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Principles of Hospital Administration & Planning
BM Sakharkar
SECTION ONE: THE HOSPITAL
CHAPTER 1:
Role of Hospitals in Health Care
HEALTH AND MEDICAL CARE
Environmental Health Services
Public Health Services
Personal Health Services
Promotion of Health
Prevention of Disease
Early Diagnosis and Treatment
Rehabilitation
Health Team
HOSPITALS
History of Hospitals
Medieval Period
Nineteenth Century
Hospitals in India
Emergence of Health Care Delivery System and Hospitals in Independent India
Hospitals, Beds and Medical Manpower
THE CHANGING ROLE OF HOSPITALS
Impediments to Medical Care Delivery and Role Perception of Hospitals
HOSPITAL VIEWED AS A SYSTEM
Peculiarities of a Hospital System
Hospital as a Social System
INTRAMURAL AND EXTRAMURAL FUNCTIONS OF HOSPITAL
HOSPITAL AND COMMUNITY
The Providers, Support Group and Community
Hospital-Community Relationship
PRIMARY HEALTH CARE (PHC) AND HOSPITALS
Elements of Primary Health Care
Benefits to the Health Care System
PHC as Entry Point into Hospitals
The Role of General Practitioners (GPs)
Some PHC Related Experiences Abroad
Development of a PHC Policy by Each Hospital
Referral Function
Support Function
THE CHANGING SCENE IN THE HOSPITAL FIELD
Urban Hospital Concentration
Sickness Insurance
Preventive Medicine, Health Promotion and Hospitals
Rising Mental Illness, Heart Disease and Cancer
Geriatric Care
Building New Hospitals and Establishing Linkages
Development of New Management Practices
MARKETING OF HOSPITALS
Strategic Planning
Marketing of Medical Services
Specialty Hospitals
CHAPTER 2:
Hospital Planning and Design
INTRODUCTION
GUIDING PRINCIPLES IN PLANNING
Patient Care of a High Quality
Effective Community Orientation
Economic Viability
Orderly Planning
Sound Architectural Plan
Medical Technology and Planning
REGIONALISATION OF HOSPITAL SERVICE
What is Regionalisation?
The General Hospital
CLASSIFICATION OF HOSPITALS
HOSPITAL PLANNING TEAM
Hospital Consultant
The Core Group
Hospital Consultant, Communication and Leadership
Hospital Architect
ASSESSMENT OF THE EXTENT OF NEED FOR THE HOSPITAL SERVICES
Relationship between Demand and Need
Epidemiological Approach in Medical Care Planning
Levels of Medical Care
Factors Influencing Hospital Utilisation
Geographical, Environmental and Miscellaneous Factors
Bed Planning
Example
Hospital Size
CHOOSING A SITE
General Considerations
Land Requirements
Soil Structure
Public Utilities
Water
Sewage Disposal
Power
Electrical Substation
THE MASTER PLAN IN ITS TOTALITY
CIRCULATION ROUTES
Internal Circulation
External Circulation
DISTANCES, COMPACTNESS, PARKING, LANDSCAPING AND VISUAL IMPACT
Distances
Compactness
Parking
Landscaping
Visual Impact
Linearity
ZONAL DISTRIBUTION AND INTER-RELATIONSHIPS OF DEPARTMENTS
Hospital Stores
CSSD
Hospital Kitchen
Hospital Workshop
Laundry
Miscellaneous
Considering the Requirements of Residential Campus, Community Centre and Dharamshala
Residential Campus
Community Centre
Dharamshala
GROSS SPACE REQUIREMENTS
Space Requirements of Some Basic Departments and their Inter-relationships
OPD and Casualty
Inpatient Service
Operation Theatres
Laboratory
Radiology Department
CLIMATIC CONSIDERATION IN DESIGN
Orientation of Buildings
Artificial Ventilation
Planning for Energy Conservation and Saving
PREPARATION OF FUNCTIONAL BRIEF
Architect's Brief
Contents of the Brief
Preliminary Drawings, Working Drawings and Estimate
Reading Architect's Drawing and Sketches
Modular Grids
Design Efficiency
Project Administrator and Coordination
Project Cost
Break-up of Project Cost
EQUIPPING A HOSPITAL
CONSTRUCTION AND COMMISSIONING
Construction
Phasing
Commissioning
Scheduling the Sequence of Services
Shake-down Period
EPILOGUE
SECTION TWO: OUTPATIENT, INPATIENT AND NURSING SERVICES
CHAPTER 3:
Outpatient Services
INTRODUCTION
Definition
MAGNITUDE AND IMPORTANCE OF OUTPATIENT SERVICES
DEFINITIONS
Outpatient
Emergency Outpatient
Referred Outpatient
General Outpatient
Outpatient Visit
Unit of Service
Service Time
PLANNING OF OUTPATIENT SERVICES
PROJECTION OF OUTPATIENT LOAD FOR SELECTED TARGET AREA
PLANNING CONSIDERATIONS
Defining the Range of Outpatient Services and Scope of the Service
Daily and Hourly Capacity Envisaged
Staff Organisation and the Tasks Required of Staff
Possible Service Time per Patient and its Distribution
Flow of Patients and Work Scheduling
Holding Capacity and Lifting Capacity
SITTING, ACCOMMODATION AND PHYSICAL FACILITIES
Flow Pattern
Reception and Enquiry
Waiting Area
Wheelchair and Trolley Bay
Registration Counters and Medical Record Room
Consulting and Examination Rooms
Determining the Requirement of Consulting-cum-examination Room
ANCILLARY SERVICES
Injection Room
Dressing Room
Minor Operating Theatre
Dispensary
Laboratory Sample Collection Centre
Outpatient Radiology
POLICIES AND PROCEDURES
COMMON PROBLEMS IN OUTPATIENT SERVICES
What are the Problems?
