REPORT ON VIRTUAL HOSPITAL FRAMEWORK

Department Hospital Administrator/CEO

Presented To Dr Faisal Haq Faculty Hospital Administration Institute of Business management

By Dr Shahida Mirza ID-9636

Table of Contents
CEO/HOSPITAL ADMINISTRATOR ................................................................................................................... 3 Administrator ............................................................................................................................................. 5 POLICY ............................................................................................................................................................ 5 Objectives ....................................................................................................................................................... 6 Procedures ..................................................................................................................................................... 7 Programs ........................................................................................................................................................ 7 Standards........................................................................................................................................................ 8 Duties & Responsibilities ................................................................................................................................ 9 Logistics ............................................................................................................................................ 11 Long-Term Planning ......................................................................................................................... 11 Policies ............................................................................................................................................. 11

Organogram ................................................................................................................................................. 12 Hospital Environment................................................................................................................................... 13 Macro Environment ................................................................................................................................. 13 Micro Environment .................................................................................................................................. 13 Objectives ................................................................................................................................................. 14 POLICIES ................................................................................................................................................... 14 Fire Safety Services................................................................................................................................... 15 Environment Management Services ........................................................................................................ 16 Occupational safety & Health services ..................................................................................................... 17 By-Laws in general........................................................................................................................................ 20 Departmental By-Laws ................................................................................................................................. 21 BY-Laws Directly Related to Patient Care..................................................................................................... 21 AIR-CONDITIONING OF HOSPITAL ................................................................................................................ 23 OBJECTIVES................................................................................................................................................... 25 POLICIES OF FINANCE DEPARTMENT (FD).................................................................................................... 26 PROCEDURES OF FINANCE DEPARTMENT.................................................................................................... 27 HOSPITAL'S ANTI-FRAUD BYLAWS ............................................................................................................... 28 DEPARTMENTAL WORK FLOW ..................................................................................................................... 30 INTERDEPARTMENTAL HIERARCHY .............................................................................................................. 31

STAFFING ...................................................................................................................................................... 32 SOURCES OF REVENUE (FUNDING) ................................................................. Error! Bookmark not defined. HOSPITAL BUDGETING ................................................................................................................................. 33 Hospitals Budget Calendar .......................................................................................................................... 39 HUMAN RESOURCE DEPARTMENT.................................................................. Error! Bookmark not defined. INTER DEPARTMENTAL HIERARCHY ................................................................ Error! Bookmark not defined. Medical Department .................................................................................................................................... 40 Summarized History Of Nursing: .................................................................................................................. 53 RADIOLOGY DEPARTMENT ........................................................................................................................... 82

CEO/HOSPITAL ADMINISTRATOR
One of the most important assets of any community is a hospital. A hospital is a resource for anyone needing emergency medical attention or care beyond what a physician's office can provide. A hospital is staffed by a multitude of employees, and in such a busy, complex environment, there must be someone who can organize and coordinate all of the people and services that are required. This role is fulfilled by a hospital administrator, the person who oversees everything that goes on in a hospital. Our Hospital Administration Class is committed to building an exemplary patient care community that offers a nurturing and challenging intellectual climate, a respect for the spectrum of human diversity, and a genuine understanding of the many differences-including race, ethnicity, gender, age, socio-economic status, national origin, sexual orientation, disability and religion that will enrich the Virtual Hospital community. Hospital is an organization that mobilizes the skills and efforts of widely divergent group of professionals and semi-professionals, so as to provide highly personalized services to individual patients. It is therefore essential to bring together the various components to a unified whole to achieve the objective through the authority of central co-ordination. This warrants a systematic functioning of a hospital as an institution. The Word HOSPITAL is self explanatory as it is given below: H - HEALING O - OBSERVATION S - SUPERVISION P - PERSUATION I - INVESTIGATION T - TREATMENT A - ASSURANCE L - LIESURE

Administrator
In addition to the care provided to the patients by the physicians and nurses, most medical facilities require a significant amount of behind-the-scene administrative support. Hospital Administrators are the professionals responsible for managing hospitals. The hospital administrator plays a vital a role in saving lives, without having to take scalpel in hand. Hospital administrators manage hospitals, outpatient clinics, hospices, and drugabuse treatment centers. In large hospitals, there may be several administrators, one for each department. In smaller facilities, they oversee the day-to-day operations of all departments. The doctors strive to keep the blood flowing and the heart beating, BUT The hospital administrator is doing his job in keeping the hospital alive and healthy.

POLICY
To make sure that hospitals are operating efficiently & providing adequate medical care to the patients. To act as Liaison between Governing Boards, Medical staff, & Department head. To integrate the activities of all departments so they function as a whole To plan, organize, direct, control & co-ordinate medical & health services following policies set by a governing board of trustees.

 To recruit, hire and sometimes train doctors, nurses, interns & assistant administrators to develop a stable staff. To develop strengths and neutralize workers weaknesses. To develop procedures for medical treatments (in collaboration with consultants), quality assurance, patient services, and public relations activities such as community health. To attend staff meetings & participate in health planning councils. They need to keep up with advances in: Medicine, Computerized diagnostic & treatment equipment, Data processing technology, Government regulations, Health insurance changes Financing options

Objectives
Directing hospital activities according to governing boards overall objectives & policies. Reviewing departments reports and activities Settling patients complaints. Assembling competent workers to direct & undertake given activities & to develop them useful environmental and medical teams. Preparing & operating sound financial structure& effective control & safety of funds. Submitting a long term plan for hospital and growth & a periodic, annual financial budget to the Governing Board for its approval or otherwise.

 Studying advances in hospital practices in order to advise the Governing Board. Studying the means to meet the communitys changing hospital needs.

Procedures
Writing proposals for government grants. Preparing periodic budgets. Allocating scarce funds & other resources. Determining patients fee Schedule. Determining space, equipment, materials & human resource needed to provide services. Convening conferences. Determining on-duty schedule for Administration Department. Making a formal inspection round.

Programs
Fire Prevention and Fighting: Prevention of fires by documented regular inspections of facilities and firefighting equipment, and drills. Disaster: Expeditious care of mass casualties from a catastrophe and maintenance of services during disrupted utility supplies, workers strikes, and guerilla attacks

 Safety: Documents periodic inspections of facilities and job procedures to prevent accidents which may cause death, injury, loss of time, lowered morale, and increased accident insurances Noise : reviews outside unwelcome sound about which little can be done and inside excessive television and radio volume, door slamming, and equipment squeaking wheels about much can be done Time Conservation : Involves prompt and accurate information, managers delegation of routine tasks and elimination of indecision and orderly arrangement of items at work place to obviate searching Quality Patient Care : Documents periodic review of patients needs for good care and evaluation of departments coordinated activities and resources to meet such needs Patients Suggestions: Invitation, acknowledgement, consideration with appropriate department, and acceptance, if suitable, of patients suggestions for service importance

Standards
For the Administrators periodic report - To ensure uniform presentations, - Prevent omission & duplications - Facilitate comparison with previous reports.

 For the quantity of patient care, - Total patients days - Outpatient Attendances - Social Service Visit For Quality of Care - No. of clinical tests performed Resources used - Staff man-hours paid - Pounds of soiled linen processed For Quality of Resources Used - By workers qualifications and secretaries shorthand and typing speed.

Duties & Responsibilities

There are many duties of an administrator, but regardless, they are just as vital to patients lives as regular doctors and nurses are. Supervision The main responsibility of hospital administrators is to supervise and oversee the daily operations of the hospital facility or the department(s) for which they are in charge. They must be sure that the facility in which they work is operating in an adequate and efficient manner to provide the best care possible to patients. Communication It's a large responsibility of hospital administrators to hold good communication skills. Because they act as the main communicator between medical staff, medical governing boards, and the heads of other medical departments, communication is vital to the success of all involved, so all departments within a facility can function together.

They must also be sure to follow all policies and guidelines that are set by the medical board of trustees, and they must be sure that the medical staff they are in charge of supervising follows these policies as well. Staff Hiring Hospital administrators are responsible for the hiring of most staff, including physicians, nurses and support staff. For elite positions, such as surgeons or other kinds of specialists, the administrator may work to recruit top candidates. Co-ordination of Business Functions Most hospitals have a variety of business and support functions, and the hospital administrator coordinates and oversees these functions. In a small hospital, the administrator may handle these tasks directly. In a larger hospital, assistants and managers may be appointed to handle various business and support functions, but the hospital administrator will still oversee their work. Policy Development & Implantation Every hospital has its own set of policies that govern employees, procedures and services offered to patients. A hospital administrator may be required to develop policies and procedures and ensure that they are followed, or he may implement policies created by a governing board or body. Short-range and long-range plans for a hospital's development and overall growth are also usually handled, or at least supervised, by a hospital administrator. Managing Patients records A large part of the hospital administrator's job concerns managing patient records. The administrator must make sure that medical histories, current health information, and billing, insurance and legal documents are all being handled appropriately. Keeping all of this information organized and up to date is an essential role that a hospital administrator must fill. Employee Evaluation As part of their hiring duties, hospital administrators must perform regular evaluations of employees, rating them for competency and performance. This can lead to promotions, demotions, transfers and firings.

 Public Relations Hospital administrators will often act as the public face of a hospital, appearing at professional conventions, meetings, public events and health planning councils. They must present the hospital in a good light and facilitate interactions with the community. Program Development Hospital administrators are also responsible for various kinds of program development. Programs can include different approaches to treatment, as well as ones that relate to the hospital's organizational and managerial structure. Most programs begin by identifying a need, either among patients or health-care providers, and developing solutions to address it, which can then be formalized into a new or designed program or initiative. Budget Hospital administrators are responsible for helping to prepare the hospital's budget, assessing priorities and allocating resources to various departments and programs. After the budget has been prepared and approved, administrators must supervise its implementation. Logistics Hospital administrators are also responsible for overseeing a hospital's logistical concerns. This includes organizing the hospital's supply chain to ensure that physicians and nurses consistently have resources, such as medical supplies, to provide appropriate patient care. Long-Term Planning Hospital administrators are also responsible for planning the hospital's future in the long term. This includes outlining the hospital's future goals, identifying likely challenges, and making sure that financial and logistical resources are in place to accomplish the facility's mission. Policies Hospital administrators must help develop and implement hospital policies, making sure they meet the needs of patients and staff, and that they are consistent with the requirements set forth by the hospital's board of directors. They should also ensure that all policies comply with applicable laws.

