Akuh final report

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PREPARED BY;
SYED IJLAL AHMED WALEED

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RESEARCH REPORT
REPORT PREPARED BY:
SYED IJLAL AHMED WALEED
UNIVERSITY OF KARACHI

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Aga Khan University Hospital

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Vision
Aga Khan University will be an autonomous, international institution of distinction,
primarily serving the developing world and Muslim societies in innovative and
enduring ways.
Mission
AKU is committed to the development of human capacities through the discovery
and dissemination of knowledge, and application through service.
It seeks to prepare individuals for constructive and exemplary leadership roles, and
shaping public and private policies, through strength in research and excellence in
education, all dedicated to providing meaningful contributions to society.
To advance this mission, AKU will:
 Offer programs of international quality 
 Respond to identified needs in the countries and regions which it serves 

 Priorities teaching and research which will inform and underpin intellectual
innovation and change 
 Provide service to advance its educational and research mandate 

 Foster and develop leadership capacity through its education and research
programs 
 Assess its impact and effectiveness 

 Promote access and equity by taking positive measures to make the University
inclusive of all socio-economic groups, addressing the particular needs and
circumstances of the disadvantaged; promoting the welfare and advancement
of women 
 Engage in knowledge networking and emerging technologies 

 Add value by promoting partnership and networking across the Aga Khan
Development Network and with other national and international institutions 
Values
As an international institution in achieving its mission, AKUH operates on the core
principles of:
 Quality 
 Relevance 
 Impact 
 Access 

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AKUH Model for change

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Table of contents
S.No Title of heading Page No
1. Vision, Mission, Values 4-5
2. Acronyms, Glossary, Preface, Acknowledgement, Abstract 7-16
3. Organization Overview 11-17
a. Facilities 17-18
b. Purpose and Direction of the Organization 18
c. Structure 19-20
d. People 21
i. Training and Development 21
ii. MBO AND AKUH 22
4. Competitors of AKUH 23
5. Operating Regions 24-25
6. Expense and Revenue 25
7. Hierarchy of Onsite AKU 26
8. Hierarchy of Offsite AKU 27
9. Hospital goals 28
10. Challenges 29
a. Human Resource
b. Space
c. Access
d. Structure/Mind Sets
11. 4 Basic Functions Performed By AKU 30
a. Planning 31-32
b. Organizing 32
c. Leading 33
d. Controlling System of AKUH 33-35
12. The Strategic Plan of AKUH 36
a. Develop an "Integrated" Healthcare System 36-37
b. Establish Centers of Excellence (Coe) 38
c. Enhance Capacity 39
Situation Analysis of AKUH, Karachi And Secondary 40
Hospital
a. Strengths
b. Weaknesses
c. Opportunities
d. Threats
Conclusion and achievements 41-53
Recommendation and references and Annex 54-64

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Acronyms
ACE (Inhibitor) Angiotensin Converting Enzyme MSDS Material Safety Data Sheet
AJK Azad Jammu and Kashmir MVR Motor Vehicle Ordinance Rule
AKUH Aga Khan University Hospital NCD Non-Communicable Disease
ARUP Association of Road Users of Pakistan NEAP National Environment Action Plan
ASIR Age-specific incidence rate NEAP-SP National Environment Action Plan -
ASR Age-standardized rates Support Programme
ATS American Thoracic Society NEQS National Environmental Quality Standards
BDN Basic Development Needs NGO Non-governmental organization
BHU Basic Health Unit NH&MP National Highway and Motorway Police
BMI Body mass index NHA National Highway Authority
BPH Benign Prostatic Hyperplasia NHLBI National Heart, Lung and Blood Institute
CAD Coronary artery disease NHSO National Highway Safety Ordinance
CARMEN Conjunto de Acciones para Reduccion NICVD National Institute of Cardiovascular
Multifactorial de Enfermedades Non Diseases
Transmissible (Set of actions for NLC National Logistic Cell
multifactorial reduction of Non- NPMH National Programme for Mental Health
Communicable Diseases) NTRC National Transport Research Centre
CDC Centers for Disease Control and NWFP North-West Frontier Province
Prevention PAMH Pakistan Association of Mental Health
CI5 Cancer incidence in five continents PC-1 Pakistan Planning Commission Project
CINDI Countrywide Integrated Non- Proposal-1
Communicable Disease Intervention PCB Pakistan Cricket Board
CME Continuing medical education PEPA Pakistan Environmental Protection Act
CNG Compressed Natural Gas PEPO Pakistan Environmental Protection
CNS Central nervous system Ordinance
CO Carbon monoxide PHC Primary healthcare
COPD Chronic obstructive pulmonary disease PIA Pakistan International Airlines
CRD Chronic respiratory disease PIMS Pakistan Institute of Medical Sciences
CVD Cardiovascular disease PMA Pakistan Medical Association
DALYs Disability adjusted life years PPE Personal protective equipment
DCO District Coordinating Officer PREMISE Prevention of REcurrences of Myocardial
ECG Electrocardiogram Infarction and StrokE
EOBI Employees’ Old Age Benefit Institution PRSP Poverty Reduction Strategy Paper
EPI Expanded Programme for Immunization PSA Prostate-specific antigen
FCTC Framework Convention on Tobacco PSO Pakistan State Oil
Control PTC Pakistan Tobacco Company
FIFA Federation of International Football RHD Rheumatic heart disease
Association RTC Road traffic crashes
GDP Gross Domestic Product SMARP Self-monitoring and reporting
GNP Gross National Product SMS Swift Mail Service
GYTS Global Youth Tobacco Survey TFI Tobacco-Free Initiative
HDL High-density lipoprotein THQ Tehsil headquarters
IARC International Agency for Research on UNDP United Nations Development Programme
Cancer UNEP United Nations Environmental Programme
IFA Integrated Framework for Action WHO World Health Organization
IGT Impaired glucose tolerance WHO EMRO World Health Organization Eastern
IRNUM Institute of Radiotherapy and Nuclear Mediterranean Regional Office
Medicine WHO JPRM World Health Organization Joint
JPMC Jinnah Postgraduate Medical Centre Programme Review Mission
LHV Lady Health Visitor WHO WPRO World Health Organization Western
LHW Lady Health Worker Pacific Regional Office
MDGs Millennium Development Goals WTO World Trade Organization
MoU Memorandum of Understanding

