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Hospital Administration
DC Joshi, Mamta Joshi
SECTION ONE: INTRODUCTION TO HOSPITAL ADMINISTRATION
CHAPTER 1:
Hospital Administration—the Beginning
FLORENCE NIGHTINGALE(1820–1910)
CHAPTER 2:
Hospital Administration—Introduction
HOSPITAL ADMINISTRATION CAN HAVE DIFFERENT MEANINGS
DEFINITION
ROLES OF HOSPITAL ADMINISTRATORS
A. General Roles
B. Specific Roles
1. Role Towards Patients
2. Role Towards Hospital Organization
i. Strategic Planning
ii. Environmental Influence on the Hospital
iii. Operational Management
iv. Management of Hospital Staff
v. Materials Management
vi. Financial Management
vii. Hospital Information
viii. Communication
ix. Public Relation
x. Risk Management
xi. Law, Ethics and Code of Conduct
xii. Marketing of Health Services
xiii. Quality Management
3. Role Towards Community
Skills of Hospital Administrator
FUNCTIONS OF MANAGEMENT
Principles of Scientific Management
PRINCIPLES OF MANAGEMENT
Gang Plank
CHAPTER 3:
Rationale of Hospital Administration
CHALLENGES OF THE HOSPITAL
LINKAGE FUNCTIONS OF THE HOSPITAL ADMINISTRATOR
HOSPITAL ORGANIZATION AND MANAGEMENT MODEL
TYPES OF HOSPITAL ADMINISTRATORS
Professional Bodies
MANAGEMENT APPROACH IN HOSPITAL VS INDUSTRIES
Management Process in General
COMPARATIVE ASSESSMENT OF MANAGEMENT PROCESS BETWEEN HOSPITALS ANDPRODUCTION INDUSTRY
CHAPTER 4:
Role of Hospitals
ROLE OF HOSPITALS
Care of the Sick
Role of Hospital in Primary Care
Surveillance Centre
Continuing Care of Patients
Rehabilitation
Education and Training
Research
Medical Tourism
Contractual System in Hospitals
Productivity
Telemedicine
CHAPTER 5:
Evolution of Hospitals
EVOLUTION OF HOSPITALS
HISTORY OF HOSPITALS
Early History
Ancient Asia
Modern Era
Period of Growth
Consolidation (1920–1950)
Hospitals after Independence
Changing Concepts of Hospitals
Review of Status of Present Hospitals
CHAPTER 6:
Types and Classification of Hospitals
TYPES AND CLASSIFICATION OF HOSPITALS
According to Ownership and Control
According to Directory of Hospitals
According to Systems of Medicine
According to Size of Hospital
According to Clinical Basis
According to Level of Care
According to Teaching Facilities
Based Upon Accreditation
Based Upon the Gender
According to Length of Stay
CHAPTER 7:
Problem Solving in Hospital
PROBLEM SOLVING IN HOSPITALS
MANAGEMENT PROCESS APPROACH
STEPS IN PROBLEM SOLVING
APPROACHES TO PROBLEM SOLVING
Routine Approach
Scientific Approach
Decisional Approach
Creative Approach
Quantitative Approach
CHAPTER 8:
Hospital Statistics
HOSPITAL STATISTICS
Data
Information
Intelligence
TOOLS OF MEASUREMENTS
Rate
Ratio
Proportion
MEASURES OF CENTRAL TENDENCY
Requisite of Measures
Arithmetic Mean
Merit of Mean
Demerit of Mean
Median
Merits
Demerits
Mode
Measures of Dispersion
Standard Error (SE)
TESTS OF SIGNIFICANCE
NULL HYPOTHESIS
STANDARD ERROR OF THE MEAN
Standard Error of Mean
STANDARD ERROR OF DIFFERENCE BETWEEN TWO MEANS
‘t’ Test
STANDARD ERROR OF PROPORTION
STANDARD ERROR OF DIFFERENCE BETWEEN TWO PROPORTIONS
CH-SQUARE χ2 TEST
Steps in Testing the Hypothesis
CORRELATION AND REGRESSION
Correlation Analysis
Regression Model
Reports Related to Hospital Beds
Report Related to Admission/Discharge/Death
Work Load Statistics
Hospital Care Evaluation Statistics
Admission/Discharge of Patient in Hospital
Admission
Discharge
Bed Complement
HOSPITAL UTILIZATION STATISTICS
Bed Turn Over Interval
Death Rates
DEVELOPMENT OF HOSPITAL INFORMATION SYSTEM (HIS)
Standards of Structure
Standards of Process
Standards of Outcome
CHAPTER 9:
Research in Hospital Administration
TYPES OF RESEARCH
PURPOSE OF RESEARCH IN HOSPITAL
PREREQUISITES TO CONDUCT RESEARCH
STEPS IN CONDUCTING THE RESEARCH
Data Collection
Analysis and Interpretation of Data
Discussion
Verification of Hypothesis
Conclusion
Summary
Writing the Report
Purpose of Report Writing
Dissemination of Report
Documentation
Format for the Publication of Articles
Title Page
Summary and Key Words
Introduction
Materials and Methods
Results
DISCUSSION
ACKNOWLEDGEMENTS
TABLES AND FIGURES
FORMAT FOR REPORT WRITING
AREAS OF INTEREST IN HOSPITAL ADMINISTRATION
CHAPTER 10:
Legal Aspects of Hospital Administration
LAW
ETHICS
CODE OF MEDICAL ETHICS (MEDICAL COUNCIL OF INDIA)
Declaration
Duties and Responsibilities of the Physician in General
Character of Physician
Maintaining Good Medical Practice
Maintenance of Medical Records
Display of Registration Numbers
