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Finalized project on shifa international hospital ltd. 16.5.2013   copy
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Finalized project on shifa international hospital ltd. 16.5.2013   copy
Finalized project on shifa international hospital ltd. 16.5.2013   copy
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  • 1. Page |1 Project Report on Total QualityManagement (TQM) of Shifa International Hospital Ltd. Total Quality Management (TQM) of Shifa International Hospital Ltd. Presented By Badar-e-Alam Anwar MBA (HR) 7th Quatar IN PARTCIAL FULFILLMENT OF MASTER OF BUSINESS ADIMINISRATION IN HUMAN RESOURSE MANAGEMENT PRESTON UNIVERSITY ISLAMABAD CAMPUS 5 June 2013
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  • 5. Page |5 Dedication This project is dedicated to all those people of the world who never let the candle of optimism to distinguish even in every in very crucial circumstance. To those who scarifies their comforts who set noble standards. To those who are hopeful that their efforts for good will be answered one day by Almighty Allah. To those who have love for humanity ... ... ...
  • 6. Page |6 MESSAGE FROM DR. ZAHEER AHMAD M. Pharm, M.D. PRESIDENT & CEO SHIFA INTERNATIONAL HOSPITALS LTD. I feel pleased and honoured to write this message on the occasion of First National Conference on “Patient Care Pharmacist” by the Department of Pharmacy, Shifa International Hospital. I heartily felicitate the team of Pharmacy Department and the management of Shifa International Hospital for conceiving and executing this idea. Healthcare in our times has undergone tremendous transformation and the term “Quality Healthcare” now refers to a process that represents functioning of various healthcare professionals in complete unison. Only this smooth functioning can help achieve the optimum welfare of the patient and result in a “product” that can be then referred to as “Quality Healthcare”. I am quite happy that like many other 'Firsts', the idea of First National Conference on Patient Care Pharmacist came from the “Team Shifa”. I cordially welcome and congratulate the worthy speakers who have made it to the conference and have become a part of this humble but much-needed beginning. God bless us with courage and vision to do good deeds, amen!
  • 7. Page |7 MESSAGE FROM SHAFQAT ALI HAMDANI. RPH CHIEF OF PHARMACY SERVICES SHIFA INTERNATIONAL HOSPITALS LTD. It is matter of great satisfaction that Allah (SWT) has bestowed us the courage to organize “1st National Conference of Patient Care Pharmacist”. On behalf of organizing committee I welcome you all on this historic event and first step to establish and achieve the pivotal role of pharmacists in health care system of Pakistan. The objective of the conference is to educate and train the pharmacists to take cognizance of its role as Patient Care Pharmacists to make dream of healthier Pakistan come true by changing health care system drastically. We seniors as a part of society need to set an example for young professional pharmacist to get inspiration from both educational and compassionate quality health care, commitment for patient to bring change. As worldwide there are massive changes in health care industry, and bright future is waiting for those competent professional pharmacists. Who dare and has belief, for such professionals Iqbal has said: ALLAH (SWT) accepts our endeavour. Aameen
  • 8. Page |8 CERTIFICATE OF APPROVAL This Project is submitted in the partial fulfilment of the requirement for the award of Master of Business Administration of Preston University Islamabad Campus. Submitted BY: Badar-e-Alam-Anwar Registration No: 1432-212048 7th Quarter MBA (HR) Evening Supervised BY: - APPROVED BY:- ___________________ _____________________ Dr. Perwez Nusrat Prof. Dr. Abdul Basit Chancellor of Preston University Islamabad Campus
  • 9. Page |9 DECLARATION BY THE CANDIDATE I hereby declare that the project work entitled “TQM of Shifa International Hospital Ltd.” submitted by me to Preston University Islamabad Campus. Badar-e-Alam-Anwar in partial fulfilment of the requirement for the award of the Degree of MBA in Human Resource Management is a record of an original work done by under the guidance of Dr. Nusrat Parwez. I further declare that the work reported in this project has not been submitted and will not be submitted, either is part or in full, for the award of any other degree or diploma in this institute or any other institute or university. (Signature of the Candidate) Badar-e-Alam Anwar Registration no. 1432-212048 Date: 5 June 2013
  • 10. P a g e | 10 Executive Summary The hospital was established by the assembly of doctors who were working in USA. It was integrated as Private Limited Company on 20th September 1987, as Private Company Limited it was converted as public limited company in 20th October 1989. This hospital is scheduled in Karachi, Lahore and Islamabad accumulation interactions. This hospital was fixed by a group of professionals working in USA. The hospital’s group (originator and supporter) reserved getting higher all from corner to corner the world. The Hospital by the time of aperture on June 26, 1993, over 400 plus sponsors supported, with a Rupee 500 million impartiality. Turn over this time the Hospital has not hired a single rupee from any other basis. Within three and half years, the Hospital's Block-A with a five storey structure, plus decorate slab area and a mosque with a total 100,000 square feet covered area was ready to take its first patient on June 26, 1993. Modest start from June 26, 1993, with eight consultants in seven specialties, has developed to more than 70 highly experienced consultants in approximately all specialties under one roof. Shifa International Hospital bid 150 IPD beds with superiority care and OPD facility in 35 different specializations. On the other hand, it is an everlasting journey. Shifa improved by people, bring durable motivated incessantly and uniqueness with every temporary instant. Now after more than one and a part decade Shifa International Hospital proudly rises as a representation of quality healthcare with its own brand name"SHIFA". In Short, Shifa observed exceptional dedication and devotion by their consultants, management and staff who worked hard to make Shifa a reality of its own.
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  • 13. P a g e | 13 ACKNOWLEDGMENT We bow in Gratitude to Almighty ALLAH, for giving us courage and wisdom to reach this point of completion. We thank our parents who had faith in us and supported us throughout our lives. In the end we would like to thank and praise our Supervisor Dr. Perwez Nusrat and family members who helped me for this project and made me capable of stepping into professional life with courage. THANK YOU Badar-e-Alam Anwar Specialization in HR Preston University Islamabad Campus
  • 14. P a g e | 14 Table of Contents Page No.s TITLE PAGES------------------------------------------------------------------------------------------15 MESSAGES---------------------------------------------------------------------------------------------67 APPROVEL SHEET------------------------------------------------------------------------------------8 DECLARATION OF THE CADIDATE --------------------------------------------------------------9 EXECUTIVE SUMMARY---------------------------------------------------------------------------10 ALSHIFA HOSPITAL MAP----------------------------------------------------------------------1112 ACKNOWLEDGEMENT-----------------------------------------------------------------------------13 RECOMMENDATION--------------------------------------------------------------------------------94 BIBLIOGRAPHY --------------------------------------------------------------------------------------95 QUOTE--------------------------------------------------------------------------------------------------96
  • 15. P a g e | 15 CHAPTER # 1 Objective and Scope of Shifa Page No.s Introduction--------------------------------------------------------------------------------------------------------------------25 Background--------------------------------------------------------------------------------------------------------------------25 Mission and vision------------------------------------------------------------------------------------------------------------26 Scope----------------------------------------------------------------------------------------------------------------------------26 Ethics Goal---------------------------------------------------------------------------------------------------------------------26 The Values---------------------------------------------------------------------------------------------------------------------27 Strategic Priorities -------------------------------------------------------------------------------------------------------------27 The Decomposition of Shifa----------------------------------------------------------------------------------------27 The Medical Affairs Department--------------------------------------------------------------------------------------------27 Department of Surgery-------------------------------------------------------------------------------------------------------27 Offices of Chief Operating Officers----------------------------------------------------------------------------------------28 Organization Decomposing Chart -------------------------------------------------------------------------------------------28
  • 16. P a g e | 16 Chapter # 2 TQM and Services Quality of Shifa & Miscellaneous Page No.s Total Quality Management Definition-------------------------------------------------------------------------------------30 Total Quality Management in Hospitals-----------------------------------------------------------------------------------30 Quality Management at Shifa International Hospital (SIH) -----------------------------------------31 Quality Policy------------------------------------------------------------------------------------------------------------------31 Quality Objective--------------------------------------------------------------------------------------------------------------31 Management practices at Shifa International Hospital ---------------------------------------------------------32 Management functions at Shifa international Hospital-------------------------------------------------------------------32 Planning------------------------------------------------------------------------------------------------------------------------32 Leading-------------------------------------------------------------------------------------------------------------------------32
  • 17. P a g e | 17 Organizing----------------------------------------------------------------------------------------------------------------------32 Controlling---------------------------------------------------------------------------------------------------------------------32 Executive Management committee-----------------------------------------------------------------------------------------32 Diversity Management at Shifa---------------------------------------------------------------------------------------------33 Ethical Management Practices at Shifa------------------------------------------------------------------------------------34 Centralized Mode of Management at Shifa--------------------------------------------------------------------------------34 Market stage-------------------------------------------------------------------------------------------------------------------34 Management skills------------------------------------------------------------------------------------------------------------34 Scientific Management -------------------------------------------------------------------------------------------------------34 Shifa as an Open System-----------------------------------------------------------------------------------------------------35 Social Responsibilities at Shifa International-----------------------------------------------------------------------------35 Shifa stake holders------------------------------------------------------------------------------------------------------------36 Vanguard Organization-------------------------------------------------------------------------------------------------------37 Type Z Management style at Shifa-----------------------------------------------------------------------------------------37 Inter Organizational Culture at Shifa---------------------------------------------------------------------------------------37 Theory Y-----------------------------------------------------------------------------------------------------------------------37 Employees Departmental Rotation-----------------------------------------------------------------------------------------37 Facilities at Shifa--------------------------------------------------------------------------------------------------------------37
  • 18. P a g e | 18 Chapter # 3 Internal and external service quality of Shifa & Miscellaneous Page No.s Shifa at Internal Services Quality------------------------------------------------------------------40 Cancer Centre------------------------------------------------------------------------------------------------------------------40 Medical Oncology-------------------------------------------------------------------------------------------------------------40 Radiation Oncology-----------------------------------------------------------------------------------------------------------40 Future Plans------------------------------------------------------------------------------------------------------------------41 Shifa at External Quality services-----------------------------------------------------------------42 Emergency Services----------------------------------------------------------------------------------------------------------42 Diagnostic Services-----------------------------------------------------------------------------------------------------------42 Laboratory----------------------------------------------------------------------------------------------------------------------42 Diagnostic Surgical Pathology----------------------------------------------------------------------------------------------42 Chemical Pathology-----------------------------------------------------------------------------------------------------------43 Haematology-------------------------------------------------------------------------------------------------------------------43 Blood Bank---------------------------------------------------------------------------------------------------------------------44 Flow Cytometry Lab----------------------------------------------------------------------------------------------------------44 PCR Lab(Polymerase Chain Reaction) -------------------------------------------------------------------------------------44 Microbiology Lab-------------------------------------------------------------------------------------------------------------44 Radiology Services------------------------------------------------------------------------------------------------------------45 General Radiology------------------------------------------------------------------------------------------------------------46 MRI(Magnetic resonance imaging)----------------------------------------------------------------------------------------46 CT-Scan(Computerized Tomography) -------------------------------------------------------------------------------------46 Digital Fluoroscopy-----------------------------------------------------------------------------------------------------------46 Ultra Sound ---------------------------------------------------------------------------------------------------------------------46 Nuclear Medicine-------------------------------------------------------------------------------------------------------------47 Pharmacy Services------------------------------------------------------------------------------------------------------------47
  • 19. P a g e | 19 Clinical pharmacy-------------------------------------------------------------------------------------------------------------48 Future goals-------------------------------------------------------------------------------------------------------------------48 Miscellaneous -------------------------------------------------------------------------------------------49 Shifa Heart Centre------------------------------------------------------------------------------------49 Cardiac MRI Service----------------------------------------------------------------------------------------------------------49 National Integrated Anticoagulation Service (NIACS) ------------------------------------------------------------------49 Patient Education Program---------------------------------------------------------------------------------------------------49 Heart Failure Service---------------------------------------------------------------------------------------------------------49 Lifestyle Improvement Initiative--------------------------------------------------------------------------------------------51 Cardiothoracic Surgery -------------------------------------------------------------------------------------------------------51 Neuro-care at Shifa------------------------------------------------------------------------------------------------------------51 Orthopedics--------------------------------------------------------------------------------------------------------------------51 Transplant & Urology--------------------------------------------------------------------------------------------------------52 Ophthalmology----------------------------------------------------------------------------------------------------------------52 Plastic Surgery-----------------------------------------------------------------------------------------------------------------53 Mother and Child Health----------------------------------------------------------------------------54 OBS/ GYNE-------------------------------------------------------------------------------------------------------------------54 Pediatrics-----------------------------------------------------------------------------------------------------------------------54 Pediatric Surgery--------------------------------------------------------------------------------------------------------------54 Shifa Center of Liver Pancreas and Biliary Sciences (LPBS) --------------------------------55 Gastroenterology--------------------------------------------------------------------------------------------------------------55 Critical Care & Pulmonary Medicine--------------------------------------------------------------------------------------56 Nephrology---------------------------------------------------------------------------------------------------------------------56 Allergy/ Clinical Immunology----------------------------------------------------------------------------------------------56 Endocrinology-----------------------------------------------------------------------------------------------------------------56 Psychiatry----------------------------------------------------------------------------------------------------------------------56 Dermatology-------------------------------------------------------------------------------------------------------------------57
