administration and organization of hospital
TRANSCRIPT
NURSING SERVICE ADMINISTRATION SEMINAR
ON
ADMINISTRATION AND
ORGANISATION OF HOSPITAL
SUBMITTED TO,
RESPECTED MADAM,
MRS. MISTRY / MRS. KAMBLE.
DEPT. OF NURSING SERVICE ADMINISTRATION & EDUCATION.
INSTITUTE OF NURSING EDUCATION.
J. J. HOSPITAL, MUMBAI.
SUBMITTED BY,
MRS VAISHALI AUTI.
SECOND YEAR P. B. Bsc. NURSING
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INSTITUTE OF NURSING EDUCATION
INDEX
INDEX...........................................................................................................................................2
AIM-..............................................................................................................................................4
Objectives-..................................................................................................................................4
Administration and organization of hospital.................................................................5
Meaning.......................................................................................................................................5
Definition....................................................................................................................................5
Philosophy of the hospital....................................................................................................6
Objectives of the hospital......................................................................................................7
Scope of hospital......................................................................................................................8
The optimum health services consist of following elements....................................9
FUNCTIONS OF THE HOSPITAL.........................................................................................11
Classification of hospitals...................................................................................................13
Hospital utilization and statisistics.................................................................................19
Factors influencing hospital utilization.........................................................................21
HOSPITAL DEPARTMENTS.................................................................................................24
PLANNING JOB REQUIREMENTS AND JOB DISCRIPTION OF HOSPITAL..............29
Job analysis:.............................................................................................................................29
JOB DISCRIPTION:.................................................................................................................31
Job specification:...................................................................................................................32
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POLICY, RULES AND REGULATIONS OF HOSPITAL.....................................................33
POLICIES AND PROCEDURES..............................................................................................34
RULES AND REGULATIONS:................................................................................................36
HOSPITAL POLICY.................................................................................................................37
TEAMWORK IN HOSPITAL..................................................................................................38
CHARACTERISTICS OF EFFECTIVE TEAM......................................................................39
INDICATORS OF TEAM WORK...........................................................................................40
HUMAN RELATIONS IN HOSPITALS AND HEALTH CARE INSTITUTIONS............46
Total Quality Management and Accreditation.............................................................49
NABH Accreditation:.............................................................................................................56
Technical Requirements And Standards In the Design & Upgrades Of Health Care Facilities.........................................................................................................................65
Conclusion-..............................................................................................................................79
Bilography...............................................................................................................................80
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SEMINAR ON
ORGANISATION AND ADMINISTRATION OF HOSPITAL
AIM-
The seminar will enable students to gain knowledge regarding the
organization and administration of hospital.
OBJECTIVES-
At the end of seminar the student will be able to ,
Define the hospital and it’s administration.
Know the functions of the hospital.
Describe various classifications of the hospital.
Explain different departments in the hospital.
Understand the various policies and rules, regulations of the hospital.
Know the importance of team work.
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ADMINISTRATION AND ORGANIZATION OF HOSPITAL
MEANING
The word hospital is derived from the latin word ‘Hospis ’ ,meaning a ‘Host’
DEFINITION
The hospital is an integral part of a social and medical organization. The
function of which is to provide for population complete health care, both
curative, preventive and whose outpatient services reach out to the family
and it’s environment
The hospital is training centre of health worker and biosocial research
The modern hospital is an institution which possesses adequate
accommodation and well qualified and experienced personnel to provide
services of curative, restorative, preventive and promotive character of the
highest quality possible to all people. It conducts educational and training
programme for the health personnel particularly required for patient care
and hospital services.
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PHILOSOPHY OF THE HOSPITAL
Hospital organization is an essential part of the medical care , it should have its
own philosophy . many hospitals in practice are hard into their definition of
philosophy . It may be due to the changing needs of the society
The philosophy is statement of the values and beliefs that direct individuals or
groups in their attempts to achieve a purpose , it explains why things are carried
out in the way that they are and it serves as a directive to the way that they are
and it serves as a directive to the way a purpose is achieved. A purpose is a reason
for an organisation’s existence ‘ it is the why of the organization’s existence ;it
why of the organization
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OBJECTIVES OF THE HOSPITAL
Provide optimum health services to all people irrespective of race , colour,
caste, creed and economic and social status.
Provide care, cure, and preventive services to all people irrespective of race,
colour, creed and economic and social status.
Protect the human rights of the clients while taking care in its jurisdiction /
in all areas of its services.
Provide training for professionals i.e. doctors, nurses and other technical
personnel who are involving in health care services.
Provide in service / continuing education in all discipline professional /
technical personnel involving health care.
Participate / conduct research that will benefited patient care, improves the
community status, the management of hospital services and education of
individual who perform the required service.
Define its leadership role in the community and possibly the region
depending upon its size, type and facilities in relation to regional area
planning of hospital.
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SCOPE OF HOSPITAL
As stated in the objectives of the hospital , optimum health care services
have the basis of scientific method, and should be applied in apersonalised
manner with full recognition and attention to personal dimentions in clients
need and is carried out within a framework of social responsibility .
1. Team Approach
2. Contents of service
6. Evaluation & research
SCOPE OF HOSPTIAL
3 Co-ordination
5. Integration
4. Continuity
of care
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THE OPTIMUM HEALTH SERVICES CONSIST OF FOLLOWING ELEMENTS.
Team approach-
the care of needy person will be taken by the team of professional
members and paraprofessionals ,technicians under the leadership of
medically qualified persons with integration and coordination.
Content of service-
the spectrum of services that includes diagnosis, specific treatment,
rehabilitation, education and prevention.
Coordination-
clients’ care will cover the coordinated efforts of all agencies, which have
required facilities at all levels.
Continuity of care-
continuity of client care will be available and rendered by the particular
agency with specific services whenever needed
Integration-
organization of hospital care of both ambulatory and nonambulatory
patients into continuum with common integrated services.