Where are the Problems?
Whose View?
Cause and Effect
A Search for Solution to the Problems
Queuing and Waiting Time Problems
Appointment System
Filter Clinics
Satellite Clinics
Selective Service Charge
Starting OPD in Time and Prolonging OPD Timings
Physical Facilities Problems
Resources Problems
Coordination Problems
OTHER MEASURES
CHAPTER 4:
The Nursing Unit
INTRODUCTION
THE NIGHTINGALE WARD
PROGRESSIVE PATIENT CARE
Intensive Care
Intermediate Care
Self Care
Long-term Care
CLASSIFICATION OF WARD ACCOMMODATION
WARD SIZE AND CONFIGURATION
Modular Grids
Combining Two Wards with Common Service Facilities
Ceiling Height
Width of Corridors
Windows
Doors
Dado
Noise Reduction
Bedside Lockers and Built in Cupboards
Simplicity Combined with Efficiency and Effectiveness
NURSING STATION
Doctor's Room
SANITARY FACILITIES
WCs and Bathrooms
Wash Basins
Dirty Utility Room and House-keeper's Closet
TREATMENT AND DRESSING ROOM
ISOLATION ROOM
WARD PANTRY
CLEAN UTILITY ROOM
DAY ROOM
AUXILIARY ACCOMMODATION
MISCELLANEOUS FACILITIES
PATIENT MONITORING
SPECIAL NURSING UNITS
Intensive Care Unit
Infectious Diseases Ward
Barrier Nursing
WARD VENTILATION
WARD LIGHTING
General Lighting
Reading Light
Examination Light
Night Lighting
Lighting in Corridors
Light Source
Light and Power Sockets
Call Bell
CHAPTER 5:
Intensive Care Unit
INTRODUCTION
ROLE AND FUNCTIONS OF ICU
ICU SIZE
TYPES OF PATIENTS
TYPES OF INTENSIVE CARE UNITS
PLANNING AND ORGANISATION
Location and Spatial Requirements
Private ICU Room Vs Open Ward
Traffic
Design and Layout
Patient Bed Area
Central Nursing Station
Toilets for the ICU
Clean and Dirty Utility Rooms
Storage Room
Equipment
Medical Staff
Nursing Staff
Auxillary Personnel
ANCILLARY AND SUPPORT SERVICES
Air Conditioning
Lighting and Electrification
Diagnostic Support
Equipment Maintenance
Stand-by Generator
Visitor Lounge
ETHICAL PRINCIPLES GOVERNING CRITICAL CARE
Ethical Issues in Terminal Illness
Withholding Life Support and Withdrawal of Life Support System
Euthanasia
Euthanasia Includes
POLICIES AND PROCEDURES
CHAPTER 6:
Nursing Services
INTRODUCTION
FUNCTION OF THE NURSING SERVICES
ROLE OF NURSING SERVICES
DETERMINING THE NURSING STAFF REQUIREMENT
Case Method
Group Assignment Method
Functional Assignment Method
Team Nursing Method
Primary Nursing Method
FACTORS WHICH INFLUENCE THENUMBER OF NURSES
Type of Service
Acuteness of Illness
Experience of Nurses
Amount and Quality of Supervision
Availability of Nursing Aides
Teaching Function
Plan of Nursing Units (Wards)
Physical Facilities
Location of Equipment and Supplies
Working Hours and Shifts
Hospital Routine
Assignment Method
Standard of Care Desired
STEPS IN DETERMINING NURSING TIME AVAILABLE PER PATIENT PER DAY
NURSING TIME UTILISATION STUDIES
TIME UTILISATION IN NONNURSING DUTIES
STAFFING NORMS
ORGANISATION
Director of Nursing
Nursing Supervisor
Head Nurse
Staff Nurse
Student Nurses
Motivation of Student Nurses
POLICIES AND PROCEDURES
Dichotomy in Technical and Managerial Responsibilities
Evaluation
Efficiency
Job Satisfaction
SECTION THREE: MANAGEMENT
CHAPTER 7:
Effective Hospital Management
INTRODUCTION
PRINCIPLES OF MANAGEMENT
1. Division of Work
2. Authority and Responsibility
3. Discipline
4. Unity of Command
5. Unity of Direction
6. Centralisation of Authority
7. Scalar Chain
8. Order
9. Remuneration
10. Stability of Tenure
11. Delegation of Authority
12. Initiative
13. Subordination of Individual Interest to Organisational Interest
14. Equity
Administration or Management?
