Post on 18-May-2020
A PROJECT REPORT ON
“TIME MOTION STUDY as per NABH guidelines” OF
QUALITY DEPARTMENT”
CONDUCTED AT
WOODLANDS MULTISPECIALITY HOSPITAL
SUBMITTED BY: ASMITA DAS
BHM 6TH SEMESTER
ROLL-12,
REG.NO-151541310005
DINABANDHU ANDREWS INSTITUTE OF TECHNOLOGY & MANAGEMENT
ACKNOWLEDGMENT Every successful work is backed by sincerity and hard work. During this two
month tenure of my work, I was able to gain a lot of knowledge both
application and theory wise. My training period would not have been possible
without the wonderful support and guide of respected trainers and official
staffs.
I am very grateful to those people who have helped me in every ways of
training report
I would like to express my warm and heart full gratitude towards Dr. Vikram
Singh Raghuvanshi (Chief Executive Officer), Dr. MalatiPurkait (COO) and
Mrs. Lina Mukherjee( Human Resource) for selecting and accepting me as a
management trainee in Woodlands Multispeciality Hospital Limited. I am
also thankful to Mrs. AnasuaRoychowdhury (Sr. Facilitator of Medical Service Department)
Mrs.Tinku Jana(Assistant Chief of Nnursing) Mr.SudipDey (Quality
Coordinator) Ms. Sreya Banerjee (Sr. Executive of Medical Service
Department)for inducting me and for providing their valuable guidance
throughout the training period. I would also like to thank the entire
QUALITY team for sharing their knowledge and cooperating with me and for
motivating me throughout.
I would like to thanks DR. SANJUKTA NANDY (principal, DAITM)
SURAJIT DAS (HOD) and MRS MOUMITA ROY(Project guide) for the
continues guidance and for giving me the opportunity to complete my
internship from WOODLANDS MULTISPECIALITY hospital.
DECLARATION I do hereby declare that this project work entitled “TIME MOTION
STUDY as per NABH guidelines” OF QUALITY DEPARTMENT
“atWOODLANDS MULTISPECIALITYhospital for 3months (2ND
JAN to 1ST APRIL), submitted by me in practical fulfillment for the
requirement of Bachelor Degree in Hospital Management (BHM)
from Dinabandhu Andrew’s Institute Of Technology &
Management with the collaboration of Maulana Abdul Kalam
University Of Technology (MAKAUT) is the result of my original
and independent research work carried out under the supervision
and guidance from DAITM college.
I further declare this project work or any part of these has not
been submitted by me anywhere for the award of any degree
or other similar title before
1. NAME-ASMITA DAS
2. ROLL NO.- 15403315005
3. REG NO.- 1541310005
4. DURATION OF TRAINING- 3 Month
5. (Signature of the Student) -
6. For office use only-
7.The project has been approve/ not -
EXECUTIVE SUMMARY As a part of a special internship program, I was allowed to get hands on
experience of working with trained professionals of the hospital industry and
learning about the nuances of handling and managing operations in the
Quality Department.
Throughout my training period in WOODLANDS MULTISPECIALITY
HOSPITALI have learnt floor auditing. I have checked every patient’s file,
whether all the documents were properly arranged according to the NABH
guidelines or not. I used to check every nurses record document whether it
has been clearly written with appropriate date, time & signature. I have also
checked Doctor’s initial assessment record whether it has been signed with
proper date and time or not. I have done time motion study in the Emergency
& in USG department. I have also calculated the average length of stay in ICU
in this 3 months of training. I used to organize Basic Life Support classes for
the employees
Lastly, to summarize, my overall experience has been a very fruitful one. It
was a good learning experience for me and gave me the first exposure to gain
knowledge about the working of the hospital industry.
TABLE OF CONTENTS
SERIAL
NUMBER
TOPIC
1 Introduction
2 Company Profile
3 Review of Literature
4 Training Objective
5 About the Department
6 Research Methodology
7 Discussion & Findings
8 Conclusion
INTRODUCTION The hospital was established in 1947, Woodlands Hospital, the flagship of Eastern
India started as a secondary care unit and gradually developed as a Tertiary Care
Unit over the years.
In our 70 years of journey, we have touched the lives of millions of patients of
Kolkata, Eastern India and other neighboring countries.
Since its inception we are committed to provide highest standard of medical care
which matches the global benchmark with extreme sensitivity to patient needs and
privacy.
Some years ago, the idea of privately run Nursing Home was envisaged in Kolkata
and several such were opened, the best known being "Riordans" and the "Elgin";
unfortunately both were housed in rented buildings not really suitable for this
purpose. When they were eventually taken over by the East India Clinic, it was
realized that they were quite inadequate for the requirements of modern medical
care and that a new building was essential.
A considerable period was taken up in negotiating and inspecting various sites.
Eventually a fine open site was secured in Alipore, being a part of the land owned
by the Maharaja of Cooch Behar, on which stood a large house occupied by him
known as "Woodlands Palace ", hence the name of the present Nursing Home.
On January 8th 1958, Dr. B.C. Roy, the then Chief Minister of West Bengal,
himself a distinguished doctor, laid the foundation stone and building really
commenced. From August 17th 1959, the new nursing home was officially "open"
the first three patients being admitted on the 18th, the first operation being
performed, and the first two babies born, on the next day.
Woodlands Hospital has progressive plans to change the healthcare delivery
landscape in Kolkata driven by quality and most importantly “patient-centricity”
COMPANY PROFILE Woodlands Multispecialty Hospital Ltd is a benchmark of quality care in Kolkata
for over sixty years. Founded in 1958, Woodlands has been servicing people of
East India, North East and Bangladesh for over three generations. Evidence based
medicine and care with compassion are founding values of our Organization
making Woodlands the most trusted destination for high quality medical care,
finest of doctors and nurses.
We are a 260 bedded Multispecialty Hospital have cutting edge technology like 3T
MRI, Dual source CT scan, Flat Panel Cath Lab, modern Operation Theatres to
name a few.
Our centers of excellence are:
* Heart Care
* Minimally Access Surgery
* Mother and child care
* Bone, Joints and Spine
* Kidney disease
* Critical care & Emergency
* Neuroscience
* Gastro & GI Surgery
Woodlands Multispecialty Hospital Ltd. is a multi specialty hospital is located at
85 Alipore Road, Kolkata – 700 027, and well equipped with Hi-Tech process and
Quality Controlled equipments. Their system helps us to achieve service
consistency. A competent team of highly qualified Doctors, motivated experienced
paramedical assistants and world class equipments complement their facilities and
process to make best use of them in favour of patients. Catering various medical
needs of patients. It is one of the best known medical care institutions in the city. It
has state-of-the-art equipment and technologically advanced medical gadgets. The
hospital has highly educated team of doctors and nurses who offer professional and
dedicated medical service.
The hospital has a modern infrastructure. It provides a number of treatments at
reasonable prices. The hospital offers friendly medical care to the patients. Every
patient is treated well and cured in the best manner possible. The hospital offers
comfortable stay to patients. It has peaceful patient care rooms. Woodlands
Hospital Kolkata address is present in the contact details.
