• The introduction
• Background of the study
• Purpose and objective
• Organization of the paper
• Scope and limitation of the study
• The history
• vision and mission
• location and layout
• staffing pattern
• services rendered
• future plans of IFCH.
• Introduction of Out Patient Department
• location and layout
• staffing pattern
• OPD charge
• OPD time
• Introduction of Emergency Department
• Staffing patterns
• Location and layout
• Statistics of ED.
• Introduction to Medical Record Department
• Objective and Function
• Content of MR/Types of data
• Staffing pattern and work flow
• Finding and critical observation
Hospital is multi-facet complex organization composed of
various multi skilled professionals, sensible services with the
use of sound technology and high level managerial
According to WHO According to WHO (1951) ”Hospital is
defined as an integral part of a social organization , the
function of which is to provide for the population complete
healthcare, both curative and preventive, and whose
outpatient services reach out to the family in its home
environment, the hospital is also a center for the training of
health workers and bio social research”.
Objectives of the study
1. General objective
• Develop managerial skills in hospital
• Figure out operational level functions and challenges
2. Specific objective
• To study the nature of services being rendered to
people through medium of ER,OPD and MRD
• To enlarge the managerial competency.
• To identify the hospital administrative problems and
• observation with the administration and the hospital
staffs with the motive of learning the best practice
towards delivery of health care and hospital management
• Several tools and techniques were used for
comprehensive management practice study.
1. Primary data:
i. Observation in ED, OPD and MRD
ii. Consulting with the Hospital Director, Administrator, Department
iii. Interview with the incharge of each department ED, OPD
v. Queries with the patient and patient parties and their
feedback about the health care services being rendered to them.
2. Secondary data:
i. Hospital statistics
ii. Hospital brochure, website
iii. Medical records and annual reports
v. Reports and reference books regarding hospital management
• The practicum is motivated at learning the managerial
practices, hospital activity to enhance knowledge in the
• It helps to increase managerial skills and practices so that
management practices being adopted by particular
organization could be studied well along with
internal strength and weakness external opportunities
• It is also useful to research personnel for future research
useful to student as reference increasing their
knowledge and skill
Limitation of study
• The study was limited to the management aspect of an
individual health care organization and few depart only
which cannot be generated to other organization.
• time duration is not sufficient for internship.
• The confidentially problem of the hospital and syllabus
focused by university most of the things are not allowed
to keep in this report.
Organization under study
• IFCH was registered under cooperative organization “Bal Maitri
Samudayik Sahakari Sanstha” on 27th Kartik 2065 BS (12th Nov
2008 AD) as a specialized 50 bedded pure pediatric hospital by
the group of medical professionals. It is the first pediatric
community hospital of Nepal.
• Full responsibility given to Dr. Shanta Chandra Shakya
Management under :
Managing director- Dr. Shanta Chandra Shakya (MD, MS, Phd, Er)
Philosophy / Vision and Mission
“ The Best Care For Your Child”
• to provide quality health facilities to children of different part of
the country “ Working together we provide better health care to
• In between the Police hospital and Kanti Children’s Hospital
• Three shifts for all doctors and health workers;
6 hours duty
(Morning: 7am- 1pm, Evening: 1pm-7pm) & Night (7pm-7am)
• Pediatric General, Emergency, Intensive , Immunization, nutrition
center and Dot’s Clinic facilities
International Friendship Children’s
• Upgrading and expansion of the IFCH as per the requirements.
• Educational programs.
• To be actively involved as a health related research center.
• Build own building for hospital and college and its specialized
branches to all over the country.
• Participate in children health program with national and
international child health related communities.
` Outpatient Department
Introduction of OPD
• a part of the hospital with allotted physical facilities and medical and other
staff in sufficient number with regularly scheduled hour, to provide care for
the patients who are not registered as inpatients.
• It is a stepping stone for health promotion and disease prevention.
• It acts as a filter for inpatient, help to use hospital bed efficiently and help to
earn significant income for hospital.
• It can be taken as shopping window of hospital or first contact of care.
• To provide general medical services to outpatients on
• To provide Preventive, Promotive, Curative and rehabilative
• Rehabilitative (Physiotherapy, Restorative services)
• Follow of discharged patients, chronic illness.
• Children welfare services/counselling.
• Necessary Immunization.
• Health education.
• Nutritional care.
• Medical Nursing and Paramedical education.
• To establish good impression of the hospital to the general
• Early diagnosis
• Effective treatment on ambulatory basis.
• The admission or referral for admission.
• Vaccination, Immunization
• Medical rehabilitation.
• Promotion and health of the individuals.
• Training and research.
• Proper record keeping.
• Screening and investigation for admission to hospital.
• The registration desk of OPD is located at the ground
floor of the main building which is next to the
• It is easily accessible and near to diagnostic .
• The clinics, Radiology and other departments are
left of the registration desk and also in first floor.
• X-ray room is located to the Right straight corner of
OPD entrance. Laboratory room is located in the first
• Likewise ECHO, EEG, ECG, USG, and Physiotherapy
are at other sides of OPD room and which well
Organogram of the OPD
In Medical and Surgical OPD, one doctor is available all the concerned
time. The other OPD services are made on call basis and the schedule
Private OPD Rs 450
General OPD Rs 195
Special OPD Rs 675 (for foreigners)
7:00 am to 9:00 pm.
