MBA hospital admin assignment:

1. MBA Hospital Administration (First year)
Paper - IV: PATIENT CARE AND BEHAVIOUR
1.a) What is the concept of Progressive Patient care? Explain the importance of counselling and
how will you ensure proper grief counselling in critical care unit.
Progressive patient care
Progressive patient care (PPC) is a growing concept with an objective to provide better treatment
and care by organizing hospital services around the individual patients.
A system of progressive patient care has been adopted in most hospitals which has a considerable
effect on nursing unit design. Under this system, the inpatient area is divided into various sections
based on the intensity and type of nursing care required, as follows:
• Intensive Care:
The intensive care unit is for patients in acute stage of illness who are unable to
communicate their needs. They require continuous observation and extensive nursing care
with personnel specially trained for the job.
The aim is to first support life in a crisis, prevent threat to life, and then to eliminate the
cause of disfunction by specialised treatment and extensive nursing care. Therefore, the unit
is equipped with life-saving equipment, and all necessary life-saving drugs and supplies are
immediately available.
• Intermediate Care:
The intermediate care unit is for patients who are moderately ill, including patients
transferred from intensive care unit who require moderate amount of nursing care. A large
proportion of all hospital patients will be directly admitted to this unit.
• Self-Care:
The self-care unit is for those patients who, after the acute phase of illness is over, become
ambulant during the period of convalescence, or are admitted for diagnostic procedures and
are able to look after themselves. Nursing care required for this category of patients will be
minimal.
• Long-term Care:
The long-term care unit is for patients requiring prolonged nursing care and where such
services not normally available at home, including adjustment to disabilities by physical and
rehabilitation therapy.
The basis of progressive patient care system is the amount and type of nursing care required
and the degree of dependence of the patient on others.
The design of the nursing unit and facilities to be provided differ from intensive care through
intermediate, self-and long-term care units.

2. The importance of counselling
The main purpose of counselling is to help the patient amplify the vision of the specific situation and
discover the proper potential in dealing with the conditions of disease, in order to promote a better
quality of life.
The World Health Organization defines Counseling like a well-focused process, limited in time and
specific, which uses the interaction to help people deal with their problems and respond in a proper
way to specific difficulties in order to develop new coping strategies. In medical settings, the process
of Counseling represents a valid intervention made of a quality interaction between the counsellor
and the patient, characterized by the capacity of the counsellor to empathize with the interior world
of the patient.
Healthcare counselling is an important area, which needs to be put into operation by medical
practitioners and health care specialists. When these individuals are making provision of medical
facilities to treat the physical health and psychological problems of the individuals, then apart from
making provision of medical and health care facilities, they need to impart health care counselling as
well. In making provision of health care counselling, the important areas that need to be taken into
account are, promoting good health, preventing occurrence of diseases and health problems,
alleviating various forms of psychological problems, ways of promoting healthy mind-sets and ways
of promoting healthy lifestyles. When the individuals will maintain good health physically and
psychologically, only then they will be able to generate better livelihoods opportunities. The health
conditions, living conditions and personality traits of the individuals are the factors, which need to
be taken into consideration in making provision of counselling. It needs to be ensured that
counselling is suitable to the individuals. The medical practitioners, health care specialists and
professional counsellors need to make use of innovative methods in counselling sessions.
How to ensure proper grief counselling in critical care unit
Grief counselling is intended to help the client grieve in a healthy manner, to understand and cope
with the emotions they experience, and to ultimately find a way to move on.
There are two major steps a grief counsellor is required to take while working with someone dealing
with the loss of a loved one
• The first step involves fostering a trusting relationship with the client to create a safe and
comfortable environment for the bereaved to openly share the circumstances of their loss.
• The second step, apart from actively listening to the grieving person, involves the counsellor
asking specific questions about the nature of the client’s relationship with the deceased. If
the relationship with the deceased was a difficult one, counselling would require a different
approach than in a situation where there was a healthy relationship between the griever and
deceased.
Grief counselling is not only for adults coping with loss. Grief counsellors might focus on issues such
as: individuals who lost a co-worker; children coming to terms with the loss of a parent, a friend, or a
pet; patients in hospice care; women or couples who are dealing with a miscarriage; and people who
have gone through a traumatic event.