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Preface President
President Shamsh Kassim-Lakha (1983 to 2006)
President Firoz Rasul (2006 to present)
A Role Model for Health and Education in the Developing World
For more than 30 years, AKU has been making a difference in the developing
world by enabling outstanding men and women to realize their true potential. In
each of the six countries in which we operate – Pakistan, Kenya, Tanzania,
Uganda, Afghanistan and the United Kingdom – we are:
Training Leaders:
Because a single leader can have an enormous impact, we equip our graduates
with the expertise, practical skills and entrepreneurial outlook needed to lead
change in their societies and to thrive in the global economy.
Embodying Excellence:
In places where resources are scarce and few institutions are effective, we meet
the highest quality standards and demonstrate that excellence is a powerful
force for transformation.
Discovering What Works:
One of the developing world’s leading sources of health and education research,
we are creating new knowledge that saves and enhances lives in some of the
world’s poorest places.

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Serving the Community:
To date, our Patient Welfare Programme has provided subsidized care worth
$69 million (USD) to 629,000 patients. Our prize-winning and influential Urban
Health Programme, which has significantly improved life in squatter
settlements in Karachi, is just one of many examples of our community service.
Empowering Women:
Half our faculty and three of every five AKU students are women. Moreover,
our leadership in maternal and child health research is internationally
recognized. Providing girls and women with opportunities to thrive will always
be one of our top priorities.
Fostering Pluralism: Through our scholarship, curricula and admissions
policies, we build respect and understanding across cultural, religious,
communal and national boundaries.
Always Connecting:
AKU has a long record of partnering successfully with other institutions, and
goes out of its way to forge connections between the private and public sectors,
the developed and developing worlds, cities and villages, ideas and faiths.
Planning for the Future:
In the age of the knowledge economy, great universities are more indispensable
than ever before. To equip promising young people for success, we will
introduce new undergraduate liberal arts programmes and graduate professional
education in both East Africa and Pakistan.
This is a tremendously exciting time in our history. I look forward to continuing
to work with the entire AKU community to make our University the best that it
can possibly be.

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President’s Office Staff
Karim Sayani Board Secretary
Asif Fancy Senior Advisor
Phone: +92-21-3486390
Email: asif.fancy@aku.edu
Mahmood Virani
Director
Phone: +92-21-34863900
Email: mahmood.virani@aku.edu
Amin Jivraj
General Counsel
Phone: +92-21-34863900
Email: amin.jivraj@aku.edu
Munira Janmohamed
Manager, Events & External Programmes
Phone: +92-21-34863900
Email:munira.janmohamed@aku.edu

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Acknowledgement
We would like to thank our teacher for the course of Organizational
Behavior, Sir Sheraz Ahmed Siddiqui for giving my team an opportunity
to practically examine management of organization and find out how
organization manage it work and whole organization.
Abstract
Hospitals are an important component of the health care system and
are central to the process of reform, and as institutions, they have
received remarkably attention from government and stakeholders. The
health sector of any country occupies a very crucial position in its well-
being. Today, every organization in the corporate sector is trying to
cope with the changing demands of time, management, work practices
and employee behavior. In such a competitive and demanding scenario,
it becomes quite essential for the hospitals and health institutes to take
into account the recognized methods and ways to keep their values and
performance aligned, to evaluate employee satisfaction with their jobs,
to develop a positive and conducive organizational culture, to inculcate
healthy emotions and attitudes in the workforce and most of all to lead
the organization in a direction determined by its well-thought of goals
and objectives.
This report is an endeavor to get an insight into the mission, visions,
values, guiding principles, structure, purpose, HR practices, Policies,
organizational culture and management functions of AKUH. This
analysis helped us identify the ideal practices being followed and which
should be modeled by others while it also helped us identify the
weaknesses of the system, which might become detrimental to the well-
being of the organization.

