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Organization patten

This document discusses organizing and organization structures in healthcare. It explains that nursing care is essential for patient health and comfort. Nurses comprise the largest technical staff in hospitals next to doctors. Their functions include clinical, technical, caring, administrative, and educational roles. Staffing levels depend on factors like beds, services, patient acuity, technology, and competencies. Nurses are assigned to patients using methods like functional, case, team, group, and primary nursing. Physical dependency and occupancy rates impact workload assessments. Performance is tracked using indices like nursing hours per patient per day.

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1.1. The purpose of an organization structureThe purpose of an organization structure 2.2. The meaning of "organizing" and "organization."The meaning of "organizing" and "organization." 3.3. The distinction between formal and informal organization.The distinction between formal and informal organization. 4.4. How organization structures and their levels are due to theHow organization structures and their levels are due to the limitations of the span of management.limitations of the span of management. 5.5. The exact number of people a manager can effectively superviseThe exact number of people a manager can effectively supervise depends on a number of underlying variables and situations.depends on a number of underlying variables and situations. 6.6. The nature of entrepreneuring and intrapreneuring.The nature of entrepreneuring and intrapreneuring. 7.7. The key aspects and limitations of reengineering.The key aspects and limitations of reengineering. 8.8. The logic of organizing and its relationship to other managerialThe logic of organizing and its relationship to other managerial functions.functions. 9.9. That organizing requires taking situations into account.That organizing requires taking situations into account. LEARNING OBJECTIVESLEARNING OBJECTIVES
Organizing A basic process of combining / integrating Human / Physical / Financial resources in productive interrelationship for the achievement of enterprise objectives
Definition of Organization Organization implies a formalized intentional structure of roles or positions Effort Pooling towards designated objectives throughEffort Pooling towards designated objectives through definition / division of activities / responsibilities / authoritydefinition / division of activities / responsibilities / authority
identification andidentification and classificationclassification of required activitiesof required activities grouping of activitiesgrouping of activities necessary to attain objectivesnecessary to attain objectives Assigning responsibilityAssigning responsibility with necessarywith necessary authorityauthority To a manager for each groupingTo a manager for each grouping Coordination inCoordination in organizationalorganizational StructureStructure Vertically, HorizontallyVertically, Horizontally DepartmentationDepartmentation Manageable unitsManageable units Maximum possible specializationMaximum possible specialization DelegationDelegation Aptitude / AttitudeAptitude / Attitude Job Requirement / CapabilitiesJob Requirement / Capabilities Organizing involves SynchronizationSynchronization Interrelationship between differentInterrelationship between different positions must be clearly definedpositions must be clearly defined From whom ?From whom ? To whom ?To whom ?
Organizational Structure Design What Who Results Is to do Fitting various activities Give what Smoothly Efficiently Effectively
Should not be flexible Channeled individual and group efforts intentional structure ofintentional structure of roles in a formallyroles in a formally organized enterpriseorganized enterprise Well defined jobs Definite authority / responsibility FormalFormal organizationorganization
flexible Loosely organized Any joint personal activityAny joint personal activity withoutwithout conscious joint effortconscious joint effort even through contributing towardseven through contributing towards Joint ResultsJoint Results ill defined Spontaneous InformalInformal organizationorganization A network of personal / socialA network of personal / social relationships, not established, requiredrelationships, not established, required by FORMAL organization but arisingby FORMAL organization but arising spontaneouslyspontaneously Structure (membership),Structure (membership), communication networkscommunication networks (“grapevine”), and relationships(“grapevine”), and relationships behaviors and norms) do notbehaviors and norms) do not necessarily follow those ofnecessarily follow those of the formal organization.the formal organization.
What is a Department? The department designates a distinct area, division, or branch of an organization over which a manager has Authority for the performance of specified activities
Organization Level and Span of Management
Organization with Narrow SpanLevels = 4 Span of Control = 3 Total Employees = 40 Advantages •Close supervision •Close control •Fast communication between levels Disadvantages •Too much involvement in subordinate’s work •Many levels / higher cost •Excessive distance between top and lowest level Variety of non-recurrent problems, involving non-Variety of non-recurrent problems, involving non- programmed strategic decisionsprogrammed strategic decisions
Organization with wide spanLevels = 3 Span of Control = 7 Total Employees = 57 Advantages •Superiors are forced to delegate •Clear policies are required •Subordinates must be carefully selected Disadvantages •Overloaded superior / decisional bottleneck •Superior’s loss of control •Requires exceptional quality managers For Recurrent, repetitive and routine problemsFor Recurrent, repetitive and routine problems
Principle of the Span of Management The principle of the span of management states that there is a limit to the number of subordinates a manager can effectively supervise, but the exact number will depend on the impact of underlying factors
Operational-management position: a situational approach Classical theory: No. of subordinates:3-8 Operational management theory: 1.1. What to supervise: complexity and variety of theWhat to supervise: complexity and variety of the subordinate’s worksubordinate’s work 2.2. Which tools are usedWhich tools are used 3.3. Quality of manager and subordinateQuality of manager and subordinate 4.4. Degree of interactionDegree of interaction No. depends of many underlying factors:No. depends of many underlying factors:
Difference Between an Intrapreneur and an Entrepreneur • An intrapreneur is a person who focuses on innovation and creativity and who transforms a dream or an idea into a profitable venture by operating within the organizational environment • The entrepreneur is a person who does similar things as the intrapreneur, but outside the organizational setting
Definition of Reengineering • "...the"...the fundamentalfundamental rethinking andrethinking and radicalradical redesign of businessredesign of business processesprocesses to achieveto achieve dramaticdramatic improvements in criticalimprovements in critical contemporary measures of performance,contemporary measures of performance, such as cost, quality, service, and speed.“such as cost, quality, service, and speed.“
Key Aspects of ReengineeringKey Aspects of Reengineering Fundamental rethinking of what the organization is doing and why. Radical redesign of the business processes Reengineering calls for dramatic results The need for carefully analyzing and questioning business processes
Nurses form a very important group - the largest single technical group - of personnel engaged in patient care in hospitals next to doctors, consuming approximately one-third of hospital costs. because….
• Nursing care is required for the prevention of disease and for promotion of health. • The nursing care of sick patients - a. in the interest of his or her mental and physical comfort. b. by reason of the disease from which he or she is suffering.
Functions of nursing services are: 1. Clinical 2. Technical 3. Caring relationship 4. Administrative 5. Educational
It is observed that 50% or more of her time will be spent on non-nursing functions like a. Clerical b. Answering telephones c. Supervise indent of drugs d. House keeping, etc
staffing The number of nurses required to man the nursing services in a hospital depends on many factors, • Number of beds in a hospital • The type of hospital and the prevailing medical practice, including kinds of treatment and medications given and tests and services required for the patients. • Pattern of assignment of nurses - based on functional method, case method or teach method. • The type and the number of emergency cases coming into the hospital. • Available labour - saving devices, automation, mechanization, centralization • Level of competence based on - qualification, experience, efficiency and sincerity.
Work allocation Patterns of assignment: the tasks of the nursing unit are carried out by 3 accepted patterns of assignment, depending on the training, experience and the rules of a particular institution. 1. Functional method: The tasks are divided among the staff. 2. Case method: Each nurse is assigned one or more cases. 3. Team method : Under this system the nursing staff is divided into teams each of which is guided by an experienced nurse. The team leader is responsible to the ward sister and she organizes the nursing care for her group of patients. 4. Group Assignment method: one nurse is assigned to a group of patient to provide total nursing care. 5. Primary nursing method: the primary nurse assumes 24-hour accountability for the care, planning and evaluation. When on duty on a shift, the primary nurse herself assumes responsibility for providing total care. Other functions of primary nurse is the coordination of nursing activities with physician and other health professionals.
Physical dependency of patients This is an important factor in assessing the workload. The patients can be classified under the following headings: a. Totally ambulant b. Partially bedfast c. Bedfast but not helpless d. Partially helpless e. Totally helpless
Indices of hospital nurses The nursing time provided per patient per day is the most useful and realistic index, since it takes into account Occupancy rates, working hours, and days absent from work.