  • 20. P a g e | 20 Nutrition Clinic----------------------------------------------------------------------------------------------------------------57 Anesthesiology and pain medicine------------------------------------------------------------------------------------------57 General Surgery---------------------------------------------------------------------------------------------------------------57 ENT-----------------------------------------------------------------------------------------------------------------------------58 Shifa Dental Clinic------------------------------------------------------------------------------------------------------------58 Nursing Care Services at Shifa-----------------------------------------------------------------------59 Maintenance at Shifa-----------------------------------------------------------------------------------60 Food & Nutrition Services at Shifa-------------------------------------------------------------------60 External Services Division----------------------------------------------------------------------------61 Shifa Medical Center, F-11, Islamabad--------------------------------------------------------------61 Shifa Medical Center, PWD, Rawalpindi -----------------------------------------------------------62 Community Pharmacies --------------------------------------------------------------------------------62 Laboratory Collection Points --------------------------------------------------------------------------63 Information Technology at Shifa---------------------------------------------------------------------63 Shifa Information Systems----------------------------------------------------------------------------63 EMR (Electronic Medical Record) -------------------------------------------------------------------64 Telemedicine--------------------------------------------------------------------------------------------64 Shifa Network-------------------------------------------------------------------------------------------65 Future Plans--------------------------------------------------------------------------------------------65 ERP (Enterprise Resource Planning) ---------------------------------------------------------------------------------------65 HL7( Health Level Seven) ---------------------------------------------------------------------------------------------------65 Rehabilitation & Home Health----------------------------------------------------------------------------------------------66
  • 21. P a g e | 21 Chapter # 4 Element of the Task Environment Page No.s Labour Supply--------------------------------------------------------------------------------------------------------------68 Employees at Internal Medicine---------------------------------------------------------------------------------------------68 Employees at Critical Care--------------------------------------------------------------------------------------------------68 Employees at section of Infectious Diseases------------------------------------------------------------------------------68 Employees at Psychiatry Section-------------------------------------------------------------------------------------------69 Employees at Neurology Section-------------------------------------------------------------------------------------------69 Employees at Dermatology Section----------------------------------------------------------------------------------------69 Employees at Cardiac Surgery Section-------------------------------------------------------------------------------------69 Employees at General Surgery Section------------------------------------------------------------------------------------69 Employees at Dentistry Section---------------------------------------------------------------------------------------------69 Employees at ENT Section--------------------------------------------------------------------------------------------------70 Employees at Ophthalmology Section-------------------------------------------------------------------------------------70 Employees at Urology Section----------------------------------------------------------------------------------------------70 Employees at Anaesthesiology Section------------------------------------------------------------------------------------70 Employees at Pediatrics Section--------------------------------------------------------------------------------------------71 Employees at other Branches------------------------------------------------------------------------------------------------71
  • 22. P a g e | 22 Chapter # 5 Costumer Clients Page No.s Short Time Patients-----------------------------------------------------------------------------------------------------------73 Long Time Patients-----------------------------------------------------------------------------------------------------------73 Chapter # 6 Suppliers Page No.s X-ray imaging equipment----------------------------------------------------------------------------------------------------75 Cardial equipment-------------------------------------------------------------------------------------------------------------75
  • 23. P a g e | 23 Kidney care equipment-------------------------------------------------------------------------------------------------------75 Operating room equipment--------------------------------------------------------------------------------------------------75 Radiation encology------------------------------------------------------------------------------------------------------------75 Neurological equipment------------------------------------------------------------------------------------------------------75 Chapter # 7 Competitors Page No.s AGA KHAN Hospital Karachi ---------------------------------------------------------------------77 Some General Information ---------------------------------------------------------------------------------------------------77 Operating Rooms --------------------------------------------------------------------------------------------------------------77
  • 24. P a g e | 24 Outpatient Services ------------------------------------------------------------------------------------------------------------77 Medicine------------------------------------------------------------------------------------------------------------------------77 Surgery--------------------------------------------------------------------------------------------------------------------------78 Pediatrics -----------------------------------------------------------------------------------------------------------------------78 Special Clinics -----------------------------------------------------------------------------------------------------------------78 Diagnostic Services-----------------------------------------------------------------------------------------------------------79 Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore------------79 Services & Facilities----------------------------------------------------------------------------------------------------------79 Medicine Department---------------------------------------------------------------------------------------------------------79 Future Competitors------------------------------------------------------------------------------------------------------------79 SAHARA FOR LIFE TRUST-----------------------------------------------------------------------------------------------79 Outpatient Department-------------------------------------------------------------------------------------------------------79 Inpatient Department---------------------------------------------------------------------------------------------------------79 Allied Facilities----------------------------------------------------------------------------------------------------------------80 Radiology-----------------------------------------------------------------------------------------------------------------------80 Pathology-----------------------------------------------------------------------------------------------------------------------80 Allied Facilities----------------------------------------------------------------------------------------------------------------80 QIH’s (Quaid-e-Azam International Hospital) --------------------------------------------------80
  • 25. P a g e | 25 Chapter # 8 Government Agencies Page No.s Central Board OF Revenue--------------------------------------------------------------------------------------------------82 Capital Development Authority---------------------------------------------------------------------------------------------82 The Completed Projects------------------------------------------------------------------------------------------------------82 The Continued Projects-------------------------------------------------------------------------------------------------------82 Income Tax It------------------------------------------------------------------------------------------------------------------82 Pakistan Medical & Dental Association-----------------------------------------------------------------------------------82 Bahria University, Islamabad------------------------------------------------------------------------------------------------82 Shifa College of Nursing-----------------------------------------------------------------------------------------------------83 Tameer-e-Millat Foundation-------------------------------------------------------------------------------------------------84 Chapter # 9 Progress Report of Shifa International Hospital Ltd. Islamabad Page No.s SIH Achievement Timeline--------------------------------------------------------------------------------------------------86 Statement of value addition--------------------------------------------------------------------------------------------------89 Horizontal Analysis-----------------------------------------------------------------------------------------------------------91 Vertical Analysis --------------------------------------------------------------------------------------------------------------93
  • 26. P a g e | 26
  • 27. P a g e | 27
  • 28. P a g e | 28 CHAPTER # 1 Objectives and Scope of Shifa Objectives and Scope of Shifa  Introduction Shifa Internaiontal Hospital Ltd. Background: Shifa international hospital was originated by assembly of doctors , it was incorporated on September 20 1987. It rehabilitated into Public limited company on October 12, 1989. This hospital has a covered area of 500,000 plus square feet, and begining the report by CEO who is the Board of Director of Shifa Hospital, COO, Medical Director Cheif financial officer assest the CEO. This Hospital takes experinced cowerd of consultants, Pharamedical staff and highly trained skills staff/empolyees providing the following services.
  • 29. P a g e | 29 Internal medicine Cardiology ENT Nephrology Neurology Oncology Pediatrics Urology Orthopedic Radiology Rehabilitation Gastroenterolog y Pulmonology Endocrinology Psychiatry General Surgery Ophthamology Obstrictics & Gynecology Body composition Analysis, Paracentesis Diagnostic and Therapeutic Cardiac Surgery, Cardiac Angiography, Angioplasty Holter Monitoring, Exercise Tolerance Test, Echocardiography, Carotid Ultrasounds and Doppler, Arterial and Venous Dopplers, Pericardcentesis Under Echo. ENT Procedures, Tympanometry, Audiological Screening Dialysis catheter placement, Hemo dialysis, Peritoneal dialysis Kidney biopsy, Slow extended dialysis, Pre-transplant work-up, Urine sediment examination Nerve Conduction Studies (NCS), EMG (Electromyography), Evoked Potentials (visual evoked/Somato sensory evoked) EEG (Electro Encephalo Graphy), Trans cranial Doppler (TCD) Botox Injections, Lumber Puncture Medical Oncology, Radiation Oncology, Chemo Therapy Neonatology, Pediatric Infection diseases, Pedratic Psychiatry, Pediatric Surgery, Pediatric Nephrology, Pediatric Gastroenterology, Pediatric Endoscopy. Kidney Transplant, Lithotripsy, General Urology Limb Lengthening Surgery, Arthroscopic Surgery, Joint Replacement Surgery,General Orthopedic Surgery. Sonology, Ultrasound, C.T. Scan, X- Ray Imaging, MRI, Fluoroscopy, Ultrasound Guided Biopsy, Bone Scan, Thallium Scan. Speech Therapy, Physiotherapy, Occupational Therapy Proctoscopy, Colonoscopy, Sigmiodoscopy, PEG Tube, Endoscopy , ERCP (Endoscopic Retrogratic cholingio Pancretography), Digestive and Liver Diease Thoracentesis, Diagnostic and Therapeutic, Pulmonary Function Test, Bronchoscophy, Pulmonology & Critical Care. Diabetic Clinic, Other Psychotherapy, Drug Addiction treatment, Depression, Psychosis Brest surgery, Laparoscopic surgery , Bariatric surgery, appendectomies, Laprotomies, General Surgery Children eye care, Cornea Transplant, intraocular lens implant, Diabetic eye care, General Ophthamology Normal deliveries, C-section, Antenatal care, Postnatal care, Gynecology This Hospital provide s 24 hours diagnostic & treatment services E.g. Clue blue Protocol, 24 Hours Ambulance, Operation Rooms, Emergency Services, Nutrition Clinic, Critical Care, Nuclear Medicine, Clinical Labs & Blood Bank.
  • 30. P a g e | 30 i. Mission & Vision Mission “To provide good quality medical care in all disciplines of medicine and surgery to all patients in a caring and compassionate manner by an outstanding team of healthcare professionals in an atmosphere conducive to our values and practice of good medicine” Vision Shifa International Hospitals Limited is established to provide the highest quality medical care to the people of Pakistan. Achieving a high level of quality is the result of many factors: • Medical Expertise • Clinical Excellence • State of the Art Technology • Caring People • Preventive Medicine • Health Care Management ii. iii. Scope: Shifa International Hospital Ltd. has foundation of the Quality Management system (QMS) illustrate their capabilities over and over again provides Products/Services that meet to the costumers and valid and rigid requirements and to operate with increases effectiveness and efficiency with on the whole aspire of attractive customer satisfaction. Ethics Goal They contain: • Customer Satisfaction • Service Quality • Sustain long term Viability
  • 31. P a g e | 31 • To Improve competitive position • To improve work Environment iv. The Values They contain: • Respect • Empathy • Truthfulness • Effectiveness • Quality • Intelligibility v. Strategic Priorities: • Physician Partnership and enhanced Clinical Quality • Provide seamless/Easy Access Care Delivery • Financial Strength/Viability • Strategic Growth vi. The Decomposition of Shifa The whole hospital processes are disintegrated into two major departments. • The Medical Affairs • Support Services. The medical Affairs Department is started by MD (Medical Director) and the Support Services Department is started by COO (Chief Opening Officer). These two departments have further divided into more departments and sub departments. 1. The Medical affairs Department It incorporates other departments similar to: a) -1. Department of Medicine This department further divided into more sections:
  • 32. P a g e | 32 • Section of Internal Medicine • Section of Pulmonolgy • Section of Cardiology • Section of infectious diseases • Section of Nephrology • Section of Neurology • Section of Radiology b) -2. Department of Surgery • General and Vascular Surgery Section • Orthopedic Surgery Section • Urology Section • Pediatric Surgery Section • Cardio Surgery Section • Neurosurgery Section • ENT Section • Plastic Surgery Section • Anaesthesia Section • Dental Surgery Section • Gynaecology Section • Emergency Room c) -3.Office of Chief Operating Officers It incorporates departments similar to: • Admin & General • Nursing Administration • Accounts and Finance • Pharmacy
  • 33. P a g e | 33 • Patient Services • Material Management & Purchase • Bio-Medical • Management information System • Maintenance and Plant Operations • Human Resources • Marketing services • House Keeping d) -4.Organization Decomposing Chart (Main Bodies) Hospital Administration Office of Medical Director Office of Chief Operating Officer Emergency Department
  • 34. P a g e | 34 CHAPTER # 2 TQM and Services Quality of Shifa & Miscellaneous TQM and Services Quality of Shifa & Miscellaneous 1. Total Quality Management Definition: Total Quality Management (TQM) is a comprehensive and structured approach to organizational management that seeks to improve the quality of products and services through ongoing refinements in response to continuous feedback. TQM requirements may be defined separately for a particular organization or may be in adherence to established standards, such as the International Organization for Standardization's ISO 9000 series. TQM can be applied to any type of organization; it originated in the manufacturing sector and has since been adapted for use in almost every type of organization imaginable, including schools, highway
  • 35. P a g e | 35 maintenance and hotel management. As a current focus of e-business, TQM is based on quality management from the customer's point of view. TQM processes are divided into four sequential categories: plan, do, check, and act (the PDCA cycle). In the planning phase, people define the problem to be addressed, collect relevant data, and ascertain the problem's root cause; in the doing phase, people develop and implement a solution, and decide upon a measurement to gauge its effectiveness; in the checking phase, people confirm the results through before-and-after data comparison; in the acting phase, people document their results, inform others about process changes, and make recommendations for the problem to be addressed in the next PDCA cycle. 2. Total Quality Management (TQM) in Hospitals: Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care. Contrary to popular belief, the TQM movements were not the start of concerns about quality in healthcare. The roots of quality assurance initiatives in healthcare extends at least as far back as the time of Florence Nightingales’ work during the Crimean War(1854-1856),when the introduction of nutrition, sanitation and infection control initiatives in war hospitals contributed to reduction in the death rate from 43% to 10%. TQM can be an important part of hospitals’ competitive strategy. Thus, TQM, which places on improved customer satisfaction, offers the prospect of great market share and profitability. TQM can be an important part of hospitals competitive strategy in quality of healthcare system. Hospitals in competitive markets are more likely to attempt to differentiate themselves from their competitors on the basic of greater service quality. Thus, TQM which places a heavy emphasis on improvement in Customer satisfaction index that offers the prospect of grater combines internal quality measures with value analysis and conformance to specifications. Acceptable quality services not only include direct medical services such as diagnoses, medicines, surgery and treatment but indirect operations such as administration and purchasing whose costs are reflected in what the buyer pays. It may also include Total Quality of performance that is directly related to healthcare safety, security, attitude of nursing and word boy, role of doctors in terms of ‘time’ includes appointment, delay time, service time, timing with regards to medical treatment and surgery. The Concept of Total Quality Management:
  • 36. P a g e | 36 Fig. 1, TQM structure People define quality in many ways. Some think of quality as superiority of excellence, others vies it as a lack of patient care and service defects. According to Crosby, quality is 'conformance to requirements'. (Zero defects). Today most mangers agree that the main reason to purse quality is to satisfy the customers. The American National Standards Institute (ANSI) and American Society Quality (ASQ) define quality as “The totality of features and characterizes of a care or service that bears on its ability to satisfy given needs”. The view of quality as the satisfaction of customer needs is often called fitness for use. 3. Quality Management System at Shifa International Hospital (SIH) i. Quality Policy The quality policy of Shifa International Hospital is to provide cost effective quality medical care to all patients, ensuring ethical practice of medicine. “Our quality objective is to continuously improve patient satisfaction” It is certified by ISO-9001, today everyone knows about ISO standardisation, the basic Principle of ISO is “write what you do and do what you write”. It means you writing and working should support each other. Quality service needs teams to make or more effective and efficient that brings the Standardisation and Quality. ISO-9001CERTIFIED ii. Quality Objective “Our Quality Objective is to continuously improve patient satisfaction”
