Introduction to hospital management
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Introduction to hospital management Introduction to hospital management Presentation Transcript

  • INTRODUCTION TO HOSPITAL MANAGEMENT
    • Material & Equipment Management
    • Blood Transfusion Services
    • Laboratory Services
    • NABH Accreditation
    • Legal Framework
    • Radiology Services
  • Story # 1
    • It's a fine sunny day in the forest and a lion is sitting outside his cave, lying lazily in the sun. Along comes a fox, out on a walk. Fox: "Do you know the time, because my watch is broken" Lion: "Oh, I can easily fix the watch for you" Fox: "Hmm... But it's a very complicated mechanism, and your big claws will only destroy it even more“
    • Lion: "Oh no, give it to me, and it will be fixed" Fox: "That's ridiculous! Any fool knows that lazy lions with great claws cannot fix complicated watches" Lion: "Sure they do, give it to me and it will be fixed"
    • The lion disappears into his cave, and after a while he comes back with the watch which is running perfectly. The fox is impressed, and the lion continues to lie lazily in the sun, looking very pleased with himself.
    • Soon a wolf comes along and stops to watch the lazy lion in the sun. Wolf: "Can I come and watch TV tonight with you, because mine is broken" Lion: "Oh, I can easily fix your TV for you" Wolf: "You don't expect me to believe such rubbish, do you? There is no way that a lazy lion with big claws can fix a complicated TV“ Lion: "No problem. Do you want to try it?"
    • The lion goes into his cave, and after a while comes back with a perfectly fixed TV. The wolf goes away happily and amazed.
  • : Scene :
    • Inside the lion's cave. In one corner are half a dozen small and intelligent looking rabbits who are busily doing very complicated work with very detailed instruments. In the other corner lies a huge lion looking very pleased with himself.
  • : Moral :
    • IF YOU WANT TO KNOW WHY A MANAGER IS FAMOUS; LOOK AT THE WORK OF HIS SUBORDINATES .
  • Management Lesson In the context of the working world :
    • IF YOU WANT TO KNOW WHY SOMEONE UNDESERVED IS PROMOTED; LOOK AT THE WORK OF HIS SUBORDINATES.
  • Story # 2
    • It's a fine sunny day in the forest and a rabbit is sitting outside his burrow, tippy-tapping on his typewriter. Along comes a fox, out for a walk. Fox: "What are you working on?" Rabbit: "My thesis." Fox: "Hmm... What is it about?" Rabbit: "Oh, I'm writing about how rabbits eat foxes." Fox: "That's ridiculous ! Any fool knows that rabbits don't eat foxes!"
    • Rabbit: "Come with me and I'll show you!" They both disappear into the rabbit's burrow. After few minutes, gnawing on a fox bone, the rabbit returns to his typewriter and resumes typing. Soon a wolf comes along and stops to watch the hardworking rabbit.
    • Wolf: "What's that you are writing?" Rabbit: "I'm doing a thesis on how rabbits eat wolves." Wolf: "you don't expect to get such rubbish published, do you?" Rabbit: "No problem. Do you want to see why?" The rabbit and the wolf go into the burrow and again the rabbit returns by himself, after a few minutes, and goes back to typing.
    • Finally a bear comes along and asks, "What are you doing? Rabbit: "I'm doing a thesis on how rabbits eat bears." Bear: "Well that's absurd ! " Rabbit: "Come into my home and I'll show you"
  • : Scene :
    • As they enter the burrow, the rabbit introduces the bear to the lion.
  • :Moral:
    • IT DOESN'T MATTER HOW SILLY YOUR THESIS TOPIC IS; WHAT MATTERS IS WHOM YOU HAVE AS A SUPERVISOR.
  • Management Lesson In the context of the working world:
    • IT DOESN'T MATTER HOW BAD YOUR PERFORMANCE IS; WHAT MATTERS IS WHETHER YOUR BOSS LIKES YOU OR NOT.