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Organization Overview
Aga Khan University was founded by His Highness the Aga Khan and chartered
in 1983 as Pakistan's first private university, Aga Khan University's (AKU)
objective is to promote human welfare in general, and the welfare of the people
of Pakistan in particular, by disseminating knowledge and providing instruction,
training, research and service in the health sciences, education and such other
branches of learning as the University may determine. It occupies a pivotal
place within Aga Khan Development Network. Aga Khan University Hospital,
Karachi,
Aga Khan University Hospital, Karachi, started operations in 1985, as an
integrated, health care delivery component of Aga Khan University (AKU). It
is a philanthropic, not-for-profit, private teaching institution committed to
providing the best possible options for diagnosis of disease and team
management of patient care. AKUH's multidisciplinary approach to diagnosis
and care ensures a continuum of safe and high-quality care for patients – all
services under one roof.
This University Hospital has 545 beds in operation and provides services to over
42,000 hospitalized patients and to over 500,000 outpatients annually with the
help of professional staff and facilities that are among the best in the region. Care
is available to all patients in need. Those who are unable to pay for treatment,
receive assistance through a variety of subsidies and the Hospital's Patient
Welfare Program.
AKUH is the first hospital in Pakistan and among the first few teaching
hospitals in the world to be awarded the prestigious Joint Commission
International Accreditation (JCIA) for practicing the highest internationally
recognized quality standards in health care.
Similarly, the Hospital also holds ISO 9001:2000 certification for practicing
consistent international standards of quality services.

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Stadium road, Karachi- 1970’s
Ground breaking of Aga khan hospital & medical college
1980
Ground breaking of Aga Khan Hospital and Medical College by His Highness the Aga Khan
who is assisted by Shamsh Kassim-Lakha, the then Chairman of the Owner's Representative
Board of Aga Khan Hospital and Medical College.

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Charter of AKU - 1983
President of Pakistan and Patron of Aga Khan University, General Zia-ul-Haq granted
theCharter of Aga Khan University to the Chancellor, His Highness the Aga Khan. This
marked the birth of Pakistan's the first private international university.
Inauguration of AKUH – 1985
1985 - General Zia-ul-Haq, President of Pakistan and Chancellor of Aga Khan
University unveil the inauguration plaque of Aga Khan Hospital in Karachi.

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Construction of AKUH - Early 1980’s

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AKUH starts its operations – Oct 1985
AKUH in 20th
century

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Guiding Principles
As an international institution, in achieving its mission, AKU operates on the
core principles of quality, relevance, impact and access.
Inspired by Islamic ethics, humanistic ideals and the philosophy of Aga Khan
Development Network, the University is committed to building an
environment that fosters intellectual freedom, distinction in scholarship,
pluralism, compassion and humanity's collective responsibility for a
sustainable physical, social and cultural environment.
Culture
When a new employee joins the organization, he/she under goes through an
orientation program made by the HR department as well as their own
departments in which employee learns about his/her role and responsibilities.
The managers / supervisors take out time to help the new members and guide
them about their area of work.
Employees show respect and help each other in achieving the desired
goals/targets. AKUH has provided its employees a lot of incentives that
make the workplace desirable for their employees.
a. Facilities
The Hospital is equipped to diagnose and treat Medical (including Cardiology,
Endocrinology, Gastroenterology, Hematology, Nephrology, Neurology and
Pulmonology), Surgical(Dental, General, Neurosurgery, Ophthalmology,
Orthopedics, Otolaryngology, Urology and Plastic), Obstetrics and
Gynecology, Pediatrics and Psychiatry patients, and its inpatients have an
average length of stay of 3.56 days. The Hospital also provides comprehensive
Oncology Services including: Medical and Surgical Management, Radiation
Therapy, Chemotherapy, Brachytherapy and Bone Marrow Transplant.
A total of 545 beds, 119 private and 117 semi-private air-conditioned rooms,
251 general ward beds and 54 critical care beds are available in the Intensive
Care Unit (ICU), Coronary Care Unit (CCU), Coronary Intensive Care Unit
(CICU) and Neonatal Intensive Care Unit (NICU). The Hospital has 11
main operating theaters. There are an additional five operating theaters in
Surgical Day Care, two in the Community Health Centre, one in Obstetrics
and Gynecology and two mini-theatres in Section of Emergency.

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State-of-the-art Pharmacy, Radiology (including nuclear and medicine)
Laboratory,Cardiopulmonary, Neurophysiology and Rehabilitation service
s are available at AKUH. A fully equipped Emergency Room is open 24 hours a
day with a Triage desk and Fast Track System to ensure prompt medical
attention for all patients.
AKUH Laboratory operates over 160 phlebotomy or specimen collection
centers in Karachi and all major cities of Pakistan. The Hospital also operates
nine off-site medical centers (Integrated Medical Service Units) in various parts
of Karachi. Home Physiotherapy and Home Nursing and Health Care Services
are also available in almost all areas of the city. These off-site services are a part
of AKUH's outreach program to facilitate public accessibility to quality health
care.
b. Purpose and Direction of an Organization
Aga Khan University (AKU) is an academic center of Aga Khan Development
Network (AKDN), a group of development agencies, institutions, and programs
that work primarily in the developing parts of South and Central Asia, Africa
and the Middle East. The common goal of the programs is to create real and
lasting improvement in the lives of the poor in ways that lead to self-reliance
rather than dependence. To this end, the agencies encourage the communities
themselves to identify and plan for their needs, whether it is a community health
Centre or a national program for teacher training. AKDN agencies conduct their
programs irrespective of caste, creed or gender. When appropriate, the agencies
take an integrated approach, simultaneous addressing a broad spectrum of
development issues in the social, economic and cultural contexts. AKDN
focuses on five major areas:
 Education 
 Rural development 
 Environment 
 Health 
 Civil Society 



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c. Structure
AKUH has a well-defined structure. Corporate hierarchy is vertical and
diversity in terms of culture / ethnicity is being handled fairly through standard
plan and policies. The Organogram of the organization attached in the
APPENDIX will give a well-laid out view of the hierarchy.