Services offered Woodlands Hospital Ltd., Kolkata
The Hospital has a well equipped Diagnostic centre. It consists of 12 lead ECG,
Color Doppler, 128 slice dual source dual energy CT Scan and 3 Tesla MRI
facility. It offers Cardiac Stress Tests, Holter Monitoring Pulmonary Function
Tests, Echocardiogram, Mammography, CT/USG Guided FNAC, Special Imaging
and EEG/EMG.
Various surgeries such as Cardio-thoracic & Vascular surgeries, Orthopedic
replacement & implant, Laparoscopic Abdominal procedures, Obstetric
&Gynecological, Major oncosurgical intervention Eye & ENT, Oral &
Maxillofacial; Kidney transplants, Complete Urology including Laser and major
endoscopic surgeries are performed at the hospital by skilled surgeons.
Woodlands Hospital Kolkata consists of several Laboratories such as Clinical
Pathology, Microbiology, Hematology, Immunohistochemistry, Histopathology
and Hormonal Studies. It has Lifestyle / Diabetics / Hypertension / IHD Clinic,
Well Women Clinic, Eye Clinic, ENT Clinic, Dental Clinic, Bone & Joint Clinic,
Baby Clinic and Stone Clinic.
The hospital offers Cardiac health Check Up, Executive Health Check Up; Health
Screening Schemes I, II & III; Customized Corporate Diagnostics; Renal, Hepatic,
Cardiovascular and Urological & Gastrointestinal Test Packages.
There are Intensive Therapy Unit, Intensive Cardiac care Unit, Critical care Unit,
Neo-natal Intensive Therapy Unit and Special Care Units. Procedures like
Laparoscopies, Lithotripsy, URS / Uroslometry, Cystoscopy & Allied Procedures,
Cardiotocography; Burn, Trauma & other cosmetic treatment and Smile Correction
are carried out.
The Hospital provides 24-hour service. It consists of a Blood Bank. It offers
Dialysis, Imaging and Emergency Intervention services.
The Hospital provides outpatient as well as in-patient care. It treats and cures a
wide range of maladies and complicated ailments like influenza, septicemia, closed
mitral valvotomy, complicated open heart surgery and much more.
Scope of services provided
The services being provided are clearly defined and are in consonance with the
needs of the community.
The defined services which are provided by the hospital & the services which are
not available are prominently displayed in the hospital
The staff is oriented to the services provided by the hospital & those which are not
provided during induction training provided to new staff
CAL SERVICES SUPPORT SERVICES 1. Front office Registration,
reception Patient assistance cell ,
Insurance, Billing and Accounts
1. Human resource
2. General Medicine 2. Dietary
3. General Surgery 3. Central Sterile supply Department
( CSSD )
4. Cardiovascular Thoracic Surgery 4. Biomedical Engineering Service
5. Cardiology 5. Ambulance
6. Obstetrics &Gynecology 6. Medical Records Department
7. Orthopedics 7. Information Technology
8. Diabetology and Endocrinology 8. Maintenance
9. Neurology & Neurosurgery 9. House Keeping
10. Ophthalmology 10. Pharmacy and Store
11. Pediatrics & Neonatology
12. Urology
13. ENT
14. Dental
15. Psychology & Psychiatry
16. Nephrology
17. Critical Care
18. Gastroenterology
19. Interventional Cardiology
20. Pulmonology
21. Emergency Medicine and Trauma
care
22. Fertility
23. Outpatient services
24. Health check up
Diagnostics
1. 12 lead ECG
2. Cardiac Stress Tests
3. Holter Monitoring
4. Pulmonary Function Tests
5. Echocardiogram
6. Colour Doppler
7. 128 slice dual source dual energy
CT Scan
8. 3 Tesla MRI facility
9. Digital X ray
10. USG -3D/4D
11. Endoscopy
12. CT/USG Guided FNAC
13. Special Imaging
14. EEG/EMG/ NCV
15. Endoscopy, Colonoscopy, ERCP ,
Bronchoscopy ,
16. Audiometry, Tympanometry
17. Lithotripsy
18. Uroflometry
19. Urodynamic
20. TRUS
21. DSA
Laboratory
1. Clinical Pathology
Microbiology
Haematology
Immunohistochemistry
Histopathology
Hormonal Studies
Blood Bank
Nursing
Hospital Infection Control
Physiotherapy
Wards / OT/ Cath Lab/ Critical Care
/ Day Care
Consenting to treatment
We want to make sure you fully understand your condition and the treatment
choices available to you.
Before you receive any treatment, the doctor or nurse will explain what he or she is
recommending and will discuss with you any concerns you may have and answer
your questions. It is important that you understand what is going to happen to you.
No treatment is carried out without your consent unless it is an emergency, you are
incapacitated or you are unconscious.
CENTERS OF EXCELLENCE
• HEARTINSTITUTE
PEDIATRIC CARDIOLOGY
PEDIATRIC CARDIAC SURGERY
• BONE & JOINT CARE
JOINT REPLACEMENTS
TRAUMA
• MOTHER & CHILD CARE
• KIDNEY CARE
• GI & MINIMAL ACCESS SURGERY
• SPINE SURGERY
• UROLOGY
• NEPHROLOGY
• MEDICAL ONCOLOGY
• SURGICAL ONCOLOGY
• RHEUMATOLOGY
• INFECTICOUS DISEASE
• PULMONARY AND SLEEP MEDICINE
• CRITICAL CARE
• EMERGENCY & TRAUMA
• REHABILITATION (PHYSIOTHERAPY)
• DIETETICS
VISION:
To position Woodlands as the most trusted and admired healthcare provider of
choice in Eastern India.
MISSION:
To be a patient centric organization offering our patients an experience filled with
care and empathy which exceeds their expectations.
QUALITY POLICY:
The hospital continuously strives to provide quality care by monitoring quality
standards in area of patient care, safety and clinical experience as measured by
customer satisfaction and quality benchmark by periodically evaluating processes,
systems and techniques.
“Woodlands Multispecialty Hospital Limited, Kolkata, is established with the
purpose of providing international standards of healthcare. We are further
committed to achieve patient centric care, clinical excellence and safety of patients,
their relatives and staff with the aid of trained medical, non-medical and
paramedical professionals”
MOTTO:
Ethical treatment with care.
REVIEW OF LITERATURE
J Biomed Inform. 2014 Jun: Time motion studies were first described
in the early 20th century in industrial engineering, referring to a
quantitative data collection method where an external observer captured
detailed data on the duration and movements required to accomplish a
specific task, coupled with an analysis focused on improving efficiency.
Since then, they have been broadly adopted by biomedical researchers
and have become a focus of attention due to the current interest in
clinical workflow related factors. However, attempts to aggregate results
from these studies have been difficult, resulting from a significant
variability in the implementation and reporting of methods. While
efforts have been made to standardize the reporting of such data and
findings, a lack of common understanding on what "time motion
studies" are remains, which not only hinders reviews, but could also
partially explain the methodological variability in the domain literature
(duration of the observations, number of tasks, multitasking, training
rigor and reliability assessments) caused by an attempt to cluster
dissimilar sub-techniques. We provide a detailed description of the
distinct methods used in articles referenced or classified as "time motion
studies", and conclude that currently it is used not only to define the
original technique, but also to describe a broad spectrum of studies
whose only common factor is the capture and/or analysis of the duration
of one or more events.
