Introductiontohospitalmanagement 110227002212-phpapp02

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  • 1. INTRODUCTION TOHOSPITAL MANAGEMENT
  • 2.  Material & Equipment Management Blood Transfusion Services Laboratory Services NABH Accreditation Legal Framework Radiology Services
  • 3. Story # 1 Its 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 its a very complicated mechanism, and your big claws will only destroy it even more“
  • 4. Lion: "Oh no, give it to me, and it will be fixed"Fox: "Thats ridiculous! Any fool knows that lazylions with great claws cannot fix complicatedwatches"Lion: "Sure they do, give it to me and it will befixed"
  • 5. The lion disappears into his cave, and aftera while he comes back with the watchwhich is running perfectly. The fox isimpressed, and the lion continues to lielazily in the sun, looking very pleased withhimself.
  • 6. Soon a wolf comes along and stops to watch thelazy lion in the sun.Wolf: "Can I come and watch TV tonight withyou, because mine is broken"Lion: "Oh, I can easily fix your TV for you"Wolf: "You dont expect me to believe suchrubbish, do you? There is no way that a lazy lionwith big claws can fix a complicated TV“Lion: "No problem. Do you want to try it?"
  • 7. The lion goes into his cave, and after awhile comes back with a perfectly fixedTV. The wolf goes away happily andamazed.
  • 8. : Scene :Inside the lions cave. In one corner arehalf a dozen small and intelligent lookingrabbits who are busily doing verycomplicated work with very detailedinstruments. In the other corner lies a hugelion looking very pleased with himself.
  • 9. : Moral :IF YOU WANT TO KNOW WHY AMANAGER IS FAMOUS; LOOK AT THEWORK OF HIS SUBORDINATES.
  • 10. Management LessonIn the context of the working world : IF YOU WANT TO KNOW WHY SOMEONE UNDESERVED IS PROMOTED; LOOK AT THE WORK OF HIS SUBORDINATES.
  • 11. Story # 2 Its 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, Im writing about how rabbits eat foxes." Fox: "Thats ridiculous ! Any fool knows that rabbits dont eat foxes!"
  • 12. Rabbit: "Come with me and Ill showyou!"They both disappear into the rabbitsburrow. After few minutes, gnawing on afox bone, the rabbit returns to histypewriter and resumes typing.Soon a wolf comes along and stops towatch the hardworking rabbit.
  • 13. Wolf: "Whats that you are writing?"Rabbit: "Im doing a thesis on how rabbits eatwolves."Wolf: "you dont expect to get such rubbishpublished, do you?"Rabbit: "No problem. Do you want to see why?"The rabbit and the wolf go into the burrow andagain the rabbit returns by himself, after a fewminutes, and goes back to typing.
  • 14. Finally a bear comes along and asks, "What areyou doing?Rabbit: "Im doing a thesis on how rabbits eatbears."Bear: "Well thats absurd ! "Rabbit: "Come into my home and Ill show you"
  • 15. : Scene :As they enter the burrow, the rabbitintroduces the bear to the lion.
  • 16. :Moral:IT DOESNT MATTER HOW SILLYYOUR THESIS TOPIC IS; WHATMATTERS IS WHOM YOU HAVEAS A SUPERVISOR.
  • 17. Management LessonIn the context of the working world: IT DOESNT MATTER HOW BAD YOUR PERFORMANCE IS; WHAT MATTERS IS WHETHER YOUR BOSS LIKES YOU OR NOT.
  • 18. MATERIAL MANAGEMENT
  • 19. DEFINITION EQUIPMENT, APPARATUS AND SUPPLIES PROCURED, STOCKED AND UTILISED BY AN ORGANISATION
  • 20. TYPES OF STORES BROAD CATEGORIESCONSUMABLES NON CONSUMABLES
  • 21. TYPES OF MEDICAL STORES EXPENDABLE STORES  DRUGS  DISPOSABLES  LAB REAGENTS  X RAY FILMS  MEDICAL GASES  IV FLUIDS NON EXPENDABLE STORES  EQUIPMENT & SPARES
  • 22. LIFE CYCLE CONCEPTSHORT LIFE LONG LIFE
  • 23. PRESERVATION REQUIREMENT STORE REQUIRING UPTO 2-100 C TEMP STORE REQUIRING ABOVE 100 C BUT LESS THAN 30 STORE REQUIRING LOW TEMP AND NO HUMIDITY NO RESTRICTION OF TEMP
  • 24. CATEGORISATION OF DRUG ITEMS Tablets Capsules Injections Liquids (Syrups) Ointments Drops Powder Fluids
  • 25. FUNCTIONS OF STORESMANAGEMENT  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
  • 26. FUNCTIONS OF STORESMANAGEMENT  STOCKING & DISTRIBUTION  INVENTORY CONTROL  COST REDUCTION  VALUE ANALYSIS  DISPOSAL
  • 27. INDENTING OF STORES PERIODICITY DAILY WEEKLY MONTHLY ANNUAL SUPPLEMENTARY INDENT EMERGENT INDENT
  • 28. TYPES OF PURCHASES Rate Contract Running Contract Stockless Purchasing (Just in Time) Repeat order
  • 29. INVENTORY CONTROL
  • 30. 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)
  • 31. IMPORTANT TERMINOLOGIESUSED IN INVENTORY CONTROL LEAD TIME BUFFER STOCK (SAFETY – STOCK OR RESERVE STOCK) REORDER LEVEL ECONOMIC ORDER QUANTITY INVENTORY CONTROL COSTS
  • 32. 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
  • 33. 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
  • 34. ABC Analysis (Based on Usage Value)Equal attention to all items - expensive.Basic analysis to identify & prioritise areas of attentionBased on Pareto Analysis - Vilfredo Pareto10 % item accounts for 70% of value -’A’20 % item accounts for 20% of value -’B’70 % item accounts for 10 % of value -’C’
  • 35. VitalV E D Analysis Essential Desirable ScarceS D E Analysis AP Available Difficult Easily PlentyScarce items -Not easily available -Requires source development -Long lead time -Difficult to manufacture -Few manufacturers
  • 36. BLOODTRANSFUSIONSERVICES
  • 37. 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.