Highest Quality Assurance in Patient Care
Exposure of Unethical Conduct
Payment of Professional Services
Evasion of Legal Restrictions
Medicolegal Case
Duties and Responsibilities of the Doctor
Consent
Professional Secrets
Privileged Communication
Consumer Protection Act
Consumer Protection Council
Organization of Consumer Redressal Agencies
DEFINITIONS
Complaint
Complainant
Consumer
Consideration
Service
Deficiency
Consumer Dispute
Medical Negligence
Defect
OTHER ACTS RELEVANT TO HOSPITALS
Statutory Law
Judgment Law
LAW OF TORTS
Refusal of Treatment
CHAPTER 11:
Role of Hospitals in New Millennium
SECTION TWO: INTRODUCTION TO MANAGEMENT
CHAPTER 12:
Approaches to Management
EMPIRICAL OR CASE APPROACH
INTERPERSONAL BEHAVIOR APPROACH
GROUP BEHAVIOR APPROACH
COOPERATIVE SOCIAL SYSTEM APPROACH
SOCIO-TECHNICAL SYSTEM APPROACH
DECISION THEORY APPROACH
SYSTEMS APPROACH
MATHEMATICAL OR MANAGEMENT SCIENCE APPROACH
CONTINGENCY OR SITUATIONAL APPROACH
MANAGERIAL ROLES APPROACH
McKINSEY'S 7-S APPROACH
OPERATIONAL APPROACH
CHAPTER 13:
Planning
TYPES OF PLANS
HIERARCHY OF PLANS3
Purpose or Mission
Objectives
Strategies
Policies
Procedures
Rules
Programs
Budgets
IMPORTANCE OF PLANNING
Primacy of Planning
To Offset Uncertainty and Change
To Focus Attention on Objectives
To Help in Coordination
To Help in Control
To Increase Effectiveness
STEPS IN PLANNING
Perception of Opportunities
Establishing Objectives
Considering Planning Premises
Identification of Alternatives
Evaluation of Alternatives
Choice of Alternative
Formulation of Supporting Plan
Budgeting
OBJECTIVES
HIERARCHY OF THE OBJECTIVES
MANAGEMENT BY OBJECTIVES
SYSTEMS APPROACH TO MBO
THE PROCESS OF MBO
STEPS IN PROCESS OF MBO
BENEFITS OF MBO
LIMITATIONS OF MBO
PREREQUISITES FOR INSTALLING MBO PROGRAM
CHAPTER 14:
Decision Making
TYPES OF DECISIONS
STEPS IN PROBLEM SOLVING AND DECISION MAKING
FACTORS INFLUENCING DECISION MAKING
QUANTITATIVE BASIS OF DECISION MAKING
STEPS INVOLVED IN PREPARATION OF THE PERT
Construction of a Network
CHAPTER 15:
Organizing
IDENTIFICATION OF THE ACTIVITIES
GROUPING OF THE SIMILAR ACTIVITIES
ASSIGNMENT OF AUTHORITY AND RESPONSIBILITY TO EACH GROUP
PROVISION FOR COORDINATION
TYPES OF ORGANIZATIONS
Departmentation
Span of Control (Figs 15.2 and 15.3)
CENTRALIZATION AND DECENTRALIZATION
ADVANTAGES AND LIMITATIONS OF DECENTRALIZATION
Advantages
Limitations
AUTHORITY AND POWER
Line and Staff Authority Concept
Line Staff Relationship
Functional Authority
Delegation of Functional Authority
HOSPITAL ORGANIZATION (FIGS 15.5 AND 15.6)
ORGANIZATIONAL DEVELOPMENT
The Role of OD
Process of OD
Techniques of Organizational Develpment (OD) (Fig. 15.7)
CHAPTER 16:
Staffing
SYSTEM APPROACH OF STAFFING
RECRUITMENT
Job Description and Job Specification
Sources of Recruitment
Selection
CHAPTER 17:
Job Designing
JOB DESIGNING
Skills Needed by Managers
Job Enrichment
Job Enlargement
CHAPTER 18:
Directing
IMPORTANCE OF DIRECTING
PRINCIPLES OF DIRECTING
HUMAN FACTORS IN DIRECTING
Theory X and Theory Y
CHAPTER 19:
Motivating
MOTIVATION
Reaction to Non-satisfaction of Needs
Motivation
Theories of Motivation
CHAPTER 20:
Leadership
TYPES OF POWER
Authority and Power
Techniques for Influencing
Traits of Effective Leaders
Skills of Effective Leaders
Leadership Styles
CHAPTER 21:
Communication
STEPS IN COMMUNICATION PROCESS (FIG. 21.2)
TYPES OF COMMUNICATION IN THE ORGANIZATION
DIRECTION OF THE COMMUNICATION
BARRIERS TO COMMUNICATION
Effective Communication
CHAPTER 22:
Controlling
STEPS IN CONTROLLING
TIME ELEMENTS IN CONTROLLING
TYPES OF CONTROLLING TECHNIQUES
CHAPTER 23:
Organizational Behavior
CONTRIBUTIONS IN THE FIELD OF OB
Frederick Winslow Taylor (1856–1915)
Elton Mayo (1931)
Mary Parker Follett
Douglas McGregor
OB DISCIPLINE
DEVELOPMENT OF OB MODEL
The Dependent Variables
The Independent Variables
The Individual Level in OB Model
Group Level in the OB Level
Organization System Level Variables
CHAPTER 24:
Materials Management
DEFINITIONS OF MATERIALS MANAGEMENT
Costs on Material
Cost of Material (Fig. 24.2)
Responsibility of Materials Management
Systems Approach to Materials Management
Materials Represent Money
Functions of Materials Management
Aims of Materials Management
Objectives of Materials Management
Primary Objectives
Secondary Objectives
Elements of Materials Management
Material Management System
ADVANTAGES OF MATERIAL MANAGEMENT
PURCHASING
Principles of Purchasing
Objectives of Purchasing
Responsibilities