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Evaluation and research –
periodic evaluation, programmers and provision of conducting research
included in optimum health services for adequacy in meeting needs of the
patient and the community.
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FUNCTIONS OF THE HOSPITAL
Patient Care
Diagnosis and treatment of disease
Out patient service
Medical education and traning
Medical and nursing research
Prevention of disease & promotion of
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health
Patient care –
care of the sick and injured and restoration of of the health of diseased person
without any discrimination.
Diagnosis and treatment of disease –
there are diagnosis and treatment services to in-patients. within this broad
function there are many subdivisions of medical , surgical, obstretical, gyneac
pediatric , psychiatric and other forms of care and rehabilitation.
Out-patient services-
there are services to out-patients with an equally wide range of specialities
and technical modalities.
Medical and nursing research –
since accumulation of different types of patients the basis for scientific
investigation into cuases , diagnosis, and treatment and nursing management
of diseases ,and hospital administration, ward/unit administration in
hospitals.
Prevention of diseases and promotion of health-
hospital provides services to surrounding populations that may be preventive
care and promoting their health.
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CLASSIFICATION OF HOSPITALS
Hospitals have been classified in many ways. Each hospital is distinct in its
characteristic as it differs in structure, functions, performance and the
community it serves .the most commonely accepted criteria for classification
of the modern hospital are according to:
1. Length of stay of patient (long-term, short-term)
2. Clinical basis
3. Ownership/control basis
4. Objectives
5. Size
6. Management
7. System of medicine
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1. Classification according to length of stay of patient:
A patient stays for a short term in a hospital for treatment of disease
thate is acute in nature, such as pneumonia, peptic ulcer, ect.a patient
may stay for long –term in hospital for treatment of diseases that are
cronic in nature, such as tuberculosis, leprosy, cancer, psychosis.e.g.
thane mental hospital.
2. Classification according to clinical basis:
These are hospital licensed as general hospital, treat all kinds of
diseases, but major focus on treating speed disease or conditions such
as heart disease, or cancer, ect.
e.g. tata hospital for cancer.
3. Classification according to ownership/control:
On the basis of ownership and control,hospitals can be divided in to four
categories:
Public hospitals
Voluntary hospitals
Private/ charitable/ nursing homes
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Corporate hospitals
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Public hospitals:
Public hospitals are those run by the central or state government
or local bodies on non commercial lines. These may be general
hospital or specialized hospitals or both. e.g. carporation
hospitals, j.j. group of hospitals
Voluntary hospitals
The hospitals those are established and incorporated under the
socities registration act 1860; or public trust act 1882 or any
other appropriate act of central or state government.they are run
withpublic or private funds on non commercial basis.
Private nursing hospitals /nursing homes:
Private nursing hospitals/homes are generally owned by
individual doctor or a group of doctors . they run the hospital on
commercial basis.
Corporate hospitals
Corporate hospitals are hospital which are public limited
companies formed under the companies act. They are normally
run on commercial lines they are either general or specialize or
both.
4 There are three categories according to objectives:
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Teaching – cum-research hospitals
Isolation hospitals
General hospitals
Specialized hospitals
5 Classification according to size:
Size of the hospital i.e. bed strength.
a. Teaching hospital
b. District hospital
c. Taluk hospital
d. Primary health centers
6 Classification according to management:
a. Union government/ government of india:all hospitals
administered by government of india,e.g. railway, military,
defence hospitals ect.
b. State government: all hospitals administered by state and
unionterritory.
c. Local bodies: all hospitals administered by local bodies i.e.
municipal corporation, zilha parishad etc.
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d. Private: all private hospitals owned by an individual or by a
private organization e.g. hinduja hospital Mumbai.
e. Autonomus bodies: all hospitalsestablished under special act of
parliament. Or state legislation and founded by the central / state
government.
f. Voluntary agencies: all hospitals run by a voluntary body/ trust
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HOSPITAL UTILIZATION AND STATISISTICS
The term hospital utilization denotes the manner in which a certain
community makes use of its hospital resources. There are many indices
which can healp us in evaluation of its quantitative performance .there
are indices commonly used in the assessment of hospital utilization are,
a. hospital beds-
A hospital bed is regularly maintained and stuffed for
accommodation and full time care of a succession of in-
patient , and is situated in the wards or the areas of the
hospital in which continuos medical care for in-patient is
provided.
b. Admissions:
Admissions refer to the number per year of acceptance by
hospital of a patient, who use to relieve medical care while
in residence therein and who is expected to remain for one
or more nights.
c. Discharge and deaths :
The annual number of discharges include the number of
patients who have left the hospital cared , improved ect, the
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number whohave transferred to health or social institution ,
and the number who have died.
d. Bed days or patient days :
Bed day or patient day is the unit of measure denoting the
service rendered to one in-patient in the hospital census
between one day the succeeding one.
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FACTORS INFLUENCING HOSPITAL UTILIZATION
Availability of hospital beds-
it has been observed in the economically developed countries that the larger
number of available hospital beds, the larger the volume of hospital utilization.
Better health education , increase health consciousness ,larger protection by
social security, and higher standards of living , leading to an increase number of
demands for medical care.
Methods of payment for hospital services-
As previously noted, there are two methods of payment for hospital services;
direct and indirect. In the former ,payment is made directly by the utilize of
hospital services; in the latter , services are paid for through prepaid
programmes, sickness insurance , general taxation and other indirect means.
Age of the population-
A population with high life expectancy tends to raise the volume of
hospitalization.
Service coverage and bed distribution –
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A high bed population index does not always indicate a full coverage of
population; this depend on geographic distribution of hospital beds rather
than on the total number of beds and an even geographic distribution
increases hospital utilization by making the hospital more available to all
the people.