Organogram

CEO/Administrator

Department Secretary

Chief Operational Officer

Chief Financial Officer

Human Resource

Manager Nursing

Chief Medical Officer

Assistant Manager Operation

Assit. Manager Income

Manager Recruitment

Dietary Services

Maintenance

Assit. Manager Expense

Manager Appraisal

House Keeping

Social Services

Accountant

Manager Training

Pharmacy

Laboratory

Radiology

Hospital Environment
Hospital Environmental Service is about more than just cleanliness. A hospitals appearance is the first opportunity to make an impression on patients and visitors. Creating a clean and safe facility builds confidence in services and translates into improved patient satisfaction Environmental Services is an integral part of the hospital team, and its work directly impacts not only the daily operations of the hospital, but also the most important deliverables: satisfaction and outcomes Environment affects hospital functioning in two aspects Macro Environment - Overall Law & Order situation of city. - General Economics and paying capacity of the population of Catchment area of hospital. - Disturbance in the community declines productivity of staff, e.g Riots, strikes & transportation difficulties. - Industrial noise and vibration disturbs delicately balanced scientific equipments. - High humidity, intense heat and desert dust bearing winds permeate equipment mechanism. Micro Environment - Hospital itself (Shell, building, & physical assets) - Segmentation of Climate - Split of room categories - Environment of LR, OR, ER, ICU, NICU etc

 Special emphasis on: - Air conditioning - Zoning - Interior decoration - Cross functional team with collaboration with other units - Hygiene Standards - Fire Safety

Objectives
The Department of Health & Safety Provides: Programming Processes Training As required by the Regulatory Standards & Regulatory agencies of Hospitals EH&S staff serves as consultants to identify and resolve health & safety issues, as well as Specialists on Hospital committees & provide Expertise in such areas such as: - Fire Safety - Environmental Management - Occupational safety & Health - Radiation safety

POLICIES
To Communicate & Facilitate all new program requirements & regulatory initiatives. To provide regulatory driven safety training. To perform internal self audits and minor workplace hazards to insure compliance. To assess program compliance through - Hazard surveillance rounds, - Environmental rounds, - Review of illness & injury reports - Observation of staff knowledge during actual activities & planned drills Following summarizes those services by program area:

Fire Safety Services

Regulatory Inspections Conduct general inspection of facilities, life safety surveys, and compliance surveys for compliance with applicable regulation and standards. Fire Extinguisher Inspections - Complete monthly inspections of all fire extinguishers. - Annual maintenance of all extinguishers and hydrostatic testing of all of them per code. Fire Drills Conduct quarterly drills covering all three drills.

Emergency Response Provide emergency response to fire alarms, accidents, medical emergencies and hazardous materials incidents, as well as routine responses to requests for assistance. Fire Detection & Suspension System Monitor and service Hospitals fire detection and suppression systems that have more than 15,000 components, such as smoke detectors, heat detectors, bells, manual pull stations and fixed extinguisher system. Plan Review Review, as requested, proposed Hospital rehabilitations or new facilities to ensure compliance with all applicable codes and standards. Special Events Provide safety supervision at various large events and public assemblies, including carnivals, concerts, and special activities. Safety Training Provide Fire Warden, Interim Life Safety and general Fire Safety training to Hospital staff. General Fire Safety training is provided to the off-site facilities. Accommodation for the Disabled In accordance with the Americans with Disabilities Act, activities include the retrofitting of Hospital facilities to incorporate visual fire alarms and evacuation guidance for the visually impaired.

Environment Management Services

Hazardous Waste Collection and Disposal Coordinate and guide Hospital staff on proper collection and disposal of chemical hazardous waste, asbestos waste, PCB waste, including sampling and identification of unknown waste substances.

Recordkeeping Maintain manifest and track waste disposal from Hospital operations. Safety Training Provide hazardous waste management training online, during orientation, and recertification trainings. Waste Minimization Program Assist generators with regard to waste minimization. This may include training and assisting in waste reclamation, conservation of raw materials, and less hazardous product substitution. Identify strategies to recycle, reduce and reuse Hospital resources.

Occupational safety & Health services

Hazard Surveillance Hazard surveillance rounds are performed to ensure compliance with occupational health and safety requirements, and Joint Commission, plus safety audits of all operations and areas for potential occupational hazards and risks to employees. Rounds at off-site facilities are performed by the Off-site Safety Training Conduct employee health and safety training on topics such as hazard communication protection, hearing conservation, and other specialized health and safety topics. Recordkeeping Occupational injury and illness recordkeeping and reporting, including maintaining injury and illness log and the summary. Hazard Assessments Hazard Assessments are performed to developed safety procedures for various operations. Injury and Illness Investigations Conduct investigations to determine root causes and recommend corrective action.

Occupational Exposure Monitoring Conduct chemical exposure monitoring for formaldehyde, ethylene oxide, waste anesthetic gases, and other airborne contaminants. Indoor Air Quality Conduct indoor air quality surveys, including sampling, identifying and developing appropriate remedial actions to eliminate potential sources of airborne contaminants. At off-sites, sampling is performed by the Off-site EC Coordinator. Noise and Hearing Conservation Conduct personal and area noise monitoring, as needed. Lab Safety Implement the Hospitals Chemical Hygiene Plan and Laboratory Safety Plan, including lab inspections and chemical fume hood inspections. Asbestos Management Manage the Hospitals asbestos abatement activities. Perform air and bulk sampling. Perform operations and maintenance asbestos abatements. Radiation Safety Services Radiation Protection Services provide the health physics support services that are mandated by the New York State Bureau of Environmental Radiation Protection in the University's Broad Radioactive Materials License. Licensing Management for the Academic and Medical Programs Manage the Hospital Radiation Protection Program and maintaining compliance with mandated licensing conditions. Radiation Surveys Perform radiation protection surveys for all sources of ionizing radiation. Maintain lead apron quality control monitoring program. Personnel Monitoring Provide personnel monitoring services, including provision of monitoring devices, interpretation of personnel monitoring exposure and maintenance of all records of internal and external radiation exposure.

Radiation Safety Training Instruct personnel in the safe handling procedures of all sources of ionizing radiation in accordance with University and State requirements. Emergency Response Respond to emergencies involving radioactive material. Room Design and Decommissions Participate in lead shielding design. Decommission and decontaminate authorized radiation control areas to non-control area status. Non-ionizing Radiation Maintain the non-ionizing radiation safety program for lasers and microwaves, as requested. Hospital Radiation Protection Provide full employee and patient protection services for radioactive materials and ionizing radiation producing devices. Radiation Waste Management Manage low level radioactive waste management program A. Off-site Facilities the services are provided to the off-site

Environmental services focal Points

Increase focus on patient care Guarantee service outcomes Maximize staff productivity Improve revenue stream Ensure consistently high levels of cleanliness Raise patient and staff satisfaction Employ environmentally conscious cleaning practices Prevent hospital-acquired infections

By-Laws in general
1. Copy of policy available in all departments and senior in charge of the department must be well acquainted with the document 2. Smartly dressed, respectful staff at reception area with all the information regarding the services available and the personnel departmental designations. 3. Reception staff should have all the records of the out-patient & inpatients attendance for visitors facilitation. 4. Strict compliance of visiting hours is mandatory. 5. Visiting of children under 7 years not allowed in the hospitals due to risk of carrying the infections. 6. Childrens companions are requested to attend properly to visiting children cautioning them to noisy and unruly behavior of the hospital. 7. No attendants should be allowed with the patients accept the visiting hours. 8. Display of sign Boards of all facilities at the visible points. 9. More prominently placed FIRE EXIT sign boards 10.Fire drill schedules on weekly/ fortnightly basis 11.Daily round by day/ night supervisors to all departments. 12.Special emphasis on the decoration of the departments, waiting areas and corridors to create the patient-friendly environment and easy transfer of the patients. 13. Special emphasis on the cleanliness of the hospital shell is the responsibility of the departments as well along with the hospital supervisors. 14.Make a cleanup day as a fun activity. 15.Compliance of Security guards to clearly written instructions for the safety of the patients, hospital staff and the important assets of the hospital. 16.Complete awareness of the disturbances in the community surrounding the hospital and the city in general which can affect the smooth functioning of the hospital and their corrective measures.

Departmental By-Laws
1. Duty roaster should be displayed at the soft board provided in the department 2. Punctuality of duty time and the timely medication to the patients is appreciated 3. Timely schedule of the Consultants appointment/visits for in-patients 4. Proper documentation of the in-patients regarding medication & investigations or any scheduled procedure on the patient. 5. Preparation of patient and handing- taking from ER,OR as per requirement of the procedure. 6. Timely disposal of the patient as per requirement of the medical record office and billing department. 7. Proper documentation of the services availed by the patients to avoid extra burden of cost for patients billing. 8. Proper management of all types of inventories and their turnover times 9. Quality assurance in patient care 10.All equipments should carry a tag with clearly written operating and maintenance instructions 11.All the requisitions for lab, radiology and pharmacy should be online (Provided the excellent HMIS is available), otherwise on properly designed forms with dispatch and receipt record. 12.Proper waste disposal by the department in collaboration with waste disposal management department. 13.Requisition of the material according to the P &P of the MM department. 14.Billing of patients services strictly on their actual utilization by the patients.

BY-Laws Directly Related to Patient Care

1. A general consent form, signed by or on behalf of every patient admitted to the hospital, must be obtained at the time of admission. 2. Documented evidence of such informed consent shall be included in the patient's medical record. 3. All orders for treatment and medication shall be in writing.

