Dr TBSBuxi Chairman, CT & MRI Sir GangaramHospital · Chairman, CT & MRI Sir GangaramHospital New...

Process Design in Health Care

Dr TBSBuxiDr TBSBuxi

Chairman, CT & MRI

Sir Gangaram Hospital

New Delhi

Aug 27, 2012

Top Management View

• Legacy

•Vision/Mission Statement

•Understanding Changing Trends in Healthcare

Vision and Mission

To be Leaders in Healthcare Delivery, Medical Education,

Training and Research, and Meet Expectations of the

Community

World Class Healthcare, Teaching, Training and Research by a

Team of Highly Qualified Doctors, Dedicated Nurses, Para-Team of Highly Qualified Doctors, Dedicated Nurses, Para-

medical and Non-medical Staff with State-of-the-Art

Diagnostic, Therapeutic Services in comfortable, safe

environment at an affordable cost to all sections of society

including free treatment to economically weaker sections

Process Management

• Process Innovation

• Process Implementation

• Certification

• Patient Care• Patient Care

• Cost Control

Process Approach

Effectiveness =

Ability to achievedesired results

Efficiency =

Results achieved vs resources used

Inputs OutputsProcess

�Feedback

Process Approach

�Feedback

Set & Evaluate Process Target/s

Identify Interactions with Other Processes

Visualize – Plan – Adapt

Process Design in Healthcare

If Process is Off Target…

And we are doing this…

We need to change

House Of Quality

Technical Descriptors(Voice of the organization)

Interrelationshipbetween

Technical Descriptors

(Voice of the organization)

Prioritized TechnicalDescriptors

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Relationship between

Requirements and

Descriptors

Building A House Of Quality

1. List Customer Requirements (What’s)

2. List Technical Descriptors (How’s)

3. Develop Relationships (What’s & How’s)

4. Develop Interrelationship (How’s)4. Develop Interrelationship (How’s)

5. Competitive Assessments

6. Prioritize Customer Requirements

7. Prioritize Technical Descriptors

PHASE I

• Identify processes required

• Determine sequence and interaction

PHASE II

Process Design and Improvement

• Determine control criteria and methods

• Ensure availability of process information

PHASE III

• Measure, monitor and analyze processes

• Implement actions to achieve planned results

Main Drivers of Improvement

Leadership

Systems and Processes

Training

Will to change

Know what to say

Know how to do it

DO IT and improve continuously

Leadership in SGRH

• In the last 30 years, Chairman and

Board have changed every 5 years

• Single Attachment, to live within 10 km

radius, West Delhi

• First whole body CT in the Country• First whole body CT in the Country

• Cardithoracic Surgery

• Liver Transplant Surgical Expertise

• HIS System and Telemedicine

• GRIPMER

# Dept New EquipmentNew Procedures/

Services /TestsNew Skills/Processes

1 Gynae

• 6 new CTG machines installed

in labor room and Mty ward

• Laparoscopic equipment for

optimally utilized advanced

gynae endoscopic surgery

purchased

• Pre eclampsia screening test for

antenatal women in first trimester

introduced

5 consultants trained in robotic

surgery

2Cyto

pathology

• BD Surepath system (liquid

based cytology)

