A PROJECT REPORT ON time motion OF

HOSPITAL

RABINDRANTH TAGORE INTERNATIONAL INSTITUTE OF

CARDIAC SCIENCES

PRESENTED BY –

Name : RIM HALDER

Name of the course : BHM, 5th SEMESTER

Roll No. : 11

Registration No : 151541310023

Session : 2015 - 2018

College : DINABANDHU ANDREWS INSTITUTE

OF TECHNOLOGY & MANAGEMENT

DECLARATION

I do hereby declare that this project work entitled “ A

study on overview of the hospital ” at Rabindranath Tagore

International Institute Of Cardiac Sciences hospital for 3

months (3rd January to 3rd April), submitted by me in

practical fulfilment 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.

_________________

SIGNATURE

RIM HALDER

REG NO. – 151541310023

DAITM

KOLKATA, WEST BENGAL

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.

First of all I would like to mention the name of MRS.

ROLI VERMA (Head HR) for the provision of the training

report.

And also I would like to give special thanks to our

supervisor trainer MRS. ANUPRIYA ROY (Assistant HR) for

the proper support and guidance.

I am also glad to my honourable HOD Mr. Surajit

Biswas for the continue guidance.

Finally I acknowledge my indebtedness to all the

staffs and helpers of “RABINDRANATH TAGORE

INTERNATIONAL INSTITUE OF CARDIAC SCIENCES“

for guiding us at every steps of our training and providing us

with solutions to small issues and problems that we found.

RIM HALDER

BACHELOR IN HOSPITAL MANAGEMENT

CONTENT

SERIAL TOPIC

1 Introduction About The Topic

2 Hospital Profile

3 Training Objective

4 Review of Literature

5 Broad Overview

6 Methodology

7 Data Interpretation

8 Summary of Findings

9 Conclusion

10 Bibliography

INTRODUCTION

Time is one of the most valuable things to us. A time and

motion study (or time-motion study) is a business efficiency

technique combining the time study work of Frederick

Winslow Taylor (1881 A.D) with the motion study work of

Frank B. Gilberth and his wife Lillian Gilbreth (1885A.D). It

is a major part of scientific management (Taylorism).

Motion study is designed to determine best way to complete

a repetitive job while the time study measures how long it

takes an average worker to complete a task at a normal

pace. Historically the two studies are discussed individually;

today they generally are discussed as one. The two

techniques became integrated and refined into a widely

accepted method applicable to the improvement and

upgrading of work systems. This integrated approach to

work system improvement is applied to determine schedules

and planning of work in industrial as well as service

organizations, including banks, schools and hospitals. The

objective of the Time and Motion Study is to determine a

‘normal’ or average time for a job, by using observers to

record exactly how much time is being devoted to each

task. With this objective, time and motion studies can be

effective for performance evaluations as well as can be

used for planning purposes. During the last decade, the

number of patients seeking Outpatient Department (OPD)

services has increased many folds, but the facilities in the

OPD have not increased at the same rate. Huge number of

patients in the OPDs with limited manpower creates chaos

as well as the chance of mismanagement. OPD thus requires

a systematic study of its service for its efficient

management and function. It is therefore imperative that a

simple time and motion study of an OPD system and suitable

inexpensive interventions can go a long way to improve the

efficiency of a hospital. Dearth of literature has been

found on time and motion study in OPD settings with OPD of

hospital as rarity. Hence the present study was carried out

in the OPD clinic of a hospital to know the time taken in

different service delivery points in outpatient department

and to assess the perception of beneficiaries regarding the

total time spent in the OPD.

HOSPITAL PROFILE

Rabindranath Tagore International Institute Of Cardiac

Sciences (RTIICS), setup in 2000 is a unit of Asia Heart

Foundation, a trust that aims to develop a network of

hospitals throughout India, to bring world-class cardiac

care facilities within the reach of the common man.

RTTICS is a unit of Asia Heart Foundation, Firmly believes

in its mission “an equitable distribution of quality health

care for one and all “. This hospital represents a part of the

dream to create a chain of cardiac care hospitals accessible

to everyone. The hospital comprises of Cardiac Centre, &

the Armenian Church Trauma Centre

A dedicated team of renewed cardiac surgeons,

cardiologists, nurses, technicians and per fusionists makes

it possible for this institution to undertake complex cardiac

surgeries and interventional procedures.

