INTRODUCTION TO HOSPITAL MANAGEMENT

Material & Equipment Management Blood Transfusion Services Laboratory Services NABH Accreditation Legal Framework Radiology Services

Story # 1

It's a fine sunny day in the forest and a lion is sitting outside his cave, lying lazily in the sun. Along comes a fox, out on a walk.

Fox: "Do you know the time, because my watch is broken"

Lion: "Oh, I can easily fix the watch for you"

Fox: "Hmm... But it's a very complicated mechanism, and your big claws will only destroy it even more“

Lion: "Oh no, give it to me, and it will be fixed"

Fox: "That's ridiculous! Any fool knows that lazy lions with great claws cannot fix complicated watches"

Lion: "Sure they do, give it to me and it will be fixed"

The lion disappears into his cave, and after a while he comes back with the watch which is running perfectly. The fox is impressed, and the lion continues to lie lazily in the sun, looking very pleased with himself.

Soon a wolf comes along and stops to watch the lazy lion in the sun.

Wolf: "Can I come and watch TV tonight with you, because mine is broken"

Lion: "Oh, I can easily fix your TV for you"Wolf: "You don't expect me to believe such rubbish, do you? There is no way that a lazy lion with big claws can fix a complicated TV“

Lion: "No problem. Do you want to try it?"

The lion goes into his cave, and after a while comes back with a perfectly fixed TV. The wolf goes away happily and amazed.

: Scene :

Inside the lion's cave. In one corner are half a dozen small and intelligent looking rabbits who are busily doing very complicated work with very detailed instruments. In the other corner lies a huge lion looking very pleased with himself.

: Moral :

IF YOU WANT TO KNOW WHY A MANAGER IS FAMOUS; LOOK AT THE WORK OF HIS SUBORDINATES.

Management Lesson In the context of the working world :

IF YOU WANT TO KNOW WHY SOMEONE UNDESERVED IS PROMOTED; LOOK AT THE WORK OF HIS SUBORDINATES.

Story # 2

It's a fine sunny day in the forest and a rabbit is sitting outside his burrow, tippy-tapping on his typewriter. Along comes a fox, out for a walk.

Fox: "What are you working on?"Rabbit: "My thesis."Fox: "Hmm... What is it about?"Rabbit: "Oh, I'm writing about how rabbits eat foxes."

Fox: "That's ridiculous ! Any fool knows that rabbits don't eat foxes!"

Rabbit: "Come with me and I'll show you!"

They both disappear into the rabbit's burrow. After few minutes, gnawing on a fox bone, the rabbit returns to his typewriter and resumes typing.

Soon a wolf comes along and stops to watch the hardworking rabbit.

Wolf: "What's that you are writing?"Rabbit: "I'm doing a thesis on how rabbits eat wolves."

Wolf: "you don't expect to get such rubbish published, do you?"

Rabbit: "No problem. Do you want to see why?"

The rabbit and the wolf go into the burrow and again the rabbit returns by himself, after a few minutes, and goes back to typing.

Finally a bear comes along and asks, "What are you doing?

Rabbit: "I'm doing a thesis on how rabbits eat bears."

Bear: "Well that's absurd ! "

Rabbit: "Come into my home and I'll show you"

: Scene :

As they enter the burrow, the rabbit introduces the bear to the lion.

:Moral:

IT DOESN'T MATTER HOW SILLY YOUR THESIS TOPIC IS; WHAT MATTERS IS WHOM YOU HAVE AS A SUPERVISOR.

Management LessonIn the context of the working world:

IT DOESN'T MATTER HOW BAD YOUR PERFORMANCE IS; WHAT MATTERS IS WHETHER YOUR BOSS LIKES YOU OR NOT.

MATERIAL MANAGEMENT

DEFINITIONDEFINITION

EQUIPMENT, APPARATUS EQUIPMENT, APPARATUS AND SUPPLIES PROCURED, AND SUPPLIES PROCURED, STOCKED AND UTILISED BY STOCKED AND UTILISED BY AN ORGANISATIONAN ORGANISATION

TYPES OF STORESTYPES OF STORES

BROAD CATEGORIES

CONSUMABLES NON CONSUMABLES

TYPES OF MEDICAL STORESTYPES OF MEDICAL STORES

EXPENDABLE STORESEXPENDABLE STORES DRUGSDRUGS DISPOSABLESDISPOSABLES LAB REAGENTSLAB REAGENTS X RAY FILMSX RAY FILMS MEDICAL GASESMEDICAL GASES IV FLUIDSIV FLUIDS

