chapter-5 summary of findings,...
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CHAPTER-5
SUMMARY OF FINDINGS, CONCLUSION & RECOMMENDATIONS
5.1 SUMMARY OF FINDINGS
Queuing theory application in outpatient department of Owaisi Hospital & Research
Centre and Yashoda Hospital
The first objective is to study the waiting time distribution of patients in the outpatient
department. This objective of studying the waiting time distribution of patients in the
outpatient department is achieved through the application of queuing theory. The waiting
time of patients at OP registration, billing, consultation, laboratory (sample collection),
diagnostics and pharmacy at both the hospitals i.e. Owaisi Hospital & Research Centre and
Yashoda Hospital is analyzed through the application of queuing theory. Queuing theory
application has led to the following findings at both the hospitals:
• It was found that arrival rate and service rate are following exponential distribution in
both the hospitals i.e. Owaisi Hospital & Research Centre and Yashoda Hospital.
• It was observed that for both the hospitals arrival rate ‘λ’ is more than service rate ‘µ’.
• Mean inter-arrival time is more at diagnostics (18.15 minutes) and less at pharmacy
(14.875 minutes) for Owaisi Hospital & Research Centre.
• Mean inter-arrival time is more at consultation (18.46 minutes) , OP registration
(18.26 minutes) and less at OP billing (14.88 minutes) for Yashoda Hospital.
• Mean service time is more at consultation (15.725 minutes) and less at pharmacy
(6.35 minutes) for Owaisi Hospital & Research Centre.
• Mean service time is more at consultation (14.68 minutes) and less at laboratory
sample collection (6.195 minutes) for Yashoda Hospital.
• Arrival rate ‘λ’ is highest at pharmacy with 4.034 patients per hour in Owaisi Hospital
& Research Centre.
• Arrival rate ‘λ’ is highest at OP billing with 4.02 patients per hour in Yashoda
Hospital.
• Arrival rate ‘λ’ is least with 3.306 patients per hour at diagnostics in Owaisi Hospital
& Research Centre.
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• Arrival rate ‘λ’ is least with 3.25 patients per hour at consultation in Yashoda
Hospital.
• Service rate ‘µ’ is highest at pharmacy (9.4489 patients served per hour) and OP
registration (9.248 patients served per hour) in Owaisi Hospital & Research Centre.
• Service rate ‘µ’ is highest at pharmacy (9.907 patients served per hour) and laboratory
(9.687 patients served per hour) in Yashoda Hospital.
• Service rate‘µ’ is least at consultation with 3.8156 patients served per hour in Owaisi
Hospital & Research Centre.
• Service rate‘µ’ is least at diagnostics (4.255 patients served per hour) and consultation
(4.385 patients served per hour) in Yashoda Hospital.
• Utilization rate is highest at consultation (0.923577) and diagnostics (0.7962) in
Owaisi Hospital & Research Centre. It means the server is busy for 92.357 % of the
time at consultation and 79.62 % of the time at diagnostics.
• Utilization rate is highest at diagnostics (0.86) and consultation (0.74) in Yashoda
Hospital. It means the server is busy for 86 % of the time at diagnostics and 74 % of
the time at consultation.
• Idle time is more at registration with 63.88% in Owaisi Hospital & Research Centre.
• At pharmacy (57.307%) and OP billing (53.046%) also, for more than 50% of the
time, the system is idle in Owaisi Hospital & Research Centre.
• Idle time is more at laboratory sample collection (65%) and pharmacy (65%) in
Yashoda Hospital.
• The queue length is more at consultation (11.161 patients) and less at OP registration
(0.2) for Owaisi Hospital & Research Centre.
• The queue length is more at diagnostics (5.18 patients) for Yashoda Hospital.
• The queue length is less at OP registration with 0.204 patients for Owaisi Hospital &
Research Centre.
• The queue length is less at laboratory and pharmacy with 0.19 patients for Yashoda
Hospital.
• Average number of patients in the system is also highest for consultation with 12.085
patients in Owaisi Hospital & Research Centre.
• Average number of patients in the system is highest for diagnostics with 6.04 patients
in Yashoda Hospital.
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• Average waiting time in the queue is highest at consultation with 3.16 hours in Owaisi
Hospital & Research Centre.
• Average waiting time in the queue is highest at diagnostics with 1.42 hours in
Yashoda Hospital.
• Average waiting time in the system is highest at consultation with 3.429 hours in
Owaisi Hospital & Research Centre.
• Average waiting time in the system is highest at diagnostics with 1.65 patients in
Yashoda Hospital.
• There is a 0.63884 probability that no patients are there in the system at registration in
Owaisi Hospital & Research Centre whereas it is 0.59 in Yashoda Hospital.
• There is a 0.99996 probability that less than or equal to 9 patients are in the System at
Owaisi Hospital & Research Centre registration
• It is a certainty (probability of 1) that there are less than or equal to 5 patients at any
given time at the registration in Yashoda Hospital.
• There is a 0.53046 probability that no patients are there in the system at OP billing in
Owaisi Hospital & Research Centre whereas it is 0.5 in Yashoda Hospital.
• There is a 0.99995 probability that there can be a maximum of 12 patients in the
system at OP billing in Owaisi Hospital & Research Centre whereas in Yashoda
Hospital with 1.0 probability there are a maximum of only 6 patients.
• There is a 0.07642 probability that no patients are there in the system at consultancy
in Owaisi Hospital & Research Centre whereas it is 0.26 in Yashoda Hospital.
• There is a 0.91495 probability that there are less than or equal to 30 patients in the
system at consultancy in Owaisi Hospital & Research Centre.
• The probability that there are less than or equal to 15 patients in the system at
consultancy in Yashoda Hospital is 1.
• There is a 0.04815 probability that no patients are there in the system at laboratory
(Sample collection) in Owaisi Hospital & Research Centre.
• There is a 0.65 probability that there are no patients in the system at laboratory
(Sample collection) in Yashoda Hospital.
• The probability that there are less than or equal to 13 patients in the system at
laboratory (sample collection) is 0.99990
• The probability that there are less than or equal to 4 patients in the system at
laboratory (sample collection) in Yashoda Hospital is one.
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• The probability that there are 13 patients in the system at laboratory (sample
collection) in Owaisi Hospital & Research Centre is 0.99990
• There is a 0.20376 probability that no patients are there in the system at diagnostics in
Owaisi Hospital & Research Centre whereas it is 0.14 in Yashoda Hospital.
• The probability that there are less than or equal to 30 patients in the system at
diagnostics in Owaisi Hospital & Research Centre is 0.99914 and it is 1.0 for Yashoda
Hospital.
• There is a 0.57307 probability that there are no patients in the system at pharmacy in
Owaisi Hospital & Research Centre and is 0.65 in Yashoda Hospital.
• The probability that there are less than or equal to 11 patients in the system at
pharmacy in Owaisi Hospital & Research Centre is 0.99996.
• The probability that there are less than or equal to 4 patients in the system at
Pharmacy in Yashoda Hospital is 1.0.
Though queuing theory is applied to study the waiting time of patients in the outpatient
department, further research is required to find the applications in other different areas of the
hospital. The study can be done in not only multispecialty hospitals but also at clinics, single
specialty hospitals, diagnostic centers where there is a random arrival of the patient. Queuing
theory is also helpful in studying the bed occupancy.
