosynthetic human growth hormones;

(t) Group T hospitals, being hospitals that may act as distributing centres for drugs for cystic fibrosis
treatment and that provide drug-related therapy for cystic fibrosis treatment;

(u) Group U hospitals, being hospitals that may act as distributing centres for drugs for thalassemia
treatment and that provide drug-related therapy for thalassemia treatment; and

(v) Group V hospitals, being hospitals that operate ambulatory care centres. R.R.O. 1990, Reg. 964, s.
1 (1); O. Reg. 172/95, s. 1; O. Reg. 611/98, s. 1; O. Reg. 321/01, s. 1.

(2) The hospitals, their classifications and grades are set out in the list maintained by the Minister
under subsection 32.1 (2) of the Act and available on the Internet, through the website of the Ministry
of Health and Long-Term Care at www.health.gov.on.ca O. Reg. 251/00, s. 1.
Organizational Structure of a Hospital
OBJECTIVES/RATIONALE
Every hospital, large or small, has an organizational structure that allows for the efficient management
of departments. The student will identify the levels of management and describe the activities and
concerns of specific departments within each level.
TEKS: 121.2. (c) (6) (A-C) TAKS ELA 1, 3, 4, 5, 6

KEY POINTS
POWER POINT
I. Importance of Understanding Organizational Structure of Hospital
A. facilitates the understanding of the hospital’s chain of command
B. shows which individual or department is accountable for each area of the hospital
II. Complexity of Organizational Structure Depends on Size of Healthcare Facility; large acute care
hospitals have complicated structures, whereas, the smaller institutions have a much simpler
organizational structure
III. Grouping of Hospital Departments Within the Organizational Structure
A. Although each hospital department performs specific functions, departments are
generally grouped according to similarity of duties.
B. Departments are also grouped together in order to promote efficiency of the healthcare
facility.
C. Common organizational categories might include:
1. Administration Services (often referred to simply as “administration”)
2. Informational Services
3. Therapeutic Services
4. Diagnostic Services
5. Support Services (sometimes referred to as “Environmental Services”)
IV. Administration Services—business people who “run” the hospital
A. Hospital Administrators
1. manage and oversee the operation of departments
a. oversee budgeting and finance
b. establish hospital policies and procedures
c. perform public relation duties
2. generally include: Hospital President, Vice Presidents, Executive Assistants,
Department Heads
V. Informational Services—documents and process information
A. Admissions-often the public’s first contact with hospital personnel
1. checks patients into hospital
a. responsibilities include: obtaining vital information (patient’s full name,
address, phone number, admitting doctor, admitting diagnosis, social
security number, date of birth, all insurance information)
b. frequently, admissions will assign in-house patients their hospital room
B. Billing and Collection Departments - responsible for billing patients for services
rendered
C. Medical Records - responsible for maintaining copies of all patient records
D. Information Systems - responsible for computers and hospital network
E. Health Education - responsible for staff and patient health-related education
F. Human Resources - responsible for recruiting/ hiring employees and employee benefits
VI. Therapeutic Services – provides treatment to patients
A. includes the following departments:
1. Physical Therapy (PT)
a. provide treatment to improve large-muscle mobility and prevent or limit
permanent disability
b. treatments may include: exercise, massage, hydrotherapy, ultrasound,
electrical stimulation, heat application
2. Occupational Therapy (OT)
a. goal of treatment is to help patient regain fine motor skills so that they can
function independently at home and work
b. treatments might include: arts and crafts that help with hand-eye
coordination, games and recreation to help patients develop balance and
coordination, social activities to assist patient’s with emotional health
3. Speech/Language Pathology
a. identify, evaluate, and treat patients with speech and language disorders
b. also help patients cope with problems created by speech impairments
4. Respiratory Therapy (RT)
a. treat patient’s with heart and lung diseases
b. treatment might include: oxygen, medications, breathing exercises
5. Medical Psychology
a. concerned with mental well-being of patients
b. treatments might include: talk therapy, behavior modification, muscle
relaxation, medications, group therapy, recreational therapies (art, music,
dance)
6. Social Services
a. aid patients by referring them to community resources for living assistance
(housing, medical, mental, financial)
b. social worker specialties include: child welfare, geriatrics, family,
correctional (jail)
7. Pharmacy
a. dispense medications per written orders of physician, dentists, etc.
b. provide information on drugs and correct ways to use them
c. ensure drug compatibility
8. Dietary - responsible for helping patients maintain nutritionally sound diets
9. Sports Medicine
a. provide rehabilitative services to athletes
b. teaches proper nutrition
c. prescribe exercises to increase strength and flexibility or correct
weaknesses
d. apply tape or padding to protect body parts
e. administer first aid for sports injuries
10. Nursing (RN, LVN, LPN)
a. provide care for patients as directed by physicians
b. many nursing specialties include: nurse practitioner, labor and delivery
nurse, neonatal nurse, emergency room nurse, nurse midwife, surgical
nurse, nurse anesthetist
c. In some facilities, Nursing is a service in and of itself.
VII. Diagnostic Services – determines cause(s) of illness or injury
A. includes the following departments:
1. Medical Laboratory (MT) - studies body tissues to determine abnormalities
2. Imaging
a. image body parts to determine lesions and abnormalities
b. includes the following: Diagnostic Radiology, MRI, CT, Ultra Sound
3. Emergency Medicine - provides emergency diagnoses and treatment
VIII. Support Services—provides support to entire hospital
A. includes the following departments:
1. Central Supply
a. in charge of ordering, receiving, stocking and distributing all equipment
and supplies used by healthcare facility
b. sterilize instruments or supplies
c. clean and maintain hospital linen and patient gowns
2. Biomedical Technology
a. design and build biomedical equipment (engineers)
b. diagnose and repair defective equipment (biomedical technicians)
c. provide preventative maintenance to all hospital equipment (biomedical
technicians)
d. pilot use of medical equipment to other hospital employees (biomedical
technicians)
3. Housekeeping and Maintenance
a. maintain safe clean environment
b. cleaners, electricians, carpenters, gardeners
IX. Traditional Organizational Chart:
CATEGORIES OF HOSPITAL

