Excellence in OperationsTopic: Excellence in Hospital Operations: A Quality perspective: For increasing the profitability in Tertiary Care Hospital.

Presented To: Prof Dr B A Metri.

By: Group: 4

Group Members: Bidyut Kumar Mana 15XPGDM09 Mauricio Venegas 15XPGDM19 Rahul S Deshpande 15XPGDM25 Rajesh Kumar 15XPGDM26 Shivang Mandloi 15XPGDM31 Tapas Kesarwani 15XPGDM42

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Sr.No Topic Page. No

1 Introduction & Management Summary 3

2 Attaining Excellence through Quality in Healthcare Delivery

(Quality Accreditation).

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3 Excellence in Operations through Quality Management at Rockland Hospitals.

4-10

4 Quality Measures Utilized at Rockland Hospitals. 12

5 Highlights of NABH (National Accreditation Board for Hospitals) Standards Contributing to Quality Measures.

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6 Highlights of NABL Accreditation (National Accreditation Board for Testing and Calibration) Standards Contributing to Quality Measures.

13-16

7 Excellence through Quality various operations wise perspective. 16-30

8 Conclusion. 31

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Introduction & Management Summary:

Our project report concerns with the excellence in healthcare- hospital industry. This industry is the corner stone of every nation’s progress and an extremely prime indicator of its developmental status. Then excellence in healthcare or hospital is attained by achieving desired quality standards specified by the hospital (Rockland Hospitals). The cost of quality in the service industry is the a prime factor because availing the services of the hospital is very high involvement decision which requires due diligence, evaluations and exhaustion all the options before moving onto the last option of resorting to the hospitals services. There are different perspective in which excellence in hospitals is to evaluate right from the human resources, equipment, treatment given, infections control, responsiveness towards medical emergency, operations costs and availability of the services at any given point of day and year. A multipronged approach that puts physicians—and clinical care—at the heart of performance transformation efforts can help hospitals and health systems deliver more financially sustainable, patient-oriented, and physician-friendly care. As a result, many hospitals (and the health systems they are often part of) have undertaken operational improvement programs, such as lean transformations, Six Sigma projects, and rapid improvement events. Although some of these programs have helped the hospitals reduce costs, few have achieved substantial or long-term impact— in large part because most of them focused on nonclinical operations and did not seek the active involvement of physicians. Yet clinical care accounts for a significant portion of operational expenditures at most hospitals. Without significant changes to how clinical care is delivered, hospitals will not be able to achieve the 5- to 10-percent reduction in operational costs that most experts believe is needed to cope with today’s economic challenges. Involving physicians in operational performance improvement efforts is therefore crucial. A provider that wants to lower its operational costs by 5 to 10 percent would have to reduce its nonclinical variable costs by an average of about 30 percent if it left clinical operations off the table. This level of savings is unrealistic for most hospitals. The current study reinforces the observation that increasing cost pressures force hospitals to implement structural changes. The results of this study, however, also highlight that better cost management will not be sufficient and that there is a need to prepare for the intensifying competition for patients, qualified personnel and partners. A strategic turnaround needs to be based on a financially and operationally sound and sustainable situation. This is not a given for many hospitals, which requires them to address basic issues in parallel to developing a strategic transformation program. While many hospitals have already undertaken important cost reduction efforts in recent years, there still remains substantial potential for further improvement. However, this requires structural changes in order to prevent lower quality levels and/or an unacceptably high workload for staff. Thus our study focuses on the cost reduction and at the same time involving and the actual clinical care to with the support cost reduction approach. The various factors were studied involved in the hospital operations. These involved the non-clinical and clinical aspects of the healthcare delivery systems ranging from patient handling to infection control, medical & surgical procedures, waste management, in-house pharmacy and finally discharge.

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Attaining Excellence through Quality in Healthcare Delivery (Quality Accreditation):

In healthcare excellence is achieved through achieving the quality goals of the hospitals as discussed earlier. It through excellence the hospital will increase its revenue and realize the revenue stream for itself, the excellence in-turns depends on the quality of the service provided; thus we can righteously say that the revenue generated by the hospital is directly dependent on the quality of services it provides to the patient community.

To assess the service offered by the hospital various boards and agencies have been developed for the service quality benchmarking among various hospitals. Among the various agency or bodies the two main bodies which govern the quality of the service provided are the National Accreditation Board of Hospitals (NABH) and the National Accreditation Board for Testing and Calibration Laboratories (NABL).

 National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation program for healthcare organizations. The board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of health industry.

The National Accreditation Board for Testing and Calibration Laboratories (NABL) undertakes the assessment and accreditation of Testing and Calibration Laboratories, in accordance with the international standard ISO / IEC 17025 and ISO 15189.

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Excellence in Operations through Quality Management at Rockland Hospitals:

Vision:

"To use multi-disciplinary approach with ethical practices by a team of highly responsive, caring and efficient professionals with a constant focus on excellence in delivering medical services in patient care, continuing medical education, scientific knowledge and deliver a benchmarked quality medical care” is the vision statement of the Rockland Group of Hospitals.

To achieve this vision Rockland Hospitals have developed some quality objectives such as follows:-

-To constantly comply with all applicable statutory and regulatory requirements. 

