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.