J Am Med Inform Assoc. 2011 Sep-Oct : Time and motion studies
(F02.784.412.846.707), workflow (L01.906.893), health information
technology (L01.700), medical informatics applications (L01.700.508),
collaborative technologies, personal health records and self-care
systems, developing/using clinical decision support (other than
diagnostic) and guideline systems, systems supporting patient-provider
interaction, human-computer interaction and human-centered
computing, improving healthcare workflow and process efficiency,
system implementation and management issues, social/organizational
study, qualitative/ethnographic field study, cognitive study (including
experiments emphasizing verbal protocol analysis and usability),
methods for integration of information from disparate sources,
information storage and retrieval (text and images), data exchange,
communication, integration across care settings (inter- and intra-
enterprise), visualization of data and knowledge, developing/using
computerized provider order entry
BMC Health Services Research2015 : In the upcoming decades the
ageing of our population is likely to increase the demand for healthcare
services, while more patients will acquire cancer or chronic diseases [1].
This, together with menacing budgetary restraints, will have its impact
on hospital resources and may jeopardize the quality, efficiency, and
accessibility of patient care
MarceloLopetegui:Time motion studies were first described in the
early 20th century in industrial engineering, referring to a quantitative
data collection method where an external observer captured detailed data
on the duration and movements required to accomplish a specific task,
coupled with an analysis focused on improving efficiency. Since then,
they have been broadly adopted by biomedical researchers and have
become a focus of attention due to the current interest in clinical
workflow related factors.
TRAINING OBJECTIVE
• To understand the proper overall procedure and principle of functioning of
the Quality department
• To have a clear concept of how the Quality Department work in the hospital
and knowing their respective functions.
• To understand the application of managerial tools techniques involved in the
organization.
• To put the theoretical knowledge into practical experiences.
• To observe the flow of work with proper coordination and synchronization
as it happens
• To have a clear concept of NABH guidelines
• To identify the proper time motion study of the various department
• To calculate the average length of stay
• To done the floor auditing
• Ro identify if there any drawbacks or problems occurring in the quality
department
• To be able to provide proper suggestions for the betterment or improvement
oof the respective problems.
ABOUT THE DEPARTMENT
QUALITY DEPARTTMENT QUALITY is defined as the degree to which the product or service performed
meets the customer’s expectations. A Quality Management Plan is a document or
set of documents that describe the standards, quality practices, resources, and
processes pertinent to an organization. Hospitals are now competing with each
other to offer the best possible quality care to their patients. Since accreditation is
given only to hospitals following certain basic standards these hospitals are
definitely capable of providing the best possible care. The accreditation helps
hospitals to benchmark with international quality providing world-class quality
services to its patients.
But in order to provide more& more quality service the hospital is now going for
NABH Accreditation. It advocates a very practical approach to the accreditation
process, most suitable for Indian hospitals to adhere to.
Quality of care is also a key component of the right to health, and
the route to equity and dignity for women and children. In order to achieve
universal health coverage, it is essential to deliver health services that meet quality
criteria.
QUALITY DEPARTMENTS, such as Quality Control (QC)
or Quality Assurance (QA) cannot inspect quality into the product. The Quality
Departments exist as an audit function within the manufacturing and packaging
areas.With an aging population and rising health care costs, quality management in
health care is gaining increased attention. A health care system comprises small
and large entities, such as pharmacies, medical clinics and hospitals, and all
components need to provide quality service for the system to work properly.
THE QUALITY IMPROVEMENT PROGRAM ( QIP) / PERFORMANCE
IMPROVEMENTPROGRAM ( PDCA) MODEL STRUCTURES
The four phases in the Plan-Do-Check-ActCycle involve
• Plan: Identifying and analyzing the problem.
• Do: Developing and testing a potential solution.
• Check: Measuring how effective the test solution was, and analyzing
whether it could be improved in any way.
• Act: Implementing the improved solution fully.
The guideline to identify opportunities to improve the care and
services of the Hospital by:
• Organizing an approach to improve systematically and continuously the quality
of patient care;
• Reporting to Quality Improvement Committees of the Medical Staff Departments
the department-based indicators of quality, both internal and external, and to
support the process of physician peer review;
• Reporting information about incidents and occurrences within the organization
that cause an adverse outcome for patients or have the potential to cause an adverse
outcome;
• Establishing collaborative multi-disciplinary work teams to evaluate work
processes and to identify opportunities to make improvements that will improve
care, reduce expenses associated with unnecessary or inappropriate care and
increase patient satisfaction;
• Providing to management and to the Medical Staff the necessary tools and
information to take deliberate steps to plan appropriately for services, intervene in
problematic processes, evaluate the effectiveness of the interventions and to work
collaboratively to meet the needs of the internal and external customers;
• Assuring dissemination of quality improvement information to the relevant
parties within the organization;
• Reporting to senior management on the quality of care within the Hospital to
assist them in meeting its responsibility to monitor effectively the quality and
safety of services within the Hospital; and
• Compiling information available from a multitude of sources including patient
satisfaction instruments; reports from external regulatory, and relevant
benchmarking comparative databases when useful.
INTERNAL DATA COLLECTION
The important Hospital processes on which the Hospital would collect internal data
to reevaluate and enhance the quality improvement priorities or resource allocation
priorities and to evaluate the quality of services provided include, but are not
limited to, the following:
• The operative and other invasive and non-invasive procedures that place patients at
risk;
• The use and management of medications;
• Utilization Management activities regarding the appropriateness of admissions and
length of Hospital stay, including observation on categories of patients;
• The accuracy of diagnosis and effectiveness of therapeutic interventions;
• The clinical pertinence and timeliness of Medical Records
• The effectiveness of the Infection Control Program;
• The results of patterns and trends of risk management data on incidents and
focused occurrence screens and other risk management data including the number
and type of medical liability claims;
• The effectiveness of the Safety Management Program;
•The pharmacy and therapeutics function including adverse drug reactions, drug-
drug and drug-food interactions, and medication errors;
• The clinical laboratory function as well as the diagnostic radiology function;
• The needs, expectations, and satisfaction of patients;
• The staff views regarding performance and improvement opportunities; and
• The data from important processes and outcomes including quality control
activities.
The different departments of the Hospital would participate in the Hospital's
Quality Improvement Plan (QIP) using accepted methods of quality assessment,
quality control as appropriate, continuous quality improvement and risk
management.
Each department, service, or function would use a systematic and continuous
process for planning, monitoring, evaluating, and improving the quality of care.