MANAGERIAL ACTIVITIES OF A HOSPITAL
THE GOVERNING BOARD
HOSPITAL ADMINISTRATOR
Medical or Nonmedical Person?
SURVEY OF PROBLEMS FACED BY HOSPITALS
Leadership in the Hospitals
Lack of Funds for Hospitals Services
Adaptation to External Pressures
Lack of Dedicated Professional Staff
Controls
Ineffective Organisation and Allocation of Work
Problems of Motivation and Job Satisfaction of Employees
ROLES AND FUNCTIONS OF HOSPITAL ADMINISTRATION
1. Working with People
2. The Enabling Role
3. Hospital Administration and Staff
4. Staff Motivation
5. Facilitating Decision Making
6. Management of Resources
7. Negotiating
8. Containing Costs
9. Understanding ‘Efficiency’ and ‘Effectiveness’
10. Dealing with New Technology
11. Establishing Managerial Climate
12. Management Development
13. Evaluation
14. Fact-finding and Investigation
15. Social Commitment
SKILLS OF EFFECTIVE MANAGERS
Technical Skill
Human Skill
Conceptual Skill
Importance of the Three Skills
COORDINATION
What is Coordination?
Coordination is a Mental Attitude
Coordination Vs Cooperation
How is Coordination Facilitated?
Coordination of Change
CHARACTERISTICS OF EFFECTIVE MANAGERS
• Clear and Realistic Goals
• Professional Par-Excellence
• Perceptual and Cognitive Flexibility
• Professional Growth
• Commitment to the Chosen Field
• Attitude and Confidence
• Communication
• Diversity
• Creative Orientation
• Motivation
• Satisfaction
• Self-esteem
CHAPTER 8:
Planning
INTRODUCTION
The Purpose of Planning
FORECASTING
Forecasting Demand
Forecasting Utilisation
STRATEGIC AND OPERATIONAL PLANNING
Strategic Planning
Operational Planning
PLANNING COMMITTEES
CRITERIA FOR EFFECTIVE PLANNING
Step by Step Approach to Planning
Analysis of the Situation
Identifying Priority Problems
Formulating Objectives
Setting of Goals
Reviewing Limitation/Constraints
Laying Down Operational Policy and Operational Systems
Writing Down the Plan
DECISION MAKING
Quantitative Factors in Evaluating Alternatives
Marginal Analysis
Cost Effectiveness Analysis
Operation Research and Other Techniques
Operation Research
Types of Decisions
1. Considered Decisions
2. Operational Decisions
3. Uncomfortable Decisions
4. Hurried Decisions
The Decision Process
What is to be Achieved?
STRATEGIC PLANNING
Strategic Planning Approach
Systems Engineering in Strategic Planning
Planning for Growth and Diversification
Growth
Diversification
Decision Making for Growth and Diversification
CONCLUSION
CHAPTER 9:
Organising
INTRODUCTION
ORGANISATION DEFINED
IS HOSPITAL LIKE ANY OTHER ORGANISATION?
Realities of Hospital Organisation
AUTHORITY RELATIONSHIPS
1. Superordination/Subordination
2. Authority and Responsibility
3. Scalar Principle
4. Functional Authority
Nature of Functional Authority
Methods of Exercising Functional Authority
Pitfalls in Exercising Functional Authority
5. Splintered Authority
6. Line and Staff Authority
7. The Span of Management
DELEGATION
Principles of Delegation
Steps in Delegation
Selecting and Assigning the Task
Selecting the Appropriate Subordinate
Instructing the Subordinates
Maintaining Feedback and Control
Some Basic Tenets of Delegation
What Should Never be Delegated?
Why is there not Enough Delegation?
Management Barriers
Subordinate Barriers
MULTIPLE PYRAMID OF HOSPITAL ORGANISATION
The Difficulties
Trustee Domination
Medical Domination
Administrator Domination
Multiple Domination
COMMITTEES AS PART OF ORGANISATION
Why Committees Become Necessary
1. Group Deliberation and Judgement
2. Representation of Varied Interests
3. Coordination of Department Policies and Plans
4. Sharing of Information
5. Consolidation of Splintered Authority
6. Avoidance of Action
Effective Committee Management
Checklist
Hospital Standing Committees
Medical Staff Committees
THE ORGANISATIONAL CHART
Advantages and Limitations of Organisational Charts
MATRIX ORGANISATION
Contingency Theory
CONCLUSION
CHAPTER 10:
Directing and Leading
INTRODUCTION
MOTIVATION
Approaches to Motivation
Motivations by Formal Control
Motivations through Informal Organisation and Group Dynamics
Motivation through Encouraging Full Utilisation of Workers Potential and through Internal Sources of Control
A Balanced View of Motivation
Motivating Professionals
LEADER BEHAVIOUR
Leaders and Administrators
Leadership Styles
Is there a Best Leadership Style ?