  • MATERIAL MANAGEMENT
  • DEFINITION
    • EQUIPMENT, APPARATUS AND SUPPLIES PROCURED, STOCKED AND UTILISED BY AN ORGANISATION
  • TYPES OF STORES BROAD CATEGORIES CONSUMABLES NON CONSUMABLES
  • TYPES OF MEDICAL STORES
    • EXPENDABLE STORES
      • DRUGS
      • DISPOSABLES
      • LAB REAGENTS
      • X RAY FILMS
      • MEDICAL GASES
      • IV FLUIDS
    • NON EXPENDABLE STORES
      • EQUIPMENT & SPARES
  • LIFE CYCLE CONCEPT SHORT LIFE LONG LIFE
  • PRESERVATION REQUIREMENT STORE REQUIRING UPTO 2-10 0 C TEMP STORE REQUIRING ABOVE 10 0 C BUT LESS THAN 30 STORE REQUIRING LOW TEMP AND NO HUMIDITY NO RESTRICTION OF TEMP
  • CATEGORISATION OF DRUG ITEMS
    • Tablets
    • Capsules
    • Injections
    • Liquids (Syrups)
    • Ointments
    • Drops
    • Powder
    • Fluids
  • FUNCTIONS OF STORES MANAGEMENT
      • MATERIAL PLANNING & PROGRAMMING
        • NEED ASSESSMENT
        • FORCASTING THE LEVEL OF INVENTORIES
        • SCHEDULING ORDERS
      • BUDGETING
        • AVAILABILITY OF FUNDS
        • PLANNING AS PER CASH FLOW
        • CAPITAL/REVENUE BUDGET
      • PURCHASING
      • RECEIPT & INSPECTION
  • FUNCTIONS OF STORES MANAGEMENT
      • STOCKING & DISTRIBUTION
      • INVENTORY CONTROL
      • COST REDUCTION
      • VALUE ANALYSIS
      • DISPOSAL
  • INDENTING OF STORES
    • PERIODICITY
    • DAILY
    • WEEKLY
    • MONTHLY
    • ANNUAL
    • SUPPLEMENTARY INDENT
    • EMERGENT INDENT
  • TYPES OF PURCHASES
    • Rate Contract
    • Running Contract
    • Stockless Purchasing (Just in Time)
    • Repeat order
  • INVENTORY CONTROL
  • INVENTORY CONTROL
    • INVENTORY
    • “ THE QUANTITY OF GOODS OR MATERIALS ON HAND” (WEBSTER)
    • “ IDLE RESOURCE OF ANY KIND PROVIDED THAT SUCH A RESOURCE HAS AN ECONOMIC VALUE” (FRED- HANSSMAN)
  • IMPORTANT TERMINOLOGIES USED IN INVENTORY CONTROL
    • LEAD TIME
    • BUFFER STOCK (SAFETY –STOCK OR RESERVE STOCK)
    • REORDER LEVEL
    • ECONOMIC ORDER QUANTITY
    • INVENTORY CONTROL COSTS
  • INVENTORY CONTROL TECHNIQUES
    • ABC Based on annual usage value
    • VED Vital, Essential & Desirable
    • or
    • VEN Vital, Essential & Non-Essential
    • SDE Scarce, Difficult & Easily available
    • or
    • SAP - Scarce, Available & Plenty
  • INVENTORY CONTROL TECHNIQUES
    • FSN Fast, Slow & Non- moving
    • HML High, Low & Medium cost
    • XYZ Value of Items in Store
    • GOLF Source of Supply
    • SOS Nature of Supply
    • MUSIC-3 D Multi Unit Selective Inventory Control
    • MBASIC- Multiple basic selective inventory control
  • ABC Analysis (Based on Usage Value) Equal attention to all items - expensive. Basic analysis to identify & prioritise areas of attention Based on Pareto Analysis - Vilfredo Pareto 10 % item accounts for 70% of value -’A’ 20 % item accounts for 20% of value -’B’ 70 % item accounts for 10 % of value -’C’
  • Vital Essential Desirable V E D Analysis S D E Analysis Scarce Difficult Easily S A P Analysis Scarce Available Plenty Scarce items -Not easily available -Requires source development -Long lead time -Difficult to manufacture -Few manufacturers
  • BLOOD TRANSFUSION SERVICES
  • BLOOD BANK
    • Blood bank means, a centre within an organisation or an institution for
      • Collection,
      • Grouping,
      • Cross-matching,
      • Storage,
      • Processing &
      • Distribution of Whole human blood or Human blood products from selected human donors.
  • CATEGORIES OF BLOOD BANK
    • Category-I
      • 3-7 units of blood/bed/year
      • 100-400 bedded hospital
      • <5000 units collected
    • Category-II
      • -8-15 units of blood/bed/year
      • 400-1000 bedded hospital
      • 5001-20,000 units collected
    • Category-III
      • >16 units of blood/bed/year
      • >1000 bedded hospital
      • >20,000 units collected
  • DRUGS & COSMETIC ACT 1945
    • Part X B, amended in 1999.
      • “ Requirements for collection, storage, processing & distribution of whole human blood, human blood components by blood banks & manufacture of blood products”.
  • DEFINITIONS
    • Apheresis
    • Autologous Blood
    • Blood components
    • Blood products
    • Donor
    • Professional donor
    • Replacement donor
    • Apheresis -process by which blood drawn from a donor, after separating plasma or platelets or leucocytes, is retransfused simultaneously into the said donor.