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d. People
The labor demand and supply is fulfilled through prescribed guidelines which
include that AKU recruit applicants who are suitably qualified or trainable for
employment, in accordance with pre-determined job-related criteria. A
Personnel Requisition (PR) is a formal request to hire a staff member and must
incorporate all the information required to proceed with the recruitment and
selection process. A PR must be submitted to the Recruitment Department, to
activate the recruitment process for a job vacancy which needs to be filled. It is
the policy of AKU that all decisions regarding selection and hiring of staff are
made solely on the basis of job-related criteria. Every effort will be made to
place staff members in positions that best utilize their skills and abilities, and in
which they will be able to achieve both personal satisfaction and opportunity for
growth.
i. Training and Development
AKU provides extensive learning opportunities to its employee for their
professional development to enhance their productivity and quality of work life.
For this purpose institution have Centre of English language, ISD and Human
Resource Development Department to provide employee with extensive and
job related training programs.
Following trainings are available:
 Customer Relation Trainings 
 Personal Development Trainings 
 Quality Awareness Trainings 
 Management Development Trainings 
 Safety Trainings 
 Finance Trainings



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ii. MBO and AKUH
The AKUH Workplace Wellness Program is planned and implemented by the
individual AKDN agencies/companies through the staff of their human resource
departments. The organizational arrangement aims at a highly sustainable
structure through minimal external coordination and management. Each
participating agency nominates a ‘driver’ as a central contact person; s/he has
overall responsibility for implementing the workplace policy and
organizing/coordinating the wellness activities and trainings. In addition,
trained Wellness Champions at each company/agency actively promote
wellness activities. A program implementation committee is responsible for
identifying the program’s strategic direction and defining the activities
appropriate for the agency/company by using a standardized self-assessment
and planning tool and making sure that the program stays focused and achieves
the expected results. Each agency/company participates as a member in the
National Facilitation Team (NFT) which forms the working group in each
country, also called a ‘chapter’. The NFT assists the individual
agencies/companies to prepare chapter and country-level management
guidelines for implementing and adapting the policy to accommodate the legal
requirements and social-cultural context of the country.

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Competitors of AKUH

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Operating Regions
The operating regions of AKDN are spread over the three continents of the
world.
These include:
PAKISTAN:
 Aga Khan University Faculty of Health Sciences (Medical College &
School Of Nursing) 
 Aga Khan University Hospital, Karachi. 

 Aga Khan University Institute for Educational Development &
Professional Development Centre. 
 Professional Development Centre, Gilgit & Chitral 
 Aga Khan University Examination Board 
 Aga Khan University Faculty of Arts & Sciences 
KENYA:
 Aga Khan University Hospital, Nairobi 
 Aga Khan University Postgraduate Medical Education Program 
 Aga Khan University Advanced Nursing Studies Program 
TANZANIA:
 Aga Khan University-Tanzania Institute of Higher Education Advanced
Nursing Studies Program 

 Aga Khan University-Tanzania Institute of Higher Education
Postgraduate Medical Education Program 

 Aga Khan University- Tanzania Institute of Educational Development,
Eastern Africa 
UGANDA:
 Aga Khan University Advanced Nursing Studies Program
UNITED KINGDOM:
 Aga Khan University Institute for the Study of Muslim Civilizations

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AFGHANISTAN:
 Aga Khan University School Of Nursing-Ghazanfar Institute of Health
Sciences 
 Aga khan University Manages the French Medical Institute for Children 
SYRIA:
 Aga Khan University C/O
UAE:
 Aga Khan University Hospital Representative Office
Revenues
According to the Progress Report of 2006 the consolidated
financial performance of AGA Khan University Hospital was:
Income: (USS In millions)
Hospital revenues 115.1
Tuition fees 4.1
Grants & Donations 23.4
Income from investments/endowments/other 10.0
Expenditure
Staff 67.4
Supplies 37.3
Other operating expenses 28.3
Construction projects 10.6
Excess / (shortfall) of income over expenditure (3.5)

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Hierarchy of Onsite AKU

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Hierarchy of Offsite AKU

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Challenges
a. Human Resource
 Staff and Faculty retention 
 Finding new qualified personnel - locally and internationally 
 Matching future initiatives with available skill set 
 Competitive compensation 
 Training for new programs 
 Succession planning 

b. Space
 Limited space on campus, most ancillary and support functions getting
constrained 
 Construction constraints - Vertical vs. Horizontal 