INDUCTION AND TRAINING
COMMUNICATION
Purpose of Communication
Communication Process
Sender of the Message
Transmission of Message
Receiver of the Message
Feedback
Communication Flow
Downward Communication
Upward Communication
Crosswise Communication
Communication Models: Written, Oral and Nonverbal
Written Communication
Oral Communication
Nonverbal Communication
The Art of Listening
Guidelines for Effective Communication
CONCLUSION
CHAPTER 11:
Controlling
INTRODUCTION
Controls are Based on Plans
Organisation Structure is Needed for Controls
THE BASIC CONTROL PROCESS
1. Establishing Standards
Intangible Standards
2. Measurement of Performance
3. Correction of Deviations
FORWARD ACTION
CRITICAL CONTROL POINTS AND STANDARDS
Control and Management by Exception
CONTROL TECHNIQUES
Budget: The Traditional Control Technique
Budget is Also a Plan
Concept and Purpose of Budgeting
Types of Budgets
Revenue and Expense Budget
Programme Budgeting
Zero-based Budgeting
Variable or Flexible Budgeting
Cost Accounting
Other Control Techniques
Statistical Reports
Break-even Analysis
Carrying out break-even analysis
Operational or Internal Audit
Organisation
Goals and Objectives
Policies and Procedures
Staffing and Supervision
Physical Facilities
Programme Evaluation and Review Technique (PERT)
EFFECTIVE CONTROLLING
Attitudes Toward Control
CHAPTER 12:
Financial Management
INTRODUCTION
Financial Planning
Capital
Financial Feasibility
CAUSES OF RISE IN HOSPITAL EXPENDITURE
The Changing Character of Services
Lack of Commitment
Technology Development
Changing Health Status
Increasing Proliferation of Specialists
Defensive Medicine
Lack of Awareness of Economy and Productivity
Reimbursing Practices
More Costly Facilities
GLOSSARY OF FINANCIAL TERMS
Asset
Account Payable
Accounts Receivable
Accrual Accounting
Average Cost
Balance Sheet
Benefit-cost Ratio
Book Keeping
Budget
Budgetary Control
Cash Accounting
Capital Expenditure
Chart of Accounts
Charge Slips
Cost
Cost Finding
Depreciation
Income and Expenditure Statement
Liabilities
Marginal Cost
Operating Cost
Overheads
Prepaid Expenses
Revenue Centres
Revenue Expenditure
Standard Cost
REVENUE CENTRES AND COST CENTRES
Revenue Centres
Cost Centres
STANDARD COSTING
COST FINDING
Direct Costs
Indirect Costs
Operating Costs
Fixed Costs
Variable Costs
Semivariable Costs
Allocating Indirect Costs
DEPRECIATION
Straight Line Method
Accelerated Rate
RATE SETTING
Approaches to Rate Setting
Relative Values
Cost Plus a Percentage
Hourly Rates
Gradation of Accommodation and Facilities
THE HOSPITAL BUDGET
Financial Requirements of Hospitals
Basic Inputs
Budgetary Process Covers Three Budgets
Capital Budget
Cash Budget
Operating Budget
Steps in the Budgeting Process
Budget Control
Income and Expenditure Statement
Balance Sheet
FINANCIAL CONTROL
Financial Reports and Information System
Daily Reports
Monthly Reports
Quarterly Reports
Yearly Reports
Points of Control
Cash Receipt and Payments
Purchases, Consumption and Inventory of Consumables
Patient Billing
Assets Accounting
Accounts Payable
Accounts Receivable
Accounting of Scrap
Accounting of Packing Material
Vehicles
Utilisation of Plant, Machinery and Equipment
Payroll
Missing Charges and Uncollectable Patient Accounts
CONTAINMENT OF COSTS AND IMPROVING PROFITABILITY
Reduce the Cost of Input Resources
Improve Efficieny
Volume Reduction
Use of Cost-benefit, Cost-effectiveness and Value Analysis in Cost-containment Strategy
Cost-benefit Analysis
Cost-effectiveness Analysis
Value Engineering
Steps of a VE Project8
Approaches to Improving Profitability
Improvement Inpatient Revenue
Increasing other Operating Revenue
Increasing Nonoperating Revenue
Controlling Operating Costs
A CHECKLIST FOR COST CONTAINMENT
SECTION FOUR: CLINICAL SUPPORTIVE SERVICES
CHAPTER 13:
Radiology and Imaging Services
INTRODUCTION
CLASSIFICATION OF RADIOLOGICAL WORK
WORKLOAD AND MACHINE TIME UTILISATION
SITING AND LAYOUT
Siting
Layout
Factors to be Considered
Space Requirement
Distribution of Space
Percentage
Location and Layout of Radiography Rooms
X-ray Machines
Image Intensifiers
Portable Machines
OT Radiography
Power Requirements
STAFFING
Radiographers