Application of PERT in emergency department, patient discharge process & operation
theatre of Owaisi Hospital & Research Centre and Yashoda Hospital
The second objective is focused to study the process flow of the emergency department,
patient discharge process & operation theatre and developing network diagrams. The network
diagrams were made for emergency process, discharge process and OT for both the hospitals
i.e. Owaisi Hospital & Research Centre and Yashoda Hospital. PERT is applied at both the
hospitals to find the total duration of the process, critical path, slack times and accordingly
network diagrams are developed.
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PERT application in the emergency process of Owaisi Hospital & Research Centre and
Yashoda Hospital revealed the following findings:
• The total duration of the activities of the emergency process or the expected time for
completion of the project in Owaisi Hospital & Research Centre is 84.89 minutes or
1.415 hours (figure - 4.37) & 146.41 minutes or 2.44 hours (figure - 4.38) in Yashoda
Hospital.
• The variance of the project for emergency process in Owaisi Hospital & Research
Centre is 253.1 minutes or 4.22 hours (figure - 4.37) & 35.54 minutes or 0.59 hours
(figure - 4.38) in Yashoda Hospital.
• The critical path for emergency process in Owaisi Hospital & Research Centre is
(figure - 4.37):
A B E F H I K
• The critical path for emergency process in Yashoda Hospital is (figure - 4.38):
A B D F G H I J K N O Q R T
• The activities on the critical path are critical activities. The critical activities for
emergency process in Owaisi Hospital & Research Centre as per figure 4.37 are - A
(time taken to shift the patient from ambulance or private vehicle to emergency
department), B (time taken by the registered medical officer to attend the patient), E
(time taken to call the technician), F (time taken by the technician to attend the
patient), H (time taken for performing lab tests, CT scan, ECG, X-RAY and other
investigations and minor procedures), I (time taken for the report arrival of laboratory
& diagnostic tests) & K (time between getting report and exit of the patient). As
critical activities do not permit any flexibility in scheduling, any delay in any of the
critical activities A, B, E, F, H, I & K at Owaisi Hospital & Research Centre, will
delay the duration of emergency process.
• The critical activities for emergency process in Yashoda Hospital as per figure 4.38
are - A (time taken for patient’s call), B (time taken to confirm the patient about
ambulance), D (time taken to inform emergency medicine technician), F (time taken
for emergency medicine technician to reach ambulance), G (time taken by ambulance
driver to reach patient’s location), H (time taken at patient’s house to shift patient into
ambulance), I (time taken by ambulance driver to reach hospital from patient’s
location), J (time taken to shift the patient from ambulance or private vehicle to
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emergency department), K (time taken by the registered medical officer to attend the
patient), N (Time taken to call the technician),O (time taken by the technician to
attend the patient), Q (time taken for performing laboratory tests, CT scan, ECG, X-
RAY and other investigations and minor procedures), R (time taken for the report
arrival of lab & diagnostic tests), T (time between getting report and exit of the
patient).As critical activities do not permit any flexibility in scheduling, any delay in
any of the critical activities A, B, D, F,G, H, I,J, K,N,O,Q,R and T at Yashoda
Hospital will delay the duration of emergency process.
• Activities C (time taken by the nurse to attend the patient), D (time taken to inform
the specialist), G (time taken by the specialist to attend the patient) & J (time taken for
registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency
process have total float value of 1.14, 49.2, 29.2 & 49.2 minutes respectively as
shown in table 4.91. It means that there is flexibility with regard to time available in
informing specialist, also in registration, billing and pharmacy. If the 2 activities D
and J are delayed for 49.2 minutes, they will not delay the emergency process
duration. Similarly there is flexibility of 1.14 minutes for nurse to attend the patient
and 29.2 minutes flexibility for specialist to attend the patient.
• Activities B (time taken to confirm the patient about ambulance), D (time taken to
inform emergency medicine technician), K (time taken by the RMO to attend the
patient), L (time taken by the nurse to attend the patient), O (time taken by the
technician to attend the patient), R (time taken for the report arrival of laboratory &
diagnostic tests) of Yashoda Hospital emergency process have total float value of
1.06,1.06, 1.92, 80.99, 81 & 38.5 minutes respectively as shown in table 4.94. If the 2
activities B and D are delayed for 1.06 minutes, they will not delay the emergency
process duration. Similarly if registered medical officer takes more 1.92 minutes to
attend the patient, there will not be any delay in emergency process duration. There is
flexibility of 80.99 minutes, 81 minutes and 38.5 minutes for activities L, O and R.
• Activities D (time taken to inform the specialist) and G (time taken by the Specialist
to attend the patient) of Owaisi Hospital & Research Centre emergency process have
interfering float value of 49.22 and 29.22 minutes respectively as shown in table 4.91.
This float causes a reduction in the float of the successor activities i.e. for activity D
activity G is the successor and for activity G activity J is the successor. Thus any
delay in the time taken to inform the specialist (activity D) will decrease the float time
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taken by the specialist to attend the patient (activity G). Similarly delay of specialist
attending the patient (activity G) will decrease the float time of activity J i.e. time
taken for registration, billing and pharmacy.
• Activities B (time taken to confirm the patient about ambulance), L (time taken by the
nurse to attend the patient), O (time taken by the technician to attend the patient) of
Yashoda Hospital emergency process have interfering float values of 1.05, 80.99,
80.99 minutes respectively as shown in table 4.94. This float causes a reduction in the
float of the successor activities i.e. for activity B, activities C & D are successors.
Thus any delay in time taken to confirm the patient about ambulance will reduce the
float time taken to inform ambulance driver & emergency medicine technician. For
activity L, activity O is the successor and for activity O, activity Q is the successor.
Thus any delay in the time taken by the nurse to attend the patient (activity L) will
decrease the float time taken by the technician to attend the patient (activity O).
Similarly delay by the technician to attend the patient (activity O) will decrease the
float time of activity Q i.e. time taken for performing lab tests, CT scan, ECG, X-
RAY , other investigations and minor procedures.
• Activities C (time taken by the nurse to attend the patient) and J (time taken for
registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency
process have free float value of 1.14 and 49.22 minutes as shown in table 4.91. This is
that part of the total float which can be used without affecting the float of the
succeeding activities. Thus delay by the nurse to attend the patient (activity C) by 1.14
minutes will not effect on the flexibility of scheduling its successor activity F (time
taken by the technician to attend the patient). Similarly delay in the time taken for
registration, billing and pharmacy (activity J) by 49.22 minutes will not affect the
float of its successor activity K (time between getting report and exit of the patient).