Availability of extramural medical services-
A well organized domicillary medical service can ,by caring for patients in
their homes or clinics, reduce the load on hospital. An important role is
played by out-patient department of the hospital.a good consulting out
patient department with diagnostic facilities may greatly reduce the
number of admissions to the hospital.
Hospital “bottleneck” -
Another important factor in hospital utilization, connected with the
hospital itself, is what might be term “hospital bottleneck”, or, in other
word the efficiency of the hospital’s supporting services; x-ray
department, laboratory services, operating room services & others.
Medical customs and social patterns-
The customs or attitudes of the medical profession affect hospital
utilization. Thus, early ambulation, which has been adopted in many
countries, has resulted in a lower average stay in hospital. The demand
on hospitals is also affected by social and cultural pattern of the
population.
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Research and Training –
Hospitals with programs or research or training, or both, tend to be
more selective in their admission policy. On the other hand, the average
length of the stay in these hospitals tends to be longer because there are
many specialized departments.
Housing-
The current trends of families to live in a smaller houses or apartment
has definite influence on hospital utilization. Smaller housing units
demand less home help. Therefore, combination of shortage, of and
shortage of home help in an important factor in the demand for hospital
admission.
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HOSPITAL DEPARTMENTS
The out – patient department (OPD)-
The out-patient department is a distinct and important part of the hospital. In
the past, OPD was frequently housed in a separate building away from main
body and the hospital. The out –patient department is the point of contact
between hospital and community. Many patients gain their first impression of
the hospital from the OPD. The activities of the OPD will influence those of all
the other departments of the hospital and the activities of all other of the
hospital will produce the effect on those of OPD. All the patients suffering
from diseases of minor, serious, acute, chronic nature are examined in the
OPD.The OPD should be within the main body of the hospital. The department
should be located close to public entrances, particularly where public
transportation is provided. The department should also be adjacent to the
casualty and emergency service and admitting unit.
Medical unit or department of Medicine :
The general hospitals have a medical unit. The surge unit in teaching hospital
will be called as department of medicine. Other medical unit or department in
a hospital includes all patients who admitted to hospital for treatment other
than surgery with certain exceptions.
Surgical units or Department of Surgery-
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The surgical services comprise a major sphere of hospital practice, with
accompanying problems and personnel, supply and regulation. If we want to
have surgical unit, there should be hospital with 100 to 200 bed capacity.
The maternity unit or OBG unit-
The maternity unit or department very essential in general hospital. The
department should serve both in physical set up and in personnel to provide
every care and comfort for the lying – in mother and her new born.
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Pediatric Unit –
The Pediatric services will constitute a substantial proportions of whole
hospital. The out-patient services for children are an important part of the
pediatric services.
Dental Department-
Department of radiology or x ray department-
Department of radiology deals with radio diagnosis and radio therapy. The x
ray department needs to provide services for in-patients, out-patients,
casualties and patient referred for x ray by general practitioners.
Department of pathology or laboratory-
The laboratory situated in the hospital also will be concerned with diagnostic
laboratory tests, not only for in patients and out patients but also for special
services clinic, for general practitioners in the aera.
Department of psychiatry or mental health-
Psychiatry as a basic medical science, as a field of therapeuties and a branch
of public health and preventive medicine can also play it’s part in general
hospital to improve education , training and research.
Department of pharmacy-
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The pharmaceutical service in most of hospital in india today represent the
function of procurement and compounding and dispensing of medicine on
doctors prescriptions by pharmacist.
Laundry-
All hospitals are concerned with the dangers of cross infections and need for
using only sanitary, germ-free linen. So there is a need of a efficient
mechanical laundry to ensure the availability of germ free, washed linen.
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Dietary department-
the purpose of the dietary service department in every hospital is the
preparation of nutritionally adequate, attractive meals. The goals of “dietary
service on hospital “ will include:
Optimum nutrition of the patient,
The maintenance of morale,
The dietic education of patients, and-the achievement of these
goals, with maximum effectiveness and resulting economy.
Central sterile supply services department-
The central sterile supply department is supposed to store, sterilized,
maintain and issue those instrument, materials,and garments which are
required to be sterilised.this requirement may steadily decrease as the use of
disposable items become more economical.
Department of nursing-
nursing is provided in a large portion of the total services to patients in
hospital. Nursing personnel composed of professional nurses, nurse as
practitioner, and nursing assistant of various types, constitutes the largest
single body of personnel in hospital and the nursing department of the
hospital. It is a department which interrelates with more other departments
than any other departments.
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PLANNING JOB REQUIREMENTS AND JOB DISCRIPTION OF HOSPITAL
Man power planning consists of studying job requirements and preparing job
description. The requirements of each and every job must be thoroughly
studied through job analysis.
JOB ANALYSIS:
Job analysis is the process of examining a job of identify its component parts
and the circumstances in which it is performed. It is necessary to be familiar
with this technique because its application is quite wide and extends across
the whole range of staff management functions:
Recruitment: It aims at filling jobs by recruitment, transfer or
promotion.
Training: It is intended to decide the contents of the program.
Salary: it is designed for finding the correct gradient of individual
posts.
Annual performance appraisal: It evaluates the performance of
employees annually.
Its range is comprehensive and it is, therefore, essential for every supervisor
to know this technique. The mechanics on the resources both the functional
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management who prepare the job analysis and the line management whose
work is to be analyzed.
Job analysis should concerned with realities and practical possibilities. It
should indicate how a job is taken care of within the limits of human capacity.
It is a tool of the management aimed at eliciting detailed information about a
job. At the same time it can act as a personnel problem saving device.
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JOB DISCRIPTION:
Job description is a board oh the purpose, scope duties and
responsibilities of a particular job. This is a resultant of the job analysis.
It provides detailed factual information required by candidates and
selector alike in order to obtain a thorough knowledge of the
requirements of a job. To avoid confusion and misunderstanding, a job
description should be prepared jointly by personnel department and
the concerned department head.