To find out the average number of working days per year by a nurse: Earned leave 30 days Sick leave 10 days Casual leave 14 days Weekly off 85 days Non-working days 139 days Total working days in year 365 days Therefore total working days is 226 days
To find out the average number of hours worked per year by a nurse Average number of working days per year X Average number of working hours 226 x 8 = 1808 nursing hours
To find out the total number of nursing hours per day The hours worked per year by a nurse X total number of nurses For example Total bed capacity of hospital = 500 Required number of nurses = 217 nurses (as per INC norms 1808 x 217 = 361736
To find out the number of nursing hours per day Total number of nursing hours per year ÷ 365 361736 ÷365 = 991.21 nursing hours per day To find out the number of nursing hours per Patient 991 ÷ 500 = 1.98 nursing hours per patient per day approximately
Duties of different categories of nursing staff Director of nursing The nursing director has very little or no technical duty to perform. The work is mainly administrative and conceptual. 1. Supervision - working pattern 2. Maintaining discipline 3. Planning diff. services 4. Preparing policies to upgrade the routines. 5. Participating in recruitment of staff 6. Organizing for academic purposes. 7. Arrange (in-service) training programmes.
Sister-in-charge Sister-in-charge is the administrative head of the ward/section. Therefore the duties are based on responsible attitude and supervision. 1. Maintaining cleanliness and orderliness in the ward. 2. Supervising housekeeping activities. 3. Supervise staff nurse, nurse-aides, labour staff, patients. 4. Maintaining inventory. 5. Accompany senior clinician during their rounds/ discussion and actively participate in taking and implementing the decisions.
Staff Nurse This category is the most active. The duties they are expected to carry out are 1. General and routine care of patients as per clinicians instructions. She is an active bridge between treating clinician and patients. 2. To assist clinician. 3. Assist or independently perform certain procedure like a. collecting blood, b. catheterization of bladder, c. giving IV fluids, d. first aid. 4. Assist actively at ante natal clinic, post natal clinic, diabetes, asthma, etc. 5. Educational activity like health talk, counseling, etc. 6. Attend outdoor activities. 7. Admit and discharge patients.
Problems faced: 1. Shortage of nurses due to a. improper ratio of nurse : patient b. recruitment policy c. non availability d. migration to other hospitals e. increase in requirement. 2. Dissatisfaction 3. Absenteeism : particularly for night duty. 4. Unionization 5. Deterioration in standard of performance
Professional Hazards: 1. Risk of infection 2. Stress and burn out 3. Backache due to prolonged standing and walking on hard surface. 4. Fatigue due to shift duties. 5. Improper behavior of some patients, relatives, labour staff and even doctors. 6. Frustration.
1. Receiving and sorting the soiled material used in the hospital 2. Determining whether the items should be reused or discarded. 3. Carrying out the process of decontamination or disinfection prior to sterilizing. 4. Carrying out specialized cleaning of equipment and supplies. 5. Inspecting and testing instruments, equipment and linen. 6. Assembling treatment trays, instrument sets, linen packs, etc. 7. Packaging all materials for sterilizing. 8. Sterilizing. 9. Labelling and dating materials. 10.Storing and controlling inventory. 11.Issuing and distributing. Functions of CSSD
Functions of CSSD 1. To maintain an uninterrupted supply of bacteriologically safe supplies at all times. 2. To undertake studies for improvement of sterilization practices and 3. Processing methods to provide supplies economically. 4. To impart training to hospital personnel in safe hospital practices. 5. To participate in hospital infection control programme.
Receipt Accounting, Sorting Washing, Cleaning, Drying Packing Awaiting sterilization Sterilization Sterile storage Issue Gloves Instruments Needles & Syringes Autoclaves Dry ovens Gloves Gauze & Dressings Syringes & Needles Instruments Packs Torn/punctured Unserviceable Cracked/ broken Check for Sterility Shelf-life expired Sterility Not ok
The sequence of events is as follows: 1. Materials are received into the department from various users. 2. All used materials are cleaned - prelimary cleaning before sending the articles to CSSD. 3. Clean materials are inspected, assembled and packed, ready for sterilization. 4. After sterilization, they are either stored in a sterile storage area or distributed directly as required.
Location • The location of CSSD should be convenient to its principal consumers. • Preferably sited close to OT & wards. • Doors should have the following strong colours to signify the different zones to which they give access. Red - denotes contaminated zone Yellow - denotes clean zone Green - denotes sterile zone
Space A minimum of 7 sq ft on a per bed basis ( with 100 sq ft for the smallest hospital) is considered essential for planning a CSSD with scope for future expansion and growth. Up to 100 beds 10 sq ft per bed Up to 200 beds 9 - 10 sq ft per bed Up to 300 beds 8 - 9 sq ft per bed 300 and above 7 - 8 sq ft per bed
Room Nature of work Space in % Wash room in which everything is washed up Dirty 10 Work room in which all packaging is undertaken Clean 26 Syringe & instrument processing room Clean 9 Unsterile pack store Clean 4 Bulk store Clean 11 Sterile store Sterile 16 Miscellaneous rooms Clean 19 Autoclaves Clean 5 In planning a CSSD, following concept may be kept in mind
Staffing One qualified superintendent - In-charge of the dept. CSSD supervisor - senior nurse (traditionally). In-service trained CSSD attendants CSSD assistants - Semiskilled workers CSSD technicians Sweeper. A 500-bedded teaching hospital has the following staff. Technologists 5 Technical assistants 4 Nursing aides 4 CSSD attendants 4
Equipments • Autoclaves • Dry oven • Gauze cutter • Ultrasound washer • Needle flushing device • Ethylene oxide sterilizer • Soaking sinks • High pressure water jets.
Autoclaves • Saturated steam under pressure is the safest and dependable method of sterilization. • Minimum time for sterilization by autoclaving process is 121°C in 15 min. • sterilization checks for quality control. • Sterility indicators – Mechanical indicators – Chemical indicators – Biological indicators • Shelf life
Chemical sterilization Ethylene oxide (EO) - used for heat-sensitive and moisture-sensitive materials like rubber, plastics and fibre glass. Effective sterilization by EO depends upon the Following: Concentration of gas: 450mg/litre or higher Temperature exposure: 49 to 63°C and 30 to 37.8°C Packing: The type of wrapping used should be penetrable by ethylene oxide and water vapour. Polyethylene is commonly used for wrapping. Period of exposure: The time ranges from 110 to 260 min. up to 12 hours may be required.
Sterilization process After the sterilizer chamber is sealed and the controls set, sterilization process goes through the following phases: 1. Warming the chamber 2. Evacuating residual air to partial vacuum. 3. Introduction of moisture to ensure that it penetrates wrappings and material. 4. Introduction of EO. 5. Raising the temperature(if required) 6. Exposure for the required time. 7. Release of chamber pressure.
Ultra sonic cleaner • Ultrasonic cleaner cleans by bombarding the item with sound waves. • These tiny shock waves will knock debris off nooks and corners of instruments that are not easy to reach.
The list of items and special trays commonly processed in the CSSD are: Instruments Dressings Sponges OT linen Special packs Gauze and cotton materials Gloves Bowls and trays
Standardization of surgical packs The aim is to have a standard surgical pack containing all the items required for that procedure by the operating surgeon. Some of the Special trays and sets to be processed by CSSD are as follows: • Lumbar puncture set • Sternal puncture set • Catheterization set • Bladder wash set • Liver biopsy set • Fine-needle aspiration cytology set • Suturing set • Thoracic aspiration set • Incision and drainage set • Tracheostomy set.
Laundry Services • It is a centralized function coming under the housekeeping department taking care of all activities from purchase to linen management to laundry to condemnation • Linen Management will vary based on the climate, culture, systems and procedure of the individual organization
Hospital can go for • Inside laundry services - with adequate machineries • Inside laundry services – Manual wash by dhobi • Outside laundry services – On contract basis
Functions of laundry department • Collection or receiving soiled and infected linen • Processing soiled linen through laundry equipment. This includes sorting, sluicing and disinfecting, washing, extracting, drying, conditioning ironing, pressing and folding • Inspection and repair of damaged articles, their contamination and replacement • Distributing finished linen to the respective user departments • Maintenance and control of active and back-up inventions and processed linen • Maintaining all type of registers
Organizing laundry department • Manpower requirement • Duties and responsibilities of linen in - charge housekeepers • Recruitment and selection of dhobi • Management information system • Equipments – selection, care • Linen – selection, care, stain removal procedure • Work procedure • Stain removal procedure • Management issues
Tips • Stock the linen materials in 1:3 ratio • Each day the bed sheet is dusted and the side is changed when the bed is made. This way both sides of the sheet is used. On the third day the bed sheet is changed • Use all faded and damaged fabrics for dusting and cleaning windows, furniture etc
Diet service objective • To provide individualized nutritional care to the patients using normal diet or need based special type of diet. • Service needs to be organized for o Hospital staff o Outdoor patients o Visitors o Patient’s attendants i.e. relatives.
Different types of food services include following: 1.Patient food service. 2.Cafeteria or mess for the employees. 3.Cafeteria or mess for the students in teaching hospitals. 4.Coffee shop 5.Vending machines. 6.Special meals for meetings, guests and functions.