 Offsite locations - limited expansion potential, inappropriateness, weak
infrastructure and access 

c. Structure/mind sets
 Faculty resistance 
 Departmental and Institutional governance 
 Patient perception of offsite facilities 
 Limited awareness about AKHSP facilities. 

d. Other
 Expensive image 
 Inadequate referral network 
 Overstretched 
 Limited resources 
 Regional instability & socioeconomics 
 Lack of research credibility 
 Global geo-political realities 
 Emerging new competitors for specialized services 
 Funding 
 Sustainability 
 High Cost of Quality 

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4 Basic Functions Performed By AKU

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a. Planning
The Planning and Development of Campuses (P&DC) is setup to ensure timely
and effective implementation of Aga Khan University's Projects for Pakistan as
well as for certain campuses abroad. This includes planning and design process
for the project, development and implementation of land acquisition strategies,
developing tendering and construction strategies for the projects, preparing the
project execution plan and schedules for all aspects of the projects.
This entity is led by the Director General, Planning and Development of
Campuses (South and Central Asia) and is divided into three sections i.e.
Design, Construction and Engineering & Maintenance.
Over the past few years with the expansions and the growing needs of the
University, especially construction of new projects on Stadium Road,
acquisition of four Secondary Hospitals, major outreach programs across
Pakistan including phlebotomy centers etc. and respond to requests for services
from institutions abroad, the scope of services for P&DC has increased
tremendously. Additionally, management needs to focus on developing people
to ensure both technical skills and transfer to and leadership development of
succession candidates.
A reviewing analysis of AKU shows that the Quality Improvement and Patient
Safety Program (QIPSP) of Aga Khan University Hospital (AKUH) describes a
planned, systematic and organization wide approach of AKUH towards quality
improvement and patient safety activities.
The purpose of AKUH’s Quality Improvement and Patient Safety Program is
to:
 Develop greater leadership support for an organization wide Quality
Improvement and Patient Safety program 
 Train and involve more staff 
 Set clear priorities for what to monitor 

 Make improvements based on comparison to other Organizations,
nationally and internationally 

 AKU’s vision is the guiding principle throughout. It states that “AKUH
will be recognized as one of the best health care institutions in Pakistan
and the developing world. This will be achieved through 

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 Compassionate, ethical, accessible and high quality care that meets or
exceeds the needs and expectations of AKU’s patients, their families and
others whom 
 AKU serves. 

 Providing an outstanding work environment that adopts motivation and
commitment in AKU’s staff. 

 Enabling leadership in education and research that improves the health of
the people in the region. 

b. Organizing
The organizing unit of AKUH is responsible for developing long and short term
strategic plans to identify resource requirements including financial, human,
material, equipment, space and methods for maintaining current facilities and to
cater future growth as well. Support the project management function by
providing a timely and accurate gauge of projects progress in terms of quality,
cost, and schedule dates. Scheduling will be performed to produce CPM
schedules and associated progress reporting, cost reporting, and project
analysis. Conducting operations and workflow analysis; cost and inventory
control in order to improve operations and productivity via reducing costs and
make the best use of available resources. Should undertake key project
planning, feasibility report writing and perform field inspections as and when
required.
The incumbent will be accountable to review existing work processes to
improve by eliminating rework loops. Lead the division in effective and
efficient manner to realize economical outcome. S/he has to enhance and
nurture in-house technical capacity building through various trainings and on-
the-job teachings.

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c. Leading
Over the course of the past 26 years, Aga Khan University has not only
flourished but has also become a valued and trusted partner of governments,
international agencies and other universities who share our strong belief in
the potential of human capital, ingenuity and enterprise to build communities
and improve lives.
At every level of our administration and faculty, we are deeply committed to
the development of human potential through the discovery and dissemination of
knowledge. Each day, we seek to embolden people of the developing world to
guide their own destinies and to contribute to the global community.
AKU was established to develop the leaders of tomorrow. Year after year,
AKU continue to draw upon various cultures to teach critical thinking,
problem-solving and decision-making. Ultimately, it is the powerful force of
pluralism that promotes intellectual openness, tolerance and increased
understanding between people of different societies.
Over the years we have established a growing reputation for our problem-based
research and for the quality and innovation of our programs. But perhaps most
importantly, we continue to achieve our goal of being an agent of change in the
developing world
d. Controlling
The controlling system ensures that the progress of the programs is carefully
followed-up and that outputs and achievements of the program are measured
over time. Monitoring and Evaluation is based on a coherent process, largely
implemented by the Wellness Drivers at each of the participating individual
that documents the progress and impact of the program. There are several times
of controls implemented in AKU including record keeping infection control etc.
Control of records
Environmental records can include, among others,
a) Complaint records,
b) Training records,
c) Process monitoring records,
d) Inspection, maintenance and calibration records,
e) Pertinent contractor and supplier records,
f) Incident reports,