4. The practitioner's orders must be written clearly, legibly and completely. Orders which are illegible or improperly written will not be carried out until rewritten or understood by the nurse. 5. All previous orders are canceled when patients go to surgery. 6. All drugs and medications administered to patients shall be those listed in the latest edition of Pharmacopoeia and National Formulary. 7. Consultations shall be obtained at the discretion of the attending practitioner. 8. The attending practitioner is primarily responsible for requesting consultation when indicated and for calling in a qualified consultant. He will provide written authorization to permit another attending practitioner to attend or examine his patient except in an emergency. 9. In an effort to ensure an environment conducive to the delivery of quality patient care, it is imperative that both Medical Staff and Hospital Staff conduct themselves in a professional, collaborative manner which is not abusive or harassing. Any behaviors inconsistent with this goal should be reported and addressed immediately. The following behaviors are not acceptable in the workplace which, if exhibited, will result in disciplinary action: Breaching patient confidentiality; Creating a hostile environment (by offensive language or other behavior) for patients, staff or Medical Staff members; Stealing or other forms of dishonesty; Threats or intimidation; Violation of Hospital Business Conduct and Code of Ethics; Violation of Patient Bill of Rights; Violation of Sexual Harassment Policy; Violation of the Drug Free Workplace Policy; If not exhibited, then liable to disciplinary action

AIR-CONDITIONING OF HOSPITAL
As all the hospital building cannot be set at the same temperature, it is imperative to provide the air-conditioning on the priority of services, departmental requirements. It is considered on the following basis. i. ii. Less air conditioning is required in corridors which have multiple entry and exit areas. Operation theaters, labor rooms, ICU, NICU and other procedure rooms require constant air- conditioning according to the season or the departmental requirement. Radiology department needs different temperature for its equipments. Pharmacy needs different temperature for the storage of different types of drugs. Laboratorys needs for air-conditioning should be according to the performance of test and the desired temperature. Information department (HMIS) may need different temperature grades for their electronic equipments to maintain their efficacy. Conference rooms and training departments are not operative for 24 hours so these departments should have controlled air- conditioning system Similarly, consultants clinics air-conditioning should be controlled according to their operational timings.

iii. iv. v. vi. vii.

viii.

FINANCE DEPARTMENT
Submitted to Dr. Faisal Haq By Dr Zahra Sana Makarram

OBJECTIVES
Front Office: To provide appropriate information to the patients and their attendants. To establish sound public relationship and to keep basic details of patients. Admission Department: To admit, or register all individuals when they enter a hospital for tests, treatment, scheduled surgery or emergency treatment. To serve the dual functions of getting information required for hospital records, and giving information, advice, encouragement, and reassurance to the patient. Health Information Management System: Processing the information that results in the data record for each patient encounter. Ensuring that the medical record contains the required documentation (content). Data processing Department: To manage the computerized information that is collected from various departments in the hospital. To assist surveillance staff by accessing birth defects information that is stored in computer format. Accounts Department: To Keep track of transactions and recording revenue and expenses are important business processes. To record, analyze and retrieve critical financial information that can be used to determine the hospital's financial status and provide reports and insights needed to make sound financial decisions.

Department of Treasury (Cash and Credit Management) To maintain a booth for the purpose of receiving patient payments and departmental deposits. To performs daily rounds to collect payments from hospital departments. To Post departmental charges to hospital patient system on daily basis. To provide daily reports to Accounting on cash collections. To Locate and notify customers (who were patients at the hospital) of delinquent accounts by mail, telephone, or personal visit to solicit payment. To receive payment and posting amount to patient's account. To prepare statements if customer fails to respond. To initiate repossession proceedings or service disconnection. To keep records of collection and status of accounts.

POLICIES OF FINANCE DEPARTMENT (FD)

Finance staff should complete a training program on fraud and abuse issues, which is designed to ensure compliance with the requirements of anti-fraud regulations, including, without limitation, adherence to proper coding and billing procedures. Payment must be for tangible services. Any complaints should be followed up. Where CFOs (Chief Financial Officers), or an external fraud team, undertake an investigation on behalf of the Hospital, it is the Hospital's policy to ensure that they are given unrestricted access to all personnel and documents as required.

 When fraud has been discovered the Director of Finance is also responsible for ensuring that the appropriate sanctions are taken and that financial redress is sought. Redress will always be sought where possible. FD must have written procedures for each position in the Department, detailing the employees' responsibilities. Employees should maintain the highest standards of professionalism. The reputation of the Hospital is paramount and officers must not bring it into disrepute by any of their actions. All work should be conducted applying proper standards of fairness and without discrimination in accordance with the current Equal Opportunities Policy. Employees should undertake all work with an open mind. Information obtained should be assessed without preconceptions.

PROCEDURES OF FINANCE DEPARTMENT

FD creates Department policies. The Finance Department advises the CEO (Chief Executive Officer) on financial policy and long-range planning. FD provides financial counseling and assistance to patients. The financial management team support managers within the Hospital, providing reports and analysis on expenditure and income throughout the year, setting budgets and providing financial information and support. Corporately, the team provide Hospital wide reports on the financial performance of the hospital to the senior management team and the Hospital Board. The financial accounts team manages the hospitals cash, and deals with the payment of creditors, collection of income, internal controls and production of statutory accounts. The section also manages the hospitals charitable

funds and undertakes the administration relating to the private patient and overseas patients work done in the hospital. The sales ledger team section ensures that the income due to the Hospital is received. The initial stage is the production of an invoice, and then credit control procedures are instigated if the debt is not paid within the agreed timescales. The accounts payable team is responsible for ensuring that the invoices that the Hospital receives are entered onto the finance system. Invoice payment is processed within this department, together with any supplier enquiries. The general office is the public face of the Finance Department. The office itself is the point of contact for patients travel claims and property, as well as providing services to staff. The performance management team assists in negotiation, pricing and monitoring of the Hospital's contracts. They also produce reference costs for the Hospital, which identifies the Hospital's costs for all procedures performed in the previous year. A member of the Finance Department sits on every planning board; this affords the Department a great opportunity to infuse the financial perspective into every operation.

HOSPITAL'S ANTI-FRAUD BYLAWS

Separation of duties. No employee should be responsible for both recording and processing a transaction. Access controls. Access to physical and financial assets and information, as well as accounting systems, should be restricted to authorized employees. Register accountability. Only a few employees should be assigned to one register simultaneously, and only one at a time if possible. All employees should log in their employee number when entering a transaction.

 Tracking cash variances. All cash overages and shortages should be posted so trends can be determined. If no patterns are apparent, a shotgun shortage exists, and a manager or head clerk with access to all registers may be responsible. Bad debts, where appropriate, must be written off after being approved by the CEO. General journals should be sequentially numbered, supported by narration and proper authorization Local Counter Fraud Specialist (LCFS), whom staff may contact confidentially if they suspect a fraudulent act. The LCFS will be responsible for liaising with the Human Resources Directorate, on behalf of the Director of Finance, when an investigation into suspected fraud commences. This is to ensure that existing Hospital policies and procedures in relation to disciplinary matters are followed. The Director of Finance and the LCFS are responsible for investigating suspected frauds in line with the operational directions included within the Fraud and Corruption Manual Hospital will use patients' personal health information to monitor or prevent fraud or any unauthorized receipt of services or benefits. Different types of sanction can be applied to a proven case of fraud, including criminal, civil and disciplinary action. Sanctions will always be taken where fraud is proven. Where fraud is proven this will be reported internally within the Hospital so as to raise the awareness of fraud and to assist in the attempts to deter fraud Employees must follow fraud and abuse avoidance programme, encoded in Fraud and Corruption Manual. Access to the Fraud and Corruption Manual is restricted to the Director of Finance and the LCFS, so as to prevent staff from knowing how to commit fraud.

DEPARTMENTAL WORK FLOW

INTERDEPARTMENTAL HIERARCHY

STAFFING
S.No 01. 02. 03. 04. Hierarchal Level Departmental Heads Managers Supervisors Clerks Admission Clerks (4+3+2) Front Office Clerks (3+2+2) Account Clerks (6) Cashiers (3+2+1) Recovery Team Staff (6) HMIS Clerks (4) Data Processing Clerks (4+2+2)
Working Shifts: 1st Shift: 08:00am - 04:15pm 2nd Shift: 04:00pm - 2:15am 3rd Shift: 12:00am - 08:15am Office Closing Time: Daily 1:00pm -2:00pm (lunch break)

No. of Staff 03 06 04 46

SOURCES OF REVENUE (FUNDING)

Operating Revenue: delivery of patient care Gross Patient Service Revenue (GPSR) Net Patient Service Revenue (NPSR) Other Operating Revenue: non patient care activities Cafeteria sales Gift shop sales Parking garage fees Space or equipment rentals Research grants Gains/Losses: peripheral business activities. Investment Income (marketable securities or donations). Unrestricted Donations.

HOSPITAL BUDGETING
Types of Budgeting 5 types of hospital budgets: Expense Budget Revenue Budget Operating Budget Capital Budget Cash Budget

Expense Budgeting
The expense budget is the amount of money each department expects to payout. These expenses include salaries, supplies, and other various expenses. There is the monetary resource departments must stay within.

Revenue Budgeting
The revenue budget is a forecast of the income a hospital expects to receive for the budget period. The preparation of the revenue budget entails the projection of patient service revenues, other operating revenues and non-operating revenues. Total patient service revenues are calculated by multiplying the expected service volume in each revenue center by the charge per unit of service. Finance department needs to decide what percentage of price increase will be needed to produce the desired "bottom line". Non-operating revenues are included contributions and interest from investments. Contributions are sometimes difficult to project while interest on investments is an important part of the non-operating revenues.

Operating Budget
The operating budget is composed of the expense budget and revenue budget. It lists, for the upcoming fiscal year, anticipated income by source, and anticipated expenses by natural classification such as salaries, supplies, and utilities.

 Administration always pursues a larger revenue budget than expense budget, therefore projecting a profit on the bottom line. The profit is used to finance the capital budget.

Capital Budgeting
The capital budget summarizes future plans for acquisitions of plant facilities and equipment. Hospital determine how much of its' capital plan has to devote to renovate and to expand the project. Management also examines the hospital's operating performance and current financial status to see whether future financing is needed. Capital budgeting is done in three steps: Identify capital needs Regarding financial allocations, prioritize the equipment Managing capital needs

Cash Budgeting
The petty cash is essential for any business or organization to run its errands. Cash flow is reviewed on a monthly basis to enable administration to foresee cash shortages and seek possible financing if necessary. The cash flow statements basically indicate the difference in the balance sheet accounts. The reader focuses on how the debt is being used. For example, if the hospital shows operating losses, working capital increases, and increases in capital expenditures the funds will probably have been generated by longterm or short-term borrowing.

 The cash flow statement helps determine how debt is being used by the hospital. Financial managers make sure that they do not spend too much time on deciding how to get cash rather than how to invest and manage what they have. Higher interest rates will also generate extra funds.