  • 37. P a g e | 37 • Adequate time to be spent by physician so all aspects of patient disease are assessed and treated • Provision of separate examination rooms to provide patient with privacy and to decrease patient waiting time • Patient education to improve disease management which includes written materials and public seminars • Practice guidelines and clinical pathways developed for common diseases in Internal Medicine • Produce chart reviews to monitor compliance with new practice guidelines and clinical pathways 4. Management Practices at Shifa International Hospital (SIH) Since Shifa is an Organization where different people work for Pre-define goal. The management Practices Adopted at Shifa International. 1. Management Functions at Shifa International Hospital (SIH): a) Planning: The chairman of the Shifa, Dr. Zaheer Ahmad has a goal before him. He has plan to extend the hospital business activities all around the year. He thinks that 2005 was a profitable year for them. Their earnings increased up to 53%. Secondly, he has a vision to provide the best medical health care facilities to the people of Pakistan. b) Organizing: Different people from different backgrounds are working at Shifa. Their HR department is responsible for employees and giving them specific jobs. Mr. Shahzad Choudry, Senior Manger HRD is dealing with all these. c) Leading: Every section has a head to lead the others employees under him/her. There is one Head consultant and under him/her, two or more assistant consultants are working. Since there are many sections and each of these sections has the same level of Hierarchy. d) Controlling: To assure the Quality of the Services at Shifa, Different committees have been formed. These committees make sure that the rules are not being violated. The services are quality oriented. Different Quality assurance committees at Shifa included: 2. Executive Management Committee • Quality Assurance Committee • Nursing Quality Assurance Committee
  • 38. P a g e | 38 • ER committee • Internal Audit committee • Waste management committee • Social Welfare Affairs committee • Pharmacy Committee The QA (Quality Assurance) department is involved in developing and implementing effective quality based management systems, and quality improvement programs. It aims at developing solutions which are quality based and patient satisfaction. 3. Diversity Management at Shifa: The diversity is in: Race Tradition Work Culture Gender Subculture Diversity Group Work Place Ethics Style Religion
  • 39. P a g e | 39 4. Ethical Management Practices at Shifa People at Shifa believe in: • Respect • Compassion • Intergrity • Efficiency • Excellence • Transparency 5. Centralized Mode of Management at Shifa It is clear from the data given above the there is a strong centralized management at Shifa International Hospital. The CEO and chairman is the main person. The MD & COO come under the CEO. Then there is no Long Hierarchy chain of command at different departments and Sections. Different sections have a head and under that head many consultants and senior consultants are working. This chain of common shows that there is a strong centralized management at Shifa International. 6. Market stage: Right now, Shifa is a totally customer oriented organization. It started as a private sector unite in 1987. Its main concern is on customer satisfaction and care, in a compassionate way. It is a right now in the prosperity stage. 7. Management Skills Since it is a very huge organization, different employees come here with different skills. For example, Dr Zaheer Ahmad the CEO & chairman of the company has mission before him. Different doctors at different levels have key knowledge skills according to their field of specializations. (MD, FCPS, or having any other degree). These also gave relationships with the assistants or subordinates at different levels. For example a doctor from one department has a good relationship with the employees at the radiology or any
  • 40. P a g e | 40 other department. He has to see the reports of the patients. This depicts a level of human skills. 8. Scientific Management Obviously we find a scientific management sat Shifa. People with different jobs are working and their jobs are broken down into specific routines. There workers are fully trained and selected on a merit basis, then they a relationship among themselves to make sure that they are working in the proper manner. Each person is responsible for performing his own task which is designated to him. Each person is aware of His/her job. We also find bureaucratic management at Shifa where there is an implicate set of formalized rules and regulations Each Employee has to follow the Set of Rules. The organization has a well defined Hierarchy. Everyone knows that he or she is responsible to whom. Obviously, highly qualified doctors are selected and trained. 9. Shifa as an open System Obviously Shifa is an open system. It is using its HR, Financial and other resources, through managerial and technological abilities, to provide best medical care to the people. The system provides services to patients. To get feedback from the environment and stay with tough with the media, Shifa has a magazine named Shifa News International. The editor is MR. Amer farooq. The feedback and certain FAQ’s from the readers are encouraged in the “LETTER TO THE EDITOR “Section of the magazine. The “MEDIA PRINTING & RELIGIOUS “Department is there for this purpose. They also keep arranging different seminars on different health related topics to create awareness among the general public. 10. Social responsibilities at Shifa International The Shifa People are well aware of their social responsibilities. In the recent earth quake in Pakistan, Shifa contributed a lot. The rammer Millat Foundation of Shifa International Hospital has announced to adopt 2,000 children orphaned in the devastating earthquake that struck Pakistan and Azad Kashmir on October8. Muslims, the Voice of Muslims America 18th Nov, 2005 The Tameer-e-Millat Foundation has decided ti initiate a complete rehabilitation program for the affected children in a residential environment, “said TMF chairman Dr. Zaheer Ahmad while announcing the first major Initiative in Pakistan’s private sector for the rehabilitation and resettlement of those children who lost everything in the disaster. The unprecedented initiative has been named “Tameer-e-Jannat ( Building of Heaven)/He informed Muslims Weekly over telephone form Islamabad, Pakistan, that Tameer-e-Jannat is aimed at providing standardized living, brought up, education and training to 2,000 children initially for a period of 12years. He added that if the required support and funding was available, the TMF might adopt as many as 10,000 of these orphans. “We are offering ‘Sponsor in Child’s program to the well off and God-dearing individuals, families and institutions” said Dr. Zaheer while explaining the way his organization intends to raise funds from the project. Every sponsor, he said, will be
  • 41. P a g e | 41 asked to donate $1000/ child Annually for 12years to provide him/her all needs of life including quality education. Dr. Zaheer Ahmad, it may be recalled, is a respected Pakistani doctor who has spent all his life in the service of humanity. He set a new precedent in Pakistan’s history in the 1980s, when he founded Shifa Hospital in Islamabad. The state of the art hospital, costing hundreds of millions of dollars, toay is one of the best medical facilities in Pakistan which offers diverse and Quality services. In later years, Dr. Zaheer also founded Shifa Foundation which helps the deserving patients in Pakistan and the Tameer-e-Millat Foundation. Tameer-e-Millat Foundation has extensive experience in the education sector. Currently, it is running over 380 schools in rural areas of Pakistan where over 20,000 students are receiving education. The TMF says that because of its strong credentials, it is capable of shouldering this huge task. Daily Mail The Prime Minister Also appreciated the administration of Shifa International for taking care of over 100 injured from the affected areas and for providing them excellent care. He said the patients informed that they were well looked after. “Every individual has an important role in tackling this enormous challenge that confronts the nation. It has shown the capacity of the entire country to cope with such calamities,” he said. He also lauded the role of NGOs, individuals, national and multinational organizations and international community for reaching out the people affected by this tragedy.--- APP “Pak Tribine” ISLAMABAD, November 09(online): Prime Minister shaukat Aziz has said estimate of earth quake loss will be released on Thursday adding that the estimated loss will be presented in donor’ conference on November19. The Prime Minister was talking to journalist here Tuesday in Shifa International Hospital where he had gone to Inquire about the Health of those injured in killer quake. Health minister Dr. Naseer Khan and Secretary Health Syed Anwar Mehmood also accompanied the Prime Minister. Earlier, the Prime Minister Inquired about the health of injured quake survivors and disturbed Rs10000 each in cash among them. “We pay tributes to Private hospitals, which are providing free treatment to the injured survivors,” prime minister underscored. Besides we express gratitude to over sixty countries, which had extended help. The spirit demonstrated by the world countries particularly people of Pakistan in helping the quake affects is unprecedented, he remarked. Shaukat Aziz noted that treatment process of the injured people was moving ahead. Serious patients are being shifted here from the field hospitals. Health ministry has been
  • 42. P a g e | 42 directed to make rapid Arrangements for Wheel chairs and artificial limbs for disabled patients, he indicated. They also keep on organizing different seminars on different health related topics create awareness among the general public. They also reconstructed the “NALA” passing behind the main building. They had to suffer due to the wrong engineering planning of CDA. They had to lose 40 millions. But the reconstruction was self financed. 11. Shifa stake holders The social stake holders at Shifa are: • Shareholders • Customers • Employees • Society • Local Community 12. Vanguard Organization A vanguard organization is one which pays its social responsibility along with its other operations. A few companies or organizations in the world have attained this status up till now. Shifa tended to play its social duty during the 8th Oct earth quake of Pakistan. It contributed money, looked after patients and provided free medical treatment to them. It has proved itself in the queue of vanguard organizations. They are also keen about their environment. The Shifa people have planned to make the green belt before the hospital more beautiful, as it would make the capital more beautiful. They have passed this plan from CDA and stated working on it. They have one more plan to build a public park for general public and the patients as well. They are well aware of their social responsibility. 13. Type Z management style at Shifa Type Z theory of management is there where there is a medium pace career and workers are given some relaxation and some decision making ability is also given to them. The workers are allowed to some extent to make their own decisions in Theory Z management style. Obviously, when there is problem where the senior doctor or head is not present, the junior level doctors are allowed to take their own decision. They can solve the problem encountered. When the senior manager is not available, then the junior level manager is given the privilege to make his own decision. 14. Inter Organizational Culture at Shifa The inner-organizational culture at Shifa is relaxing. There is a dress code for the nursing staff, ward boys, housekeeping department and for the security guards as well, however, the doctors are to wear the white coat. The surgical staff has to wear blue-
  • 43. P a g e | 43 green dress. They also provide different types of training to newly hired as well as the old employees to make them more aware about different scenarios and situations. 15. Theory Y Theory Y implies that the workers are highly motivated and hard working. They are fully trained and using their full potential in achieving their goals. This is the assumption used at Shifa hospital. The workers are fully trained personnel in their field of specialization. Each and every one of them is equally responsible for the improvement and work. Different tasks are assigned to different workers and they are there perform these. The Hospital provides a 24 hour service, ensuring that the workers (doctors) are working at their full. 16. Employees Departmental Rotation Employees are subject to departmental rotation after 3-4years based on their experience, to increase their skills and knowledge. The employees at junior levels face more rotation. 17. Facilities at Shifa Shifa is right now providing transport, allowances, bonuses, dividend to their share holders. It also gives shields and certificates to the best performers. Different job incentives are also rewarded according to the efficiency and effectiveness of the employees. • Shifa Card • Shifa Lab Pickup Point. 18. Employees Shift Right now, 3 shifts at Shifa: • 7am-3pm • 3pm-11pm • 11pm-7am The employees can work in any shift which they find comfortable to work in.
  • 44. P a g e | 44 CHAPTER # 3
  • 45. P a g e | 45 Internal and External service quality at Shifa & Miscellaneous Internal and External service quality at Shifa & Miscellaneous  Internal Services Quality at Shifa: a) Cancer Centre: It was in the early 90’s, when the pioneers of Shifa International Hospital, made a critical decision to make available much needed state of the art medical treatment for cancer patients. The first phase of this commitment led to the opening of the first radiation oncology department in the private sector at Shifa International Hospital in 1994. This proved to be the focal point for development of additional cancer treatment facilities over the years, till the inauguration of a full fledged Shifa Cancer Center in 2012.
  • 46. P a g e | 46 b) Medical Oncology: The Center provides comprehensive medical oncology care for solid tumors and hematological malignancies, including chemotherapy and autologous/allogenic Bone Marrow Transplant (BMT). Inpatient care for chemotherapy, supportive care and treatment of emergencies and complications is available. Multidisciplinary Tumor Board is being held regularly at this facility. The Oncology Day Care Unit is a specially designed facility for patients suffering from various benign and malignant disorders. The Day Care Unit offers various diagnostic and therapeutic modalities including blood transfusions for patients with thalassaemia, other types of blood component infusion therapy and outpatient cancer chemotherapy for all types of malignant diseases. c) Radiation Oncology: The department of radiation oncology started with the installation of an advanced linear Accelerator, X-ray Flouroscopic Simulator and computerized 2.D treatment planning. It was probably the first department in the country where each patient underwent proper simulation and treatment planning along with custom made shielding devices. In the decade of 90’s Breast conserving treatment was initiated in Pakistan and made available to suitable patients with the cooperation of surgeon from Shifa and AKUH. A second treatment unit, a Cobalt 60 Phoenix (100cm Ssd) was added in 2004. Our Radiation Therapy services were expanded by the installation of a dedicated CT-simulator and a Linear Accelerator equipped with multi leaf collimeters in 2007. The dedicated CT simulator allows us to plan the radiation treatment and shape the dose precisely according to each patient’s individual anatomy, tumor size, shape and extent. The advanced digital Linear Accelerator with MLC enables to deliver precise radiation to the target with sharp field edges defined by two banks of 40 single focused leaves (collimeters) that can be positioned with an accuracy of 1mm. All patients are thus treated by 3-D conformal techniques. In addition this capability made it possible to start IMRT (Intensity modulated Radiation Therapy) in 2010 for prostate and head & neck cancer. IMRT is a significant development in the field of radiation therapy where the higher dose region can be shaped according to the shape and extent of tumor while reducing dose to normal tissues, thereby improving cure rates and reducing normal
  • 47. P a g e | 47 tissue damage. Shifa International Hospital is one of the only two centers in Pakistan providing IMRT treatment. The quality of radiation treatment and precision dosage is ensured at Shifa Radiation Oncology, by verifying all treatment plans using specialized dosimetry equipment. d) Future Plans: In near future we plan to acquire equipment and expertise to start Stereotactic radiation therapy, which will give us another tool to treat small tumors in the Brain, Lung, Spine, etc, with sharply focused beam, using a single or few high dose fractions, thus shortening the overall treatment time and further improving results. We also plan to acquire High Dose rate Brachytherapy equipment for intracavitary and interstitial irradiation.  External Quality services at Shifa 1. Emergency Services: Our new and expanded ER is a 24-bedded fully equipped, monitored unit which is staffed with ER trained Medical and Para Medical staff who are capable of dealing with all the major Medical, Surgical, Pediatric and Obs/Gyne emergencies. They are supervised and guided by seasoned consultants who have extensive experience in ER care. Separate area for Pediatric. Surgical and Medical patients are provided OT, Separate Procedure Rooms, Triages area, Pharmacy, Lab and adjacent Radiology Department are the highlights of our new ER. Level of the patient care and satisfaction is very high in this area.
  • 48. P a g e | 48 2. Diagnostic Services: By LIS it is possible to view every patient’s laboratory and all other parameters which are mandatory for accurate diagnosis. Moreover the department is equipped with latest Immunofluorescence techniques for diagnosis of renal and skin biopsies. This technique needs expertise and fluorescent microscope In this regard. The department is getting popularity in diagnosis of renal diseases as it is evident by continuous expanding workload. 3. Laboratory: Diagnostic services at Shifa International Hospital are rapidly enhancing to achieve the highest standards in the country. There are six subspecialties including diagnostic surgical pathology, Hematology, Blood Bank services, Chemical Pathology, Microbiology and immunology. These departments are rapidly expanding not only in terms of addition of new automated equipment but also with expert and qualified technical staff using them. These departments are working under direct supervision of experienced and foreign qualified consultants. We believe that the knowledge is ongoing process and are expanding it by continuous training abroad as well as conducting seminars for budding pathologists. 4. Diagnostic Surgical Pathology: The diagnostic surgical pathology has grown by leaps and bounds in the past few years and is one of the busiest departments in the country. We offer exfoliative cytology; fine needle aspiration biopsy in addition to routine histopathology. We have extensive panel of Immunohistochemistry antibodies for exact diagnosis of tumor. This panel is continuously expanding day by day. Tumor diagnosis is also made accurate by correlation with radiologic findings and clinical details by our modern Laboratory Information System (LIS). By LIS it is possible to view every patient’s radiology and all other parameters which are mandatory for accurate diagnosis. Moreover the department is equipped with latest Immunofluorescence techniques for diagnosis of renal and skin biopsies. This technique needs expertise and fluorescent microscope In this regard. The department is getting popularity in diagnosis of renal diseases as it is evident by continuous expanding workload.