-To steadily adhere to operational protocols of the institute and enhance patient satisfaction. 

-To continually improve health and safety of the patients, visitors and staff members.

-To promote on the job training and enhance competence of the staff. 

-To constantly enhance infrastructure utilization.

Introduction:

Rockland group of hospitals provides international standard, seamless & integrated

healthcare services across all the units of group. Highly qualified and trained doctors,

nurses, adjunct staff and best-in-class professional expertise ensure that Patient avail the

latest in medicine & surgery. Rockland hospitals network is designed to serve the entire

gamut of medical needs through a network of specialized healthcare facilities across

Delhi, Dwarka and Manesar. Rockland Hospitals provide a broad range of in-patient and

outpatient health care services to match the needs of both domestic and overseas patient.

In- Patient Services include medical, surgical and rehabilitation services. Out-patient

services include emergency services, day procedures, diagnostic and assessment services,

and therapy services.

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It has played a pioneering role in defining quality standards for the Indian Health Care Industry

by bringing the thought leaders of the industry on one platform to set the standards for Quality,

Technology and Management of Health Care in India. Rockland played an important role in

drafting the NABH standards for ensuring certification of quality standards in India. NABH

Certification pilot project was carried out in Rockland in 2005. A dedicated team of doctors

contributed to setting quality standards for the Indian Health Care industry and today NABH

certification is recognized by various organizations as a basis for pricing and accreditation.

Rockland has set the trends of using appropriate technology and management practices suited to

Indian conditions to ensure that the cost of health care does not go as high as it is in the

developed countries. Rockland Hospital has set the trend for environmentally friendly

buildings matching international standards in India

In 1988, Parshuraman, Valarie Zeithmal, and Leonard Berry had defined the five dimensions that

apply across service quality standards through research. Their research has identified the five

service dimensions of service quality that apply across a variety of service context. We have

identified the quality in hospital operation in all dimensions. The Rockland hospital service

divided in Outpatient and Inpatient category. The services in Rockland hospital category are

divided in two parts (outpatient department and In-Patient dept.). All the service quality in each

category is measured in all five service dimensions which are as follows:-

1) Reliability: - It is ability to perform the promised service dependably and accurately.

Rockland hospital outpatient dept. service consists easy and fast response to the patient

and guide them to process of treatment access, Depth of knowledge and comprehension

of the patient’s condition by the responsible Medical staff and Ability to clearly explain

and communicate the right information with the patient by the OPD Medical Staff. The

hospital Inpatient service quality in this dimension consists with

When patient visits the hospital the first encounter registration/ Inquiry Desk it provides

easy and friendly conversation availability at the counter 24 x7 hours&365 days

During Diagnostics/ Doctors consultation it provides trustworthy genuine opinion

provider though sound medical knowledge of medical staffs and doctors

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During Operation Theatre and Surgical Procedure, It provides highly experienced team

of operating surgeons, Reliable paramedics and medical staff with strong experience in

patient handling and sound knowledge in medicine

In post patient care issue, It provides Trustworthy and no fraudulent bills submissions,

In billing and Discharge service it provides Trustworthy and no fraudulent bills

submissions , and also True billing generation and reliability of the treatment

administered

Responsiveness: - This dimension of service represents the willingness to help customers and

provide prompt service. Rockland hospital outpatient service category provides willingness and

preparedness to render service to the patient, Front office staff is cooperative, helpful and guide

them responsible way as soon as possible and also Medical and non-medical staff are

approachable to the patient’s personal problems. The hospital in-patient service in this dimension

provide many services. Some of them are:-

When patient visits the hospital the First Encounter Registration/ Inquiry Desk that the

Patient receives the attention of medical staff at the earliest/ immediately

During Diagnostics/ Doctors consultation it provides immediate response towards

patient's problem.

During Operation Theatre and Surgical Procedure, It provides efficient team of surgeons

able to handle all kinds of medical emergencies

In post patient care issue, it provides immediate resolution of any situations, conditions,

emergency, queries or issues.

In billing and Discharge service it provides Responsiveness towards patient's TPA

provider and future queries and also responsiveness towards patients discharge vitals and

discharge procedural demands.

3) Assurance: - This dimension of service providing employees knowledge and courtesy

and their ability to inspire trust and confidence. In outpatient service category, this

hospital provides services in Caring every individual patient give right information

which are included of Patient Registration, Doctor Information, Monetary & Time

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information by all receptionist and also Patients & relatives feel relaxed and assured

while services are being provided.

Hospital Service Standards for In Patient Department in this dimension are as follows:-

When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the

service perception which Instil confidence in patient that doctors are available and will

shortly attend them or assurance of specialist in case of an emergency

During Diagnostics/ Doctors consultation service perception Instil confidence in patient

and understand his/her main problem.

During Operation Theatre and Surgical Procedure, It provides assurance of the nurses and

medical support staff while the surgeon is under process

In post patient care issue, It’s service Instil confidence in patient after undergoing

medical procedure and assurance of the success of the treatment and speedy recovery

In billing and Discharge service it provides Assurance of best possible rates and

discounts given to the patient and the assurance of trust and honest hospital billing

generation system And Assurance in best possible treatment has been offered and

performed and the patient can lead a normal healthy life while following the routine

advised by the doctors. And the most important one to assure the patient if any problem

they are here to address their any difficulties whether medical or otherwise

4) Empathy: - This dimension of service represents caring, individualized attention to

customers. In outpatient service category in this dimension Rockland provides following

services:-

- Sincere compassion shown by sympathizing with the needs of the patients and patient relatives.