• Patient food service 1. Purchasing food items as per specification and in predetermined quantity. 2. Planning menu for different types of patients as per their a. Age b. Nutritional needs. c. Ability to consume eg. Unconscious patient, infants, etc d. Disease requiring restrictions. • Disease requiring special diet
• Different types of menu • Full diet • Light diet • Soft diet • Liquid diet • Salt-free diet • Chilly free diet/bland diet • High protein diet • High carbohydrate diet • Diabetic diet • Special diet (eliminating certain substance) Dietary habits of patients should be taken.
3. Ensuring hygienic method of cooking. 4. While cooking nutritive value and palatability do not get adversely affected. 5. Supervising food distribution. 6. Supervising consumption by patients on random basis. 7. Taking feedback from patients. 8. Avoiding wastage by not preparing excess food and preventing pilferage. 9. Avoiding shortage – particularly for new patients. 10. Counseling patients on special diets. 11. Training nurses, students and interns
• SITE, AREA & DESIGN It is necessary to have certain policies before deciding their details 1. Foods consumed outside a. Information is got at the time of admission. b. Wastage is avoided c. Attendants food pass can be issued 1. Vegetarian/ Non-Veg This policy decision will enable diet dept. in a. Purchase of raw material b. Organizing separate area for cooking veg & Non-veg meals.
• Ground floor is desirable 1.Receipt of raw materials a. Checking, b.Weighing c. Temporary storing before shifting 2.Storage area a. Godown or storeroom for non-perishable items like grains, oil, etc. b.Cold storage for perishable items milk, vegetables, etc. – refrigerator, cold room.
3. Preparation area a. Sorting out b. Washing vegetables c. Washing utensils d. Slicing, peeling, chopping, grinding e. Mixing 4. Cooking area a. Large size steam cooker. b. Cooking gas c. Special diet area
5. Serving and transportation of cooked food depends on a. Hospital policy b. Geographical area c. Vertical / horizontal /both. ｷ Mobile hot food carrier ｷ Containers of adequate size ｷ Nurse in the ward will arrange to get food served. 6. Cleaning area a. Utensils cleaning b. Dish washer
• Staffing pattern • Manager – qualified dietitian • Dietitians – 2 or 3 • Clerical staff – paper work & inventory • Cooks – one/100 beds. Health check-up, food handlers. • Helpers
• Problems 1. Patient satisfaction 2. Wastage i. Cooking more than necessary ii. Less consumption due to a. Poor taste b. Becoming cold c. Poor appetite due to illness d. Home food/eatables 1. Shortage i. Diet sheet has not been submitted on time. ii. Sudden new admissions iii. Cooking less than necessary iv. Pilferage by staff. • Theft • Fraud in materials management.
• Outsourcing dietary • Cafeteria or mess for employees • Cafeteria for students • Coffee shop • Vending machines • Special meals for guests or for functions. • Diet committee – regular rounds, taste of food is checked.
The basic function of a laboratory service is: 1. To assist doctors in arriving at or confirm a diagnosis. 2. To assist in the treatment and follow-up of patients. 3. The laboratory not only generates prompt and reliable reports, but also to function as a storehouse of reports for future references. 4. To carry out urgent tests at any part of day or night and therefore provide serve 24 hours a day, 5. And in big hospitals, the laboratory also assists in teaching programs for doctors, nurses and laboratory technologists.
Types of laboratories1. Hematology Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The lab work that goes into the study of blood is performed by a Medical Technologist. 2. Microbiology Microbiology is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms 3. Clinical chemistry Clinical biochemistry is the area of pathology that is generally concerned with analysis of bodily fluids.
4. Histopathology Histopathology (from the Greek histos (tissue) and pathos (suffering)) refers to the microscopic examination of tissue in order to study the manifestations of disease. 5. Routine urine and stool analysis
Functional planning 1. Determine approximate section wise workload. 2. Determining services to be provided. 3. Determining area and space requirement to accommodate equipment, furniture and personnel in technical, administrative and auxiliary functions. 4. Dividing the area into functional units, viz hematology, biochemistry, microbiology, histopathology, urinalysis, etc.
5.Determining the number of work stations in each functional unit/division and deciding the linear bench space allotted for each work station. 6. Determining the major equipment and appliances in each unit. This is generally classified into: i) Technical equipment peculiar to certain work stations. ii) Other equipment and appliances e.g. (refrigerators, hot air ovens, centrifuges) that can be jointly used by different work stations or units.
7. Determining the functional location of each section in relation to one another, from the point of view of flow of work, technical work considerations, auxiliary areas and administrative efficiency. 8. Identifying the units that are likely to expand, for locating them in such a manner which will permit smooth expansion. 9. Identifying the electrical and plumbing requirements for each area/work station. Independent electric circuits are required for electronic equipment items. Location of sinks and wash areas are vital for efficient performance of work stations.
10. Considering utilities, - lighting, ventilation (forced or normal exhaust, air-conditioning and air hygiene) and isolation of equipment or work stations. 11. Working out the most suitable laboratory space unit (LSU), which is a standard module for work areas. A standard module facilitates rearrangement of work units with least disruption and minimal structural changes.
Organization 1. Centralized • It avoids duplication of purchases of expensive equipment. • Avoids duplication of personnel. • Easy to monitor working and quality control • Automation will not be underutilized. • There can be delay in transporting samples and issue of reports.
2. Decentralized • Transportation • Dispatch • Can cater to the specific needs of certain areas e.g. ICCU, premature nursery • Results can be easily logged on to the ward • Duplication of equipments • Requires additional technical staff. • Lack of uniformity in procedures and conflicts. • Supervision difficulty • Quality control • Multiple lines of authority • Transfers to other area may disturb the services.
Workload • An admitted patient undergoes anywhere between 8 and 20 laboratory tests on an average during his or her hospitalization period. • In 1990, in a teaching hospital, laboratory tests averaged at 20 tests per patient in medical ward during an ALS of 10 days, giving a ratio of 2 tests per day, excluding radiographic investigations or other tests carried out in specialized laboratories.
• A 100-bedded hospital with a 10 days ALS will treat 365 ÷ 10 = 36.5 (37 pts)/bed in a yr, • 37 x 100 = 3700 total patient in a year which means that the hospital laboratory will have to carry out 3700 x 8 = 29,000 tests to 3700 x 20 = 74,000 tests during the year.
Location • Preferable on the ground floor and accessible to the wards. • Depends upon the size of the hospital and its outpatient set up, the laboratory can be situated. • Outpatient sample collection. – The design should include waiting room for patients, venepuncture room, and specimen toilets. – Provision should be made for containers with appropriate preservatives, for correct labeling of samples, and for keeping record of each patient.
• Primary space – The space utilized by technical staff for the primary task of carrying out professional work. – This space is expressed in terms of LSU. • Secondary space – The space utilized for all supportive activities. – Administrative space, viz. offices for the pathologist and other, rest and locker rooms, staff toilets, etc. should be considered separately from secondary space. • Circulation space – The space required for uncluttered movement of personnel and materials within the dept. between various technical work stations, rooms, stores and other auxiliary and admin. Areas.
Departments Primary space Space required Hematology  General hematology  Blood transfusion  Office desk/ admin 3.5 LSU 1.5 LSU 0.5 LSU 5.5 LSU 101.75sq m Clinical chemistry  Processing and preparation  Special and general tests  Office desk/ admin/ reagent stores 1.5 LSU 3.0 LSU 1.0 LSU 5.5 LSU 101.75 sq m Microbiology  General bacteriology  Media preparation  Office desk/ admin 3.5 LSU 1.0 LSU 0.5 LSU 5.0 LSU 92.50 sq m Histopathology  Specimen preparation  Section cutting and staining  Frozen section/ special techniques  Cytology  Office desk/ admin 1.0 LSU 0.5 LSU 0.5 LSU 1.0 LSU 0.5 LSU 3.5 LSU 64.75 sq m Urine and stool 0.5 LSU TOTAL 9.25 sq m 370.00 sq m Schedule of accommodation of hospital laboratory
Departments Secondary space Space required Patient area  Waiting area Consulting, examination, venepuncture, etc. Patient toilet (specimen toilet) 40 sq m 30 sq m 10 80 sq m Office and staff  pathologist office and laboratory General office: assembling, labeling, storing, distribution of reports Staff locker and rest room  staff toilet 30 60 40 10 140 sq m Supply and processing  chemical preparation Central glass washing Sterilization Distilled water still Store: general and glassware Store: chemical Disposal and cleaning 25 60 30 10 20 20 10 TOTAL 175 sq m 395 sq m Circulation space Approximately 30 % of the total of primary and secondary space
Layout • A simple, basic layout of spaces and equipment which can be supplemented or modified to suit different requirements is likely to be more efficient. • The structure, equipment and finishes should permit the original space allocation and the layout to be changed while the building is in use, with minimum disturbance. • Flexibility for use is needed so that areas can be converted from secondary to primary space and vice versa in the interest of rearrangement for expansion or change.
