original hospital management

8/3/2019 Original Hospital Management

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Introduction

Hospital is an institution or the organization for the treatment, care, and cures of the sick

and wounded, for the study of disease, and for the training of physicians (teachinghospitals), nurses, and allied health care personnel.

supervisors and managers of hospitals must not only have vocational, technical knowledge

about hospitals and treatment, but also should have knowledge about contemporary

management and its functions and principles. The work module of any job is based on two

pillars, namely technical work and management work.

Hospital management in a nutshellhospitals or any healthcare facility passes through the following stages or in other words

they need the management of below sections for the smooth running of their organizations,

but it is often felt that the hospitals are very complex in its nature and needs a lot of care

and understanding.

Operations (actions) Finance (money and resources),

Personnel(human relations)

Information(needed information for wise decisions) Time (your own and that of others) Pathology services

Each of these five elements mentioned, must be managed by any person, who has its own

set of principles and guidelines to follow. For instance, when it comes to managing people,

the teachings of Industrial Psychology become pertinent. For operations, the teachings ofOperations Management as a subject become important. So, in analyzing these five

elements, it also becomes evident that the teachings of Financial Management, Information

Management and Time Management, are also important for the other three elements. In a

nutshell, for a hospital manager it is compulsory to have the sound knowledge of Operations

Management, Financial Management, Information Management, Human Resources

Management, Time Management and Communication.

For the lower level jobs at hospitals and healthcare facilities, the principles of Supervision

can become a starting point for teaching or studying the principles of management. A

person in one of the lowest level jobs found at employers must also plan, organize and


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control work, even if it is just to clean an office or do some washing in one of the

departments of the hospital.

Top Management members of the hospitals such as Chief Executive Officer, Financial

Manager etc, must be able to plan, organize, control and lead the wards and departments

with a focus on understanding and influencing the environment, setting the strategy and

gaining commitment, planning, implementing and monitoring strategies and evaluating and

improving performance. The Top Management must therefore have high capabilities with

regard to human relations inwards and outwards, strategic planning, team building,

leadership, and negotiation and performance management.

Middle Management members must be able to plan, organize, control and lead

departments and sections with a focus on assistance upwards for application of scientific

methods and assistance downwards for application of scientific methods. They must have

the same capabilities as Senior Managers as well as Supervisory Managers and also be good

at interviewing techniques, goal achievement, conflict handling tactics and projectmanagement.

Supervisory Management members must also be able to plan, organize, control and lead

sections, units and individuals with a focus on operations, finance, people, information and

time.

Lack of Management skills in employer or employees at every hierarchy level of the hospital

or healthcare facility can be detrimental. Lack of Management skills can lead to poor

performance.

lack of improvement, low profit, decisions making, disheartening of employees, lower

productivity, and jeopardize your organization.

Therefore; it is obligatory that hospital managers should have the updated and

contemporary knowledge of Management.

Concept of Productivity in the context of hospital:

The concept of Productivity in the context of a hospital is equally important. So we must

know that every organization whether it is Profitable or non profitable, governmental or

non governmental needs and uses different resources, which is classified in many groups

-Manpower/Labour/Task Force

-Material/ Raw Material

-Money/Cash/Budget

-Machinery/Equipment

-Space

-Health Management Information System (HMIS)

- Human Resource Management


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Manpower:

As it is a clear fact and I mean it is obvious to all of us that hospital totally and almost always

on human resources/Man Power, the numbers of human resources usually higher than in

other organizations. So in a result the quality of the services in hospital totally depends on

the quality of their human resources and man power. So for that the management is very

crucial in this stage.

Actually the staff or personnel productivity (output) is quite low in many hospitals. It is a big

problem that the staff is not assigning in a specific hours of work but not with whole hearted

commitment. So they show insufficient commitment to their tasks, to the care for the

patients, and towards creativity in finding solutions to institutional problems.

Regarding the capacity building and training of the staff and personnel hospitalsinfrequently sponsor staff and personnel to external training program. But in large hospitals

the training can take place in house with the help of professionals organizations, so these

trainings should be conducted periodically so that the employees and staff make aware

from the new changes in technology and techniques. It is so vital for the hospitals to train

their staff qualitatively and quantitatively. The trainings by up gradation of staff and

personnel skills can help in the improvement of staff productivity.

The effective and appropriate usage and utilization of the above mentioned factors orresources shows and determines the organizations effectiveness. For example if it is a

profitable organization, its benefits and advantages are increased, while in case of other

organizations, its costs are reduced and diminished, therefore the reliance on private

sectors and donors or government grants and aids or itself the fee for its services are

diminished.

The effective and valuable usage/utilization/consumption of the resources or assets is

important and significant for every organization or association, whether it is public or

private.. Actually, Health care organizations or hospitals need to give more and more

concentration and attentiveness to good and better management and execution because ofthe shortage of resources. Usually the health related organizations are short of resources,

bearing in mind the demands for services placed on them.

It is useful at this phase to comprise how management and productivity concepts as well as

techniques are related to the health field. There is mistaken idea that modern management

and productivity concepts and techniques are concerns to profit- making institutions and

manufacturing organizations only.

Productivity or Output, in simplest terms, is the relationship or bond between the resources,

used and results produced. In shorter terms the productivity is the ratio or differencebetween Input and output.


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The effective usage of inputs will ultimately increase or affect the output or productivity. So

for the improvement and enhancement of the productivity it is so important to have

qualified and well trained and skilled staff, by this way they utilize and use the resources and

raw material in a good manner. This is the responsibility of the organization to conduct

seminars, workshops and trainings for their employees.

Personnel management is productive exploitation of manpower resources. This is also

termed as Manpower Management. Manpower Management is choosing the proper type

of people as and when required. It also takes into account the upgrading in existing people.

Manpower Management starts with manpower planning. Every manager in an organization

is a personnel man, dealing with people

Advantages of manpower planning:

Manpower planning ensures optimum use of available human resources.

1. It is useful both for medical organization and for others.2. It generates facilities to educate people in the organization.