  • 38. 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
  • 39. 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”.
  • 40. DEFINITIONS Apheresis Autologous Blood Blood components Blood products Donor Professional donor Replacement donor
  • 41.  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.
  • 42.  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.
  • 43.  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.
  • 44. PREMISES OF BLOOD BANKThe 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
  • 45. 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.
  • 46. 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
  • 47. STANDARD COLOR LABELS Group Color of label O A B AB
  • 48. Flow of Donor Donor Registration and Examination Room Interview, Rh , Blood group, Weight , Hb of the patient If suitable If unsuitable Reject DonorPhlebotomy done & collection of pilot tubes for processing Refreshment Room & observation Sent home
  • 49. LABORATORY SERVICES
  • 50. 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
  • 51. FUNCTIONAL COMPONENTS OFLABORATORY 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
  • 52. TYPES OF LABORATORY OPD SERVICES WARD SERVICES EMERGENCY SERVICES Round the clock services Restricted Emergency Services
  • 53. NABLNATIONAL ACCREDITATIONBOARD FOR TESTING ANDCALIBERATION LABORATORIES
  • 54. 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.
  • 55. 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.
  • 56.  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.
  • 57. TYPES OF LABORATORIES Small lab. 100 patients/day Medium lab. 100-400 pts./day Large lab. >400 pts./day
  • 58. Scope of Accreditation Clinical Biochemistry Clinical Pathology Haematology and Immunohaematology Microbiology and Serology Histopathology Cytopathology Genetics Nuclear Medicine (in-vitro tests only)
  • 59. NABHACCREDITATION
  • 60. National Accreditation Board forHospitals & Healthcare Providers (NABH)is a constituent board of Quality Councilof India, set up to establish and operateaccreditation programme for healthcareorganizations.The board while being supported by allstakeholders including industry,consumers, government, have fullfunctional autonomy in its operation.
  • 61. DEFINITION OF ACCREDITATIONA public recognition of the achievementof accreditation standards by ahealthcare organization, demonstratedthrough an independent external peerassessment of that organizations level ofperformance in relation to the standards.
  • 62.  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.
  • 63. Particulars Standards OE1 Access, assessment & continuity 15 78 of care (AAC)2 Patients Rights & Education 05 30 (PRE)3 Care of Patients (COP) 18 1044 Management of Medication 13 61 (MOM)5 Hospital Infection Control (HIC) 09 466 Continuous Quality 06 39 Improvement (CQI)7 Responsibility of Management 05 25 (ROM)8 Facility Management & Safety 09 43 (FMS)9 Human Resource Management 13 47 (HRM)10 Information Management 07 41 System (IMS)
  • 64. PREPARING FOR ACCREDITATIONStep 1 Obtain a copy of NABH standardsStep 2 Carry out self assessment on the status of compliance with the NABH standardsStep 3 Ensure that NABH standards are implemented and integrated with the hospital functioningStep 4 Obtain a copy of application formStep 5 Fill & submit the application form in NABH officeStep 6 Pay the accreditation fee.
  • 65. ACCREDITATION PROCESSStep 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)
  • 66. Application fee Annual Accreditation feeUpto 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/-
  • 67. LEGAL ASPECTS OF HEALTHCAREAN OVERVIEW
  • 68. 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.
  • 69.  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
  • 70.  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
  • 71. Radiology Services
  • 72. RADIOLOGY SERVICES TYPES  X-RAYS  ULTRASOUND & COLOUR DOPPLER  COMPUTER ASSISTED TOMOGRAPHY  MAGNETIC RESONANCE IMAGING  POSITRON EMISSION TOMOGRAPHY  MAMMOGRAPHY  NUCLEAR IMAGING
  • 73. CAT SCAN
  • 74. MRI MACHINE
  • 75. ULTRA SOUND IMAGE
  • 76. RADIATION HAZARDS BIOLOGICAL EFFECTS OF RADIATION HAZARDS TYPES OF CELLS OF BODY/ DOSE SOURCE OF RADIATION ACUTE RADIATION EFFECTS CHRONIC RADIATION EFFECTS
  • 77. 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
  • 78. RADIATION SAFETY MONITORING CONTINUOUS MONITORING RADIATION DOSIMETERS RADIATION PROOF APRON PROTECTIVE GLOVES
  • 79. 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
  • 80. ?