• A few large sinks which are capable of being moved without undue inconvenience are both more economical and more convenient than a larger number of small fixed sinks. • A fixed layout of services and equipment can be designed to be conveniently used in a number of alternative ways providing that working methods can be adapted or modified to fit the layout. • Open planning with a suitable arrangement of bays permits a higher ratio of usable bench length to floor area.
• Administrative and auxiliary areas • Waiting room • Venepuncture cubicle • Specimen toilet • Pathologists office • Glass washing and sterilizing unit • Staff locker room and toilet
Utility services • It include water, gas and compressed air system. • The need for uninterrupted functioning of these systems and the probability of future expansion, careful study is necessary in designing them for safety and efficiency. • Piping system – color, coding or labeling, non corrosive – to facilitate safety purposes and repairs. • Arrangement of laboratory benches – removable panels between the benches.
Internal design and fitments • Work benches • Lighting • Service spine • Storage • Partitions • Dust • Air-conditioning/exhaust • Working surface • Flooring
Staffing • The hospital laboratory service should be under the control and direction of a doctor with qualifications in pathology. – He becomes the overall in charge – quality control, standardization and administration. – Should be a part of the regular medical staff of the hospital.
• The number of medical laboratory technologists (MLT) and laboratory technicians will depend upon: – The number of samples per day – The range of tests to be performed under various sections, viz clinical chemistry, hematology, microbiology and histopathology. – Emergency service and – leave reserve.
• They perform all technical procedures in – Various section, – Prepare reports of completed investigations, – Check and maintain equipment and – Request for necessary supplies and materials.
Tests performed annually per medical technologist Laboratory unit Tests Hematology 13,400 Urinalysis 30,000 Serology 11,520 Biochemistry 9,600 Bacteriology 7,680 Histology 3,840 Parasitology 9,600
Equipment • The following is a list of the important items of equipments and instruments in a general hospital laboratory: – Robot cell counter – Centrifuge – Microhematocrit centrifuge – Refrigerators – Blood bank refrigerator – Water still – Pressure sterilizer – Pipette washer – Flame photometer – Spectrophotometer – Hot air oven – Incubator – Calorimeter – Analytical balance – Blood gas analyzer – Autoanalyzer.
Policies and procedures • Laboratory samples • Sample receiving • Request forms • Time of accepting specimens • Containers • Identification of specimens • Reports • Records • Blood bank service • Outpatient samples • HIV • Liaison with clinicians • Technician’s motivation • Cross-training of technicians • Laboratory waste disposal • Optimal utilization of laboratory service.
It is the area of service in the hospital, where quick and competent care can save lives and also reduce the severity and duration of illness. The casualty department provides the first impression which should be a positive one. The relationship of the casualty with other departments and wards should be close. Emergency service
Definition The casualty services provide immediate emergency, diagnostic and therapeutic care to patients with: • Injuries by accidents, suicidal, homicidal, etc. • Sudden attacks of illness or exacerbation of the disease. These patients require immediate attention and treatment. Emergency patients receive resuscitation and life-saving treatment.
Functions 1. Attend to all the patients brought to casualty & decide appropriate management which includes - Immediate resuscitation. - First aid - Emergency investigations - Hospitalization - Referral to specific specialty by calling down the concerned doctor. - Observation of patient to decide: whether the patient can go home and attend appropriate OPD - Reassurance and short counselling.
2. Carry out medico-legal formalities. 3. Maintaining up to date list of critically ill patients for the purpose of - issuing one visit pass to relatives. - replying telephone calls. - decide acceptance or rejection of transfer of patients from other hospitals. - assist intra hospital transfer.
• Following category of case can be labeled as medico legal : • 1. Cases of injuries and burns the circumstances of which suggest commission of an offence by some one. • 2. All Vehicular, factory or other unnatural accident cases specially when there is likelihood of patient’s death or grievous hurt. • 3. Cases of suspected or evident sexual assault. • 4. Cases of suspected or evident criminal abortion. • 5. Cases of unconsciousness where its cause is not natural or not clear. • 6. All cases of suspected or evident poisoning/intoxication. • 7. Cases referred from court or otherwise for age estimation etc. • 8. Cases brought dead with improper history creating suspicion of an offence. • 9. Any other case not falling under the above categories but has legal implication.
4. Carryout services of non emergency nature as per the policy of the organization. 5. Maintain list of doctors on emergency duty, their availability and alternative arrangements if they are busy. 6. Disaster preparedness for mass casualties.
Site, Area and Design • Ground floor • Proper sign board with illumination • Other human traffic restricted • Entrance pattern Compound gate OPD Casualty Inpatient Services
Important areas of casualty 1. Reception or Enquiry Counter • Sign boards with proper direction • Enquiry counter • Entrance to the casualty area should be broad enough to permit two ambulances • The entrance area should be covered. • ‘No parking’ board.
2. Waiting area for the relatives • Should be spacious with adequate light and ventilation. • Adequate sitting accommodation • All utility services should be provided • Public address system to call relative of patient to inform about patient’s condition. • Small statue of God/ Meditation hall.
3. Space for trolleys and wheel chairs • Immediate arrangement of wheel chair or trolley depending on the condition of the patient. • Based on work load, 4 - 6 trolleys/ wheel chairs are required. • Transferring of critical patients into other areas. • ‘Intensive care trolley’ should be there. • Trolley and wheel chair - parked in orderly fashion. • Soiled trolley should be kept clean always.
4. Space for security staff and police constable • Casualty is likely to get victims of assaults, riots, group rivalry, etc. so the security needs to be vigilant. • Entries should be restricted. • Cubicle with glass walls permitting visibility of hospital waiting area, compound & building entrance. • It is essential to have police constable counter either at the waiting hall or by the side of the entrance.
5. Space for administrator and night superintendent 6. Space for patient brought dead - procedural formalities - in the event of disaster - labeling is done - sent to mortuary - either to relatives or to police.
Facilities for management 1. Examination room - first aid 2. Treatment room - minor procedures 3. Observation area - depending upon the patient condition 4. Storage space - linen, consumable items, dressing material, I.V fluids, equipments 5. Fixtures: electrical connections, medical gas connection and vacuum connections. 6. Other support services: lab, radiology, blood bank, OT/table for infected and uninfected cases.
Staff required 1. Senior physician/surgeon/orthopedic surgeon who should be in-charge 2. Casualty officers - depending upon the size of the hospital. 3. Orientation given on emergency care and service. 4. Specialist doctors may be called as and when necessary. 5. Nursing staff - round the clock. 6. Labour staff - for cleaning, shifting, carry messages, samples, reports, etc.
Maintenance of record 1. Case register - all patients 2. Register for medico-legal cases 3. Police intimation register 4. Call book- to requisition services of doctors from different specialties 5. In/out register for resident doctors. Records/registers are required for: 1. Court case 2. Compensation to injured patients 3. Insurance 4. In the event of complaint 5. Medical audit.
Problems faced 1. Poor upkeep of premises and poor level of cleanliness 2. Shortage of doctors on duty due to rapid turnover. 3. Waiting for specialist opinion. 4. Casualty officer unable to take decision. 5. Inadequate staff.
Continued.. 6. Waiting for investigation report 7. Sudden shortage of certain items during heavy attendance. 8. Pressure for hospitalization in public hospitals for non medical reasons. 9. Incomplete/ poor documentation in MLC 10. Conflicts due to poor public relations and stress due to nature of work.

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Organization patten

  • 1.
    1.1. The purposeof an organization structureThe purpose of an organization structure 2.2. The meaning of "organizing" and "organization."The meaning of "organizing" and "organization." 3.3. The distinction between formal and informal organization.The distinction between formal and informal organization. 4.4. How organization structures and their levels are due to theHow organization structures and their levels are due to the limitations of the span of management.limitations of the span of management. 5.5. The exact number of people a manager can effectively superviseThe exact number of people a manager can effectively supervise depends on a number of underlying variables and situations.depends on a number of underlying variables and situations. 6.6. The nature of entrepreneuring and intrapreneuring.The nature of entrepreneuring and intrapreneuring. 7.7. The key aspects and limitations of reengineering.The key aspects and limitations of reengineering. 8.8. The logic of organizing and its relationship to other managerialThe logic of organizing and its relationship to other managerial functions.functions. 9.9. That organizing requires taking situations into account.That organizing requires taking situations into account. LEARNING OBJECTIVESLEARNING OBJECTIVES
  • 2.