- Provision of individualized care by being sensitive and flexible to the patient’s needs.- Doctors and medical staff treat patients with love and affection.

Hospital Service Standards for In Patient Department in this dimension are as follows:-

When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the service in Caring attitude towards patient's concerns and soft caring tone of conversation

During Diagnostics/ Doctors consultation service it empathize highly patient centered service attitude.

During Operation Theatre and Surgical Procedure, It provides Patient centered and concerned team of operating doctors and anesthesiologist.

In post patient care issue, it provides Empathetic attitude and behavior towards the patient concern and his/her relatives.

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In billing and Discharge service it provides empathetic attitude towards the patient for incurring expense towards the medical treatment and at the same time instilling positivity in him/her. And also it provides Caring, empathetic and friendly attitude towards the patient and wishing him all the best in life.

5) Tangibles: - This dimension of service represents appearance of physical facilities, equipment, Personnel and Communication material. In outpatient service category, this hospital provides services like

- Cleanliness of hospital surroundings.- Comfort brought about by the hospital environment with adequate utility to

the patient in waiting area.- Functionality of hospital equipment and medical instruments.- Application of Modernized hospital equipment and medical devices.

Hospital Service Standards for In Patient Department in this dimension are as follows:-

When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the

tangible service provide Comfortable waiting room/ availability of patient gurney in case

of emergency.

During Diagnostics/ Doctors consultation service this dimension of service represents

Proper prescription for the disease at hand/ Life-saving drugs at stand-by. Availability of

the life support systems and radiology.

During Operation Theatre and Surgical Procedure, It provides tangible services in

Maintenance of Highly sterile environment and strict disinfection protocol adherence, all

the necessary life-saving at hand and well maintained and calibrated equipment

In post patient care issue, it provides tangible services in Proper medication and at proper

time, healthy food and extremely efficient housekeeping services.

In billing and Discharge service it provides tangible services in proper documents of the bills, details of the treatment given and reports and CDs for future reference and also in proper documents of the bills, details of the treatment given and reports and CDs for future reference.

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S.No Encounter RATER Service StandardTarget /

GoalReliability Easy and friendly conversation availabilkity at the counter 24/7/365 95%

AssuranceInstil confidence in patient that doctors is available and will shortly attend

them/ assurance of spcecialist in case of an emergency95%

1Patient visits the hospital First Encounter Registration/ Inquiry DeskTangible Comfortable waiting room/ availability of patient gurney incase of emergency. 100%

EmpathyCaring attitude towards patient's concerns and soft caring tone of

conversation. 95%

Responsiveness Patient receives the attention of medical staff at the earliest/ immediately 100%

Responsiveness Immediate response towards patient's problem. 100%Reliability Trustworthy genuine opinion provider. Sound medical knowledge 100%

2 Diagnostics/ Doctors consultation. Assurance Instil confidence in patient and understand his/her main problem 100%

TangibleProper prescripation for the disease at hand/ Life saving drugs at stand-by.

Availability of the life support systems and radiology. 100%

Empathy Highly patient centred attitude. 100%

TangibleMaintenance of Highly sterile environment and strict disinfection protocol

adherence, all the necessary life saving at hand and well maintained and calibarated equipments

100%

Empathy Patient centred and concerned team of operating doctors and anesthesiologist 100%

3 Operation Theatre and Surgical Procedure Reliability Highly expereinced team of operating surgeons. 100%Responsiveness Effi cient team of surgeons able to handle all kinds of medical emergencies 100%

AssuranceAssurance of the nurses and medical support staff while the surgeon is under

process. 100%

ReliabilityReliable paramedics and medical staff with strong experience in patient

handling and sound knowledge in medicine. 100%

AssuranceInstill confidence in patient after undergoing medical procedure and

assurance of the success of the treatment and speedy recovery. 100%

4 Post Patient Care TangibleProper medication and at proper time, healthy food and extremely effcient

housekeeping services. 100%

EmpathyEmpathetic attitude and behavior towards the pateint concern and his/her

relatives. 100%

ResponsivenessImmediate resolution of any situations, conditions, emergency, queries or

issues100%

Reliability Trustworthy and no fraudulent bills submissions. 100%

AssuranceAssurance best possible rates and discounts given to the patient and the

assurance of trust and honest hospital billing generation system. 100%

5 Billing/Payment TangibleProper documents of the bills, details of the treatment given and reports and

CDs for fututre reference. 95%

EmpathyEmpathetic attitude towards the patient for incurring expense towards the

medical treatment and at the same time instiling positivity in him/her. 90%

Responsiveness Reponsiveness towards patient's TPA provider and future queries 100%

ResponsivenessReponsiveness towards patients discharge vitals and discharge procedural

demands. 100%

Tangible Handing out thourough and detailed documentations of the treatments,

billings and payments and follow up schedules. 100%

Discharge Reliable True billing generation and reliabiity of the treatment administered 100%

EmpatheticCaring, empathetic and friendly attitude towards the patient and wishing him

all the best in life. 100%

Assurance

Assurance best possible treatment has been offered and performed and the patient can lead a normal healthy life while following the routine advised by the doctors. And the most important one to assure the patient if any problem they are here to address their any diffi culties whether medical or otherwise.