• Activities B (time taken to confirm the patient about ambulance), D (time taken to
inform emergency medicine technician), K (time taken by the RMO to attend the
patient), O (time taken by the technician to attend the patient) and R (time taken for
the report arrival of laboratory & diagnostic tests) of Yashoda Hospital emergency
process have free float values of 0.01, 1.06, 1.92, 0.01 and 38.5 minutes as shown in
table 4.94. This is that part of the total float which can be used without affecting the
float of the succeeding activities. Thus delay of activity B for 0.01 minutes will not
affect the float time of activities C (time taken to inform ambulance driver) & D (time
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taken to inform emergency medicine technician). Delay in activity D by 1.06 minutes
will not have effect on the flexibility of scheduling its successor activity F (time taken
for emergency medicine technician to reach ambulance). Similarly delay by registered
medical officer to attend the patient (activity K) by 1.92 minutes will not affect the
float of its successor activities M (time taken to inform the specialist) & N (time taken
to call the technician). Delay of activity O (time taken by the technician to attend the
patient) by 0.01 minutes will not affect the float of its successor activity Q (time taken
for performing lab tests, CT scan, ECG, X-RAY and other investigations and minor
procedures). Delay in activity R (time taken for the report arrival of laboratory &
diagnostic tests) by 38.5 minutes will not affect the float of its successor activity T
(time between getting report and exit of the patient).
• Activities G (time taken by the specialist to attend the patient) and J (time taken for
registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency
process have independent float value of 49.22 and 29.22 minutes as shown in table
4.91. It is the amount of float time which can be used without affecting either the head
or tail events.
• Activities B (time taken to confirm the patient about ambulance), D (Time taken to
inform emergency medicine technician) & K (time taken by the registered medical
officer to attend the patient) of Yashoda Hospital emergency process have
independent float values of 0.01, 0.01 and 1.92 minutes respectively as shown in table
4.94.
• The slack of an activity measures the excess time and resources available in achieving
that particular activity. Positive slack indicates ahead of the schedule, negative slack
indicates behind the schedule, and zero slack indicates on the schedule. It is clear
from tables 4.91 & 4.94 that the activities on the critical path of the emergency
process are having zero float value in both the hospitals indicating that they are on the
scheduled time. No activities are with negative float time.
Application of PERT in the discharge process of Owaisi Hospital & Research Centre
and Yashoda Hospital revealed the following findings:
• The total duration of the activities of the discharge process or the expected time for
completion of the project for discharge process in Owaisi Hospital & Research Centre
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is 108.47 minutes or 1.807 hours (figure – 4.39) and it is 158.88 minutes or 2.468
hours (figure – 4.40) in Yashoda Hospital.
• The critical path for Owaisi Hospital & Research Centre discharge process is (figure-
4.39):
A C D E F G H I J K
• The critical path for Yashoda Hospital discharge process is (figure- 4.40):
A B D J K N O P
• The variance of the project for discharge process is 80.79 minutes or 1.3465 hours
(figure- 4.39) in Owaisi Hospital & Research Centre and is 333.87 minutes or 5.56
hours (figure – 4.40) in Yashoda Hospital.
• The critical activities for Owaisi Hospital & Research Centre discharge process as per
figure 4.39 are - A (consultant checking the patient’s condition, informing nurse
about the discharge of patient and issuing prescription), C (nurse in-charge informing
the resident doctor about the discharge & forwarding the case sheet and discharge
summary to the doctor), D (resident doctor preparing discharge summary), E
(consultant checking and signing the discharge summary), F (resident doctor
forwarding discharge summary to nursing station), G (nurse in-charge at nursing
station forwarding the case sheet to billing department.), H (final bill preparation by
the billing department), I (payment of the bill by patient attendee at the billing
department), J (billing department returning case sheet to nursing department with
patient discharge slip) & K (patient to vacate the room). Delay in any of the critical
activities A, C, D, E, F, G, H, I, J, K will delay the duration of discharge process in
Owaisi Hospital & Research Centre.
• The critical activities for Yashoda Hospital discharge process as per figure 4.40 are –
A (consultant checking the patient’s status), B (consultant informing ward in-charge
about discharge of patient), D (ward in-charge informing personal relations executive
about discharge), J (forwarding case sheet to billing Department), K (final bill
preparation by the billing department), N (payment of bill by patient attendee at
billing department), O (billing department issuing discharge intimation slip to ward
in-charge) and P (discharge of patient at ward and patient vacating the room). Delay
in any of the critical activities A, B, D, J, K, N, O, and P will delay the duration of
discharge process in Yashoda Hospital.
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• In Owaisi Hospital & Research Centre, activity B (nurse entering the discharge date &
time in register and returning excess medicine to the pharmacy) of discharge process
has got the same float time of 39.81 minutes for total, interfering and independent
floats (table - 4.97 ). It means that there is flexibility with regard to time available for
nurse to enter the discharge date & time in register and return excess medicine to the
pharmacy. Delay of activity B for 39.81 minutes will not delay the discharge process
duration. As free float can be used without affecting the float of the succeeding
activities , delay in activity B (nurse entering the discharge date & time in register and
returning excess medicine to the pharmacy) will not cause any affect on the flexibility
of scheduling its successor activity G (nurse in-charge at nursing station forwarding
the case sheet to billing department.) . Thus delay in the time taken by activity B for
39.81 minutes will not affect the float of its successor activity G. As activity B of
Owaisi Hospital & Research Centre discharge process has independent float value of
39.81 minutes (table 4.97), it is the amount of float time which can be used without
affecting either the head or tail events.
• Activities C (consultant issuing prescription and instructing patient about medication),
E (ward in- charge informing duty medical doctor about discharge), F (preparation of
discharge notes by duty medical doctor), G (returning excess medicine to pharmacy),
H (medicine brought to pharmacy by the ward attender), I (time taken by ward
attender to return medicine at pharmacy), L (checking of discharge summary for
corrections) and M (final preparation of discharge summary and attestation by
consultant) of Yashoda Hospital discharge process have total float value of 63.05,
45.84, 45.83, 63.05, 63.05, 63.05, 45.83 & 45.83 minutes respectively as shown in
table 4.100. If the activities C, G, H and I are delayed for 63.05 minutes, they will not
delay the discharge process duration. Similarly delay of activities E, F, L, and M by
45.83 minutes will not delay the discharge process duration.
• Activities C (consultant issuing prescription and instructing patient about medication),
E (ward in- charge informing duty medical doctor about discharge), F (preparation of
discharge notes by duty medical doctor), G (returning excess medicine to pharmacy),
H (medicine brought to pharmacy by the ward attender) and L (checking of discharge
summary for corrections) of Yashoda Hospital discharge process have interfering
float values of 63.05, 45.84, 45.83, 63.05, 63.05 and 45.83 minutes respectively as
shown in table 4.100. This float causes a reduction in the float of the successor
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activities i.e. for activity C, G is the successor. Similarly for activities C, F, G, H & L,
successor activities are F, L, H, I & M. Thus any delay in activities C (consultant
issuing prescription and instructing patient about medication), G (returning excess
medicine to pharmacy) and H (medicine brought to pharmacy by the ward attender)
by 63.05 minutes will reduce the float of their successors G (returning excess
medicine to pharmacy), H (medicine brought to pharmacy by the ward attender) and I
(time taken by ward attender to return medicine at pharmacy). Similarly delay in
activities E (ward in- charge informing duty medical doctor about discharge), F
(preparation of discharge notes by duty medical doctor) and L (checking of discharge
summary for corrections) by 45.83 minutes will reduce the float of their successors F
(preparation of discharge notes by duty medical doctor), L (checking of discharge
summary for corrections) and M (final preparation of discharge summary and
attestation by consultant).