In the U.S., you can differentiate hospitals based on a variety of factors that includes functionality, size,
location, ownership and specialization. Here they are in more detail:

1. Functionality
Functionality refers to whether the hospitals are general-purpose, teaching hospitals, acute care
facilities, long-term hospitals, community hospitals, research hospitals or if they provide trauma care for
patients. It refers to how the hospitals themselves function within the communities they serve.

2. Size
There are three primary classifications when it comes to size:

Small hospitals: Fewer than 100 beds

Medium hospitals: 100 to 499 beds
Large hospitals: 500 or more beds
Typically, these sizes are classified by the number of beds they have — although there can be some
variation within these groups of hospitals and medical centers.

3. Location
You can also classify hospitals by their locations. Rural hospitals aid smaller communities and often have
limited access to advanced equipment or specialized procedures and techniques. Since they also face
competition, urban hospitals serve larger metropolitan areas and must often offer a wide degree of
versatility when it comes to treatment options and patient experience.

4. Ownership
Knowing who owns the hospital will also tell you a great deal about how the hospital will operate. Some
hospitals are part of larger networks that offer a streamlined approach to management. While some
physicians feel this improves efficiency and patient experience, some feel it removes the emphasis from
the patient and makes treatment less personal.
Private hospitals often offer access to the latest technologies and equipment, but may under-serve
community members who need healthcare the most.

Government-supported facilities operate via grants and other public funds. They have greater
restrictions but also reach out to members of the community who may not otherwise receive healthcare
and medical treatment.

5. Specializations
Specialized hospitals appeal to physicians who entered the medical field with plans to treat people with
a specific condition. Most physicians choose specializations due to personal reasons, an area of intense
interest or a desire to provide a comfortable life for themselves and their families.

The Many Types of Hospitals

Now that you have a general idea of the main categories of hospitals, it’s time to explore individual
types to learn more about what they have to offer.
There’s a vast array of types of hospitals out in the world today, so let’s get started.

Academic Medical Centers

Academic medical centers often serve specific medical schools or universities. Facilities like this offer a
variety of services to treat the general healthcare needs of their communities as well as specialized
services while simultaneously offering educational opportunities to students in the healthcare field.

Acute Hospitals
Acute hospitals focus solely on the treatment and care of people with short-term needs like the
following:

Illnesses
Diseases
Injuries
Surgeries
Surgery recoveries
Obstetric care
Postnatal care
They are not equipped to handle chronic or long-term care for patients. According to EOSCU,
approximately 91 percent of hospitals are acute care facilities. Most people who are treated in acute
care hospitals stay for 10 days or fewer.

Ambulatory Surgery Centers

Focusing on same-day surgical care, ambulatory surgery centers offer surgical procedures without
requiring patients to be admitted to hospitals for the operation or recovery. They are cost-effective
options for patients and provide a less stressful surgical environment than many hospitals can provide.

Children’s Hospitals
Children’s hospitals specialize in the care and treatment of children and the conditions that affect
younger patients. It is a type of specialty hospital, which means the staff has received additional training
to aid in the treatment of children for a variety of acute and long-term medical needs.

In addition to offering medical treatment to children, children’s hospitals are widely praised for the level
of psychosocial support they offer the children in their care and their families — especially in the case of
children who require long stays in the hospital.

Clinics
Clinics are typically much smaller than hospitals and operate solely on an outpatient basis. They aren’t
equipped to keep patients overnight for recovery, treatment, diagnosis or observation. Government
agencies may run clinics or they may operate as private entities and partnerships among surgeons or
private physicians.
Community Hospitals
Non-teaching hospitals serving local communities without federal funding are known as community
hospitals. They can be found in rural or urban settings and provide vital services to their local
populations. The American Hospital Association reports that there are 4,840 community hospitals
operating in the U.S. today.

District Hospitals
District hospitals serve as healthcare hubs for their geographic regions. They have more extensive
intensive care facilities and long-term care programs in addition to providing necessary treatments in
fields like obstetrics, general surgery, plastic surgery and more.

Federal Hospitals
Sometimes referred to as government hospitals, federal hospitals receive funding from the federal
government. In the United States, federally funded hospitals typically handle the healthcare and medical
needs of select populations such as Native Americans and Veterans.