100%

Rockland Hospital Service Standards for In Patient Department starting with OPD registration

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Rockland Hospital Service Standards for OPD registration

Encounter RATER Service Standard Target / Goal

Reliability Easy and fast response to the patient and guide them to process of treatment access. Depth of knowledge and comprehension of the patient’s condition by the responsible Medical staff.

Ability to clearly explain and communicate the right information with the patient by the OPD Medical Staff.

95%

Assurance All receptionist in OPD help to care every individual patient give right information which are included of Patient Registration, Doctor Information, Monetary & Time information.

Patients & relatives feel relaxed and assured while services are being provided.

95%

OPD Service Standard Measurement

Tangible Cleanliness of hospital surroundings. Comfort brought about by the hospital environment with adequate

utility to the patient in waiting area. Functionality of hospital equipment and medical instruments. Application of Modernized hospital equipment and medical devices.

95%

Empathy Sincere compassion shown by sympathizing with the needs of the patients and patient relatives.

Provision of individualized care by being sensitive and flexible to the patient’s needs.

Doctors and medical staff treat patients with love and affection.

90%

Responsiveness Willingness and preparedness to render service to the patient. Front office staff is cooperative, helpful and guide them responsible

way as soon as possible. Medical and non-medical staff are approachable to the patient’s

personal problems.

100%

What do the quality measures inform us?

-Whether or not hospitals / providers are providing care in a timely manner

-Whether or not the care provided is safe and effective

-Whether or not health care delivery is patient centred

-The experience, knowledge and success rate of treating particular diseases / conditions

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-Data and information regarding our quality and outcomes.

Quality Measures Utilized at Rockland Hospitals:

In the year 2010, Rockland received NABH accreditation and registered as NABH accredited hospital on June 12 2010. After the rigorous hard work and continuous efforts for the last few years, Rockland finally established the highest standards of quality and fulfilled all the requirements of NABH. All departments put in their efforts to maintain the quality standards as per the norms of ISO and NABH. The first Surveillance Audit of ISO 9001: 2008 was also carried out successfully in February 2010.

The hospital management closely monitors the quality of the care and services provided at the hospital. Most importantly, the hospital maintains a very close relationship with their patients. They listen to what their patients and families have to say. The information and feedback they gather is used to develop lasting, positive change in the way the hospital delivers care. The tools they use to check and measure performance include:

Phone and mail-in surveys regularly conducted with patients and families

Clinical outcomes (how patients are doing following care / treatment)

The hospital's goal is to provide patients and families with meaningful information to make informed decisions about their healthcare and to make data available on the quality of the services they provide in the annual report. To maintain quality and measure the quality, the hospital complies with the standards set for hospitals and healthcare providers by NABH & international standards ISO 9001:2008.

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Highlights of NABH (National Accreditation Board for Hospitals) Standards Contributing to Quality Measures:

Rockland Hospital Qutub has earned the prestigious accreditation from National Accreditation Board for Hospital & Healthcare Providers. The NABH accreditation is a recognition of their commitment to provide Safe and Quality of care to their patients.

Time for initial assessment of indoor and emergency patients. Life sustaining Equipment Down time. Percentage of Possible contrast related reactions. Patient Satisfaction index. Re-exploration rate. Infection rates like UTI, RTI, SSI, IVD etc. Turnaround time for issue of blood and blood components. Patient rights and education. Patients cared for by the organization undergo an established initial assessment.

Highlights of NABL Accreditation (National Accreditation Board for Testing and Calibration) Standards Contributing to Quality Measures:

The labs at Rockland Hospital Qutub has earned the prestigious accreditation from National Accreditation Board for Testing and Calibration Laboratories (NABL) in the field of medical testing. The NABL accreditation ensures that their labs continuously conforms to the stringent International Standards for Medical Testing and is also a recognition of our commitment to provide quality care to our patients.

All 3 units of Rockland Hospitals were assessed & accredited in accordance with the Standard ISO 15189: 2003Medical Laboratories - particular requirements for Quality & Competence for their facilities in the field of Medical Testing.

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-Highly developed medical Infrastructure.

The driving force behind our success is our ability to assimilate modern medical technologies with a highly developed medical infrastructure built to meet international standards.

Our hospitals are equipped with the most recent and advanced medical instrumentation needed to support the best standards of healthcare treatment.

All our specialties embrace neatly maintained operation theatres, critical care, inpatient rooms, outpatient areas and consultation rooms, with high focus on infection control, supported by patient centric nursing and support staff to ensure holistic care.