Types of Purchasing
Advantages
Disadvantages
Advantages
Disadvantages
Purchase Policy
Supplier Selection
Purchase Procedure
THE PURCHASING CYCLE
Recognition of Need
Requisition
Authority to Purchase
Authorization for Purchases
Purchase Plan
Supplier's Selection
Purchase Order
Supplier's Acceptance
Follow Up
Receiving and Inspection
Verification and Payment of Bills
MATERIAL PLANNING AND BUDGETING
Techniques
Guidelines
Budgeting
STATISTICAL BASIS FOR DEMAND ESTIMATION
Probability and its Role
Consumption Control
Normal Distribution
Measures of Central Tendency
Requirements of Good Average
Mean
Mode
Median
Standard Deviation
Poisson Distribution
Control by Consumption Norms
FORECASTING
Concept of Forecasting
Steps in Forecasting
Methods of Forecasting
Business Barometer
Time Series Analysis
Extrapolation
Visionary Forecast
Panel Consensus
Market Research
Delphi Method
Moving Average Method
Exponential Smoothing
Input Output/Diffusion Index
Correlation Analysis
Regression Model
Econometric Model
Opinion Poll
Causal Model
RECEIVING AND INSPECTION OF STORES
Indenting of Stores
TENDER SYSTEM
EVALUATION OF TENDERS
ECONOMIC ORDER QUANTITY
Economic Order Quantity
STOCKING AND DISTRIBUTION
DRUG STORAGE
Proper Drug Storage
Arrangement of Drugs on Shelves
The Storeroom
DISTRIBUTION SYSTEM IN HOSPITALS
INVENTORY CONTROL
Official Inventory
Unofficial Inventory
Terminology Used in Inventory Control
Inventory Analysis
Overall Analysis
Category Analysis
Selective Inventory Control
Steps
JUST IN TIME(JIT) TECHNIQUE
EVALUATION OF INVENTORY PERFORMANCE
VALUE ANALYSIS
Benefits of Value Analysis
CONDEMNATION AND DISPOSAL
CHAPTER 25:
Financial Management in Health Care
DEFINITION OF ACCOUNTING
OBJECTIVES OF ACCOUNTING
THE ACCOUNTING PROCESS
THE ACCOUNTING PRINCIPLES
ACCOUNTING CONCEPTS
Separate Entity Concept
Going Concern Concept
Money Measurement Concept
Cost Concept
Dual Aspect Concept
Accounting Period Concept
Period Matching of Cost and Revenue Concept
Realisation Concept
ACCOUNTING CONVENTIONS
Conservatism
Full Disclosure
Consistency
Materiality
Types of Accounting Information
CHARACTERISTICS OF ACCOUNTING INFORMATION
Understandability
Relevance
Consistency
Comparability
Reliability
Objectivity
FINANCIAL V/S MANAGEMENT ACCOUNTING
JOURNALISING TRANSACTIONS
Journal
TYPES OF ACCOUNTS
Ledger
Posting
Relationship between Journal and Ledger
Trial Balance
Balance Sheet
Difference between Trial Balance and Balance Sheet
Costs
Elements of Cost
Overheads
Primary Cost
Classification of Costs
Cost Centre
Profit Centre
Cost Control
Cost Reduction
Cost Audit
Cost Accounting
Functions of Cost Accounting
COST ANALYSIS
Methods of Cost Analysis
Cost Allocation
Cost Benefit Analysis
Step 1: Define the Scope or Perspective of the Analysis
Step 2: Conduct Cost Analysis
Step 3: Estimate Program Effects
Step 4: Estimate the Monetary Value of Outcomes
Step 5: Account for the Effects of Time
Step 6: Aggregate and Apply a Decision Rule
Step 7: Describe Distributional Consequences
Step 8: Conduct Sensitivity Analysis
Step 9: Discuss the Qualitative Residual
Cost Effective Analysis
Cost-Volume Profit Analysis
Budget
Advantages of Budgeting
Types of Budgets
BUDGETING APPROACHES
Incremental Budgets
Performance Budgets
Main Objectives of Performance Budget
Steps in Performance Budgeting
Zero-Base Budgeting (ZBB)
Objectives of Zero Based Budgeting
Steps in Preparation of ZBB
MASTER BUDGET
ROLLING BUDGETS
COMPONENTS OF MASTER BUDGET
Operating Budget
Financial Budget
STEPS IN PREPARING A MASTER BUDGET
Preparation of Budget Manual
Budget Officer
Budget Committee
Budget Period
Budget Calendar
Budget Procedure
Steps in Budget Preparation of Hospital Budget
FINANCIAL CONTROL SYSTEM IN HOSPITALS
Budget
Statistical Analysis and Cost Control
Financial Analysis and Control
Cost Analysis and Control
Financial Reports and Information System
Daily Reports
Monthly Reports
Quarterly Reports
Annual Reports
Cost Containment
CHAPTER 26:
Management Techniques in Hospitals
MANAGEMENT TECHNIQUES
Operations Research
The Characteristics of OR
The Application of OR in Hospitals
The Phases of OR Methods
ECONOMIC ORDER QUANTITY (EOQ)
ABC ANALYSIS
Steps
JUST IN TIME TECHNIQUE (JIT)
DISTRIBUTION LOGISTICS
WAITING LINE MODEL/QUEUING THEORY
TERMINOLOGY IN QUEUING THEORY
Equations
LINEAR PROGRAMMING
Game Theory
Sequencing
Network Analysis—Program Evaluation and Review Technique (PERT)
Construction of a Network
WORK STUDY
The Method Study
The Time Study