• Activities I (time taken by ward attender to return medicine at pharmacy) and M
(final preparation of discharge summary and attestation by consultant) of Yashoda
Hospital discharge process have free float values of 63.05 and 45.83 minutes
respectively as shown in table 4.100. This is that part of the total float which can be
used without affecting the float of the succeeding activities. Thus delay of activity I
for 63.05 minutes will not affect the float time of activity N (payment of bill by
patient attendee at billing department). Similarly delay in activity M by 45.83 minutes
will not cause any affect on the flexibility of scheduling its successor activity P
(discharge of patient at ward and patient vacating the room).
• It is clear from tables – 4.97 & 4.100, that the critical activities of Owaisi Hospital &
Research Centre and Yashoda Hospital discharge process are having zero float value
indicating that they are on the scheduled time. No activities of discharge process are
with negative float time.
• The total duration of the activities of the operation theatre process or the expected
time for completion of the project for Owaisi Hospital & Research Centre operation
theatre process is 168.23 minutes or 2.80 hours (figure – 4.41) and is 517.08 minutes
or 8.618 hours for Yashoda Hospital (figure 4.42).
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PERT application in operation theater of Owaisi Hospital & Research Centre and
Yashoda Hospital revealed the following findings:
• The critical path for Owaisi Hospital & Research Centre operation theatre process is
(figure – 4.41):
• A B D F I J L M N O P Q R S.
• The critical path for Yashoda Hospital operation theatre process is (figure – 4.42):
• A B D G H I J L M N O P Q R S T.
• The variance of the project for operation theatre process in Owaisi Hospital &
Research Centre is 261.1 minutes or 4.35 hours (figure – 4.41) and is 3758.81 minutes
or 62.647 hours in Yashoda Hospital (figure 4.42).
• The critical activities for operation theatre process in Owaisi Hospital & Research
Centre are A (operation theatre manager calling the respective ward to inform the
nurse to shift the patient & taking confirmation), B (shifting of the patient from
respective ward to the operation theatre), D (junior anesthetist performing pre-
anesthesia check-up), F (Head of the department of anesthesia permitting the
concerned anesthetist for giving anesthesia to the patient), I (shifting of the patient
into the theatre by ward boy or aya), J (transferring the patient to the operation table),
L (team of doctors verifying patient’s name , consent and pre-anesthesia check-up
before starting the surgery), M (team of anesthetists giving anesthesia), N (doctor
marking the site of surgery on patient), O (surgeons performing the surgery), P
(shifting of the patient to the recovery room by ward boy / aya), Q (monitoring and
documenting the patient’s physiological status & post-anesthesia status), R (informing
the ward boy/ aya to shift the patient to post- operative ward), S (shifting of the
patient from recovery room to post- operative ward by ward boy / aya). As critical
activities do not permit any flexibility in scheduling, any delay in any of the critical
activities A, B, D, F, I, J, L, M, N, O, P, Q, R & S will delay the duration of operation
theatre process at Owaisi Hospital & Research Centre .
• The critical activities for operation theatre process in Yashoda Hospital are A
(operation theatre manager calling the respective ward to inform the nurse to shift the
patient & taking confirmation) , B (shifting of the patient from respective ward to the
operation theatre) , D (the junior anesthetist performing pre-anesthesia check-up) , G
(informing the ward boy or aya to change the dress of the patient) , H (ward boy or
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aya changing the dress of the patient) , I (shifting of the patient into the theatre by
ward boy or aya) , J (transferring the patient to the operation table), L (the team of
doctors verifying patient’s name , consent , pre-anesthesia check-up and other
parameters like blood pressure, pulse rate etc. before starting the surgery) , M (the
team of anesthetists giving anesthesia), N (doctor marking the site of surgery on
patient), O (surgeons performing the surgery), P (informing the ward boy or aya to
shift the patient to recovery room), Q (shifting of the patient to the recovery room by
ward boy / aya) , R (monitoring and documenting the patient’s physiological status &
post-anesthesia status) ,S (informing the ward boy/ aya to shift the patient to post-
operative ward) and T (shifting of the patient from recovery room to post- operative
ward by ward boy/aya). As critical activities do not permit any flexibility in
scheduling, any delay in any of the critical activities A, B, D, G, H, I, J, L, M, N, O,
P, Q, R, S and T will delay the duration of operation theatre process at Yashoda
Hospital.
• Activities C (operation theatre manager writing the consent in the case sheet), E
(doctor explaining the complications of operation to the patient & the attendee), G
(informing the ward boy or ‘aya’ to change the dress of the patient), H (ward boy or
‘aya’ changing the dress of the patient) & K (nurses arranging the instruments set for
surgery) of the operation theatre process at Owaisi Hospital & Research Centre have
total float value of 10.01, 10.01, 0.67, 0.67 & 33.31 respectively as shown in table-
4.103. It means that there is flexibility in regard to time available for activities C, E,
G, H & K. Delaying activities C and E by 10.01 minutes will not delay the project
duration. Similarly delay of the activities G, H & K by 0.67, 0.67 & 33.31
respectively will not affect the total duration of the operation theatre process.
• Activities C (operation theatre manager / concerned doctor writing the consent in the
case sheet), E (doctor explaining the complications of operation to the patient & the
attendee), F (the head of the department of anesthesia permitting the concerned
anesthetist for giving anesthesia to the patient) and K (team of nurses arranging
instruments for surgery) of the operation theatre process at Yashoda Hospital have
total float value of 6.74, 6.74, 4.15 & 42.39 respectively as shown in table- 4.106. It
means that there is flexibility with respect to time available for activities C, E, F & K.
Delaying activities C and E by 6.74 minutes will not delay the project duration.
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Similarly delay of the activities F, K by 4.15 & 42.39 will not affect the total duration
of the operation theatre process.
• Activities C (operation theatre manager writing the consent in the case sheet) and G
(informing the ward boy or aya to change the dress of the patient) of Owaisi Hospital
& Research Centre operation theatre process have interfering float value of 10.01 and
0.67 as shown in table – 4.103. This float causes a reduction in the float of the
successor activities i.e. for activity C activity E is the successor and for activity G
activity H is the successor. Thus any delay in operation theatre manager writing the
consent in the case sheet (activity C) will decrease the float time taken by the doctor
explaining the complications of operation to the patient & the attendee (activity E).
Similarly informing the ward boy or aya to change the dress of the patient (activity G)
will decrease the float time of activity H (ward boy or aya changing the dress of the
patient).
• Activity C (operation theatre manager / concerned doctor writing the consent in the
case sheet) of Yashoda Hospital operation theatre process has interfering float value
of 6.74 minutes as shown in table – 4.106. As this float causes a reduction in the float
of the successor activity, delay in activity C by 6.74 minutes will decrease the float
time taken by activity E (doctor explaining the complications of operation to the
patient & the attendee).