3. After the circumstances surrounding the loss have been successfully established, the grief counsellor
may move on to specific grief counselling techniques, which may include the following:
• Talking about the deceased person. Sometimes people who are grieving need to talk about
their loss but are unable to find a safe space to do so. A grief counsellor should encourage
the grieving person to talk about the deceased’s life: what were they like, who did they love
and who loved them, what were their hobbies? Specific qualities that made them so special
(and even what made them difficult)?
• Distinguishing grief from trauma. If someone is feeling traumatized from the memory or the
circumstances surrounding the death of a loved one, a grief counsellor will help them to
readjust their outlook on those memories and reframe their relation to the deceased to
encourage healthier grieving.
• Addressing feelings of guilt. Some people feel guilty for things they did or didn’t do while
their loved one was with them. A grief counsellor should encourage the grieving person to
let go of the guilt, or even to allow themselves to forget their loved one for a little while, so
that they can remember the person fondly at other times.
1.b) Explain the various legal implications associated with hospital administration.
There are no specific laws relating to hospital/staff/equipment/administration.
A hospital being an integral part of the social system is subject to all laws of the land.
General Acts/Legislation applicable to a hospital are:
• Industrial dispute act 1948: Where >50persons.
• Minimum wages Act1948: Categories wise.
• Employees Provident Fund Act: where >20 persons & is punishable by imprisonment.
• Payment Of Bonus Act: Where >40 persons but not applicable to charitable/ Non-profit
hosp.
• Payment of Gratuity act 1972: Where 10 or more persons work.
• Payment of wages act 1936: within 7 days.
• ESI act 1948: Hosp contributes 4% of total wage bill.
Medical / professional Acts
• Indian Medical Council Act 1933.
• Indian Nursing Council Act 1947.
• The Pharmacy Act 1948: The hospital has to acquire drug licence if it sells drug etc.
• Births & Deaths & Marriages registration Act: The hospital is bound to inform all
births/deaths taking place in a hospital
Miscellaneous Acts Applicable to Hospitals
• Societies registration Act,1860: It governs working and management of institutions,
establishments or owned by charitable trusts.
• State Public charitable Trust Acts.
• Acts in relation Establishment of Nursing homes.

4. Law of Torts
• Tort is defined as “Any wrong, injury or damages done to the person for which a civil suit can
be brought in” e.g., wrong operation, operating without consent, leaving instrument inside
the body, Invading the right of privacy, breach of professional secrecy, defamation, malicious
prosecution, misrepresentation.
COPRA 1986
• This Act came into force w.e.f.1 Sep ,1987.
• The advantage with this act is that, a minimal cost is involved & matter is decided within 3 to
4 months.
• Provides redressal for defective goods, deficient service, unfair trade practices.
• Consumer is a person who hires any services for any considerations, and any beneficiary of
such services other than who hires, when such services are availed of with the approval of
the first mentioned person.
• Deficiency: Any fault, Imperfection shortcoming or inadequacy in the quality, nature &
manner of performance of a contract, or otherwise in relation to the service.
• Service means service of any description except free service & personal service.
• A claim for compensation under COPRA must be filed within 3Yrs.
• National Forum deals cases >10 lakhs, state forum >5lakhs & district forum up to 5lakhs.
Bill of rights
• Respectful care
• Complete information regarding diagnosis, treatment and prognosis.
• The patient has a right to information from the doctor before he gives a consent.
• Right to refuse treatment, to the extent permitted by law & to be informed of medical
consequences.
• Right to privacy, all communication and records be treated as confidential.
• A hospital must provide evaluation, service, and or referral as indicated by the urgency of
case.
• Relationship of the hospital to the other hospital where one is being referred to.
• Right to refuse to participate in research.
• Right to know appointments/availability of doctors, continuity of healthcare requirements
after discharge.
• Right to examine and receive an explanation of various bill.
• Right to Hospital rules
Offences & Professional Misconducts
• Adultery/improper conduct/association with patient.
• Issuing false certificates.
• Conviction by court of law for offences involving moral factors.
• Selling of schedule poisons
• Performing an abortion or illegal operation/op without consent. Disclosing patients secrets.
• Issuing certificates to unqualified persons.
• Advertisement of services or the institutions run by the physicians. Use of agents.

5. Organ Transplant
• There is no specific central legislation which permits sale/purchase of organs. Indian law is
silent on trade in human organs.
• Transplant of Human organs Bill 1992 is under consideration and it deals with various
aspects of organ transplantation. It deals with measure to curb malpractice, punishment for
donors, doctors & even advertisement seeking donation of organs.
MTP Act of 1972
• Specifies conditions under which pregnancy can be terminated., the persons who can
perform termination & places where such procedures can be performed. It can be
performed either in government hospitals or other places approved by the government.
Important Current Ethical Issues
• AIDS
• Abortions
• Euthanasia
• Sterilization
• Adoption of children
• Ethical issues & poor patients
• Ethical Issue of Examination of females.
• Use of new drugs on trial on patients.
Various other Medico-legal issues of importance
The administration is responsible for safety from explosives & inflammatory gases, chemicals,
machinery, steam damages from slippery floors etc.
The hospital administration has an obligation to have clear understanding of Ethical & legal
responsibilities. Management is responsible for policies, for maintaining a safe hospital, physical
facilities and services, the hospital must ensure that the building conforms to local bye laws, safety
regulations, sanitation arrangements.