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JOB SPECIFICATION:
A job specification can be defined as a list of various qualities which the
person during the job should process. It is prepared by analyzing the
jobs description. The job description is translated in terms of
qualifications required and personality requirements. These
requirements can be grouped under the heads:
Mental requirements: which include intelligence need, and
educational and professional qualifications.
Physical requirements which include age, height, health and
eyesights etc.
Skill requirements such as dexterity required for doing a
job, communication, human relations and leadership skills.
Responsibility requirements to do the job efficiently.
Working conditions requirements such as physical
surroundings.
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POLICY, RULES AND REGULATIONS OF HOSPITAL
INTRODUCTION
A policy is a statement or general understanding which provides guideline in
decision making to members of an organization in respect of any course action. They
provide framework within which decision must be made by the managers in
different spheres.
DEFINITION
Policy- plan of action (Fippo 1976) “is a man made rule of predetermined course of
action that is established to guide the performance of work toward the organization
objectives. It is a type of standing plan that serves to guide subordinates in the
execution of their tasks”.
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POLICIES AND PROCEDURES
Policies are plans reduced to statements or instructions that direct organizations in
their decision making. These comprehensive statements, derived from the
organization’s philosophy, goals, and objectives, explain how goals will be met and
guide the general curse and scope of organizational activities.
Policies refer to boar general statement of excepted actions that serves as a guide to
managerial decision making or to supervising the actions of subordinates. Policies
direct individual behavior, the organization mission and define board limits and
desired outcomes of commonly recurring situations. While leaving some discretion
and initiative to those who must carry out that policy.
Policies also can be implied or expressed. Implied policies, neither written nor
expressed verbally, have usually developed overtime and follow a precedent, e.g.
taking maternity leave and resuming duty. Expressed policies are delineated
verbally, or in writing. Most organizations have many written policies that are
readily available to all individuals and promote consistency of action. It will include
wearing uniforms/dress, policy of leave facility and disciplinary procedures. Policy
is a long range statement of organizational objectives.
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Policies are generally divided into four types:
Those that applies to the patients
Those that apply to personnel
Those that apply to environment in which patients receive care and in
which personnel work
Those that apply to relationship with other departments or discipline.
Nursing administration or nurse managers have to take active role in foundation of
a policies related to health care institutions and should take part in reviewing the
policies. After formulation of policies, the nursing managers should communicate to
all who may be affected by it. This information should be transmitted in writing and
verbally. The relative value of policies if often perceived in relation to how it is
communicated.
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RULES AND REGULATIONS:
Rules and regulations are plans that define specific action or non action. Generally
included as a part of policy and procedure statements, rules describe situations that
allow only one choice of action. Because rules are the least flexible type of planning,
in the planning hierarchy, there should be as few rules as possible in the
organization. Editing rules, however should be enforce to keep morale from
breaking down to allow organizational structure.
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HOSPITAL POLICY
The major policies for a hospital will include those related to:
1) Providing patient care service, standard of care, type and volume of services,
emergency services.
2) Purchase of drugs, equipments and supplies.
3) Working capital investment.
4) Depreciation allowances
5) Hospital personnel
6) Public relations
7) Medical services
8) Nursing services
9) Dietary services
10) Controlling financial inputs and outputs
In the formulation of minor and derivative policies for the sub systems to the
hospital, the lower level managers in the organization, are directly involved in the
implementation of policies.
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TEAMWORK IN HOSPITAL
Team work is co ordinate action by a co operative group whose members contribute
responsibly and enthusiastically towards task achievement. It works best in a
supportive environment. The essentials of team work are,
a) A group
b) Leader
c) A common goal
d) Regular inter action
e) Each member contributing responsibility
f) Co ordination
g) Team spirit
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CHARACTERISTICS OF EFFECTIVE TEAM
1) The working atmosphere is informal, comfortable, and relaxed
2) There is a lot of discussion in which virtually every one participated, but it
remains pertinent to the task of the group.
3) The task of the objective of a group is well understood and accepted by the
members after free discussion of the objectives,
4) The members listen to each other. Every ideas is given a hearing.
5) There is disagreement. Disagreements are not suppressed or overridden.
Options are carefully examined and the group works for resolution.
6) Most decisions are reached by kinds of consensus in which everybody is in
general agreement and willing to go along.
7) Criticism is frequent , frank and relatively comfortable.
8) People are free in expressing “feeling” and “thoughts”. Everybody seems to
know how everybody else feels about any matter being discussed.
9) When action is taken, clear assignments are made and accepted.
10) The chairperson of the group does not dominated, nor does the group
defer unduly to him or her. Leadership shifts as circumstance dictate.
11) The group is aware of its own operation, and examines how well it is
doing.
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INDICATORS OF TEAM WORK
BAD INDICATORS
1 Frustration 2 Grumbling
4 Poor Techniuqes 3 Unhealthy Competion
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Frustration :
Frequently people who work in organizations become frustrated
because they can no longer see a clear way of meeting their own needs
and aspirations. People lose inspirations and lack the commitment and
motivation which are essential ingredients of effective team work.
Grumbling:
In many organizations, the symptoms of grumbling and retaliation are
evident. If people can not express themselves through the system, they
do it privately through discussion in the corridors, lavatories and car
parks.
Unhealthy competition:
It is another indicator of poor team work.
Poor technique:
another sure indicator of poor teamwork is the expression employees
wear on their faces. The work place does not have to be a dull and
unenjoyable place; it can so easily be a rewarding place where people
love to be.
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THE GOODINDICATORS
1 Openness & Honesty
2 Meeting
6 Creativity 3 Relationship
5 Attitude
4 Devolopement
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Openness and honesty:
Are the key indicators of organizational health. Many managers
particularly seem to go to enormous lengths to avoid telling truth. There
are of course, occasions in every organization where total openness is
not feasible, but where good team work exists.
