Let me run a hospital - Part 1

2010-11-16T03:27:00.000-08:00

After working for 6 months, I, like every other person in the hospital, think that I could run the place better than whoever is up there. Unfortunately, this realisation has occurred several months/years too late. The 'old' hospitals are already ingrained in their ways of doing things and are unlikely to change; the new Khoo Teck Phuat Hospital is already operational and would be simply too busy coping, let alone able to implement last minute concepts. But hark! Jurong General Hospital is still in its infancy, and perhaps someone high and powerful would stumble upon this. Perhaps.

Thus begins my multiple part series I call "Let me run a hospital".

As I move from hospital to hospital, system to system, and (hopefully) up the hierachy, the way I view things and the way I think things ought to be run will change. So I would like to apologise for my immaturity of thought beforehand. Now, if you have accepted by apology, let's begin.

Team-based versus ward-based

Most clinical departments in the hospital operate either team-based or ward-based. Team-based operations are divided into "teams", each with their own list of patients which tend to scattered throughout the entire hospital. Each team has a fixed number of consultants, registrars, medical officers and house officers. Ward-based operations look after patients usually within a single ward, with the medical officer and house officer being stationed within that ward. There may be patients belonging to different consultants in that ward, but as long as the patient is in that ward and is under the care of your department, they belong to you.

Traditionally, most surgical disciplines operate team-based, while medical disciplines operate ward-based. Each hospital and department have their own variations on how team-based and ward-based operations work (ie. overflows, a mixture of being team and ward-based, HOs covering several teams etc.), but the basic concept remains the same and it is not within the scope of this entry to go into the details.

Advantages of being ward-based
1. Less walking
2. Fixed number of patients
3. Familiarity with ward systems

Advantages of being team-based
1. Familiarity with team systems
2. Greater incentive to discharge patients
3. Continuity of care

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Let me run a hospital - Part 1