6. 2.a) Explain about different methods you will adapt to improve patient satisfaction in intensive
care unit and inpatient department of hospital.
In order to improve your patient satisfaction level in the ICU/Inpatient wards, you will need to get in
the mindset of your patients. You will have to ask yourself questions like: What do patients expect
from healthcare providers? What do patients value in healthcare? Keeping these questions in mind,
here are some actionable ways to boost patient satisfaction:
• Train your employees: Make sure your employees are focused on delivering service that is
not only high-quality but also delivers a positive patient experience. The first step to
ensuring patient-centric care is by making sure that your employees have this common goal
in mind. You should encourage your team to suggest ideas for improving patient satisfaction
within your practice. You should convey the message to your staff that providing exceptional
patient service is not an option; rather it is compulsory for every employee. Your staff must
realize the significance of providing excellent service to patients and their families. It is
critical to hold your employees responsible for the overall patient experience.
• Educate your patients: Providing your patients with necessary information is critical to
achieving a positive patient experience. A patient will feel empowered when he or she
leaves your office with more knowledge about his or her diagnosis and treatment options.
Not just that, studies have revealed that greater patient empowerment leads to better
patient adherence, which leads to improvements in patient satisfaction and clinical
outcomes.
• Differentiate between medical and non-medical staff: Patients find it frustrating when they
are surrounded by so many people but are not sure whom to approach when they have a
concern or a request. This may become even more frustrating when the patient approaches
one employee only to be directed to another employee. The easiest way to differentiate
your staff is by implementing different-colour uniforms so that patients can easily tell who is
an RN, PA, physician, etc.
• Empower nurses: Nurses have a critical role in patient experience and improving the
satisfaction level in patients. Nurses who are more experienced and independent will
provide better patient care as they feel empowered in their work. You can consider creating
a staffing committee to allow your nurses to collaborate for better patient care and give
them the freedom to improve their performance.
• Be flexible: By improving the efficiency of your practice, you can reduce long wait times both
for scheduling appointments and while a patient is waiting to be seen. One of the top
complaints of patients is having to wait longer in the waiting room just to be seen. You can
consider creating a system in which a patient is kept informed about wait times.
• Build a follow-up mechanism: Patients are often irritated by the inability to communicate
with their providers between appointments. You can use technology and build systems that
open the lines of communication between the doctor and the patient. This will not only
foster long-term patient relationships, but it will create better clinical outcomes by making it
easy for patients to schedule appointments.

7. 2.b) What do you mean by accreditation? Explain in brief about NABH.
Accreditation
Accreditation means that the hospital or surgical/medical centre is committed to providing high-
quality health care and that it has demonstrated commitment to meeting high patient-safety
standards.
Hospital accreditation remains a cornerstone for ensuring at least a basic level of quality, at least for
things that the health care system assesses. Patients want to know that a hospital provides safe and
effective care, and accreditation, if done right, can be a powerful tool to offer that assurance.
Accreditation helps determine if an institution meets or exceeds minimum quality standards. It helps
patients determine acceptable institutions for seeking medical/surgical help.
The benefits of a hospital/institution getting accredited are as under:
Benefits for Patients
• Patients are the biggest beneficiary among all the stakeholders.
• Accreditation results in high quality of care and patient safety.
• The patients are serviced by credentialed medical staff.
• Rights of patients are respected and protected. Patient’s satisfaction is regularly
evaluated.
Benefits for Organization
• Accreditation to a health care organization stimulates continuous improvement.
• It enables the organization in demonstrating commitment to quality care and
patient safety thereby ensures best clinical outcomes.
• It raises community confidence in the services provided by the health care
organization as services provided by credentialed medical staff.
• It also provides opportunity to healthcare unit to benchmark with the best.
• An accreditation status also provides marketing advantage in a competitive health
care.
• The HCO standards having been certified by ISQua gives an international recognition
which will also help to promote medical tourism.
• Finally, accreditation provides an objective system of empanelment by insurance
and other third parties.
Benefits for Staff
• The staff in an accredited Hospital is satisfied lot as it provides for continuous
learning, good working environment and leadership.
• Efficiencies and competencies of staff also gets improved in an accredited Hospital.
• It improves overall professional development, knowledge and competencies in
systematic ways with defined ownership and accountability of all the staff including
Medical and Para Medical Staff.
Benefits to paying and regulatory bodies
• Finally, accreditation provides an objective system of empanelment by insurance and other
third parties. Accreditation provides access to reliable and certified information on facilities,
infrastructure and level of care.

8. NABH (National accreditation board for Hospital and health care providers)
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
organisations. the board is structured to cater to much desired needs of the consumers and to set
benchmarks for progress of health industry. The board while being supported by all stakeholders
including industry, consumers, government, have full functional autonomy in its operation.
The vision of NABH is “To be the apex national healthcare accreditation and quality improvement
body, functioning at par with global benchmarks”.
The mission of NABH is “To operate accreditation and allied programs in collaboration with
stakeholders focusing on patient safety and quality of healthcare based upon national/international
standards, through process of self and external evaluation”.
The values provided by NABH are:
• Credibility: Provide credible and value addition services
• Responsiveness: Willingness to listen and continuously improving service
• Transparency: Openness in communication and freedom of information to its stakeholders
• Innovation: Incorporating change, creativity, continuous learning and new ideas to improve
the services being provided
The scope of NABH and its objectives are:
• Accreditation of healthcare facilities
• Quality promotion: initiatives like Nursing Excellence, Laboratory certification programs (not
limited to these)
• IEC activities: public lecture, advertisement, workshops/ seminars
• Education and Training for Quality & Patient Safety
• Recognition: Endorsement of various healthcare quality courses/ workshops
The structure of NABH is as under:

9. 3.a) What are the different methods of concurrent and retrospective evaluation of patient care?
Discuss in detail about Medical Audit.
Concurrent collection is an activity that occurs while the patient is hospitalized or undergoing active
treatment, while retrospective collection occurs after the patient has left the facility.
Quality management professionals have debated the advantages of concurrent vs. retrospective
data collection. Concurrent collection is an activity that occurs while the patient is hospitalized or
undergoing active treatment, while retrospective collection occurs after the patient has left the
facility. The choice between the two is not easily made.
Concurrent review procedure:
• Written request for utilization review (UR) of proposed ongoing medical services received by
UR agent.
• The day the UR request is received; UR staff confirms demographic information and
documents any changes, confirms compensability, and forwards all information to the initial
licensed utilization reviewer to complete the case record. If compensability is not confirmed,
the UR agent should inform the injured employee and the ordering provider in writing that
UR will not proceed because of a compensability issue. The parties should be told to contact
the claim adjuster.
• Initial licensed reviewer begins the review by the following business day and documents all
required information in the case record. The diagnosis should be provided by the ordering
provider.
• If additional medical information is required, the initial licensed reviewer should follow the
procedure for request of additional medical information.
• If no additional medical information is required, the initial licensed reviewer consults the
hospital’s Treatment Guidelines/Protocols to determine medical necessity and
appropriateness of the proposed treatment/protocol. If the reviewer determines that the
hospital’s treatment guidelines do not apply or do not address the condition, a secondary
source which is listed in the application should be consulted. If no secondary source
addresses the condition, the reviewer notifies the appropriate person designated in the UR
application to move forward with the development of an Internal Guideline.
• Concurrent reviews shall be completed at least 1 day prior to the start/implementation date
for the ongoing care if the ordering practitioner contacts the UR agent at least 3 business
days prior to the start/implementation date. If the ordering practitioner fails to contact the
UR agent at least 3 business days prior to the start/implementation date for ongoing care,
the UR agent shall issue the concurrent review determination within 5 business days from
the date the concurrent review request was received.
• Written notification of the determination shall be provided to the ordering practitioner and
injured employee/representative. The determination letter needs to state the
treatment/procedure allowed or denied; start and end dates if applicable; the treatment
guideline; clinical rationale; and name and professional degree of reviewer. Approved
determination letters shall inform the ordering practitioner to forward all requests for
ongoing/concurrent care at least 3 business days prior to the start/implementation date.
• If additional medical information is required, the initial reviewer should follow procedure for
request of additional medical information.

10. Retrospective review procedures
• Written request for utilization review (UR) of medical services received by UR agent.
• The day the UR request is received; UR staff enters demographic information, confirms
compensability, and forwards all information to the initial licensed utilization reviewer to
complete the case record. If compensability is not confirmed, the UR agent should inform
the injured employee and the ordering provider in writing that UR won't proceed because of
a compensability issue. The parties should be instructed to contact the claim adjuster.
• Initial licensed reviewer starts the review and documents all required information in the case
record. The diagnosis should be provided by the ordering provider.
• If additional medical information is required, the initial licensed reviewer should follow the
procedure for request of additional medical information.
• If no additional medical information is required, the initial licensed reviewer consults the
hospital’s treatment Guidelines/Protocols to determine medical necessity and
appropriateness of the proposed treatment/protocol. If the reviewer determines that the
hospital’s Treatment Guidelines/Protocol don't apply or don't address the condition, a
secondary source which is listed in the application, should be consulted. If no secondary
source addresses the condition, the reviewer notifies the appropriate person designated in
the UR application to move forward with the development of an Internal Guideline.
• Retrospective reviews shall be completed within 20 business days from receipt of the UR
request, and written notification of the determination shall be provided to the ordering
practitioner and injured employee/representative. Approved determination letters shall
specify approved treatment/procedure; start and end dates if applicable; treatment
guideline; clinical rationale; and name and professional degree of reviewer.
Medical Audit
Medical audit is a systematic, critical analysis and quantified comparison against explicit standards,
of the quality of current medical practice, including the procedures used for diagnosis and
treatment, the use of resources, and the resulting outcome and quality of life for the patient in order
to improve the quality of care to patients.
The motivation to carry out audits arise from the desire of providers of care to know the level of
quality of the services they provide and to improve it to a higher level. The main objectives of
carrying out an audit is to know whether the provider of care has achieved the desired quality
characteristics of its service. The results are used to:
• provide comparison with previous and future performance:
• allow comparison with other care providers
• know the degree of inadequacy or shortcoming
• provide feedback for quality improvement
Role Of Medical Audit in Quality Management
Audit is a form of quality assessment that gives an indication on the level of quality achieved for a
given service for a defined group of patients in a given period. It is an assessment of past events. The
main value is in using lessons learned from it to plan the improvement of service delivery in the
future. It is not a very useful as a tool for Quality Control because it cannot prevent poor quality
service at the time of its delivery. Indeed, the realization of occurrence of poor quality may be made
too late to allow for corrections to be made. If it to be taken as Quality Control it can be equated

11. with after-sales assessment just like customer satisfaction questionnaires. In the manufacturing
industry, the goods can be recalled and then repaired or replaced. With patient care, unlike in other
services, the same cannot be done because the unwanted outcome cannot be undone. The
correction is limited only to damage control e.g., managing the complications that arise.
Factors taken into consideration in a medical audit for quality control is a system that describes the
factors involved in manufacturing or service delivery is often called the Systems Theory of
Operations Management. It is as depicted below:
A good outcome is the result of the transformation of inputs by various processes. In patient care, it
is dependent on:
• the initial condition of the patient,
• adequacy and condition of machines, instruments and material used
• how well the process is carried out
• knowledge and skills of care providers
• presence of a conducive environment
• how well patients comply with instructions and advice.
A medical audit can be summarised as shown in the figure below:

12. 3.b) Explain about infection control committee in hospital. Enumerate the various infection
control measures followed in ICU and OT.
Infection control committee in a hospital
The Infection control committee is an integral component of the patient safety programme of a
health care facility, and is responsible for establishing and maintaining infection prevention and
control, its monitoring, surveillance, reporting, research and education.
Prevention of HCAI in patients is a concern of everyone in the facility and is the responsibility of all
individuals and services providing health care. Risk prevention for patients and staff must be
supported at the level of senior administration. The role of the hospital infection control committee
(HICC) is to implement the annual infection control programme and policies.
o Commitment towards Maintenance of Surveillance over HCAIs.
o Develop a system for identifying, reporting, analysing, investigating
and controlling HCAIs.
o Develop and implement preventive and corrective programs in
specific situations where infection hazards exist.
o Advice the Medical Superintendent on matters related to the proper
use of antibiotics, develop antibiotic policies and recommend
remedial measures when antibiotic resistant strains are detected.
o Review and update hospital infection control policies and procedures
from time to time.
o Help to provide employee health education regarding matters
related to HCAIs.
HICC shall meet regularly - once a month and as often as required. The Committee is responsible for
establishing and maintaining infection prevention and control, its monitoring, surveillance,
reporting, research and education.
The structure of an Infection control team in a hospital should be as mentioned below:
• Chairperson: Head of the Institute (preferably)
• Member Secretary: Senior Microbiologist
• Members: Representation from
• Management/Administration (Dean/Director of Hospital;
• Nursing Services; Medical Services; Operations)
• Relevant Medical Faculties
• Support Services: (OT/CSSD, Housekeeping/Sanitation, Engineering, Pharmacologist, Store
• Officer / Materials Department)
• Infection Control Nurse (s)
• Infection Control officer

13. Infection control measures adopted in the ICU/OT
1) Isolation
Assess the need for isolation. Screen all intensive care unit (ICU) patients for the following:
• Neutropenia and immunological disorder
• Diarrhoea
• Skin rashes
• Known communicable disease
• Known carriers of an epidemic strain of bacterium.
Identify the type of isolation needed. There are two types of isolation in the ICU:
• Protective isolation for neutropenic or other immunocompromised patients to reduce the
chances of acquiring opportunistic infections
• Source isolation of colonized or infected patients to minimize potential transmission to other
patients or staff.
Isolation rooms should have tight-fitting doors, glass partitions for observation and both negative-
pressure (for source isolation) and positive-pressure (for protective isolation) ventilations.
2) Patient at risk of nosocomial infections
There are patient, therapy and environment related risk factors for the development of nosocomial
infection.
• Age more than 70 years
• Shock
• Major trauma
• Acute renal failure
• Coma
• Prior antibiotics
• Mechanical ventilation
• Drugs affecting the immune system (steroids, chemotherapy)
• Indwelling catheters
• Prolonged ICU stay (>3 days).
3) Observe hand hygiene
Hands are the most common vehicle for transmission of organisms and “hand hygiene” is the single
most effective means of preventing the horizontal transmission of infections among hospital
patients and health care personnel.
4) Follow standard precautions
Standard precautions include prudent preventive measures to be used at all times,
regardless of a patient's infection status.
Gloves
• Sterile gloves should be worn after hand hygiene procedure while touching mucous
membrane and non-intact skin and performing sterile procedures e.g., arterial,
central line and Foley catheter insertion

14. • Clean, non-sterile gloves are safe for touching blood, other body fluids,
contaminated items and any other potentially infectious materials
• Change gloves between tasks and procedures in the same patient especially when
moving from a contaminated body area to a clean body area
• Never wear the same pair of gloves for the care of more than one patient
• Remove gloves after caring for a patient
• Practice hand hygiene whenever gloves are removed.
Gown
• Wear a gown to prevent soiling of clothing and skin during procedures that are likely
to generate splashes of blood, body fluids, secretions or excretions
• The sterile gown is required only for aseptic procedures and for the rest, a clean,
non-sterile gown is sufficient
• Remove the soiled gown as soon as possible, with care to avoid contamination.
Mask, eye protection/face shield
• Wear a mask and adequate eye protection (eyeglasses are not enough), or a face
shield to protect mucous membranes of the eyes, nose and mouth during
procedures and patient care activities that are likely to generate splashes/sprays of
blood and body fluids, etc.,
• Patients, relatives and health care workers (HCWs) presenting with respiratory
symptoms should also use masks (e.g., cough)
Shoe and head coverings
• They are not required for routine care
Patient-care equipment
• Used patient-care equipment soiled with blood, body fluids, secretions, or
excretions should be handled carefully to prevent skin and mucous membrane
exposures, contamination of clothing and transfer of microorganisms to HCWs,
other patients or the environment
• Ensure that reusable equipment is not used for the care of another patient until it
has been cleaned and sterilized appropriately
• Ensure that single use items and sharps are discarded properly
5) Follow transmission-based precautions
In addition to standard precautions, the following should be observed in those patients known or
suspected to have airborne, contact or droplet infections:
Airborne precautions
✓ Disease-causing microorganisms may be suspended in the air as small particles, aerosols, or
dust and remain infective over time and distance, for example, Mycobacterium tuberculosis
(pulmonary/laryngeal), varicella zoster virus (chickenpox), herpes zoster (shingles), rubella
virus and measles
✓ Isolate with negative-pressure ventilation
✓ Respiratory protection must be employed when entering the isolation room
✓ Use the disposable N-95 respirator mask, which fits tightly around the nose and mouth to
protect against both large and small droplets. This should be worn by all persons entering
the room, including visitors (1B).