For-Profit Hospitals
For-profit hospitals are investor-owned facilities. This means the profits they earn go to shareholders
who have invested in the facilities rather than back into the hospital for improvements, new services
and medical advancements. Some fifty-eight percent of hospitals today, according to EOSCU, are not-
for-profit hospitals.
Free Hospitals
Free hospitals do not charge patients for the services they provide. They are generally located in areas
that reach out to patients of poor socio-economic classes and frequently operate at a loss. As a result,
they often struggle to provide the amenities and level of services many physicians strive to offer.

General Services Hospitals

General service hospitals focus on general and necessary services for the community, like:

Surgery
OB/GYN services
Pediatric services
General medical care
They offer little in the way of specialty services and may not be equipped to provide long-term care to
patients. Most hospitals today are general services hospitals.

Government-Funded Hospitals
State or federal governments provide grants or public funding to government-funded hospitals to
operate. Veterans hospitals are perhaps the most famous of these kinds of hospitals. EOSCU reports that
there are currently 213 federally funded hospitals in the U.S.
Hospitals in a Network
Hospitals in a network operate in connection with one another to deliver a range of services to a single
community or multiple communities. The benefits of becoming affiliated with a hospital network are
mainly economic, as this helps to improve efficiency, eliminate redundancy in services and ensure the
quality of care to all patients — whether in rural communities or larger cities.

Hospitals in a System
Hospital systems are a lot like hospital networks. Larger systems can offer specialty services as well as
general services, though patients may have to travel to a different facility to have their needs met. This
helps reduce costs for the hospitals while offering confidence among patients that they will receive a
certain standard of care from any hospital within that system.

Independent Hospitals
Independent hospitals are becoming increasingly rare as healthcare costs rise and many hospitals look
for the financial benefits network affiliation provides. However, there are still independent hospitals
throughout the country finding great success while meeting the medical and healthcare needs of their
communities.

Large Hospitals
Because they typically have 500 or more beds, large hospitals are capable of serving the broader needs
of the community. Some larger hospitals offer a combination of acute and long-term care services while
also providing research opportunities in some cases and accommodating a variety of specializations.

Local Hospitals
While once the backbone of healthcare in America, many local hospitals are either facing closure or
being incorporated into larger healthcare systems so that they can continue to provide necessary
services to their communities while meeting the substantial financial burdens local hospitals experience.

Long-Term Hospitals
Hospitals providing long-term care can meet the needs of patients suffering from chronic illnesses,
requiring psychiatric care, cardiac rehabilitation, or who are going through extensive rehabilitation after
accidents or injuries. This might include hospitals that offer burn centers, cancer centers, and similar
types of care facilities.

Medium Hospitals
Medium hospitals usually have between 100 and 300 beds though some may have as many as 500 beds.

Municipal-Funded Hospitals
Municipal-funded hospitals are community hospitals funded, at least in part, by local governments. They
are often small facilities that provide limited acute care services to local populations.

Non-Community Hospitals
This is another term used to reference federally funded or government hospitals. While community
hospitals exist to serve the short-term acute care needs of the general public, non-community hospitals
often provide for specific groups such as veterans or Native American populations.

Non-Teaching Hospitals
Non-teaching hospitals are unaffiliated with medical schools and do not provide educational
opportunities for students studying to become doctors, nurses or other medical professionals. They
provide necessary medical services to the communities they serve and often operate more cost-
effectively, as they do not absorb the many costs associated with educating medical professionals of the
future.

Not-for-Profit Hospitals
Nearly two-thirds of all hospitals located in urban areas are considered to be not-for-profit hospitals,
meaning they are not beholden to shareholders to earn profits. Many of these nonprofit facilities
receive tax benefits that are unavailable to for-profit facilities.
Osteopathic Hospitals
Focusing on diet and the environment to influence health as well as manipulation of the body,
osteopathic hospitals take a holistic approach to healing and patient care. Rather than treatment,
osteopathic hospitals tend to concentrate on preventative measures.

Private Hospitals
Owners and investors — who recover their investments via fees charged to the patients they assist or
their insurance providers — provide funding for private hospitals. Facility owners and administrators
determine the budget, manage finances and ensure compliance with various codes and regulations
related to medical care.

Patients often prefer private hospitals because of the many offered amenities, better doctor-to-patient
ratios and a variety of services that are unavailable in facilities that have more limited budgets.

Psychiatric Hospitals
Psychiatric hospitals attend to the mental health needs of their patients. The staff who work in them
treat a variety of mental health conditions through the use of medications, psychotherapy and
behavioral therapies. Some hospitals and treatment centers focus on short-term treatments while
others offer long-term care for psychiatric patients.

Rehabilitation Hospitals
Rehab hospitals and treatment centers focus exclusively on patient rehabilitation for a variety of
illnesses and injuries. Some facilities offer both inpatient and outpatient rehabilitation services while
others focus exclusively on inpatient services and intensive therapy regimens.

Research Hospitals
Research hospitals commit their efforts to researching cures for certain conditions in addition to treating
illnesses, diseases, injuries and various healthcare conditions. St. Jude Children’s Research Hospital may
be one of the most famous research hospitals in the United States, but there are plenty more.