Meetings:
Meetings are another key indicator of teamwork. The main reason for
having meeting is to utilize the collective skills of a group of people
whilst working on common problems or opportunities. The quality of
meetings can usually be determined by the way in which individuals
either look forward to or dread the normal weekly or monthly get –
together.
Relationships:
In many organizations, the quality of the relationships between
managers and those they manage is so low that effective teamwork
cannot get off the ground. Another sign of low-quality relationships is
that the leader becomes increasingly isolated from his team. He does not
represent their view and they do not subscribe to his. The effective team
leader needs to be very much a part of his team.
Development:
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People just not developing is another sure sign of ineffective team work.
If a team is to be effective it need to be continually facilitating individual
as well as team development.
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Attitude:
The effective team uses external help constructively by recognizing the
new contribution and view point which can bring, but it always
maintains the response of its own problem and its own destiny.
Creativity:
It Is the delicate flower which flourishes only in the conditions; namely
conditions of personal freedom and support, freedom to experiment ,to
try out new ideas concept with the team is really like seizes all offers of
help. A dearth of new idea generally goes with poor teamwork, because
it is within a team that the conditions for creativity can most easily be
created.
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HUMAN RELATIONS IN HOSPITALS AND HEALTH CARE INSTITUTIONS
Hospitals provide medical care to the sick and needy. They are not in
the business of manufacturing goods but for rendering service and are
far more dependent than other organizations upon their employees
morale and commitment. Employees in such institutions are constantly
facing the public. Institutions which provide medical care are generally
criticized more for the attitudes of their personnel than for the quality
of the care. Patients and visitors are more impressed and concerned
with the attentiveness, empathy and responsiveness of the health care
personnel.
The following is a list of do’s and don’ts in the interest of good human
relations:
1. Do not injure the pride and sense of dignity of your
employees in any manner.
2. Set the target of their work in consultation with then and
place your confidence and trust in them.
3. Allow your employees to represent any current grievances
and pay due need and give priority to such representations.
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4. Maintain contact with employee, either directly or through
supervisors, and foster an environment of empathy and
good human relations.
5. Make every effort to solve the problems – both official and
personal of your employee to their satisfaction.
6. Ensure the training, better placement and promotional
opportunity of each individual employee, if possible.
7. Welcome constructive suggestions from patients and
visitors in general and from employee in particular.
8. Suppress tendencies towards luxuries working
environment for senior officers but do not spare any effort
in improving the working environment for lower categories
of employees.
9. Fill higher posts by promoting your own personnel rather
that recurring people from outside. This will boost morale og
your existing employees.
10. Reassure your employees regarding your responsibility for
their future security.
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11. It is a good idea to give employees a small gift on the
occasion of their festival not a box of sweets which will eaten
and forgotten.
12. During the festival days, employees are suddenly faces with
expanses which they often cannot meet out of their normal
salary. It is good idea to give your employees a loan at that
time.
13. Then an employee gives a very good performance,
supervisors and managers should not hesitate in giving
recognition to his work.
14. If the hospital can affor to it should provide a proper
canteen and subsidized meals to the employees.
15. Where the distance from the nearest railway station or
major bus-stop is considerable, hospital authorities should
persuade local transport officials to provide transport
facilities.
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TOTAL QUALITY MANAGEMENT AND ACCREDITATION
STRATEGIC ESSENTIALS FOR THE NEXT MILLENNIUM
BY SHAKTI GUPTA, SUNIL KANT
Introduction
The last decade has witnessed a revolutionary array in health care dimensions. Terms
like 'Total Quality Management', 'ISO-9000', 'Continuous Quality Management',
'Reengineering', 'Benchmarking' and 'Accreditation' have embraced and got
incorporated in the delivery of health care services. Globalisation, economic
liberalisation, privatisation of health services, patients enhanced awareness and
expectations fromproviders of health care have made 'Quality' and inseparable part of
the health care delivery system.
To achieve quality is thus an essential ingredient and to formulate, evaluate standards
as per predetermined objectives is a requisite which has become universally applicable
to all health care institutions. Total Quality Management (TQM) and Accreditation
are two main strategic essentials which have to be initiated, evolved and sustained in all
health care institutions. These are imperative managerial tools for successful functioning
ofa complex, matrix and a multidisciplinary institution i. e. the modern hospital.
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WHAT IS TQM?
The word most central to the acronym is quality and is formally defined as 'Ihe 10lalily
offealures and characteristics ofa produci or service Ihal bear on ils
abilily to satisfy slaled or implied needs'. Simply stated Quality is conformance to
specifications. Donabedian has defined quality as applicable to health care as: (I)
"Thai kind of care which is expecled 10 maximise and inclusive measure ofpatient
welfare after one has laken accounl oflhe balance ofexpecledgains and losses Ihat
aI/end Ihe process ofcare in all its paris n. Quality is not the end, it is a means to an end.
Quality is not an absolute standard but must be worked at and consciously achieved.
Quality in health care institutions is different from other organisations since the product
i. e. health case is multifaceted and multidimensional product and is delivered
personally to the customer.
Interaction between the provider and consumer significantly affects perception of
quality. Quality COlltrol comprises the qualitative or quantitative measurements or
tests of performance and the determination of adequacy and acceptability of
performance. Qualily ASSUrtlllCe is the application of a series of quality control steps at
multiple stages of a procedure to verify that all aspects of the procedure are of
acceptable quality.
TQM involves a systematic managerial appraach in an organisation based on continuous
improvement of all operations, processes and functions. It is used
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interchangeably with Continuous Quality Improvement in many areas. It is achieved by
understanding, meeting and exceeding the needs ofthe customer
TQM begins with a simple idea and an assumption that everything can be continuously
improved.