Each department, service or function would:
• Designate an individual (s) responsible for departmental monitoring and quality
Improvement;
• Identify the scope of services and essential functions;
• Evaluate resource allocation;
• Identify the most important functional aspects of the department or service;
• Identify measurable indicators to monitor the quality of important functions of
care such as incidents, sentinel events, patterns, comparative data bases with other
organizations, and rate based indicators;
• Collect data for indicators based on volume, problem prone or high cost or high
risk nature of the care utilizing the dimensions of performance that include
efficacy, availability,
effectiveness, safety, respect and caring, appropriateness, timeliness, continuity
and efficiency;
• Organize the data in a meaningful way, in order to effectively identify the need
for further assessment or evaluation of the care to identify opportunities to improve
the quality of care or services provided to patients;
• Prioritize the need for corrective action{s) based on the volume of patients, the
degree of risk to patients or staff; the extent to which the issue contributes to
problems in patient care and the cost of quantity of resources required to correct
the issue;
• Act or develop an intervention to improve the issue identified;
• Develop corrective actions if the initial action is ineffective or continue
monitoring the initial action if it is initially effective in correcting the problem;
• Document and report meeting minutes;
• Evaluate, at least annually, the effectiveness of quality improvement monitoring
process and the effectiveness of the services provided;
Internal Audits- Every year 2 Internal Audits.
QUALITY AWARENESS AND TRAINING PLAN
Quality awareness is imperative and the first step on the path to Continuous
Quality Improvement. The role of quality in the performance improvement
processes needs to be communicated to all stakeholders of the hospital. Initially a
group of employees from administration and the clinical side will be identified and
trained on quality processes and tools to develop them into 'Quality Champions'.
These employees would be expected to promote the concept of quality amongst all
other employees and drive the quality effort through the organization.
The following initiatives would be implemented under the Quality
Awareness and Training Plan:
• The Quality Champions will undergo training program on 'Introduction and
Concepts of Quality and Internal Audit'
• The training would be conducted for identified employees, who would be the
facilitators and team leaders for all performance improvement initiatives
• After acquiring competence in Quality Management Processes, the Quality
Champions will be certified
• All Nurses, Resident Doctors, technicians and other staff in sensitive areas of the
hospital would be trained in Basic Life Support
• All employees having direct Customer interface will undergo training on 'Service
Excellence & Customer Centricity’ and ‘soft skill training’.
• Certification programs will be developed for Critical Care Nursing, Diabetic
Nursing andInfusion Nursing
• All nurses at the time of joining will undergo competency assessment, gap
assessment, and training on required skills
• Training programs will be conducted for Pediatric Nursing, Critical Care
Nursing.
LIST OF HOSPITAL COMMITTEES
1. CPR Analysis Committee ( CODE Blue
committee)
2. Safety Committee
3. Quality committee & Medical Records audit
committee
4. Infection Control Committee
5. Pharmacy & Therapeutics Committee (Including
Anti Microbial Stewardship)
6. Blood Transfusion Committee
7. Internal complaint for sexual Harassment
Committee
8. Radiation safety Committee
9. Clinical Audit Committee
LIST OF QIPs (Quality Improvement Projects/Clinical Audits) 2017
- 2018
Medical Audit
Nursing Audit-
• Study to evaluate Response to Call bell
• Audit to determine Crash Cart Checklist compliance.
• Audit on HAPU
• Audit on Hand Hygiene compliance
• Audit on Medication Error
• Audit on Thrombophlebitis
PATIENT SAFETY GOALS:
The international Patient Safety Goals implemented are as follows:
1. Identify Patients Correctly.
2. Improve Effective Communication.
3. Improve the Safety of High-Alert Medications.
4. Ensure Correct-Site, Correct-Procedure, Correct-Patient Surgery.
5. Reduce the Risk of health Care-Associated Infections.
6. Reduce the Risk of Patient Harm Resulting from Falls.
SCOPE OF PATIENT SAFETY FUNCTION:
a. There is a system for voluntary reporting of safety risks to the patients,
near misses and adverse events through the incident reporting process.
b. Root Cause Analysis (RCA) is performed for sentinel events and the plan
for will include Failure Mode Effect Analysis (FMEA) for proactive risk
reduction.
c. International Patient Safety Goals (IPSG) shall be continually monitored
for enhanced patient safety.
FUNCTIONS OF QUALITY DPARTMENT:
• To provide an environment which assures safety for patients/clients, staff and the
public, within a framework of continuously improving quality of care.
• To improve a quality culture and place quality at the core of service delivery.
• To encourage attainment of best practice.
• To promote a patient/client organization and delivery of service.
• The primary goal of quality management system is to beat the competition. It
does this by adding value at each stage of production.
• It defines long term plan for the company while at the same time providing
framework for it.
• Quality management system makes every employee the owner of customer
satisfaction.
• It improves customer satisfaction, increases sale and furthers the goodwill of the
business.
• Quality management focuses on the quality of products and services offered by
organizations as well as the means by which this quality is achieved.
ADVANTAGE OF QUALITY DEPARTMENT:
• To improve the quality of medical and behavioral health care and service
provider.
• To identify, develop and/or enhance activities that promote member safety and
encourage a reduction in medical errors.
• To communicate with doctors/care providers about quality activities, provide
feedback on results of plan-wide and practice-specific performance assessments,
and collaboratively develop improvement plans.
• To disseminate information on practitioner/provider performance to promote
member empowerment and informed decision making.
• To comply with all regulatory requirements, and to achieve and to maintain
accreditation and necessary certification.
• To create a better relationship with customers.
• To reduce cost and increase profit.
• To attend the patients physical and non-physical needs.
• To support delivery of nursing care with administrative and managerial service.
• To evaluate achievement of nursing care.
• To demonstrate the efforts of the health care providers to provide the best
possible results.
• To formulate plan of care.
QUALITY MANAGEMENT IN HEALTH CARE SERVICES
Quality management seeks to improve effectiveness of treatments and increase
patient satisfaction with the service. With an aging population and rising health
care costs, quality management in health care is gaining increased attention. A
health care system comprises small and large entities, such as pharmacies, medical
clinics and hospitals, and all components need to provide quality service for the
system to work properly.
PATIENT FOCUS
Effective quality management is focused on the needs of the patients because they
are the ones who judge the effectiveness of treatments and the appropriateness of
the service. Patient needs and expectations change over time; consequently, sound
quality management calls for constant monitoring of the patients’ progress and
satisfaction with the service. This monitoring uses both objective and subjective
means -- for example, medical test results and the patient’s opinion of the
effectiveness of treatments -- to judge the quality of the treatment approach.
LEADERSHIP
Quality management in health care requires the close cooperation of people with
diverse expertise. Service providers should agree on the shared goal of providing
quality service, and this can come about only if supervisors assume a leadership
role and motivate employees.
RELIABILITY
Quality management is essentially about delivering consistent quality, which, in
turn, requires reliable processes. Reliability requires the existence of performance
goals, risk reduction procedures, quality improvement policies, quality
measurement systems and reward mechanisms.
EXTERNAL ENVIRONMENT
The health care sector is highly regulated and relies on state-of-the-art diagnostic
technologies. Additionally, health care costs usually are covered by a third party,
such as an insurance company or a government program. These factors call for a
quality management system that complies with external regulations and adopts
latest technologies and the required knowledge for effective application of those
technologies.