Conceptualized by DR.DEVI SHETTY,RTIICS has ushered

in hope for multitude of cardiac patients in the eastern part

of the country and beyond.

RABINDRANATH TAGORE INTERNATIONAL

INSTITUTE OF CARDIAC SCIENCES (RTIICS)

“Armenian Church Trauma Centre” (ACTC). An unit of

Rabindranath Tagore International Institute Of Cardiac

Sciences ,within the same premises, which caters to

Orthopaedics, Neurosurgery, Urology, Nephrology,

Endocrinology, General Surgery and Radiology.

In an effort to bridge the gap in the paucity of emergency

care for trauma victims, The American Holy Church of

Nazareth has joined hands with AHF and has set up the

American Church Trauma Centre (ACTC).

67 intensive care beds, 9 Operation Theatres, a fully

fledged department of radio diagnostics with services like

MRI, CT scan, Gamma camera, a blood bank with component

separator and an entire gamut of support and utility

services.

AMERICAN CHURCH TRAUMA CENTRE (ACTC)

The USP of the hospital is all super specialty services under

one roof, backed with highly trained Doctors, Nurses and

Paramedics in a high volume low cost model.

A decade or so ago there was a heavy exodus of

patients from the East and North Eastern part of the

country, seeking medical treatment in the south India due

to dearth of quality healthcare services providers in our

region.

A population bank of about nine cores in West Bengal and

around the three cores in the northeaster states were left

with less choice of affordable and quality treatment.

However, the last 10 years have seen lot of health care

providers emerging in this part of the country and

Rabindranath Tagore International Institute Of Cardiac

Sciences (RTIICS) takes pride in being a pioneer amongst

them in terms of quality and volume of services at

affordable rates.

To serve the people of West Bengal and the neighbouring

states, RTIICS was set up in April 2000. It stated as a 100

bedded cardiac super specialty hospital and later on in 2004

other 32 disciplines were brought into spectrum to provide

complete, affordable and quality healthcare under one roof.

Today it is a 550 bed super specialty tertiary care hospital

with 33 multi-specialty departments with focus on

Cardiology, Cardiac Surgery, Urology, Nephrology, Kidney

Transplant, Joint Replacement, Minimal invasive surgery and

Neuro-sciences. Patients not only from the region, but also

from neighboring countries like Bangladesh, Myanmar, Nepal

and the African sub-continent come here for treatment.

USP

Powered by the vision of DR. DEVI SHETTY, The Chairman,

RTIICS was built on solid foundation of ethical, high quality

medical practice at affordable cost. The biggest USP of the

hospital is that all super specialty services are available

under one roof, backed with highly trained Doctors, Nurses

and Paramedics in a high volume, low cost model.

CERTIFICATIONS/AFFILIATIONS:

The hospital is NABH, NABL, certified. In addition it has

been recognized as the centre for DNB and PGDCC studies.

COST & SERVICES VIS-A-VIS OTHER HOSPITALS IN THE

STATE:

RTIICS is a cost conscious hospital that strives constantly

in bringing down the cost of care, still maintaining the

highest standards in quality of care. It has a transparent

billing system backed by top management commitment to

maintain packages.

SAFETY AND SECURITY:

The NABH certified hospital is driven by patient safety and

security guidelines. Right site surgical identifications,

patient falls, and other clinical safety measures are

constantly monitored.

CSR ACTIVITIES:

The hospital is driven by their chairman’s vision of making

healthcare affordable for masses. CSR activities from the

daily activities, and partner organization like Rotary, NGOs

and also individuals who have an approach to philanthropy.

They have been making all efforts to ensure that a patient

is not refused care, due to lack of funds. In last 13 years,

more than 18000 patients received financial assistance

through the Guest Support Cell.

MISSION We dream to make sophisticated healthcare facilities

available to the mass, irrespective of Status, Class, Creed,

or Community, with the sole aim of care, compassion and

services to the sick and unhealthy.

“AN EQUITABLE DISTRIBUTION OF HEALTHCARE FOR

ALL “

VISSION We desire to emerge as a health care destination and

training hub for everyone all over the world and reach to

the masses in the remotest corner of the country and

outside.

We welcome you to an organization committed to the cause

of providing quality health care to the common masses at

their doorsteps at an affordable price , through a network

of healthcare facilities in India and in their countries.

Asia Heart Foundation strongly believes in teamwork, both

within the organization and outside. This is exactly why

AHF has tied up with the various governments and

organization across the continent in its effort towards

providing Critical Health Care Services to the people who

have been denied the same due to socio-economic and

geographical reasons.