  • 49. P a g e | 49 Nephrologists not only across northern area of country but also from Faisalabad, Lahore and Peshawar are sending this test here. Since department also provides specialized transport media which keeps biopsies fresh even for 2-3 days. Frozen section facility for quick intra-operative diagnosis is not only used by our hospital but also by adjacent large hospitals where this facility is not available. The diagnostic surgical pathology team includes six histopathologists with special expertise in renal, liver, breast, head, neck and hematopathology. The technical staff is highly trained and experienced going training programme for technicians. The department is all set to start fluorescence in situ hybridization technique (FISH) initially for Her2Neu for breast and gastric cancer followed by detection of common genetic abnormalities in other tumors. These are needed by our expert oncologists for planning exact treatment of cancer. This is our goal for the coming year. Tumor registry has also started from Jan 2012 which will be a source of reliable data for research of cancer affecting our population. Liver transplant at Shifa International Hospital has added another dimension to our pathology services as we are dealing with biopsies from donors and recipients as well as explanted livers. We hope to gain expertise in this area which is so far uncharted territory in this country. The surgical pathology department also runs a vibrant residency programme to obtain fellowship in this field, with a long list of applicant doctors awaiting entry. We aspire to become one of the best if not “The Best” departments in the whole country comparable to any in the developed world. 5. Chemical Pathology: Department of chemical pathology is utilizing the services of a fully automated state-of-the-art integrated chemistry analyzer. This performs routine and specialized chemistry tests including hormones and drug levels. Ever since its installation five years ago the scope of tests being performed on this instrument has been expanding with addition of newer tests every year. The department is also providing services in emergency rooms as stat chemistry tests which have facilitated health care delivery more efficiently. As liver transplant has started, the department is keeping pace with it providing results within minutes during surgery which facilitates the work of surgeons and anesthetists. 6. Haematology: In addition to routine hematology test, bone marrow biopsies, the department also offer complete set of immune testing for final diagnosis of lymphomas / Leukemias. Department is now recognized for getting fellowship in this specialty and training is also started. We have already started with plan of getting automation in most of sections as this will reduce human error and aid our pathologists for accurate and quick diagnosis. “Nephrologists not only across northern area of country but also from Faisalabad, Lahore and Peshawar are sending this test here. Since department also provides specialized transport media which keeps biopsies fresh even for 2-3 days.”
  • 50. P a g e | 50 7. Blood Bank: Blood transplant department is supporting big transfusion dependent venture of liver transplantation with successful completion of six critical patients who underwent liver transplant. It is also offering pre-storage leuko-depletion on request in addition to routine bone marrow stem cell separation and plasmapheresis. 8. Flow Cytometry Lab: This is the newest addition to the department of Pathology. Flow Cytometry Lab was recently established after two years through campaign to acquire a state-of-the-art Flow Cytometry. The instrument is 6-8 color laser equipment which is the first of its kind in the whole country. Now Pathology department is fully capable of rendering leukemia and lymphoma diagnosis according to the International Standards in a very short period of time. This process will facilitate the oncologists in their critical management decision. The Flow Cytometric analysis is performed by America Board certified hematopathologist. 9. PCR Lab (Polymerase Chain Reaction): PCR stands for polymerase chain reaction, which is a method for amplifying segments of DNA, by generating multiple copies using DNA polymerase enzymes under controlled conditions. As little as a single copy of the DNA segment or gene can be cloned into millions of copies, allowing detection using dyes and other visualization techniques. The process of PCR has made it possible to perform DNA sequencing and identify the order of nucleotides in individual genes. PCR techniques are applied in many areas of biotechnology including protein engineering, cloning, forensics (DNA fingerprinting) and for analysis of environmental samples. Shifa International Hospital recently also has established a stat-of-the-art PCR Lab for the diagnosis of infectious disease like Hepatitis B, C and genotyping. The lab is equipped with a fully automated walk-away instrument which helps in accurate diagnosis with least chances of any contamination. The results are interpreted by American Board certified Pathologists.
  • 51. P a g e | 51 10. Microbiology Lab: Microbiology lab is dealing with routine culture and sensitivity testing since the very start of our hospital providing the patient care and catering the needs of our Infection Control department. Since then it established and equipped TB lab which started functioning in 2005 catering the customer’s need for TB identification, 1st line TB Drug Sensitivity Testing (DST) and 2nd line TB Drug Sensitivity Testing. “Microbiology lab is dealing with routine culture and sensitivity testing since the very start of our hospital providing the patient care and catering the needs of our Infection Control department.” Department has Initiated new tests for Fabric Industry mandatory for export purposes in 2010 including Quantitative and Qualitative testing. Microbiology has started full range of viral detection including antibody status. Established and equipped a new PCR diagnostic lab in 2011 which is going to look after the rapid testing of Mycobacterium tuberculosis from smear positive pulmonary specimens. Tumor board meeting is one of the big achievements of the departments. As most of cancer patients are now discussed with whole panel of Oncologists, Radiologists, Pathologists and treating Surgeons before their treatment. In addition to routine Clinic opathologic conferences with departments of urology, nephrology and Gynaecology departments also conducts slide seminars monthly for training of junior pathologists all over the region. 11. Radiology Services: Radiology at Shifa supplements almost every critical specialty by facilitating in prompt and flawless diagnoses. Recent advances in modern technology have revolutionized the health care horizons particularly in the fields of diagnostic and interventional imaging. This has made early diagnosis and prompt treatment of almost all illnesses ever more feasible. This state of the art facility is staffed and run by a team
  • 52. P a g e | 52 of dedicated specialists consisting of Neuro, Interventional and diagnostic radiologists as well as ultrasound physicians and technical staff. 12. General Radiology: General Radiology at Shifa consists of four computerized radiography X-ray rooms capable of entire gamut of standard, general radiological exams transmitted to all Physicians on Picture Archiving and Communication System (PACS), at their respective clinics for urgent access. 13. MRI (Magnetic resonance imaging): A 24/7 facility in the heart of Capital City Islamabad, MRI at Shifa Radiology is Pakistan’s first wide bore MRI (Vantage Titan) with gantry size of 71 cm has patient focused features which significantly improve patient comfort and increase the range of patients who can undergo an MR exam. Claustrophobic and obese patients can now be imaged with this higher field strength MR as its wide bore provides a greater feeling of openness. Its technology dramatically reduces acoustic noise, the most significant cause of patient discomfort during an MR exam. Patients sensitive to contrast agents can now have excellent quality non-contrast MR angiogram. 14. CT-Scan (Computerized Tomography): CT stands for Computerized Tomography (commonly known as a CAT scan). The Aquilion ONE 640 slice CT-Scan, also first in Pakistan and South Asia with 16 cm of body coverage in single gantry rotation, is a latest addition to Radiology at Shifa. It images the entire brain and heart within 0.35 seconds with very low radiation dose. State of the art imaging of the stroke in single examination in only 50 seconds including a Non contrast CT, CT-Angiography, CTVenogram, 4D-Digital Subtraction Angiography and whole brain perfusion. This CT is capable of doing 4D dynamic imaging of joints and 4D Angiographies. 15. Digital Fluoroscopy: Digital fluoroscopy reduces the radiation dose through improvements in image quality and improved mechanical features. Better image quality and the ability to manipulate contrast and brightness reduce the number of images that must be obtained to complete a procedure. They also shorten procedure time and enhance patient throughput. 16. Ultra Sound: The Department is also equipped with state of the art Toshiba Xario ultrasound systems. Trans Rectal Ultrasound for evaluation of prostate, TRUS guided biopsies, local staging of Carcinoma Prostate, male infertility, 3D & 4D ultrasounds, fetal echocardiography and gray scale color Doppler are also unique ultrasounds services offered by Shifa Radiology.
  • 53. P a g e | 53 17. Nuclear Medicine: The section consists of dual head spect camera providing diagnostic options including cardiac, renal, endocrine and oncologic imaging. 18. Pharmacy Services: The Division of Pharmacy Services at Shifa international Hospital is not limited to the traditional role of just dispensing of medicines. The primary goal of the division of pharmacy services at Shifa international hospital is to provide safe and effective pharmaceutical care to patients in an efficient manner. Our first line Pharmacists, besides being involved in the traditional jobs of Dispensing medicines and maintaining inventories are involved in reviewing the patients therapy and intervening on, as and when need basis. Our pharmacists review each and every prescription for completeness and appropriateness of the medications and when required consult with the physicians to modify and correct the prescriptions if and when required. Previously the in-patients pharmacy (currently the central pharmacy) was located at A-0, and was working with a limited space and resources; most of the tasks were performed by various individuals due to which the tasks were partially fulfilled. There was limited space for extemporaneous compounding of medicines, and there was no proper sterile area for mixing of chemotherapeutic drugs or for preparation of sterile intra venous preparations. The pharmacy store (presently Pharmacy ware house) was also operating with limited area and resources. The division of pharmacy services has bloomed and expanded very rapidly, and has achieved many milestones in the previous few years. The Central Pharmacy has been shifted to the new H-0 location and has been expanded. The role of pharmacist has also been improved to provide better quality pharmaceutical care. The extemporaneous compounding area has been developed into a whole new setup with improved facilities and many new formulations have been added. The main conspicuous achievement of pharmacy is the establishment of a state-of the art, oncology sterile admixture area, in which specialized pharmacy personnel works to ensure the quality and safety of the prepared medications, which eventually improves the patient safety outcomes.
  • 54. P a g e | 54 The oncology area also boasts the achievement of dealing online prescriptions, which is an important step towards paper less environment, and it also ensures the timely dispensing of prepared chemo medicines. Modified labeling of the chemo has improved the handling of these medicines by adding warning signs like “cytotoxic medication”,” handle with care” “light sensitive” etc. The oncology sterile admixture area has been divided into two sections, one area has been dedicated for the day care chemotherapy bay, and the other area provides services to inpatients of chemotherapy. The pharmacy store has been developed into a “ware house” with improved systems and better storage conditions. 19. Clinical pharmacy: Clinical Pharmacy is a commonly used term in pharmacy practice. It is a health specialty, which describes the activities and services of the clinical pharmacist to develop and promote the rational and appropriate use of medicinal products and devices. There are following major areas where clinical pharmacy is focusing at SIH (Shifa International Hospital): • Indigenous System Development • Antibiotic Stewardship • Drug Information Resource • Drug intervention • Drug – drug interaction • LASA drugs • High alert medications • Doing pharmacy consultation Technology and transformation will revolutionize the pharmacy working and the health care delivery system. Development of indigenous system is one of the most challenging tasks, and requires deliberation and comprehensive efforts to develop that tool. SIH is working to develop such indigenous system that can support all pharmacists for clinical services. Clinical pharmacist is presently working on Antibiotic Stewardship. Antibiotics are the most widely prescribed and used medicines all over the world. Infections from various microbes and other organisms are responsible for most hospital and clinic visits. The most emerging danger for Antibiotic therapy is the development of resistance, which emerged over the years due to the irrational use of antibiotics Ultimate goal is to optimize the patient’s health-related quality of life, and achieve positive clinical outcomes, within realistic economic expenditures
  • 55. P a g e | 55 Future Goals:Develop a Drug Information Resource and its implementation, Drug Information and Poison Control Centre. The major future goal of the Pharmacy services division is to develop a computerized Physician Order entry system (CPOE system), to reduce medication errors and improve patient safety. Improve quality of service by providing counselling services to discharged patients and out patients. Add structured Clinical pharmacy rounds with consultants and physicians for better point of care pharmacy services.
