Hospital Management

Q 1 Hospital Components and Healing environment?

Derived from a Latin word Hospitum =a place where guests are received.

An institution for the treatment, care and cure of the sick and wounded, for the study of disease, and
for the training of physicians and nurses.

Hospital Components:

 Management Planning, Administration, Accounts, Budget

 Support Services waste management, environment, laundry, kitchen, cafeteria, utilities,
mortuary, security, bank blood bank, PAEC, alternative power supply, post office.
 Services wards, OPD, OT, therapeutic, diagnostics, preventive, pharmacy
 Resource Generation Medical School, Nursing School, Paramedics School, technical firms,
PMRC, DoH
 Allied Departments WAPDA, building departments, PWD, SWD, WARSA, audit, accounts,
municipal, police, medico legal, press, politician, NGO, boiler inspector, staff association.
 Clients Active, potential, OPD (therapeutic,, diagnostic, consultation), Ambulatory (emergency),
Inpatient, Community, Institutions.

Healing Environment: HEALING ENVIRONMENTS IS COST EFFECTIVE!!!

• A more welcoming, caring, comforting hospital environment ---- help patients heal better and
faster.

• more sensitive delivery of care in a more therapeutic environment can benefit patients

• The cost-effectiveness of the approach has been established.

Effects of:

• equipment, their sounds,

• setup and design

• staff attitude,

• peculiar disinfectant smell and florescent lights

• surroundings

• available space, equipment, and staff

CREATING A LESS STRESSFUL ENVIRONMENT

• strive to reduce costs,

• create a therapeutic environment,

• improve patients' experiences, and

• accommodate constant change

• to be functionally efficient

CONCEPTS OF QUALITY OF CARE AND CLIENT ORIENTATION

Q2 Risk Management?

• Risk management in healthcare comprises the clinical and administrative systems, processes,
and reports employed to detect, monitor, assess, mitigate, and prevent risks

• By employing risk management, healthcare organizations proactively and systematically

safeguard patient safety as well as the organization’s assets, market share, accreditation,
reimbursement levels, brand value, and community standing, management, in contrast to
complications of disease.

• Any deviation from usual medical care that causes an injury to the patient or poses a risk of
harm

• Errors are defined as "an act of commission (doing something wrong) or omission (failing to do
the right thing) leading to an undesirable outcome or significant potential for such an outcome.

The other risks are:

• Near Miss is an event or process variation that could have resulted in injury but did not, either
by chance or timely intervention

• Probability is the measure of the likelihood that an event will occur

• Threat is any activity that represents a possible danger.

• Vulnerability is a weakness which will add to the risk

A five step process

• Step 1: Establish the context

• Step 2: Identify risks

• Step 3: Analyze risks

• Step 4: Evaluate risks

• Step 5: Treat/Manage risks

1. Context

• Context is very important in risk identification and management

• All departments of the hospitals are potential places of ‘risk’

• Define the areas prone to risk with high volume & potential of severity
 • ICU, OR, E.R (Emergency Room), Blood Transfusion services, CCU, Medication management
including medication administration are contextually high priority areas for risk management in
relation to patient care

2. Identify Risks

• It’s a process by which healthcare professional and the healthcare employees become aware of
the risks in the health care services and environment

• Sources of Risk Identification: (Screening of patients record, Adverse event reports, Risks
identified in similar hospitals, Reports of accreditation bodies, Patients complaints and
Satisfaction Surveys reports, Formal Meetings; Mortality meetings, Infection Control Committee
meeting, Blood transfusion committee & Safety committee)

• Discussions with department heads, managers and staff – Nurses in IPDs

• Patient tracer activity (tracing the journey of a patient from admission till discharge)

3. Analyze risks

• It is understanding the level of the healthcare risk, its importance and underlying causes, and
current measures in place to address it

• Certain risks have common underlying causes

– HR - KAP

• Existing control measures

– What can stop it? Are we doing enough for it?

– Root Cause Analysis (RCA) represents a systematic approach to identifying the

underlying causes, so that effective steps can be taken to modify processes and prevent
the risk from happening

– Brain storming with a team of relevant and informed people still remains the best
method to do Root cause analysis

4. Evaluate risk

• Risk Calculation (R) = Probability or Likelihood (P) x (S) Severity

• P (1,2,3) x S (1,2,3) = R

1-3= Low Risk, 4-6= Medium Risk and 7-9= Severe Risk

• To prioritize the risks based on risk analysis score and to decide which risks require treatment
and the mode of treatment

5. Risk Treatment

• Also called Risk Reduction/Mitigation

• It's impossible for any healthcare organization – any organization, really – to completely
eliminate risks.

• Anything which could go wrong do go wrong in hospitals – multiple issue

• This can be minimized by instituting a system of RM in the hospital – ownership

• ISO 9001-2015 system promotes Risk Based Thinking

• Every department Identifies the common and potential adverse eventualities

• Root Cause Analysis points towards the underlying cause

• Once a facility understands the underlying causes, scope, and potential severity, it can treat and
manage the risk

• The ownership of the RM remains with the top management

• QA department is the focal area

• General areas of concern are dealt at Management level

• Policies, Safety Committee, Adverse events reporting, WMS, IPC etc

• All staff is sensitized and trained in identifying risk and assessing it

• It is the responsibility of the department in-charge to ensure that departmental SOPs are
updated

• Each department should put in writing the possible risks of the procedures and their mitigation
strategy – standard format

• Monitoring and reviewing the implementation and effectiveness of the risk management is
crucial
Q3 Quality Control and Total Quality Management?