3. It brings about fast economic developments.

4. It boosts the geographical mobility of labour .

5. It provides smooth working even after expansion of the organization.

6. It opens possibility for workers for future promotions, thus providing incentive.

7. It creates healthy atmosphere of encouragement and motivation in the organization.

8. Training becomes effective.

9. It provides help for career development of the employees

Recruitment and selection:-

Recruitment and selection is the important stage in HRM, actually the selection processes, if

use it inappropriately, may have the potential to discriminate against certain groups. Equally

subjective judgments based on stereotypes, appearance, can disadvantage the applicant.

The entire selection process must therefore be based on criteria related to the

requirements of the job, the necessary competencies to perform the job and the potential

for development such as intelligence, qualification, aptitude. The panel therefore needs to

be clear on the necessary competencies for the job and how to identify them.

Interviewers need training, because every administrator or a medical doctor can not be a

good interviewer. As we know in many private institutions the recruitment is done by

referral basis, while in governmental institutions the routine advertisements of the posts,

screening of documents, and then interviewing. So these all need an overhaul, and to

introduce scientific methods for the selection and recruitment in order to avoid nepotism

and referral system.


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Job and Organization design:-

As it is clear from the definition of Job design, that job design is the specification of thecontents, method and relationships of the jobs to satisfy technological and organizational

requirements as well as the personal needs of the job holder.

So the evidence that we have from social sciences and behavioural sciences such as

sociology, psychology, they have been incorporated and applied in the management of

organizations, so these all have a focus on the analysis of the jobs, roles and regulations,

design and development of the organizations.

Like other organizations and institutions, hospital and health facilities also have the same

structure and roles; sometimes they are not able to achieve their targeted goals andobjectives.

So hospitals need clear job description and image, proper declaration of personnel policies

and procedures, organizational charts and so on as much the other organizations have.

Employee Communication:-

Effective communication have much more effect on the human and organizational health,

because if we have a proper channel and code of communication, so it is not easy that wehave face any problems, the problems and obstacle is preventing by the virtue of effective

communication, effective communication is the blood of any organization

When there is a strike or the spread of infectious disease so in that time the effective

communication can play a significant role to control all the matters. So newsletters,

pamphlets, leaflets, slide presentations, and cassettes are so essential for employee

communication.

Material:

It is clear fact that the good material management can be use to diminish operating costs for

the time it is somehow been neglected in hospitals and other facilities, so it is most

important to take inconsideration the vitality of the material management in order to

achieve the goals and objectives of the hospital.

As it is indicated in previous surveys that 40 to 50 percent of the annual budget of the

hospital are spending on material used.

Hospitals must adapt the ways and methods to streamline and make more efficient their

procurement, consumption and utilization control, inventory and records control, storage

and dissemination and service organization.


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The following factors have a big role in the effectiveness of materials.

-The items which are needed urgently should be provided.

-Use the money in such a way that the cost of storage is reduced to a minimum.

-Handle the items and equipments with the least loss in storage and management.

In order to achieve the above mentioned objectives when need to have a good and

stabilized policy decisions. However we have to put the short term polices for the time

being to run our work.

MONEY:

In most hospitals and health facilities the financial and costing system are usually weak. The

particular income or surpluses and the expenses of various departments are not separatelyanalyzed or the different costs fixed. As a result the related medical and other staff has no

idea and concept of the financial management and its implications of the resources at their

disposal, or the relationship between costs and the fees for various resources. It is obvious

that financial management becomes very critical to the productivity of hospitals.

Public hospitals in general need a financial advisor who can advise the management on its

spending policies; this will help cost reduction which is so vital. Many of the health related

institutions suffer from the unfavorable and unpleasant ratio of administrative and actual

healthcare expenditure.

The financial management is so compulsory for the hospital and healthcare organization;

because the hospitals are growing day by day and they are becoming capital intensive which

requires a lot of investments by mean of equipment Purchasement and operating expenses.

The hospital and other health facilities which are privately running or it is government based

they need a tight and well managed financial department, financial Management is also one

of the most important branch of the hospital as other branches like operation,

administration, logistic and so on.

We have many hospital in our society which are running and financed by Government, someare running by voluntary organizations and some are running and financed by influential

and charitable members, so all of these need a financial management section, because if

there will be no financial management so how we can analyze our revenues.

Steps in Financial Management:

Some of the best techniques in Financing


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Budgeting:

-The process of translating planning and programming decisions into specific projected

financial plans for relatively short periods of time. Budgets are short-range segments of

action programs adopted that set out planned accomplishments and estimate the resources

to be applied for the budget periods in order to attain those accomplishments.

Budgeting is the back bone of the financial management, actually the budget is the financial

forecast for the upcoming year, and it can be made quarterly or on monthly bases.

In general it estimates the income and expenditure and also the inflow and out-flow of

funds, so every department should have there own report on their activities and also the

expenditure and should report to finance section.

Cost accounting and Cost Control:

Cost accounting is actually the process of tracking, recording and analyzing costs associated

with the products or activities of an organization, where cost is defined as 'required time or

resources'. Costs are measured in units of currency by convention. Cost accounting could

also be defined as a kind of management accounting that translates the Supply Chain (the

physical movement of products) into financial value to support decision making to improve

costs and cash flows. While Cost analysis (also called economic evaluation, cost allocation,

efficiency assessment, cost-benefit analysis, or cost-effectiveness analysis by different

authors) is currently a somewhat controversial set of methods in program evaluation. One

reason for the controversy is that these terms cover a wide range of methods, but are often

used interchangeably.

In general cost control has to be exercised if it is possible, while in some cases the income is

enhanced by charging clients (Patients) more, it is the ethical obligation of the hospital to

exercise cost control, so the patient does not have to charge or pay than standard values. It

is essential that control must be exercised at all level and departments of the hospital.

Prices/Fees/Charges

It is important that an appropriate amount of fee for various services be charged. Actually

the charges influence the number of patients receiving services and the income of the

hospital or other health facilities.

The fees should be based on:-- Cost and Competitors fees.


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Funds:-

1-Sources of Funds

o Public or Governmental hospitals are financed by government fund and grants,which is financed by income tax and custom duties.

o Trust or charity hospitals or health facilities depends on the benevolent andcharitable people of the society or community, they mainly deliver free of charge

services.

o Privately owned hospitals or health facilities are proprietary in nature orpartnership types which are mostly managed by medical professionals.

o Corporate hospitals and health facilities invite the civil people to invest and share.