Case Load
Other Staff
RADIATION PROTECTION
Basis of Calculation of Wall Thickness
ULTRASONOGRAPHY
Equipment, Physical Facilities and Staffing
POLICIES AND PROCEDURES
COMPUTED TOMOGRAPHY (CT)
Spiral CT
MAGNETIC RESONANCE IMAGING (MRI)
CHAPTER 14:
Laboratory Services
INTRODUCTION
WORKLOAD
FUNCTIONAL DIVISIONS
FUNCTIONAL PLANNING
Microbiology
Histopathology and Cytology
SPECIALISED SERVICES
Hormone/Tumour Markers (ELISA/RIA)
Molecular Lab (PCR, Flow Cytometry, Immunohistochemistry)
ORGANISATION
SITTING AND SPACE
Location
Outpatient Sample Collection
Area/Space
Primary Space
Secondary Space
Circulation Space
Laboratory Space Unit (LSU)
Dimensions and Space of LSU
DESCRIPTION OF ACCOMMODATION
Layout
Administrative and Auxiliary Areas
Reception and Sample Collection
Bar-coding System for Samples
Specimen Toilet
Pathologists Office
Glass Washing and Sterilising Unit
Report Issue
Staff Locker Room and Toilet
Utility Services
Internal Design and Fitments
Work Benches
Lighting
Service Spine
Storage
Partitions
Dust
Air-conditioning/Exhaust
Working Surface
Flooring
STAFFING
Number of Personnel
Nonproductive Activities
Scheduling and Turnover
Avoiding Monotony
EQUIPMENT
Instruments
POLICIES AND PROCEDURES
Laboratory Samples
Sample Receiving
Request Forms
Time for Accepting Specimens
Containers
Identification of Specimens
Reports
Records
Blood Bank Service
Outpatient Samples
HIV
Liaison with Clinicians
Technician's Motivation
Cross-training of Technicians
Laboratory Waste Disposal
Optimal Utilisation of Laboratory Service
QUALITY CONTROL
Medicolegal Issues and Insurance
Accreditation
CHAPTER 15:
Operation Theatre Suite
INTRODUCTION
LOCATION
NUMBER OF OPERATING ROOMS
Time Utilisation Study
OPERATING ROOM ACCOMMODATION
SCHEDULE OF FACILITIES IN THE OT SUITE
Major Equipment and Appliances
Minor OT
ZONING
Criteria for Zoning
General Principles
Sterile Zone
Clean Zone
Protective Zone
Disposal Zone
FUNCTIONAL INTERRELATIONSHIP OF ROOMS
Scrub-up
Anaesthesia Room
Substerilising Room
Anaesthesia Equipment Room
Darkroom
Fracture Room
Locker and Changing Room
Instrument Stores
Trolley Parking
Cleaner's Closet
Viewing Gallery
Recovery Room
OT Supervisor's Room
LIGHTING, ELECTRICAL AND AIR-CONDITIONING
Lighting
Electrical Outlets
Air-Conditioning in OT Suite
Air Intake
Airflow
FLOORING, CEILING AND FINISHES
Flooring
Ceiling
Wall Finishes and Colour
Wall Finishing
Colour
POLICIES AND PROCEDURES
Safety Hazards
Emergency Equipment
Protection of Patients
Bacteriological Practices
Recovery Room
CHAPTER 16:
Pharmacy
INTRODUCTION
FUNCTIONS OF THE PHARMACY
Responsibilities of Chief Pharmacist
DRUGS AND THERAPEUTICS COMMITTEE
Composition of Drugs and Therapeutics Committee
NEED FOR A HOSPITAL FORMULARY
Guiding Factors in Preparation of Hospital Formulary
INVENTORY MANAGEMENT
Purchase
Size of Inventory
Turnover
Storage Facility
Stock Location System
Issues
Outpatient Prescriptions
Wards
Emergency Drugs
QUALITY
CHARGES FOR DRUGS
Part-inclusive Rate
Cost Plus a given Percentage
Cost Related to Maximum Retail Price (MRP)
For Items Prepared by Pharmacy
PHYSICAL FACILITIES
Arrangement of Shelves and Cabinet
Communication
Equipments
STAFFING
DRUG INFORMATION CENTRE
MANUFACTURING
MANAGEMENT INFORMATIONAND REPORTING
CHAPTER 17:
Central Sterile Supply Department (CSSD)
INTRODUCTION
Functions of CSSD
Location
Space
Physical Facilities
Staffing
Equipment
Ultrasonic Cleaner
POLICIES AND PROCEDURES
Responsibility
Disposables
Segregation of Sterile and Unsterile Supplies
Standardisations of Packs
Packing Procedures
Manual of Operations
Packing Material
AUTOCLAVING
Quality Control: Sterilisation Checks
Sterility Indicators
Shelf-life
Chemical Sterilisation by Ethylene Oxide
Sterilisation Process
CSSD Distribution System
SECTION FIVE: ADMINISTRATIVE SERVICES
CHAPTER 18:
Medical Records
INTRODUCTION
Patient's Needs
Physicians Needs
Institution's Needs
Health Authorities’ Needs
Historical Background
Medical Record: Definition
Characteristics of Good Medical Records
Forms
Major Functions of Medical Records Department
Outpatient Record
Filing
Numbering
Medicolegal Records
Incomplete Records
Medical Records Committee
Retention of Records