    Organizing A basic processof combining / integrating Human / Physical / Financial resources in productive interrelationship for the achievement of enterprise objectives
  • 3.
    Definition of Organization Organizationimplies a formalized intentional structure of roles or positions Effort Pooling towards designated objectives throughEffort Pooling towards designated objectives through definition / division of activities / responsibilities / authoritydefinition / division of activities / responsibilities / authority
  • 4.
    identification andidentification and classificationclassification ofrequired activitiesof required activities grouping of activitiesgrouping of activities necessary to attain objectivesnecessary to attain objectives Assigning responsibilityAssigning responsibility with necessarywith necessary authorityauthority To a manager for each groupingTo a manager for each grouping Coordination inCoordination in organizationalorganizational StructureStructure Vertically, HorizontallyVertically, Horizontally DepartmentationDepartmentation Manageable unitsManageable units Maximum possible specializationMaximum possible specialization DelegationDelegation Aptitude / AttitudeAptitude / Attitude Job Requirement / CapabilitiesJob Requirement / Capabilities Organizing involves SynchronizationSynchronization Interrelationship between differentInterrelationship between different positions must be clearly definedpositions must be clearly defined From whom ?From whom ? To whom ?To whom ?
  • 5.
    Organizational Structure Design What Who Results Isto do Fitting various activities Give what Smoothly Efficiently Effectively
  • 6.
    Should not be flexible Channeled individual and groupefforts intentional structure ofintentional structure of roles in a formallyroles in a formally organized enterpriseorganized enterprise Well defined jobs Definite authority / responsibility FormalFormal organizationorganization
  • 7.
    flexible Loosely organized Any joint personalactivityAny joint personal activity withoutwithout conscious joint effortconscious joint effort even through contributing towardseven through contributing towards Joint ResultsJoint Results ill defined Spontaneous InformalInformal organizationorganization A network of personal / socialA network of personal / social relationships, not established, requiredrelationships, not established, required by FORMAL organization but arisingby FORMAL organization but arising spontaneouslyspontaneously Structure (membership),Structure (membership), communication networkscommunication networks (“grapevine”), and relationships(“grapevine”), and relationships behaviors and norms) do notbehaviors and norms) do not necessarily follow those ofnecessarily follow those of the formal organization.the formal organization.
  • 8.
    What is aDepartment? The department designates a distinct area, division, or branch of an organization over which a manager has Authority for the performance of specified activities
  • 9.
    Organization Level andSpan of Management
  • 10.
    Organization with NarrowSpanLevels = 4 Span of Control = 3 Total Employees = 40 Advantages •Close supervision •Close control •Fast communication between levels Disadvantages •Too much involvement in subordinate’s work •Many levels / higher cost •Excessive distance between top and lowest level Variety of non-recurrent problems, involving non-Variety of non-recurrent problems, involving non- programmed strategic decisionsprogrammed strategic decisions
  • 11.
    Organization with widespanLevels = 3 Span of Control = 7 Total Employees = 57 Advantages •Superiors are forced to delegate •Clear policies are required •Subordinates must be carefully selected Disadvantages •Overloaded superior / decisional bottleneck •Superior’s loss of control •Requires exceptional quality managers For Recurrent, repetitive and routine problemsFor Recurrent, repetitive and routine problems
  • 12.
    Principle of theSpan of Management The principle of the span of management states that there is a limit to the number of subordinates a manager can effectively supervise, but the exact number will depend on the impact of underlying factors
  • 13.
    Operational-management position: asituational approach Classical theory: No. of subordinates:3-8 Operational management theory: 1.1. What to supervise: complexity and variety of theWhat to supervise: complexity and variety of the subordinate’s worksubordinate’s work 2.2. Which tools are usedWhich tools are used 3.3. Quality of manager and subordinateQuality of manager and subordinate 4.4. Degree of interactionDegree of interaction No. depends of many underlying factors:No. depends of many underlying factors:
  • 14.
    Difference Between anIntrapreneur and an Entrepreneur • An intrapreneur is a person who focuses on innovation and creativity and who transforms a dream or an idea into a profitable venture by operating within the organizational environment • The entrepreneur is a person who does similar things as the intrapreneur, but outside the organizational setting
  • 15.
    Definition of Reengineering •"...the"...the fundamentalfundamental rethinking andrethinking and radicalradical redesign of businessredesign of business processesprocesses to achieveto achieve dramaticdramatic improvements in criticalimprovements in critical contemporary measures of performance,contemporary measures of performance, such as cost, quality, service, and speed.“such as cost, quality, service, and speed.“
  • 16.
    Key Aspects ofReengineeringKey Aspects of Reengineering Fundamental rethinking of what the organization is doing and why. Radical redesign of the business processes Reengineering calls for dramatic results The need for carefully analyzing and questioning business processes
  • 17.
    Nurses form avery important group - the largest single technical group - of personnel engaged in patient care in hospitals next to doctors, consuming approximately one-third of hospital costs. because….
  • 18.
    • Nursing careis required for the prevention of disease and for promotion of health. • The nursing care of sick patients - a. in the interest of his or her mental and physical comfort. b. by reason of the disease from which he or she is suffering.
  • 19.
    Functions of nursingservices are: 1. Clinical 2. Technical 3. Caring relationship 4. Administrative 5. Educational
  • 20.
    It is observedthat 50% or more of her time will be spent on non-nursing functions like a. Clerical b. Answering telephones c. Supervise indent of drugs d. House keeping, etc
  • 21.
    staffing The number ofnurses required to man the nursing services in a hospital depends on many factors, • Number of beds in a hospital • The type of hospital and the prevailing medical practice, including kinds of treatment and medications given and tests and services required for the patients. • Pattern of assignment of nurses - based on functional method, case method or teach method. • The type and the number of emergency cases coming into the hospital. • Available labour - saving devices, automation, mechanization, centralization • Level of competence based on - qualification, experience, efficiency and sincerity.
  • 22.
    Work allocation Patterns ofassignment: the tasks of the nursing unit are carried out by 3 accepted patterns of assignment, depending on the training, experience and the rules of a particular institution. 1. Functional method: The tasks are divided among the staff. 2. Case method: Each nurse is assigned one or more cases. 3. Team method : Under this system the nursing staff is divided into teams each of which is guided by an experienced nurse. The team leader is responsible to the ward sister and she organizes the nursing care for her group of patients. 4. Group Assignment method: one nurse is assigned to a group of patient to provide total nursing care. 5. Primary nursing method: the primary nurse assumes 24-hour accountability for the care, planning and evaluation. When on duty on a shift, the primary nurse herself assumes responsibility for providing total care. Other functions of primary nurse is the coordination of nursing activities with physician and other health professionals.
  • 23.
    Physical dependency ofpatients This is an important factor in assessing the workload. The patients can be classified under the following headings: a. Totally ambulant b. Partially bedfast c. Bedfast but not helpless d. Partially helpless e. Totally helpless
  • 24.
    Indices of hospitalnurses The nursing time provided per patient per day is the most useful and realistic index, since it takes into account Occupancy rates, working hours, and days absent from work.
  • 25.
    To find outthe average number of working days per year by a nurse: Earned leave 30 days Sick leave 10 days Casual leave 14 days Weekly off 85 days Non-working days 139 days Total working days in year 365 days Therefore total working days is 226 days
  • 26.
    To find outthe average number of hours worked per year by a nurse Average number of working days per year X Average number of working hours 226 x 8 = 1808 nursing hours
  • 27.
    To find outthe total number of nursing hours per day The hours worked per year by a nurse X total number of nurses For example Total bed capacity of hospital = 500 Required number of nurses = 217 nurses (as per INC norms 1808 x 217 = 361736
  • 28.
    To find outthe number of nursing hours per day Total number of nursing hours per year ÷ 365 361736 ÷365 = 991.21 nursing hours per day To find out the number of nursing hours per Patient 991 ÷ 500 = 1.98 nursing hours per patient per day approximately
  • 29.
    Duties of differentcategories of nursing staff Director of nursing The nursing director has very little or no technical duty to perform. The work is mainly administrative and conceptual. 1. Supervision - working pattern 2. Maintaining discipline 3. Planning diff. services 4. Preparing policies to upgrade the routines. 5. Participating in recruitment of staff 6. Organizing for academic purposes. 7. Arrange (in-service) training programmes.
  • 30.