15. Contact precautions
✓ Infections can be spread by usual direct or indirect contact with an infected person, the
surfaces or patient care items in the room, for example, parainfluenza virus infection,
respiratory syncytial virus infection, varicella (chickenpox), herpes zoster, hepatitis A and
rotavirus infections.
✓ Isolation is required
✓ Non-critical patient-care equipment should preferably be of single use. If unavoidable, then
clean and disinfect them adequately before using to another patient
✓ Limit transport of the patient
Droplet precautions
✓ Microorganisms are also transmitted by droplets (large particles >5 μm in size) generated
during coughing, sneezing and talking, or a short-distance travelling, for example, influenza
virus, Bordetella pertussis, Hemophilus influenzae (meningitis, pneumonia), Neisseria
meningitidis (meningitis, pneumonia and bacteraemia), Mycoplasma pneumoniae, severe
acute respiratory syndrome-associated coronavirus, Group A Streptococcus, adenovirus and
rhinovirus.
✓ Isolation is required
✓ Respiratory protection must be employed when entering the isolation room or within 6-10 ft
of the patient. Use the disposable N-95 respirator mask, which fits tightly around the nose
and mouth to protect against both large and small droplets. This should be worn by all
persons entering the room, including visitors
✓ Limit transport of the patient
6) Use specific strategies focused on prevention of specific nosocomial infections
• In addition to the standard and transmission-based precautions, there are several strategies
focused on prevention of specific nosocomial infections in critically ill patients. Of these,
ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI) and
urinary tract infection (UTI) are the most important.
7) Consider environmental factors
Cleaning and disinfection
✓ High-quality cleaning and disinfection of all patient-care areas is important,
especially surfaces close to the patient (e.g., bedrails, bedside tables, doorknobs and
equipment)
✓ Some pathogens can survive for long periods in the environment, particularly
methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant
Enterococcus (VRE), Acinetobacter species, Clostridium difficile and norovirus
✓ EPA-registered disinfectants or detergents that best meet the overall needs of the
ICU should be used for routine cleaning and disinfection
✓ Frequency of cleaning should be as follows: Surface cleaning (walls) twice weekly,
floor cleaning 2-3 times/day and terminal cleaning (patient bed area) after discharge
or death

16. Architecture and layout, especially while designing a new ICU
✓ The unit may be situated close to the operating theatre and emergency department
for easy accessibility, but should be away from the main ward areas
✓ Central air-conditioning systems are designed in such a way that recirculated air
must pass through appropriate filters
✓ It is recommended that all air should be filtered to 99% efficiency down to 5 μm
✓ Suitable and safe air quality must be maintained at all times. Air movement should
always be from clean to dirty areas
✓ It is recommended to have a minimum of six total air changes per room per hour,
with two air changes per hour composed of outside air
✓ Isolation facility should be with both negative- and positive-pressure ventilations
✓ Clearly demarcated routes of traffic flow through the ICU are required
✓ Adequate space around beds is ideally 2.5-3 m
✓ Electricity, air, vacuum outlets/connections should not hamper access around the
bed
✓ Adequate number of washbasins should be installed
✓ Alcohol gel dispensers are required at the ICU entry, exits, every bed space and
every workstation
✓ There should be separate medication preparation area
✓ There should be separate areas for clean storage and soiled and waste storage and
disposal
✓ Adequate toilet facilities should be provided
Organizational and administrative measures
✓ Work with hospital administration for better patient to nurse ratio in the ICU
✓ Policies for controlling traffic flow to and from the unit to reduce sources of
contamination from visitors, staff and equipment
✓ Waste and sharp disposal policy
✓ Education and training for ICU staff about prevention of nosocomial infections
✓ ICU protocols for prevention of nosocomial infections
✓ Audit and surveillance of infections and infection control practices
✓ Infection control team (multidisciplinary approach)
✓ Antibiotic stewardship
✓ Vaccination of health care personnel
4.a) Define Communication. Explain about internal and external communication system in hospital
for providing better patient care.
Communication
Communication in healthcare is defined as the exchange of information, thoughts, and feelings
between the healthcare professional and the patient using speech or other means. The patient
conveys their fears and concerns to their healthcare professional to help them make a correct
diagnosis and treatment thereof.