Rural Hospitals
Usually fitted with 100 or fewer beds, rural hospitals are located outside large urban areas and operate
on small budgets. They generally provide basic care. If needed, they’ll transport patients in need of more
critical care to larger hospitals in their regions.
Seniors’ Geriatric Hospitals
Geriatric or seniors’ hospitals exclusively treat aging adults. They focus on diseases and conditions that
impact adults aged 65 and over. According to Psych Central, elderly patients who receive care in a
specialized geriatric facility enjoyed a reduced risk of functional decline at discharge (18 percent lower)
and a 30 percent higher likelihood of returning home upon leaving the hospital than those treated in
general hospitals.

Small Hospitals
As the name implies, these are typically small-scale operations with fewer than 100 beds. Many of them
are located in rural communities with no other hospital or medical center within short driving range or
offer highly specialized treatment options.

Specialty Hospitals
Specialized hospitals are typically affiliated with larger hospitals or healthcare networks and offer
specific treatments. You may find a variety of specialty hospitals within one community, including:

Women’s hospitals
Children’s hospitals
Cardiac hospitals
Oncology hospitals
Psychiatric hospitals
Trauma centers
Cancer treatment centers
Specialty facilities typically excel at providing the types of services listed above while offering limited
specialized care, other than the basics, for conditions outside their specialties.

State Hospitals
Many state hospitals are teaching hospitals that offer vital educational experiences to students while
meeting the medical care and treatment needs of their communities. State hospitals often receive a
substantial portion of their funding from the state, though they may also receive grants and
endowments from charitable organizations in the communities they serve.

Super Specialty Hospitals

Super specialty hospitals offer highly specialized treatments along with a staff that has received
extensive education and training in isolated conditions. They will often have cutting-edge equipment to
offer highly sophisticated diagnostic and treatment options to the patients who visit them.

Specialized hospitals or units within hospitals may have access to treatment options that aren’t available
at other hospitals, such as organ transplants, specialty medical devices and medications that require
very precise handling and training to administer.

Teaching Hospitals
Typically affiliated with universities, colleges, medical schools or nursing schools, teaching hospitals
provide medical and healthcare services while teaching and training healers of the future. The students,
interns and fellows working and learning in these hospitals are all supervised by qualified physicians,
teachers, department chairs and other medical staff.

Because teaching hospitals exist to provide educational opportunities to students, they often treat sicker
patients, which may result in lower quality scores than non-teaching hospitals — even if the ranking is
somewhat undeserved.

Trauma Center Hospitals

Trauma centers are hospitals specifically equipped to provide care for patients who have experienced
traumatic injuries. These can be from a variety of occurrences, including:

Falls
Auto accidents
Gunshot wounds
Other life-threatening injuries
The American Trauma Society describes five levels that classify trauma centers. Requirements for
classifications vary from one state to the next and most trauma center hospitals also have designations
or levels assigned to adult trauma and pediatric trauma.

Trust Hospitals
Trust hospitals are either charitable hospitals or semi-charitable, with many charges funded through
trusts. Some trust hospitals, widely used by middle-class patients, are referred to as “no profit, no loss”
hospitals and they provide subsidized services.
Veterans Affairs (VA) Hospitals
Veterans Affairs hospitals are tax-supported hospitals widely utilized by the men and women who have
served their country in any branch of the Armed Forces. Treatment at VA hospitals is provided free of
charge to veterans as thanks from a grateful nation for their service to the country.

Get Medical Malpractice Insurance for All Types of Hospitals

Today’s healthcare systems and their many facilities are complex and multi-faceted. And like the
healthcare system itself, medical malpractice insurance is an intricate, omnipresent part of every
hospital throughout the country and the physicians who practice within them.

On top of that, healthcare has evolved into an extremely litigious industry, resulting in hospitals paying
high premiums to protect not only their employees but the hospital itself. While small hospitals may pay
medical malpractice premiums of several hundred thousand dollars annually, large hospitals in highly
populated urban areas can dispense payments of several million dollars per year.

Hospitals commonly carry a $1,000,000 per claim limit of liability, in addition to having a medical
malpractice insurance policy covering excesses at much higher limits. For instance, hospital chains and
large hospitals often carry excess liability limits in the neighborhood of $50,000,000.

And because frivolous lawsuits, medical errors and hospital negligence are unavoidable, going without
medical liability insurance is not an option. Hospitals can protect themselves with medical malpractice
insurance to cover the entire organization, including the NICU, the ICI, operating rooms and radiology
department.