Computerisation of Medical Records
Census and Discharge Analysis
Assembling of Records and Deficiency Check
Patient Index
Coding
Indexing (Diagnostic)
Filing
Group Study
Vital and Health Statistics
Compilation of General Health Statistics
Correspondence
CHAPTER 19:
Hospital Infection
INTRODUCTION
EXTENT OF THE PROBLEM
HOW INFECTION PERPETUATES
Source of Infection
The Agent
Routes of Spread of Infection
MANIFESTATIONS OF HOSPITAL INFECTION
HIGH-RISK AREAS IN HOSPITAL
HOSPITAL INFECTIONCONTROL PROGRAMME
Basic Elements of a Control Programme
Infection Control Committee (ICC)
Members
Role and Functions of ICC
Role of Hospital Laboratory
SURVEILLANCE
Infection Control Nurse
Tasks of Infection Control Nurse
EFFECTIVE CONTROL MEASURES
People
Aseptic Techniques
Segregation of Contaminated Instruments
Disinfection Practices
Sterilisation Practices
Isolation Facilities
Antibiotic Policy
Precautions for Staff
Outpatient Department
Dietary Service
Careful Handling of Soiled Linen
Good Housekeeping
Terminal Disinfection
Air Hygiene in Operation Theatres
Developing a Sense of Awareness
INFECTION CONTROL INRELATION TO HIV AND AIDS
AIDS and Disinfection
Disinfection of Hands
Disinfection of Instruments
SUMMARY OF PRECAUTIONS FOR PREVENTION OF SPREAD OFHIV/AIDS INFECTION
CHAPTER 20:
Hospital Utilisation Statistics
HOSPITAL UTILISATION STATISTICS
COMMUNITY INDICES
Bed:Population Ratio
Hospital Admission Rate
Per Capita Hospitalisation rate
HOSPITAL UTILISATION INDICES (QUANTITATIVE STATISTICS)
Definitions
Hospital Bed
Bed Complement
Admission
Discharge
Hospital Death
Dead Bed Space
Daily Ward Census (Medical Census)
Bed Days or Patient Days
Utilisation Indices
Average Daily Census or Average Daily Bed Occupancy
Bed Occupancy Rate (BOR)
Bed Turnover Rate (BTR)
Bed Turnover Interval (BTI)
Average Length of Stay (ALS)
OUTPATIENTS AND OTHER SERVICES UTILISATION STATISTICS5
Outpatient Services
Surgical Services
Laboratory Services
Imaging Services
ECG and EEG
MORBIDITY STATISTICS
MORTALITY STATISTICS
Other Statistics
CHAPTER 21:
Materials Management
ORGANISATION
Separate Stores and Purchase Departments
Integrated Stores Purchase Department
MATERIALS MANAGEMENT PROCESS
DEMAND, FORECASTING AND PLANNING
PURCHASING
Purchasing Procedure
Value Analysis
Rate Contracts
Purchase Order
Effective Purchasing
RECEIPT, INSPECTION AND STORAGE
Receipt and Inspection
Stores
Layout of Stores
Using an Effective Stock Location Method
Stock Turnover
Stock Verification
Bin Card
INVENTORY CONTROL
ABC Analysis
VED Analysis and Other Classifications
Economic Order Quantity
Ordering Cost
Inventory Carrying Cost
The EOQ Formula
Factors which Influence Order Quantities
Ordering Systems
Stock Turnover
ISSUE/DISTRIBUTION
DISPOSAL/CONDEMNATION
MINIMISING LOSS AND PILFERAGE
Effectiveness of the Materials Management Department
CHAPTER 22:
Marketing of Health Services
OVERVIEW
MEANING AND SCOPE OF MARKETING
Some common points emerge from these definitions. These are:
MARKETING ELEMENTS AND MARKETING MIX
MARKET SEGMENTATION
DISTINCTIVE NATURE AND CHARACTERISTICS OF SERVICES
Definition of Services
Special Characteristics of Services
Intangibility
Heterogeneity
Inseparability of Production and Consumption
Perishability
THE EXPANDED MARKETING-MIX OF SERVICES
Service Mix : Health care
UNDERSTANDING THE MARKETING PROFILE
Potential Market
The Changing Environment
Pricing Practices
Advertising
Competition
Market Research
Service Quality Dimensions
MARKETING IMPLICATIONS OF THE DISTINCTIVE CHARACTERISTICS OF SERVICES
MARKETING TARGETS
Patients
Physicians
Corporate Employers and Third Party Payers
Employees of Health Care Organisation
Customer Contact Staff
ORGANISATION FOR MARKETING
Marketing Function and Marketing Department
Internal Marketing
OUTSIDE MARKETING CONSULTANT versus THE IN-HOUSE MARKETING TEAM
MARKETING INFORMATION AND MARKET RESEARCH
Marketing Information
Market Research
Market Research Questions
MARKETING PROMOTION
What is Promotion?
The Promotion-Mix
Advertising
Advertising Strategies and Channels
Publicity
Personal Selling
Word-of-Mouth Communication
Sales Promotion
Public Relations
CONCLUSION
CHAPTER 23:
Evaluation of Hospital Services
WHY EVALUATION?