17. The core concepts of patient-centred communication include
• eliciting and understanding patient perspectives (e.g., concerns, ideas, expectations,
needs, feelings, and functioning),
• understanding the patient within his or her unique psychosocial and cultural
contexts, and
• reaching a shared understanding of patient problems and the treatments that are
concordant with patient values
Internal and external communication system in hospital for providing better patient care
1) Internal Communication
Communication has to be done with the systemic approach and strategic planning for
delivering quality care. Healthcare Consulting Firms (HCF) can help in making optimal use of
knowledge and experience generated in the hospital for better communication. This
produces best patient outcomes and increases hospital revenues and reputation.
Most hospitals use Hospital Information System (HIS) with digitised records for storing,
maintaining and retrieving patient information and also administrative/operational data.
The widely used internal communication technologies include:
• Electronic Dashboards
• Mobile Computing
• Electronic Health Records (EHR)
• Digital Voice Communication
• Hospital Intranet and Emails
• Handheld Wireless Devices
• Digital Radiography
Internal communication can be enhanced by the following measures:
• Fostering an environment that encourages and promotes better collaboration and
teamwork of hospital staff- This helps in collective decision making rather than taking
individual calls which is detrimental to patient care. Consolidated information makes
hospital staff aware of their roles and responsibilities. It also enhances employee
engagement and productivity.
• Developing a seamless and integrated information system – By doing this, critical
information may be accurately communicated to the authorised staff involved in patient
care. For example, diagnostic test results and contact details of patients may be instantly
conveyed to physicians to expedite faster treatment. Likewise, they may be alerted on
patient admissions or health emergencies. This creates a seamless, consistent experience for
the patient and ensures high-quality care.
• Constantly reviewing and updating the hospital policies and terms – For handling new
healthcare regulations, enhanced accreditation requirements or internal process
modifications, this is necessary. Clear internal communication to employees ensures that
required changes are quickly and consistently implemented across the hospital.
• Equipping hospital staff with adequate skill sets and training – It is important that every
employee is able to fully understand and utilize the hospital communication system. This
calls for sufficient training and repeated practice on communication aspects and also on
technology advancements. Thus, fear of failures and resistance to change is overcome.

18. • Using strategic top management driven approach for clarity – By clearly communicating
goals and expectations, hospital managers and administrators can help employees
understand and work towards them. This may be enabled through periodic memos, emails,
meetings and policy manuals.
2) External communication:
External Communication is the "image that the hospital portrays to the world". It is the
message that people derive from print, social and digital media about the hospital. A
hospital's reputation, stature, social and business standing and professional competence - all
depends on its external communication. This is why external communication is pivotal for
the hospital’s functionality.
The following are the ways of enhancing the external communication of a hospital:
• Define Communication Strategy - Outline a clear Communications strategy
with definite goals, audiences and timelines. Communications Strategy is a
must for any hospital. It can be created in-house or with the help of a
Healthcare Marketing Agency. The Communications Strategy must
synchronize with your brand values and mission statement
• Proactive or Reactive? - External communication involves media campaigns
about the hospital in print, electronic and social media like print and TV ads,
Facebook ads, Instagram or Twitter posts, promotional campaign mailers
and leaflets, newspaper article and blogs. Decide whether your external
communication is going to be proactive and talk about the hospital's values
or be reactive and just reply to comments and feedback in the media? A
right mix of both proactive and reactive responses makes your
communication effective.
• Integrate internal and external communication - For effective
communication, integrate your hospital's internal and external
communication seamlessly. The same message must be conveyed
throughout both inside and outside the hospital. Use your hospital's
communication department to achieve this by keeping them well-informed
about the campaigns, PR events and all necessary details to handle media
inquiries.
• Convey a strong, positive and unique image - Your hospital is doing a
wonderful work. So, why not talk about it strong and positive? Highlight the
uniqueness of your hospital- Is it the strong competence of the medical
professionals, the genuine patient care, cost optimization or the latest
equipment or healthcare information systems? Create a bold brand image
and stick to it.
• Use real-life examples - With concurrence from the patients, try to cite real-
life successful examples using EMRs from your Hospital Information
Management systems. This renders an authentic touch to your external
communication

19. 4.b) Elaborate the role public relation department in association with better patient experience in
hospital.
The Public Relations Department is responsible for implementation of hospital marketing programs,
advertising, communication, patient satisfaction monitoring. Not only does it help the hospital
organization achieve its socio- economic goals but also helps in patients’ well-being/speedy
recovery.
Public relations officers in health care settings are responsible for maintaining the desired image of a
health care facility in the public eye. As such, they must be knowledgeable about the internal
workings of the facility and must also be aware of its strategic objectives.
Public relation is a fresh concept in hospital management. From the recent rapid economic growth
and establishment of public relations programs and speciality personnel in many set-ups we can
opine that it has earned an important place in the hospital set -up.
Responsibilities of a public relations office in a healthcare organization are:
• Promotions of the health organisations and implementations of the hospital’s
marketing programmes that are related to overall Mission and vision of the hospital,
also manage and improve the flow of information within the hospital and between
the hospital and the community it serves.
• Help management to keep in touch with public, actively solicit both employee and
consumer opinion and make management aware of the effects various decisions will
have on employee and consumers.
• Writing and distributing news release, feature articles to the press, compiling press
list, writing of newsletters, handling and maintain a media information service,
arranging press, radio and television interviews for management, preparing
marketing plans for various programmes and strategies for promotional and
marketing efforts.
• Public relation department is responsible for community relations, hospital
publications, media relations, special events and support for fundraising.
Analysis and problem-solving.
• To develop and maintain good relations with the media and communicate with the
press.
• Participate in community affairs that have bearing on the wellbeing of the hospital.
Factors to improvise a PR department of a hospital:
• High quality of patient care will ensure simultaneously good public relations.
• All courtesies must be extended to the patients projecting a good image of the
hospital.
• Environmental sanitation, cleanliness and physical comforts provided to patients
create good impression.
• Reception, Enquiry and Admission office should be established as one single unit.
• Allotting priorities in admission on need basis ward reception, privacy to be ensured,
and information about illness.