  • 56. P a g e | 56 Miscellaneous 1. Shifa Heart Centre: Shifa Heart Center is busy in providing a wide range of general and specialized cardiac services, including but not limited to angiography, angioplasty, stents, intra aortic balloon pump, EECP and Cardiac MR. In fact the scope of our services encompasses critical areas and conditions and treatments of heart like Heart Failure, Interventional Cardiology/PCI, CHD/Valve Replacement, Peripheral Vascular Disease & Peripheral Artery Disease (PVD & PAD), Electrophysiology/Arrhythmias, Cardiac Imaging and Cardiac Rehabilitation. We are providing EP studies with Cardiac ablation, Cardiac Resynchronization Therapy and Implantable Cardiac Defibrillator. We have Cardiac CT (640 slice) that is advance and fast Technology and has made it possible to record coronary angiogram without placing catheters in the heart and without the risk associated with conventional coronary angiography. Shifa Heart Center including cardiology and cardiac surgery is considered one of the best heart health centers in Pakistan. We are into a fast expansion and improvement plan aimed at revolutionizing heart health facilities’ culture, some of the initiatives in this regard are mentioned below. a) Cardiac MRI Service: We are all set to offer this new and very exciting diagnostic modality full-fledged. It is currently being worked out and we hope we will be able to start the service with full strength in 4-6 weeks. Our goal is to establish a full time and dedicated cardiac MR and cardiac CT set up in next couple of years catering for the needs of the whole region. b) National Integrated Anticoagulation Service (NIACS): Anticoagulation is an important but unregulated and unmonitored therapy in our and most of the developing countries with sometimes catastrophic results. We are currently working on developing a comprehensive and integrated anticoagulation service in collaboration with our Hematology department and National University of Science and Technology (NUST) and Roche pharmaceuticals. Our aim is to provide an INR monitoring and appropriate dosage facility to our and other patients at their doorstep. Currently we are testing the INR testing portable equipment and also developing a software incorporating warfarin dosing algorithms. We have also arranged to acquire smaller strength warfarin for the patients. We hope after establishing the authenticity of the hardware and electronic algorithms, we will start a formal service by mid October, initially at the hospital and later through our outlets and other facilities throughout the region. c) Patient Education Program: We are currently working on a project to provide health education and information for general public in collaboration with NUST. This initiative is called IMPROVED or Improving Public Perception of Diseases. It will be in the form of pamphlets, newspaper articles, emails and mobile text. We hope to start it formally in October or November this year. d) Heart Failure Service: Chronic heart failure is widely prevalent condition with worst prognosis than certain cancers if not managed optimally. We intend to start a heart failure treatment optimization service for such patients in January next year. It will be supervised by the consultants and run by cardiology fellows and nurse practitioners. Patients will not only be provided support in the clinic but also through emailing, mobile
  • 57. P a g e | 57 text and telephones. It will be a unique and pioneering service and will help establish our hospital in providing extensive and comprehensive health provider. e) Lifestyle Improvement Initiative: In the New Year we are planning to start an initiative and research study to help improve cardiovascular risks in general population. We have termed it INCREDIBLE or Initiative for Cardiovascular Risk Reduction through Dietary, Behavioral, Lifestyle modifications and Exercise. We will be looking for sponsors for such milestone study. It will be aimed at mainly younger and middle aged population with multiple cardiac risks of the capital city and beyond. We will incorporate cardiac rehab program into this initiative and utilize our cardiac rehab facility as a centre for education and exercise program, obviously introducing people to our resources. Cardiothoracic Surgery This is now a firmly established unit, which has completed a decade of its services backed up with internationally comparable results. Ever since its inception, this unit has stayed abreast with technological advancements. We were equipped with most modern heart lung machine, cell saver, high class instruments and IABP from the beginning. We have a latest ultra modern and highly sophisticated new Heart Lung Machine. We also have two systems of Beating Heart Surgery i.e. Genzyme and Medtronic in place which is used in performing procedures on beating heart. f) Cardiothoracic Surgery: This is now a firmly established unit, which has completed a decade of its services backed up with internationally comparable results. Ever since its inception, this unit has stayed abreast with technological advancements. We were equipped with most modern heart lung machine, cell saver, high class instruments and IABP from the beginning. We have a latest ultra modern and highly sophisticated new Heart Lung Machine. We also have two systems of Beating Heart Surgery i.e. Genzyme and Medtronic in place which is used in performing procedures on beating heart. Neuro-care at Shifa:“Our neurologists are highly qualified and trained in different subspecialties. Electroencephalography, nerve conduction studies and electromyography and evoked potential studies are carried out on the latest digital EEG and EMG machines. The addition of a 640 slice CT scanner and an open MRI to the existing CT and MRI machines has further enhanced our diagnostic capabilities in Neurology. The neurology section is providing cartoid artery stenting in collaboration with interventional cardiologists and interventional radiologist”. g) Orthopedics: Orthopedic is a field of surgery in which meticulous care to detail especially with aseptic conditions is absolutely essential The equipment used in surgery has to be of possible highest standards as well the availability of taking X-rays on the specialized orthopedic table with image intensifier and power instruments are some state of- the-art facilities that are available to Orthopaedics at Shifa. The department is staffed with highly qualified US & UK trained surgeons with special interest in trauma and joint replacement surgeries as well as paediatrics and spinal surgeries. This section
  • 58. P a g e | 58 manages patients with musculoskeletal conditions such as bone and Joint injuries and degenerative joint diseases etc. It provides 24/7 trauma service to the Hospitals. Excellent results have been achieved in hip and knee joint replacement surgeries. Major procedures offered include management of fractures and dislocation, joint replacement, management of upper/ lower limb injuries, arthroscopy, arthrocentesis, muscle biopsy and management/correction of limb deformities. We have the honor of successfully performing the first ASI hip replacement surgery in Pakistan. Our Lead surgeon Dr Mir Amanullah Khan was assisted by Consultant Orthopedic Surgeon Colleague Dr. Sajjad Hassan Orakzai. Pioneering orthopedic surgeon Dr Erik De Witte from the General City Hospital (ASZ) in Aalst, Belgium, has specialized in these procedures. Since 2004, Dr De Witte, who retired on December 31, 2011 has performed the anterior supine intramuscular (ASI) approach in 3,500 hip replacements. Dr. Mir Amanullah Khan, Consultant orthopaedic surgeon at SIH, specializes in this approach for Total Hip Replacement surgery. He has been personally trained by Dr. De Witte in the intricacies of this procedure. Dr Khan has performed multiple combine procedures with Dr DeWitte, both in Belgium and UK. Unlike traditional minimally invasive hip replacement techniques, the ASI technique uses an incision at the front of the hip instead of the side or back of the hip. This modified incision placement allows surgeons to directly approach the hip joint by going between the muscles that surround the hip joint, rather than cutting them. Traditional approaches would require cutting the muscles and/or tendons that surround the hip. The ASI minimally invasive hip replacement procedure is designed to reduce the trauma to the tissues surrounding the hip joint. By preserving the muscles and tendons, surgeons may enable their patients to walk the day of surgery, to experience less postoperative pain, and to return to daily activities more quickly. The potential benefits of this technique include shorter hospital stays ( 2-3 days instead of 5-7), earlier mobilization ( same day walking), fast recovery, lesser blood loss, lesser pain and smaller incision (4-5 cm compared to 12-14cm with traditional incisions). h) Transplant & Urology: The treatment options provided by the section of Urology range from simple urinary tract infections, stones, prostate, diseases, infertility, and impotence to major urological cancer surgeries for kidney, bladder and prostate. All sorts of endourological procedures and re-constructive surgeries are done as well. The provision of renal transplantation has made this a comprehensive unit with internationally comparable results. Lithotriptor is available and helpful for patient with stones in kidney & urinary tract stones.
  • 59. P a g e | 59 i) Ophthalmology: Ophthalmology at Shifa has become a state-of-the-art tertiary referral center for various types of eye diseases. It is equipped with all the latest equipment for diagnosis and treatment of eye aliments. The section does corneal transplant surgeries besides phacoemulsification, refractive surgeries, glaucoma management, vitreoretinal surgeries, pediatric ophthalmology & diabetic eye care etc. j) Plastic Surgery: Plastic Surgery Clinic was established in 2009 with 2 fulltime consultants and one part-time consultant, who soon after joined Shifa as fulltime consultant. From 150 major cases a year in 2009, we have become a busy clinic with 600 major cases a year now (in 2011). Plastic surgeries are tertiary referred cases and primarily they include reconstruction (major or minor) and micro vascular free tissue transfer. Plastic surgery clinic had marked their 100th micro vascular case (free flap) on June 2012, mostly referred by Ear, Nose, Throat (head & neck reconstruction post cancer), Orthopaedic and General Surgery (sarcoma & breast cancer). Plastic Surgery Clinic got its registration with the College of Physicians & Surgeons Pakistan in 2010 and currently enrolled for residents for FCPS in Plastic Surgery. The clinic is looking forward for performing craniofacial (head or skull plus facial structures) surgery in future.
  • 60. P a g e | 60 2. Mother and Child Health a) OBS/ GYNE: The department of Obs/Gyne at Shifa International Hospital is one of the busiest and sought after departments. Being the only tertiary-care center in the north of Pakistan, it has become a referral center for the whole region. Obs/ Gyne department works in close collaboration with the department of Pediatrics, which makes it possible to save babies as small as 26-weeks old. The department centers almost all the major sub-specialties of Obs/ Gyne. It is amply equipped with almost all the main equipment for conventional surgical purposes. Besides equipment for conventional surgical procedures, we have the whole range of endoscopic instruments like hysterscopes, laparoscope etc. Laboratory facilities, Ultrasound, Radiology, and Fluoroscopic of the fallopian tubes, Mammograms, Antepartum and Intrapartum fetal monitoring are available 24 hours a day and seven days a week. The provisions of Spinal and Epidural analgesic are also available in the department round the clock. b) Pediatrics: Department of Pediatrics has been established since the beginning of Shifa International Hospital in 1993. The services available are out patient, inpatient, neonatal intensive care, pediatric intensive care. Department of Pediatrics has 73 beds, which includes 32 neonatal intensive care beds; there are about 3000 deliveries per year. 20 % of all the new born would need level-II or level- III care during their stay in the hospital. The pediatric Outpatient has turnover of more than 35,000 patients per year. The facility is considered to be the state of art in the region catering large area of northern Punjab, KPK, and AJK as well as neighboring Afghanistan. Department of Pediatrics have nine faculty members, all have post graduate degrees from USA, UK or Pakistan. The subspecialty services are offered in the disciplines of pediatrics gastroenterology and liver transplant, pediatric nephrology, urology, and renal transplant, pediatric hematology/oncology and bone marrow transplant. Two surgeons are on board that provide pediatrics and neonatal surgery, cardiac thoracic surgery. Department of Pediatrics has 19 postgraduates’ trainees and 6 house officers. Department provides primary care facility that includes routine check-up for the new born, vaccination, developmental assessment and treatment of common childhood illnesses Pediatrics emergency services provide 24 hours coverage via Emergency Department. Department of pediatrics is likely to have more beds in neonatal and pediatric intensive care units in near future., pediatric liver transplant service is expected to expand as people would come to know about this relatively new specialty in Pakistan. c) Pediatric Surgery: The section deals with the surgical treatment of children and newborn babies. It includes the surgery for all types of congenital and acquired diseases up to 12 years. Major procedures being performed include operations for complete anorectal, congenital defects of gastrointestinal tract and hernia repair, correction of undescended testes, hypospadias repair, cleft lip repair, all types of abdominal surgeries and correction of congenital birth defects.
  • 61. P a g e | 61  3) Shifa Center of Liver Pancreas and Biliary Sciences (LPBS): We are rightly proud of our success in the last quarter of the previous year in very critical area of Liver Transplant. We are the only hospital in Pakistan to have carried out successful liver transplant. We started this journey in May 2012 and have done many Hepatobiliary & Liver Transplants so far. One of our objectives is to set up a Center of Excellence for Liver Diseases in Children. We are in the process of equipping our facility with the service-specific technology and developing infrastructure to cope with the increasing demand for Liver Transplant that has virtually deluged us. Simultaneously we are in the process of hiring highest quality human resource in all areas and from paramedical staff to medical professionals like dedicated liver intensitivist, anesthesiologist, pediatric gastroenterologists and more surgeons. a) Gastroenterology: This is perhaps the busiest section of the department of medicine. It is equipped with the latest video equipment like Gastroscopes, Colonoscopes and Duodenoscopes. We are pursuing to become an academic centre of excellence in Hepatopancreatobiliary diseases. The division is actively pursuing expansion of the services and also involved in the extensive research activities.
  • 62. P a g e | 62 b) Critical Care & Pulmonary Medicine: Critical Care & Pulmonary Medicine has taken a new dimension at Shifa. In keeping with the International trends and concepts of “Closed ICU”, the patients are managed by the consultants trained in Critical Care and Pulmonary Medicine. The foreign trained and certified consultants are providing a variety of services to patients presenting with a variety of pulmonary problems. Bronchoscopy suite is equipped with two fiber optic Olympus Bronchoscopes. Other state of the art equipment includes new Raphael Silver Ventilators, Pulmonary Function Lab Vitalograph and BEARS Noninvasive Ventilator. We rightly take pride in the fact that after the expansion of our Critical Care Unit that is underway, we shall be offering 100 plus critical care beds which would be the largest number in a single hospital in Pakistan. c) Nephrology: Nephrology at Shifa is one of the key clinics of tertiary level care. Nephrology deals with the care of people having kidney disease of various stages, salt water and other electrolyte disorders and various types of therapies like dialysis and kidney transplant. Over a period of 20 years, Nephrology has grown up from a team of just two nephrologists to a team of three Nephrologists and eight FCPS trainee Fellows. Our fellows will start graduating from 2013. Dialysis at our unit was started soon after the start of the hospital. Our dialysis unit has grown up from just couple of machines to six machines about eleven year ago, and now we have 33 machines. The dialysis unit is open 24/7, even on the holidays. The number of the dialysis has increased from couple of hundred patients per month to 2000 per month. Our dialysis staffs are quite competent and hard working and eager to come up to the expectations of the patients. We have started CRRT treatments for critically ill patients. We also perform kidney biopsies and dialysis access of all kinds is made at our hospital period. We have an active living related kidney transplant program. Our next few years we would like to initiate peritoneal dialysis program. We would like to have a custom made dialysis unit with 50 stations and build a chain of satellite dialysis units in various parts of the country where our trained fellows can facilitate patients near to their homes and start their career in Nephrology. d) Allergy/ Clinical Immunology: The section of Allergy/Clinical Immunology caters to a wider number of allergies related afflictions including bronchial asthma, allergic rhinitis, allergic conjunctivitis, skin rashes/itching, allergic contact dermatitis, atopic eczema, allergic drug reactions, food allergies, pollen allergies and recurrent infections. The section led by an experienced board certified consultant, also conducts allergy skin tests with various techniques. Allergy vaccination injections (immunoa therapy) are also available. The Allergy clinic also deals with life threatening anaphylatic disorders and insect sting allergies, and also offers environmental control methods e) Endocrinology: Diabetes and its complications constitute a major segment of our patients coming to Endocrinology. At Shifa our Endocrinology department is busy in taking care of these and other endocrine patients. Teaching of insulin use, diabetic diet,
  • 63. P a g e | 63 diabetic foot care and prevention of the complications of diabetes are the areas where we are making a difference in the life of these patients. f) Psychiatry: The department of Psychiatry is recognized for its expertise in the provision of clinical, academic and therapeutic services to adults and old age people in the behavioral and psychiatric disorders. The department also offers personal psychotherapeutic care for individuals, couples and families with emotional and psychological distress. The department also offers long-term care to address drug addictions and related psychiatric disorders. The multidisciplinary team includes consultants with training from prestigious international institutions. g) Dermatology: Dermatology at Shifa provides best facilities for the diagnosis and treatment of skin, hair, and nail diseases. Electrocautery, cryotherapy and surgical procedures to remove moles, cysts and warts are some of the services being offered here. h) Nutrition Clinic: Nutrition is a scientifically rigorous discipline that focuses on the impact of food habits on health and disease management. Globally, nutrition is considered to be an integral part of the medical care of all patients. Nutritional therapy leads to a nutritional prescription, which may include an oral diet plan, anteral and parenteral nutrition for the caring of hospitalized and home patients. Latest dietary delivery techniques are used to administer nutrients both safely and effectively. Clinical services provided by the nutrition team includes; outpatient and inpatient consultation, home nutritional support educational programs for patients, clinicians and professionals. Additionally, our department offers special programs related to weight management, hyperlipidemia, diabetes, eating disorders and hypertension treatment. The program offered by the Nutrition Clinic is supported by the latest computer-based assessment that ascertains the exact amount of fat, lean body mass, water content and basal metabolism of the individuals, which can lead to very precise diagnosis and treatment. Every nutritional plan is tailored to the specific need of individual patients. i) Anesthesiology and pain medicine: Anesthesiology department is providing state-ofthe-art care for all types of surgical procedures, including but not limited to, adult cardiothoracic, congenital cardiac, neurosurgical, major vascular, transplant, general surgical, urological and Ob/Gyne surgeries. They are also providing anesthetic care to MRI, CT and ultrasound guided procedures etc. The department also provides additional anesthesia services like pre-anesthesia evaluation, epidural anesthesia, patient controlled analgesia, acute pain management and chronic pain management. Our anesthesiologists are highly qualified professionals who have been exclusively trained in US, UK and Pakistan. Our anesthesiology program is fully recognized for PG training by College of Physicians & Surgeons of Pakistan. The department has nine stateof- the-art Operation Theaters, which are equipped with the most modern and latest instruments and equipments. Excellent infection control is the hall mark of our operation theaters. Our Pain Management clinics cover prevention, treatment and alleviation of chronic and acute pain like cervical and lumbar radiculopathies, arthritis etc. We have modern modalities and highly trained therapists are available for managing pain. Patients of Cervical spondylosis, lumbar spondylosis etc. can get benefit from this service. Our pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. We are the only private hospital in the Capital City offering Pain Medicine facility.