What is Evaluation?
What to Evaluate?
Evaluation of the “Means”
Evaluation of the “Methods”
Evaluation of the “End-results”
Difficulty with Outputs
STEPS IN EVALUATION
Step-I: Definition of the Purpose and Scope of Evaluation
Step-II: Detailed Description of the Hospital System and Its Operation
Step-III: Determination of Indices and Criteria for Measuring the Achievement of Objectives
Step-IV: Preparing and Execution of Evaluation
Step-V: Reporting the Results of Evaluation
External Evaluation or Internal?
FACTORS WHICH INFLUENCEHOSPITAL SERVICES
1. The Hospital Staff
2. Physical Facilities and Equipment
3. Clinical and Service Facilities
4. Load of Work
5. Effective Use of Beds
6. Hospital Administration
ORGANISATION
Organisational Structure
Facilities
Human Resources
Medical Staff
Nursing and Technical Paramedical Staff
Services Provided
Quality
Quantity
Cost
Utilisation
Utilisation of Inpatient Facilities
Utilisation of Outpatient Facilities
Utilisation of Supportive Services
Consumer Satisfaction
Gross Results, Complications, Hospital Infection Rate
Gross Results
Complications
Hospital Infection Rate
INDIVIDUAL CLINICAL ANDSUPPORTIVE SERVICES
Medical Services
Surgical Services
Obstetrical Services
Anaesthesiology Services
Laboratory Services
Paediatric Services
Radiology Services
Outpatient Department
Physiotherapy and Rehabilitation
Nursing Services
Communicable Diseases
TOOLS OF EVALUATION
Evaluation of “Care” Services and Patient Welfare
Evaluation of Management Services and Use of Resources
The Tools of Evaluation
Inspections
Reports and Returns (MIS)
Statistical Quality Control
Professional Reviews
Social Surveys
Cost Studies
Medical Audit/Comprehensive Quality Assurance Programme
CONCLUSION
SECTION SIX: FUNCTIONAL HOSPITAL ORGANISATION
CHAPTER 24:
Hospital Linen and Laundry Service
OVERVIEW
HOSPITAL LAUNDRY VIS-A-VIS COMMERCIAL LAUNDRY SERVICE
LINEN CLASSIFICATION
LINEN REQUIREMENT FOR HOSPITALS
Norms for Linen per Bed (Bed Linen and Patient Linen)
Classification of Linen for Laundering Purpose
CENTRAL LINEN ROOM
LAUNDRY EQUIPMENT
Washing Machines/Washers
Hydroextractor (Fig. 24.3)
Washer-cum-Extractor (Fig. 24.4)
Dryer or Trumbler
Sluicing Machine
Flatwork Ironer or Calendar
Presses
HARD WATER
OPERATIONAL MANAGEMENT
Laundry Manager
Equipment
PREVENTIVE MAINTENANCE
Siting of Machines
Schematic Layout of Laundry
Soiled Linen Room
Containers for Infected Linen
LAUNDRY EFFICIENCY
Performance Figures, Work Load per Worker
Staff
Water and Steam
Laundering Cost
Disposable Items
Linen Distribution System
The Role of Laundry Manager
CHAPTER 25:
Disposal of Hospital Waste
TYPES OF WASTE
CHARACTERISTICS OF A GOOD WASTE DISPOSAL SYSTEM
COLLECTION AND REMOVAL
DISPOSAL
GENERAL CLASSIFICATION OF WASTE
Type 0 Waste: Trash
Type 1 Waste: Rubbish
Type 2 Waste: Refuse
Type 3 Waste: Garbage
Type 4 Waste: Pathological
Type 5 and 6 Wastes: Industrial Operations
BIOMEDICAL WASTE RULES—1998
Salient Points of Biomedical Waste Rules
Thermal Treatment and Incineration
COLOUR CODING OF CONTAINERS
THERMAL TREATMENT TECHNOLOGY
1. Autoclaving
2. Microwaving
3. Incineration
Choice of Technology
SEWAGE DISPOSAL
CHAPTER 26:
Public Relations in Hospitals
INTRODUCTION
PUBLIC RELATIONS SPRING FROM HUMAN RELATIONS
BASE OF A GOOD IMAGE
Operative Methods
Communicative Methods
Indicators for Measuring Public Relations
Public Relations Officer
ADDITIONAL IMPORTANT CONSIDERATIONS
Communication to the Press
Medical Information and Information Regarding Patients
Nursing Services
Role of Women's Voluntary Organisation
CONCLUSION
CHAPTER 27:
Ethical and Legal Aspects of Hospital Administration
INTRODUCTION
GENERAL ACTS/LEGISLATIONSAPPLICABLE TO HOSPITALS
Industrial Disputes Act, 1948
Minimum Wages Act, 1948
Employees Provident Fund Act
Payment of Bonus Act, 1956
Payment of Gratuity Act, 1972
Payment of Wages Act, 1936
Employees State Insurance Act, 1948
MEDICAL/PROFESSIONAL ACTS APPLICABLE TO HOSPITALS
Indian Medical Council Act, 1933
Indian Nursing Council Act, 1947
The Pharmacy Act, 1948
Births and Deaths and Marriages Registration Act