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INTRODUCTION: CLASSIFICATION OF
HOSPITALS
____________________________________________________
A. Classification of Hospitals
Hospitals are classified according to:
· Ownership
· Scope of Services
General Hospitals are further classified by functional capability.
1. Classification According to Ownership
a. Government – a hospital owned, established, established and
created by law; facility may be under the national government like the,
the Department of Health (DOH), Department of National Defense
(DND), Philippine National Police (PNP), Department of Justice (DOJ),
State Universities and Colleges (SUCs), Government Owned or
Controlled Corporations (GOCC) or Local Government Units (LGUs).
b. Private – a hospital owned, established and operated with funds
through donation, principal investment or other means by any
individual, non-government corporation, association or organization.
2. Classification According to Scope of Services
a. General – a hospital that provides services for all kinds of illnesses,
diseases, injuries or deformities. A general hospital shall provide
medical and surgical care to the sick and injured, as well as maternity,
newborn and child care. It shall be equipped with the service
capabilities needed to support board certified/eligible medical
specialists and other licensed physicians rendering services in, but not
limited to, the following:
i. Clinical Services
1) Family Medicine
2) Pediatrics
3) Internal Medicine
4) Obstetrics and Gynecology
3
5) Surgery
ii. Emergency Services
iii. Outpatient Services
iv. Ancillary and Support Services, such as clinical laboratory,
imaging facility and pharmacy.
b. Specialty – a hospital that specializes in a particular disease or
condition or in one type of patient. A speciality hospital may be devoted
to treatment of any of the following:
i. Treatment of patients suffering from diseases of a particular
organ or groups of organs (e.g. Lung Center of the Philippines,
Philippine Heart Center, National Kidney and Transplant
Institute); or a hospital dedicated to treatment of eye disorders
or cancers.
ii. Treatment of patients belonging to a particular group such as
children, women, elderly and others (e.g. Philippine Children’s
Medical Center).
B. Categories of General Hospitals According to Functional Capacity
1. Level 1 Hospital
A Level 1 hospital shall have, as minimum, the following services and
capacity:
a. A staff of qualified medical, allied medical and administrative personnel
headed by a physician duly licensed by the Professional Regulation
Commission (PRC);
b. Bed space for its authorized bed capacity in accordance with DOH
Guidelines in the Planning and Design of Hospitals;
c. An operating room with standard equipment and provision for
sterilization of equipment and supplies in accordance with the:
i. DOH Reference Plan in the Planning and Design of an Operating
Room/Theater
4
ii. DOH Guidelines on Cleaning, Disinfection and Sterilization of
Reusable Medical Devices in Hospital Facilities in the Philippines
d. A post-operative recovery room;
e. Maternity facilities, consisting of ward(s), room(s), and a delivery room
exclusively for maternity patients and newborns;
f. Isolation facilities with proper procedures for the care and control of
infectious and communicable diseases as well as for the prevention of
cross infections;
g. A separate dental section/clinic;
h. A blood station;
i. A DOH-licensed secondary clinical laboratory with the services of
consulting pathologist;
j. A DOH-licensed Level 1 imaging facility with the services of a consulting
radiologist; and
k. A DOH-licensed pharmacy

MODEL ORGANIZATIONAL STRUCTURE

____________________________________________________
A. ORGANIZATIONAL CONFIGURATION
1. The new standards on organizational structure and staffing pattern of
government hospitals took into consideration the following factors:
a. Minimum DOH Licensing Requirements and Philhealth Accreditation
Requirements
b. New hospital licensing category (Level 1, Level 2, Level 3 hospitals)
based on Department of Health Administrative Order No. 2012-0012.
c. Specialty Society Training Accreditation Requirements (particularly for
Medical Staff)
d. Distribution of Medical Staff to cover the Outpatient Department,
Emergency Room and Inpatient hospital areas; and
e. Health Human Resource Master Plan
Level 1 and Level 2 hospitals shall have four (4) basic organizational units: the
Office of the Chief of Hospital; Medical Service; Nursing Service; and
Hospital Operations and Patient Support Service (HOPSS). Internal
management functions are combined under one organizational unit, the
HOPSS, which shall subsume both administrative and finance services.
A Level 3 hospital shall be provided with an additional division-level entity, the
Finance Service, to handle accounting, budgeting, cashiering, billing and
claims and cash operations. Given the need to attain financial sustainability of
said hospitals, this unit shall be tasked to improve revenue generating
capacity.
2. The general functions of the major organizational units are as follows:
a. Office of the Chief of Hospital/ Medical Center Chief
Shall be responsible for the overall management and administration of
the hospital; formulation of policies, plans, programs and strategies to
ensure implementation of health standards for the attainment of quality
health care and high standards of clinical training for medical and allied
medical personnel; and the day-to-day supervision and administration
of the functional units.
9
b. Medical Service
Shall be responsible for providing quality inpatient and outpatient care
and high standards of clinical training for medical and allied medical
personnel; provision of ancillary and allied health services to patients;
promotion of research activities; implementation of clinical resource
management system; and advising and assisting the chief of hospital in
the formulation and implementation of policies, plans and programs of
the hospital.
c. Nursing Service
Shall be responsible for implementing nursing programs for total quality
health care; providing nursing care to medical cases; and developing,
coordinating and implementing relevant training programs for nursing
personnel.
d. Hospital Operations and Patient Support Service
(formerly Administrative Service)
Shall be responsible for the provision of administrative services relating
to personnel management, administrative records management,
property and supply management, general services, engineering, and
security.
e. Finance Service
Shall be responsible for the provision of financial services relating to
budgeting, accounting, cash operations, billing and claims.
3. Below these offices/services, sub-units are allowed depending on service
capability, ancillary services, kind and level of care and segregation of
patients, and kind and variety of support functions. The hospital
administration is given the flexibility to structure/group its internal
management support units in a manner deemed more efficient and effective
for the hospital’s organization and operation.
B. The model organizational structure for each category of hospital
and authorized bed capacity is shown in the succeeding pages.
 Level 1 Hospital_ _____________
Model Organizational Structure for a Level 1 Hospital
(25 to 75 Bed Capacity)