SENIOR CITIZEN CELL

Senior Citizen Cell is a very special services wings for

senior guests. This facility is also for parents and all other

seniors, children’s who are out of the country.

GUEST SUPPORT CELL

In keeping with RTIICS vision of equitable distribution of

super speciality health care, the hospital maintain a Guest

Support Cell to help the patient from economically

backward families to continue their by arranging funds. A

number of welfare organization & committees, government

as well as corporate bodies are approached to support this

cause.

TELEMEDICINE

The department administers the high technology medical

project for online myocardial infarction treatment,

together with NARAYANA HRUDALAYA, Bangalore in

association with ISRO, the state government of West

Bengal & North Eastern States the department act as a

main hub for telemedicine, linking of these states, to

provide expert diagnosis treatment at hospitals that do not

possess the facility of Coronary Care Unit. So far

approximately 9000 patient both outpatient & impatient,

have been treated through this networking last 18 months.

ECG report, audio/visual data, CT scan, X-Ray, MRI, and

their analysis are exchanged via telephone line, board band

connection or satellite.

HEALTH CHECK UP PROGRAMMES

To make assessment of one health status easier a

specially design health check up programs. The problems

have designed under able and experience of our hospital.

FREE HEALTH CHECK UP CAMP

In our effort to take health care to the door step the

masses and as a part outreach program, RTIICS regularly

conduct free heart camp all over the country.

QUALITY POLICY

We are committed to provide professional healthcare

services by continually improving and innovating changes in

the quality management parameters.

Objective of the project

To study the present organization of OPD services

of RTIICS –Hospital Block. To conduct a time motion

study to assess the average waiting time of patients,

average time consumed in queuing at various levels such

as registration, consultation, pathology, radiology,

pharmacy etc.

To identify the short comings at various levels leading

to such congestion and to suggest various means to

reduce congestion in OPD.

To measure and assess the average time taken by an

outdoor patient during each visit in various OPDs and to find

out areas where delay takes place. To study the patients’

perception regarding delay/ waiting in the hospital

and its subsequent impact on the Patient satisfaction To

suggest measures to reduce the waiting time and delays

at various steps of treatment of the outdoor patients. To

understand the scope of the refreshment system.

REVIEW OF LITERATURE

1. Linda V. Green, Sergei Savin (2007): “Reducing Delays

for Medical Appointments: A Queuing Approach”,

Operations Research, Volume 56, No. 6, ISSN 0030-364X.

This research results demonstrate the usefulness of the

queuing models in providing guidance on identifying patient

panel sizes for medical practices that are trying to

implement a policy of “advanced access.”

2. Johanna Hirvonen (2007): “Effect of Waiting Time on

Health Outcomes and Service Utilization“, National

Research and Development Centre for Welfare and Health,

ISBN 978-951-33-2032-4. The researcher analyzes the

different problem of total hip or knee replacement

patients.

3. Diwakar Gupta, Brian Denton (2007): “Appointment

Scheduling in Health Care: Challenges and Opportunities”,

IIE Transactions, Volume 40, ISSN: 0740-817X. In this

paper, we summarized key issues in designing and managing

patient appointment systems for health services.

4. Linda V. Green (2008): Using Operations Research to

Reduce Delays for Healthcare”, Tutorials in Operation

Research, Informs, ISBN: 978-1-877640-23-0. The

researcher describes all reasons of delay in patient

treatment. This paper discuss the implementation of

Operational Research method to reduce those delays.

5. Zhu Z. C., Heng B. H., Teow, K. L. (2009): “Simulation

Study of the Optimal Appointment Number for Outpatient

Clinics”, International Journal of Simulation Modeling,

Volume 8, No. 3, ISSN 1726-4529. This paper study the

appointment scheduling systems in outpatient clinics to

determine the optimal number of appointments to be

schedule in one session with criteria of different

performance indicators and consult room configurations.

6. Devon M. Herrick, Linda Gorman, John C. Goodman

(2010): “Health Information Technology: Benefits and

Problems”, National Center for Policy Analysis, ISBN #1-

56808-203-7. This book represents involvement of

information technology in all health care related sectors in

United States.

7. Abhijit Chakravarty (2011): “Evaluation of Service

Quality of Hospital Outpatient Department Services”,

Medical Journal Armed Force India, Volume 67, issue 3,

DOI: http://dx.doi.org/10.1016/S0377-1237(11)60045-2.