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-State-of-the-art Operation Theatres (OT) equipped with the latest equipment and laminar airflow systems, to maintain internationally accepted sterility norms that minimize the risk of infection

-64 Slice CT, High-end MRI, Neuro-navigation Surgical Systems

-Diagnostic & Therapeutic procedures covering Angioplasty, Stenting, Atherectomy, and Intra-Aortic balloon Pump Insertion and Pacemaker Insertions

-Cardiac Catheterization Suites for Pacemaker Insertions

-Neuro-physiology, specialized physiotherapy, Comprehensive Rehabilitation services

-Our Clinical Expertise

Our clinical Expertise is committed to providing patients with a comprehensive range of tertiary and secondary care services backed by state of the art technology, infrastructure and trained clinicians. We have a pool of highly skilled and experienced doctors with international affiliations .They have earned their knowledge and education from some of the top universities in the country and across the world. In fact, most of our doctors had already worked in the top international patient care centers in the US, UK, and Australia. Our senior doctors regularly take part in various international meetings/CME as both speakers and visitors. This in turn helps them in staying updated with the most advanced treatments across their specialties. Additionally we have a dedicated team to cater to the needs of our International Patients.

-Strong Facility Support:

-Highly skilled, specially trained and dedicated team of Nursing and Paramedical professionals

-Use of Implants that are of internationally accepted quality

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-Imported prostheses and consumables

-Foolproof procedures and processes for Blood Transfusion

-Exhaustive tests for unexpected antibodies from donors and patients

-Compatibility testing.

Excellence through Quality various operations wise perspective:

OPD Care:

Patients' waiting time has been defined as "the length of time from when the patient entered the outpatient clinic to the time the patient actually leaves the OPD". Whether it's a time used for registration of patient, routine doctor's appointment, emergency room treatment, laboratory/diagnostic test, procedures, receiving the results of various tests, waiting happens to just about everyone seeking medical care. It's often one of the most frustrating parts about healthcare delivery system. Waiting times for elective care have been considered a serious problem in many health care systems since it acts as a barriers to efficient patient flows. OPDs is considered as the window to hospital services and a patient's impression of the hospital begins at the OPD. This impression often influences the patient's sensitivity to the hospital and therefore it is essential to ensure that OPD services provide an excellent experience for customers. It is also well-established that 8-10 per cent of OPD patients need hospitalization.

Step 1:- Employee will take time attend the patient within 5-7 minutes after His /Her arrival to our health care organization.

Step 2:-If patient is disabled or not able to walk or move, we have to provide a wheel chair to the patient with the help of ward boy and patient attendant.

Step 3:-The above thing is done within 3-4 minutes after patient is attended by front office executive.

Step 4:- If patient is having past history of his/her treatment, ask him/her for a previous /past treatment file and ask him/her to sit in lobby.

Note- Whenever they talk to any client or patient or relatives we have to be very calm. Always maintain a smiling face as we are the front office executive. We have to maintain the voice pitch whenever we having conversation with patient & relatives.

Step 5:- Ask the patient for referral slip if the patient is from WCL or Raymond or any companies (we have to take care that the corresponding company is empanelled with us).

Step 6:- Register them with OPD register with Name, Address, Age, Telephone No., i.e., all the details as per our OPD form. (As a mandatory element)

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Step 6A:- Executive take registration charges from patient then give a receipt to the patient and same time register the patient in hospital HIS with registration number.

Step 7:- Then calculating the time from register & coordination with doctor we have to tell the patient the estimated waiting time, i.e., for how much time they have to wait for their turn to come.

Step 8:- When the patient’s turn comes to be examined by the doctor, call the name of patient by PAS (Public Address system)With the help of ward boy or patient attendant move the patient from lobby to OPD chamber with the patient past treatment file and current OPD file with 2 to 3 OPD empty sheets attached.

Step 10: executive have to take care that, don’t interrupt between the patients or relatives while they having a conversation but also we don’t have to move from OPD chamber as we have to be the OPD attendant. Note: - Hospital have policy to take care of privacy of patient, in that while examination of patient by the doctor only Doctor, OPD attendant And OPD sister will only present in the chamber.

Step11:- If the patient is a lady, then strictly no male is allowed to be present in OPD chamber.

NOTE: - Hospital having a “Do Not Disturb” board to hang on the door to avoid unacceptable disturbance to the doctor while they examine the patient.

Step 12:- If the doctor advises the patient for X-Ray, ECG, TMT, dressing, minor surgeries etc we have to shift the patient to relevant department/chamber/room, before start any other procedural or relevant treatment take the patient’ file to accountant and ask for total amount/fees of the patient request the patient to pay the amount. Don’t talk loudly or in a uncouth language/ manner with the patient or relatives or client as we create the first impression of hospital.

320 patient data was collected and analysis are used to identify defects in processes and reduce variation Respondents of this study included selected patients, staffs and doctors in the diffrent department of hospital.  This is the first step that refers to defining the goals of the project. Process improvement goals may be aimed at increasing market share, the output of a particular department, bringing about improved employee satisfaction as well as customer satisfaction and so on. The goal has to align the customer demands and the strategic goals of the organization. Data mining methods can be used to find prospective ideas for project implementation. In other words, businesses are designing a road map for achieving the targets and goals of the organization.

Measurables

1.      Total waiting time for a consult.2.      Time taken for laboratory result.3.      Time taken for laboratory and ECG result.

 As is evident from the above diagram, 64% of the patients had to wait for more than 3 hours for a consultation with 24% of patients waiting anywhere between 2 hours to three hours.