TQM is a philosophy as well as a set of guiding principles and practices .that represent
the foundations of a continuously improving organisation. It integrates
fundamental management techniques, existing improvement efforts, futuristic quality
plans, innovations and their successful implementation.
In TQM everyone strives to get things right the first time, everytime. The main
objectives of TQM are:
(a) Customer Focus
(b) Scientific approach
(c) Continuous improvement
(d) Participation by everyone at all levels.
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WHAT IS ACCREDITATION?
Hospital accreditation is a process whereby a hospital IS objectively judged against an
accepted level of performance and is evaluated to determine the appropriateness of
organisational structure, facilities and outcome. In the process, the fixility is informed of
weaknesses in ils opera/ions andgiven advice on how to correct the detected problems.
In health services accreditation encourages professional participation from within the
institution but is subject to external and objective control.
NEED FOR ACCREDITATION
In the management ofany type of system, success can most readily be attained if
appropriate goals are first established. The development of appropriate hospital
standards provides these goals. Hospital administrators may then focus an attaining
levels ofcare, that although challenging are achievable. With the availability of
managers are less likely to become solely llc(l'Ipied by day-to-day problems and more
likely to place some effort in a proactive search for institutional improvement.
A successful accreditation programme is educational in nature rather than punitive. The
standards that are developed should facilitate improvement in quality of care, must be
realistic and achievable within the available
The standards lIsed in accreditation programmes previously focussed on structural
evaluation but now attention is being given also to outcome evaluation.
Accreditation programmes are operated to ensure that good qual ity services are
provided by health institutions, the.ir evaluation standards contain all the components
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of quality care. Modern accreditation programmes contain all aspects of the three
components of quality care (5).
Accreditation and TQM : A means end relationship Accreditation is at times viewed just
as a variant of audit procedure, However, accreditation in philosophy
and practice ensures that quality care is a priority in the organisation, By continually
updating standards the accreditation programme has a positive effect on the quality of
patient care, Accreditation programmes highlight inefficiency ifany, in a health care
institution and this aids in optimal utilisation ofresollrce.
Quality Assurance is now a precondition for accreditation by the accreditating agency in
the United States of America, JCAHO (Joint Commission on the Accreditation of Health
Care Organisation), Before the implementation of the Quality Assurance Standard,
auditing method was utilised by JCAHO for accreditation, However the results ofthe
audits were not translated into any specific programmes, as many times merely a
"numbers game" was being performed in which the emphasis was on quantity and not
quality. JCAHO has now given an agenda for change under which all health care
organisations are expected to adopt – CQII TQM methodology, assessing user needs;
assessing, improving and monitoring key processes within the organisation and
educating all personnel in the techniques of TQM
While accreditation programmes are not a quality assurance panacea, it is an essential
requisite for more sophisticated quality assurance programmes, and a means to achieve
TQM in health care institutions.
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ARE TQM AND ACCREDITATION OLD WINES IN NEW BOTTLES?
Some health administrators andclinicians view TQM and Accreditation as just
buzzwords, Medical audits, review committees have existedfor long, so what is the
necessity ofTQMand Accreditation?
A modern hospital is a matrix organisation, an amalgam of human resources,
architecture wonders and technological advancement. Traditional Quality Assurance
efforts are focussed on retrospective review of documented patient care mainly in the
form of conventional medical audits. Outcome in the form of patient review are not
included in these audits. TQM focuses on all the facets of effectiveness and efficiency in
an organisation. In traditional Quality Assurance, effort is to achieve local or national
standards, however in TQM attempts are also made to improve upon these standards
e. g. turnaround time in a particular hospital's Emergency Department from patient
arrival to disposal is 20 minutes.
A preliminary analysis of the process may reveal major issues affecting the through put
time e. g. a delay in the registration of the patient. By resolving this turnaround time
may be decreased to 18 minutes.
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TRADITIONAL QUALITY
Assurance terminates here. However TQM process will well further and it may reveal
inadequate nurse staffing as one more component for the delay. Hence a further
reduction in the turnaround time may be achieved. Another important consideration in
TQM is the patients input, If the patients perceive that they are being rushed through
the system, the improvement in through put time may hamper in patient's satisfaction.
Quality IS not a number rather a function of positive perceptions.
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NABH ACCREDITATION:
CHOOSING THE RIGHT HOSPITAL
There are a number of hospitals in India that offer a multitude of medical services. In a
medical emergency, the nearest hospital is chosen. However, when there is time to
choose a hospital, how should one choose?
More important than the infrastructure, it is essential to know if the hospital has a
documented process for its healthcare activities. Patient care not only involves the core
clinical care, but also other support activities like requisition of tests, medicines, nurse
doctor coordination, infection control practices, training, and so on. These need to run
seamlessly in the background to provide the best experience to the patient and the
relatives.
A quality-conscious hospital should define all such activities internally, document the
same, and impart necessary training to the staff. These documented activities include
detailed job responsibilities, work instructions, checklists and quality indicators for the
staff to follow.
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So how will the patient know about these processes? He is not expected to inquire with
the hospital whether they have these processes laid down. And how many processes
could he check even if allowed to?
ACCREDITATION IS THE KEY
Organisations like the Quality Council of India [QCI] and its National Accreditation Board
for Hospitals and Healthcare providers [NABH] have designed an exhaustive healthcare
standard for hospitals and healthcare providers. This standard consists of stringent 500
plus objective elements for the hospital to achieve in order to get the NABH
accreditation.
To comply with these standard elements, the hospital will need to have a process-driven
approach in all aspects of hospital activities – from registration, admission, pre-surgery,
peri-surgery and post-surgery protocols, discharge from the hospital to follow-up with
the hospital after discharge.
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NABH ACCREDITATION CRITERIA
To give an idea what NABH standard comprises of, some of the 500-plus objective
elements are listed here. The requirements have been grouped for easy understanding.