Whether it Private, corporate, or governmental hospitals or health facilities they are facing

the same problem of limited/restricted financial resources.

2-Fund Raising.

a- Fees Charged:-It is necessary that independence should be given to thegovernmental hospitals or health facilities and they should be confident to enhance

the financial resources, it is not fair that all services should be rendered free. SpecialAllowance/Concession should be given to some of the departments, to whom the

patients are more going, specially those patients who can not support the fee or

charges.

b- Institutional Contracts: - One of the good ways for the enhancement of income is tocontract with other organizations for providing medical services to their employees

or staff. It is necessary for the hospital to have a special budget for their employees,

so the employees can get benefits from this budget in order to take free and

subsided treatment.

c- Donations/Contributions: - The type of donation to the charitable hospitals is tomake concession in taxation with donors. Fund raising through charity is a special

occasion or case.

How to Launch a Fund raising Campaign, to do this we have different techniques and

methods:-

Face to face Solicitation: - It means that we have conduct face to facemeeting with prospective or tentative donor or philanthropic personalities ofthe community.


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Direct Mail: - Describing and briefing the subject through leaflets, broacherand pamphlets by mail.

Legacies and Bequests: - Encouraging donor or stakeholders to run offlegacies.

Special Events/ Procedures: - Organizing special meetings, events to invitethe donors and philanthropic people of the community to donate and by this

way to raise the fund.

Pay-roll deductions: - It is a kind of in-house fund raising method, in thismethod some amount of money is deducting directly from the salaries of the

middle and upper rank officers.

Therefore; the above mentioned methods are the good way to raise the fund, so we have to

adopt and choose one of them for our health organization to raise our fund in order to

render good quality of medical services. And by this way we can offer good services to the

needy patients who cant afford high medical charges, and eventually we will have a healthy

community.

Investing funds:-

The funds which is not been utilized yet should be invested and the interest earned should

be utilized or used for hospital operation, so in this way we will move swiftly to render good

medical services.

Loans:-

This is also a good method for fund raising, to take some amount of loan from bank in order

to run the daily operation of the hospital or nursing home, but the hospital should return

the interest and benefits to the bank on time. So by this way we can render a good quality

of medical services.

Equipment:

As it is obvious and more apparent that most hospital or health facilities have expensive

equipment remains out of the order or inventory list because of the insufficiency of the

engineering department, improper maintenance, defective service contracts and so on.

The expensive and costly equipment is under utilized because often the users do no have a

clear understanding of the capital cost of the equipment or machinery and the bond

between these costs, capacity utilization and a fee charged from the patients. It is important

to improve and enhance the quality of medical services without raising fees and other

charges. And it is also possible to increase the quality of services by improving the utilization

and usage of the existing equipments and machinery.

Thus the engineering department of the hospital or health facility is the most and critical

department, because they are mostly involved in the maintenance and repairing theequipments and machinery, A planned and scheduled maintenance can reduce the chance


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of breakdown and damage in of machinery and deterioration in normal routine hospital

activities. All the staff of the hospital must understand about the usage and operation of

electrical/mechanical appliances and equipments.

It is a clear fact that the engineering department is so neglected, so the hospital

management should in take all these concerns regarding the engineering department, their

problems should be solved in a better way for the betterment of hospital services.

The breakdown and even the collapse of the equipments and other instruments are

common in all hospitals, so the collapse pave the way for the idling of instruments, so in the

result the test are not doing properly and the income will also decreased and hence at the

end the results of the patients test is also delayed.

The majority of the machinery and the instruments which are so important they are mainly

imported from the other countries, so in case of the breakdown and failure the spare parts

of these equipments is not easily found in the market, so we have make the maintenance

program for these equipments.

Space:

Space also plays a dominant role in the productivity of hospitals, as we have seen some of

the hospital have so small space while other has a plenty of space. The poor use of space,

and defective layouts of equipment cause unnecessary movements of personnel and

hospital staff, patients and materials.

For the better planning of hospitals we need a coordinated thinking of medical specialists,engineers and architects specializing in the hospital field.

Health Management Information System (HMIS)

The healthcare industry is continuously evolving and becoming more technologically

advanced. The need for information managers in this field is escalating rapidly. The major

provides a solid foundation of knowledge about management in the healthcare industry

and, specifically, the management of information systems within the healthcare field.

Emphasis is on managing and advancing the application of information technology and

systems to improve the effectiveness of healthcare delivery in a variety of settings. Thismajor meets the industrys desire for professionally educated individuals in the converging

healthcare fields of people and information management. Graduates with a degree in

Healthcare Information Systems Management will be able to:

Analyze the informatics processes as it relates to thehealthcare enterprise

Integrate information management processes with clinicalprocesses to provide effective healthcare delivery


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Develop a plan to integrate the convergence of varioushealthcare information technologies into a healthcare

organization.

Identify the implications of federal regulations on healthcareIT

Compare and contrast the various process improvementstrategies that can be used in a healthcare IT environment

The reliable Management information system is the key toany organization for its better performance, prompt

availability of the information can help the management in

order perform the work with full accuracy and quality.

Computers can help in this regard to improve the

management information system.

Advantages of Computers:-

It provides less staff to operate and manage. Decrease the paper work and enhance the accuracy. It is easy to track, compile and get back the entered information. It can store large of data and information. It can provide only one click type of ease.

Possibility of computer usage in hospitals:-

Prior to introduce the computers to the hospital the possibility study should be done to find

out the:-

Requirement for computerization. Requirement of software and hardware and costs. Degree of computerization compulsory.


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It is so necessary that prior to introduce the computer to the hospitals, we must do and

perform the feasibility study and survey with the help of ICT Manager or Officer.

The Profit/Advantage of Computerization;

The investment is easily can be phased.

There is chance for staff to be trained on the usage of computer, soin future there will be no difficulty with computers.

The fear for using new technology will be overcome by this method.

In hospital the incorporated network is not present to be used by staff, but have their

Personal computers which can not do the same work which is done through integrated

network system.

Some of the Problems in Computerization:-

The below are the problems which is facing during computerization.

The staff may fright from economizing due to computerization. Fear about new technology. Finance (Salary, profit, benefits and hazards).