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g) Records of tests for emergency preparedness,
h) Audit results,
i) Management review results,
j) External communications decision,
k) Records of applicable legal requirements,
l) Records of significant environmental aspects,
m) Records of environmental meetings,
n) Environmental performance information,
o) Legal compliance records, and
p) Communications with interested parties.
Proper account should be taken of confidential information.
Infection Control
Purpose of Infection Control
The Infection Control Manual is developed to increase awareness among all
health care workers regarding the prevention and control of nosocomial
infections and to increase compliance with safety measures, particularly
Universal Precautions. The safety of the patients and employees lies in the
understanding and conscientious application of these basic principles, especially
for those patients with infections or diminished resistance to infection. It is well
recognized that nosocomial infections are preventable. Nosocomial infections
not only prolong the hospital stay and increase the cost of hospitalization; they
also result in increased morbidity and mortality. Therefore it is the
responsibility of all health care workers to practice preventive measures. An
effective infection control program requires support from higher management
and active participation from all patient care team members and support
services. The Infection Control Manual constitutes the policies, protocols,
guidelines and infection control procedures implemented and monitored for safe
practice at Aga Khan University Hospital (AKUH). Several documents are
referred to during the preparation of this manual, including the
recommendations of the Center for Disease Control (CDC). Policies written in
this manual have been approved by the Joint Staff Committee of AKUH.

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Philosophy of Infection Control
The aim of the Infection Control Team is to limit the acquisition and spread of
pathogenic micro-organisms by using scientifically based knowledge, thorough
planning, surveillance, education and research as a part of an organizational
policy of providing the best possible and cost efficient care to our patients. We
believe that the Infection Control Committee has a responsibility to create a
safe environment for all patients, care givers and visitors. We believe that the
Infection Control Committee has a responsibility for reinforcing the Infection
Control Policy and Procedures in order to prevent the spread of infection and to
promote a healthy environment. We believe that the Infection Control
Committee has a responsibility for establishing a practical system of
identifying, reporting, evaluating and maintaining records of infection among
patients and employees. Infection Control Committee also has the responsibility
for establishing a practical system of ongoing-data collection, the analysis of
that data and the follow-up action. We believe that continuing education is
essential for the professional growth, development and orientation of all new
employees as to the importance of infection control. We believe that the
Infection Control orientation consists of the following:
1. Personal hygiene
2. Chain of infection, preventive measures
3. Isolation categories and patient care
4. Safe management of sharps, linen and hospital waste
5. Universal blood and body fluid precautions
6. Management of exposure to blood and body fluid and needle stick injuries
7. Employees responsibility in the Infection Control Program
We believe that the Infection Control Committee must support and contribute
to the philosophy, goal, objectives and policies of the organization. We believe
that infection is preventable in hospital settings by implementing and
reinforcing preventive measures. We believe that it is the ethical and legal
responsibility of every care giver to protect their patients, colleagues and
themselves from acquiring nosocomial infection by practicing safe patient care
practice.

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The strategic plan of AKUH
In keeping true to our Mission and Vision, the strategic plan 2010-2023
has the following three thrusts:
1.Develop an "Integrated" Healthcare System
2.Establish Centers of Excellence
3.Enhance Capacity
a. Develop an "Integrated" Healthcare System
AKUH aims to become an integrated health system which provides primary,
secondary and tertiary care, where Stadium Road, Karachi is the hub, around
which the peripheral services are as shown:

43 | P a g e
AKUH has the ability and the capacity to provide care that has a noticeable
impact on the population it serves. An integrated health system addresses the
issue of decongestion but also connects the various components of health care
into a comprehensive and meaningful network. In essence, this will develop a
strong referral network between primary, secondary, tertiary and possibly
quaternary care (AKUH) sites, thereby assuring seamless transition of patients
during course of treatment. There is an opportunity to raise the levels of care at
the various off site locations. The ultimate goal would be to have tertiary level
set ups (sub-hubs) in all the provincial capitals of the country. There will be
cross referrals between the various sites. This will decongest AKUH main
campus by managing primary, secondary and limited tertiary level cases at off
campus sites and enable AKUH Stadium road to focus on a more complex case
mix. There are plans to have Lahore and Gilgit set up tertiary and secondary
levels of care respectively with integration with the Karachi campus.
It is proposed that offsite laboratory operations will expand phlebotomy stations
throughout the country as well as their scope in the form of a "semi-full" service
facility. Similarly the concept and scope of Integrated Medical Services (IMS),
providing primary, secondary and diagnostic facilities, are envisioned. Clifton
Medical Service (CMS) expansion is being considered to encompass day care
services (Endoscopy, dialysis), day surgery and expanded diagnostics.
The secondary hospitals located in Kharadar and Garden will continue to focus
on mother and child services. Karimabad and Hyderabad centers will be
developed into general hospitals with limited tertiary capacity in term of day
services.
Linkages with hospitals such as FMIC, Afghanistan and the AKUH, Nairobi
health network will also increase in importance and will further evolve the AKU
network from a regional to a continental integrated healthcare services network.
Some of these sites can be set-up to offer subsidized/low cost care, without
compromise in quality. This will serve our mission of accessibility.