  • 64. P a g e | 64 j) General Surgery: The surgical side of medicine has practically revolutionized the modern healthcare, especially with the addition of minimal invasive surgeries in different specialties. The department of surgery forms an essential part of any hospital and all the more so for Shifa because it is the only quality tertiary-care Hospital in the region. The section of General Surgery at Shifa offers variety of services by a strong team of seasoned surgeons. The section offers surgical solutions in a wide range of conditions like thyroid disease, breast, gastrointestinal tract and hepatico-pancreatic and biliary disease. The section has established itself as a centre of excellence in laparoscopic surgery where most of cholecystecomies are done utilizing this method, and service of laparoscopic hernia repair and routine appendectomies are being done also. Shifa being a tertiary care centre has inter-departmental cohesion and support enabling us to provide surgical care and procedures on high risk patients with multi body systems and compromised patients with challenging surgical problems. k) ENT: Section of ENT at Shifa, staffed by qualified and experienced consultants, is choice of many with problems of Ear, Nose and Thyroid. Presence of latest diagnostic equipment with video monitoring is making the diagnosis prompt, precise and cost effective. l) Shifa Dental Clinic: Dental department started functioning in 2001 with one surgery, two rooms and a reception. Since its inception it has grown manifolds. It is now housed in the state of the art modern purpose built facility that has 5 operatories equipped with German dental chairs, digital x-ray both intra and extra oral. The facility has a large waiting room and there is still room for expansion. Dentistry has its own central sterilization room equipped with type B latest autoclaves. Instruments are packed in pouches and autoclaved. There are 5 consultants and 2 medical officers.AII consultants are foreign trained and specialist in their respective areas of specializations like, Restorative dentistry, Implant dentistry, Prosthetic dentistry, Oral surgery, Pediatric dentistry, Orthodontics, Aesthetic dentistry and smile makeovers, Periodontology procedures involving root planning bleaching and teeth whitening and Endodontics. As multi-specialization dental centre the work load and quality of care has increased over five times and continues to grow.
  • 65. P a g e | 65 1. Nursing Care Services at Shifa: Nursing care is vital to the process of healing. World Health Organization’s expert committee on nursing defines the nursing services as the part of the total health organization which aims to satisfy major objective of the nursing services that is to help prevent disease and promote health through service excellence. Congruent with the philosophy and core values of best nursing practices, Shifa International Hospital and its Nursing Division reflects the beliefs in a set of core values that are fundamental excellence in services, shared and upheld by the nursing management and staff and other clinical partners. Shifa International Hospitals envision creating a centre Of excellence in nursing services and education. Nursing management aims to establish core competencies necessary to achieve the primary goals of increasing capacity, establishing new standards, communication, assessment, critical thinking and innovative approaches of nursing professionals, while utilizing an advanced array of technical skills. These are being specifically designed to inculcate competency in nurturing nursing leaders to meet challenges of the profession globally as well as in culturally sensitive environment nationally. To fulfill this mission, at Shifa we are committed to nurturing an innovative, dynamic and socio-culturally relevant model of nursing services. It has also developed the standards of interventions for prevention of patient fall, pressure ulcers, and hospital acquired infections. Shifa nursing division had dedicated infection control nurses to ensure safe environment for patients during their stay at Shifa. This has contributed to a gradual decline over the year in infection rate at the Hospital. It has also helped the individual departments to formulate empirical antibiotic treatment strategies and cost reduction in treating infections by the identification of causative sources. Also the practice has helped in changing attitudes of all healthcare providers on board over the years and has made them more sensitive towards the infection control policies and protocols at Shifa International Hospitals. Studies have found a strong correlation between the availability of human resources in the healthcare field and health outcomes in a country. There is evidence that an increase in nurses and midwives decreases the rate of infant and maternal mortality. This relationship is significant in Pakistan as there is a high incidence of infant and maternal mortality. Nursing division at Shifa is committed to achieving service excellence and has reached the nurse-patient ratio as prescribed by the International Council of Nursing. Similarly, there is a growing body of evidence showing that nurses prepared through BScN program bring unique skills to their work and play an important role in the delivery of safe patient care. A clear link has been identified between higher levels of nursing education and better patient outcomes. This extensive study found that surgical
  • 66. P a g e | 66 patients have a “substantial survival advantage” if treated in hospitals with higher proportions of nurses educated at the BScN or higher degree level. Acknowledging the need of higher levels of nursing education and better patient outcomes, Shifa nursing division has inducted BScN qualified nurses and currently we have more than fifty nurses with BScN degree working in different inpatient departments. Recognizing the need to create a professional nursing workforce and to improve the standard of nursing and competence of nurses at Shifa, especially those working in critical care areas are being offered on-going refresher courses, and one year specialized training in cardiac intensive care and trauma management. Moreover, the nursing leadership is also focusing on retention of qualified nurses and their development, by encouraging them for specialty certifications and higher professional education i.e. B.Sc. Nursing and M.Sc. nursing degree programs. To seek accreditation from Joint Commission International (JCI) there is a focus on program improvement of healthcare facility, research has been initiated that would be thematic and relevant to the national needs in disciplines of health sciences and human resource development in the context of healthcare needs of the people of Pakistan. Continuous professional development for managerial and nursing staff is being offered by Nursing Education Services Department through Quality management programs. To promote evidence based practices, nursing management has developed area specific key performance indicators, and encourages participation of nurses in internal and external audits for quality assurance. 2. Maintenance at Shifa: Shifa continues to focus on ways to provide a comforting hospital environment beyond patient and visitor’s expectation, through employing best available machinery/ equipment for air conditioning and electric power generation. SIH is the only hospital, unlike majority healthcare service providers, which provide round the clock uninterrupted air conditioning, electricity and other utility services to its patients and visitors. This is not only a physical relief; it helps keep the hospital environment infection free as well. For more than 700,000 square feet area, 5 electric power generators of 1MW capacity each ensure availability of reliable and continuous power supply for round the clock. Availability of uninterrupted power supply to the hospital not only guarantees reliable operation of precious life saving medical equipment but also contributes towards enhancement of patient confidence in our services. Similarly, almost 1800 ton air conditioning round the clock services contribute to the patient safety by eliminating infection risk and also serves a multiplier of patient comfort. Maintenance department ensures provision of these services through preventive and corrective maintenance programs to improve operational efficiency, equipment life and safety. 3. Food & Nutrition Services at Shifa: The goal of possible optimum care cannot be achieved without taking care of patients’ nutritional needs. Food & Nutrition Services (FNS) at Shifa takes care of nutritional and dietary needs of admitted patients, attendants, outdoor patients, visitors and employees. Inpatients are counseled about their diet on regular basis by FNS dietitians according to the patient’s diagnosis. The goal is to promote the nutritional awareness and optimize the chances of early recovery by providing food according to individual conditions.
  • 67. P a g e | 67 It is ensured that highest standards of hygiene are maintained at all times, from preparation to serving the food. Similarly, special emphasis is put on ensuring that all food handlers are free from infection and contagious conditions. They are medically checked for fitness regularly. In addition to its primary responsibility of preparing and serving food for patient’s individual condition and need, FNS also organized in house banqueting for different functions. There are five cafeterias to serve patients, visitors and employees. 4. External Services Division: External Services Division (ESD) at Shifa has been created to expand service outreach to make quality healthcare accessible to different demographic and geographic segments of society, by establishing quality benchmarks in primary, secondary, and tertiary healthcare. Due to variety of factors, including diverse geography and social fragmentation, many communities within Pakistan face severe limitation in their access to medical care. Shifa realises that private sector’s role and contribution to strengthen healthcare delivery channel is ever increasing. Shifa believes that ease of access and outreach of quality healthcare services is the main determinant to ensure wellbeing and health of social communities. ESD has been working upon to explore frontiers all across Pakistan to open primary and tertiary care hospitals, consulting clinics, diagnostic centres, laboratory collection points, and retail community pharmacies. Establishing and expanding quality healthcare facilities at one end are associated with commitment and dedication. On the other hand, capital and physical infrastructure is also a prerequisite to accomplish service outreach. Shifa, being socially responsible organisation is determined to overcome these challenges to contribute value to the society. ESD’s service portfolio comprises diagnostic facilities by establishing Laboratory Collection Points and Stat laboratories at different locations, Radiology services, Community Pharmacies, secondary and tertiary care hospitals, and consulting clinic setups to provide consultancy services in different medical and surgical specialties. Currently we have our presence in one or the other of these forms at 32 locations in Islamabad, AJK and Punjab and KPK provinces. 5. Shifa Medical Center, F-11, Islamabad
  • 68. P a g e | 68 F-11 Markaz was strategically chosen as a location for the medical center to facilitate residents of F-10, F-11, E-9, G-10, G-11, Rawalpindi and surrounding areas by delivering quality services at reduced time/traveling cost. This facility offers services in a variety of medical and surgical specialties along with laboratory tests, x-ray, ultrasound, dentistry, and an onsite pharmacy. OPD specialties: - Internal Medicine - Family Health - Obstetrics/ Gynecology - Pediatrics - Pulmonology - Dermatology - Dentistry - ENT - General Surgery - Ophthalmology - Nephrology – Physiotherapy 6. Shifa Medical Center, PWD, Rawalpindi PWD Society was strategically chosen as a location for the medical center to facilitate residents of Behria Town, DHA, Canyon Valley, Naval Anchroage, Pakistan Town, Post Town and surrounding areas by delivering quality services at reduced time/traveling cost. This facility offers services in four major medical specialties along with laboratory tests and an onsite pharmacy. OPD specialties: - Internal Medicine - Family Health - Pediatrics – Dermatology 7. Community Pharmacies: Shifa has conceived idea of establishing a community pharmacy chain all across Pakistan. The point of differentiation at Shifa’s community pharmacy would be centred to offer patient counselling and education by empowering communities to better manage their medicine administration needs, rather than solely focusing on traditional selling concept. The presence of community pharmacists at each outlet equipped with required skills and competence would deliver professional services to the masses. In compliance with Shifa’s vision, ethical medical practices have been given foremost importance by procuring and managing authentic and reliable products in line with the efficacy standards and guidelines by Pakistan Drug Act. To cater to diverse buying needs of customers, Inventory categories at retail pharmacies also includes wide range of products and brand besides medicines, vaccines, and surgical, which includes cosmetics, optics, beverages, baby care and food products. At present, pharmacy outlets are operational in Islamabad, Rawalpindi, Mirpur, Jhelum, Gujrat, Faisalabad, and Lahore.
  • 69. P a g e | 69 8. Laboratory Collection Points: One of the unique elements of community pharmacy network is association of diagnostic facility, in form of Laboratory Collection Points, at each pharmacy outlet. Shifa believes that outreach of quality laboratory diagnostic facility is crucial to facilitate physician’s communities in determining disease diagnosis and treatment plan. The diagnostic laboratory test range covers segments of biochemistry, microbiology, blood bank, haematology, and histopathology. The purpose behind establishing a network of Laboratory Collections Points is to provide reliable and authentic laboratory diagnostic services to facilitate referring physicians’ community and ultimately patients. In this regard, ESD has been operating franchisee Laboratory Collection Points, along with opening self-owned setups at more than 20 cities in Punjab, and Khyber Pakhtoon Khowa. Besides, opening laboratory collection points in different cities, stat laboratories will also be established at different locations to ensure efficient lead time and same day reporting. In this regard, Shifa’s first external laboratory setup has already been in-placed at Women and Children Hospital at Faisalabad. 9. Information Technology at Shifa: Information technology is vital for healthcare industry, improving the flow of information within a healthcare organization is becoming a quality differentiator among healthcare providers. Fundamental to the success of investments in IT, is to understand the strategic goals of the organization and understanding how IT, from technological and organizational perspectives, can help to achieve them. 10. Shifa Information Systems: The IT Department at Shifa International hospital has developed Shifa Information Systems that are providing new ways for physicians to readily access and use health information from different sources, thus increasing the ability of physicians and other clinical staff to readily access and use the right
  • 70. P a g e | 70 information about their patients to improve patient care. Switching from a paper-based system to a fully automated workflow system or combining the two has saved institution money, errors, time and even lives. The aim is to provide the hospital with a method to find certain patterns in their data that foster profitability, efficiency, proactive decision making, and competitive advantage. IT in Shifa has made significant progress during the year in developing and implementing new and better ways to improve patient safety, time saving, reducing medical errors, communication and documentation of clinical care and test results and information processing. Some of the major initiatives are: a) EMR (Electronic Medical Record): The electronic medical record system has been successfully developed that gives a single source for viewing all relevant patient information from all aspects of clinical care. The information contained in the EMR is updated on a real time basis. The EMR system gives physicians and nurses instant and immediate access to a complete, computerized record of current patient care and clinical procedures. This enhances accessibility to required patient data and includes following features: • Electronic order placement • Medications • Vital signs • Progress Notes • Allergies • Reports • Test Results • Historical patient data • Graphical display of data The system is user-friendly and will make physicians and nurses more productive by simplifying the important elements of healthcare delivery. The result is a quicker path to effective care management and measurable quality gains. PACS (Picture Archiving & Communication System), In accordance with our goals regarding the implementation & integration of a fully functional Picture Archiving and Communication System (PACS) which has the capability to communicate with our existing Radiology Information System using standard HL7 messaging with all our modalities has been successfully tested. A massive Storage Area Network has been deployed to cater all our needs. Currently thirteen pilot clinics are running a web based PACS services integrated to the HMIS. All such efforts are put in place to facilitate the care givers complete,
  • 71. P a g e | 71 accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making to enhance the quality and reliability of healthcare delivery. b) Telemedicine: Telemedicine has been introduced at Shifa International Hospital to enable the patients as well as a doctor to communicate with a consultant who may be 100 miles away. This will provide equal access to medical expertise irrespective of the geographical location of the person in need. As timing is critical in healthcare, telemedicine will provide emergency care in real-time and on demand, without transferring patients, when time is of the essence. Telemedicine will make quality healthcare cost-effective by reducing costly transfers and travel and lowering the burden on patients and families. This will also speed up the referral process by reducing unnecessary referrals. It is part of Shifa International Hospital (SIH) horizontal expansion program. c) Shifa Network: To augment the overall efficiency and productivity of the HMIS, the infrastructure is always under exhaustive improvement. The network backbone within the Shifa International Hospital Main premises has been upgraded to 10 GB Fibre Optics Links with advance core switches. The Wide Area Network (WAN) connecting the remote Hospitals, Medical Centres, Laboratory Pickup Points and Pharmacies have been enhanced to more secured and reliable connections, supported through advanced authentication mechanisms. For the ease of control of all such locations advanced remote control applications have been deployed. To support such a big IT infrastructure issues are tracked and monitored online. Advanced auto installations of end users systems have been deployed to minimize the downtime. To stay abreast with the ever changing technological changes in the world, new avenues have been researched upon, which include 64 bit Operation Systems, Oracle 11g Infrastructure, Hardware based Firewalls, Unified Mail Servers etc. d) Future Plans:1. ERP (Enterprise Resource Planning): The need for organization to assess how they are performing against generally accepted standards and against their peers is essential. The dependence on Business intelligence (BI) tools is eminent. The key objective is to integrate all our Information systems into single software i.e. an ERP system comprising of finance/accounting, human resource management, payroll, material requisition, FNSD etc. This will facilitate the flow of information between all business functions within Shifa International Hospital. 2. HL7 ( Health Level Seven) : HL 7 stands for ( Health Level Seven) and will be implemented in order to make the various health care information systems interoperable to share data for better health care and clinical research. It will facilitate information sharing within the hospital and also at cross enterprise level. This will allow utilizing the resources efficiently and expedite the processes of the hospital. As Shifa International Hospital adopts new IT innovations and initiatives, it will see the proven cost benefits and it will also see improved care and patient outcomes. Information technology has the potential to enable a remarkable transformation in providing health care, making it safer, more effective and efficient. Organizations have already realized major gains through the implementation of multifunctional, interoperable Health information technology systems. The promise of information systems that put together comprehensive data from patient care is great. The world is
  • 72. P a g e | 72 evolving. The business world and the medical world are merging into Health Business Intelligence in order to provide the best services to the customers and consumers. The best services are provided for the benefit of the end-users. With the development of various technologies, human life is all set to get comfortable and with minimal health risks. 3. Rehabilitation & Home Health: The Rehabilitation department caters to patients having physical and medical problems. It endeavours to bring back the independent living style of individuals who suffer consequences of some mishaps or innate problems. The following services run in the Rehabilitation department of Shifa: • • • • • Physical Therapy Occupational Therapy Speech Therapy Orthotic Help Hydrotherapy We have a Home Health program through which we provide Home Base Physiotherapy delivery of medicines and phlebotomy services.