Budgeting of Finance Department

Departments Front office Admitting Health management information (HIMS) Data processing Accounting Cashier Credit/Collector Required Expense Budget 15% 17% 25% 14% 15% 15% Allocation of Required Expense Budget Salaries 12%Supplies 3% Salaries 14%Supplies 1%Equipment 2% Salaries 16%Supplies 2%Equipment 4%Utility 3% Salaries 10%Supplies 2%Equipment 2% Salaries 13%Supplies 2% Salaries 11%Supplies 1%Other Expense 3%

Allocation of Budget by Department

Department Governing board/authority Expense Budget Salaries Subtotal 2.7%Supplies 0.3%Subtotal 3% Revenue Budget 0%

Medical committee Salaries Subtotal 4.7%Supplies 0.3%Subtotal 5%

0%

Department Finance

Expense Budget Salaries Subtotal 13%Supplies 1%Subtotal 14% Equipment Salaries Supplies Medicine Education Subtotal

Revenue Budget 0%

Nursing

2% Patient service revenues 9% 2% Other operating revenues 1% Subtotal 2% 16% 2% Subtotal 13% 2% 2% 19% 4% Patient service revenues 9% 1% Other operating revenues 2% Subtotal 2% 18% 3% Patient service revenues 13% 2% Other operating revenues 1% Subtotal 2% 21%

47% 0% 47%

Support services general administration

Equipment Salaries Supplies Education Subtotal

0%

Ancillary Depts

Equipment Salaries Supplies Medicine Education Subtotal

4% 16% 20%

Medical Staff Depts

Equipment Salaries Supplies Medicine Education Subtotal

30% 3% 33%

Department

Expense Budget Salaries Supplies Training Subtotal 3% Subtotal 0.5% 0.5% 4% 100 %

Revenue Budget 0%

Marketing

Total

100 %

Allocation of Costs between Departments

Department Governing board/authority Medical committee Finance Percentage of costs 3% 5% 14% Sub-departments & percentage of costs Data processing 1% Accounting 2.38% Admitting 2.38% Front office 0.15% Cashier /Credit/Collector 2.38% Health management information (HIMS) 3.5% Nursing education 2% Inpatient 5% Central Sterile Supply Department 2% Operation Room 2% Outpatient department 3% Emergency Department 2% Support services - general administration 19% Medical Records 4% Human Resource 5% Environmental 2% Maintenance 2% House Keeping 2% Social Services 2% Dietary 2%

Nursing

16%

Department Ancillary Depts.

Percentage of costs 18%

Sub-departments & percentage of costs Radiology 6% Pharmacy 4% Laboratory 8% Medicine 7% Surgery 6% Obstetrics/Gynecology 5% House Staff 3% Marketing plan 4%

Medical Staff Depts.

21%

Marketing

4%

Hospitals Budget Calendar

January 2011 Jan 16-22 Budget information & training sessions February 2011 Feb 8 Top down FY12 Operating Budget forecast and Ten Year Models are completed Feb 11 Last day for departments to edit and submit budget requests Feb 18 Populate Operating Budget tools with historical data March 2011 March 4 Budget Team holds initial meeting April 2011 April 9 Departments complete submission of Operating Budget revisions determined during reviews May 2011 May 1 Hospital completes compilation of budget requests and comparison to Operating Budget Forecast June 2011 June 16 CEO approves Budget and departments are notified August 2011 Aug 29 Evaluate budget process and follow-up on recommendations September 2011 Sept 12 Salary recommendations for management staff are completed

Medical Department

Prepared by Komal Daredia Talat Nur

Medical Department
Objectives: 1. 2. 3. 4. To diagnose and treat disease or injury for healing, curing or relief To educate staff for maintenance of professional standards To conduct research for new medical techniques To provide preventive health care

Policies: 1. 2. 3. 4. 5. To emphasize ambulatory instead of in-patient care To detect diseases as early as possible for optimum recovery To use the least resources consistent with effective care To give patients with common ailment equal consideration To involve patients with medical teaching and research without discrimination

Programs: 1. 2. 3. 4. Rules: 1. 2. 3. 4. 5. Staff appointments Staff engagement in private practice and disciplinary action Confidential nature of medical records information Routine laboratory work needed for patients on admissions Personal use of hospital equipment General Practitioners Continued Education Community practitioners participation in medical staff seminars and conferences, doctor rounds and library use. Development of community Health Officers and Medical Assistants Training of patients to live with life term conditions.

Constraints: 1. 2. 3. 4. Physicians accept a code of conduct respecting human life Medical and Surgical procedure consents (such as for blood transfusions and interventional procedures) Only registered nurses can receive physicians telephoned orders for treatment Constraining ethical issues e.g. sterilization

Standards: 1. 2. 3. Regulatory agencies requirement for current membership International standard nomenclature of diseases and operations Standards of staff performance 1. 2. 3. Death rate Average length of patient stay Evaluation of work performance

Environment: 1. 2. 3. Temperature control for scientific equipment Physicians need to work with confidence and a reasonable degree of freedom Excessive concern on malpractice suits

Physical Facilities: 1. Medical Staff Offices include: 1. 2. 3. Office for Medical Officer Office for Specialists Office for Assistant Administrator

2.

Lounge 1. For medical staff and visiting specialists

3. 4.

Conference Room Medical Library

Records: 1. Medical Record Includes: 1. 2. Signed and witnessed consents for medical procedures

Administration Record Includes: 1. 2. 3. 4. Staffs completed applications for appointments Professional staff register Minutes and reports of meetings and conferences Medical library card catalogue by subject and matter

Committees: 1. Staff Appointments Committee 1. 2. Reviews applications for staff positions and for annual reappointments and make recommendations to Executive Committee

Infection Control Committee 1. 2. Implements aseptic measures and remedies deviations from them Responsible for isolation of infectious patients

SWOT Analysis 1. Strengths 1. 2. A diverse pool of qualified specialists

Weaknesses 1. High turnover of nursing staff

3.

Opportunities 1. Increased demand of quality care and private sector hospitals

4.

Threats 1. Uncertain political conditions of the country

Organogram

Interdepartmental Hierarchy

Procedures: Protocols: General Guidelines 1. 2. 3. Procedures should be in black and white Should be grouped according to body systems Administration procedures include: 1. Appointment to medical staff, obtaining specialists opinion, conveying meetings, arranging conferences, withdrawing library books

4.

Each procedure may include: 1. Equipment/Instruments and material needed, preparation of patient, place of performing procedure and staff, length of time needed.

Pre-Anesthesia Assessment 1. The pre-anesthetic evaluation is defined as the process of clinical assessment that precedes the delivery of anesthesia care for surgery and for non-surgical procedures. Involves the assessment of information from multiple sources e.g. medical records, patient interviews, physical examinations, and findings from preoperative tests At a minimum, a pre-anesthetic physical examination should include: 1. 2. 3. 1) An airway examination 2) A pulmonary examination to include auscultation of the lungs and 3) A cardiovascular examination

2.

3.

Pre-Anesthesia Assessment 1. Timing 1. Guided by considering combinations of surgical invasiveness and severity of disease

Surgical Invasiveness

Severity of Disease Any severity of disease High severity of disease Low severity of disease

Timing of Evaluation

High surgical invasiveness Any surgical invasiveness Low/Moderate surgical invasiveness Informed Consent 1.

Prior to day of surgery Prior to day of surgery On/Before day of surgery

Informed consent is the process by which a fully informed patient can participate in choices about his/her health care. It originates from the legal and ethical right the patient has to direct what happens to his/her body and from the ethical duty of the physician to involve the patient in his/her health care. Elements of a full Informed Consent 1. 2. 3. 4. 5. The nature of the decision/procedure Reasonable alternatives to the proposed intervention The relevant risks, benefits, and uncertainties related to each alternative Assessment of patient understanding The acceptance of the intervention by the patient

What is adequate information? 6. 7. 8. Reasonable physician standard: what would a typical physician say about this intervention? Reasonable patient standard: what would the average patient need to know in order to be an informed participant in the decision? Subjective standard: what would this patient need to know and understand in order to make an informed decision?

Where is informed consent needed? 9. 10. Surgery, anesthesia, and other invasive procedures For a wide range of decisions, written consent is neither required or needed e.g. a man contemplating having a prostate-specific antigen screen for prostate cancer should know the relevant arguments for and against this screening test, discussed in layman's terms

What happens when a patient cannot give informed consent? 11. A surrogate decision maker consents if patient is determined to be incapacitated/incompetent to make health care decisions

What is presumed /implied consent? 12. The patient's consent should only be "presumed", rather than obtained, in emergency situations when the patient is unconscious or incompetent and no surrogate decision maker is available

While the principle of respect for person obligates you to do your best to include the patient in the health care decisions that affect his life and body, the principle of beneficence may require you to act on the patient's behalf when his life is at stake. Sterilization & Disinfection

1.

Contamination 1. The soiling or pollution of inanimate objects or living material with harmful, potentially infectious or other unwanted material

2.

Decontamination 1. A process which removes or destroys contamination so that infectious agents or other contaminants cannot reach a susceptible site in sufficient quantities to initiate infection or any other harmful response

3.

Cleaning 1. A process which physically removes infectious agents and the organic matter on which they thrive but does not necessarily destroy infectious agents. Cleaning is an essential prerequisite to ensure effective disinfection or sterilization

4.

Disinfection 1. A process used to reduce the number of viable infectious agents but which may not necessarily inactivate some microbial agents, such as certain viruses and bacterial spores

5.

Sterilization 1. A process used to render an object free from viable micro-organisms including viruses and bacterial spores

Classification of infection risk associated with the decontamination of medical devices

Risk High Application of item 1. In close contact with a break in the skin or mucous membrane Introduced into sterile body areas In contact with mucous membranes Contaminated with particularly virulent or readily transmissible organisms Prior to use on immuneocompromised patients In contact with healthy skin Not in contact with patient Cleaning Sterilization/Disinfection Recommendation Sterilization

2. Intermediate 1.

2.

3.

Low

1. 2.

1. 2.

Devices designated for single-use only must never be re-processed Packaging and dispatch of contaminated items 1. 2. 3. double package the device in appropriate packaging give prior warning to the intended recipient clearly label equipment to indicate that it is contaminated

3.