Some Recommendations to overcome these problems:-

Phasing

It will not just diminish the strain on the finance department, but it will help the staff

to use the new technology and new computerized system. It is recommended that a

single and small department should be computerized first, because it easy to measure

the benefits or achievement of the computerization.


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Training

Whenever the office is going to be equipped by new technology, so it necessary that

the relevant staff should be trained, because the staff are not familiar with the new

technology , so it is the responsibility of the information and technology department to

undertake the training on computerization. ICT should compare the advantage and

disadvantage of the new technology and should compare the old manual and monolog

system with the new digitalized and computerized system.

Finance

Computerization is so important for the finance department, because the finance

department is always engaged with sorting, analyzing and compiling the expenses and

budget issues, so it is always recommended by the information and technologyconsultant the finance department should also be computerized.

At the end we can say the in this world of transition and competition, only those

organizations are stay alive who have the capacity of changing and adapting quickly and

abruptly. Computerization facilitates more quick works and tasks, there is no

department in the hospital which doesnt need computerization, and every department

needs to be computerized.

Computerization:-

Computerization of the financial record is very crucial because we can sort, track and

compile all the financial matter in a due time with more feasibility and easy way. And this is

easy way of financial reporting. The computer software is available in the market, we can

buy this software with ease, so we have use computer in the hospital to track and compile

the financial records, calculation of balance sheets and budget.

Finance Personnel

Large hospital must have a finance manager to control and audit all the financial issues, and

it will help the hospital in financial management .While in Small hospital the Administrator

can run the finance section also or they must be trained in finance. Generally the hospital

must have a chartered professional accountant. So by this way all the financial issue will run

smoothly.


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Human Resource Management-

The Human Resources Management (HRM) function includes a variety of activities, and key

among them is deciding what staffing needs you have and whether to use independent

contractors or hire employees to fill these needs, recruiting and training the best

employees, ensuring they are high performers, dealing with performance issues, and

ensuring your personnel and management practices conform to various regulations.

Activities also include managing your approach to employee benefits and compensation,

employee records and personnel policies. Usually small businesses (for-profit or non profit)

have to carry out these activities themselves because they can't yet afford part- or full-time

help. However, they should always ensure that employees have an dare aware of --

personnel policies which conform to current regulations. These policies are often in the

form of employee manuals, which all employees have.

The goal of the management of human resources function is to identify and provide the

right number of competent staff to meet the needs of patients served by the hospital.

Labour Management/Unionization:-

Labour Management is one of the most important and even a crucial part of Personnel

Management. Since the emergence of unionization the management has faced with many

challenges and obstacles. Some times these unions are creating many problems and

headache in the hospitals, and we hope that they have contribute in a positive side such as

trade unions and so far.

The constructive and destructive role of unions depends on some factors, such as past

management practices and leadership style, many union are emerging like a virulent and

infectious disease who are not following the healthy personnel policies.

External political and trade unions giving birth to such disruptive and virulent unions, which

can only infect the people in the external environment, in addition they can help theirmembers in the workplace, most unions and central Labour bodies are also active in their

communities, helping to make conditions better for working people and their families, both

union and non-union. Unions individually and collectively pressure the government on

issues that impact working people such as minimum wage, hours of work, health and safety

regulations and other employment standards.

Unions have been at the forefront of struggles to preserve and protect health care,

education and other important public services. Unions fight budget cuts and laws that help

big business while eroding the quality of life in our communities. Unions support people in

need by lobby in government on Employment Insurance, public pension plans, and welfare


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to ensure that all people have a safety net underneath them. Unions have been a key player

in educating the public about the negative impacts of globalization.

On the other side union members enjoy better wages, better benefits and increased job

security. But the biggest benefit is the strength that comes from solidarity. Unlike non-union

workers, unionized workers are not alone when they have grievances.

Functions of Human Resource Management:-

Human resource planning Training and Development Employee Communication Staffing (recruitment and selection) Compensation and benefits Job design and Organization design Employee/Labour industrial relations Performance Appraisal

Employees training and development:-

Training and Development provides employees with background information about an

employer. It can also teach you a new skill and can provide you with overall knowledge that

can help you better perform your job.

There are many different kinds of training. You can start by handing out a packet of

information that people can use as a handbook about the organization. If you are trying to

teach a skill, a video or some type of visual aid can be very beneficial. Seminars comprise

another form of training. These can be used to teach any size group and are very helpful in

providing a vast amount of information in a short period of time. Other types of training can

involve on-the-job observation in which you watch what others are doing and learn while

they work.

With all these different types of training, people can choose the best training for their

organization. Since it is important to provide clear, accurate and up to date training, it is also

important to revamp your training styles every couple of years. This will make it so your

employees enjoy the training they are going through and that they are learning informationthat will be beneficial not only to themselves but also to the employer.

Benefits of Training and development:-

1. Increased job satisfaction and morale among employees

2. Increased employee motivation

3. Increased efficiencies in processes, resulting in financial gain

4. Increased capacity to adopt new technologies and methods


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5. Increased innovation in strategies and products

Updating Medical Knowledge:-

It is so necessary to keep the medical staff updated and trained in order to fit them for the

emergence of new technology in the medical field, Participation in medical seminars,

workshops, and joining medical communities and reading the medical books, journals and

literature is essential but it is not enough. There is also advance in training technology such

as the software and hard wares (videos, projectors, and other instruments).

Hospitals and other health facilities require professional and expert training manager and

instructors on their staff, and it is so hard that these organizations have trained and skilled

expertise.

Some Key Issues to be addressed:

1. Trained/Skilled Staff:Hospitals need trained and skilled technologists and staff, as it is obvious that many

hospitals have no professional technologists because they are not paid satisfactory. The

professional technologists have their own private laboratories in the city and they can earn

more than monthly salary of the hospitals, so if the hospitals are welling to attract and

absorb the professionals in hospital so they must pay for them a good wage salary and other

bonuses. These medical technicians who are working in the hospitals must be trained and

they need these trainings, these training programs must be undertaken by different medical

association.

2-Waste Control:

The wastage management is the crucial step in the hospitals, and it is so important that thestaff should be aware of the cost of wastages.

Hospital waste refers to all waste generated, discarded and not intended for further use in

the hospital.