• Activities E (doctor explaining the complications of operation to the patient & the
attendee), H (ward boy or aya changing the dress of the patient) and K (nurses
arranging the instruments set for surgery) of Owaisi Hospital & Research Centre
operation theatre process have free float value of 10.01, 0.67 & 33.31 as shown in
table – 4.103. As this float doesn’t affect the float of the succeeding activities, delay
of activity E & H by 10.01, 0.67 minutes respectively will not cause any effect on the
flexibility of scheduling their successor activity I (shifting of the patient into the
theatre by ward boy or aya). Similarly delay in the time taken by activity K by 33.31
minutes will not affect the float of its successor activity M (the team of anesthetists
giving anesthesia).
• Activities E (doctor explaining the complications of operation to the patient & the
attendee), F (the head of the department of anesthesia permitting the anesthetist
concerned for giving anesthesia to the patient) and K (team of nurses arranging
instruments for surgery) of Yashoda Hospital operation theatre process have free float
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value of 6.74, 4.15 and 42.39 minutes respectively as shown in table – 4.106. As this
float doesn’t affect the float of the succeeding activities, delay of activity E, F by
6.74&4.15 minutes will not cause any effect on the flexibility of scheduling their
successor activity I (shifting of the patient into the theatre by ward boy or aya).
Similarly delay in the time taken by activity K by 42.39 minutes will not affect the
float of its successor activity M (the team of anesthetists giving anesthesia).
• Activities H (ward boy or aya changing the dress of the patient) and K(nurses
arranging the instruments set for surgery) of Owaisi Hospital & Research Centre
operation theatre process have independent float values of 1.34 and 33.31 minutes
respectively as shown in table – 4.103. It is the amount of float time which can be
used without affecting either the head or tail events.
• Activities F (the head of the department of anesthesia permitting the anesthetist
concerned for giving anesthesia to the patient) and K (team of nurses arranging
instruments for surgery) of Yashoda Hospital operation theatre process have
independent float values of 4.15 and 42.39 minutes respectively as shown in table –
4.106. It is the amount of float time which can be used without affecting either the
head or tail events.
• As per tables 4.103 and 4.106, the critical activities of operation theatre process at
Owaisi Hospital & Research Centre (A, B, D, F, I, J, L, M, N, O, P, Q, R & S) and
Yashoda Hospital (A, B, D, G, H, I, J, L, M, N, O, P, Q, R, S and T) are having zero
float value indicating that they are on the scheduled time. No activities are with
negative float time.
Network analysis finds its applications in many areas of the hospital right from hospital
planning to management of operations. Reviews also show that not much application of
PERT is done in hospitals. Though the study is focused on understanding the critical path and
slack times at emergency, discharge and OT, there is further scope to extend the application
to other areas like hospital billing, hospital bed expansion, Arogyasree cases, health camps,
process flow analysis of a central sterile supply department etc.
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Application of MUSIC – 3D in pharmaceutical inventory of Owaisi Hospital &
Research Centre and Yashoda Hospital
The third objective is to study MUSIC -3D process of inventory management by classifying
the pharmaceutical inventory into ABC, VED & SDE. The third objective concentrates on
applying MUSIC -3D in the pharmaceutical inventory of Owaisi Hospital & Research Centre
and Yashoda Hospital, by classifying the pharmaceutical inventory into ABC, VED & SDE.
An insight into the application of MUSIC-3D in the pharmaceutical inventory resulted in the
findings as discussed below.
ABC analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and
Yashoda Hospital
ABC analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre from table
4.107 revealed the following findings:
There are 55 ‘A' items accounting to 19.5035 % of total items & 70.07791 % of total
consumption.
There are 86 ‘B’ items accounting to 30.4964 % of total items & 20.05315 % of total
consumption.
There are 141 ‘C’ items accounting to 50% of total items & 9.868 % of total
consumption.
ABC analysis of pharmaceutical inventory at Yashoda Hospital from table 4.112 revealed the
following findings:
There are 123 ‘A’ items accounting to 33.79 % of total items & 70.19 % of total
consumption.
There are 102 ‘B’ items accounting to 28.03 % of total items & 19.85 % of total
consumption.
There are 139 ‘C’ items accounting to 38.18 % of total items & 9.96 % of total
consumption.
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VED analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and
Yashoda Hospital
The following are the findings of VED analysis of pharmaceutical inventory at Owaisi
Hospital & Research Centre (table- 4.108):
There are 27 'V' items accounting to 9.57447 % of total items that are vital for patient
care.
There are 165 'E' items accounting to 58.5106 % of total items that are essential for
patient care.
There are 90 'D' items accounting to 31.9149 % of total items that are desirable for
patient care.
The following are the findings of VED analysis of pharmaceutical inventory at Yashoda
Hospital (table- 4.113):
There are 65 'V' items accounting to 17.8 % of total items that are vital for patient
care.
There are 236 'E' items accounting to 64.8 % of total items that are essential for
patient care.
There are 63 'D' items accounting to 17.4 % of total items that are desirable for patient
care.
In both the hospitals ‘E’ items (165 in Owaisi Hospital & Research Centre and 236 in
Yashoda Hospital) which are essential for patient care are more when compared to ‘V’ or ‘D’
items. Though requirement of ‘V’ items in both the hospitals is less in comparison to ‘E’
items, ‘V’ items are vital for patient care and it should be seen that they are always available.
SDE analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and
Yashoda Hospital
The following are the findings of SDE analysis of pharmaceutical inventory at Owaisi
Hospital & Research Centre (table -4.109):
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There are 6 'S items accounting to 2.12766 % of total items that are scarcely available,
have short supply & are especially imported.
There are 33 'D' items accounting to 11.7021 % of total items that are difficultly
available in indigenous market
There are 243 'E' items accounting to 86.1702 % of total items that are easily
available.
The following are the findings of SDE analysis of pharmaceutical inventory at Yashoda
Hospital (table -4.114):
There are 10 'S items accounting to 2.7 % of total items that are scarcely available,
have short supply & are especially imported.
There are 72 'D' items accounting to 19.8 % of total items that are difficultly available
in indigenous market
There are 282 'E' items accounting to 77.5 % of total items that are easily available.
SDE analysis shows that maximum pharmaceutical items are easily and locally available
(86.17 % in Owaisi Hospital & Research Centre and 77.5 % in Yashoda Hospital). But
hospitals should concentrate on obtaining scarce items, as they need long lead time.
MUSIC – 3D analysis of pharmaceutical inventory at Owaisi Hospital & Research
Centre and Yashoda Hospital
The following are the findings of MUSIC-3D analysis of pharmaceutical inventory at Owaisi
Hospital & Research Centre (table – 4.110):
No items are there under HLC (high consumption value , long lead time, critical)
category
0.7 % of the items are under HSC (high consumption value, short lead time, critical)
category.
1.06 % of the items are under HLN (high consumption value, long lead time, non-
critical) category.
18.08 % of the items are under HSN (high consumption value, short lead time, non-
critical) category.
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7.09 % of the items are under LLC (low consumption value, long lead time, critical)
category.
5.3 % of the items are under LSC (low consumption value, short lead time, critical)
category.
4.25 % of the items are under LLN (low consumption value, long lead time, non-
critical) category.
63.4 % of the items are under LSN (low consumption value, short lead time, non-
critical) category.
The following are the findings of MUSIC-3D analysis of pharmaceutical inventory at
Yashoda Hospital (table – 4.115):
5.76 % items are there under HLC (high consumption value , long lead time, critical)
category
3.29 % of the items are under HSC (high consumption value, short lead time, critical)
category.