44 | P a g e
b. Establish Centers of Excellence (CoE)
AKU has a well established reputation globally. The vision is to further build
on our mission of best practices, innovation, patient centeredness,
comprehensiveness, infrastructure, quality, governance, research, education and
technology by introducing the concept of CoEs.
CoEs will accomplish the above by bringing the needed focus on the "processes"
to improve and advance existing and new practices, to encompass and develop
new knowledge, and to improve on current processes. CoEs will draw on not
just the assets of AKU but also AKDN, AKHS and AKF.
The following centers for excellence for health sciences have been identified
and somewhat prioritized. These have been chosen from previous areas of focus
based on Burden of Disease, HSC deliberations and our strengths.
 Maternal and Child Health/Human Development 
 Diagnostics 
 Oncology 
 Cardiac Diseases 
 Critical care and Emergency Medicine (incl. Trauma) 
 Neurosciences 
 Renal and Digestive Diseases 
 Population and Community Medicine 

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











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45 | P a g e
c. Enhance Capacity
As volumes grow and new programs are introduced, the rising average daily
census continues to apply pressure on available inpatient beds, necessitating the
need for new beds. Over the years, growth of some services has been only
possible by sacrificing inpatient bed space. The expansion of the Emergency
room has also increased the demand for inpatient beds. With the level of acuity
of patients on the increase, the need for more critical care beds has arisen. While
ACB2, arriving in 2012, is critical in releasing 83 inpatient beds and associated
spaces, there are several areas of the hospital that are now constrained.
Many services exist on campus that have the potential of being relocated to off
campus locations in a hub and spoke model, such as, Day care surgery,
Dentistry, Psychiatry, Dermatology, Dialysis, Community health services,
elective Endoscopy and Day care chemotherapy. Some of these can be mutually
exclusive while others may have benefit in being duplicated both on and off
campus. Taking these entities off campus would free up significant inpatient
and other hospital areas which can then be pursued for expansion of programs,
besides improving access and reaching out to the community.
It is expected that in 15 years, the integrated hospital will contain 800 - 1600
beds, nationally, on and off campus. Secondary Hospitals in the Outreach
Program will also be expanded in the period 2014 - 2025 to convert two of the
four locations into full general hospitals. This will allow the main campus to
Decongest while also increasing access and service offering. The arrival of
Electronic Health Records is expected to greatly facilitate this integration.
Additionally, a growing home health care program will also cater to specialized
needs off-site.

46 | P a g e
Situation Analysis of AKUH, Karachi and Secondary
Hospital
a. STRENGTHS
High brand equity and quality of care
Competent and credentialed clinical
faculty, including state-of-the-art
equipment and diagnostic facilities
Vision and governance
Proactive approach
Medical College and School of Nursing
Residency and Fellowship Programs
Multidisciplinary approach
Growth focus
All services under one roof
International Accreditations
Secondary Hospitals
Dedicated Maternal and Child Health
Hospitals offering primary and
secondary care services
b. WEAKNESSES
Expensive image
Inadequate referral
network
High staff turnover and scarcity
of trained manpower
Physical infrastructure and
space limitations
Overstretched acute care beds,
ventilators, radiology and clinical
space. Ability to retain graduates of
Medical College and School of Nursing
Secondary Hospitals
Limited awareness about
Outreach facilities
Outreach perceived as an inferior
health facility when compared with
AKUH Space limitations at Kharadar
and Garden Hospitals
c. OPPORTUNITIES
Support AKDN in achieving its overall
hospital strategy
Facilitate Teaching and
Research opportunities
Become the leader for Health care
integration
Increase access to quality primary,
secondary and tertiary care
Networking with AKDN and leading
regional players
International scope by developing e-
health infrastructure
Secondary Hospitals
Establish Centers of Excellence
d. THREATS
Limited resources for expansion
and cutting edge technology
Regional instability &
socioeconomics Dilution of existing
strengths as competitors gain pace
Lack of research credibility
Global geo-political realities
Inability to respond to opportunities
and issues proactively
Secondary Hospitals
Limited marketability for certain on-
campus services when relocated

47 | P a g e
Conclusion
"AKUH will be recognized as one of the best health care institutions in
Pakistan and the developing world". We will achieve this:
-By providing compassionate, ethical, accessible and high Quality care that
meets or exceeds the needs and expectations of our patients, their families
and others -whom we serve.
-By providing an outstanding work environment that fosters motivation
and commitment in our staff.
-By enabling leadership in education and research that improves the health
of the people in the region."

48 | P a g e
Achievements
Joint Commission International Accreditation (JCIA)
In September 2006, Aga Khan University Hospital (AKUH), Karachi
became the first Hospital in Pakistan and one of the first few University
Teaching Hospitals in the world to be awarded the prestigious JCIA for
achieving and maintaining international quality standards in health care.
In August 2009, the Hospital went through its first triennial re-accreditation
survey. A team of surveyors from the Joint Commission visited the hospital to
reevaluate the compliance of all accredited standards. The hospital received
excellent reviews and continued to provide the highest level of patient care
and was re-accredited for another 3 years.
JCIA is a division of the American-based Joint Commission on Accreditation of
Healthcare Organization (JCAHO). JCIA was created in 1998 to develop
standards applicable to the international community. These standards are
organized around the important functions common to all healthcare
organizations. The standards are grouped by those functions related to providing
patient care and those related to providing a safe, effective and well-managed
organization. The survey process gathers standards compliance information
throughout the organization, and the accreditation decision is based on the
overall level of compliance found throughout the organization
ISO 9001:2008 Quality Management System (QMS) Certification
In June 2000, AKUH became the first University Teaching Hospital in Pakistan
and one of the first few University Teaching Hospitals in the world to receive
ISO 9001: 2000 certification for Quality Management System for Patient Care
and Support Services. Since then, the Hospital has successfully demonstrated its
focus on quality improvement in subsequent recertification audits and continued
to hold the certification.