Classification of hospital waste

(1) General waste: Largely composed of domestic or house hold type waste. It is

non-hazardous to human beings, e.g. kitchen waste, packaging material, paper,

wrappers, plastics.


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(2) Pathological waste: Consists of tissue, organ, body part, human foetuses,

blood and body fluid. It is hazardous waste.

(3) Infectious waste: The wastes which contain pathogens in sufficient

concentration or quantity that could cause diseases. It is hazardous e.g. culture

and stocks of infectious agents from laboratories, waste from surgery, wasteoriginating from infectious patients.

(4) Sharps: Waste materials which could cause the person handling it, a cut or

puncture of skin e.g. needles, broken glass, saws, nail, blades, scalpels.

(5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and

chemicals that have been returned from wards, have been spilled, are

outdated, or contaminated.

(6) Chemical waste: This comprises discarded solid, liquid and gaseous chemicalse.g. cleaning, house keeping, and disinfecting product.

(7) Radioactive waste: It includes solid, liquid, and gaseous waste that is

contaminated with radio nuclides generated from in-vitro analysis of body

tissues and fluid, in-vivo body organ imaging and tumour localization and

therapeutic procedures.

Biomedical waste-

Any solid, fluid and liquid or liquid waste, including it's container and anyintermediate product, which is generated during the diagnosis, treatment or immunisation

of human being or animals, in research pertaining thereto, or in the production or testing of

biological and the animal waste from slaughter houses or any other similar establishment.

All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste.

Rationale of hospital waste management-

Hospital waste management is a part of hospital hygiene and maintenance activities.

In fact only 15% of hospital waste i.e. "Biomedical waste" is hazardous, not the complete.

But when hazardous waste is not segregated at the source of generation and mixed withnonhazardous waste, then 100% waste becomes hazardous. The question then arises that

what is the need or rationale for spending so much resources in terms of money, man

power, material and machine for management of hospital waste ? The reasons are:

Injuries from sharps leading to infection to all categories of hospitalpersonnel and waste handler.

nosocomial infections in patients from poor infection control practices andpoor waste management.

risk of infection outside hospital for waste handlers and scavengers and attime general public living in the vicinity of hospitals.


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Risk associated with hazardous chemicals, drugs to persons handling wastesat all levels.

"disposable" being repacked and sold by unscrupulous elements withouteven being washed.

drugs which have been disposed of, being repacked and sold off tounsuspecting buyers.

risk of air, water and soil pollution directly due to waste, or due to defectiveincineration emissions and ash.

Approach for hospital waste management-

Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under

the Environment Protection Act by the Ministry of Environment and Forest (Government of

India).

Segregation of waste-

Segregation is the essence of waste management and should be done at the source

of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services

areas, operation theatres, labour rooms, treatment rooms etc. The responsibility of

segregation should be with the generator of biomedical waste i.e. doctors, nurses,

technicians etc. (medical and paramedical personnel). The biomedical waste should be

segregated as per categories mentioned in the rules.

Collection of bio-medical waste-

Collection of bio-medical waste should be done as per Bio-medical waste

(Management and Handling) Rules. At ordinary room temperature the collected waste

should not be stored for more than 24 hours.

Transportation-

Within hospital, waste routes must be designated to avoid the passage of waste

through patient care areas. Separate time should be earmarked for transportation of bio-

medical waste to reduce chances of it's mixing with general waste. Desiccated wheeled

containers, trolleys or carts should be used to transport the waste/plastic bags to the site of

storage/ treatment.

Trolleys or carts should be thoroughly cleaned and disinfected in the event of any

spillage. The wheeled containers should be so designed that the waste can be easily loaded,

remains secured during transportation, does not have any sharp edges and is easy to clean

and disinfect. Hazardous biomedical waste needing transport to a long distance should be

kept in containers and should have proper labels. The transport is done through desiccated

vehicles specially constructed for the purpose having fully enclosed body, lined internallywith stainless steel or aluminium to provide smooth and impervious surface which can be


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cleaned. The drivers compartment should be separated from the load compartment with a

bulkhead. The load compartment should be provided with roof vents for ventilation.

Treatment of hospital waste-

Treatment of waste is required:

to disinfect the waste so that it is no longer the source of infection. to reduce the volume of the waste. Make waste unrecognizable for aesthetic reasons. make recycled items unusable.

a-General waste-

The 85% of the waste generated in the hospital belongs to this category. The, safe

disposal of this waste is the responsibility of the local authority.

b- bio-medical waste: 15% of hospital waste-

Deep burial: The waste under category 1 and 2 only can be accorded deepburial and only in cities having less than 5 lakh population.

Autoclave and microwave treatment Standards for the autoclaving andmicrowaving are also mentioned in the Biomedical waste (Management and

Handling) Rules 1998. All equipment installed/shared should meet these

specifications. The waste under category 3,4,6,7 can be treated by these

techniques. Standards for the autoclaving are also laid down.

Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps(needles, blades, glass etc) should be shredded but only after chemical

treatment/microwaving/autoclaving. Needle destroyers can be used for

disposal of needles directly without chemical treatment.

Secured landfill:: The incinerator ash, discarded medicines, cytotoxicsubstances and solid chemical waste should be treated by this option.

Incineration: The incinerator should be installed and made operational as perspecification under the BMW rules 1998 and a certificate may be taken from

CPCB/State Pollution Control Board and emission levels etc should be

defined. In case of small hospitals, facilities can be shared. The waste under

category 1,2,3,5,6 can be incinerated depending upon the local policies of the

hospital and feasibility. The polythene bags made of chlorinated plastics

should not be incinerated.

.

Safety measures

5.1 All the generators of bio--medical waste should adopt universal precautions and

appropriate safety measures while doing therapeutic and diagnostic activities

and also while handling the bio-medical waste.


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5.2 It should be ensured that:

Drivers, collectors and other handlers are aware of the nature and risk of thewaste.

Written instructions, provided regarding the procedures to be adopted in theevent of spillage/ accidents.

protective gears provided and instructions regarding their use are given. Workers are protected by vaccination against tetanus and hepatitis B.

Training

Each and every hospital must have well planned awareness and training programmefor all category of personnel including administrators (medical, paramedical and

administrative).