Organizational Unit
Number of Positions
Bed Capacity

Office of the Chief of 3 3 3

Hospital
Medical Service 52 64 74
Outpatient 5 5 5
Emergency Room 5 9 12
Clinical Units 11 14 16
Clinical Laboratory 5 6 7
Blood Station 3 3 3
. Radiology 4 5 6
Dental 2 2 2
Health Information 3 3 3
Management
Admitting/Information 4 4 4
. Nutrition and 4 5 6
Dietetics
Pharmacy 4 5 6
Medical Social Work 2 3 4

C. Nursing Service 39 51 61
Office of the Nurse 1 1 1
Supervisor
Clinical Nursing Units 13 24 34
Operating Room 6 6 6
Recovery Room 6 6 6
Isolation Room 4 4 4
Delivery Room 9 10 10
D. Hospital Operations 19 26 28
and Patient Support
Service
. Office of the 2 2 2
Administrative Officer
 Human Resource 2 2 2
Management

Procurement, Property 2 2 2
and Supply
Engineering and 5 9 11
Facilities Management
Accounting 2 3 3
Billing and Claims 2 2 2
Housekeeping/Laundry 2 3 3
Cash Operations 2 3 3
. Security -
Total Number of 113 114 166
Positions

Organizational Chart
Level 1 Hospital

Office of the
Chief of
Hospital
NURSING Patient Support
Medical Service
Service
SERVICE
STANDARD STAFFING PATTERN

______________________________________________________

The staffing pattern of a hospital is determined based on the assigned classification,

bed capacity and organizational structure of the hospital.

A. Medical Staff

The medical staff is divided into general practitioners and specialists such as

surgeons, eye, ear, nose and throat specialists, internist, obstetricians,

roentgenologists, pathologists, radiologists, urologists, orthopedic surgeons,

dermatologists and psychiatrists.

The number of general practitioners needed for each hospital is based on the

ratio of one general practitioner for every 1,000 population.

The number and type of specialists required to staff a hospital are variable

depending on the services offered and the specialties and sub-specialties.

1. Medical Staff Positions

The Philippine hospitals’ standard for medical staffing is derived from

the study entitled “Developing Metrics for Hospital Medical Workforce

Allocation” (Shannon, et al, 2007) which is used internationally.

In addition, the DOH Administrative Order No. 2012-0012 dated July

18, 2012 entitled “Rules and Regulations Governing New Classification

of Hospitals and Health Facilities in the Philippines” is used as

reference.

Based on the Shannon formula, DOH considered the last 3 years’

average increase in inpatient discharges and outpatient visits for

each level of hospitals to determine the needed staff per level and bed

capacity of the hospitals. The formula applied follows:

a. Computation of the Required Number of Medical Specialist

(Average Inpatients x 0.489) (Average Outpatients x 0.252)

1,000 + 1,000

25

b. Computation of the Required Number of Medical Officers

(Average Inpatients x 0.737) (Average Outpatients x 0.181)

1,000 + 1,000

The total number of the required medical staff is based on the sum of the

computed number of Medical Specialists and Medical Officers. However,

this does not include the following:

a. Chief of the Medical Service

b. Head of the different Medical Departments

c. Medical Specialist and Medical Officers of the Pathology

Department

d. Medical Specialist and Medical Officers of the Radiology

Department

2. Computation of Additional Medical Staff for Teaching and

Training Hospital

The number of resident physicians and interns will be governed by the

type of hospital or level of care delivered by a teaching and training

hospital; and the accreditation requirement of Specialty Societies1

The considerations in number and types of medical specialists depend

on the level of care, number of inpatients and outpatients, authorized

and implementing bed capacity, specialty services, capability of the

hospital based on the physical structure, availability of

equipment, presence of accredited residency training program, wherein

the ratio of medical specialist to resident physician depends on the

particular specialty. In general, the standard ratio of one surgeon for

every 50 beds is applied.

The specialty requirements for training are the following:

SPECIALTY RATIO
· Pediatrics 1 Consultant2 : 4 Resident3 Physicians
Surgery 1 Consultant : 1 Resident Physician Minimum of 3
Fellows4 for 8 or fewer residents. A Fellow is
added for every two (2) additional residents.
Nuerology 3 Training Neurologists : 3 Resident Physicians 1
faculty member responsible for each of the
following: Neurophysiology, Neuroanatomy,
Psychiatry and Behavioral Sciences, Internal
Medicine, Pediatric Neurology, Neuropathology,
Neuroimaging
Dermatology 1 Consultant : 3 Resident Physicians
· Nuclear Medicine At least 3 Nuclear Medicine full time physicians,
diplomate status, for every gamma machine, and
at least 3 training residents for every accredited
Nuclear Medicine residency training facility
Anesthesiology 1 Consultant : 2 Resident Physicians
Radiation Oncology 1 Consultant : 3 Resident Physicians
Obstetrics and Gynecology 1 Consultant : 2 Resident Physicians
Urology 1 Consultant : 1 Resident Physician
Otolaryncology (head and neck surgery) 1 Consultant : 1 Resident Physician