Miscellaneous Acts Applicable to Hospitals
Societies Registration Act, 1860
State Public Charitable Trust Acts
Acts in Relation to Establishment of Hospitals or Nursing Homes
Shops and Establishment Acts
LAW OF TORTS
Various Examples of Major Torts as follows
CONSUMER PROTECTION ACT (CPA)
A Primer on Consumer Protection Act
Consumer
Deficiency
Service
Time Limitation
Consumer Disputes Redressal Levels
Powers of Redressal Forum
Epilogue
Patients’ Bill of Rights
SUMMARY OF THE INDIAN MEDICAL COUNCIL'S LIST OF OFFENCES AND PROFESSIONAL MISCONDUCT
HOSPITAL'S RESPONSIBILITIES
Consent for Medical Examination, Treatment and Autopsy
The Medical Service
Refusal of Treatment
Defective Equipment
Negligent Monitoring
Observation of Patients
Drug Handling
Drug Trials
Negligent Supervision
Physical Facilities
Hospital Infection
Blood Bank Service
Unlawful Detention
Invasion of Privacy
Anaesthesia
Operating Room Procedure
Disclosing of Information to Patients
Terminal Illness
Withholding of Life Support in the Critically Ill
Euthanasia
Dying Declaration
Medical Records
Right to Life, Sex Determination and Abortion
PROFESSIONAL NEGLIGENCE
Reasonable Skill
Reasonable Care
The Law of Negligence
Causing Death by Negligence
Criminal Rashness
Criminal Negligence
Civil Negligence
Contributory Negligence
Legal Position
Valid Consent for Surgery
Assault and Battery
In Emergency or Life-threatening Situation, Do Not Wait for Consent
Respondent Superior and Vicarious Liability
Doctrine of Deucistecum
MEDICAL INDEMNITY INSURANCE AGAINST MALPRACTICE SUITS
CHAPTER 28:
Disaster Management
PHASES OF A DISASTER
1. Predisaster Phase
2. Alert Phase
3. Impact Phase
4. Postimpact Phase
GENERAL CONSIDERATIONS
SORTING OUT CASUALTIES IN A DISASTER SITUATION: THE CONCEPT OF TRIAGE
TRIAGE AT SITE OF DISASTER
Medical Command Post
ORGANISATION OF DISASTER MANAGEMENT AT THE HOSPITAL
Forming a Disaster Management Committee
Preparing a Disaster Plan
DISASTER ORGANISATION
Headquarters
Issuing the Disaster Alert
Activation of Disaster Plan
Reception of Casualties
Tasks at the Reception
Minimum Documentation
Triage at the Hospital
Patient Holding Areas and Allocation of Patients
Patient Turnover
Communication Systems
Medical Supplies
Classification of Stores
Blood Bank
Physical Plant
Emergency Mortuary
Traffic Control
Volunteers
Public Relations
CONCLUSION
CHECK-LIST
CHAPTER 29:
Quality Assurance through Record Review and Medical Audit
A REVIEW OF THE PROCESS, CONTENT AND OUTCOME
Theory and Practice
Purpose of Quality Assurance
Quality Assurance and Costs
PROFESSIONAL REVIEW OR CLINICAL AUDIT
Method
Concurrent or on-the-spot Audit
The Retrospective Audit
Choosing Appropriate Criteria and Standards
Establishing Criteria for Diagnosis, Investigations and Treatment
Some Standards and Criteria
Focus Group
External or Internal
Quality Assurance Committee (QAC)
Mechanics of the Review
THE COMPREHENSIVE QUALITY ASSURANCES SYSTEM (CQAS)
TOTAL QUALITY MANAGEMENT (TQM)
What is Total Quality in Health Care?
Quality Improvement Project [QIP]
Step 1: Identification of the Problem, and Need to Improve
Step 2: Remedical Action
Retrospective Reviews and Medical Audit can be Quite Simple
CONCLUSION
APPENDICES
APPENDIX I:
Significance of the Aesculapaeus' Rod and the Snakes in Medical Emblem
APPENDIX II:
Schedules of Accommodation
APPENDIX III:
Classification of Various Service Areas and Departments in a Hospital
Clinical Service
Clinical Supportive Services
Clinicoadministrative Departments
Administrative Departments
APPENDIX IV:
Recommendation of the Workshop on Medical Records
APPENDIX V:
Salient Points of Biomedical Waste Rules
SCHEDULE I
SCHEDULE II
SCHEDULE III
SCHEDULE IV
APPENDIX VI:
Medical Audit
SUNRISE HOSPITALMEDICAL AUDIT: CHART REVIEW
Part—I
Part—II
Part—III
Relating to the Records
Relating to Diagnosis
Relating to Treatment
Relating to End Result
Relating to Complications and Cross-infection
Relating to Operation Cases
Relating to the Length of Stay of Patient
APPENDIX VII:
Check-list for Preparation of a Disaster Plan
INDEX
TOC
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