Receipt of contaminated items in decontamination area 1. Items will be received into the designated dirty items section of the decontamination area

4.

Choice of decontamination method 1. 2. 3. 4. The manufacturers instructions The nature of the contamination the ultimate use of the item the heat, pressure, moisture or chemical tolerance of the item

Safe handling and disposal of sharp items Type of equipment ________________ Manufacturer _________________

Description of equipment____________________ Other identifying marks _____________________ Model No _______________ Fault __________________ Is the item contaminated? Yes* No Don't know Serial No __________________

*State type of contamination: blood, body fluids, respired gases, pathological samples, chemicals (including cytotoxic drugs), radioactive material or any other hazard: ________________________ Has the item been decontaminated? Yes No Don't know

What method of decontamination has been used? Please provide details Cleaning ______________________

Disinfection ______________________ Sterilization ______________________ Please explain why the item has not been decontaminated:

______________________ Procedures Approximate Time Procedure Caesarean Section Laparoscopic Appendecetomy Laparoscopic Gallbladder Surgery Cardiac By-pass Surgery Joint Replacement Surgery Staffing Norms Efficient OR Staffing Maximize OR Efficiency by minimizing hours of over-utilized OR time 1. Under-utilized OR Staff 1. 2. 3. 2. 3. Staffing is planned from 7 AM to 3 PM An ORs last case of the day ends at 1 PM There are 2 hrs of under-utilized OR time Surgery Time 30 minutes to an hour 45 minutes to an hour Recovery Time 1-2 hours 1-2 hours

An hour

1-2 hours

4-5 hours 3-4 hours

1-2 days in ICU 2-3 hours

Under-utilized time is from 1 PM to 3 PM Over-utilized OR Staff 1. 2. 3. OR staffing is planned from 7 AM to 3 PM ORs last case of the day ends at 6 PM There are 3 hrs of over-utilized OR time

4.

Over-utilized OR time is from 3 PM to 6 PM

VIRTUAL HOSPITALFRAMEWORK:
NURSING IS.. The use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.
(Royal College Nursing)

We who are nurses are inheritors of a great tradition. It is ours to guard, to strengthen, to enlarge where needed, and to equip ourselves worthily for so doing.
M. Adelaide Nutting (1939)

Nursing is both an art and a science and this is evident in the application of scientific knowledge and principles, in the assessment of patients' needs, in the development and implementation of a care plan, and in the evaluation of patient and family responses.

By ; Dr Sheikh Sajjad Ali. 10102 Hospital Administration.

SUMMARIZED HISTORY OF NURSING

Nightingale developed and used her coxcomb diagrams, which are credited with having spawned the use of pie charts, to identify the differences nurses care made in the lives of British soldiers during the 18541856 Crimean war. However, what was most unusual and unique was how she presented her data to demonstrate the number of preventable soldier deaths before and after the advent of nurses care. Trained nurses, indeed, did make a quantifiable difference in the lives of the British soldiers. Accordingly, the death rate of soldiers, resulting from disease and infections, decreased from 47% before the introduction of trained nurses to 2% after their arrival (Florence Nightingale Museum, 18541856).
60 40 20 0 -20 -40 -60 -80 -100 No Train Nurses Trained Nurses 2 47

NURSING DEPARTMENT: We believe nursing is concerned with the wellbeing of the total person. Through its unique contribution, nursing can and must be an effective social force in promoting the quality and availability of health care services for all persons and worth. OBJECTIVES: To provide path to nurses to ensure delivering of high quality of nursing care. To collaborate with other paramedical staffs to ensure the integrated and holistic care to the patient.

 To provide assistance to physician to carry procedure as prescribed by them. To promote leadership in nursing practice, education, administration, and research. To establish and implement the philosophy, standards, policies, rules and procedures for the nursing service. To ensure appropriate distribution of duties and responsibilities among the nursing staff at various levels. To periodically appraise the performance of nurses and carry out regular nursing audits. To estimate the requirement for nursing personnel, appointment of competent nurses and establishes policies and programs for their orientation, placement, on the job training and supervision.

POLICIES: To achieve the highest level of individual's health. To encourage families to participate in the patients care. E.g. hygiene care, wound care, nutrition etc. To accommodate patient with same problem in the same areas. To focus on evidence-base practice. To ensure healthy work environment

MISSION:
Partnership with the people to ensure equity, quality, leadership in providing compassionate focuses on the unique needs of patients and their families. Service commit to: Treating patients with compassion and respect for their human dignity, individual values and religious beliefs. Being responsive to the customer's needs while making decisions that are based upon sound, ethical business principles and practices.

 Caring equally for all without regard to race, color, national origin, disability, age, religion, sex or any other basis prohibited by law. The provision of emergency services to the people of our community regardless of their ability to pay. Working together interdependently to serve our clients better Continuing Education VIRTUAL HOSPITAL believes that continuing education for all staff is essential to our future. A minimum oft 0.7 Continuing Education Units (CEUs) are required (7 contact hours) annually. One tenth of a CEU equals one hour of education. One contact hour equals one hour of education. A maximum of ten contact hours related to formal credits are allowed. Purpose of the Bylaws Bylaws provide for the governance of the professional nursing staff of VIRTUAL HOSPITAL, a framework for its operation, and are reflective of the peer review process. These Bylaws describe the staff and the responsibility of the professional staff within a shared governance model. The professional nursing staff is a component of VIRTUAL HOSPITAL, and not a separate legal entity or organization.

Description of Nursing Services : Nursing services are provided through the following departments: Birthing CenterProvides a family-centered approach to the birthing process through labor, delivery, post-partum, and nursery care. Cardiac RehabilitationA supervised outpatient program that includes exercise, life-style changes, education and emotional support for people who have had a cardiac event. This program is medically supervised and individually designed to enhance the patients quality of life. Clinic Services o Family Practice Clinics - Provides preventive health services, counseling, well person check-ups and many other services . o General Surgery Clinic - Provides a variety of surgical procedures . o Women's Clinic - Provides obstetric, gynecology and urogynecology services. EducationEvaluates the organization's training needs and develops and facilitates programs for staff training and competency assessment to support quality and positive patient and service outcomes. Emergency DepartmentProvides Level IV trauma care in two trauma beds and four emergency treatment rooms. The emergency department is staffed with specially educated registered nurses 24 hours a day. Emergency physicians provide 24 hour in-house coverage. Home and Community HealthProvides quality, comprehensive in-home health services that are designed to decrease the need for institutional care and help promote patient independence, serving a 33 mile radius surrounding Waverly. Community health services, including flu and pneumonia clinics, blood pressure screening, adult hepatitis B immunizations, tobacco cessation and prevention programs. Infection Prevention/Occupational Health/Employee HealthInfection control is responsible for establishing WHC policy and providing education on prevention of infections in staff, visitors, and patients.

To evaluate the Performance: The following process as developed by the members of the Nursing Performance Improvement Council and adopted by the staff defines the process of performance evaluation as PEACHS. P= Problem Identification E= Establish PI Steps A= Apply the Change C= Check the Change H= Have the Process Revised S= Status Check Meeting Times: Nursing councils shall meet monthly and function consistent with By-laws. Minutes will be taken, duly recorded and distributed to the nursing staff. Meeting times and length will be specifically approved by the majority of the Council members present. NURSING EDUCATION: Provide both the foundation of general education and a nursing curriculum that emphasizes the knowledge, skills and values. Faculty and students establish a partnership wherein the faculty provides diverse learning opportunities and the student accepts responsibility for their own learning. Systems comprise the structure: Student System: accept responsibility for their own learning Nurse System: when implementing safe, effective patient care within various roles. Health Care System: Safe, quality health care is attained and continuously improved utilizing the expertise of health

PROGRAM: Infection Control Grievance Medication Basic Life Support Vital signs Operation Theater (Patient handing over and receiving) ROTA/ ROTATION Orientation

Infection control: The highest incidence HAI is observed amongst invasive procedures. CDC, 2 Millions pts in US developed HAI. 90k pts died. 4th leading cause of death in US. Cost additional $4-5 billions/yr.

Role of Nursing Personnel in prevention of HAI: Nursing background helps them in there job with infection control. The physician might be more in tune with the disease and its process. The nurse is more in tune with the hospital policy development & compliance ,would like to see. More programs to educate nurses in epidemiology. Risk Factors for HAI: Low resistance of patients to infections. Contact with infectious persons. Invasive procedures/interventions. Inappropriate antimicrobial usage. Drug resistance. Contaminated environment

High Risk Areas in Hospital: Nurseries. ICUs. Dialysis Units. Organ transplant. Oncology ward. OTs(Delivery rooms,Post Op Rooms)

Hospital Infection Control Program Monitoring: Microbiological surveillance. Investigation & Control of outbreaks if any. Monitoring Of anti microbial resistance. Providing facilities to the hospital staff to maintain good infection control Educating/training programs for hospital staff. Provisions for staff health activities. Written documents outlining the various infection control policies.

Effective Control Measures: Hospital planning (Riggs pattern wards, isolation room ICU, air lock systems, corridors cleaning, hand washing, natural ventilation) Administrative Control: (Rounds, training to nurses, health education, hosp inf. control committee, people, aseptic techniques, disinfections, antibiotic policy, CSSD, laundry, ICU, house- keeping)

Grievance: is used to describe circumstances where an employee wishes to raise a matter of concern in connection with his or her employment, including the application of terms and conditions of service. Common issues which may give rise to a grievance (not intended to constitute an exhaustive list) include; a decision taken by your manager, terms and conditions of employment, health and safety, new working practices, organizational change and equal opportunities. Stage 1 - Informal - Let the Trust know the nature of your grievance . through a informal conversation or in writing manager will seek to resolve the grievance informally first . Stage 2 - The Formal Grievance Process Normally be done within 14 calendar days of it becoming clear that the issue has not be resolved Informally. Manager must invite the employee to a meeting to discuss the grievance, normally be confirmed within 7 working days. Human Resources representative must be present at this meeting. Stage 3 - The Right To Appeal employee believes that their grievance has not been satisfactorily writing summarizing appeal to the Deputy Director of Human Resources, within 14 calendar days following the date of the decision letter. Appeal meeting= not less than 7 days. Medication: Only RNs and Physicians are allowed. Strict action would be taken if uncertified personnel will attempt to administer drugs to patient. Basic Life Support: (BLS). Life saving technique. Every new nurse/staff. Every 3months for 2 days and validity for 2 years.