All the medical professionals must be made aware of Bio-medical Waste(Management and Handling) Rules 1

To institute awards for safe hospital waste management and universal precautionpractices.

Training should be conducted to all categories of staff in appropriatelanguage/medium and in an acceptable manner.

Coordination between. hospital and outside agencies

Municipal authority : As quite a large percentage of waste (in India up to85%), generated in Indian hospitals, belong to general category (non-toxic

and non-hazardous), hospital should have constant interaction with

municipal authorities so that this category of waste is regularly taken out of

the hospital premises for land fill or other treatment.

Co-ordination with Pollution Control Boards: Search for better methodstechnology, provision of facilities for testing, approval of certain models for

hospital use in conformity with standards 'aid down.

To search for cost effective and environmental friendly technology fortreatment of bio-medical and hazardous waste. Also, to search for suitable

materials to be used as containers for bio-medical waste requiring

incineration/autoclaving/ microwaving.

Development of non-PVC plastics as a substitute for plastic which is used inthe manufacture of disposable items


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3Optimum Utilization:

Many of the hospitals have small number of technician and these technicians are busy in

other clerical works so this is the big problem in the hospitals. Those laboratories have many

problems which is facing the above said problem. The laboratories which is owned by the

pathologists the so these pathologists are also busy with its administrative responsibilities.

So it is important for the hospitals to train extra staff for the administrative and clerical

works in order to improve the quality of the work in laboratories.

In another hand the computerization of record and documents can reduce the paperwork

load on the staff, the other benefit of the computerization and compilation of the data and

information is to facilitate subsequent and ultimate analysis and tracking of the information.

4- Maximum utilization of Lab Service;

Some of the steps for the development of the laboratory services are as follows.

Making links with small hospitals and nursing. It is impossible for the patient to wait for long hours to get the result of their lab

exam. They have to go to the laboratories at specific time. It is also possible that

technician go to the home of the patients and to collect the sample from the

patients and after the lab exam the result should be given back to the patient, so by

this way the patients can charged for the services. Many of the patients are willing to

pay for their lab exams.

Relations with general practitioners who can collect the sample from the patient andthen these samples are checked in the laboratory after examining it is given back to

the patient.

It is good to have a 24 hours service instead of having fixed time collection ofsample, because in 24 hours service program take and give the results and reports

quickly, so in this way their will be no delay in treatment of the patient.

It is also possible that laboratories can give the results of the laboratory tests viaphone to the medical or pathology specialist in the urgent cases, so in this there will

be also no delay in the treatment of the patient.


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5-Radiology Services:

As it is obvious to all of us by moving this world forward and advanced in technology and

physics so the radiology also moved with this advancement and the advancement of the

radiological services also need more capital or financial investment. The cost of operation is

also increasing with the consumption of inputs such as x-ray films, chemicals which is used

for the washing and cleaning of films. But the radiology department center is the big

department in the hospital for that the cost or the expenses of this department is high from

the other departments, on the other hand its profit is also high in contrast to other

departments. So it is most important to keep this department managed and well equipped

because the surplus or the profit which are coming from this department should be spent

on the less income department by this way we can run the hospital daily expenses.

In many hospitals the radiology departments are situated in a very important place because

the patients can not move with films in the front of the departments and wards. So for that

the radiology departments are located from the beginning in a very strategic place.

6-Pathology Services:

In general the pathology services are the cornerstone of the medical field and it is playing a

great role in diagnosis of different pathologies and diseases. Pathological laboratories have

a crucial role in the diagnosis and detection and eventually in treatment of the patients. The

course of treatment and the cost of the medicine is quietly related to the out come of the

pathological tests, so the management and maintenance of this department has a great

importance.

The load of work increased on pathological laboratories is increased every patient should goprior to his treatment to medical or pathological laboratories, so by this the laboratories are

overloaded, this overload is more in those laboratories who are attached to the hospital or

in hospital territory, and in contrast there is less load on those laboratories which are

outside the hospital or private laboratories. The hospitals and laboratories which are

located in surrounding area can enter into common understanding. Routinely the hospitals

are collecting the samples from the patient and after the examination they are giving

reports to the patients back. So in this way the load will be decrease on the laboratories and

hospitals.

7-School Health Services:-

School Health Services fosters the growth, development and educational achievement,

students by promoting their health and well being. It monitors health status and identifies

and addresses the unmet needs of students, families and school personnel. It builds public

and private partnerships to ensure quality services that are effective, culturally appropriate,

and responsive to the diverse, changing needs of students and their communities, and most

of all school health services have a major role to play in preventive health. Health education

is important for the school children for the better and bright future of the nation.

It is known to all, that once child learn something in early childhood from his

parents/family or teachers so he/she repeating that thing throughout his/her life. The


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school health education not merely ensures a healthy generation, but also promotes

preventive health care awareness among the society.

Most of the school have the facility of health services for their students, and they have

dental/skin checkups, it the school doctor find some problem, so they prescribe some

medicine for the students, but they are not following the case with the parents of the child

School Health Services should cover the following steps:-

-Regular checkups of the students.

-Education of the children in preventive health and care.

-Encouragement of the children to know about the symptoms and signs of

the local disease in order to alert to early symptoms of health problems.

-And the most important, the doctor should follow-up the disease of the

children with their parents.

8-Management of Blood Banks:

Blood is the part of life that is given to those who need it by those who have the resource to

satisfy the need. Emergencies occur every minute. For each patient requiring blood, it is an

emergency and the patients could have set back if blood is not available. And also the

surgeries need blood, and also the blood is also required in blood disease, such as

leukemias, thalassemia, and a blood cancer.

The main tasks of blood banks are as follows:-

-Collection of Blood

-Testing of the blood.

-Storage of Blood.

-Supply of Blood to the hospitals and other health facilities.

How we can collect a Blood:-

1-Voluntary/intentional donors: - This kind of blood collection is done

by the voluntary organization, they are establishing blood camps in

different organization and institutions and they persuade the people

to donate with the poor and venerable patient and save their life.


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2-Professional Donors: they are the private blood banks, even they

collect the blood voluntarily or they buy the blood and then they sale

the blood.