    Sister-in-charge Sister-in-charge is theadministrative head of the ward/section. Therefore the duties are based on responsible attitude and supervision. 1. Maintaining cleanliness and orderliness in the ward. 2. Supervising housekeeping activities. 3. Supervise staff nurse, nurse-aides, labour staff, patients. 4. Maintaining inventory. 5. Accompany senior clinician during their rounds/ discussion and actively participate in taking and implementing the decisions.
  • 31.
    Staff Nurse This categoryis the most active. The duties they are expected to carry out are 1. General and routine care of patients as per clinicians instructions. She is an active bridge between treating clinician and patients. 2. To assist clinician. 3. Assist or independently perform certain procedure like a. collecting blood, b. catheterization of bladder, c. giving IV fluids, d. first aid. 4. Assist actively at ante natal clinic, post natal clinic, diabetes, asthma, etc. 5. Educational activity like health talk, counseling, etc. 6. Attend outdoor activities. 7. Admit and discharge patients.
  • 32.
    Problems faced: 1. Shortageof nurses due to a. improper ratio of nurse : patient b. recruitment policy c. non availability d. migration to other hospitals e. increase in requirement. 2. Dissatisfaction 3. Absenteeism : particularly for night duty. 4. Unionization 5. Deterioration in standard of performance
  • 33.
    Professional Hazards: 1. Riskof infection 2. Stress and burn out 3. Backache due to prolonged standing and walking on hard surface. 4. Fatigue due to shift duties. 5. Improper behavior of some patients, relatives, labour staff and even doctors. 6. Frustration.
  • 34.
    1. Receiving andsorting the soiled material used in the hospital 2. Determining whether the items should be reused or discarded. 3. Carrying out the process of decontamination or disinfection prior to sterilizing. 4. Carrying out specialized cleaning of equipment and supplies. 5. Inspecting and testing instruments, equipment and linen. 6. Assembling treatment trays, instrument sets, linen packs, etc. 7. Packaging all materials for sterilizing. 8. Sterilizing. 9. Labelling and dating materials. 10.Storing and controlling inventory. 11.Issuing and distributing. Functions of CSSD
  • 35.
    Functions of CSSD 1.To maintain an uninterrupted supply of bacteriologically safe supplies at all times. 2. To undertake studies for improvement of sterilization practices and 3. Processing methods to provide supplies economically. 4. To impart training to hospital personnel in safe hospital practices. 5. To participate in hospital infection control programme.
  • 36.
    Receipt Accounting, Sorting Washing, Cleaning,Drying Packing Awaiting sterilization Sterilization Sterile storage Issue Gloves Instruments Needles & Syringes Autoclaves Dry ovens Gloves Gauze & Dressings Syringes & Needles Instruments Packs Torn/punctured Unserviceable Cracked/ broken Check for Sterility Shelf-life expired Sterility Not ok
  • 37.
    The sequence ofevents is as follows: 1. Materials are received into the department from various users. 2. All used materials are cleaned - prelimary cleaning before sending the articles to CSSD. 3. Clean materials are inspected, assembled and packed, ready for sterilization. 4. After sterilization, they are either stored in a sterile storage area or distributed directly as required.
  • 38.
    Location • The locationof CSSD should be convenient to its principal consumers. • Preferably sited close to OT & wards. • Doors should have the following strong colours to signify the different zones to which they give access. Red - denotes contaminated zone Yellow - denotes clean zone Green - denotes sterile zone
  • 39.
    Space A minimum of7 sq ft on a per bed basis ( with 100 sq ft for the smallest hospital) is considered essential for planning a CSSD with scope for future expansion and growth. Up to 100 beds 10 sq ft per bed Up to 200 beds 9 - 10 sq ft per bed Up to 300 beds 8 - 9 sq ft per bed 300 and above 7 - 8 sq ft per bed
  • 40.
    Room Nature of work Spacein % Wash room in which everything is washed up Dirty 10 Work room in which all packaging is undertaken Clean 26 Syringe & instrument processing room Clean 9 Unsterile pack store Clean 4 Bulk store Clean 11 Sterile store Sterile 16 Miscellaneous rooms Clean 19 Autoclaves Clean 5 In planning a CSSD, following concept may be kept in mind
  • 41.
    Staffing One qualified superintendent- In-charge of the dept. CSSD supervisor - senior nurse (traditionally). In-service trained CSSD attendants CSSD assistants - Semiskilled workers CSSD technicians Sweeper. A 500-bedded teaching hospital has the following staff. Technologists 5 Technical assistants 4 Nursing aides 4 CSSD attendants 4
  • 42.
    Equipments • Autoclaves • Dryoven • Gauze cutter • Ultrasound washer • Needle flushing device • Ethylene oxide sterilizer • Soaking sinks • High pressure water jets.
  • 43.
    Autoclaves • Saturated steamunder pressure is the safest and dependable method of sterilization. • Minimum time for sterilization by autoclaving process is 121°C in 15 min. • sterilization checks for quality control. • Sterility indicators – Mechanical indicators – Chemical indicators – Biological indicators • Shelf life
  • 44.
    Chemical sterilization Ethylene oxide(EO) - used for heat-sensitive and moisture-sensitive materials like rubber, plastics and fibre glass. Effective sterilization by EO depends upon the Following: Concentration of gas: 450mg/litre or higher Temperature exposure: 49 to 63°C and 30 to 37.8°C Packing: The type of wrapping used should be penetrable by ethylene oxide and water vapour. Polyethylene is commonly used for wrapping. Period of exposure: The time ranges from 110 to 260 min. up to 12 hours may be required.
  • 45.
    Sterilization process After thesterilizer chamber is sealed and the controls set, sterilization process goes through the following phases: 1. Warming the chamber 2. Evacuating residual air to partial vacuum. 3. Introduction of moisture to ensure that it penetrates wrappings and material. 4. Introduction of EO. 5. Raising the temperature(if required) 6. Exposure for the required time. 7. Release of chamber pressure.
  • 46.
    Ultra sonic cleaner •Ultrasonic cleaner cleans by bombarding the item with sound waves. • These tiny shock waves will knock debris off nooks and corners of instruments that are not easy to reach.
  • 47.
    The list ofitems and special trays commonly processed in the CSSD are: Instruments Dressings Sponges OT linen Special packs Gauze and cotton materials Gloves Bowls and trays
  • 48.
    Standardization of surgicalpacks The aim is to have a standard surgical pack containing all the items required for that procedure by the operating surgeon. Some of the Special trays and sets to be processed by CSSD are as follows: • Lumbar puncture set • Sternal puncture set • Catheterization set • Bladder wash set • Liver biopsy set • Fine-needle aspiration cytology set • Suturing set • Thoracic aspiration set • Incision and drainage set • Tracheostomy set.
  • 50.
    Laundry Services • Itis a centralized function coming under the housekeeping department taking care of all activities from purchase to linen management to laundry to condemnation • Linen Management will vary based on the climate, culture, systems and procedure of the individual organization
  • 51.
    Hospital can gofor • Inside laundry services - with adequate machineries • Inside laundry services – Manual wash by dhobi • Outside laundry services – On contract basis
  • 52.
    Functions of laundrydepartment • Collection or receiving soiled and infected linen • Processing soiled linen through laundry equipment. This includes sorting, sluicing and disinfecting, washing, extracting, drying, conditioning ironing, pressing and folding • Inspection and repair of damaged articles, their contamination and replacement • Distributing finished linen to the respective user departments • Maintenance and control of active and back-up inventions and processed linen • Maintaining all type of registers
  • 53.
    Organizing laundry department •Manpower requirement • Duties and responsibilities of linen in - charge housekeepers • Recruitment and selection of dhobi • Management information system • Equipments – selection, care • Linen – selection, care, stain removal procedure • Work procedure • Stain removal procedure • Management issues
  • 54.
    Tips • Stock thelinen materials in 1:3 ratio • Each day the bed sheet is dusted and the side is changed when the bed is made. This way both sides of the sheet is used. On the third day the bed sheet is changed • Use all faded and damaged fabrics for dusting and cleaning windows, furniture etc
  • 55.
    Diet service objective • Toprovide individualized nutritional care to the patients using normal diet or need based special type of diet. • Service needs to be organized for o Hospital staff o Outdoor patients o Visitors o Patient’s attendants i.e. relatives.
  • 56.
    Different types offood services include following: 1.Patient food service. 2.Cafeteria or mess for the employees. 3.Cafeteria or mess for the students in teaching hospitals. 4.Coffee shop 5.Vending machines. 6.Special meals for meetings, guests and functions.
  • 57.
    • Patient foodservice 1. Purchasing food items as per specification and in predetermined quantity. 2. Planning menu for different types of patients as per their a. Age b. Nutritional needs. c. Ability to consume eg. Unconscious patient, infants, etc d. Disease requiring restrictions. • Disease requiring special diet
  • 58.