 ROTATION: for employees in learning the subtleties of some tasks and thus end up increasing the physical demands employees to be physically able to perform the most difficult tasks Education and training of workers for new jobs

Orientation:
orientation should include provision of adequate and appropriate information regarding local procedures and departmental orientation. staff should be nominated to show the new employee around the department. Within the first two months of employment, the line manager should meet with the new appointee to establish their performance objectives, standards to met, and any training needs . All new staff should have completed their local orientation checklist . Orientation of ward, policies and procedures, different system , off basic skills .

Organogram Of Nursing Department:

CEO

COO

CFO

HR

Chief Nurse

CMO

Asst.Chief Nurse Services.

Asst.Chief Nurse Training & Research.

Coordinator Clinical areas

Coordinator Special areas.

Surg/Med/Obs/Gyn

Opd/OR/Minor

Clinical Nurse Manager/ Nurse Lead responsible for an entire directorate/department (i.e. Surgical, Medical Diagnostic & Imaging etc.) least Modern Matrons is responsible for overseeing all nursing within a department or directorate. Healthcare Assistants Staff Nurses Senior staff nurses Junior/Deputy Sister; Charge Nurse; Ward Manager Sister/Charge Nurse; Ward Manager Senior Sister; Charge Nurse; Senior Ward Manager

Chief Nurse Nurse III Nurse III Nurse III

Nurse II
Nurse I
Non Nursing Duties:

Nurse II
Nurse I

Nurse II
Nurse I

Physicians' secretary

Ward clerk

Porter

Billing clerk

Medico-social worker Record keeper.

Pharmacist

STAFFING: 1. No UNIVERSAL FORMULA which guarantees safe and effective patient care. 2. Unpopular methods include G.R.A.S.P ----- General responsibility assignment software pattern. P.I.N.I ------ Patient intensity for nursing index. N.I.S.C.M ----- National info system for Crisis management. 3. Top Down Planning: Historical Data Bed occupancy and throughput. 4. Formulae dependant on patient dependency and work load.

Skill Mix:

General wards

BASIC SKILLS FOR NURSES I/V cannulation,

Medication, BLS ACLS, SCU training

ADDITIONAL Skills
Special Care Unit CICU/ICU

SPECIAL TRAINING care Ventilator care, Critical

courses

CSSD:Central Sterile Supply Department Include processing and sterilization of syringes, rubber goods [catheters, tubing], surgical instruments, treatment trays and sets, dressings etc

Advantages -Quality improvement. -Sustainable process optimization -Reduction of administrative responsibility -Assurance about compliance to all relevant norms (ISO EN ) Operating Room Nurse Objectives Candidate required for management of surgical procedures during and after major/minor operations. Checklist to monitor the physical plan of the operating room Communication lines, both interdepartmentally and interdepartmentally, to provide for total needs of the patient. Maintain a record excellent inter-personal skills Should have 5 years of experience in this field Opd Nurse: An OPD Nurse is one that works in the Out Patient Department of the hospital, where patients receive diagnoses and/or treatment but do not stay overnight

EMERGENCY Room Objective: Working within trauma units, emergency room/critical care units, evaluating acute responses, providing emergency medical, preparing patients for stress testing and echocardiography, patient referrals and managing assessments. Levels Of Care: Level 1= minimal care Level 2= intermediate care. Level 3= total care. Level 4= specialized care.

SWOT ANALYSIS:

Strengths:
Qualified Nursing staff and experienced Nursing managers Standardized care Improved quality of care Improve leadership. set of documents Good clinical governance Existing skills (high level) of some Departmental nurses Take pressure off General Practitioners and Specialists

Weaknesses:
Increase Turn over of staff. Resources required to educate and supervise Nurse Practitioners Potential for staff to leave organization after training Lack of consistent clinical practice (in some specialty areas) Low ability to retain the professional

Opportunities:
Improve response time Expand services Decrease length of stay Improve links between health professionals Develop infrastructure to strengthen nursing health care and increase efficiency in hospital sector. Societal changes Technological development

Challenges:
Competitor Problems. Lack of knowledge understanding of the Nurse Practitioner role Funding / cost Medico legal issues Workload for candidates Demographic change Raising population expectations to health system.

Improvement Nursing through staffing care: Improvement of technique in nursing care. Time and work assignment. Need to increase the number of staff. Training of auxiliary workers. Evaluation of performance on individual basis. Optimum utilization of staff through supervision. Analysis of task performed by different categories of workers

Shifting Of Nursing Personnel: (Vary in different Hospitals) Morning Shift 8am 2pm. Evening Shift 2pm -8pm. Night Shift 8pm-8am.

Budget: Nursing Salary & wages are 68% of the nursing direct expense budget. Nursing Salary & Wages are 15% of the hospital direct expense budget The Clinical Practice Guideline and Education and Mentoring Working Parties will provided support for the development of nurse practitioner roles within existing budgets.

Participation Of Chief Nurse in budget preparation leads to cost consciousness. -Increase cost effectiveness. -Efficient use of resources. Budget primary concern with: Personnel salaries Supplies. Equipment outlay. Capital expenditure. Factors affecting: Type of hospital & level of care. Personnel policies. Training & research programs. Authorized bed capacity Proportion of nursing care 1. Turnover rate. 2. Standard of nursing care. 3. Physical layout of hospital 4. Methods of assignments.

Budgeting Staff
Daily FTE required-used to plan daily staffing Total Patient Care Hours = Daily Hours of Care 365 For 8 hour shifts Daily Hours/8 For 12 hour shifts Daily Hours/12

PHARMACY DEPARTMENT

Saba Ilyas Qureshi Roll No: 11071

What is a Hospital? Hospital is a complex organization and an institute which provides health to people through complicated but specialized scientific equipments and a team of trained medical staff educated in the problems of modern medical science Thus the hospital is a specialized body where the patient care is the focus point and about which all activities of the hospital revolve Salient Features of Hospital Pharmacy Usually found within the premises of the hospital. Usually stock a larger range of medications, including more specialized and investigational medications (medicines that are being studied, but have not yet been approved), than would be feasible in the community setting. Provide medications for the hospitalized patients only, and are not retail establishments. Does not provide prescription service to the public. Some hospitals do have retail pharmacies within them which sell over the counter as well as prescription medications to the public, but these are not the actual hospital pharmacy. What does the Pharmacy department do? Administrative P & T committee Hospital Formulary Educating staff

 Clinical Services / Patient Care Patient counseling Poison and drug information Information Service Drug Distribution and Control MM and inventory control Automated pharmacy services Quality & Performance Improvement Pharmacy improvement programs Medication Safety Adverse drug reactions (ADR) Objectives To provide at all times, medications of the highest standard in appropriate dosage forms consistent with the needs of the patients in collaboration with the medical staff; To rationalize drug utilization and procurement in collaboration with the Pharmacy and Therapeutics Committee; To render effective and efficient professional service to in and out- patients of all economic levels; To utilize resources of the hospital pharmacy in the development and improvement of the profession as a whole; To conduct and support medical and pharmaceutical researches appropriate to the goals, objectives and resources of the pharmacy and hospital;

Policies To decide to whom services are available as well as patients, such as staff and community physicians. Whether to use hospitals manufacture of tablets, sterile solutions and other products. Use of patients own medications brought to the hospital. Use of automatic stop orders on dangerous drugs. Use of unit dose system Whether medications are sold to patients at cost or other price. Role of Pharmacist in a hospital To participate and adhere to the safety programs of the hospital To estimate the needs of facilities, supplies and equipments To ensure a proper control of inventory, stocks, dispensing of medications To maintain patient records and reports To act as a liaison between administrative authorities and medical doctors who will order drugs and ancillary product

Hierarchy for the Department

Administrator

Head of Pharmacy Services

Dispensing Pharmacist

Manufacturing Chemist

Clinical pharmacist

Medical Store Pharmacist

In patient

Out Patient

Procedures Checking drugs and other material on delivery Sorting of disinfectants and poisons Checking prescriptions for patient allergies Preparing sterile solutions Disposing outdated drugs Programs Patient Counseling Drugs purpose, side effects, effectiveness when used properly

 Trainings Internships Guidance for primary health care workers Fire prevention and disasters Rules: Dispensed only on pharmacist/authorized persons written prescription Dangerous drugs stored separately Liquids poured with label facing upwards Destruction of containers that are damaged, have no label or worn Environment Adequate lighting Space to obviate over crowding Manufacture requires a germ-free environment Heat and dampness affects physical properties Drug Label Drug container labels must include Generic name of the drug, strength and dosage form, and Hospital approved abbreviations and symbols. Only hospital pharmacy staff may alter a drug container label. Inpatient prescription labels must include a unique patient name and identifier, the generic name of the drug, strength and dosage form, Parenteral vehicle if applicable, and Hospital approved abbreviations and symbols. Formulary A list of prescription drugs, both generic and brand name, that are preferred by any hospital plan. In most health plans, the formulary is developed by a pharmacy and therapeutics committee composed of pharmacists and physicians from various medical specialties.