Stop Watch Time Study
Predetermined Motion Time Systems/Synthetic Time Standards
Work Sampling
Representative Sample
Example
Value Engineering
Work Simplification
Quality Circle (QC)
CAD/CAM
Zero Base Budgets (ZBB)
Objectives of Zero Based Budgeting
STEPS IN PREPARATION OF ZBB
Formulation of Decision Package
Performance Budgeting
MAIN OBJECTIVES OF PERFORMANCE BUDGET
STEPS IN PERFORMANCE BUDGETING
MBO: (MANAGEMENT BY OBJECTIVES)
SYSTEMS APPROACH TO MBO
THE PROCESS OF MBO
STEPS IN PROCESS OF MBO
Benefits of MBO
LIMITATIONS OF MBO
Prerequisites for Installing MBO Program
SWOT Analysis
Cost Effective Analysis
Cost Benefit Analysis
Step 1: Define the Scope or Perspective of the Analysis
Step 2: Conduct Cost Analysis
Step 3: Estimate Program Effects
Step 4: Estimate the Monetary Value of Outcomes
Step 5: Account for the Effects of Time
Step 6: Aggregate and Apply a Decision Rule
Step 7: Describe Distributional Consequences
Step 8: Conduct Sensitivity Analysis
Step 9: Discuss the Qualitative Residual
FORECASTING
Concept of Forecasting
Steps in Forecasting
Methods of Forecasting
Decision Tree
Break-even Analysis and Break-even Point
CHAPTER 27:
Industrial Relations in Hospitals
ROLE OF HOSPITAL ADMINISTRATION IN LABOR RELATIONS
Formalised Machinery for Bargaining
Collective Bargaining
Trade Union Recognition
Observance of Agreements
Support of Labor Administration Authorities
Good Faith
Proper Internal Communication
Advantages of Collective Bargaining (Fig. 27.2)
SECTION THREE: HOSPITAL PLANNING
CHAPTER 28:
Hospital Planning
DEFINITION OF HOSPITAL
AIMS OF HOSPITAL PLANNING
FACTORS AFFECTING UTILIZATION OF THE HOSPITAL SERVICES
Which Type of Hospital is Required?
According to Ownership and Control
According to Directory of Hospitals
According to Systems of Medicine
According to Size of Hospital
According to Clinical Basis
According to Level of Care
According to Teaching Facilities
Based upon Accreditation
Based upon the Gender
According to Length of Stay
HOSPITAL PLANNING PROCESS
Conceptualization of Hospital
Support Groups
Temporary Organization
Securing Funds
General Assessment of the Situation
Need of the Hospital
Use of Hospital Facility
Feasibility Study Survey of the Community
Community Diagnosis
Morbidity Data
Mortality Data
Environmental Statistics
Demographic Data
Institutional Data
Data on Socioeconomic Status
Data on Other Sectors
Environmental Analysis
Organization of Governing Board
Hospital Consultant
Hospital Architect
Architect Brief
Hospital Zones
Engineers
Hospital Design
Site Selection
Site Survey
Soil Structure
Land Requirement
Size of the Site
Water Requirement
Electricity
Sewage Disposal
SANITARY REQUIREMENTS OF THE HOSPITAL5
General Parameters in Hospital Planning5
Traction System
Fire Protection
APPROVAL OF PLAN BY THE LOCAL AUTHORITIES
HOSPITAL PROJECT
STAGES IN THE HOSPITAL PROJECT
Hospital Project Management
Bed Planning
Direct Encatchment Area
Indirect En-catchment Area
TYPE AND SIZE OF THE HOSPITAL
Circulation
Internal Circulation
External Circulation
Parking
Landscaping and Garden
Space Requirement
Cost Evaluation of Construction of Hospital
GENERAL HOSPITAL COST/BED
Hospital Project Cost
Construction of the Hospital
Hospital Commissioning
Scheduling of the Services
Inauguration of Hospital
Shake-down Period
HOSPITALS OF 21ST CENTURY
SECTION FOUR: CLINICAL SERVICES
CHAPTER 29:
Outpatient Department Services
TYPES OF OPD
THE IMPORTANCE OF OPD
DEMAND
FUNCTIONS OF OPD (FIG. 29.1)
PHYSICAL FACILITIES
LOCATION
LAYOUT OF OPD
SIZE
PATIENT'S AREA
Clinical Areas
Administrative Area
Circulation Area
EQUIPMENTS
STAFFING
POLICIES
PROCEDURE
MANAGERIAL ISSUES (FIG. 29.6)
EVALUATION
CHAPTER 30:
Emergency Services Department
FUNCTIONS OF EMERGENCY DEPARTMENT
TYPES OF EMERGENCY
TYPES OF EMERGENCY SERVICES
PLANNING OF EMERGENCY SERVICES
LOCATION
PHYSICAL FACILITIES
Patient Area
Clinical Area
Administrative Area
Circulation
DESIGNING OF THE EMERGENCY DEPARTMENT
EQUIPMENTS
STAFFING
POLICIES
PROCEDURE
AMBULANCES
RECORD MAINTENANCE
Referral Policy
Medicolegal Case
Disaster Preparedness
Code Blue Procedure
Evaluation of Services
GRIEVANCE REDRESSAL SYSTEM
CHAPTER 31:
Inpatient Department
PROGRESSIVE PATIENT CARE
PLANNING AND DESIGNING OF WARD
FEATURES OF IPD
LOCATION
INTERDEPARTMENTAL RELATIONSHIP
CIRCULATION OF IPD
Arrangement for Vertical Circulation
Arrangement for Horizontal Circulation
SIZE OF THE IPD
FORMS OF WARD
NIGHTINGALE WARD
DISADVANTAGES OF NIGHTINGALE WARD