Overcoming certain problems;-

1. the overcrowding problem2. hospital safety3. Cut Practice in medical field

1- Overcrowding in Hospitals and its Management:-

What are the primary causes of hospital overcrowding?

The primary cause is a mismatch between the supply of beds, poor flow of patients through

beds, and demand. As demand increases and the bed supply shrinks, flow through hospitals

becomes impaired.

The most important driver has been the increasing age of patients coming into hospitals. As

patients get older, they tend to consume more resources for the same kind of medical

conditions. For example, if someone comes in to have their knee replaced at 50 years old,

and he is otherwise well, he'll have a short, uneventful medical stay. At 75, with chronic

obstructive pulmonary disease, length of stay is likely to be longer and there's more risk of

complications. In the past 20years, expectations have changed. We tend to be more invasive

in our approach to older patients. And that typically drives up costs.

We can shortly discuss the main causes of overcrowding, and basically it is divided in toparts

IPD/Ward:-

The admission of those patients who needs its treatment in OPD. Some of the patients escaping from work, so they are insisting on unnecessary

admission.

Delay in the treatment of the patient due to insufficient resources of the hospitals.

Delay in discharging of patients. Unnecessary or unscheduled absence of doctors or other medical services.


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OPD (Out-Patient Department):-

Hospital Management should always be in strives to facilitate the patients in puttingproper direction signs in corridors or lawns.

Irregularities in the attendance of doctors/nurses and other medical staff. Absence and poor functioning of inquiry services. Rhythmic visiting of patients, who have already been visited by the same ward

doctor

There are two broad strategies for managing access block resulting from hospital

overcrowding reducing hospital demand and optimizing hospital bed capacity.

a-Reduce hospital demand

Diversion/substitution: The major focus of this strategy has been to divertpatients to community services and provide more services in the community

that traditionally occur in hospital (e.g. hospital outreach programs, hospital

in the home, and improved after-hours general practice services).

Reducing expectations: Reducing community expectations of what a publichospital system can provide. Access block cannot be controlled without some

limits being placed on the provision of services. Demand for health care is

elastic and potentially unlimited, especially in an essentially free health care

system. There must be public debate about what is essential versus what isdesirable, and how much the community is willing to pay.

Prevention: There is potential to reduce demand by disease preventionstrategies, and improved management of patients with chronic ill health.

b-Optimize hospital bed capacity

Balancing elective and emergency workload :Contrary to popular opinion,the emergency workload is highly predictable across metropolitan areas.Elective treatment must be tailored to match the capacity allowed by

predicted emergency work.

Better discharge: Moving patients quickly from acute hospitals to moreappropriate facilities increases hospital bed availability. Access to

rehabilitation, residential aged care and community outreach programs is an

essential component of an efficient and well managed health system.

Addressing physical, social and psychological issues through care

coordination in the emergency department and after hospital discharge can

also help reduce hospital length of stay and readmission.


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Increased bed numbers: It is important to note that access block does notcorrelate well with the absolute number of hospital beds. Increasing the

number of hospital beds temporarily alleviates access block, but does not

solve the problem the beds quickly fill and the problem recurs.

Nevertheless, governments must fund an adequate number of beds to

provide the health care that the community demands.

2-Safety Management:

a. Hazard Recognition:

Hazard identification is the process used to identify all possible situations in the

hospital where people (patient, staff, visitors etc) may be exposed to injury,infections or disease. The risk management authorities undertakes periodic

evaluation of safety precautions to be followed by each department.

For hazard recognition the following steps will be undertaken:

1. Both Clinical and Non-clinical audits will be undertaken on a periodical basis toidentify the measures taken to prevent/reduce the impact of the potential hazards.

2. All the staff of the hospital will be encouraged to routinely assess all activities toidentify potential hazards.

3. Departmental Heads and Managers will identify hazards within their specific area ofcontrol. The same should be notified to the appropriate hospital authorities for

immediate corrective actions.

b. ELECTRICAL SAFETY:

The following measures are undertaken to ensure Electrical safety:

1. Routine Inspection of the power outlets through out the hospital by the electrician.

2. Trip Switches are located in different parts of the hospital to prevent short circuits.

3. Periodic inspection of wires to ensures that they are in appropriate conditions.

4. Before any electrical appliance is brought into RML Hospital, a safety inspection is

provided.


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5. Electrical equipment not required during night are switched off.

6. Areas around electrical switchboards must be kept clear for a distance of at least 1

meter.

7. ABC type fire extinguisher will be located adjacent to electrical switchboards.

c. Power Loss:

The Hospital may experience temporary power losses due to

1. Storms2. Power company disruptions, or damage to the service lines entering the hospital.3. Malfunctioning of the internal electrical wire system of the hospital.

d. Immediate Action:

In the event of power loss, every effort should be made to immediately turn off all

electrical equipment (if required) within an employees work area before power is

restored to protect the equipment.

e. Reporting Power Losses:

In general, the loss of power or the disruption in normal electrical service should be

reported immediately to the Electrician.

Maintenance staff will investigate the scope and condition of power loss and

proceed to correct the matter accordingly.

f. Biological Hazard:

Two primary sources for biological hazards has been identified which are:

1. Infectious Sharp objects.

2. Blood and Body fluid spills.

g. Infectious Sharp Objects:

Sharps are any medical or non-medical equipment that is capable of cutting and/orpuncturing the skin.

Sharps' injuries represent the major occupational cause of accidents involvingpotential exposure to blood borne illnesses.

i. The Hospitals policy on Sharps Handling is:

Any equipment designated as a sharp must be handled and disposed of safely


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Sharps are to be handled carefully at all times. Sharps are designated as clinical waste .

ii. PROCEDURE

Sharps must be disposed of at point of use. Used needles:

o must not be recapped after use unless using an appropriate device.o must not be removed from syringes by hand.o must not be bent, broken or otherwise manipulated by hand.o must be destroyed immediately after its use.

Used disposable sharps are disposed of in a designated, clearly marked, punctureresistant container.

Reusable sharps are disposed of in a clearly labeled, puncture resistant container fortransport to the reprocessing area (CSSD).

Sharp sections on intravenous giving sets are cut off and disposed of in the sharp'scontainer. The remainder is disposed of in the general waste. This only applies to

giving sets that have no visible blood in the line. This does not apply to IV sets that

have been used for cytotoxic drugs.