Emergency OPD : On call services
EMERGENCY’ is a condition determined clinically or
considered by the patient or his relatives as requiring urgent
medical or allied services failing which it hold result in loss of
life or limb. Emergency is an illness or injury for which the
patient requires/desires the immediate attention of a clinical
• To provide treatment for cases requiring emergency measures.
• To complete official procedures of medical record.
• To be available as an information center for the emergency
medical question of the community.
• To provide immediate relief and management of accident victims,
providing first-aid treatment of minor injuries as well.
• To provide well organized services during the disaster situation.
• To deal with ethical and medical problems that can arise in an
• To refer the cases to the specialist after proper screening.
• To maintain effective communication and coordination with all
• To manage medico-legal cases as per requirement.
• Collection of casualties.
• Community oriented infant and child health services.
• Education, training and research activities.
• Emergency diagnostic services and Information center.
• Liaison with the policies and local authority in case of
• Provide emergency medical care and facilities.
• Referral center for admission and other center.
• Early detection, reporting and response.
• Transfer to required specialists.
• Staffing Pattern
• Emergency department have qualified and experienced
doctor, nurses and auxiliary staff. ER department
• Registrar 1
• Medical officer 1
• Staff nurse 2
• Ward Attendant 1
• Security 1
Total 20 staffs
Duty hour is from 7am to 1pm (morning shift),
1pm to 7pm (evening shift), & 7pm to 7am (night shift).
In each shift, it consists of 4-5 staffs.
Organogram of the Emergency
2068 2069 2070
• Emergency is easy to access with ambulatory structure.
• Round the clock emergency services.
• Least cost with Medical officer visit to treatment.
• Based on digital and manual recording system.
• Pharmacy, Laboratory, Radiology at door service.
• Good Communication, security services, available
trolly, stretcher, lift etc
• Emergency cases are RTA, Pneumonia, fever, RTI etc
• 24 hours of ambulance services.
• Located at ground floor for quick receive of emergency
• There is no Triage system available emergency due to
lack of area.
• Less number of beds for emergency observation care.
• No Medical Record, Cash, Inquiry, Laboratory stations
are closely available.
• Small area of lift, no ramp is available.
• Patients are needed to carry for radiological services.
• No waiting room for patient’s party.
• No area in treatment at mass casualties.
• No isolation room, plaster room, available.
• No enough number of baby cot.
Medical Record Department
• A medical record or health record in general is
a systematic documentation of a single
patient's long-term medical history and care.
• According to B.M Sakharkar, “MR is simply
defined as a systematic documentation of a
patient’s personal and social data, history of
his or her ailment, clinical findings,
Investigations, diagnosis, treatment given and
an account of follow up and final outcomes.”
• To provide quality and effective treatment and care to
• To serve as means of communication between the
physicians and the entire professionals group
contributing to the care of the patient.
• To provide detail history of the patient.
• To save time, effort, and money.
• To help in auditing purpose.
• To evaluate the hospital performance.
• To help for teaching, research and training purpose.
• To act as legal proof for patient, physician, institution,
health authorities and so on.
• To avoid unnecessary duplication of diagnosis and
• Patient registration.
• Booking of appointments and initiation of medical record.
• Filing, custody, storage, prompt retrieval, file track in/out, issues and
transport of patients files to clinics and wards, collection of the files
promptly ate patient disposal.
• Issues and transport of patients files to clinics and wards.
• Collection of files promptly after patients disposal
• Ensuring confidentiality of patient’s data.
• Reporting births and deaths, and notifiable disease to state health
• Storage of medico-legal data and evidence, liaison with police.
• Issues of birth/death notification certificates, medical reports, coordination
and release of sickness and medico-legal certificates.
• Providing data for infection control, risk management, medical audit,
quality assurance, utilization review.
• OPD and emergency medical files, folders and
registers are provided to MRD at end of every
• Files are submitted to MRD every day after
discharge from wards.
• Medical records are manually and digitally
• All available files are categorized at monthly
• Files and folders are stored after the payments
• There is less available staffs at MRD during office
• Medical records are not systematically stored.
• Lack of adequate space for MRD.
• No specific orders of files and folders.
• Medical records are retrieved with the reference
of report submitted to District Public Health
• No enough physical resources for handling,
retrieving and disseminating final report.
• No cross check and analysis of duly record
• IFCH in fully functioning Pediatric Hospital.
• It is Nepal first cooperative children’s hospital.
• Equipped with essential life saving features.
• Based upon children affordability prices.
• Run with International donation and free bed charity ward.
• Immunization, Nutrition Home, Mother’s Room, Visitor’s
Room available facilities.
• Dedicated, specialized and experience manpower.
• 24/7 pediatric medicine and surgery facilities with ambulance
• Focused on hygienic and children friendly environment with
playground and playroom.
• Sakharkar B.M. . “ Principle of Hospital
Administration and Planning”
• Kaini B.K, “Principles of Hospital
• Brochure of International Friendship
• Hospital Practicum Report “National Open