Modified Nightingale Ward
RIG'S WARD
The Advantages are:
The Disadvantages are:
OTHER TYPES OF WARDS
COMPONENTS OF A NURSING UNIT
Primary Accommodation
SIZE, SPACE AND FACILITIES
Ancillary Accommodation
Nursing Station
Sanitary Accommodation
Water and Electricity Supply
Communication
Air-conditioning
Auxiliary Accommodation
SPECIAL WARDS
Children's Ward
Maternity Ward
Psychiatric Ward
STAFFING
A. Medical
B. Nursing
Nurse Patient Ratio
Nursing Hours Requirement
Norms for Gr. D Staff
Management in the Ward
Ward Management
Objectives
PERSONNEL MANAGEMENT IN THE WARD
Management of Patient Care
Management of Personnel
Coordinating
Counseling
Strategic Management
Operational Management
MONITORING AND EVALUATION
Role of Nursing Service
NURSING NEEDS OF THE PATIENTS
Function of the Nursing care Services of the Hospital
Factors Influencing In-patient Care (Fig. 31.24)
Medical Audit
NURSING SERVICES
Nursing Activities
NURSING TASKS
Organization of Nursing Services
Nursing Superintendent
Qualifications
Line of Authority
Duties and Responsibilities
Planning, Organizing and Control of Services in Hospital
General Administration
Miscellaneous
Assistant Nursing Superintendents
Qualification
Line Authority
Duties and Responsibilities
Job Description of Sister
Roles
A. Clinical Activities
B. Supervisory Activities
C. Administrative Activities
D. Educative Activities
JOB DESCRIPTION OF STAFF NURSE
Qualification
Job Specification
Administrative
Nursing Care
Teaching
Staffing Pattern of Nurses
The Master Staffing Pattern
Shortage and Turnover
Ward Management and Nursing Care
Definition of Nursing Care
Nursing Service Department
Housekeeping Services
NURSING CARE METHODS
Functional Method
Patient/Case Method
The Team Method
POLICY AND PROCEDURES
Policy
Procedures
MANAGERIAL ISSUES
Actions for Ward Management (Fig. 31.30)
Nursing Audit
CHAPTER 32:
The Operation Theater
THE OPERATION THEATER (OT)
Aims of Planning
Criteria for Planning
PHYSICAL FACILITIES
Location
Orientation
Number of Operation Theaters
Number of Operating Suites and Hospital Beds
No. of OT Required
Grouping of OT
Advantage of Grouping of OT
Decision Criteria
Size of the Operating Room
Zoning of OT
ENGINEERING SPECIFICATIONS OF OT8
Design of Operating Suites with Circulation Area (Figs 32.2 to 32.6)
ESSENTIAL PHYSICAL REQUIREMENTS OF SURGICAL OPERATING ROOM
Space Requirement
Modular Operating Theater
Staffing of OT
Staffing of OT in a District Hospital (201–300 beds)9
Equipments of OT
POLICIES AND PROCEDURES
Administration of the OT
OT Scheduling
Punctuality
Training of Staff
Operating List
Dirty Cases
MONITORING OF OT ASEPSIS
Fogging
CHAPTER 33:
Intensive Care Unit
INTENSIVE CARE UNIT (ICU)
FUNCTIONS OF ICU
CRITERIA FOR SELECTION OF PATIENT
TYPES OF ICU
PHYSICAL FACILITIES (Figs 33.2 and 33.3)
OTHER SERVICES REQUIRED FOR ICU
Inside the ICU
Outside the ICU
Staffing
Intensive Care Unit Staff Requirement
EQUIPMENT
POLICIES and PROCEDURES
Admission / Discharge Policy of ICU
Quality Assurance Policy of the ICU
CHAPTER 34:
Physical Medicine and Rehabilitation (PMR) Services
PHYSICAL MEDICINE AND REHABILITATION (PMR) SERVICES
Impairment
Disability
Handicaps
Objectives
Approaches of Rehabilitation
Physical Facilities of Department
Location
Space Requirements
EQUIPMENTS
Essential Equipments
Physiotherapy
Occupational Therapy
Ortho Prosthetic, Workshop Equipments
Desirable Equipments
Physio-occupational Therapy
Ortho prosth. Workshop Equipments
High-tech Equipments
Another Criteria of Classifying the Equipments
Staffing
Managerial Issues
SECTION FIVE: DIAGNOSTIC AND THERAPEUTIC SERVICES
CHAPTER 35:
Laboratory Services
LABORATORY SERVICES
TYPES OF LABORATORIES
Components of Laboratory
Organization of Pathology Laboratory
Regional Laboratory
Location and Space
Staffing
Intermediate Hospital Laboratory
Engineering Specification
Staffing
Criteria
Equipments and Reagents
QUALITY ASSURANCE PROGRAM IN THE LABORATORY
Quality Control
Quality Assurance
Quality Control Policy
Quality Control for Qualitative Tests
Quality Control for Quantitative Tests
QUALITY CONTROL TECHNIQUES
Types of Quality Control Procedures
Internal Quality Control
Statistical Quality Control (SQC) Techniques
Mean and Range (Standard Deviation) Techniques
Arithmetic Mean
STANDARD DEVIATION (SD)
Coefficient of Variance
External Quality Control
Techniques Used for External QC
Quality Assurance
Accreditation
Why Accreditation?
What are the Processes Involved?