Sharps containers must be sealed and replaced.h. Blood and Body Fluid Spills:

i. The Hospitals policy on Blood and Body Spills is:

Blood and body fluid spills must be cleaned up immediately or as soon aspossible.

Standard precautions must be used when cleaning up spills of blood or bodyfluids.

Gloves and other personal protective equipment appropriate for the task mustbe worn.

ii. Hands must be washed properly after the spill has been cleaned up.

iii. Procedure

The following points should be taken into account while cleaning up body fluids:

Type of body fluid Size of spill Surface type area involved


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iv. Impervious Surfaces:

a. Wipe the spill up using absorbent paper towel.

b. Wash the area with water and detergent.c. If there is a likelihood of bare skin contact with the surface, the area is disinfected

with sodium hypochlorite solution.

v. Operating theatres

a. Spills should be attended to as soon as it is safe to do so.

b. Area to be disinfected with sodium hypochlorite.

vi. Bathrooms and toilets

a. Spill are hosed off into sewerage system and are flushed with water and detergent.

b. The area is disinfected with sodium hypochlorite.

I-Fire protection:

Incidents of fire has been termed as CODE RED.

In an incident of fire the staff has been instructed not to shout the word FIRE instead of

that the word CODE RED to be used for informing the other staff about the incidence offire.

The two-fold objectives of the Fire Safety Plan are :

i. Fire Prevention: To prevent the incidence of fire by implementing appropriate measure to

control fire hazards in the building and by the maintenance of the building facilities

provided

for the safety of the occupants.(patients, staff ,visitors etc)

a. The hospital has been declared No Smoking zone.b. Smoke Detection Devices are placed in different parts of the hospital, incase of the

fire, on detecting smoke the devices are activated and an hoofer is alarmed in the

security office.

c. Fire Extinguisher: Fire extinguishers, in appropriate sizes and types (ABC), areprovided throughout the hospital in every floor of the hospital. Extinguishers are

inspected as required by a qualified contractor. The theft of or tampering with anextinguisher should be reported immediately to the Maintenance Incharge.


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ii. Emergency Evacuation: To establish a systematic method of safe and orderly

evacuation of an area or building, by and of its occupants, in case of fire or other

emergency.

3-Cut Practice in medical field , so how it can be discouraged

and curtailed:

As it is obvious to every doctor that, all doctors qualified to practice modern medicine take

the classical Hippocratic Oath before beginning their professional career, The idealistic

values learned during the period of training get shaken up when the doctor steps out from a

world of practice ofmedicine to one of medical practice. Here he sees practical

adjustments that he is required to make in his clinical and therapeutic decisions and

encounters open offers of referral of patients for a predetermined and regularized practice

of fee- sharing (cut practice) Which is unethical practice.

Cut practice (Malpractice) occurs in many forms:

Giving a share of fees to the referring doctor. Referring patients for unnecessary consultations or tests to ensure a kickback from

the consultant or laboratory.

Giving expensive gifts periodically to the referring doctor. Appointing junior specialists to a super specialty hospital so that procedural work is

always referred by them to you.

Unnecessary admissions in nursing homes/hospitals. Sponsoring of a conference or payment of travel expenses by a company in return

for the use of its equipment or prescription of its drugs.

The basic problem is that, that the patients are neither aware of their rights in getting

neither information nor do they take any action against the doctors if they know that the

doctors are mal practicing.

Basis for charging fees:-

Every doctor determines his/her professional fees on the basis of experience, wisdom and

self-perception of the level of skills required for a particular treatment. Fees thus vary

widely from doctor to doctor. Hence a particular amount cannot be termed unreasonable

as long as the patient is aware of the sum to be paid before the service is rendered. What

the treating doctor does with the fee after it is received by him is entirely and solely his

concern and the patient or any other person has no say in it. Hence if a doctor decides to

give a portion of his fees to another person (medical or non-medical) it is entirely legal and

ethical to do so provide this is done openly and after obtaining a receipt.


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Various specialized procedures - such as endoscopy, angiography, angioplasty - form

lucrative sources of income and are therefore frequently advised even when the stated

indications are not scientifically valid. (At times it is difficult for a doctor to say that the

procedure advised by another was not required because on most such issues, opinions

published in the medical literature support both points of view. There is truly no substitute

for ones own competence and conscience acting as an internal judge and counsel.)

How we can control this mal-practice or cut practice:-

Public Education or awareness on such mal-practices is the first stepof controlling.

In the absence of a clear, logical, bold and community oriented healthcare policy on the part of the government and a lobby of strong,

honest, clear thinkers representing the medical profession in the

corridors of power, the present situation is unlikely to change in the

near future.

To avoid this mal-practice we have to have strong local or nationalmedical association or federations, with the strong code of ethics.

Themselves medical doctors should talk and conduct meetings toprohibit and condemn the mal-practice.

Consumer protection act needs to be implemented in order to stopthis cut or mal-practice.-

The monthly salary and other benefits of full time doctors especiallyin teaching hospitals should be such that they are able to maintain a

decent standard of living commensurate with their position and

seniority. There will then be no need or incentive for unethical ways

of earning extra income.

Each general practitioner must charge a publicly stated fee from thepatient for the act of medical examination, making a diagnosis and

recommending appropriate treatment or referral to an appropriateconsultant or hospital.

A body of experts in each hospital or nursing home should monitor the performance of

various procedures to ensure that they are based on scientifically valid indications


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Doctor Patient Contact:-

The contact or relationship between the doctor and patient should so transparent, and

this relationship and contact is so important in order to satisfy the patient. And he will

satisfy from the relation and behave of the doctors because the patients are waiting for

hours, and even the patients are waiting for doctors appointments for weeks, and when

they visit the doctor, so the doctor just see them for a minute, so this will disappoint the

patient, so in this case the doctor has no fault because he is overcrowded by patients and he

has no enough time to give to all patient.

Points for the satisfaction of patient

Enough time should be given to the patient to define his illness and doctor shouldtake the full history from the patient.

The doctor should give full information regarding the patients illness or disease. The patient is willing to know about his/her problem so the doctor should strive to

give necessary information regarding his illness.

original hospital management

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