TIME AND MOTION STUDY
As per NABH guidelines
TIME STUDYis defined as a work measurement technique for recording the times
and rates of working for the elements of a specified job carried out under specified
conditions and for analyzing the data to determine the time necessary for carrying
out the job at a defined level of performance.
MOTION STUDYimplies dividing the work into fundamental elements or basic
operations of a job or a process with the object of eliminating unnecessary or
defective elements in a job. After investigating all movements in a job, process or
operation it finds out the most scientific and systematic method of performing the
operation or completing the job.
OBJECTIVES
1. They eliminate unnecessary motions, fatigue, and seek to improve human
efforts in doing a job.
2. They bring about improvement in method, procedure, techniques and
processes relating to a job.
3. They make effective utilization of materials, machines, human resources.
4. They also improve layout and design of plant and equipment and working
environment.
BENEFITS 1. Optimum utilization of materials, plant, labour and financial resources are
possible.
2. Labour requirements can be properly assessed.
3. Job can be standardized.
4. Improvement in work methods by making comparison between time taken to
complete a job and time taken to complete the same type of job under
different methods.
5. Effective cost control and proper planning can be made with the help of
time and motion study.
HEALTH CARE TIME AND MOTION STUDIESmeasure time and motion of
health care workers to research and track efficiency and quality. In the case of
nurses, numerous programs have been initiated to increase the percent of a shift
nurses spend providing direct care to patients. Prior to interventions nurses were
found to spend ~20% of their time doing direct care. After focused intervention,
some hospitals doubled that number, with some even exceeding 70% of shift time
with patients, resulting in reduced errors, codes, and falls.
A time and motion study is used to determine the amount of time
required for a specific activity, work function, or mechanical process. Few such
studies have been reported in the in-patient department & outpatient department of
the hospital.
The present trend toward increased efficiency in all kinds of skilled work has
brought about a widespread interest in motion and time study. The term “time
study” and “motion study” have been given many interpretations since their origin.
Time study, originated by Taylor was mainly used for rate setting; and motion
study, developed by the Gilbreths, was largely employed for improving methods,
one group saw time study only as a means of determining the size of the task that
should constitute a day's work, using the stop watch as the timing device. Another
group saw motion study only as an expensive and elaborate technique for
determining a good method of doing work. Today the discussion of the
comparative value of using either the one or the other of the two techniques has
largely passed; industry has found that motion study and time study are
inseparable, as their combined use in many sectors now demonstrates. Taking
cognizance of present trends and recognizing the fact that motion study always
precedes the setting of a time standard. Time-motion study may be used for two
purposes: (1) To assist in finding the most efficient method of doing work; and (2)
to assist in training individuals to understand the meaning of time-motion
importance, and when the training is carried out with sufficient thoroughness, to
enable them to become proficient in applying time-motion principles.
Today, the Indian hospital systems has in a state of transition and outpatient
services in tertiary hospitals face daunting challenges, such as evolving
technologies and reimbursement policies, demographic trends, competing fiscal
demands, and a worsening skilled workforce shortage. This point in time also
affords a unique opportunity as the India is in the midst of one of the largest health
services and renovation booms in history. A reconsideration of skilled health work
force and work processes holds the potential to affect the efficiency and
effectiveness of healthcare delivery for the foreseeable future. Bold changes in the
outpatient work environment are imperative to ensure the sustainability and
affordability of the outpatient as part of the Indian healthcare delivery system.
There is requirement to note the record of accountability staff and time spent
debriefing and to make sure that an explanation of the debriefing is noted in the
additional information of the data collection form.
A time and motion study is a scientific method for recording time spent on a
variety of tasks. The methods used in the study have been done in a narrow range
of specialized work settings, such as the initial registration and nutritional
assessment of the children. The results have to be very accurate since the mothers
in the study record the amount of time spent on specific tasks. The sum for each
specific case type, that is, old/new registration was averaged to yield the average
time spent, but this value used in the calculations did not determine the need for an
additional time.
To the extent operations are concerned, time and motion study is one of the better
methods for determining the capacity of the hospital and furthermore the particular
time when the effectiveness and productivity can be improved. This study is a
proper answer to determine the “time” taken to finish a certain task by a particular
department.
Time and Motion studies outline the ground work and facilitate to arrive at a better
capacity, robust planning system which will lead the operations of a hospital to
operational excellence.
Basics on How to Do a Time and Motion Study Includes
• Look closely at the present task/current situation
• Identify the opportunities to be more efficient
• Modify the current process that is followed
• Examine if it produces the expected outcomes
• Rinse and repeat
Time and Motion study is an observation method used to decide the timing and
duration of tasks or procedures. It is a work measurement technique used for
recording the times and rates of working for the components of a specified job
carried out under specified conditions and for analyzing data. The study helps in
reducing and controlling costs, enhancing working conditions and motivating
individuals.
At the point when the time taken to finish a task is measured, machine delays,
personal needs, exhaustion, and any other foreign obstruction are likewise
considered. Effectively a job is separated into its parts. The time taken to finish
every part is noted. Furthermore, the parts are ordered or rearranged, keeping
efficiency in mind.
A Time Standard is a vital part of Time and Motion Study. A time standard
considers three factors: qualified laborer, working at a normal pace and doing a
specific task.
A comprehensive time study comprises of:
• Study objective setting.
• Experimental design.
• Time data collection
• Data analysis.
The collection of time data should be done in a few ways, depending upon study
objective and environmental conditions. Time and motion data can be taken with a
typical stopwatch, a handheld PC or a video recorder. There are various dedicated
software packages used to transform a palmtop or a handheld PC into a time study
device. As an option, time and motion data can be gathered consequently from the
memory of computer control machines (i.e. computerized time studies). However, Time and Motion study is an essential tool for further improvement in
productivity and operations in any Health care organization.
NABH (National Accreditation Board of Hospital
NABH is an institutional member of the INTERNATIONAL SOCIETY FOR
QUALITY IN HEALTH CARE (ISQUA). ISQUA is an international body which
grants approval to Accreditation Bodies in the area of healthcare as mark of
equivalence of accreditation program of member countries. Accreditation National
Board for Hospital & Healthcare provider constitutes board of QCI Quality
Council of India set to establish and operate accreditation program for health
organization and hospitals.
To implement the NABH standards to a hospital, it follows some basic criteria or
guideline. By the help of NABH Standards a hospital can get accreditation of
National Accreditation Board for Hospital & Healthcare Providers. Following are
the general and technical NABH accreditation requirements that any organization
must follow while implementation of NABH system to achieve best results and
quick certification.
BENEFITS OF NABH ACCREDITATION:
Following are the key benefits that organization can achieve with
Implementation of NABH accreditation system in any hospital and healthcare
units.
• Patients are benefited with accreditation most.
• Accreditation results in high quality of care and patient safety. The patients get
services by credential medical staff.
• Rights of patients are respected and protected.
• Patient satisfaction can be evaluated.
• Accreditation to a health care organization stimulates continuous improvements.
• It enables the organization in demonstrating commitment to quality care.
• It also provides opportunity to healthcare unit to benchmark with the best.