    • Different typesof menu • Full diet • Light diet • Soft diet • Liquid diet • Salt-free diet • Chilly free diet/bland diet • High protein diet • High carbohydrate diet • Diabetic diet • Special diet (eliminating certain substance) Dietary habits of patients should be taken.
  • 59.
    3. Ensuring hygienicmethod of cooking. 4. While cooking nutritive value and palatability do not get adversely affected. 5. Supervising food distribution. 6. Supervising consumption by patients on random basis. 7. Taking feedback from patients. 8. Avoiding wastage by not preparing excess food and preventing pilferage. 9. Avoiding shortage – particularly for new patients. 10. Counseling patients on special diets. 11. Training nurses, students and interns
  • 60.
    • SITE, AREA& DESIGN It is necessary to have certain policies before deciding their details 1. Foods consumed outside a. Information is got at the time of admission. b. Wastage is avoided c. Attendants food pass can be issued 1. Vegetarian/ Non-Veg This policy decision will enable diet dept. in a. Purchase of raw material b. Organizing separate area for cooking veg & Non-veg meals.
  • 61.
    • Ground flooris desirable 1.Receipt of raw materials a. Checking, b.Weighing c. Temporary storing before shifting 2.Storage area a. Godown or storeroom for non-perishable items like grains, oil, etc. b.Cold storage for perishable items milk, vegetables, etc. – refrigerator, cold room.
  • 62.
    3. Preparation area a.Sorting out b. Washing vegetables c. Washing utensils d. Slicing, peeling, chopping, grinding e. Mixing 4. Cooking area a. Large size steam cooker. b. Cooking gas c. Special diet area
  • 63.
    5. Serving andtransportation of cooked food depends on a. Hospital policy b. Geographical area c. Vertical / horizontal /both. ｷ Mobile hot food carrier ｷ Containers of adequate size ｷ Nurse in the ward will arrange to get food served. 6. Cleaning area a. Utensils cleaning b. Dish washer
  • 64.
    • Staffing pattern •Manager – qualified dietitian • Dietitians – 2 or 3 • Clerical staff – paper work & inventory • Cooks – one/100 beds. Health check-up, food handlers. • Helpers
  • 65.
    • Problems 1. Patientsatisfaction 2. Wastage i. Cooking more than necessary ii. Less consumption due to a. Poor taste b. Becoming cold c. Poor appetite due to illness d. Home food/eatables 1. Shortage i. Diet sheet has not been submitted on time. ii. Sudden new admissions iii. Cooking less than necessary iv. Pilferage by staff. • Theft • Fraud in materials management.
  • 66.
    • Outsourcing dietary •Cafeteria or mess for employees • Cafeteria for students • Coffee shop • Vending machines • Special meals for guests or for functions. • Diet committee – regular rounds, taste of food is checked.
  • 67.
    The basic functionof a laboratory service is: 1. To assist doctors in arriving at or confirm a diagnosis. 2. To assist in the treatment and follow-up of patients. 3. The laboratory not only generates prompt and reliable reports, but also to function as a storehouse of reports for future references. 4. To carry out urgent tests at any part of day or night and therefore provide serve 24 hours a day, 5. And in big hospitals, the laboratory also assists in teaching programs for doctors, nurses and laboratory technologists.
  • 68.
    Types of laboratories1.Hematology Hematology includes the study of etiology, diagnosis, treatment, prognosis, and prevention of blood diseases. The lab work that goes into the study of blood is performed by a Medical Technologist. 2. Microbiology Microbiology is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms 3. Clinical chemistry Clinical biochemistry is the area of pathology that is generally concerned with analysis of bodily fluids.
  • 69.
    4. Histopathology Histopathology (fromthe Greek histos (tissue) and pathos (suffering)) refers to the microscopic examination of tissue in order to study the manifestations of disease. 5. Routine urine and stool analysis
  • 70.
    Functional planning 1. Determineapproximate section wise workload. 2. Determining services to be provided. 3. Determining area and space requirement to accommodate equipment, furniture and personnel in technical, administrative and auxiliary functions. 4. Dividing the area into functional units, viz hematology, biochemistry, microbiology, histopathology, urinalysis, etc.
  • 71.
    5.Determining the numberof work stations in each functional unit/division and deciding the linear bench space allotted for each work station. 6. Determining the major equipment and appliances in each unit. This is generally classified into: i) Technical equipment peculiar to certain work stations. ii) Other equipment and appliances e.g. (refrigerators, hot air ovens, centrifuges) that can be jointly used by different work stations or units.
  • 72.
    7. Determining thefunctional location of each section in relation to one another, from the point of view of flow of work, technical work considerations, auxiliary areas and administrative efficiency. 8. Identifying the units that are likely to expand, for locating them in such a manner which will permit smooth expansion. 9. Identifying the electrical and plumbing requirements for each area/work station. Independent electric circuits are required for electronic equipment items. Location of sinks and wash areas are vital for efficient performance of work stations.
  • 73.
    10. Considering utilities,- lighting, ventilation (forced or normal exhaust, air-conditioning and air hygiene) and isolation of equipment or work stations. 11. Working out the most suitable laboratory space unit (LSU), which is a standard module for work areas. A standard module facilitates rearrangement of work units with least disruption and minimal structural changes.
  • 74.
    Organization 1. Centralized • Itavoids duplication of purchases of expensive equipment. • Avoids duplication of personnel. • Easy to monitor working and quality control • Automation will not be underutilized. • There can be delay in transporting samples and issue of reports.
  • 75.
    2. Decentralized • Transportation •Dispatch • Can cater to the specific needs of certain areas e.g. ICCU, premature nursery • Results can be easily logged on to the ward • Duplication of equipments • Requires additional technical staff. • Lack of uniformity in procedures and conflicts. • Supervision difficulty • Quality control • Multiple lines of authority • Transfers to other area may disturb the services.
  • 76.
    Workload • An admittedpatient undergoes anywhere between 8 and 20 laboratory tests on an average during his or her hospitalization period. • In 1990, in a teaching hospital, laboratory tests averaged at 20 tests per patient in medical ward during an ALS of 10 days, giving a ratio of 2 tests per day, excluding radiographic investigations or other tests carried out in specialized laboratories.
  • 77.
    • A 100-beddedhospital with a 10 days ALS will treat 365 ÷ 10 = 36.5 (37 pts)/bed in a yr, • 37 x 100 = 3700 total patient in a year which means that the hospital laboratory will have to carry out 3700 x 8 = 29,000 tests to 3700 x 20 = 74,000 tests during the year.
  • 78.
    Location • Preferable onthe ground floor and accessible to the wards. • Depends upon the size of the hospital and its outpatient set up, the laboratory can be situated. • Outpatient sample collection. – The design should include waiting room for patients, venepuncture room, and specimen toilets. – Provision should be made for containers with appropriate preservatives, for correct labeling of samples, and for keeping record of each patient.
  • 79.
    • Primary space –The space utilized by technical staff for the primary task of carrying out professional work. – This space is expressed in terms of LSU. • Secondary space – The space utilized for all supportive activities. – Administrative space, viz. offices for the pathologist and other, rest and locker rooms, staff toilets, etc. should be considered separately from secondary space. • Circulation space – The space required for uncluttered movement of personnel and materials within the dept. between various technical work stations, rooms, stores and other auxiliary and admin. Areas.
  • 80.
    Departments Primary space Space required Hematology General hematology  Blood transfusion  Office desk/ admin 3.5 LSU 1.5 LSU 0.5 LSU 5.5 LSU 101.75sq m Clinical chemistry  Processing and preparation  Special and general tests  Office desk/ admin/ reagent stores 1.5 LSU 3.0 LSU 1.0 LSU 5.5 LSU 101.75 sq m Microbiology  General bacteriology  Media preparation  Office desk/ admin 3.5 LSU 1.0 LSU 0.5 LSU 5.0 LSU 92.50 sq m Histopathology  Specimen preparation  Section cutting and staining  Frozen section/ special techniques  Cytology  Office desk/ admin 1.0 LSU 0.5 LSU 0.5 LSU 1.0 LSU 0.5 LSU 3.5 LSU 64.75 sq m Urine and stool 0.5 LSU TOTAL 9.25 sq m 370.00 sq m Schedule of accommodation of hospital laboratory
  • 81.