Significance of Accreditation
Benefits of Accreditation
Certifications Granted to Laboratories
National Accreditation Board for Laboratories (NABL)
Total Quality Management
Six-Sigma
Policies and Procedure
CHAPTER 36:
Radiology Services
RADIOLOGY SERVICES
Diagnostic Radiology
Therapeutic Radiology
The Radiological Services
Types of Services
Planning and Organizing of Radiology Department
Physical Facilities
Location
Space Requirement
Administrative Area
General Area
Storage Area
Diagnostic Areas
Film Processing and Distribution Area
Other Area and Facilities
Physical Facilities for Special Equipment and Procedures
Circulation Area
Staffing
Equipments
Different Types of Equipments
Policy and Procedure
Radiotherapy Department
Location of the Department
Structure of Radiotherapy Room
Staffing
Equipments
Policy and Procedure
Nuclear Medicine
Location
Physical Facilities
Staffing
Equipments
Policies and Procedures
CHAPTER 37:
Pharmacy Services
ROLES AND FUNCTIONS OF HOSPITALPHARMACY
PHYSICAL FACILITIES
STAFFING
EQUIPMENT & FURNITURE
HOSPITAL FORMULARY
TYPES OF PHARMACIES
DRUG DISTRIBUTION SYSTEM
POLICY AND PROCEDURES
Managerial Issues Related to Pharmacy
CHAPTER 38:
Transfusion Services
HISTORY OF BLOOD BANK
DEFINITION
Functions of Blood Banks
Level of Blood Banks
PHYSICAL FACILITIES
Location
Physical Facilities and Space
Space Requirements
Staffing
Equipments
Policy and Procedures
Selection of Donor and Bleeding Donor
The donor should have:
Deferral of Donor for Donation of Blood
Other Important Considerations
Phlebotomy
Labeling and Storage of Donor Blood
Tests on Donor Blood
Pretransfusion Testing of the Recipient's Blood
Issue of Blood
MANAGERIAL ISSUES
National Blood Policy
General Guidelines for Blood Transfusion Services
Quality Assurance System
Manpower
Financial Activities
Policy for Outdoor Blood Donation Camps
Policy Regarding Apheresis
Introduction
Guidelines
Plasmapheresis
Introduction
Selection of Donors for Apheresis
Records
Volume of Plasma
Cytapheresis
Selection of Donors
Care of Donors
Records
Organizational Structure
Inventory Control
SUPREME COURT JUDGMENT ANDDIRECTIONS (1996)
Supreme Court Judgment
Supreme Court Directions
Coordination and Control
Blood Components
Indications
Investigations in a Case of Transfusion Reaction
To Overcome Transfusion Reactions the Blood Bank should maintain
The Occupational Hazards & Safety Measures5
Potential Hazard
Possible Solutions
SECTION SIX: SUPPORT AND UTILITY SERVICES
CHAPTER 39:
Medical Records Department
HISTORICAL BACKGROUND (FIG. 39.2)
What is Medical Record?
Purpose and Scope of Medical Record
Medicolegal Importance of Medical Records
Medicolegal Importance
Retention of Medical Records
Retention Period of Medical Records
Functions of Medical Record Department
Processing of Medical Records
Assembling and Deficiency Check Desk
Incomplete Records Control Desk
Coding
Indexing
Storage and Retrieval of Medical Records
Storage
Filing System
Methods of Filing System
Reports and Returns
Reports
Hospital Utilization Statistics
Bed Turn Over Interval
Average Length of Stay
Death Rates
Physical Facilities
Staffing
Additional Staff for Teaching Hospital
Equipments
Managerial Aspects, Policy and Procedures
CHAPTER 40:
Central Sterile Supply Department
CSSD
Historical Development
AIM AND OBJECTIVES
Aim
Objectives
Work Flow of CSSD (Fig. 40.2)
PHYSICAL FACILITIES
Location
Space Requirement
Staffing
Equipments
Automatic Autoclaves
STERILIZATION
Ethylene Oxide Sterilizer (ETO)
Steam Sterilizer (Autoclave)
Dry Heat Sterilizer (Fig. 40.6)
Multi-column Distilled Water Plant and Pure Steam Generators
Medical Washer Disinfectors
Sterilization
Operation
Policy and Procedures
Biological Indicator System
Smart-Read™ EZTest® Biological Indicator Monitoring System
CHAPTER 41:
Linen and Laundry Services
CHAPTER 42:
Dietary Services
TYPES OF FOOD SERVICES
Centralized Dietary Services
Advantages
Disadvantage
Decentralized Dietary Service
Advantages
Disadvantages
PHYSICAL FACILITIES
Location
Space Requirement
Work Flow
Planning consideration
LAYOUT OF DIETARY SERVICES
Receipt and Storage Area
Food Preparation Area
Special Diet Area
Formula Room
Serving Area
Dining Hall
Washing Area
Garbage Disposal
Sanitation
Ventilation
Air Curtains
Lighting
Facility for Workers
Engineering Services
STAFFING
Policies and Procedures
Equipments of Dietary Department
CHAPTER 43:
Hospital Housekeeping Services
HISTORY
FUNCTIONS OF HOUSEKEEPING SERVICES
QUALITIES OF A GOOD HOUSEKEEPER
Types of Housekeeping Services
Housekeeping Activities
CLEANING AGENTS
Criteria for Good Cleaning Agent
Physical Facilities
Organization of Housekeeping Services
Job Description of Housekeeper
Housekeeping Equipment
Recent trend in Housekeeping
CHAPTER 44:
Hospital Engineering Services
BASIC ENGINEERING SERVICES OF A HOSPITAL
Civil Works
Water Supply
Electricity
Supply of Steam
Medical Gases
Functions of the Engineering Service Department
Engineering Services Types
Staffing Pattern
CHAPTER 45:
Hospital Transportation System
TYPES OF AMBULANCES
Motor Vehicle Ambulance
Air Ambulance
Helicopter Ambulance
Ambulance Trains
Centralized Accidents and Trauma Services (CATS)