NON EXPENDABLE STORESNON EXPENDABLE STORES EQUIPMENT & SPARESEQUIPMENT & SPARES

LIFE CYCLE CONCEPT

SHORT LIFE LONG LIFE

PRESERVATION REQUIREMENT

STORE REQUIRING UPTO 2-100 C TEMP

STORE REQUIRING ABOVE 100 C BUT LESS THAN 30

STORE REQUIRING LOW TEMP AND NO HUMIDITY

NO RESTRICTION OF TEMP

CATEGORISATION OF DRUG ITEMSCATEGORISATION OF DRUG ITEMS

TabletsTablets CapsulesCapsules InjectionsInjections Liquids (Syrups)Liquids (Syrups) OintmentsOintments DropsDrops PowderPowder FluidsFluids

FUNCTIONS OF STORES FUNCTIONS OF STORES MANAGEMENTMANAGEMENT

MATERIAL PLANNING & PROGRAMMINGMATERIAL PLANNING & PROGRAMMING NEED ASSESSMENTNEED ASSESSMENT FORCASTING THE LEVEL OF INVENTORIESFORCASTING THE LEVEL OF INVENTORIES SCHEDULING ORDERSSCHEDULING ORDERS

BUDGETINGBUDGETING AVAILABILITY OF FUNDSAVAILABILITY OF FUNDS PLANNING AS PER CASH FLOWPLANNING AS PER CASH FLOW CAPITAL/REVENUE BUDGETCAPITAL/REVENUE BUDGET

PURCHASINGPURCHASING RECEIPT & INSPECTIONRECEIPT & INSPECTION

FUNCTIONS OF STORES FUNCTIONS OF STORES MANAGEMENTMANAGEMENT

STOCKING & DISTRIBUTIONSTOCKING & DISTRIBUTION INVENTORY CONTROLINVENTORY CONTROL COST REDUCTIONCOST REDUCTION VALUE ANALYSISVALUE ANALYSIS DISPOSALDISPOSAL

INDENTING OF STORESINDENTING OF STORES

PERIODICITYPERIODICITY DAILYDAILY WEEKLYWEEKLY MONTHLYMONTHLY ANNUALANNUAL SUPPLEMENTARY INDENTSUPPLEMENTARY INDENT EMERGENT INDENTEMERGENT INDENT

TYPES OF PURCHASESTYPES OF PURCHASES

Rate ContractRate Contract Running ContractRunning Contract Stockless Purchasing (Just in Time)Stockless Purchasing (Just in Time) Repeat orderRepeat order

INVENTORY CONTROLINVENTORY CONTROL

INVENTORY CONTROLINVENTORY CONTROL

INVENTORYINVENTORY

““THE QUANTITY OF GOODS OR THE QUANTITY OF GOODS OR MATERIALS ON HAND” (WEBSTER)MATERIALS ON HAND” (WEBSTER)

““IDLE RESOURCE OF ANY KIND IDLE RESOURCE OF ANY KIND PROVIDED THAT SUCH A RESOURCE PROVIDED THAT SUCH A RESOURCE HAS AN ECONOMIC VALUE” (FRED- HAS AN ECONOMIC VALUE” (FRED- HANSSMAN)HANSSMAN)

IMPORTANT TERMINOLOGIES IMPORTANT TERMINOLOGIES USED IN INVENTORY CONTROLUSED IN INVENTORY CONTROL

LEAD TIMELEAD TIME BUFFER STOCK (SAFETY –BUFFER STOCK (SAFETY –

STOCK OR RESERVE STOCK)STOCK OR RESERVE STOCK) REORDER LEVELREORDER LEVEL ECONOMIC ORDER QUANTITY ECONOMIC ORDER QUANTITY INVENTORY CONTROL COSTSINVENTORY CONTROL COSTS

INVENTORY CONTROL TECHNIQUES

ABC Based on annual usage value VED Vital, Essential & Desirable

or VEN Vital, Essential & Non-Essential SDE Scarce, Difficult & Easily available

or SAP - Scarce, Available & Plenty

INVENTORY CONTROL TECHNIQUES

FSN Fast, Slow & Non- moving HML High, Low & Medium cost XYZ Value of Items in Store GOLF Source of Supply SOS Nature of Supply MUSIC-3 D Multi Unit Selective Inventory

Control MBASIC- Multiple basic selective inventory

control

ABC Analysis (Based on Usage Value)

Equal attention to all items - expensive.

Basic analysis to identify & prioritise areas of attention

Based on Pareto Analysis - Vilfredo Pareto

10 % item accounts for 70% of value -’A’

20 % item accounts for 20% of value -’B’

70 % item accounts for 10 % of value -’C’

Vital Essential Desirable

V E D Analysis

S D E AnalysisScarce

DifficultEasily

S A P AnalysisScarce

AvailablePlenty

Scarce items -Not easily available -Requires source development -Long lead time -Difficult to manufacture -Few manufacturers

BLOOD TRANSFUSION SERVICES

BLOOD BANK

Blood bank means, a centre within an organisation or an institution for Collection, Grouping, Cross-matching, Storage, Processing & Distribution of Whole human blood or

Human blood products from selected human donors.