Information to patients : -
1. The patients and/or family members are explained about the proposed care.
2. The patients and/or family members are explained about the expected results.
3. The patients and/or family members are explained about the possible
complications.
4. The patients and/or family members are explained about the expected costs.
RIGHTS OF THE PATIENT AND FAMILY : -
1. Respect for personal dignity and privacy during examination, procedures and
treatment.
2. Right to refusal of treatment.
3. Informed consent before anaesthesia, blood and blood product transfusions and
any invasive or high-risk procedures.
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4. Information on how to voice a complaint.
5. Access to his / her clinical records.
QUALITY IN INVESTIGATIONS : -
1. Adequately qualified and trained personnel perform and/or supervise the lab
investigations.
2. Policies and procedures guide collection, identification, handling, safe
transportation and disposal of lab specimens.
3. Laboratory and imaging results are available within a defined time frame.
4. Critical results are intimated immediately to the concerned personnel.
5. The lab and imaging quality programme addresses verification and validation of
test methods.
6. The lab and imaging quality programme includes periodic calibration and
maintenance of all equipments.
7. The lab and imaging programme includes the documentation of corrective and
preventive actions.
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SURGICAL SERVICES : -
1. Surgical patients have a pre-operative assessment and a provisional diagnosis,
documented prior to surgery.
2. Documented policies and procedures exist to prevent adverse events like wrong
site, wrong patient and wrong surgery.
3. The operating surgeon documents the post-operative plan of care.
4. There is a documented policy and procedure for the administration of
anaesthesia.
5. All patients for anaesthesia have a pre-anaesthesia assessment by a qualified
individual.
6. During anaesthesia, monitoring includes regular and periodic recording of heart
rate, cardiac rhythm, respiratory rate, blood pressure, oxygen saturation, airway
security and level of anaesthesia.
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MEDICATION : -
1. Documented policies and procedures exist for prescription of medications.
2. The organisation defines a list of high-risk medication.
3. High-risk medication orders are verified prior to dispensing.
INFECTION CONTROL : -
1. The hospital has an infection control team.
2. The hospital has designated and qualified infection control nurse[s] for this
activity.
3. Hand-washing facilities in all patient care areas are accessible to health care
providers.
4. Compliance regarding proper washing of hands is monitored regularly.
5. Isolation/ barrier nursing facilities are available.
6. Adequate gloves, masks, soaps, and disinfectants are available and used correctly.
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FACILITY AND INFRASTRUCTURE MAINTENANCE : -
1. The organisation’s environment and facilities operate to ensure safety of patients,
staff and visitors
2. There is a documented operational and maintenance [preventive and breakdown]
plan.
3. Up-to-date drawings are maintained which detail the site layout, floor plans and
fire escape routes.
4. The provision of space shall be in accordance with the available literature on good
practices [Indian or International Standards] and directives from government agencies.
5. There are designated individuals responsible for the maintenance of all the
facilities.
6. Maintenance staff is contactable round the clock for emergency repairs.
7. Response times are monitored from reporting to inspection and implementation
of corrective actions.
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OTHER : -
1. Defined procedures for situation of bed shortages are followed.
2. Ambulance[s] is appropriately equipped.
3. Ambulance[s] is manned by trained personnel.
4. There is a checklist of all equipment and emergency medications in the
ambulance.
Q. HOW NABH ACCREDITATION HELPS PATIENTS
In an NABH accredited hospital, there is a strong focus on the following : -
• Patient rights and benefits
• Patient safety
• Control and prevention of infections
• Practicing good patient-care protocols e.g. special care for vulnerable groups,
critically ill patients
• Better and controlled clinical outcome.
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NABH now is a member of the International Society for Quality in Health Care and thus
NABH standard is at the threshold of being recognised globally. So, if a hospital is NABH
accredited, the patient can rest assured that the hospital follows stringent standards as
laid down by the accreditation body for providing best in patient care comparable to any
international hospital of repute.
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TECHNICAL REQUIREMENTS AND STANDARDS IN THE DESIGN & UPGRADES OF HEALTH CARE FACILITIES
HASHEM AL FADEL, MBA,CCE
VICE PRESIDENT
AGMEST MULTI ENGINEERING SYSTEMS & TECHNLGIES
AMMAN/BAGHDAD
• Bird View
• Introduction
• Components of healthcare environment
• Healthcare technology needs
• Installation needs
• Related standards; JCAHO,JCIA,NFPA,AIA,CDC,OSHA
• Consideration for clinical needs
• Clinical engineers role in construction and design
• Phases of constructions and the clinical engineers role
• Conclusion
• Background
• HealthCare in general
• Medical technology advances
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• Paradigm shift in HealthCare
• Economic pressure
• Equipment requirement for facility design
• Medical requirement
• Safety requirements and needs
• Needed regulation
• Components of HealthCare
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PHYSICAL HUMAN ENGINEERING, EASE OF
movement, flexibility, adoptability
and address medical function and
furniture and equipment.
PSYCHOLOGICAL HUMAN NEEDS INTERACTION, COMMUNICATION
Relationships, acceptance, partners in
healing, comfort, security.
ECONOMIC FACILITY WITHIN ECONOMIC CONDITION
costs factors and financial impact on design.
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• HC Technology Needs
• Space
• Electricity
• Strength
• Mechanical
• Gaseous
• Environment
• Expansion
• Isolation
• Infection Control
• Future expansion
• Others; Plumbing etc.