  • 73. P a g e | 73 CHAPTER # 4 Elements of the Task Environment
  • 74. P a g e | 74 Elements of the Task Environment Labour Supply: Labour Supply comprises those individuals which are employable by an organization. The people at Shifa are mostly USA qualified Professionals who have an Urge to serve the People at their most with an objective. Labour supply at Shifa International consists of Dr. Zaheer Ahmed, Chairman & CEO, Dr. Manzur Qazi, MD (Medical Director), Syed Illyas Ahmad COO (Chief Operating Officer) 1. Employees at Internal Medicine Name Qualification MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA Consultant Consultant Consultant Consultant Consultant Consultant Consultant Consultant Qualification Dr. Mazhar A.Mufti Dr. Tara Jaffery Dr. Amer Nazir Ahmed Dr. Sabeen Mufti Dr. Amjad Suhail Dr. Mohammad Ata Dr. Mahmud Majeed Dr. Mohammad Iqbal Position Position 2. Employees at Critical Care Name Dr. Syed Arif Hussain FRCP Dr. Mohammad Anwar MD, DABIM,USA Dr. Shazli Manzur MD DABIM,USA Dr. Aftab Akhtar MD DABIM,USA Consultant Critical Care & Pulmonary Consultant Critical Care & Pulmonary Consultant Critical Care & Pulmonary Consultant Critical Care & Pulmonary 3. Employees at section of Infectious Diseases Name Qualification Dr. Muhmud Haider MD, DABIM Dr. Kh. Sayeed Ahmad MD, DABIM Position Consultant Infectious Diseases Consultant Infectious
  • 75. P a g e | 75 Dr. S. Nayyar Mahmud MD, DABIM Diseases Consultant Infectious Diseases 4. Employees at Psychiatry Section Name Dr. Rizwan Taj Dr. Fawad Kaiser Dr. Mohammad Amin Dr. Mohammad Habib Qualification MRCPych UK MRCPych UK FRCP CANADA MD DABPhych, USA MRCPych UK Position Consultant Psychiatry Consultant Psychiatry Consultant Psychiatry Consultant Psychiatry 5. Employees at Neurology Section Name Dr. Ali Hassan Dr. Arsalan Ahmad Qualification FCPS MD Neurology Pakistan Position Consultant Neurology Consultant Neurology 6. Employees at Dermatology Section Name Dr. Razzan Khan Dr. Ikramullah Khan Dr. Rasheed Choudry Dr. Ahsan Hameed Qualification PhD Food & Nutrition MRCP, UK D.DERM, Pakistan FCPS, Pakistan Position Consultant Nutrition Consultant Dermatology Consultant Dermatology Consultant Dermatology 7. Employees at Cardiac Surgery Section Name Dr. Khalid Rasheed Dr. Munir Ahmed Dr. Javed Hayat Qualification FRCP, UK FRCP, IRE FRCP, IRE Position Consultant Cardiac Surgery Consultant Cardiac Surgery Consultant Cardiac Surgery 8. Employees at General Surgery Section Name Dr. Tahir Hussain Dr. Mohammad Iqbal Dr. Mussadiq Khan Dr. Tahira Farooq Mirza Qualification FCPS, Pakistan FRCS, UK MD DABS, FACS USA EMS, USA Position Consultant General Surgery Consultant General Surgery Consultant General Surgery Consultant General Surgery
  • 76. P a g e | 76 Dr. Tahir Saleem Dr. Mohammad Amir FRCS DLS IRE FRCS UK, FRSP Pakistan Consultant General Surgery Consultant General Surgery 9. Employees at Dentistry Section Name Dr. Shahid Mehmood Dr. Noreen Arshad Qualification BDS Pakistan BDS Pakistan, MSC UK Position Consultant Dental Surgery Consultant Dental Surgery 10. Employees at ENT Section Name Dr. Zafar Iqbal Dr. Zaffar Rabbani Dr. Zulfiqar Ali Qualification DLO Pakistan MCPS, FCPS Pakistan FRCS, UK Position Consultant ENT Consultant ENT Consultant ENT 11. Employees at Ophthalmology Section Name Dr. Farooq Afzal Dr. Kamran Hamid Dr. Zeba Matin Qualification FRCS, FRCO UK FCPS UK FCPS Pakistan, FCPS UK Position Consultant Ophthalmology Consultant Ophthalmology Consultant Ophthalmology 12. Employees at Urology Section Name Dr. Ajaz Sami Dr. Saeed Akhtar Dr. Mian Khalid Akbar Dr. Asim Masood Choudry Dr. Mukhtar Nasir Dr. Kamran Majeed Qualification MD DABO USA MD DABO USA FRCS UK FRCS, D. USA MD DABO FACS USA FRCS UK Position Consultant Urology Consultant Urology Consultant Urology Consultant Urology Consultant Urology Consultant Urology 13. Employees at Anaesthesiology Section Name Dr. Harris Baig Dr. Mohammad Sami Iqbal Dr. Masooma Syed Dr. Bushra Noman Dr. Mohammad Iqbal Memon Dr. Rashid Mehmood Dr. Mohammad Ashraf Dr. Mohammad Nasir Ayub Khan Qualification Position MD DABO USA MD USA MD USA MD USA FCPS Pakistan Consultant Anaesthesiology Consultant Anaesthesiology Consultant Anaesthesiology Consultant Anaesthesiology Consultant Anaesthesiology MD DABO USA FCPS Pakistan FCPS Pakistan Consultant Anaesthesiology Consultant Anaesthesiology Consultant Anaesthesiology
  • 77. P a g e | 77 14. Employees at Pediatrics Section Name Dr. Rehana Syed Dr. Ejaz A. Khan Dr. Munir Iqbal Malik Dr. Iffat Fatima Zaman Dr. Khawaja Ahmed Abbas Dr. Musarat Hussain Dr. Kamran Khattak Dr. Anwar ul Haq Qualification MD USA MD DAPB USA MD, DAPB USA MD, USA DCH FRCP FRCPCH UK MD DABO USA MRCP UK FCPS Pakistan Position Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics 15. Employees at other Branches Name Syed Munir hussain Bukhari Mr. Wazir Mohammad Mr. Aqeel Mir Mr. Mohammad Shahid Tanvir Mr. Mohammad Aslam Shahzad Choudry Mr. Ahsan Hassain Ms Nuzhat Sultana Mr. Anis Alam Mr. A D Zia Maj. R Qaser Rafiq Mr. Rafiq Choudry Mr. Afzal Ahmed Mr. Azmatullah Qureshi Col. R Saeed Ahmed Mr. Amer Farooq Postion GM Finance Manager Account & Finance Associate Manager Purchase Assistant Manager Material Management Sr. Manager Patient services Sr. Manager, Human Resources & Development Manager MIS Manager Nursing GM Allied Services Manager Food & Nutrition Services Manager Bio Medical Services Sr. Manager Maintenance Sr. Manager Marketing Manager Media Associate Manager Security Editor Shifa Pulications
  • 78. P a g e | 78 CHAPTER # 5 Customers & Clients
  • 79. P a g e | 79 Customers & Clients Lists of customers of Shifa International hospital are Definitely Patients. People having health problems and suffering from any illness are patients. Now there are two Categories of patients. • Short time patients • Long time Patients 1. Short Time Patients Short time patients Include people suffering from Typhoid, Malaria, Cholera or any Dentistry Problem. 2. Long Time Patients Long term Patients include mothers on family way, Patient suffering from Cancer, Diabetes, Ulcer or High BP. These Patients need to go for a check up after certain Periods and are placed in the long term period. A person suffering from cancer undergoes many treatments (radiations) and Diabetic has to check his sugar level after certain time. Kidney Dialysis Patients also come in the long term category. They need to undergo a dialysis after a certain period of time. Mothers on family way also need to go for medical check up after several weeks. Patients of plastic surgery might not be the long term patients. They just make it once. Heart Patients (Cardiology Section) also need to go for a complete check up after some months. These are Different categories of Patients. There are certain patients who after recovering and discharging, may be prescribed a routine visits, in order to make sure that the relapse does not happen to them.
  • 80. P a g e | 80 CHAPTER # 6 Suppliers
  • 81. P a g e | 81 Suppliers A group of suppliers would include those people who provide services to the Shifa Hospital to run its operations effectively. Since it a big hospital and the number of suppliers would be a bigger one if mentioned all of them. However some of the suppliers are mentioned: Description A X-RAY IMAGING EQUIPMENT CT Scanner Laser Imager Processor X-Ray Film Processors Ultrasounds B CARDIAL EQUIPMENT Integris Sc4000- Digital Angiography ECG & Stress Test ECHO- Cardiography C KIDNEY CARE EQUIPMENT MFL 5000 Hemo Dialysis Equipment D OPERATING ROOM EQUIPMENT Multipurpose Operating Table Defiblirator Servo Ventilator Hanalus Operating Light System Operating Table Laparoscopic Equipment Plastic Surgery Equipment Ultrasonic Cleaner Sterilizer 666 E RADIATION ENCOLOGY Linera Accelerator Simulator Cobalt 60 F NEUROLOGICAL EQUIPMENT Suppliers Name Toshiba Japan Kodak-USA Japan/Germany Toshiba Japan Phillips Holland USA Japan Toshiba Japan Phillips Holland Gambro Swedan Siemens Germany Siemens Elma Sweden Siemens Elma Sweden Siemens Elma Sweden Siemens Elma Sweden Storres Germany MISC Siemens Germany Siemens Germany Phillips Holland Toshiba Japan MDS Canada
  • 82. P a g e | 82 EEG Toshiba Japan EMG Toshiba Japan G Other Equipment Pulmonary Function analyzer Fukuda Denshi Co. Blood Gas Analyzer NOVA USA Hemathlogy Analyzer Abbott USA Leica Microscope LEICA Germany Video Endoscopes for Gastroenterology Olympus These are the major equipment which helps Shifa People to run their system and Impart health care services. CHAPTER # 7 Competitors
  • 83. P a g e | 83 Competitors We find two Competitors of Shifa International Hospital. • AGA KHAN Hospital Karachi • Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore 1. AGA KHAN Hospital Karachi Some General Information This provides High-Quality Patient care in a broad range of Secondary and tertiary care services. This academic media centre’s professional Staff and Facilities are among the best in the region Modern patient care is made possible through collaboration between various health professionals and provision of State-of –the –art equipment to support diagnosis and treatment. Care is available to all patients in need.  Services & Facilities at AGA KHAN A) Operating Rooms • Main: 8 • Lithotripsy and Day Care: 4 • Obstetrics Labor: 2 B) Outpatient Services • Emergency • Consulting Clinics
  • 84. P a g e | 84 C) Medicine • Allergy • Cardiology • Dermatology • Endocrinology and Diabetes • Gastroenterology • General Medicine • Hematalogy • Infectious Diseases • Nephrology • Neurology • Oncology • Pulmonary • Rheumatology D) Surgery • Cardio-thoracic • Dental • Ear Nose Throat • General Surgery • Maxillo-Facial • Neurosurgery • Ophthalmology (Eyes) • Orthopaedics(Bones)
  • 85. P a g e | 85 • Pediatric Surgery • Plastic Surgery • Urology including make Infertility • Vascular Surgery E) Pediatrics • Cardiology • Gastroenterology • General • Hematology and oncology (Blood disease / Cancer) • Infectious Disease • Nephrology (Kidney) • Obstetrics/ Gynaecology and Infertility • Psychiatry (Mental Health) • Family Medicine • Community health Centre – low cost Walk-in clinics F) Special Clinics • Anesthesia • Brest Screening • Cleft Palate • Colostomy • Dietary/Nutrition • ENT Head and Neck Cancer • Executive Clinic- Annual Health screen Programme. • Family Planning • Liposuction • Lithotripsy (Stone in Kidneys)
  • 86. P a g e | 86 • Nasal Allergy • Physiotherapy • Speech Therapy • Stoma Care • Surgical Day Care G) Diagnostic Services • Clinical Laboratory • Blood Bank and Blood Products • Clinical Chemistry • Hematology • Histopathology • Microbiology 2. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore  Services & Facilities at Shaukat Khanum Memorial Cancer Hospital and Research Centre 1. Medicine Department The Clinical Area Include: • Medicine • Surgery • Anestheiology • Pediatric • Pharmacy • Radiation Oncology • Nuclear
  • 87. P a g e | 87 • Radiology • Pahology • Nursing Future Competitors: SAHARA FOR LIFE TRUST a) Outpatient Department (OPD) • Internal Medicine • 20 beds Emergency/Trauma centre • Surgery • Pediatrics • Gynecology and Obstetrics • Cardiology • Liver and Kidney Clinic b) Inpatient Department • Obs/Gynae Ward • Male Medical Ward • Female Medical Ward • Male Surgical Ward • Female Surgical Ward • Pediatrics Ward • Paeds isolation Ward • Nursery • Dialysis Centre • Coronary care Unit
  • 88. P a g e | 88 • Intensive care Unit • Operation Theaters • Labor Room • Private Rooms c) Allied Facilities • 4 state of the art and modern operation Theatres. • • • Dialysis Unit Free medicine provided to all the poor and deserving indoor and outdoor patients. Free catering for all indoor patients. d) Radiology • X-Ray • Ultrasound • Color Doppler e) Pathology • 24 hours Service Laboratory • Blood bank facility f) Allied Facilities • 24 hours free ambulance service for poor patients • Laundry, Incinerator and Mortuary • Permanent Staff accommodation • Help Line managed by duty medical officers to respond to the queries of the callers.