Formulary Objective Medical staff working in collaboration with PTC; evaluates, selects drugs those are considered most useful in patient care Important tool for assuring quality of drug used and controlling its cost Provide hospital staff information on drugs being used. How medicines are selected for a formulary? Medications are those that satisfy the priority health care needs of a population Medicines are selected with regard to disease prevalence, evidence of efficacy, safety and cost effectiveness. Components The Formulary is divided into four general sections*: Introduction, Therapeutic Index, Drug Monographs, General Reference Section * no standard format for formularies Therapeutic Index Listing of pharmacological or therapeutic category of those drugs which are in the pharmacy Alphabetical by generic name From this the physician can determine the dosage form available in the hospital

Drug Monograph Alphabetical listing of both trade names and generic names available It includes: Dosage form Category Trade name Any special note General Reference section Information that aid in patient care Dosing formula conversion, table for weight, measures, and temperatures. Functions of Formulary Heart of the formulary system is P & T committee The main function of formularies today is to specify which medicines are approved to be prescribed under a particular contract. The development of formularies is based on evaluations of efficacy, safety, and cost-effectiveness of drugs Distribution of formulary Copies should be placed at each patient care unit HODs should have a copy Hospital administration should have a copy Each member of medical staff should receive a copy

Keeping the formulary current Needs to be revised annually Additions, deletions, removal of a drug from the market places, change in hospital policy and procedure may result in changes. Pharmacy and Therapeutic Committee Advisory group of the medical staff which serves as the organizational line of communication between the medical staff and pharmacy department Policy recommending body Members of PTC Generally PTC is composed of: At least 3 physicians from the Medical staff Pharmacist Representative of the nursing staff Hospital administrator with his/her designated member of the committee one of the physicians may be appointed as the chairman of the PTC* Committee should meet regularly six times a year, also when required *size of the committee may vary from organization to organization

Structure of PTC

Primary Purpose of PTC POLICY DEVELOPMENT Formulates policies regarding evaluation, selection and therapeutic use of drugs and related devices in the hospital EDUCATION Complete current knowledge on matters related to drugs and drug use Functions and Scope Advisory capacity evaluative, educational matters related to drug use Develop formulary of drugs Establish programs and procedures To ensure cost effective drug therapy To ensure safe and effective drug therapy

Functions and Scope Monitor and evaluate adverse drug reactions Advise pharmacy department in the implementation of effective drug distribution and control procedures Unit Dose System Portable cart containing a drawer for each patient's medications is prepared by the hospital pharmacy with a 24-hour supply of the medications. Medications which are dispensed towards for administration to a specific patient, in a specific dose, at a specific time, on a regular basis. In this system, each dose is individually prepared, packaged, and labeled Unit Dose System Advantages Drug Identity Maintained Dose of medication is individually packaged and identified according to name, strength, and the patient for which it is intended Central Location of Drugs Size of ward stock is reduced, with most of the stock located in the pharmacy Medications Ready for Administration Medications are in a cart which can be taken directly to the patient's bedside Greater Interaction Greater interaction amongst the staff of the hospital

Unit Dose System Disadvantages Increased Cost requires additional equipment and more expensive "forms" of medications Time Consuming more time to handle each dose individually rather than send the drug in bulk to a ward Increased Staffing need for additional pharmacy personnel

Terms to remember DRUG BASKET METHOD MOBILE DISPENSING UNIT

RADIOLOGY DEPARTMENT
By

Samia Zaheer

RADIOLOGY DEPARTMENT POLICIES To perform diagnostic tests such as X-Ray, Ultra-sonography, Mammography. To report promptly the results of test. To provide services to out patients, inpatients and community physicians. To check availability of previous radiograph to avoid unnecessary repeated costs & pt. exposure to radiation. To check availability of emergency drugs and resuscitation equipment for unstable pt. OBJECTIVES To provide diagnostic services by radiography & fluoroscopy. To advise physician on the interpretation of findings. To provide satellite services for better turn around time. PROCEDURES Procedures are grouped by body systems and structure. It includes: 1. Patients preparation 2. Patients position on bed 3. Procedure location (ward/department) Other procedures include: 1. 2. 3. 4. Care of critically-ill patients Identifying radiographs Indexing reports Handling radioactive isotopes

STAFFING CENTRAL DEPARTMENT 2 Principle Radiologist 3-5 Radiology Technicians 2-3 Nurses 2 Radiology Assistant Secretary

SATELLITE 1 Radiology Technician 1 Nurse 1 Radiology Assistant

INTER-DEPARTMENT HIERARCHY

BY-LAWS 1. Name The department shall be designated "Department of Radiology". 2. Object The department shall carry out the functions and directives specified in the medical staff bylaws concerning radiology department. 3. Members Members shall be board certified or board eligible in Radiology. 4. Officers There shall be a Director, an Assistant Director and a Secretary. 5. Meetings Monthly department meetings shall be called for discussion of department business, including quality assurance/quality improvement activities. 6. Executive Board The Director shall be Appointee and Chairman of the Board. The Executive Board members shall be the Director, Assistant Director, Secretary and all Section Chiefs. 7. Committees The Department of Radiology will maintain a standing committee. Standing Committees shall be the Executive Committee, Education Committee, and Quality Assurance Committee. 8. Parliamentary Authority (Rules of Order) In the absence of any provisions in the Rules and Regulations of the Department or of the Medical Staff, all meetings of the Department and of the Executive Committee shall be governed by the parliamentary rules and usages contained in the Rules Of Order. 9. Amendments These Rules and Regulations may be amended by two-thirds of the entire voting members of the Department at any meeting, provided that written notice of the proposed amendment(s) has been sent to the members of the Department at least one month in advance of the meeting.

WORK FLOW

BUDGET Annual 5 million 29% for Professional Staff 23% for Faculty 48% for following: Drugs 1. Radioactive Tracers Furniture & Equipments 1. Film processing unit 2. Film drying cabinet 3. Film viewing cabinet Physical Facility 1. Directors, Radiologists and Secretary Office 2. Waiting Room 3. Changing Cubicles 4. Clothing Lockers 5. Radiography Rooms

6. Film Processing Rooms 7. Other Rooms (mixing chemicals, sorting radiographs, radiation therapy etc)

SWOT ANALYSIS STRENGTHS 1. Expected growth in utilization of imaging services due to demography. 2. Strong fund-raising. 3. Broad network of contacts throughput radiology community at large. WEAKNESSES 1. Expected shortage of radiologist. 2. Lack of direct control over referral of patients for imaging services. 3. Relatively limited number of grants. OPPORTUNITIES 1. 2. 3. 4. Tele-radiology Mobile X-ray unit for critically ill patients 24-hours emergency ultrasound facility Fully digitalized filmless radiology via PACS (Picture Archiving and communication system) reduces TT (Transfer Time) and improves TAT 5. New roles such as disease screening and medical informatics 6. Molecular imaging and bioengineering THREATS 1. Insufficient supply of radiologist to cover increased demand for services 2. Continuing squeeze on reimbursement for radiology services. 3. Radiologist could be too busy to improve customer service.

Pakistan Nuclear Regulatory Authority

PNRA is a regulatory body authorizing licensees to nuclear facilities, medical, agriculture and research centre for safe and proper utilization of radioactive material and apparatus. They ensure: safe operation of nuclear facilities Protection of radiation workers Protection of general public Protection of environment, from the harmful effects of radiation by formulating and implementing effective regulations. Based on policies and procedure approved by international and national obligations: The medical facilities are given license to use radioactive material and radiation apparatus for X-ray imaging, radiotherapy and nuclear medicine. Proper rules, regulation and guidance regarding proper use and disposal of radioactive material are also given. The license is renewed annually, as well.

CLINICAL LABORATORY
By Tehseen KK

POLICIES
To perform tests such as chemistry, serology and haematology. To report promptly the results of test. To make available services to ambulatory patients. To select and use blood transfusion donors.

OBJECTIVES
To perform tests for physicians and other authorised persons. To educate interns, residents and other students . To conduct research. To perform post-mortem examination. To examine food, milk, dishes, and cutlery for possible contamination.

PROCEDURES
Preparing standard solutions. Cross-matching blood donors and recipient. Preservation and storage of specimens.

PROGRAMMES
Register of donors and blood testing and collecting for bank. Teaching programes for student nurses and medical laboratory technicians. Environment Adequate fresh air. Removal of noxious and toxic fumes. Lighting should be adequate.

STAFFING
2 Pathologist- working in divided shifts (direct and supervise laboratory and assist in diagnosis) 3-5 Technicians (perform various diagnostics and therapeutic chemical tests, prepare solution and vaccine, obtain specimen from patient, makes written report) Special technicians (Blood Bank technician, microbiologist) 3-4 Lab helper (prepare standard solutions,washes and sterilises glassware)

Clinical Pathology
Microbiology tests of feces, urine, blood sputum etc CBC Hb Hematocrit Coagulation Urinalysis Blood Films etc Biochemistry BUN Serum Glucose HbA1C Serum Potassium Serum Iron Bilirubin BUN:Creatinnine Serum Bicarbonate Serum Aspartate Aminotransferrace etc Histopathology Biopsy or surgical specimen study for identifying manifestation of disease like cancer cells detection etc BASE LINE INVESTIGATION CBC UCE CHEST XRAY URINE DR

TURNAROUND TIME: Turnaround time (TAT) is one of the most noticeable signs of laboratory service and is often used as a key performance indicator of laboratory performance. CBC : 45 MINUTE ELECTOLYTE : 15 MINUTE ABGS : 15 MINUTE TROPONIN : 45 MINUTE CKMB : 40 MINUTE CPK : 70 MINUTE CSF D/R : 60 MINUTE PRE-OP LABS Major Surgery CBC, Hb, Hematocrit, Electrolytes, Coagulation factors, LFTs, Blood-Cross matching, ABGs, BMP, CPK Other test are Chest X-Ray, ECG, ECHO Minor Surgery CBC, Hb, Hematocrit, PT. Other include Chest X-ray C-Section CBC, Hb, Hematocrit, Blood-gp, PT

POST-OP LAB Major Surgery CBC, Hb, Hematocrit, Electrolytes, Coagulation factors, ABGs. Minor Surgery CBC C-Section CBC, Hb. REPORTING RESULTS written report Reports will be mailed or faxed. A copy of report should be stored. Additional reports will be provided on request. verbal report facility should be provided.

BUDGET CHARGING/BILLING Required information for billing includes Patient's full name. Patient's current address Patient's current phone # Patient's Social Insurance/ security # Guardian's full name, address and phone #. ICD-codes( narrative descriptions of presenting symptoms) required for all lab tests. Zakat billing patient is required to fill zakat form, for further verification and accuracy Medicare Billing Complete Medicare information or insurance information. Limitation and % of coverage Direct billing Requisition form include: Patient's full name.add, phone # Patient's Social Insurance/ security # Guardian's full name, address and phone #. Provide a copy of bill to Pt. Inform about working credit card

Medical Record Department

By Samra Zeeshan

OBJECTIVES To be the custodian of patients health record charts. To provide prompt and efficient service to users(Doctors & Patients). To provide benefits of handling large volume of medical data, improve efficiency, easy storage of documents in minimal space, quick retrieval of records. Compiling statistics of various data & services. To develop MRD policies in conjunction with the hospitals policies. POLICIES The MRO liaising with clinical staff and hospital administration about the content of medical records, and procedures required in the management of medical record services. Sufficiently train staff to complete all basic medical record procedures. To guard the privacy of patients medical information. To provide data for medical research if any , with patients consent. PROCEDURES ADMISSION PATIENT IDENTIFICATION & MPI MEDICAL RECORD FILLING DISCHARGE DISEASE CLASSIFICATION

BYLAWS No unauthorized person can take any part of medical record out of file. Information cannot be released without the consent of the patient. Hampering of patients medical record. Entry of unauthorized person into the file area.