B. Nursing Staff Staffing of nurses is the largest and the most crucial aspect of administration because
the quality of the personnel and their performance will determine the degree of achieving the goals of
the Nursing Service. The goal of staffing is to provide the appropriate number and mix of nursing staff
(nursing care hours) to the actual or projected patient care needs that will lead to the delivery of
effective and efficient nursing care. This means determining the level of care, average daily census and
hours of care provided for 24 hours a day, 7 days a week. 1. Factors in Determining Nursing Staffing
Needs · Patients Acuity of Illness i. Level of Care a) Obstetrics – Gynecology b) Pediatrics c) Medical d)
Surgical ii Degree of Dependence iii. Communicability iv. Rehabilitation Needs · Special treatment and
procedures · Type of hospital · Ratio of professional to non-professional nursing personnel · Turn-over of
patients and nursing personnel · Hospital policy i. Budget ii. Available equipment/materials/supplies iii.
Population served. · Patient Care Classification System Patient care classification allows a more accurate
computation of nursing hours needed for different categories of care and patients. The manner of
computing the required number of nursing personnel using the patient care classification system shall
consider such factors as the percentage of patients in each level of care, the number of nursing care
hours, ratio of professional nurses to non-professional nursing personnel and distribution by shifts and
number of relievers. 28 2. Required Staff to Patient/Bed Ratio The nursing service staffing requirement
shall adhere to the following staff-patient/bed ratio: C. Other Hospital Professional Personnel in Indirect
Patient Care Services In general, units or sections needing 24 hours services will require a minimum of 5
personnel to fill the 24 hours-seven days a week schedule following the 40-hour labor law. Hence, the
Emergency Room, Operating Room, Delivery Room, X-ray, Laboratory and even the Pharmacy staff
requirements will need to be computed accordingly. With the operation of DOH Botikas, additional
pharmacists are needed. Also, with present demands for a commercial pharmacy (service for
outpatients as well), an extra pharmacist for such purpose will be needed. In Dispensing Pharmacy, the
ratio of pharmacist to administrative assistant (pharmacy assistant) is: 1 pharmacist: 2 administrative
assistants. The requirement for other allied health personnel is determined based on the time and
motion study conducted by DOH's National Center for Health Facility Development (NCHFD). As the
result of the study, the ratios of staff to bed capacity in the following units are indicated below: 1.
Pharmacy 1:25 2. Nutritionist-Dietetics 1:60 3. Medical Social Work 1:25 4. Health Information
Management 1:20 (formerly Medical Records) UNIT Nurse to Staff

UNIT Nurse to Staff Ratio

Ward 1 Supervising Nurse (Nurse III) : 50 Staff Nurses 1
Head Nurse (Nurse II) : 15 Staff Nurses 1 Staff
Nurse ( Nurse I) : 12 beds per shift 1 Nursing
Attendant : 24 beds per shift
Critical Care 1 Supervising Nurse (Nurse III) : 30 Staff Nurses 1
Head Nurse (Nurse II) : 15 Staff Nurses 1 Staff
Nurse (Nurse II) : 3 beds per shift 1 Nursing
Attendant : 15 beds per shift