    Departments Secondary space Space required Patientarea  Waiting area Consulting, examination, venepuncture, etc. Patient toilet (specimen toilet) 40 sq m 30 sq m 10 80 sq m Office and staff  pathologist office and laboratory General office: assembling, labeling, storing, distribution of reports Staff locker and rest room  staff toilet 30 60 40 10 140 sq m Supply and processing  chemical preparation Central glass washing Sterilization Distilled water still Store: general and glassware Store: chemical Disposal and cleaning 25 60 30 10 20 20 10 TOTAL 175 sq m 395 sq m Circulation space Approximately 30 % of the total of primary and secondary space
  • 82.
    Layout • A simple,basic layout of spaces and equipment which can be supplemented or modified to suit different requirements is likely to be more efficient. • The structure, equipment and finishes should permit the original space allocation and the layout to be changed while the building is in use, with minimum disturbance. • Flexibility for use is needed so that areas can be converted from secondary to primary space and vice versa in the interest of rearrangement for expansion or change.
  • 83.
    • A fewlarge sinks which are capable of being moved without undue inconvenience are both more economical and more convenient than a larger number of small fixed sinks. • A fixed layout of services and equipment can be designed to be conveniently used in a number of alternative ways providing that working methods can be adapted or modified to fit the layout. • Open planning with a suitable arrangement of bays permits a higher ratio of usable bench length to floor area.
  • 84.
    • Administrative andauxiliary areas • Waiting room • Venepuncture cubicle • Specimen toilet • Pathologists office • Glass washing and sterilizing unit • Staff locker room and toilet
  • 85.
    Utility services • Itinclude water, gas and compressed air system. • The need for uninterrupted functioning of these systems and the probability of future expansion, careful study is necessary in designing them for safety and efficiency. • Piping system – color, coding or labeling, non corrosive – to facilitate safety purposes and repairs. • Arrangement of laboratory benches – removable panels between the benches.
  • 86.
    Internal design andfitments • Work benches • Lighting • Service spine • Storage • Partitions • Dust • Air-conditioning/exhaust • Working surface • Flooring
  • 87.
    Staffing • The hospitallaboratory service should be under the control and direction of a doctor with qualifications in pathology. – He becomes the overall in charge – quality control, standardization and administration. – Should be a part of the regular medical staff of the hospital.
  • 88.
    • The numberof medical laboratory technologists (MLT) and laboratory technicians will depend upon: – The number of samples per day – The range of tests to be performed under various sections, viz clinical chemistry, hematology, microbiology and histopathology. – Emergency service and – leave reserve.
  • 89.
    • They performall technical procedures in – Various section, – Prepare reports of completed investigations, – Check and maintain equipment and – Request for necessary supplies and materials.
  • 90.
    Tests performed annuallyper medical technologist Laboratory unit Tests Hematology 13,400 Urinalysis 30,000 Serology 11,520 Biochemistry 9,600 Bacteriology 7,680 Histology 3,840 Parasitology 9,600
  • 91.
    Equipment • The followingis a list of the important items of equipments and instruments in a general hospital laboratory: – Robot cell counter – Centrifuge – Microhematocrit centrifuge – Refrigerators – Blood bank refrigerator – Water still – Pressure sterilizer – Pipette washer – Flame photometer – Spectrophotometer – Hot air oven – Incubator – Calorimeter – Analytical balance – Blood gas analyzer – Autoanalyzer.
  • 92.
    Policies and procedures •Laboratory samples • Sample receiving • Request forms • Time of accepting specimens • Containers • Identification of specimens • Reports • Records • Blood bank service • Outpatient samples • HIV • Liaison with clinicians • Technician’s motivation • Cross-training of technicians • Laboratory waste disposal • Optimal utilization of laboratory service.
  • 93.
    It is thearea of service in the hospital, where quick and competent care can save lives and also reduce the severity and duration of illness. The casualty department provides the first impression which should be a positive one. The relationship of the casualty with other departments and wards should be close. Emergency service
  • 94.
    Definition The casualty servicesprovide immediate emergency, diagnostic and therapeutic care to patients with: • Injuries by accidents, suicidal, homicidal, etc. • Sudden attacks of illness or exacerbation of the disease. These patients require immediate attention and treatment. Emergency patients receive resuscitation and life-saving treatment.
  • 95.
    Functions 1. Attend toall the patients brought to casualty & decide appropriate management which includes - Immediate resuscitation. - First aid - Emergency investigations - Hospitalization - Referral to specific specialty by calling down the concerned doctor. - Observation of patient to decide: whether the patient can go home and attend appropriate OPD - Reassurance and short counselling.
  • 96.
    2. Carry outmedico-legal formalities. 3. Maintaining up to date list of critically ill patients for the purpose of - issuing one visit pass to relatives. - replying telephone calls. - decide acceptance or rejection of transfer of patients from other hospitals. - assist intra hospital transfer.
  • 97.
    • Following categoryof case can be labeled as medico legal : • 1. Cases of injuries and burns the circumstances of which suggest commission of an offence by some one. • 2. All Vehicular, factory or other unnatural accident cases specially when there is likelihood of patient’s death or grievous hurt. • 3. Cases of suspected or evident sexual assault. • 4. Cases of suspected or evident criminal abortion. • 5. Cases of unconsciousness where its cause is not natural or not clear. • 6. All cases of suspected or evident poisoning/intoxication. • 7. Cases referred from court or otherwise for age estimation etc. • 8. Cases brought dead with improper history creating suspicion of an offence. • 9. Any other case not falling under the above categories but has legal implication.
  • 98.
    4. Carryout servicesof non emergency nature as per the policy of the organization. 5. Maintain list of doctors on emergency duty, their availability and alternative arrangements if they are busy. 6. Disaster preparedness for mass casualties.
  • 99.
    Site, Area andDesign • Ground floor • Proper sign board with illumination • Other human traffic restricted • Entrance pattern Compound gate OPD Casualty Inpatient Services
  • 100.
    Important areas ofcasualty 1. Reception or Enquiry Counter • Sign boards with proper direction • Enquiry counter • Entrance to the casualty area should be broad enough to permit two ambulances • The entrance area should be covered. • ‘No parking’ board.
  • 101.
    2. Waiting areafor the relatives • Should be spacious with adequate light and ventilation. • Adequate sitting accommodation • All utility services should be provided • Public address system to call relative of patient to inform about patient’s condition. • Small statue of God/ Meditation hall.
  • 102.
    3. Space fortrolleys and wheel chairs • Immediate arrangement of wheel chair or trolley depending on the condition of the patient. • Based on work load, 4 - 6 trolleys/ wheel chairs are required. • Transferring of critical patients into other areas. • ‘Intensive care trolley’ should be there. • Trolley and wheel chair - parked in orderly fashion. • Soiled trolley should be kept clean always.
  • 103.
    4. Space forsecurity staff and police constable • Casualty is likely to get victims of assaults, riots, group rivalry, etc. so the security needs to be vigilant. • Entries should be restricted. • Cubicle with glass walls permitting visibility of hospital waiting area, compound & building entrance. • It is essential to have police constable counter either at the waiting hall or by the side of the entrance.
  • 104.
    5. Space foradministrator and night superintendent 6. Space for patient brought dead - procedural formalities - in the event of disaster - labeling is done - sent to mortuary - either to relatives or to police.
  • 105.
    Facilities for management 1.Examination room - first aid 2. Treatment room - minor procedures 3. Observation area - depending upon the patient condition 4. Storage space - linen, consumable items, dressing material, I.V fluids, equipments 5. Fixtures: electrical connections, medical gas connection and vacuum connections. 6. Other support services: lab, radiology, blood bank, OT/table for infected and uninfected cases.
  • 106.
    Staff required 1. Seniorphysician/surgeon/orthopedic surgeon who should be in-charge 2. Casualty officers - depending upon the size of the hospital. 3. Orientation given on emergency care and service. 4. Specialist doctors may be called as and when necessary. 5. Nursing staff - round the clock. 6. Labour staff - for cleaning, shifting, carry messages, samples, reports, etc.
  • 107.
    Maintenance of record 1.Case register - all patients 2. Register for medico-legal cases 3. Police intimation register 4. Call book- to requisition services of doctors from different specialties 5. In/out register for resident doctors. Records/registers are required for: 1. Court case 2. Compensation to injured patients 3. Insurance 4. In the event of complaint 5. Medical audit.
  • 108.
    Problems faced 1. Poorupkeep of premises and poor level of cleanliness 2. Shortage of doctors on duty due to rapid turnover. 3. Waiting for specialist opinion. 4. Casualty officer unable to take decision. 5. Inadequate staff.
  • 109.
    Continued.. 6. Waiting forinvestigation report 7. Sudden shortage of certain items during heavy attendance. 8. Pressure for hospitalization in public hospitals for non medical reasons. 9. Incomplete/ poor documentation in MLC 10. Conflicts due to poor public relations and stress due to nature of work.