    • Autologous blood- the blood drawn from the patient for re-transfusion into himself later on.
    • Blood components- means a drug prepared, obtained, derived or separated from a unit of blood drawn from donor.
    • Blood products- means a drug manufactured or obtained from pooled plasma of blood by fractionation, drawn from donors.
    • Donors -A person who voluntarily donates blood after he has been declared fit after a medical examination, for donating blood, on fulfilling the criteria, without accepting in return any consideration.
    • Professional donor- A person who donates blood for a valuable consideration, in cash or kind, for any source, on behalf of the recipient patient and includes a paid donor or a commercial donor.
    • Replacement donor- A donor who is a family friend or a relative of the patient recipient.
  • PREMISES OF BLOOD BANK
    • The premises of Blood bank consists of the following different segregated sections:
    • Donor Recruitment Area
    • Bleeding Complex
    • Medical Officer’s Room
    • Laboratories
    • Issuing Counter
    • Teaching Facilities
    • Refreshment Area
    • Stores
    • Sterilization and Washing room
  • PHLEBOTOMY
    • Bleeding should be smooth and painless
    • Strict aseptic procedure to be followed and all disposables used.
    • Venipuncture site should be free of skin lesions
    • Donor bag, sample tube, and donor record should be properly identified and labeled before drawing blood.
    • Each bag should be examined for defects and anticoagulants
    • Thorough mixing is essential.
  • TESTS ON DONORS BLOOD
    • ABO and Rh typing for confirmation of donor’s blood group and antibody screening.
    • Every donor’s blood must be tested for:
        • HIV I and II
        • Hepatitis B & C
        • VDRL
        • Malaria
  • STANDARD COLOR LABELS Group Color of label O A B AB
  • Flow of Donor Donor Registration and Examination Room Interview, Rh , Blood group, Weight , Hb of the patient If suitable If unsuitable Reject Donor Phlebotomy done & collection of pilot tubes for processing Refreshment Room & observation Sent home
  • LABORATORY SERVICES
  • ROLE AND FUNCTION OF LAB
    • Attend to ailing patients
    • Carry out investigations asked
    • Prompt issue of accurate result
    • Provide diagnostic information to physician for further management
  • FUNCTIONAL COMPONENTS OF LABORATORY
    • HISTOPATHOLOGY
      • Organ, tissue, cell examination
    • CLINICAL PATHOLOGY
      • Examination of body fluids-blood, urine,
      • sputum, stool, pleural & peritoneal fluids
    • MICROBIOLOGY
      • Examination of bacteria, viruses, parasites etc.
    • HAEMATOLOGY
      • Examination of blood and blood components
    • BIOCHEMISTRY (CHEMICAL PATH.)
      • Examination of chemical substances e.g. hormones, enzymes, etc.
    • CLINICAL RESEARCH LABORATORIES
  • TYPES OF LABORATORY
    • OPD SERVICES
    • WARD SERVICES
    • EMERGENCY SERVICES
      • Round the clock services
      • Restricted Emergency Services
  • NABL NATIONAL ACCREDITATION BOARD FOR TESTING AND CALIBERATION LABORATORIES
  • ACCREDITATION
    • Laboratory accreditation is a procedure by which an authoritative body gives formal recognition of technical competence of testing and or calibration for a laboratory to carry out specific tests. This is based on third party assessment against set standards.
  • NABL
    • NABL accreditation is a formal recognition of the technical competence of a testing or calibration laboratory for a specific task following ISO/IEC 17025 Standard.
    • Medical lab ISO 15189:2003
    • This is based on third party assessment.
    • National Accreditation Board for Testing and Calibration Laboratories (NABL) is an autonomous body under the aegis of Department of Science & Technology, Government of India, and is registered under the Societies Act.
    • NABL website is updated continuously with respect to status of accredited laboratories and their scope of accreditation.
  • TYPES OF LABORATORIES
    • Small lab. 100 patients/day
    • Medium lab. 100-400 pts./day
    • Large lab. >400 pts./day
  • Scope of Accreditation
    • Clinical Biochemistry
    • Clinical Pathology
    • Haematology and Immunohaematology
    • Microbiology and Serology
    • Histopathology
    • Cytopathology
    • Genetics
    • Nuclear Medicine (in-vitro tests only)
  • NABH ACCREDITATION
    • National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organizations.
    • The board while being supported by all stakeholders including industry, consumers, government, have full functional autonomy in its operation.
    • DEFINITION OF ACCREDITATION
    • A public recognition of the achievement of accreditation standards by a healthcare organization, demonstrated through an independent external peer assessment of that organization's level of performance in relation to the standards.
    • The standards for hospitals have been drafted by the Technical Committee of NABH and contain complete set of standards for evaluation of hospitals for grant of accreditation.