• Patient focus leads to better quality services and satisfaction of the patients.
• Waste expenses and activities are minimized and the efficiency is enhanced.
•Gainful activities are optimized and outcomes improved.
1.List of Departmental SOPs & Manuals:
Support service SOPs Clinical SOPs Manuals
Admission Anaesthesia Infection control manual
Billing Cath lab Safety manual
Biomedical Dental Radiation safety manual
Blood Bank Dialysis Lab safety manual
CSSD Emergency Apex manual(Quality
Manual)
Dietetics Endoscopy Nursing procedure manual
Food and Beverage Neonatal
Health Check up Obs& Gynae
HMS Operation Theater
Room
House Keeping Pediatrics
HR Radiology
Insurance Urology OPD
Maintenance &
Engineering OPD
1. List of NABH Chapter Manuals:
MRD Pathology
Pharmacy Critical Care
Physiotherapy Day Care
Purchase
Materials Management
Sl
No
Chapter Manual Name
1.
Access, Assessment and Continuity of
Care (AAC)
2.
Care of Patients(COP)
3.
Management of Medication(MOM)
4.
Patient Rights and Education (PRE)
5.
Hospital Infection Control(HIC)
6.
Continuous Quality Improvement(CQI)
7.
Responsibility of Management (ROM)
List of Quality Indicators captured and monitored by Woodlands
Multispeciality Hospital Ltd-
8.
Facility Management and Safety (FMS)
9.
Human Resource Management (HRM)
10.
Information Management System (IMS)
Sl No Indicator
1. Time for initial assessment of Indoor & Emergency
patients
2. Percentage of cases (in-patients)wherein care plan
with desired outcomes is documented & counter-
signed by the clinician within 24 hrs
3. Percentage of cases (in-patients) wherein screening
for nutritional needs has been done within 24hrs.
4. Percentage of cases (in-patients) wherein the
nursing care plan is documented
5. Number of Reporting errors/1000
investigations(Lab & Radiology)
6. Rate of re-dos(Lab & Radiology)
7. Percentage of reports co-relating with clinical
diagnosis(Lab & Radiology)
8. Percentage of adherence to safety precautions by
employees working in diagnostics(Lab &
Radiology)
9. Incidence of Medication Errors
10. Percentage of Admissions with Adverse Drug
reaction
11. Percentage of Medication Chart with Error Prone
Abbreviations
12. Percentage of patients receiving high risk
medication developing ADR
13. Percentage of modification in anesthesia plan Cases
14. Percentage of unplanned ventilation following
anesthesia
15. Percentage of Adverse Anesthesia events
16. Anesthesia Related Mortality
17. Re-exploration rate
18. Percentage of Unplanned Return to OT
19. Percentage of Rescheduling of OT Surgeries
20. Percentage of cases where the organizations
procedure to prevent adverse events like wrong site
, wrong patient and wrong surgery have been
adhered to
21. Percentage of cases who received appropriate
prophylactic antibiotics within the specified time
frame
22. Percentage of cases in which the planned surgery is
changed intraoperatively
23. Re-exploration rate
24. Percentage of Transfusion Reaction Recipient
25. Percentage of wastage of blood & blood products
26. Percentage of wastage of blood & blood products
27. Percentage of Blood Component Usage
28. TAT for issue of blood and blood components
29. Catheter associated urinary tract infection rate
30. Ventilator associated Pneumonia rate
31. Central line associated Blood stream infection rate
32. Surgical site infection rate
33. Mortality Rate
34. Return to ICU within 48 hrs
35. Return to emergency department within 72 hrs with
similar presenting complaints
36. Re - Intubation rate within 48 hours
37. Percentage of drugs procured by local purchase
38. Percentage of Stock outs including emergency
drugs
39. Percentage of Drugs Rejected Before Preparation of
Goods Receipt Note (GRN)
40. Percentage of variations from the procurement
process
41. Incidences of fall
42. Incidence of hospital associated pressure ulcers
after admission
43. Percentage of Employees provided Pre - Exposure
Prophylaxis
44. Bed Occupancy
45. Average Length of Stay
46. OT utilization Rate
47. ICU Utilization Rate
48. Percentage of critical Equipment downtime
49. Nurse Patient Ratio
50. Waiting time for diagnostics services
51. Waiting time for OP Consultation
52. Waiting time for diagnostics services
53. Time taken for discharge
54. Employee satisfaction index
55. Employee attrition rate
56. Employee absenteeism rate
57. Percentage of employees who are aware of
employee rights, responsibilities and welfare
schemes
58. OP Satisfaction index
59. IP Satisfaction index
60. Number of sentinel events reported collected and
analyzed within the defined time frame
61. Percentage of Near Miss
62. Incidences of blood body fluid exposure
63. Incidence of Needles stick injuries
64. Percentage of medical records not having discharge
summary
65. Percentage of medical records not having
codification as per ICD
NABH GUIDELINES
• AAC.1 – THE ORGANIZATION DEFINES AND DISPLAYS THE
SERVICES THAT IT CAN PROVIDE. • AAC.2- THE ORGANIZATION HAS A DOCUMENTED
REGISTRATION, ADMISSION,AND TRANSFER PROCESS • AAC3. PATIENTS CARED FOR BY THE ORGANIZATION UNDERGO
AN ESTABLISHED INITIAL ASSESSMENT • AAC4.PATIENT CARE IS CONTINOUS AND ALL PATIENTS CARED
FOR BY THE ORGANIZATION UNDERGO A REGULAR
REASSESSMENT • AAC.5 LABORATORY SERVICES ARE PROVIDED AS PER THE
SCOPE OF THE HOSPITAL’S SERVICES AND LABORATORY • AAC.6-IMAGING SERVICES ARE PROVIDED AS PER THE SCOPE
OF THE HOSPITAL’S SERVICES AND ESTABLISHED • AAC.7-THE ORGANIZATION HAS A DEFINED DISCHARGE