CATEGORIES OF BLOOD BANK

Category-I 3-7 units of blood/bed/year 100-400 bedded hospital <5000 units collected

Category-II -8-15 units of blood/bed/year 400-1000 bedded hospital 5001-20,000 units collected

Category-III >16 units of blood/bed/year >1000 bedded hospital >20,000 units collected

DRUGS & COSMETIC ACT 1945

Part X B, amended in 1999. “Requirements for collection, storage,

processing & distribution of whole human blood, human blood components by blood banks & manufacture of blood products”.

DEFINITIONS

Apheresis Autologous Blood Blood components Blood products Donor Professional donor Replacement donor

Apheresis-process by which blood drawn from a donor, after separating plasma or platelets or leucocytes, is retransfused simultaneously into the said donor.

Autologous blood- the blood drawn from the patient for re-transfusion into himself later on.

Blood components-means a drug prepared, obtained, derived or separated from a unit of blood drawn from donor.

Blood products- means a drug manufactured or obtained from pooled plasma of blood by fractionation, drawn from donors.

Donors-A person who voluntarily donates blood after he has been declared fit after a medical examination, for donating blood, on fulfilling the criteria, without accepting in return any consideration.

Professional donor-A person who donates blood for a valuable consideration, in cash or kind, for any source, on behalf of the recipient patient and includes a paid donor or a commercial donor.

Replacement donor- A donor who is a family friend or a relative of the patient recipient.

PREMISES OF BLOOD BANK

The premises of Blood bank consists of the following different segregated sections:

Donor Recruitment Area Bleeding Complex Medical Officer’s Room Laboratories Issuing Counter Teaching Facilities Refreshment Area Stores Sterilization and Washing room

PHLEBOTOMY

Bleeding should be smooth and painless Strict aseptic procedure to be followed and all

disposables used. Venipuncture site should be free of skin lesions Donor bag, sample tube, and donor record should

be properly identified and labeled before drawing blood.

Each bag should be examined for defects and anticoagulants

Thorough mixing is essential.

TESTS ON DONORS BLOOD

ABO and Rh typing for confirmation of donor’s blood group and antibody screening.

Every donor’s blood must be tested for:

HIV I and II Hepatitis B & C VDRL Malaria

STANDARD COLOR LABELS

Group Color of label

O

A

B

AB

Flow of Donor

Donor Registration and Examination Room

Interview, Rh , Blood group, Weight , Hb of the patient

If suitable If unsuitable Reject Donor

Phlebotomy done & collection of pilot tubes for processing

Refreshment Room & observation Sent home

LABORATORY SERVICES

ROLE AND FUNCTION OF LAB

Attend to ailing patients Carry out investigations asked Prompt issue of accurate result Provide diagnostic information to

physician for further management

FUNCTIONAL COMPONENTS OF LABORATORY

HISTOPATHOLOGY Organ, tissue, cell examination

CLINICAL PATHOLOGY Examination of body fluids-blood, urine, sputum, stool, pleural & peritoneal fluids

MICROBIOLOGY Examination of bacteria, viruses, parasites etc.

HAEMATOLOGY Examination of blood and blood components

BIOCHEMISTRY (CHEMICAL PATH.) Examination of chemical substances e.g. hormones,

enzymes, etc. CLINICAL RESEARCH LABORATORIES

TYPES OF LABORATORY

OPD SERVICESWARD SERVICESEMERGENCY SERVICES

Round the clock servicesRestricted Emergency Services

NABL

NATIONAL ACCREDITATION BOARD FOR TESTING AND CALIBERATION LABORATORIES

ACCREDITATION

Laboratory accreditation is a procedure by which an authoritative body gives formal recognition of technical competence of testing and or calibration for a laboratory to carry out specific tests. This is based on third party assessment against set standards.

NABL

NABL accreditation is a formal recognition of the technical competence of a testing or calibration laboratory for a specific task following ISO/IEC 17025 Standard.

Medical lab ISO 15189:2003 This is based on third party

assessment.

National Accreditation Board for Testing and Calibration Laboratories (NABL) is an autonomous body under the aegis of Department of Science & Technology, Government of India, and is registered under the Societies Act.

NABL website is updated continuously with respect to status of accredited laboratories and their scope of accreditation.