In this article study was conducted at a peripheral service

hospital to ascertain any service gap between consumer

expectations and perceptions in respect of the hospital

outpatient department (OPD) services.

8. Srividya Bhat, Nandini S. Sidnal, Ravi S. Malashetty,

Sunilkumar. S. Manvi (2011): “Intelligent Scheduling in

Health Care Domain”, International Journal of Computer

Science Issues, Volume 8, Issue 5, ISSN (online) 1694-

0814. The paper work integrates accessing distributed

health care services in multi-agent environment to achieve

better Quality of service by using java platform. This

develops a framework to schedule the meeting between the

patients and the relevant doctors meeting in an efficient

way for routine and emergency services.

9. Kavitha, A. Venkat Ramana, S. Sushma Raj(2012):

“Embedded Management System for Out Patient

Department”, International Journal of Embedded Systems

and Applications (IJESA), Volume 2, No.3, DOI :

10.5121/ijesa.2012.2305. The authors create the embedded

based device to assist patients to easily locate the doctor’s

cabin. The device displays the patient’s name and token

number outside of the consultant’s room. Out patients who

wish to consult a particular doctor finds it very difficult to

locate their respective doctor’s cabin.

10. Mageshwari, E. Grace Mary Kanaga(2012): “Literature

Review on Patient Scheduling Techniques”, International

Journal on Computer Science and Engineering (IJCSE),

Volume 4, No. 03, ISSN : 0975-3397. This paper

researcher describes the challenges of patient scheduling

and patient scheduling techniques. They provide an option of

patient scheduling with Multi-agent System; Distributed

Computing; Coordination.

Broad overview

Historically time motion studies were used in the

manufacturing industry to evolve pay scales with the

thought that money was the only motivation for the work.

Today, time motion study can be effective for performance

evaluation, for planning purposes in order to predict the

level of output that may be achieved and can be used to

unmask problems and create solutions and also can be used

for time cost analysis. The outpatient department is the

point of contact between the health care facility and the

community. The problems of OPDs of developing countries

are long waiting times, long queues, inefficient staffs,

absence of staffs etc. The problem is graver when the OPD

runs in the area, because of huge patient load. No

comparable time motion studies have been carried out in any

other OPD of hospital. But other time motion studies have

been carried out in relation to immunization clinic, surgical

interventions, nursing activity monitoring.

During the last decade the number of patients seeking out

patient department services has increased many folds, but

the facilities in the OPD have not increased at the same

rate. Patients are attended in various OPD within the

hospital system, but almost invariably, a high percentage of

these patients arrive and leave the hospital at various

times. The amount of time the patient waits to be seen, is

one factor which affects the utilisation of health care

services. In a competitively managed health care

environment patient waiting time play an increasingly

important role in a clinics ability to attract new business. It

is difficult to sell services if individuals are dissatisfied

with waiting time. Patient satisfaction has emerged as an

increasingly important parameter in the assessment of

quality of health care; hence health care facility

performance can be best assessed by measuring the level of

patient’s satisfaction. Because of great volume of ambulant

patients in most communities, an efficient outpatient

department (OPD) in hospital is clearly of critical

importance. This is more because of lower cost of

outpatient services compared to inpatients. In most

developing countries, the outpatient department is over-

crowded. Patients are mixed together and any attempt to

impose rules fails before such a huge attendance. Patients

coming to hospital for treatment loss their valuable time

which ultimately cause many more difficulties. So, increase

waiting time causes a negative impact on patient’s

satisfaction. It is revealed that there is significance

difference between the patients and their physician’s view

of patients waiting time in OPD care and perspective to

improve the situation. As majority of the people come in

contact with the OPD services of the hospital so it is the

area of importance to satisfy and address the peoples

demand accordingly and in an effective way. Waiting time is

the time required just after patient’s arrival at the OPD to

meet his health needs. It is the total time elapsed in

circulating the patient from one room to another. These

include the time spent for collecting the treatment ticket,

for attending the physician, for submission of samples for

investigations and for collecting medicines including

receiving instructions for their use. Patient’s waiting

depends on many factors including efficiency, sincerity and

punctuality of the health care providers as well as the

existing facilities of the institution. Different studies have

been done on public hospitals mainly at emergency

department and inpatient departments, but not as much at

OPD of a government health care facility like teaching

hospitals. A study of this nature is critical to public

appreciation of the quality of health care operating

environment. Hence this study was aimed at assessing

patients waiting time and factors affecting waiting in the

OPD and their satisfaction towards some services rendered

at OPD.