PROCESS
• COP1. CARE OF PATIENTS IS GUIDED BY ACCEPTED NORMS AND
PRACTICE
• COP2.EMERGENCY SERVICES INCLUDING AMBULANCE ARE
GUIDED BY DOCUMENTED PROCEDURES
• COP3.DOCUMENTED PROCEDURES DEFINE RATIONAL USE OF
BLOOD AND BLOOD PRODUCTS
66. Percentage of Medical Records having incomplete
and/ or improper consent
67. Percentage of Missing Records
68. Appropriate handovers during shift change (for
doctors & nurses)
69. Incidence of patient identification errors
70. Compliance to hand hygiene practice
• COP4.DOCUMENTED PROCEDURES GUIDE THE CARE OF
PATIENTS AS PER THE SCOPE OF SERVICES PROVED BY
HOSPITAL CARE AND HIGH DEPENDENCY
• COP5.DOCUMENTED PROCEDURES GUIDE THE CARE OF
OBSTETRICAL PATIENTS AS PER THE SCOPE OF SERVICES
PROVIDED BY HOSPITAL
• COP6.DOCUMENTED PROCEDURES GUIDE THE CARE OF
PAEDIATRIC PATIENTS AS PER THE SCOPE OF SERVICES
• COP7.DOCUMENTED PROCEDURES GUIDE THE
ADMINISTRATION OF ANAESTHESIA
• COP8.DOCUMENTED PROCEDURE GUIDES THE CARE OF
PATIENTS UNDERGOING SURGICAL PROCEDURES
• MOM.1 DOCUMENTED PROCEDURES GUIDE THE ORGANISATION
OF PHARMACY SERVICES AND USAGE OF MEDICATION
• MOM.2 DOCUMENTED POLICIES AND PROCEDURES GUIDE THE
STORAGE OF MEDICATION
• MOM.3DOCUMENTED PROCEDURES GUIDE THE PRESCRIPTION
OF MEDICATIONS
• MOM.4 POLICIES AND PROCEDURES GUIDE THE SAFE
DISPENSING OF MEDICATIONS
• MOM.5 THERE ARE DEFINED PROCEDURES FOR MEDICATION
ADMINISTRATION
• MOM.6 ADVERSE DRUG EVENTS ARE MONITORED
• MOM.7 DOCUMENTED POLICIES AND PROCEDURES GOVERN
USAGE OF RADIOACTIVE
• PRE.1 PATIENTS RIGHTS ARE DOCUMENTED DISPLAYED AND
SUPPORT INDIVIDUAL BELIEFS, VALUES AND INVOLVE THE
PATIENT AND FAMILY IN DECISION MAKING PROCESS
• PRE.2 PATIENT AND FAMILIES HAVE A RIGHT TO INFORMATION
AND EDUCATION ABOUT THEIR HEALTHCARE NEEDS
• HIC.1 THE HOSPITAL HAS AN INFECTION CONTROL MANUAL,
WHICH IS PERIODICALLY UPDATED AND CONDUCTS
SURVEILLANCE ACTIVITIES
• HIC.2 THE HOSPITAL TAKES ACTIONS TO PREVENT OR REDUCE
THE RISKS OF HOSPITAL ASSOCIATED INFECTIONS (HAI) IN
PATIENTS AND EMPLOYEES
• HIC.3 BIO-MEDICAL WASTE (BMW) MANAGEMENT PRACTICES
ARE FOLLOWED
• CQI.1 THERE IS A STRUCTURED QUALITY IMPROVEMENT,
PATIENT SAFETY AND CONTINOUS MONITORING PROGRAMME
IN THE ORGANIZATION
• CQI THE ORGANISATION IDENTIFIES KEY INDICATORS TO
MONITOR THE STRUCTURE PROCESSES AND OUTCOMES WHICH
ARE USED AS TOOLS FOR CONTINUOUS IMPROVEMENT
• ROM.1 THE RESPONSIBILITIES OF THE MANAGEMENT ARE
DEFINED
• ROM.2 THE ORGANIZATION IS MANAGED BY THE LEADERS IN
AN ETHICAL MANNER
• ROM.3 THE ORGANIZATION HAS SET UP MULTI- DISCIPLINARY
COMMITTEES TO OVERSEE SPECIFIC AREAS OF QUALITY AND
PATIENT SAFETY
• FMS.1 THE ORGANIZATION’S ENVIRONMENT AND FACILITIES
OPERATE TO ENSURE SAFETY OF PATIENTS, THEIR FAMILIES,
STAFF AND VISITORS
• FMS.2 THE ORGANIZATION HAS PROVISIONS FOR SAFE WATER,
ELECTRICITY, MEDICAL GAS AND VACUUM SYSTEMS • FMS.4 THE ORGANISATION HAS PLANS FOR FIRE AND NON-FIRE
EMERGENCIES WITHIN THE FACILITIES
• HRM.1 THE ORGANISATION HAS STAFFING COMMENSURATE
WITH PATIENT CARE NEEDS
• HRM.2 THERE IS AN ON-GOINHG PROGRAMME FOR
PROFFESIONAL TRAINING AND DEVELOPMENT OF THE STAFF
• HRM.3 THE ORGANIZATION HAS A WELL DOCUMENTED
DISCIPLINARY AND GRIEVANCE HANDLING PROCEDURE
• HRM.4 THE ORGANIZATION ADDRESSES THE HEALTH NEEDS OF
THE EMPLOYEES
• HRM.5 THERE IS DOCUMENTED PERSONAL RECORD TO EACH
STAFF MEMBER
• IMS.1 THE ORGANIZATION HAS A COMPLETE AND ACCURATE
MEDICAL RECORD FOR EVERY PATIENT
• IMS.2 THE MEDICAL RECORD REFLECTS CONTINUITY OF CARE
• IMS.3 DOCUMENTED POLICIES AND PROCEDURES ARE IN PLACE
FOR MAINTAINING CONFIDENTIALITY,INTEGRITY AND
SECURITY OF RECORDS,DATA AND INFORMATION
• IMS.4 DOCUMENTED PROCEDURES EXIST FOR RETENTION TIME
OF RECORDS,DATA AND INFORMATION
-
RESEARCH METHODOLOGY
PLACE OF STUDY: WOODLANDS MULTISPECIALITY HOSPITAL 8/5, Alipore Road, Kolkata – 700 027 E-mail : enquiry@woodlandshospital.in Phone : 033-24567075-89 Fax : 033-24567090/123 Outdoor Patient : (033) 4033 7032 / 33 Helpline : 7604075551-55
DURATION OF STUDY: 2ND JAN-1ST APRIL
SPECIALISED DEPARTMENT: QUALITY DEPARTMENT
❖ SOURCES OF DATA :
i. Primary Observation
ii. Annexure
DATA ANALYSIS
AVERAGE LENGTH OF STAY IN ICCU-A
• IN THE MONTH OF JANUARY’18
INTERPRETATION:According to the survey in WHML, in the month of January the
total number of patient was admitted in the ICCUA was 50%, out of them, 15% was the
total number of discharge, 30% was the total number of transfer, & 5%was the total
number of death.
AVERAGE LENGTH OF STAY:
Total length of stay for each discharged resident in the month/dividing by the number of
discharge residents in a month.
524/31 = 16.9%
As we can see, the average length of stay in ICCUA was 16.9% in the month of
January.
46%
11%
36%
7%
Chart TitleIN THE MONTH OFJANUARY'18 TOTAL NO. OFPATIENT
IN THE MONTH OFJANUARY'18 TOTALDISCHARGE
IN THE MONTH OFJANUARY'18 TOTALTRANSFER
IN THE MONTH OFJANUARY'18 TOTAL DEATH
• IN THE MONTH OF FEBRUARY’18
INTERPRETATION: According to the survey in WHML, in the month of February the
total number of patient was admitted in the ICCUA was 49%, out of them, 18% was the
total number of discharge, 29% was the total number of transfer, & 4%was the total
number of death.
AVERAGE LENGTH OF STAY:
Total length of stay for each discharged resident in the month/dividing by the number of
discharge residents in a month.
500/28 = 17.8%
As we can see, the average length of stay in ICCUA was 17.8% in the month of
February.