2.47 % of the items are under HLN (high consumption value, long lead time, non-
critical) category.
22.25 % of the items are under HSN (high consumption value, short lead time, non-
critical) category.
4.39 % of the items are under LLC (low consumption value, long lead time, critical)
category.
4.94 % of the items are under LSC (low consumption value, short lead time, critical)
category.
9.89 % of the items are under LLN (low consumption value, long lead time, non-
critical) category.
46.97 % of the items are under LSN (low consumption value, short lead time, non-
critical) category.
Although MUSIC-3D shows maximum percentage of items under LSN (low consumption
value, short lead time, non-critical) category for both the hospitals i.e. Owaisi Hospital &
Research Centre (63.4%) and Yashoda Hospital (46.97%), all the other categories of items
under MUSIC -3D also play an important role in providing timely patient care. Strategies
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have to be developed accordingly to procure these pharmaceutical items based on the
category obtained by MUSIC-3D analysis.
MUSIC-3D is a very good inventory management tool as it considers inventory management
from a three dimensional view. In the present study pharmaceutical inventory is analysed
keeping in mind the consumption value, criticality and lead time. Further research can be
done to apply MUSIC-3D at pharmacy outlets, surgical items, linen and any other
consumables of the hospital.
Replacement analysis of medical equipment revealed the following findings:
The fourth objective of the study is the application of replacement model in understanding the
optimal replacement period of major medical equipment. Replacement model is applied to
study the optimum replacement period for the medical equipment of Yashoda hospital
It is found that the average cost of MRI equipment for replacement is a minimum of
Rs 48,25,000 in the 12th year, and increases from thereon. This clearly shows that
MRI equipment should be replaced at the end of the 12th year from the date of
purchase.
For CT scan equipment the average cost for replacement is found to be a minimum of
Rs 33,50,000 in the 10th year, and increases from thereon. CT-Scan equipment should
be replaced at the end of the 10th year from the date of purchase.
The average cost for X-ray machine for replacement is found to be a minimum of Rs
10,87,500 in the 8th year, and increases from thereon. So the X-ray machine should be
replaced at the end of the 8th year from the date of purchase.
For Ultrasound monitor, the average cost for replacement is a minimum of Rs
2,81,363.636 in the 11th year, and increases from thereon. This means the Ultrasound
monitor should be replaced at the end of the 11th year from the date of purchase.
It is observed that the average cost for replacement is a minimum of Rs 2,85,000 in
the 9th year for 2D-ECHO equipment, and increases from thereon. Thus 2D-ECHO
equipment should be replaced at the end of the 9th year from the date of purchase.
For C-ARM equipment, the average cost for replacement is a minimum of Rs
1,54,375 in the 8th year and increases from thereon. So the C-ARM equipment should
be replaced at the end of the 8th year from the date of purchase.
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The average cost of replacement for ENMG machine is a minimum of Rs 1,71,500 in
the 10th year and increases from thereon. So the ENMG machine should be replaced at
the end of the 10th year from the date of purchase.
Ventilator equipment has a minimum average cost of replacement of Rs 1,10,000 in
the 9th year and increase from thereon. Hence optimum replacement policy for
Ventilator is to replace it at the end of the 9th year from the date of purchase.
The average cost for replacement of Dialysis machine is found to be a minimum of Rs
96,888.889 in the 9th year and increases from thereon. Accordingly the Dialysis
machine should be replaced at the end of the 9th year from the date of purchase.
For ECG Monitor, the average cost of replacement is found to be a minimum of Rs
24,222.222 in the 9th year and increases from thereon. Thus the optimum policy for
Monitor (ECG) is to replace it at the end of the 9th year from the date of purchase.
In the present study, replacement analysis is performed for the major medical equipment
of the hospital. Further research is required to understand how replacement models find
use in framing replacement policies for ambulances and replacement of old equipment
with the new one. Optimal replacement period for minor equipment can also be found.
Similar application of replacement analysis can be carried out for the equipment of the
diagnostic centers.
Application of LPP for diet problem revealed the following findings:
The fifth objective of the study is the application of LPP in formulating an optimal cost
balanced diet problem for a healthy life style. Two solutions have been provided for the
balanced diet problem:
• First one is an optimal or minimum cost solution to the balanced-diet problem.
Minimum cost solution entails a total cost of Rs. 2,842.991 per month per person.
But, it resulted in an unpalatable diet. Out of 89 food items, the solution resulted in
use of only 12 items (table 4.148).
• Second one is a sub-optimal cost solution to the balanced-diet problem which is
formulated keeping the cultural and culinary background of local people. The sub-
optimal cost diet is not only nutritious but also palatable. The quantity of all the 89
food items that can be consumed in a month is found keeping in mind the constraints
that have to be satisfied (table 4.149).
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• The sub-optimal solution provides a balanced diet with total cost of Rs. 4,121.103 per
month per person and includes a wide variety of food items.
Though LPP is used in formulating a nutritious balanced diet, several other applications
can be done in hospitals. One can explore on how it can be applied, as LPP has several
applications right from man power scheduling, transportation, finance, media selection to
product mix problems. In hospitals, LPP can be effectively applied to study the
scheduling of operation theater, nurses, doctors and other manpower. Transportation of
sterile items from central sterile supply department to other departments and receiving
back the used items from various departments to central sterile supply department can
also be effectively planned through LPP. Assigning nurses to different wards,
transportation of patients using ambulances etc. are some other areas where research has
to be focused.
5.2 CONCLUSION
The basic objective of the study is the application of OR techniques to optimize hospital
services. Several OR techniques like queuing theory, PERT, MUSIC-3D analysis,
replacement analysis and LPP have been applied during the research. Queuing theory is
applied to study the waiting time of patients in both the hospitals i.e. Owaisi Hospital &
Research Centre and Yashoda Hospital. PERT is used in developing network diagrams for
the processes of emergency, discharge and OT in both the hospitals. MUSIC-3D is performed
for the pharmaceutical inventory of both the hospitals. Replacement analysis is used to find
the optimum replacement period of the medical equipment of Yashoda Hospital. LPP is
formulated for finding an optimal cost diet which satisfies the nutritional requirements.
Conclusion based on queuing theory application in Owaisi Hospital & Research Centre
and Yashoda Hospital
In Owaisi Hospital & Research Centre, waiting time of patients in the queue is more at
consultation (3.16 hours) and diagnostics (0.941 hours). Waiting time of patients in the
system is also more at consultation (3.429 hours) and diagnostics (1.182 hours). Long waiting
may result in more rush at consultancy and diagnostics. The waiting time in the queue (1.42
hours) and system (1.65 hours) is more at diagnostics in Yashoda Hospital when compared to
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other stations. It is observed that for both the hospitals waiting time is more at diagnostics
when compared to other stations.
Waiting time and length of the queue are more at consultation when compared to other
stations. As Owaisi Hospital & Research Centre is a teaching hospital, waiting time and
queue length might be more at consultancy. This is because of senior doctors teaching the
medical students. Many times junior doctors or intern students with little experience attend
the cases. Only complicated cases are seen by the senior consultants. This also causes longer
queues and more waiting for the patients in Owaisi Hospital & Research Centre.