Report of Rao Committee (1968)
Ambulance Service in Primary Health Care
Role and Function of Ambulances
Utilization of Ambulances
Physical Facilities
Staffing
Scale of Ambulance
Equipments
CHAPTER 46:
Hospital Equipments Management
CHAPTER 47:
Public Relations in Hospital
CHAPTER 48:
Mortuary Services of Hospital
MANAGERIAL ISSUES, POLICY ANDPROCEDURES
SECTION SEVEN: RISK MANAGEMENT
CHAPTER 49:
Hospital Waste Management
CLASSIFICATION OF HOSPITAL WASTE
Categories of Biomedical Waste
Importance of Hospital Waste
The Hospital Waste Management Program
GENERATION AND SEGREGATION OFBIOMEDICAL WASTE
Generation of Waste
Source of Waste
Classification of Waste
Quantity of Waste Generation
Segregation of Waste
COLLECTION AND STORAGE OF WASTE
Color Coding Criteria for Segregation
Storage of Wastes
Characteristics of Wastes Storage Containers
Transportation of Wastes
Types of Transportation
Treatment of Wastes
Chemical Method
COMMON CHEMICALS USED FOR DISINFECTION
Thermal Method
Autoclave
Hydroclave
Microwave
Incinerators
INCINERATION PROCESS
Mechanical Methods
Selection of Technology
DISPOSAL OF WASTES
MANAGERIAL ISSUES, POLICY AND PROCEDURES IN BIOMEDICAL WASTE MANAGEMENT
Possible Solutions
Glass Capillary Tubes
CHAPTER 50:
Nosocomial Infections
DEFINITIONS
Prevalence of Infection
The Most Common Hospital Infections
Epidemiology of the Nosocomial Infection
HOSPITAL INFECTION CONTROL
Hospital Infection Control Committee (HICCOM)
Chairperson
Member Secretary
Members
Functions of HICCOM
Infection Surveillance Team (IST)
HIGH RISK PROCEDURES IN THE HOSPITAL
Injections
Surgical Procedures
Dressing of Wounds
Management of Child Birth
Investigative Procedure
Laboratory Investigations
Dialysis
ROLE OF SERVICE DEPARTMENTS IN THE CONTROL OF HOSPITAL INFECTIONS
Housekeeping Services
Methods and Techniques
Dietary Services
Laundry Services
Decontamination of Blankets
Decontamination of Mattress
CSSD
Security Services
Air Conditioning
Design of Building
Nursing Care
Waste Disposal Program
Antibiotics Policy of Hospital
Universal Precautions
What are these precautions?
CHAPTER 51:
Disaster Management
THE GLOBAL SCENARIO OF DISASTER
CLASSIFICATION OF DISASTERS
Natural Disasters
Man-made Disasters
Phases in the Management of Disasters
Assessment of the Disaster (Fig. 51.7)
Long-term Recovery and Development
Inter-sectoral Coordination
Disaster Management–Course of Action
Principles of Disaster Management
Health Problems Associated with the Disasters
Factors Responsible for Health Hazards due to Disasters
Organization of Medical Relief (Fig. 51.8)
Assessment of Situation
Principles of Mass Casualty Management
Hospital Disaster Plan
Objectives of the Hospital Disaster Plan
Designing of Hospital Disaster Plan
Organising Disaster Facilities
CHAPTER 52:
Hospital Security Services
CHAPTER 53:
Occupational Safety in Hospitals
COMMON OCCUPATIONAL HAZARDS INDIFFERENT AREAS OF THE HOSPITAL
Occupational Hazards in Administrative Office of Hospitals (Fig. 53.2)
Possible Solutions (Fig. 53.3)
Occupational Hazards in CSSD
Exposure to Ethylene Oxide Gas (ETO)
Glutaraldehyde
Contaminated Laundry
Possible Solutions
Other Recommended Good Practices
Radiation Exposure
Blood borne Pathogens
Dietary Services
Fire Hazards
Machine Guarding Potential Hazard
Hazardous Chemicals
Slips / Trips / Falls
Workplace Violence
Sharps and Containers
Laser Plume
Equipment Hazards
Latex Allergy
Heat Stress
Morgue
Workplace Stress
Terrorism
Work Practices and Behaviours
SECTION EIGHT: RECENT ADVANCES IN HOSPITAL ADMINISTRATION
CHAPTER 54:
Contracting in Health Care
THE MODELS OF HEALTH CARE DELIVERY SYSTEMS IN INDIA
Public Sector
Private Sector
Voluntary Health Agencies
National Health Programs
Unregistered Practitioners
At the Level of Resources / Inputs
At the Processing Level
At the Output Level
MODELS OF PUBLIC–PRIVATE PARTNERSHIPS IN HOSPITALS
Key Issues in Contracting
Approaches to Contracting in Health Systems (Fig. 54.4)
CHAPTER 55:
Health Care Financing
HEALTHCARE FINANCING IN INDIA
THE BACKGROUND OF HEALTH CAREFINANCING
Public Health Spending in Some Countries
Role of World Bank and UNDP
Health Care in Plan Priorities
Health in the Classification of Plan Heads
Plan Allocations
Per Capital Expenditure
Concerns and Challenges
Recent Trends
Health Care Financing
RECOMMENDATIONS
CHAPTER 56:
Role of Health Insurance
HISTORY OF HEALTH INSURANCE
STATE OF PUBLIC HEALTH IN INDIA
Health Insurance
Health Insurance Policy
Types of Insurance
Third Party Administrator (TPA)
Services Provided by TPAs
Benefits of TPAs
Disadvantages of TPAs
The Future of TPAs
INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY (IRDA)
Composition of Authority under IRDA Act, 1999
Duties, Powers and Functions of IRDA
List of Insurers in India Participating in Health Insurance
CHAPTER 57:
Quality in Health Care Organizations
ORGANIZATION OF QUALITY MANAGEMENT SYSTEM (QMS) IN HOSPITALS
Organizational Analysis
Training
Development of Quality Manual
Development of Hospital Information System (HIS)
Standards of Structure
Standards of Process
STANDARDS OF OUTCOME
MEDICAL AUDIT
Prerequisites of Medical Audit
Relating to Diagnosis
ISO 9000
What is ISO 9000?