40%
9%
49%
2%
Chart Title
IN THE MONTH OFFEBRUARY'18 TOTAL NO. OFPATIENT
IN THE MONTH OFFEBRUARY'18 TOTALDISCHARGE
IN THE MONTH OFFEBRUARY'18 TOTALTRANSFER
IN THE MONTH OFFEBRUARY'18 TOTAL DEATH
AVERAGE LENGTH OF STAY IN ICCU-B
• IN THE MONTH OF JANUARY’18
INTERPRETATION: According to the survey in WHML, in the month of January the
total number of patient was admitted in the ICCUA was 46%, out of them, 11% was the
total number of discharge, 36% was the total number of transfer, & 7%was the total
number of death.
AVERAGE LENGTH OF STAY:
Total length of stay for each discharged resident in the month/dividing by the number of
discharge residents in a month.
445/31 = 14.35%
As we can see, the average length of stay in ICCUA was 14.35% in the month
of January.
46%
11%
36%
7%
Chart Title
IN THE MONTH OFJANUARY'18 TOTAL NO. OFPATIENT
IN THE MONTH OFJANUARY'18 TOTALDISCHARGE
IN THE MONTH OFJANUARY'18 TOTAL TRANSFER
IN THE MONTH OFJANUARY'18 TOTAL DEATH
• IN THE MONTH OF FEBRUARY’18
INTERPRETATION: According to the survey in WHML, in the month of February the
total number of patient was admitted in the ICCUA was 40%, out of them, 9% was the
total number of discharge, 49% was the total number of transfer, &2%was the total
number of death.
AVERAGE LENGTH OF STAY:
Total length of stay for each discharged resident in the month/dividing by the number of
discharge residents in a month.
405/28 = 14.46%
As we can see, the average length of stay in ICCUA was 14.46% in the month
of February
40%
9%
49%
2%
Chart Title
IN THE MONTH OF FEBRUARY'18TOTAL NO. OF PATIENT
IN THE MONTH OF FEBRUARY'18TOTAL DISCHARGE
IN THE MONTH OF FEBRUARY'18TOTAL TRANSFER
IN THE MONTH OF FEBRUARY'18TOTAL DEATH
• TIME TAKEN IN SHIFTING OF PATIENT FROM THE
EMERGENCY DEPARTMENT TO WARD
INTERPRETATION: According to the survey in WHMLThe total time taken in shifting
of patient from emergency department to ward is as we can see from the chart the
maximum time taken is 30mintues and the minimum time taken is 5minutes
0
5
10
15
20
25
30
35
LESS THAN15 MINS
15- 20MINS
20- 25MINS
25- 30MINS
30- 35MINS
NO OF. PATIENTS 35 21 15 10 11
NO OF. PATIENTS
• AUDIT SHEET FOR CQI(WAITING TIME FOR
DIAGNOSIS PROCEDURE USG)USG TIME & MOTION
STUDY
INTERPRETATION: According to the survey in WHMLThe total time taken in shifting
of patient from emergency department to ward is as we can see from the chart the
maximum time taken is 30mintues and the minimum time taken is 5minutes
35
21
15
10
11
8
0 5 10 15 20 25 30 35 40
LESS THAN 15 MINS
15- 20 MINS
20- 25 MINS
25- 30 MINS
30- 35 MINS
MORE THAN 35 MINS
LESS THAN 15MINS
15- 20 MINS 20- 25 MINS 25- 30 MINS 30- 35 MINSMORE THAN 35
MINS
NO OF. PATIENTS 35 21 15 10 11 8
NO OF. PATIENTS
• BED OCCUPANCY IN GENERAL WARDS
INTERPRETATION: According to the survey in WHML, the bed occupancy in general
wards in jan 18 was 87%, in feb 18 was 77% and in mar 18 was 83%
72% 74% 76% 78% 80% 82% 84% 86% 88%
Jan/18
Feb/18
Mar/18
Column1
• MORTALITY PERCENTAGE IN GENERAL WARD
INTERPRETATION: According to the survey in WHML, the mortality percentage in
general ward in jan 18 was 2.75%, feb 18 was 2.54% and in mar 18 was 2.62%
2.40% 2.45% 2.50% 2.55% 2.60% 2.65% 2.70% 2.75% 2.80%
Jan/18
Feb/18
Mar/18
Column1
PROBLEM AREAS IN THE QUALITY ASSURANCE:
• Counter signature by consultant in history and Physical Record Sheet is not found. • Most
of the time it is found that the doctor’s name and attending time is not found in the
treatment sheet. • The nursing attendants forget to fill up the Initial Nursing Assessment
sheet. If they fill up also then they forget to mention the time of arrival and time of
assessment. • The nursing handover is sometimes not well by the nursing attendants. They
forget sign or provide the date of the handover. • In the Surgical Safety Checklist,
sometimes the consultant does not sign or provide their full name. • There is a lack of
standing guidelines and procedures. • Low number of auditors is also a concern.
SOLUTIONS FOR EFFECTIVE FUNCTIONING:
• Circular distribution has been started to the consultants and it is informed verbally to
provide signature in the counter sign column by mentioning the name, date and time in
History and Physical record sheet and treatment sheet. • Nurse must be actively involved
and trained throughout the process. • Decisions must be supported by quality research. •
Staff should feel empowered to make decisions and be held accountable. • Quality
outcomes should be transparent.
CONCLUSION Our review revealed a common and reoccurring misunderstanding regarding the definition
and scope of time motion studies. It is currently being used in two ways: at a high level,
referring to the conglomeration of studies on which the duration of an event is one of the
variables of interest, and at a more granular level, making reference to the use of an
external observer recording time data continuously. To maintain compliance with the
existing scope of the term, we propose to preserve the expanded conception and
recommend the use of a specific qualifier “continuous observation time motion studies” for
referring to the use of an external observer recording data continuously. It should be
remembered that patient care includes elements that may be examined objectively or
subjectively or both. The objective elements can be measured by statistical documentation
& analysis to serve as a point of departure from which qualitative judgment can be made,
where as the subjective elements require qualitative judgment through clinical evaluation.
Continuous evaluation provides stimulation for improvement of clinical services,
professional education, hospital administration & better patient care. Medical audit, when
practiced can go long way in improving the quality of patient care in our hospitals, which
at present is far below the expectation of the community. In healthcare delivery, quality
audit focuses on guaranteeing and maintaining high standard of the service provided in
different healthcare systems. When the services delivered by the care provider is in
accordance with what the recipients of healthcare expect, then quality in healthcare is
considered to be present. Quality audit is needed for rapid advancement in healthcare
sector, rapid development in diagnostic and operation technology. The value of quality
audit, as an instrument forimprovement of quality of care is being gradually realized now
as it has been included in the NABH/JCI accreditation standards also.
BIBLIOGRAPHY
1. HOSPITAL ADMINISTRATION by DC JOSHI and MAMTA
JOSHI.
2. QUALITY MANAGEMENT by SD JOSHI.
3. http:// en.wikipedia.org/wiki/Joint Commission.
4. http:// www.ishqua.org.au
5. http:// en.wikipedia.org/wiki/HL7.