The probability that the server is idle at laboratory services is 0.558 in Owaisi Hospital &
Research Centre. More than 50% of the time the server is idle at laboratory. So, measures
may be taken to optimize the laboratory services at Owaisi Hospital & Research Centre. As
idle time is more at Owaisi Hospital & Research Centre registration & billing with 63.88% &
53.04% respectively, the staff may be trained for carrying out other tasks apart from their
routine duties. In Yashoda Hospital, laboratory and pharmacy are idle for 65% of time
followed by OP registration for 59% of time. Measures may be taken to improve the
utilization rate at these stations.
Pharmacy in Owaisi Hospital & Research Centre has more utilization rate of 42.69 % when
compared to 35% in Yashoda Hospital. The queue length of the patients at pharmacy is only
0.318 in Owaisi Hospital & Research Centre and 0.19 in Yashoda Hospital.
At Owaisi Hospital & Research Centre OP registration, there is a probability of 0.95289 that
the number of patients in the system is less than or equal to 2 and the probability that the
patients is greater than or equal to 3 is 0.01701. This clearly shows that the patient flow can
be improved. Similarly, there are probabilities of 0.95139, 0.92776 & 0.96678 at OP billing,
laboratory & pharmacy respectively for patients to be less than are equal to 3. The
management should plan for optimizing the services at these departments. At Yashoda
Hospital OP registration there is a 0.97 probability that the number of patients is less than or
equal to 3.
The probability of number of patients is less than or equal to k (number of patients in the
queuing system) at OP registration is less at Yashoda (5 patients with probability 1) when
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compared to Owaisi Hospital & Research Centre (9 patients with probability 0.99996).
Probability that there are more than 6 patients in Yashoda Hospital OP registration is zero. It
means that the patients in the queuing system at OP registration cannot be more than 6. When
compared to Owaisi Hospital & Research Centre registration & OP billing, number of
patients in the queuing system at Yashoda Hospital is less. There is a 100 % probability that
there are only 6 patients in the queuing system at OP billing in Yashoda Hospital. The
probability of number of patients in the queuing system <= K (number of patients in the
queuing system) at consultation is almost double in Owaisi Hospital & Research Centre when
compared to Yashoda Hospital.
Conclusion based on PERT applications in emergency, discharge and OT process flows
of Owaisi Hospital & Research Centre and Yashoda Hospital
Emergency process duration time is more in Yashoda Hospital (2.44 hours) when compared
to Owaisi Hospital & Research Centre (1.415 hours). This is because in Owaisi Hospital &
Research Centre, ambulance service is not that effective. So, process flow is starting from the
time patient is brought to the hospital. Variance for emergency process flow is less in
Yashoda Hospital (0.59 hours) when compared to Owaisi Hospital & Research Centre (4.22
hours). Though activities are more in Yashoda Hospital emergency process (as it includes
ambulance services), variance in emergency process duration is less. This shows how
effectively the emergency services are managed in Yashoda Hospital.
Activities D (time taken to inform the specialist), G (time taken by the specialist to attend the
patient) & J (time taken for registration, billing and pharmacy) of Owaisi Hospital &
Research Centre emergency process have larger total float values of 49.2, 29.2 & 49.2
minutes respectively. Activities D (time taken to inform the specialist) & G (time taken by
the specialist to attend the patient) of Owaisi Hospital & Research Centre emergency process
have larger interfering float values of 49.22 and 29.22 minutes respectively. Activity J (time
taken for registration, billing and pharmacy) of Owaisi Hospital & Research Centre
emergency process has large free float value of 49.22 minutes. Activity G (time taken by the
Specialist to attend the patient) of Owaisi Hospital & Research Centre emergency process has
larger independent float value of 49.2 minutes. Activities L (time taken by the nurse to attend
the patient), O (time taken by the technician to attend the patient) & R (Time taken for the
report arrival of lab & diagnostic tests) of Yashoda Hospital emergency process have larger
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total float values of 80.99, 81 & 38.5 minutes respectively. Activities L (time taken by the
nurse to attend the patient) & O (time taken by the technician to attend the patient) of
Yashoda Hospital emergency process have larger interfering float value of 80.99 minutes.
Activity R (time taken for the report arrival of lab & diagnostic tests) of Yashoda Hospital
emergency process has large free float value of 38.5 minutes.
Discharge process duration is more in Yashoda Hospital (2.468 hours) when compared to
Owaisi Hospital & Research Centre (1.807 hours). Variance is very large for Yashoda
Hospital discharge process (5.56 hours) when compared to Owaisi Hospital & Research
Centre (1.3465 hours). It is observed that the expected time for OT process is more at
Yashoda Hospital (8.618 hours) when compared to Owaisi Hospital & Research Centre (2.80
hours). This might be due to the complicated operations performed in Yashoda Hospital than
in Owaisi Hospital & Research Centre.
Variance of OT process is more in Yashoda Hospital (62.647 hours) than in Owaisi Hospital
& Research Centre (4.35 hours). This might be due to the range of surgeries that are
performed in Yashoda Hospital when compared to Owaisi Hospital & Research Centre.
Activity K (nurses arranging the instruments set for surgery) of OT process in Owaisi
Hospital & Research Centre has flexibility with slack time of 33.31 minutes for total, free and
independent floats. Activity K (nurses arranging the instruments set for surgery) of OT
process in Yashoda Hospital has also flexibility with slack time of 42.39 minutes for total,
free and independent floats.
Conclusion based on application of MUSIC-3D analysis, replacement analysis and LPP
in Owaisi Hospital & Research Centre and Yashoda Hospital
The conventional ABC analysis is not an effective selective control mechanism, as there are
other influencing mechanisms like criticality and availability, which influence a great deal on
controlling the materials. Thus, the three-dimensional approach MUSIC -3D is helpful to
classify all materials into eight categories and to control the materials effectively on all
aspects and achieve ‘cost reduction', in order to facilitate the materials department as a profit
center.
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The initial efforts required to implement MUSIC-3D inventory policy may be requiring some
effort, but once implemented, only a marginal action is needed to maintain and improve it.
The benefits are immense. The importance of inventory control is now realized by the
hospital administrators. Its basic objectives are to reduce investment in inventories and
simultaneously avoid stock-outs situation. An effective inventory control balances the two
objectives to optimum advantage. Computerization, automation and use of technique like
MUSIC-3D will aid in achieving these objectives.
It is imperative that all measures for the prevention of stock out situations should be
implemented. Availability of pharmaceutical products is essential for timely patient
treatment. It is also an essential requisite for provision of life saving, effective and efficient
healthcare. Frequency of stock outs is an indicator to assess the effectiveness of the stores
department and the materials management.
Replacement analysis of medical equipment helps to frame an optimum replacement policy.
Except MRI equipment (replacement period of 12th year), all the other equipment are found
to have an optimum replacement period between 8- 10years.