• Installation needs
• Critical units
• OR locations
• Clinical services
• General care
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• Out patient areas
• Specialized clinical areas
• Other service areas
• HealthCare Standards
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• JCAHO: Join Commission on Accreditation of Healthcare organization
• JCIA : Join Commission International Accreditation
• NFPA : National Fire Protection Agency
• AIA : American Institute of Architect
• CDC : Center of Disease Control and prevention
• OSHA : Occupational Safety and Health Administration
• JCAHO Join commission on accreditations of healthcare organization
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• GUIDELINES FOR DESIGN AND CONSTRUCTION OF HOSPITALS
• Applicable state rules and regulation
• Environment of care
• Design to protect lives
• Physical safety of patients and visitors
• Safety, electrical, fire, gas,flammable,etc
• JCIA
• Join commission international accreditation
ACCREDITS HOSPITALS OUTSIDE THE USA
• Healthcare organization work to provide a safe, functional, and supportive facility
for patients, families, staff members, and visitors.
• Effective management is necessary to reach the goals:
1. Reduce and control hazards and risks
2. Prevents accidents and injuries
3. Maintain safe conditions
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• JCIA: EFFECTIVE MANAGEMENT
• Planning: Plan the space, equipment and resources to support clinical services
• Education: Staff to be educated about facility, how to reduce risks, and how to
monitor and report situations that pose risks
• Monitoring: Monitor important systems and identify needed improvement by a
performance criteria
• Country Based Accreditation
• MOH basic requirements
• Regulatory requirements
• Policies and procedures
• Committees for clinical needs
• Other requirements
• Environment of Care Standards
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SECTION REQUIREMENT
EC 1.1 Construction of facilities designed with NFPA LSC
EC 1.7 Management plan address life safety
EC 1.9 Management plans addresses utility systems
EC 1.8 Management Plan addresses medical equipment
EC 2.1 Personnel can describe their role in each EC plan:
Safety, fire, hazardous mat., emergency prep.,
utility outage, technical training records, recording
equipment maintenance, security.
EC 2.7 Medical equipment management plan
EC 2.13 Medical Equipment maintenance
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• NFPA
• National fire protection agency
• Codes, for buildings, service and design (300)
• Design for patient safety
• NFPA 70 NEC
• NFPA 99 for healthcare facility
• NFPA 101 for life safety code (LSC)
• NFPA 70
• National Electric Code: Healthcare facilities are designed to insure patient safety
by providing guidance to electricians in the field, article 517
• Wiring requirements for patient care
• Grounding requirements – GFCI
• Essential Electrical Systems
• Emergency Systems for essential life and critical areas
• Fuel generators for acute care facilities
• NFPA 99, Article 517
NFPA 99:
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Provides guidelines for the performance design and maintenance of Electrical systems
for the purpose of Safeguarding patients, staff and visitors within the healthcare facility.
Article 517:
Defines healthcare facilities as buildings or portion of
buildings in which specialized care is provided.
• NFPA 101
• Life Safety Code
• Spells out the majority requirements of hospitals to provide minimum
requirements with regards to function, for the design, operation and maintenance of
buildings and structures for safety to life from fires and similar emergencies.
• Building services section includes:
utilities, heating ventilations and AC,
smoke control, elevators, Incinerators,
fire detections, sprinklers etc.
• AIA
• The American Institute of Architects
• Guidelines for design and constructions of Hospitals and healthcare facilities.
• Provides specific guidelines for many design issues; size of patient rooms, no. of
Oxygen outlets at ICU bed locations, no. of air changes per hour for Ors
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• Highlights Key aspects of design and construction process by providing guidelines
for handling critical issues.
• Infection control issues during constructions, negative pressures etc.
• CDC
• Center for Disease Control & Prevention
• Environment Health
• Standard EC3.2.1 Proactive risk assessment during construction
• Engineering & Infection Concern during Design and Construction
• Demolition
• Renovation
• Catastrophic events
• OSHA
• The occupational Safety & Health administration Standards
• Focuses on personal protection equipment, Blood born pathogens, Hazard
communication, Ergonomics, confined space, asbestos, electrical & others
• Inspect for violation of agency standards, levy fines for obvious serious work place
hazards
• All healthcare facilities must have proactive safety programs
• Clinical Needs
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• Liaison between Clinicians and Technical designers
• Using appropriate standards
• Focusing on:
Long term users’ needs
Medical Technology trend and expectations
Higher age population trends
Diversity in users expectation
HOSPITAL STAFF ROLE IN CONSTRUCTION AND DESIGN
• Assist Architects and planners
• Pre installation requirements
• Installation of Equipment review
• Standard translation of clinical needs into technical requirements
• Service requirement of Technology
• Commissioning role
• CE/ BME Role Continued
• EMC and EMI
• Electrical Safety
• Disposal requirements
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• Infection control for technology aspects
• Liaison between hospital and technology suppliers
• Equipment Purchasing requirement
• Phases of Construction and
the Hospital staff Role
PHASE ISSUES CE TASK
PLANNING NEEDS/BUDGETS EQUIP. BUDGET
SITE DEVELOPMENT POSITIONING BUILDINGS IDENTIFY SYS. NEEDS
CONCEPTUAL DESIGN LOCATING DEPT. IN BUILD. ADJACENCY IMPACT
SCHEMATIC DESIGN FUNCTION ROOM LOC. QUANTITIES & SIZES
DESIGN DEVELOPMENT LAY OUTS IN EACH ROOM UTILITIES REQUIRE.
CONSTRUCTION DOC. BUILDING ASS. INSTRUCTION CO. REUSE RE-FIT
BUILDING CONSTRUCTION ASS. ALL BUILDING SYSTEM INTERFACE W CONT.
COMMISSIONING INSTALLATION/ TESTING WARRANTY IMPL.
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CONCLUSION-
From the seminar students are able to understand regarding
the administration and organization of hospital. This helps students
to know various types of hospitals and their classification. It is also
help students different departments in the hospital and their
organization and functions according to their importance in the
hospital. This seminar is also helps in understanding the students
various policies, rules and regulations for the staffs and the patients.
This seminar helps the students to understand job descriptions , job
specification, and job analysis of the staff members. The students
understand the importance of team work in hospital.
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BILOGRAPHY