  • 89. P a g e | 89  QIH’s (Quaid-e-Azam International Hospital) It is one of the future competitors; It is right now in the process of construction. It is located near Frobles, Peshawar Road, Rawalpindi. CHAPTER # 8 Government Agencies
  • 90. P a g e | 90 Government Agencies The government agencies, with which Shifa operates, are: 1. Central Board OF Revenue Shifa International Hospital Operates under CBR, for paying of its taxes and other bills. The taxes include income taxes, Dispense taxes and other miscleaous taxes. Since, under ordinance Act, some of the taxes are exempted and some are to be paid off. 2. Capital Development Authority Shifa is located in H-8/4 Islamabad. It is working on many extension projects like expansion of certain wards and construction of certain departments. All these plans have to be approved by CDA. Right now many under construction projects are: 3. The Completed Projects • Floor G-5 • Under Deck IPD for Social work • Block D • Block E1 • Block H1 • Block H2 • Block H3 • Block H4 • Block H5 • Block F2 & F3 (for radiology department)
  • 91. P a g e | 91 • Block D1 4. The Continued Projects: Today, the hospital’s Block-A along with Block-B and partially constructed Block-C and Block-G sprawled on its site is efficiently functioning with already finished covered area of 315000 square feet. 5. Income Tax It: It is also an income tax authority with which Shifa operates. 6. Pakistan Medical & Dental Association: The Shifa College of Medicine is recognized by PMDC and it was approved in 2003. The PMDC has the name of Shifa College of medicine in its approved lists of colleges. 7. Bahria University, Islamabad: The Shifa College is affiliated with Bahria University for its BDS degree. The final BDS degree is awarded by Bahria University. The University also Implements rules and regulations of PMDC is govern the professional MBBS examinations, syllabi and academic standard of the college. A) Shifa College of Nursing (SCN): It is a project of Shifa foundation, committed to health education and providing free health care to the needy.SCN is in collaboration with Shifa College of Medicine. The BSCN program is built on the premise that enables the nurse to make critical decisions and providing care to the people. It is following under the rules of PNC (Pakistan Nursing Council). A four year program which help in basic nursing courses.
  • 92. P a g e | 92 B) Tameer-e-Millat Foundation TMF was established in 1987 by a group of USA Pakistanis. The Organization is a registed body.Since TMF is a charity based organization. All decision related to palnning and implementations of projects are taken by Borad of Governors. The policy guide lines are also provieded by BOG( Board Of Governors). It has recently launched an education prgrame to help people in getting ideas and its mean aim is to educate masses.
  • 93. P a g e | 93
  • 94. P a g e | 94 CHAPTER # 9 Progress Report of Shifa International Hospital Ltd. Islamabad Progress Report of Shifa International Hospital Ltd. Islamabad 1. SIH Achievements Timeline 1987/1989 & 1993: 1994/1995 1996 1998/1999 & 2000 2001 2002 & 2003 2004
  • 95. P a g e | 95 Shifa Idea Lap Chole Conceived started-1987 1994 02 modular satellite clinics in Rawalpindi Shifa College of Medicine (SCM) Started– 1999 LPP’s in 17 cities of Pakistan Master Plan Design Completio n/ Construct ion Started1989 Inpatient beds increased from 33 to 80 Inpatient beds increase from 80 to 112 SIH made profit of 2.1 Million Rs as compare to a loss of 19.5 million last year ISO 9002 certification June 26, 1993 Opening of Hospital 8 clinics Offered Corneal Transplant & Total Knee Transplant Cardiac Bypass initiation Formation of Shifa Dental Clinic Kidney Transplant Service initiation2001 Oct 1993 Opening of inpatients beds, 36 beds Establish ment of Block ‘B’ for OBS/ GYNAE & NICU Total Hipbone Replaceme nt initiation– 1996 Introducti on of Radiation Therapy Total Knee Replacem ent–1995 Operations disrupted by Floods – 2001 Purchased Fluoroscopy , X-Ray Unit, Ultrasound Unit, Helical Spiral CT Scan SIH’s senior consultant cardiology has been appointed to the curriculum developmen t committee for cardiology training for FCPS students NEW ECG, EMG & TCD equipment for Neurology Opening of new 45 ICU beds Commissio ning of new Cobalt machine for radiation therapy (recovery from July 23, 2001 flood) Both SIH radiation oncologists were Launched Rehabilitatio n Center Gallup Pakistan survey state that 96% patients of Shifa are satisfied with Shifa services LPP’s in 36 cities of Pakistan Launched new MRI Facility
  • 96. P a g e | 96 first time ever in Pakistan private Hospitals Total clinical space = 25,250 sqft appointed by CPSP for FCPS curriculum developmen t for radiation therapy training program SCM first batch graduated – 2003 First Baby Mahnoor Sheikh born 1993/1994 New structural space = 37,390 sqft Shifa College of Nursing (SCN) started–2004 10 Years of healthcare service delivery Completio n of Block A& Service Launch Completio n of Block ‘G’ Mosque 2005 2006 2007 2008 2009 2010 2011/2012
  • 97. P a g e | 97 Induction of EECP (Enhanced External Counterpu lsation) Machine Sep 15, Opening of pharmacy at Jehlum Psychiatry departmen t initiated the Pakistan chapter of world association of biological psychiatris ts Nov 08, Prime Minister Shaukat Aziz Visited Revenue touched Rs. 1 Billion – 2006 Induction of stateofthe art computeri zed machine backup battery to assure service delivery in power failure Acquire latest version of Linear Accelerato r for cancer treatment Launched Cancer Center Building June 29, Opening of Emirates Global Islamic Bank’s branch at Shifa Acquired MRI 1.5 Tesla Titanium Launched Cancer Center Building Acquillium HIP bone 320 replacement (virtual 640) slice CT Scan machine Acquire latest version of Linear Accelerato r for cancer treatment Launched Cancer Center Building Nuclear Medicine Telemedicine Bone Marrow Transplant initiation2010 27 Ramadan, August 28, 2011Opening of Faisalabad Hospital Revenue touched Rs. 3 Billion – 2011 Revenue touched Rs. 2 Billion – 2010 Liver Transplant
  • 98. P a g e | 98 Revenue touched Rs. 4 Billion – 2012 2. Statement of Addition 2012 Rs. in thousand % Value added Total revenue inclusive of other income 4,451,781 Supplies and other operating costs 2,437,491 Total value added 2,014,290 Value allocated To employees Salaries, wages and other benefits 1,412,807 To Government Income tax, sales tax and federal excise duty etc. 179,712 10 To society Donation 15,100 1 To providers of capital 75,771 Dividend to shareholders 145,876 Finance cost of borrowed funds 221,647 16 Retained in the Company 185,024 7 Total value allocated 2,014,290 100 2012 2011 % Rs. in thousand 3,412,688 1,814,855 1,597,833 70 1,047,850 9 159,366 1 20,000 4 7 151,541 112,018 11 263,559 9 107,058 100 1,597,833 66 9 16
  • 99. P a g e | 99 2011
  • 100. P a g e | 100 3. HORIZONTAL ANALYSIS 2007 BALANCE SHEET 07 Rs 2008 07 Vs. 06 Rs 08 Vs. % EQUITY AND LIABILITIES Paid up capital Capital reserve - share premium Unappropriated profit Shareholder’s equity Surplus on revaluation of PP&E Non current Liabilities Current Liabilities (23) Total 505,138 40,000 163,040 708,178 226,041 691,969 553,599 2009 09 Vs. 08 505,138 40,000 269,998 815,136 223,250 860,180 425,358 28 7 1 32 29 1,797,488 11,424 396,193 11 515,013 2,179,788 28 2,323,925 1,308,300 13 1,652,459 (1,107,027) 18 (1,344,782) 7,829 (2) 12,230 209,103 (9) 319,907 (66,360) 66 (86,996) (28,641) (51) (78,230) 114,103 Rs 66 15 (1) 24 2,323,924 1,773,567 10,028 PROFIT & LOSS ACCOUNT Operating revenue 26 Operating costs 21 Other operating income 56 Operating profit 53 Finance cost 31 Tax 173 Net profit Rs 69 10 (1) 89 19 2,179,787 ASSETS Property, plant and equipment Long term deposits 14 Current assets 30 Total 7 % (12) 154,681 2010 10 Vs. 09 Rs 2011 11 Vs. 10 % 24 9 (1) 5 55 15 14 (28) 19 15 505,138 40,000 549,929 1,095,067 597,730 732,354 1,027,811 3,452,962 2,720,993 10,296 721,673 3,452,962 Rs 36 2012 12 Vs. 11 505,138 40,000 350,663 895,801 612,089 794,603 536,835 2,839,328 2,283,028 12,170 544,130 2,839,328 % 30 10 174 (8) 26 22 27 7 6 22 505,138 40,000 435,691 980,829 604,909 832,994 833,641 3,252,373 2,594,352 8,820 649,202 3,252,374 % 26 12 (1) (12) 23 6 5 17 11 6 505,138 40,000 742,132 1,287,270 590,551 1,669,350 1,106,987 4,654,158 3,469,388 22,065 1,162,705 4,654,158 % 35 18 (1) 128 8 35 28 114 61 35
  • 101. P a g e | 101 1,948,835 18 (1,652,684) 23 20,103 64 316,253 (1) (109,119) 25 (79,478) 2 127,656 (17) 2,555,759 (2,155,203) 10,971 411,527 (91,041) (131,506) 188,980 31 30 (45) 30 (17) 65 48 3,412,688 (2,942,407) 12,928 483,209 (115,680) (108,929) 258,600 34 37 18 17 27 (17) 37 4,451,781 * (3,944,838) ** 14,812 521,756 (150,800) *** (110,161) 260,795 30 34 15 8 30 1 1 Comments: i. Revenue earned during the year under review increased to Rs. 4,451.8 million from Rs. 3,412.7 million as compared to last year due to increase in IPD facilities, increase in revenue of external pharmacies and lab pick up points. ii. With the increase of more utilization of services as well as increase in operating costs of the new recently opened SIH Faisalabad, external pharmacies and lab pick up points, the operating cost also increased to Rs. 3,944.8 million from Rs. 2,942.4 million during the year under review. iii. Due to substantial increase of new borrowings during the year finance cost increased to Rs. 150.8 million from RS. 115.7 million As compared to last year.
  • 102. P a g e | 102 4. VERTICAL ANALYSIS 2007 2008 BALANCE SHEET EQUITY AND LIABILITIES Paid up capital Capital reserve - share premium Unappropriated profit Shareholders’ Equity Surplus on revaluation of PP&E Non current Liabilities Current Liabilities Total Rs % 505,138 40,000 163,040 708,178 226,041 691,969 553,599 2,179,787 23 2 7 32 10 32 26 100 505,138 40,000 269,998 815,136 223,250 860,180 425,358 2,323,924 22 2 12 36 9 37 18 100 ASSETS Property, plant and equipment Long term deposits Current assets Total 1,773,567 81.4 10,028 0.5 396,193 18.1 2,179,788 100 1,797,488 11,424 515,013 2,323,925 77.4 0.5 22.2 100 PROFIT & LOSS ACCOUNT: Operating revenue Operating costs Other operating income Operating profit Finance cost Tax Net profit 1,308,300 (1,107,027) 7,829 209,103 (66,360) (28,641) 114,103 2011 Rs 100 85 1 16 5 2 9 2009 Rs % 2010 Rs 505,138 40,000 350,663 895,801 612,089 794,603 536,835 2,839,328 18 1 12 31 22 28 19 100 505,138 16 40,000 1 435,691 13 980,829 30 604,909 19 832,994 26 833,641 26 3,252,373 100 505,138 40,000 549,929 1,095,067 597,730 732,354 1,027,811 3,452,962 2,283,028 12,170 544,130 2,839,328 80.4 0.4 19.2 100 2,594,352 79.7 8,820 0.3 649,202 20 3,252,374 100 2,720,993 78.8 10,296 0.3 721,673 20.9 3,452,962 100 % Rs % 15 1 16 32 17 21 30 100 % 1,652,459 (1,344,782) 12,230 319,907 (86,996) (78,230) 154,681 2012 Rs % 505,138 11 40,000 1 742,132 16 1,287,270 28 590,551 13 1,669,350 36 1,106,987 23 4,654,158 100 3,469,388 74.5 22,065 0.5 1,162,705 25.0 4,654,158 100 100 81 1 20 5 5 10
  • 103. P a g e | 103 1,948,835 100 (1,652,684) 85 20,103 1 316,253 16 (109,119) 6 (79,478) 4 127,656 6 2,555,759 100 (2,155,203) 84.4 10,971 0.4 411,527 16 (91,041) 4 (131,506) 5 188,980 7 3,412,688 100 4,451,781 100 (2,942,407) 86 (3,944,838) 89 12,928 0.38 14,812 0.33 483,209 14.4 521,756 11.3 (115,680) 3 (150,800) 3 (108,929) 3 (110,161) 2 258,600 8.4 260,795 6.3* * During the year under review, we have opened SIH Faisalabad and various pharmacies and Lab-pickup points; return on these investments is yet awaited. Recommendations I recommended that: a) To change the perceptions & education system b) To improve the emergency management c) To construct car parking layout properly d) To improve the future extension [web interface (propose for future), remote a/v consulting etc] e) To improve management reports, whole security levels, accounting etc. f) To improve resource allocation g) Patient details and registration h) Consultations i) User interface conforming to usability guidelines
  • 104. P a g e | 104 Bibliography http://www.google.com.pk/ www.globlehealth.org Shifa international Annual report 2012 http://www.shifa.com.pk/shifa/general.php http://www.shifa.com.pk/ http://www.scribd.com/doc/74296704/Muhammad-Naeem-Jawaid-Islam-Shifa-InternationalHospital-Pvt-Ltd http://www.scribd.com/doc/29435471/Management-Practices-at-Shifa-International-Hospital Muslims, the Voice of Muslims America “Pak Tribune”
  • 105. P a g e | 105 FO U N D ER OF PAKISTAN
  • 106. P a g e | 106 “With faith, Discipline and Selfless devotion to duty, there is nothing worthless that you cannot achieve.”

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