Minimum cost diet resulted in selection of 12 food items: rice, red gram, cabbage, yam,
cucumber, peanut, banana, watermelon, egg, milk, cooking oil and sugar. Though 12 items
are satisfying all the 62 constraints of nutritional requirement, it is difficult for a person to
have variety of tasty foods with only on 12 items in a month. For that reason a diet covering
wide variety of food items is planned which resulted in a palatable diet consisting 89 food
items providing the entire nutritional requirement.
The optimal or minimum cost diet is Rs. 2,842.991 per month per person whereas total cost
of Sub-optimal diet is Rs. 4,121.103 per month per person. Though there is a difference of
Rs. 1,278.904 per month per person for optimal and sub-optimal solution, it is preferable to
go for solution based on suboptimal approach as it would be not only nourishing but also
meet aesthetic tastes and culinary preferences of most of the Indian people.
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5.3 RECOMMENDATIONS
Based on the application of different OR techniques like queuing theory, PERT, MUSIC-3D,
replacement analysis and LPP, areas for improvement have been identified in both the
hospitals i.e. Owaisi Hospital & Research Centre and Yashoda Hospital. Accordingly, a few
recommendations have been given for optimizing the services at outpatient department,
laboratory, diagnostics, emergency, OT and for medical equipment replacement. An optimal
diet plan is also proposed for meeting the nutritional requirements of average individual in
general and convalescing patients in particular. The following are the recommendations of
the study, based on the application of different OR techniques like queuing theory, PERT,
MUSIC-3D, replacement analysis and LPP:
• Waiting time of patients in both the hospitals Owaisi Hospital & Research Centre and
Yashoda hospital can be reduced at consultancy by having proper appointment
scheduling. Appointment scheduling has to be done on the same day or before.
• Though the hospital is offering consultation at minimal rate (Rs. 30 per visit) in
Owaisi Hospital & Research Centre, patients may not be interested to wait for longer
duration. Some patients may even like to visit only senior consultants and not like to
be seen by junior doctors or interns. So the hospital should see that the patients who
are interested in visiting senior consultants should be seen by them only. This of
course could be achieved by having high consultation fees (say Rs. 100) for the senior
consultants. This also helps in increasing the hospital revenue.
• For both the hospitals Owaisi Hospital & Research Centre and Yashoda hospital,
measures have to be taken to reduce the waiting time at diagnostics. Though the
waiting time cannot be reduced to zero, it should be seen that patient should not have
to wait for long at diagnostics. This can be achieved by giving prior appointment to
non-emergency patients who have to undergo scans (ultrasound, MRI) for a longer
period.
• As idle time is more than 50% at Owaisi Hospital & Research Centre laboratory and
65% at Yashoda Hospital, services can be optimized by extending the laboratory
facilities to nearby small hospitals and clinics that lack laboratory services, thus
increasing the revenue of the hospital.
• It is observed that most of the medicines prescribed by the doctors are not available in
the pharmacy of Owaisi Hospital & Research Centre, except some commonly
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prescribed drugs. So patients are not showing interest to buy medicines at hospital
pharmacy in Owaisi Hospital & Research Centre. Pharmacy services can be improved
by providing range of drugs. Pharmacy should at least store the drugs prescribed by
in-house doctors. Only then patients will show interest to buy drugs in the hospital
pharmacy.
• Pharmacy in Yashoda Hospital is idle for 65% of time. This might be because the
hospital pharmacy is utilized by only Yashoda Hospital patients. It is better to re-
locate the pharmacy adjacent to hospital main entrance, so that other patients can also
have easy access to hospital pharmacy.
• The server is busy only for 36.12% of the time at Owaisi Hospital & Research Centre
OP registration. So the staff at OP registration counter should be trained to provide
more quality service to patients. This can be done by providing additional information
to patients regarding doctor’s availability, location of the service areas, other facilities
offered at hospital etc. which will improve the quality of care provided by hospital to
patients.
• The server is busy only for 53.04% of the time at Owaisi Hospital & Research Centre
OP billing. In fact management can remove separate enquiry counter at reception. A
notice should be kept at reception that all enquiries are handled at registration and
billing counters. This will optimize the man power at reception.
• Study on the probabilities at Owaisi Hospital & Research Centre OP registration
showed that the patient flow is very less. The hospital should concentrate on medical
camps and healthcare packages to attract more patients. Designing healthcare
packages for overall body check-up, cardiac packages, fitness packages etc. will
attract more patients.
• Even in Yashoda Hospital the probabilities for patients to be more than seven is zero
at OP registration, OP billing, laboratory and pharmacy. The hospital should
concentrate on cost leadership and differentiation. The cost of the services is found to
be more in Yashoda Hospital than in Owaisi Hospital & Research Centre. Yashoda
Hospital should concentrate on providing quality services at affordable costs to face
the competition.
• As Owaisi Hospital & Research Centre is well equipped and has good infrastructure,
it should concentrate on optimizing the services at laboratory and diagnostics. This
can be done by having tie-up with nearby clinics and doctors to send patients for
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diagnostic, lab & specialty services. This will in turn increase the revenue of hospital
as well optimize the manpower utilization at the respective departments.
• Owaisi Hospital & Research Centre should improve the emergency services.
Ambulance services play very important role for any hospital. Owaisi Hospital &
Research Centre should concentrate on improving the ambulance services as the
hospital is in a prime location.
• Total time for discharge process is too long in Yashoda Hospital (estimated time
2.468 hours and variance 5.56 hours). Measures have to be taken to reduce the
discharge process time in Yashoda Hospital.
• Owaisi Hospital & Research Centre has very good infrastructure and facilities in OT.
The hospital should have tie up with good surgeons to perform complicated surgeries.
Only then the quality of the services will improve and optimum utilization of the
operation theatre facilities will happen.
• Application of PERT in hospitals helps to understand the critical and slack times for
various activities. So the hospitals should take enough care in seeing that the critical
activities are not delayed. Any flexibility in timing can be there only for non - critical
activities.
• Indent for materials from different departments in the hospital should be
computerized to reduce errors. Stock of critical items which has high consumption
should be monitored very critically.
• Decentralization of pharmacy store is required at cardiology department, operation
theater, intensive care unit etc. for easy accessibility of drugs for patients.
• Supply of materials from central stores should have separate passage for delivery to
the respective departments.
• Periodic assessment of pharmaceutical items for their expiry dates should be
incorporated.
• Implementation of MUSIC-3D to the inventory stock will enhance the performance at
pharmacy.
• The safety stock level of vital items should be fixed in such way that operation of the
pharmacy does not suffer for want of these items.
• Implementation of computer integrated system with all the critical departments
(operation theatre, intensive care units, etc.) of the hospital to ensure coordinated
planning and smooth flow of drugs.
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• Heavy investment is incurred by the hospitals for procuring medical equipment.
Optimum replacement policy is a must to see that the equipment is replaced on time.
Failure to do so will not only result in higher maintenance costs and poor
productivity, but also diminishes the quality of output.
• The LPP problem is applied to find out a nutritious balanced diet for a healthy life
style. It is recommended to follow the sub-optimal diet which includes 89 food items
and costing Rs.4,121.103 per month per person. Sub-optimal diet is recommended in
comparison with optimal diet, as it is giving a palatable diet.
As long as increasing the productivity of healthcare organizations remains important,
analysis should be done to apply relevant models to improve the performance of healthcare
processes.
299
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