TYPES OF LABORATORIES

Small lab. 100 patients/day

Medium lab. 100-400 pts./day

Large lab. >400 pts./day

Scope of Accreditation

Clinical Biochemistry Clinical Pathology Haematology and Immunohaematology Microbiology and Serology Histopathology Cytopathology Genetics Nuclear Medicine (in-vitro tests only)

NABHACCREDITATION

National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations. The board while being supported by all stakeholders including industry, consumers, government, have full functional autonomy in its operation.

DEFINITION OF ACCREDITATION

A public recognition of the achievement of accreditation standards by a healthcare organization, demonstrated through an independent external peer assessment of that organization's level of performance in relation to the standards.

The standards for hospitals have been drafted by the Technical Committee of NABH and contain complete set of standards for evaluation of hospitals for grant of accreditation.

The organization is evaluated against 100 standards and 512 objective elements contained in 10 chapters.

Particulars Standards OE

1 Access, assessment & continuity of care (AAC)

15 78

2 Patients Rights & Education (PRE)

05 30

3 Care of Patients (COP) 18 104

4 Management of Medication (MOM)

13 61

5 Hospital Infection Control (HIC) 09 46

6 Continuous Quality Improvement (CQI)

06 39

7 Responsibility of Management (ROM)

05 25

8 Facility Management & Safety (FMS)

09 43

9 Human Resource Management (HRM)

13 47

10 Information Management System (IMS)

07 41

PREPARING FOR ACCREDITATION

Step 1 Obtain a copy of NABH standards Step 2 Carry out self assessment on the

status of compliance with the NABH standards

Step 3 Ensure that NABH standards are implemented and integrated with the hospital functioning

Step 4 Obtain a copy of application form Step 5 Fill & submit the application form in

NABH office Step 6 Pay the accreditation fee. 

ACCREDITATION PROCESS Step 1 Application for accreditation

( submitted by the Healthcare Organisation) Step 2 Acknowledgement for accreditation

(by NABH secretariat) Step 3 Pre assessment visit ( by Assessor ) Step 4 Final assessment of hospitals

(by Assessment Team) Step 5 Scrutiny of the assessment report

(by NABH secretariat) Step 6 Recommendation for accreditation

(by Accreditation Committee) Step 7 Approval for accreditation

(by Chairman NABH) Step 8 Issue of accreditation certificate

(by NABH secretariat)

Application fee Annual Accreditation fee

Upto 100 beds Rs. 25,000/- Rs. 1,00,000/-

101-300 beds Rs. 50,000/- Rs. 1,50,000/-

>300 beds Rs. 50,000/- Rs. 2,10,000/-

LEGAL ASPECTS OF HEALTHCARE AN OVERVIEW

Statutory Obligations

There are about 85 licenses and statutory obligations which are applicable to hospitals, but all of them might not be applicable to all hospitals.

Building Permit NOC from Chief Fire Officer Bio-medical Waste Management Radiation protection Certificate in respect of

all X-rays & CT Scanners from BARC Narcotics & Psychotropic substance Act Consumer Protection Act Dentist Regulations Drugs & Cosmetics Act Employees Provident Fund Act ESI Act

Code of Medical Ethics Indian Nursing Council Act MTP Act Minimum Wages Act National Building Code Payment of Gratuity Act Pharmacy Act PNDT Act Registration of Births & Deaths Act License for Blood Bank Transplantation of Human Organs Act

Radiology Services

RADIOLOGY SERVICES

TYPES X-RAYS ULTRASOUND & COLOUR DOPPLER COMPUTER ASSISTED TOMOGRAPHY MAGNETIC RESONANCE IMAGING POSITRON EMISSION TOMOGRAPHY MAMMOGRAPHY NUCLEAR IMAGING

CAT SCAN

MRI MACHINE

ULTRA SOUND IMAGE

RADIATION HAZARDS

BIOLOGICAL EFFECTS OF RADIATION HAZARDS

TYPES OF CELLS OF BODY/ DOSE SOURCE OF RADIATION

ACUTE RADIATION EFFECTS CHRONIC RADIATION EFFECTS

RADIATION PROTECTION

WALL THICKNESS ONE MM OF LEAD EQUIVALENT

8-12 CM CONCRETE/ 12-15 CM BRICK

WITHIN X-RAY ROOM TWO HIGH RISK AREAS WALL BEHIND CHEST STAND WALL OF DARK ROOM

RADIATION SAFETY MONITORING

CONTINUOUS MONITORING RADIATION DOSIMETERS RADIATION PROOF APRON PROTECTIVE GLOVES

APPLICATIONS OF NUCLEAR MEDICINE

IMAGING OF VARIOUS ORGANS THYROID FUNCTION STUDIES CENTRAL NERVOUS SYSTEM ABSORPTION STUDIES IN G I TRACT NUCLEAR HAEMATOLOGY RENAL FUNCTION STUDIES NUCLEAR CARDIOLOGY- STRESS

THALLIUM

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