The totality of features and characteristics of care or service that bears on its ability to satisfy given
needs. Quality care is directly related to Healthcare safety and security, Attitude of staff and Role of
healthcare professionals. In terms of “time” for example: reduces delay: in appointments, in services, in
follow up.

QA is the planned and systematic activities implemented within the quality system that can be
demonstrated to provide confidence that a product or service will fulfill requirements for quality. QA
relates to how a process is performed or how a product is made

WHILE, QC is the operational techniques and activities used to fulfill requirements for quality OR subset
of QA activities. QC is part of quality management focused on fulfilling quality requirements

Total Quality Management

TQM is a comprehensive strategy of organizational and attitude change for enabling personnel to learn
and use quality methods, in order to reduce costs and meet the requirements of patients and other
customers". It aims to improve efficiency and provide high quality patient care
TQM Principles

 Customer focused organization (Current and future needs of customer to meet customer
requirements)

 Leadership (encourage and lead the team to achieve organizational objective)

 Involvement of people (Evert team member is involved in achieving and ensuring quality)

 Process approach (Processes are important to look into by managers by using tools and
techniques to solve issues while processing any activity)

 System approach to Management (Identifying, understanding and management system thereby

increasing Effectiveness and efficiency)

 Continual quality improvement (It’s a never ending process in system

 PDCA cycle Plan (direct and drive)  Do (participate, deploy, support)  Check (review) 
Action (recognize, communicate and revise), Overall aim is to achieve performance objective)

 Factual approach to decision making (Collecting and analyzing: Accurate, timely and objective
data, For taking decisions on objectively measured output)

 Mutually beneficial supplier relationships (Organizations and suppliers are inter-dependent,

Mutually beneficial relationship enhances the ability of both to create value)

Model on TQM

 Analyzes system for errors and variation rather than blaming people

 Develops long term partnership with external and internal suppliers

 Uses accurate data to analyze processes and measure system improvement

 Involves the staff who work in system analysis and improvement

 Sets up effective collaborative meetings as the basis of teamwork

 Train supervisors and managers in leading the ongoing improvement process;

 Engages staff in setting targets and ensures that results are feedback
  Highlights the need for senior executives to plan strategically

 Achieves long-term improvement through small incremental steps

Q4 Hierarchy of control of hazards in infection prevention and control?

Infection Prevention and Control Committee plays a supervisory role

• The committee must have adequate secretarial support

• The IPC committee includes wide representation from relevant departments

• The committee shall be led/chaired by the hospital administrator or a suitable senior nominee

Composition

• Medical Superintendent/Administrator

• Medical Microbiologist

• Infectious Disease Physician

• Hospital Epidemiologist

• Senior member from key clinical specialties and allied departments

• Senior member of Nursing/Matron’s office

• Clinical pharmacist

• Head of the Operating theater

• Head of Sterile Supply Department

• Head of the procurement of goods and services and stores department

• Head of the catering department

• Head of sanitary and housekeeping services

• Biomedical Engineer

• Civil engineer

• Another co-opted member as and when required

Q5 Hospital Waste Management and its cycle?

Health-care activities protect and restore health and save lives. But hospitals generate a huge amount of
waste which may pose a threat not only to healthcare workers, patients and visitors, but also to the
general public and the environment. Average waste generated may vary from 1 to 3 kg per hospital bed.
Of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous
waste. The remaining 15% is considered hazardous material that may be infectious, toxic or radioactive
(WHO Fact sheet 235).

Each hospital will have a Waste Management Committee and (preferably) a Public Health Specialist be
appointed as Waste Management Officer. Hospital must have a proper and functional Waste
Management System. The steps in the management of healthcare waste include:

• waste minimization

• appropriate segregation/separation at the point of generation

• safe collection

• on-site storage

• off–site transport

• and final disposal of waste as per local guidelines

There should be separate collection and disposal for;

• Kitchen waste, wrappers and other non infectious items

• Infectious Waste - laboratory cultures, waste from surgeries, autopsies and originating
from patient care

• Pathological Waste – Hyman tissues, foetuses, body parts/fluids

• Genotoxic Waste – Cytotoxic drugs etc

 • Chemical Waste – lab reagents, film developers etc

• Radioactive Waste

• Pharmaceutical Waste

• Sharps etc

Q6 Theories of motivations?

Theories of Motivation
Q8 Key Performance Indicators?

A healthcare Key Performance Indicator (KPI) or metric is a well-defined performance measure that is
used to observe, analyze, optimize, and transform a healthcare process to increase satisfaction for both
patients and healthcare providers alike. Good KPIs: Provide objective evidence of progress towards
achieving a desired result. Measure what is intended to be measured to help inform better decision
making. Offer a comparison that gauges the degree of performance change over time.

Operational Healthcare KPIs

1. Average Hospital Stay:

2. Bed or Room Turnover:

3. Medical Equipment Utilization:

4. Average Patient Wait Time:

Healthcare Financial Metrics

5. Patient Drug Cost Per Stay:

6. Average Treatment Charge:

7. Insurance Claim Processing Time:

8. Claims Denial Rate:

9. Average Cost per Discharge:

10. Operating Cash Flow:

11. Net Profit Margin:

Public Healthcare Metrics

12. Childhood Immunization Rate:

13. Number of Educational Programs

14. Emergency Department KPIs

15. Time Between Symptom Onset and Hospitalization:

16. Patient Mortality Rate:

17. Emergency Room Wait Time:

Care Quality Metrics in Healthcare

18. Staff-to-Patient Ratio:

19. Patient Follow-Up Rate:.

20. Overall Patient Satisfaction:

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