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Only 6% of patients could have their consultation within one hour. This clearly indicates that majority of patients are not satisfied with the present waiting time. Customer expectation to see doctor within 60 minutes of Registration/Encounter. It was found that routine lab test and ECG results are critical information for a cardiac medical consultation. Patients were waiting for either the lab test or both lab test and ECG.To assess this measurable the time taken for the blood test results and ECG results were collected separately in the measure phase: 

1.      Time to complete the Blood Test.2.      Time to complete the Blood Test and ECG.

 

Infection Control Management:

Purpose:

To maintain standards in infection control measures and minimize hospital infection in patients and staff. To define policy and procedure regarding hospital acquired infections in the hospital.

High risk areas Operation Theater Intensive care unit Recovery room

Institute have established committee which look after infection control activities around the institute. The committee meet in every month with past one month report and discussed issue of each month happened in before the meeting. The objective the committee is minimize the risk of infection to patients, staff and visitor, maintain surveillance over hospital acquired infections. The committee responsible for to develop and implement preventive and corrective program in specific situations where infection hazards exist and identify the roles and responsibilities of keep personnel involved in the prevention and control of infection.

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Infection control Process

Maintenance of sound habits in personal hygiene and individual responsibility in infection control by training the staff throughout the organization. Monitoring and investigating infectious diseases, potentially harmful infectious exposures, and outbreaks of infections among personnel. Providing care to personnel for work-related illnesses or exposures. Identifying infection risks areas related to employment and instituting appropriate preventive measures. Surveillance activities for tracking and analyzing appropriate infection rates. Providing feedback regarding these rates on regular basis to top management, medical and nursing staff. 

Regular visit to the all clinical areas to make sure that the patients with particular infection receives an appropriate treatment in regard to the isolation precaution, and the type of treatment. To make sure that, the staffs are educated and updated with the protocols in relation to the infection control. To advise and supervise the work of staff for the best infection control practices like Bio-Medical waste management, Hand washing, Isolation throughout the hospital. To arrange special teaching session to the staff and even for specific group of patients pertaining to the infection control and prevention. To collect data of patients with infections that require isolation precaution and use of specific antibiotics.eg; MRSA To conduct clinical audit as a member of Infection control committee member, to make sure that, the infection control  and prevention. To updates his/ her knowledge by participating in the clinical governance meeting.

To share her or his concerns to the Director or the microbiologist in order to get an idea and for a possible solution. In the hospital situation, any outbreak of infection is normally informed by the Head of the microbiology or virology department. The information will then be cascaded to the local unit/ward through the infection control nurses and infection control link nurses.

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Process Chart-1.

Process Chart-2

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Infection Control Measurement:

Proper Hand wash technique (Refer policy and procedure for hand wash NUR/SOP/VER1). Isolation /Nursing barrier techniques (Refer policy and procedure for Isolation /Nursing barrier NUR/SOP/VER.  Appropriate pre and post exposure prophylaxis (Refer policy and procedure for pre and post exposure prophylaxis HR/SOP/VER1) Sterilization Technique (Refer policy and procedure for Sterilization OT/SOP/VER1) Proper Bio- Medical waste management (Refer policy and procedure for Bio- Medical waste management HK/SOP/VER1) Proper Equipment cleaning (Refer policy and procedure for Equipment cleaning HK/SOP/VER1) Laundry and linen Management (Outsourced) Kitchen sanitation and food handling (Outsourced) Engineering control Programme (Refer policy and procedure for Engineering control Programme ENG/SOP/VER1). They regularly basis sensitization programme for staff. In service training programme for staff. Surveillance programme (Refer policy and procedure for Surveillance Programme NUR/SOP/VER1.

Analysis Infection Control:

To analyses the report they use Histogram method, Pareto analysis and route cause analysis. After due analysis of every month report they structured it through quality assurance and continuous monitoring. AQ department define the key indicators to monitor the clinical structures, processes and outcomes.

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Biomedical Waste Management:

Handling and Segregation of bio-medical waste is done at the point of generation/source and is put into a different color bags in same color bins. The “Bio Medical Waste Management and Handling Biomedical waste is the leading cause for spreading of nosocomial infections in the hospital. Improper maintenance of Biomedical Waste may lead to increased risk of blood born; air born and needle prick injuries in the Staff as well as the patients and their attendants. For Proper treatment and Disposal of Biomedical Waste in the facility following steps should be ensured.

Biomedical Waste Management In-charge responsible maintain the hospital west management with the committee.

Roles and Responsibilities Biomedical Waste Management of committee includes following but not limited to

Daily inspection of waste segregation and reporting. Supervising the maintenance of registers. Ensure availability of equipment’s like needle cutters, autoclaves and sterilizers, waste

carrying trolleys, personnel protective gears (masks, apron, gloves etc) and other materials like bleaching solution or hypohloride solution.

Ensuring availability of color coded bins and bags as per Biomedical Waste Management and Handling Rules, 1998.

Formation of Monthly and Annual reports. Maintain records about various categories of waste generated in the hospital, if outsourced

maintaining the records of the receipts and other documents related to Biomedical Waste Management.