20. Indicators of a good PR department in a hospital:
• Patient Satisfaction Surveys
• General public opinion
• Number of complaints received
• Turnover of Medical Staff
• Extent of voluntary effort by community
• Consistency in attendance by patients
• Donations
• Letters to editors in local papers
• Media opinion
Scope of the PR department of a Hospital/Healthcare institution are as shown below:

21. 5.a) Explain the importance of supportive services in improving patient care.
Within a hospital, different departments are responsible for providing the levels of service that make
a hospital run, from environmental services, equipment distribution and linens to biomed/clinical
engineering, facilities and many others. All these support services are necessary to keep the hospital
going, so that hospital staff can provide care and patients can receive treatment. These support
services also have an opportunity to drive operational improvement.
The positive influence of a proper supportive services can be summarised in four main ways
(examples) in the way they positively influenced their facility’s performance:
1. More time for nurses: Nursing care is always on an overload in major
hospital settings. Even before COVID-19, they were being stretched far
beyond the responsibilities of patient care. Support services staff can
reduce the burden. All support departments contribute to reducing the
workload for nurses. But one of the biggest opportunities for giving them
more time is making interdepartmental communication more efficient.
One study shows this saves nurses’ time by over 6,000 hours per year.
That means more time to focus on patients, and more time spent
improving patient satisfaction. The team also reduced patient wait times
and recaptured an estimated 30,764 hours of actual bed capacity each
year. That’s a massive improvement, and it gave back meaningful hours of
clinical care to the nursing staff.
2. Improved patient recovery and healing: Clinical care is not the only
variable at play for patient recovery. Hospital support services should be
designed to promote healing and provide excellent patient care. The
environmental services department is perfectly positioned to help. They
help patients and staff stay safe, not just from major problems like COVID-
19, but also from healthcare-associated infections (HAIs).
3. Reduced costs: It takes a lot of resources to run your hospital. Non-clinical
departments can often be places where extra costs get overlooked. A
good example is in the management of linens. Hospital’s overuse and
misuse linen every single day. Because of this, your linen program is one of
the first places you should look when trying to save money. Just by
installing a dedicated, knowledgeable on-site linen manager, we’ve found
you can reduce linen usage by 26% in the first year. That can mean up to 6
figures in linen cost-savings. By overlooking your support services
departments, you might be missing an opportunity to save a lot of money.
And on top of saving, your money, investing in these departments can
have significant returns on patient satisfaction.
4. Improved the overall patient experience: At the centre of your operations
is the patient. Everything should revolve around them. And one of the
biggest factors in their experience is their wait time. This is directly
affected by how quickly your environmental services team can clean and
disinfect a room to get it ready for the next patient.
In short, hospital support services are critical to your facility’s operations. Failing to properly invest in
them results in a higher workload for nurses, unnecessary costs, and poor patient experiences.

22. 5.b) Discuss the role of knowledge exchange and training program in hospital for improving
patient care.
Knowledge transfer/exchange is a process by which relevant research information is made available
and accessible for practice, planning, and policy-making through interactive engagement with
audiences. Knowledge transfer is supported by user friendly materials and a communication strategy
that enhances the credibility of the organization. Where relevant, knowledge transfer reinforces key
messages from the research. There are many terms that are used to describe this knowledge
transfer process. These terms include: research transfer, knowledge exchange, knowledge
translation, knowledge mobilization, research uptake, research/knowledge utilization, and
dissemination.
A healthcare knowledge management system can create a more efficient flow of information
between all your providers and staff, which can ultimately lead to increased efficiency and
productivity. An advanced and meticulously organized healthcare knowledge management solution
can enable doctors to immediately search for and identify symptoms, procedures, and other
valuable information that could forever change the lives of patients for the better.
There are many different techniques that are available to share knowledge. These techniques range
from traditional approaches, such as distribution of education materials and conference
presentations, to more recently popular approaches, such as the use of knowledge brokers and
communities of practice.
While traditional knowledge management frameworks emerged from the business world, modern
knowledge management—the practice of harnessing and building upon a core set of knowledge to
enable groups and individuals to do their best work—has become crucial in the healthcare industry.
The perceived advantages are as listed below:
• It can turn information overload into educated and empowered decision-making.
• It helps practitioners avoid medical malpractice.
• It powers collaboration between medical professionals while protecting doctor/patient
confidentiality.
• It encourages a continuous-learning environment in your healthcare organization.
• It’s an essential part of digital transformation in healthcare.
To summarize, healthcare knowledge management solutions allow hospitals to completely
standardize all procedures and provide easily accessible training on these procedures. That way,
even if someone with specialized knowledge leaves the organization, other providers can still access
that information—therefore reducing the potential for mistakes due to a lack of education or
knowledge. In addition, if the knowledge management solution has a powerful search engine and a
mobile application, doctors, nurses, and medical technicians can access procedures at a moment’s
notice while on the go.