METHODOLOGY

Time was directly noted and observed at each and every

station by observer with the help of a same functioning

watch, having least count of one second. Time difference

was calculated and analyzed for every counter.

QUESTIONNAIRE DESIGN:

Proper care had been taken to ensure that the information

needs match the objectives which in turn match the data

collected through the questionnaire. The basic cardinal

rules of Questionnaire design like using simple and clear

words, the logical and sequential arrangement of questions

had been taken care of.

SOURCE OF DATA:

Primary source:

A. For Time motion study:

Through direct observation of OPD Functioning and

recording of the time taken by a patient at each counter

B. For Patient interview:

The primary data was collected through an administered

Questionnaire. The Questionnaire consisted of a variety of

questions that lay consistent with the objectives of the

research.

Secondary source: The advertisements published by the

hospital, the catalogues, brochures, website of the

organization served as secondary sources of data.

DATA COLLECTION AND INTERPRETATION

Dr’s entry time evaluation

RTIICS OPD Staff work efficiency

65%

10%

15%

10%

yes

no

somewhat

don’t know

There was enough Facility-like food, drinking water, Parking

Time taken to complete the paperwork

0

20

40

60

80

yesno

somewhatdon’t know

yes

no

Proper Seating arrangement in waiting area is mandatory in

OPD

72%

11%

17%

yes

no

somewhat

yes

no

somewhat

don’t know

0 10 20 30 40 50 60 70

Do the hospital has senior specialist Doctor and Nurse

available at the time of OPD

FINDINGS

The time taken for treatment at all the OPDs is higher than

that at the private clinics but statistically significant

difference could be established only for department of

Neuro medicine, Gastro medicine and CTVS. Also

Ophthalmology and radiology were other major areas of

delay. The process analysis shows that there are many non

value adding steps in the entire process. Also, load distance

analysis and systematic layout planning indicates possible

65%10%

15%

10%

yes no somewhat don’t know

relocation of the department of medicine. Though the

administrative offices do not directly deal with the

patients still they are located closest to registration. The

patients rank the prompt services only third to reliability

and empathy in the overall quality of services. The patients

perceive that lot of delay takes place in transportation.

However time study shows that the time taken in

transportation is only 40% of the total time spent. The

signage and help desk are neither appropriate nor

adequate. In the opinion of the doctors and students the

services in this hospital are prompt or very prompt whereas

the patients feel the contrary. This could be a reason for

the staff being non responsive

The operations at the OPDs should be revised especially in

gastro medicine, neuromedicine and CTVS by standardizing

the processes. The residents may do the routine jobs while

the doctors will do the detail check up. The nurse’s roles

will be well defined and additional responsibility of guiding

patients to referred service centres should be given to

them as they are not the bottlenecks. Induction of nurses

and other support staff to make them more polite, caring

and concerned about patients. Developing cross functional

skills amongst staff of registration and pharmacy and share

man-power during peak hours. Also the doctors should avoid

talking on the phone and gossiping as they are the major

bottlenecks during peak hours of operation. Simple changes

in layouts like shifting the waiting chairs, shift in nurse’s

position, separate seats for patients and their attendants

etc. will make the operations smoother. Pull instead of push

strategy should be adopted so as to reduce number of

referred cases from the present level of 14%. Establish a

stronger central control in Pathology and Radiology to

bring formalization and reduce errors and repeat tests in

MRD file should be arrange on daily basis make sure if file

is out of department proper entry in to the register should

be done. Improvement of signage and information delivery.

CONCLUSION

After getting a summarized idea of hospital out-patient

management ,I have reached to a conclusion that hospital is

dealing a very sensitive area. Not only that the hospital is

only a place where the diseased person should have to come

and they are trying to get recovery after paying a lot. It

always kept in mind to give relief to the patient and patient

relatives both.

The demand on quality services in hospital is increasing and

many hospitals have realized that the quality is essential

for their services and lowering their cost . There must be a

focus in the patients need and the ways to meet those

needs and ongoing support system and continuous

improvement in the “QUALITY CARE “.

BIBLIOGRAPHY

http://www.google.com

http://www.wikipedia.com

http://www.rticcs.com