C. Other Hospital Professional Personnel in Indirect Patient Care Services In general, units or sections
needing 24 hours services will require a minimum of 5 personnel to fill the 24 hours-seven days a week
schedule following the 40-hour labor law. Hence, the Emergency Room, Operating Room, Delivery
Room, X-ray, Laboratory and even the Pharmacy staff requirements will need to be computed
accordingly. With the operation of DOH Botikas, additional pharmacists are needed. Also, with present
demands for a commercial pharmacy (service for outpatients as well), an extra pharmacist for such
purpose will be needed. In Dispensing Pharmacy, the ratio of pharmacist to administrative assistant
(pharmacy assistant) is: 1 pharmacist: 2 administrative assistants. The requirement for other allied
health personnel is determined based on the time and motion study conducted by DOH's National
Center for Health Facility Development (NCHFD). As the result of the study, the ratios of staff to bed
capacity in the following units are indicated below: 1. Pharmacy 1:25 2. Nutritionist-Dietetics 1:60 3.
Medical Social Work 1:25 4. Health Information Management 1:20 (formerly Medical Records) UNIT
Nurse to Staff Ratio Ward 1 Supervising Nurse (Nurse III) : 50 Staff Nurses 1 Head Nurse (Nurse II) : 15
Staff Nurses 1 Staff Nurse ( Nurse I) : 12 beds per shift 1 Nursing Attendant : 24 beds per shift Critical
Care 1 Supervising Nurse (Nurse III) : 30 Staff Nurses 1 Head Nurse (Nurse II) : 15 Staff Nurses 1 Staff
Nurse (Nurse II) : 3 beds per shift 1 Nursing Attendant : 15 beds per shift 29 In addition to the hospital
administrator, there will be required assistants, clerks, bookkeepers, cooks, engineers, attendants, nurse
aide, orderlies, janitors, maintenance crew and others so that the total hospital personnel will amount
to approximately two and one half (2.5) for each occupied bed. D. Supplemental Guidelines 1. The
number and level of positions prescribed for each hospital category shall be the maximum that will be
allowed for the various organizational units. However, hospitals may adopt a lesser number and lower
levels of positions and/or merge different staff offices in the internal management and support units,
depending on their financial capability. 2. Hospitals that qualify for the next higher category shall adopt
the corresponding organizational structure and staffing pattern (OSSP) herein prescribed. However, the
hospital management has the option to adopt a leaner OSSP by merging the prescribed organizational
units or using lower-level positions. If the authorized bed capacity of a hospital falls between two of the
specified bed capacities in the standard staffing pattern, the higher set of standards shall be applied if
the number of beds is in excess of one half of their difference. 3. Hospitals that are not qualified for
upward categorization may continue to adopt their existing OSSP provided that existing positions higher
than those provided in the SP prescribed for their appropriate category shall be abolished once vacated
by their present incumbents. Hospitals may also be allowed to adopt the new OSSP prescribed for the
category that corresponds to their existing category approved by the DOH. 4. In the case of downward
categorization, the hospitals shall adopt the model OSSP for the new category, provided that
incumbents of positions higher than those prescribed shall continue to retain their positions. Once
vacated, the same will be abolished and replaced by those appropriate under the new category. 5. The
security, dietary and utility services may be contracted out in accordance with pertinent guidelines. 6.
The Housekeeping, Linen and Laundry service may be contracted out but subject to infection control
mechanism. 7. As an option, additional staff per approved Specialty/Sub-specialty service may be
provided as part of the Medical Staff, contingent on the service capability of the particular hospital and
subject to the approval 30 of the Department of Health. The number of staff is not part of the regular
staffing standards for Level 3 Hospitals. The standard staffing pattern for each category of hospital and
authorized bed capacity is shown in the succeeding pages.

C. Other Hospital Professional Personnel in Indirect Patient Care Services

In general, units or sections needing 24 hours services will require a minimum of 5 personnel to fill the
24 hours-seven days a week schedule following the 40-hour labor law. Hence, the Emergency Room,
Operating Room, Delivery Room, X-ray, Laboratory and even the Pharmacy staff requirements will need
to be computed accordingly. With the operation of DOH Botikas, additional pharmacists are needed.
Also, with present demands for a commercial pharmacy (service for outpatients as well), an extra
pharmacist for such purpose will be needed. In Dispensing Pharmacy, the ratio of pharmacist to
administrative assistant (pharmacy assistant) is: 1 pharmacist: 2 administrative assistants. The
requirement for other allied health personnel is determined based on the time and motion study
conducted by DOH's National Center for Health Facility Development (NCHFD). As the result of the
study, the ratios of staff to bed capacity in the following units are indicated below: 1. Pharmacy 1:25 2.
Nutritionist-Dietetics 1:60 3. Medical Social Work 1:25 4. Health Information Management 1:20
(formerly Medical Records)

In addition to the hospital administrator, there will be required assistants, clerks, bookkeepers, cooks,
engineers, attendants, nurse aide, orderlies, janitors, maintenance crew and others so that the total
hospital personnel will amount to approximately two and one half (2.5) for each occupied bed.

D. Supplemental Guidelines

1. The number and level of positions prescribed for each hospital category shall be the maximum that
will be allowed for the various organizational units. However, hospitals may adopt a lesser number
and lower levels of positions and/or merge different staff offices in the internal management and
support units, depending on their financial capability.
2. Hospitals that qualify for the next higher category shall adopt the corresponding organizational
structure and staffing pattern (OSSP) herein prescribed. However, the hospital management has the
option to adopt a leaner OSSP by merging the prescribed organizational units or using lower-level
positions. If the authorized bed capacity of a hospital falls between two of the specified bed
capacities in the standard staffing pattern, the higher set of standards shall be applied if the number
of beds is in excess of one half of their difference.
3. Hospitals that are not qualified for upward categorization may continue to adopt their existing
OSSP provided that existing positions higher than those provided in the SP prescribed for their
appropriate category shall be abolished once vacated by their present incumbents. Hospitals may
also be allowed to adopt the new OSSP prescribed for the category that corresponds to their
existing category approved by the DOH
4. In the case of downward categorization, the hospitals shall adopt the model OSSP for the new
category, provided that incumbents of positions higher than those prescribed shall continue to
retain their positions. Once vacated, the same will be abolished and replaced by those appropriate
under the new category.
5. The security, dietary and utility services may be contracted out in accordance with pertinent
guidelines.
6. The Housekeeping, Linen and Laundry service may be contracted out but subject to infection
control mechanism.
7. As an option, additional staff per approved Specialty/Sub-specialty service may be provided as part
of the Medical Staff, contingent on the service capability of the particular hospital and subject to
the approval of the Department of Health. The number of staff is not part of the regular staffing
standards for Level 3 Hospitals. The standard staffing pattern for each category of hospital and
authorized bed capacity is shown in the succeeding pages.