INTERDEPARTMENTAL HIERARCHY
HEAD OF ADMINISTRATION

MEDICAL RECORD COMMITTE

SECRETARY

MEDICAL RECORD OFFICER\LIBRARIAN

ADMISSION OFFICER

SUB OFFICER

ADMISSION CLERK

SOFTWARE ENGINEER

WORK FLOW

BUDGET In accordance with the Finance department BUDGET FOR SALARIES BUDGET FOR MAINTANACE &UPGRADING OF MEDICAL RECORDS

MATERIAL MANAGEMENT Department

By: Dr. Zuhaib Uddin ID #: 10231

 Mission Statement We acquire and administer the procurement and storage of all goods and services for Hospital with the objective of obtaining the best overall value in a timely manner while providing quality customer service for all internal customers POLICIES 1. Materials Management department has the responsibility for the procurement and storage of all goods and services. 2. To identify products or services that lend themselves to standardization of product selection which will assist in lowering the overall cost to Hospital. 3. To make the final determination of source of supply, quantities purchased, delivery schedules and price negotiations, except where others are so authorized These decisions are made in conjunction with the Materials Management department and other departments, as appropriate. 4. To initiate and maintain effective and professional relationships with current and potential suppliers 5. The Materials Management department is the channel through which all requests regarding prices and products are handled To conduct all correspondence with suppliers involving prices or quotations. In cases where technical details are necessary, the requisitioning department may correspond with suppliers. Close communication and coordination between the Materials Management department and the requisitioning departments is important. 6. To Place Purchase order without political and social influence 7. To purchase ahead of immediate needs

 OBJECTIVES AIM OF MATERIAL MANAGEMENT To get 5 Rs 1. The Right quality 2. Right quantity of supplies 3. At the Right time 4. At the Right place 5. For the Right cost PURPOSE OF MATERIAL MANAGEMENT To gain economy in purchasing To satisfy the demand during period of replenishment To carry reserve stock to avoid stock out To stabilize fluctuations in consumption To provide reasonable level of client services To maintain optimum levels of stock in order to avoid wastage, scrap and obsolescence. INTER DEPARTMENT HIERARCHY
Head of Material Management

Purchase Manager

Head of Logistics

Clerk/Typist

Store Manager/Keeper

Manager Planning & Inventory Control

Asst. Purchasing Manager

Asst. Store Keeper

Buyer

Store Clerks

Staffing
Role Head of Material Management Purchase Manager Head of Logistics Asst. Purchase Manager Clerk Store Manager/ Keeper Manger Planning & Inventory Control Asst. Store Keeper Store Clerk Number 01 01 01 02 02 01 01 02 02

BY Laws Anti- Bribery and Anti-Corruption rule To Prevent Pilferage To prevent purchase of substandard material To prevent purchase from un approved supplier To ensure controls access to hazardous material Code of Ethics (NAEB) Only professional certified persons should be engaged in the purchasing and materials management profession. To prevent entry in to personnel restricted areas especially Warehouses

 Work Flow/Process of Material Management The process of materials management involves planning, review and control of: Budgeting and Materials Planning Demand Forecasting Procurement Receipt, Inspection, Payment Inventory Control Issue, Distribution Usage Maintenance Disposal

BUDGETING AND MATERIALS PLANNING What is the item/component? What is it intended to do? What does it cost? What else can do the same job? What does the suggested alternative cost? DEMAND FORECASTING Materials in a hospital may be requisitioned. for an urgent/immediate use or in anticipation of a need on a one-time basis or repeatedly and continuously to replenish the stock as a single unit or as a bulk requirement Anticipation of future need is done through demand forecasting, which involves application of statistical techniques to predict future requirements based on past consumption patterns.

 PROCUREMENT An effective purchasing system aims at procurement of items of acceptable quality, in appropriate quantities, at the minimum price, and within the available time. Purchasing entails the following steps: drawing up specifications inviting quotations making a comparison of offers based on basic price, freight and insurance charges, taxes and levies, quantity and payment discounts, payment terms, delivery period, guarantee vendor reputation short-listing offers and negotiating for better terms issuing purchase orders taking care to list out all requirements of the institution; seeking an order acknowledgement and following-up for early supply Process Flow

INDENT IS RAISED

NEED IS ASSESSED THROUGH JUSTIFICATION FORMS

MANAGEMENT FINALIZE THE PURCHASE ACTIVITY

PURCHASE PROCEDURE

PURCHASE OF EQUIPMENT

 Process For The Purchase Of Consumables

WHEN STOCK REACHES REORDER LEVEL INDENT IS SENT

PURCHASE ORDER IS RAISED

4-COPIES OF P.O IS GENERATED VENDOR SENDS THE GOODS TO THE STORES & BILL TO THE PURCHASE DEPARTMENT ACCOUNTS DEPT PASSES THE BILL & THE BILL IS CLEARED

RECEIPT, INSPECTION, ACCEPTANCE, PAYMENT: Items ordered from suppliers should be received at a common receiving area The procedure for receipt, inspection and acceptance of supplies includes: Check containers for deficiency and damage. Any damage / loss should be registered immediately through a claims statement. On receipt at the hospital, check supplies for discrepancies in quantity, quality, product specifications, etc. Record shortages, incorrect or damaged material, out-dated supply and take action accordingly. All supplies should be inspected and certified by the Purchase / Stores department, though in the case of technical items, the requisitioner/ user should also certify.. Samples of drugs should also be analyzed and certified by the Drug Analytical Laboratory. The necessary documentation should be carried out: day book of receipts, goods inward note, stock ledger, purchase register, bin card.

 Indenters of special purchase requisitions should be notifies regarding arrival of materials. STORAGE The object of storage is to ensure that, till the time of issue for usage, the supplies are adequately preserved to prevent loss or damage The materials should be adequately protected from fire, pests, water seepage, etc. The following principles may be kept in mind: Store must be of adequate space Materials must be stored in an appropriate place in a correct way Group wise & alphabetical arrangement helps in identification & retrieval First-in, first-out principle to be followed Monitor expiry date Follow two bin or double shelf system, to avoid Stock outs Reserve bin should contain stock that will cover lead time and a small safety stock Inventory control Inventory control principles seek to minimize investment on materials so that sufficient working capital is made available for other more important activities of the organization Cyclic System: This is a periodic inventory system where the physical stock position is reviewed at periodic /fixed intervals and orders are placed depending on the stock on hand and rate of consumption. Two-Bin System: This is a perpetual inventory system where, conceptually the stock of each item is held in two bins, one larger bin containing sufficient stock to meet the demands during the interval between arrival of an order quantity and placing of a next order, the other bin containing stocks large enough to satisfy probable demands during the period of replenishment.

 Inventory control Lead Time: This is the time required to obtain the supply once the need is determined, i.e. it is the average number of days between placing an indent and receiving the material. Lead time is composed of administrative lead time or buyers time delivery lead time or suppliers time Minimum Stock or Safety / Buffer Stock: This is the amount of stock that should be kept in reserve to avoid a stock-out in case consumption increases unexpectedly or in case the lead time turns out to be longer than normal. It is also the level at which fresh supply should normally arrive and expediting action should commence if delivery is not effected. Reorder Point / Level: ROP is the predetermined stock level at which an item is to be reordered for replenishing the stock. Economic order of quantity

ECONOMIC ORDER OF QUANTITY(EOQ)

PURCHASING COST

CARRYING COST

ABC ANALYSIS (ABC = Always Better Control) This is based on cost criteria. It helps to exercise selective control when confronted with large number of items it rationalizes the number of orders, number of items & reduce the inventory. About 10 % of materials consume 70 % of resources About 20 % of materials consume 20 % of resources About 70 % of materials consume 10 % of resources A ITEMS Small in number, but consume large amount of resources Must have: Tight control Rigid estimate of requirements Strict & closer watch Low safety stocks Managed by top management

B ITEM Intermediate Must have: Moderate control Purchase based on rigid requirements Reasonably strict watch & control Moderate safety stocks Managed by middle level management C ITEMS Larger in number, but consume lesser amount of resources Must have: Ordinary control measures Purchase based on usage estimates High safety stocks

ABC analysis does not stress on items those are less costly but may be vital

ABC
A N A L Y S I S

ITEM %
10 %

ITEM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

ANNUAL COST [Rs.] 90000 50000 20000 7500 7500 5000 4500 4000 2750 1750 1500 1500 500 500 500 500 500 500 500 500

CUMMULATIVE COST [Rs.] 90000 140000 160000 167500 175000 180000 184500 188500 191250 193000 194500 196000 196500 197000 197500 198000 198500 199000 199500 200000

COST %

70 %

20 %

20 %

70 %

10 %

WORK SHEET

Issue/Distribution: Requisition or Drug-basket system: Par-level or Topping-up system: Exchange-cart system: Maintenance: Durability Periodical disinfection: Repairability: Spare-parts availability: Operation and Service Manuals: Service-contracts Stand-by-units:

 Disposal / Condemnation: Each hospital should also have a condemnation committee to review used materials that are to be disposed off. At times it is possible to recycle or reuse materials (e.g. IV bottles, polyethylene bags) or find some other use for the item (e.g. Torn linen, bottles for sample collection). In the case of equipment, cannibalization may be possible by removing parts of a machine that cannot be repaired and fixing the same to some other unit being rehabilitated. If no further use can be found for disposables, used consumables and damaged equipment, it may still have value as scrap. SWOT ANALYSIS STRENGTH A Lean JIT production system Organization wide resource Planning system In-house Knowledge Accurate and consistent flow of information Reduction in delays, costs and resources implication OPPURTUNITIES Re-education of workforce Old PCs can be replaced by New standardized and high tech PCs Integration of sustainable and resource use and waste methodologies THREATS Virus and hackers attacks on computer Breakdown of server hosting software WEAKNESS Inconsistent level of expertise and skills Heterogeneous PC portfolio (High Cost in Maintenance) Uneducated Workforce Cost of Software Packages

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