Protocols for Mercury Spillage:

Remove everyone from the area that has been contaminated with mercury. Keep the heat below 200 C and ventilate the area. Put on face mask in order to prevent breathing of mercury vapor. Remove all jewelry from hands and wrists. Use Personal Protective Equipment while handling mercury. Cardboard sheets should be used to locate and push the spilled beads of mercury together Mercury should be placed carefully in a container with some water. Never us a broom or

vacuum cleaner. It should be disposed of at hazardous waste facility or given to a mercury-based equipment manufacture.

Protocols for cleaning Spillage of Blood

Wear Gloves Pour, without splashing, a disinfectant appropriate for the size and surface contaminated,

e.g. Isopropyl alcohol, Dakin’s or house hold bleach 1: 100 dil or 1: 10 dilution. Place absorbent paper (e.g. news / tissue paper over the spill. Allow a contact time of 20

minutes.

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Wipe up the spill. Put absorbent paper in the yellow bag. Wash hands (with gloves on). Remove gloves. Wash hands.

Rockland Hospital Biomedical West Management Do’s

Segregate waste as soon as it is generated into different categories of waste. DEYes

Collect the waste in properly labeled specific color coded covered bins. Yes Keep same color bags in the bins. YesClean regularly with soap and water and disinfect the bins. Yes Collect the domestic waste (eatables, wrappers, fruit peels, papers etc., in green bin). YesUse dedicated waste collection bins/trolleys/ wheel barrows for transporting waste. YesTransport waste through a pre- defined route and time within the hospital. YesMutilate and disinfect the needle soon after administration of injection. YesMutilate and disinfect solid waste (plastic waste) as soon as it is generated. YesAlways disinfect the sharps and the solid waste with either hypochlorite solution or Bleaching powder before disposing.

Yes

Disinfect needle and solid waste (plastic) after mutilation. YesDispose body parts in yellow bin. YesDispose waste within 48 hours. YesAlways use protective gears while handling the waste Yes

Rockland Hospital Biomedical West Management Don’t’s

Never mix infectious and non- infectious waste No

Never mix plastic wastes with the waste which goes for incineration. NoNever overfill the bins. NoNever store waste beyond 48 hours. NoThere should not be any spillage of waste on the way of transport. NoAvoid transport of waste through crowded areas. NoDo not put infectious waste into general waste. NoDon’t dispose waste sharps with other wastes. NoDon’t dispose the solid waste and sharp waste without mutilation and disinfection. NoOverloading of the Bags and the bins should be avoided. Colour coded bags to be replaced when

No

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Quality in-house Pharmacy:

Rockland effective medication delivery process care policy for the patients and the hospital pharmacists has been maintaining effectively and reflects their responsibility and accountability. The systematic approach to the delivery of in-house pharmacy involves the following four steps, as depicted in figure

Step 1: Assess the patient’s medicine therapy needs and identify actual and potential drug therapy problems (DTP)

Step 2: Develop a care plan to resolve and/or prevent the DTPs Step 3: Implement the care plan Step 4: Evaluate and review the care plan

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Follow Up, Monitoring, and Evaluation

1. Hospital pharmacy only ward round is a visit made by a group of pharmacists to hospital inpatients to review and follow up their progress in achieving the goals of therapy. Pharmacy only morning sessions (POMS) are organized to discuss selected patient cases and to get updated information on patient management. Pharmacy only rounds (POR) and morning sessions aim to facilitate better patient care by ensuring appropriate medicine use wherein each pharmacist has a key role and responsibility. The pharmacy team should decide the number of rounds and morning sessions that should be conducted per week.

2. The multidisciplinary team (MDT) round is conducted by health care providers to share their contributions to cases and patient-specific issues. MDT facilitates better patient treatment and appropriate medicine use wherein each health professional plays his/her role and responsibility. As a member of the health care team, the pharmacist should be actively involved in MDT activities.

Quality OPD Pharmacy:

Infrastructure:The Drug Dispensing Counter (Pharmacy) located in basement near the Out Patient Department and it outsourced by the hospital.

Human Resource:1. 10 Pharmacists should be present during each shift.2. 5 ward boy or helper to bring the medicines from the drug store as per the need.

Services:

The Pharmacist checks the availability of the drugs prescribed by the doctors. If the Drug is available the pharmacist provides the prescribed medicines and makes an entry into

the records pertaining to the quantity of the drug. At the end of the shift the pharmacist makes an entry of the total medicines dispensed and

reduces the same from the stock book in pharmacy inventory software. They followed First in First out (FIFO) principle which help them identify the stock for moving

the drugs in stock. They maintain the buffer stock of drugs as per the patient load. 24X7, pharmacy service available in the hospital. The most important List of the “Drugs Available” are displayed outside the pharmacy and

updated periodically. Before the medicines are dispensed the date of expiry checked by pharmacist. While disbursing

the medicines, the pharmacist explain the dosage and timing of drugs.

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Hospital in Patient Department:

The Rockland Hospital presently serving 110 beds with different specialty wards included of Emergency Bed (5), ICU (20), Cardiac Bed (20), General Bed (50), Neonatal Bed (10) and Neurology Bed (5). Nightingale types of beds are aligned perpendicular to the wall and Cabin type: 4-10 beds are kept in the cabin which reduces nosocomial infection. The distance between two beds should be 6ft from the center of the beds. This is required for two reasons mainly, one for the free movement of the trolleys/ wheelchairs and secondly to reduce nosocomial infection.