Key Success Factors in Business
Benefits of ISO Certification
For People in the Organization
Customers
Suppliers
THE CONCEPT OF HOSPITAL ACCREDITATION
Global Scenario
Joint Commission on Accreditation of Health Care Organization (JCAHO)
Patient Safety Goals for 2007
ACCREDITATION OF HEALTH CARE ORGANIZATIONS
Accreditation of Hospitals in India
Constitutional Provisions
Issues Related to Health Regulation
Review of Global Experience
Legislation
Hospital Accreditation in India
Initiatives taken by the Ministry of Health & Family Welfare
Recommendations for Accreditations
QUALITY COUNCIL OF INDIA
Vision
Mission
National Accreditation Board for Hospitals and Health Care Providers (NABH)
Outline of NABH Standards
BENEFITS OF ACCREDITATION
Benefits for Patients
Benefits for Hospitals
Benefits for Hospital Staff
Benefits to Paying and Regulatory Bodies
NATIONAL ACCREDITATION BOARD FOR HOSPITALS & HEALTH CARE PROVIDERS (NABH)
Organizational Structure (Fig. 57.7)
Assessment Criteria
Preparing for NABH Accreditation
Accreditation Process (Fig. 57.9)
SIX SIGMA (FIG. 57.12)
DMAIC
DMADV
Process Capability
5-M CHECKLIST
Men
Machine
Material
Method
Measurement
Variance in Quality
Application of “5 S” Technique for Quality Assurance in Housekeeping Services of the Hospital
HL7 Quality Standards
CHAPTER 58:
Effective Media Communication
CHAPTER 59:
Telemedicine
INTRODUCTION
HISTORICAL DEVELOPMENT OF TELEMEDICINE
Technology
TRANSMISSION TECHNOLOGIES
Networks
End-user Equipment
Internet Services
APPLICATIONS IN HEALTH CARE (FIG. 59.1)
Reasons for Application of Telemedicine
Telemedicine v/s e-Health
Telemedicine
Branches of Telemedicine
e-Health
People-centred e-Health System
Barriers to Telemedicine
CHAPTER 60:
Medical Tourism
MEDICAL TOURISM
FACTORS AFFECTING MEDICAL TOURISM
Accreditation of Health Care Organization
Risks and Benefits of Medical Tourism
Sponsored Medical Tourism
Destinations for Medical Tourism
SECTION NINE: ANNEXURE
ANNEXURE ONE:
Code of Medical Ethics
CHAPTER 1: CODE OF MEDICAL ETHICS
A. Declaration
B. Duties and Responsibilities of the Physician in General
CHAPTER 2: DUTIES OF PHYSICIANS TO THEIR PATIENTS
CHAPTER 3: DUTIES OF PHYSICIAN IN CONSULTATION
CHAPTER 4: RESPONSIBILITIES OF PHYSICIANS TO EACH OTHER
CHAPTER 5: DUTIES OF PHYSICIAN TO THE PUBLIC AND TO THE PARAMEDICAL PROFESSION
CHAPTER 6: UNETHICAL ACTS
CHAPTER 7: MISCONDUCT
CHAPTER 8: PUNISHMENT AND DISCIPLINARY ACTION
APPENDIX 1: DECLARATION
APPENDIX 2: FORM OF CERTIFICATE RECOMMENDED FOR LEAVE OR EXTENSION OR COMMUNICATION OF LEAVE AND FOR FITNESS
APPENDIX 3: FORMAT FOR MEDICAL RECORD
APPENDIX 4: LIST OF CERTIFICATES, REPORTS, NOTIFICATIONS, ETC. ISSUED BY DOCTORS FOR THE PURPOSES OF VARIOUS ACTS/ADMINISTRATIVE REQUIREMENTS
Short Title and Commencement
ANNEXURE TWO:
The Consumer Protection Act, 1986
CHAPTER I: PRELIMINARY
CHAPTER II: CONSUMER PROTECTION COUNCILS
CHAPTER III: CONSUMER DISPUTES REDRESSAL AGENCIES
CHAPTER IV: MISCELLANEOUS
ANNEXURE THREE:
Tender Document
SECTION-I: INSTRUCTIONS TO BIDDERS
Envelope No. 1: Called “Technical Bid Envelope” containing:
Envelope No. 2: Called “Commercial Bid Envelope” which shall contain
SECTION-II: CONDITIONS OF CONTRACT
ANNEXURE FOUR:
Biomedical Waste Disposal Rules
STANDARDS FOR WASTE AUTOCLAVING
Spore Testing
STANDARD FOR LIQUID WASTE
STANDARDS OF MICROWAVING
STANDARDS FOR DEEP BURIAL
ANNEXURE FIVE:
The Prenatal Diagnostic Techniques Act and Rules
ACT NO. 57 OF 1994
CHAPTER I
Preliminary
Definitions
CHAPTER II
Regulation of Genetic Counselling Centers, Genetic Laboratories and Genetic Clinics
CHAPTER III
Regulation of Prenatal Diagnostic Techniques
CHAPTER IV
Central Supervisory Board
CHAPTER V
Appropriate Authority and Advisory Committee
CHAPTER VI
Registration of Genetic Counselling Centers, Genetic Laboratories and Genetic Clinics
CHAPTER VII
Offences and Penalties
CHAPTER VIII
Miscellaneous
ANNEXURE SIX:
Human Organ Transplantation Act
SHORT TITLE, APPLICATION AND COMMENCEMENT
Definition
Authority for Removal of Human Organs
Preservation of Human Organs
Restrictions on Removal and Transplantation of Human Organs
Chapter III: Regulation of Hospitals
CHAPTER IV APPROPRIATE AUTHORITY
CHAPTER V: REGISTRATION OF HOSPITALS
Certificate of Registration
Suspension or Cancellation of Registration
Appeals
Punishment for Commercial Dealings in Human Organs
Offences by Companies
Cognizance of Offence
CHAPTER VII MISCELLANEOUS
Power to Make Rules
Repeal and Savings
INDEX
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