    • The organization is evaluated against 100 standards and 512 objective elements contained in 10 chapters.
  • Particulars Standards OE 1 Access, assessment & continuity of care (AAC) 15 78 2 Patients Rights & Education (PRE) 05 30 3 Care of Patients (COP) 18 104 4 Management of Medication (MOM) 13 61 5 Hospital Infection Control (HIC) 09 46 6 Continuous Quality Improvement (CQI) 06 39 7 Responsibility of Management (ROM) 05 25 8 Facility Management & Safety (FMS) 09 43 9 Human Resource Management (HRM) 13 47 10 Information Management System (IMS) 07 41
    • PREPARING FOR ACCREDITATION
    • Step 1 Obtain a copy of NABH standards
    • Step 2 Carry out self assessment on the
    • status of compliance with the NABH
    • standards
    • Step 3 Ensure that NABH standards are
    • implemented and integrated with the
    • hospital functioning
    • Step 4 Obtain a copy of application form
    • Step 5 Fill & submit the application form in
    • NABH office
    • Step 6 Pay the accreditation fee. 
    • ACCREDITATION PROCESS
    • Step 1 Application for accreditation ( submitted by the Healthcare Organisation)
    • Step 2 Acknowledgement for accreditation (by NABH secretariat)
    • Step 3 Pre assessment visit ( by Assessor )
    • Step 4 Final assessment of hospitals (by Assessment Team)
    • Step 5 Scrutiny of the assessment report (by NABH secretariat)
    • Step 6 Recommendation for accreditation (by Accreditation Committee)
    • Step 7 Approval for accreditation (by Chairman NABH)
    • Step 8 Issue of accreditation certificate (by NABH secretariat)
  • Application fee Annual Accreditation fee Upto 100 beds Rs. 25,000/- Rs. 1,00,000/- 101-300 beds Rs. 50,000/- Rs. 1,50,000/- >300 beds Rs. 50,000/- Rs. 2,10,000/-
  • LEGAL ASPECTS OF HEALTHCARE AN OVERVIEW
  • Statutory Obligations
    • There are about 85 licenses and statutory obligations which are applicable to hospitals, but all of them might not be applicable to all hospitals.
    • Building Permit
    • NOC from Chief Fire Officer
    • Bio-medical Waste Management
    • Radiation protection Certificate in respect of all X-rays & CT Scanners from BARC
    • Narcotics & Psychotropic substance Act
    • Consumer Protection Act
    • Dentist Regulations
    • Drugs & Cosmetics Act
    • Employees Provident Fund Act
    • ESI Act
    • Code of Medical Ethics
    • Indian Nursing Council Act
    • MTP Act
    • Minimum Wages Act
    • National Building Code
    • Payment of Gratuity Act
    • Pharmacy Act
    • PNDT Act
    • Registration of Births & Deaths Act
    • License for Blood Bank
    • Transplantation of Human Organs Act
  • Radiology Services
  • RADIOLOGY SERVICES
    • TYPES
      • X-RAYS
      • ULTRASOUND & COLOUR DOPPLER
      • COMPUTER ASSISTED TOMOGRAPHY
      • MAGNETIC RESONANCE IMAGING
      • POSITRON EMISSION TOMOGRAPHY
      • MAMMOGRAPHY
      • NUCLEAR IMAGING
  • CAT SCAN
  • MRI MACHINE
  • ULTRA SOUND IMAGE
  • RADIATION HAZARDS
    • BIOLOGICAL EFFECTS OF RADIATION HAZARDS
    • TYPES OF CELLS OF BODY/ DOSE
    • SOURCE OF RADIATION
    • ACUTE RADIATION EFFECTS
    • CHRONIC RADIATION EFFECTS
  • RADIATION PROTECTION
    • WALL THICKNESS ONE MM OF LEAD EQUIVALENT
    • 8-12 CM CONCRETE/ 12-15 CM BRICK
    • WITHIN X-RAY ROOM TWO HIGH RISK AREAS
      • WALL BEHIND CHEST STAND
      • WALL OF DARK ROOM
  • RADIATION SAFETY MONITORING
    • CONTINUOUS MONITORING
    • RADIATION DOSIMETERS
    • RADIATION PROOF APRON
    • PROTECTIVE GLOVES
  • APPLICATIONS OF NUCLEAR MEDICINE
    • IMAGING OF VARIOUS ORGANS
    • THYROID FUNCTION STUDIES
    • CENTRAL NERVOUS SYSTEM
    • ABSORPTION STUDIES IN G I TRACT
    • NUCLEAR HAEMATOLOGY
    • RENAL FUNCTION STUDIES
    • NUCLEAR CARDIOLOGY- STRESS THALLIUM
    • ?