49 | P a g e
In June 2009, the Hospital successfully completed its recertification for the new
revised version of ISO 9001:2008. This recertification speaks of our
commitment to continuous quality improvement (CQI) initiatives, leading to
the provision of high quality and safe care for our valuable patients.
ISO 22000:2005 Quality Management System (QMS) Certification
AKUH's Nutrition and Food Services Department (NFSD) successfully
accomplished a new milestone in its quality initiatives by achieving ISO
22000:2005 certification in May 2009. AKU's NFSD is the first hospital based
food production and service in Pakistan to be certified on these specialized food
safety standards.
This standard is exclusive to Food and Beverage Industry and includes
requirements and practices that involve interactive communication, prerequisite
programs and Hazard Analysis and Critical Control Points (HACCP) principles.

50 | P a g e
Quality circles - 1990 - 2000
Visit of Prof. Kondo to AKUH, Karachi - 1997

51 | P a g e
Quality Convention - 1999
Arthur Andersen Quality Award

52 | P a g e
ISO 9002:1994 Certification - 1999

53 | P a g e
ISO 9002:1994 Certification - 2000
ISO 9001:2000 Re-Certification - 2003

54 | P a g e
Fowzia Siddiqui
Aga Khan University Hospital, Pakistan
Title: A case of GBS or myasthenia gravis ,A diagnostic and therapeutic dilemma
Fowzia Siddiqui is a Medical Doctor, Clinical Researcher and completed
her Clinical Neurophysiology training from Brigham and Women’s Hospital,
Harvard University.
She is Honored Lifetime Member of America’s Registry of Outstanding
Professionals. She is Honorary Director of Clinical Neurophysiology, NICH,
Karachi. She is Lecturer and Consultant Neurologist in Aga Khan University
Hospital. She is also the President of Epilepsy Foundation Pakistan. She is the
Vice President of the National Health Care Advisory Committee for good
governance, Pakistan. She has published more than 20 papers in reputed
journals and has been serving as an Editorial Board Member of repute with the
Disease Digest and Epilepsy News. She has received several awards for
advocacy in epilepsy and recipient of Gold Medal for excellence in service.

55 | P a g e
CQI Facilitation Tools Training 2005
JCIA Accreditation - July 2006

56 | P a g e
Quality improvement Colloquium – 2008
ISO 22000: 2005 Certification May 20, 2009

57 | P a g e
ISO 9001: 2008 Re-Certification – June 2009
JCIA Reaccreditation – August 2009

58 | P a g e
Quality Improvement Colloquium 2010

59 | P a g e
Improve Priority Setting for Emergency and Add-on Cases by Introducing Color Code
System in Main Operating Room Division: Nursing Services
Project Team: Munira Amin, Tehmina Tariq, Shazia Tabassum, Dr. Masood Umer,
Rahim Noorullah, Parveen Amir Ali
Improved Turn Around Timings for Completion of Material Stock Request (MSR)
Division: Materials Management
Project Team: Farhan Bhayani, Khaliq Pesnani, Azad Sajwani, Kamal Shahbuddin,
Khairunissa Sahfiq, Ali Gulamani

60 | P a g e
Recommendations
AKU should expand the hospital to 250 beds, which will enable delivery of
care to adults and children, including maternal care, obstetrics and neonatology,
cardiac and neurosurgery and other services to be defined as the hospital grows.
This will be a phased approach, with the initial 52 beds of women’s obstetrics
and gynecological wing added to current services by 2016. This will enable the
hospital to grow beyond its initial focus on pediatrics, making possible the
delivery of medical care to male and female adults and children, including
maternal care, obstetrics, neonatology, oncology and other general and
specialized services. FMIC is also working toward establishing a
comprehensive medical complex in Kabul which will serve not only the
Afghan population but Central Asia as well as a medical Centre of excellence
One of the most significant transformations taking place at the University is
the planned establishment of Aga Khan University Faculties of Arts and
Sciences (AKU-FAS) for Pakistan and East Africa - a major step towards
building a comprehensive university.
AKU should establish a residential campus in Karachi that wills double the
current student body while tripling its physical facilities. In Tanzania, the
Arusha campus will be the University's first permanent campus in East
Africa, serving students from across the region.
The investment in physical facilities will be matched by programs intended to
have far-reaching impact.
Quality human resource is one of the greatest challenges to development in
Pakistan and East Africa. AKU will play a pivotal role in developing leaders
who are well-equipped to drive the social and economic revitalization of
both these regions

61 | P a g e
References
a. Websites
http://aku.edu/Pages/home.aspx
http://www.aku.edu/aboutaku/akuataglance/pages/visionandmission.aspx
http://www.scribd.com/doc/27552306/Hospital-Management-Module-Final-
Version
http://www.akdn.org/about_akdn_chart.asp
http://hospitals.aku.edu/karachi/PublishingImages/Organization%20Chart%20O n-
Campus.jpg
https://www.google.com.pk/

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