The Inpatient department activities includes of

1. Admission of Patients

2. Treatment of the patient

3. Investigations.

4. Operation

5. Information of Medico Legal cases to Police.

6. Physiotherapy

7. Counseling

8. Discharge.

Admission Process and treatment care:

Before admission the doctor must have examined the each and every patient .He should give clinical diagnosis, advise investigations and prescribe treatment on the case sheet so that the treatment can be started. All admissions are done in registration counter where all the entries be filled. After admission in the wards, ward coordinator entry made in the ward register clearly indicating the time and date of admission in the ward. Meanwhile the treatment will started. The treatment given should be entered into the records.

Patients transferred to the hospital with I.V.line and indwelling catheter will changed with new, on arrival into the Hospital. At the time of admission patient should be provided fresh linen. Patient linen changed every day or as and when it is soiled. Care generally taken that soiled linen to protect transmit infection to other wards. Aseptic techniques are to be followed. All invasive procedures by doing nursing staff only after wearing gloves and following universal precautions. During shift change the nursing staff give a detail description in regards to condition of the patient and the treatment being given in the handover register. Infected Patients are treated in the Isolation room as far as possible. During the rounds by the consultant the instruction given by the

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consultant take care thoroughly recorded. If the patient is absconding from bed for more than 30 minutes the same should be recorded and reported to the authorities. For pathological investigation, sample are taken from the ward and be sent to the laboratory for investigation. The reports of the same sent by the laboratory to the wards / collected from laboratory for further course of treatment. The non-ambulatory patients are shifted for radiological investigations like X – ray, USG CT Scan by wheel chair or stretcher which are situated in basement. Before discharge the patient and relatives made aware about his present condition further treatment and medications to be followed as well as about his follow up visit details. The condition of the patient as well as detailed summary of the case as regards to the procedures done, investigations and treatment provided in the hospital at the time of discharge properly mentioned in the discharge summary by the doctor. After the patient has been discharged the file should be sent to the Medical Records Department for storage. If the patient wants a copy of the records the photocopy of the same may be given.

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Out PatientDepartment

Emergency Department

In Patient Registration

Admission Ward

Referred

Surgery

Treatment & Invetigation

LAMA /Discharging

Death

In Patient Discharge Process at Rockland hospital:

Discharge planning is the development of an individualized discharge plan for the patient prior to leaving the hospital, to ensure that patients are discharged at an appropriate time and with provision of adequate post-discharge services. Discharge planning is a complex process that seeks to determine the appropriate level of services required by the patient and then match the patient to an appropriate site of care. This process ideally begins at the start of the hospitalization. The hospital case manager should be involved as soon as it is clear that the patient will require services at home, or will require transfer to an alternative level of care.

When it has been determined that a patient is medically ready for discharge, the treating doctor determine the appropriate site of care involve medical, functional, and social aspects of the patient's illness. The patient’s acute and chronic medical conditions, potential for rehabilitation, and decision-making capacity must be taken into account. In order for the patient to be deemed safe and ready for discharge to home or to a non-acute environment (rehabilitative, transitional, or chronic care), a provider must take into account a number of factors beyond the medical determinants. These factors include:

Patient cognitive status.

Patient activity level and functional status

The nature of the patient's current home and suitability for the patient's conditions (eg, presence of stairways, cleanliness)

Availability of family or companion support

Ability to obtain medications and services

Availability of transportation from hospital to home and for follow-up visits

Availability of services in the community to assist the patient with ongoing care.

Post-Discharge of hospital:

Obtain and self-administer medications.

Perform self-care activities

Eat an appropriate diet or otherwise manage nutritional needs

Follow-up with designated providers

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Discharge Process Flowchart

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Discharge Plaining

Doctor Confirmation

Pament Post Discharge Instruction

Trtetment Summary

Patient Exit hospital

Medication reconciliation

Conclusion:

Today Hospitals are being forced to develop a better understanding of what service quality means to the patient and how it could be best measured. A key factor in designing and delivering quality services is the need to understand the patient’s requirements and needs in order to provide services which meet those needs as per the resources available. While patients of hospitals are making decisions based on their perceptions of the quality and satisfaction with hospitals, health care managers need to understand how patients evaluate health services. If health care providers understand what attribute patients and their relatives use to judge the hospital quality, steps may be taken to monitor and enhance the performance of those areas. There is tremendous scope to improve the OPD services of a public or private hospital. More than a decade ago, two landmark reports: The World Health Report (2005) and the Institute of Medicine’s crossing the Quality Chasm (2001), called for the realignment of incentives to balance the competing goals of cost containment and quality improvement. Both reports concluded that responsiveness to citizen’s expectations was a valued and desired outcome of health care performance. Through use of various quality theories and the latest QC tools we can see that the excellence in hospital services can be obtained through a quality initiative. As per the mentioned desired percent of the target goals Rockland Hospitals are working towards this objective of service quality excellence in its operations. This ultimately results in reduce cost of operations and increase in the profitability. Because of the quality gurus Philips B Crosby saying DRIFT ie “Do it right the first time”, this will reduce the repeat cost of service delivery and negative cost of quality and saving would be done in established in service quality recovery (Medical Negligence penalty levied on hospital for wrong deliverance of the service).

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