• New liquid based cytology protocol

for Gynae cytology

• Technique for cell blocks

preparation for fluids and FNA

material standardized

• 10% increase in cytology

specimen

• 10% increase (approx)HPV

DNA test

• Training of staff for New BI-PAP • Training

3 Nursing

• Training of staff for New BI-PAP

(RESMED) introduced in

respiratory unit

• Advanced infusion pumps

(Volumetry) are supplied in units

and nurses trained to handle it

• Frequent rounds by senior nurses

to improve patient satisfaction

• Training

• Certificate course on

infection prevention

conducted on April 2012

• Training on ISO, nursing

administration, HIV/AIDS

prevention and care,

neonatal and childhood

4House

keeping

• New washable plastic covered

bins, imported noise free linen

& Trolley with separate section

for all items introduced + Big

trolley for soiled linen

• Microfiber mops for cleaning

• Daily rounds, feedback from every

patient

• Bathing facility in ICU and PICU

waiting area for attendants

Checking of all patient trolleys,

wheelchairs, etc , every Sunday

# Deptt New EquipmentNew Procedures/


5 Spine

surgery

• Spinal cord monitoring

equipment for complex

spinal deformities

introduced

• Centralized data collection

system and teaching schedule

was implemented

• Two new research projects are

undertaken and are in process

• Fixed teaching schedule on Wednesday

and Saturdays

• Stress Echo to be done round the clock

• Department conducts degenerative

spine week every year to impart

training to budding spine surgeons

6Transfusion

Medicine

• Automatic analyzer IH-

1000 for blood group

serology investigations

introduced

• Antibody screening for the

patient with 3 panel cell started

• Antibody screening for the

donors with pooled cells

started in IH 1000

• Leukocyte reduced RBC are

• Training for operating auto analyzer IH-

1000 given to blood bank staff

• Nucleic acid tested (NAT) for HIV 1,

HBV, HCV blood components supplied

for patients• Leukocyte reduced RBC are

now issued

for patients

7

Clinical

Micro

biology

• Laminar flow

• Refrigerated incubator

• ELISA reader

• Biosafety cabinet

• HEV Real Time Quantitative PCR

Assay

• RSV NASBA

• Influenza virus A & B

Qualitative PCR

• Legionella urinary antigen ICT

assay

• Regular training to the staff on various

topic every alternate Friday with

training of staff by outside agencies as

and when required

• Close monitoring of performance

indicators

8Human

Resource

• Colored printed forms

for HIS, Medical

Insurance, Personnel

Information,

Nomination, etc

introduced

• Performance appraisal format

for tenured employees

• Record of outsourced staff has been

streamlined for easy retrieval

• Entry of personnel data of employees

in the HRMS module on trial basis

# Deptt New EquipmentNew Procedures/


9Genetic

Medicine

• Nanodrop for DNA

quantification

• Gel documentation

system (vilber)

installed

• HLA typing and DSA detection

by Luminex technology

• HLA typing by sequencing (SBT)

• DNA Fingerprinting

• Increase in sample volume

• Lab has enrolled for external quality

control programme with-

APIHA(International) and AIIMS (National

) and achieved 100% consensus results so

far

• Lab is being recommended for HLA typing

tests by All Major Transplant Centers In

Delhi and Across India

• A new system of monthly check

of earthing resistance of all

electronic points in OT,CSSD,

Gas Manifold and Laundry

• OTs maximally utilized-Highest ever

surgeries 2615 in May 2012

10 OT

• Robot commissioned

in march 2012

• New OT

commissioned

Gas Manifold and Laundry

• New Co2 points installed in OTs

• All outsourced staff (Ward and

Houseboys) vaccinated against

Hepatitis B (all 3 doses

administrated)

• Sensitization of OT reception

staff and also inducted a new

wandering PRO for prompt and

easy communication with day

care patients

• Sharp edged towel clip improvised to

round ended for longevity of OT linen

• Time norm for almost all activities defined

and implemented to prevent menace of

string pulling

• 27 training sessions conducted in early 6

months to all category of employees in

OT, CSSD & gas manifold

• Cost reduction measures were

undertaken

# DepttNew

Equipment

New Procedures/


11Biochemical

Genetics

Four new

equipments

are installed

• G6PD (Quantitative) test started for

follow up cases

• DBFP test started for Gaucher

• TNF-a,IL2 started in abortion cases

• PIGF and Inhibin A are going to start

new markers In Prenatal Screening,

• EQAS started for G6PD screening

• Quadruple test is added in triple

marker screening

• Consultants and scientists attended various

national & international conferences &

workshops

• Various new projects started in laboratory

• Participating in EQAS/ILC in International &

National Programs

• International workshops: ‘ an introduction

to quality assurance in genetic diagnostic

laboratories” attended by consultant in

charge at AIIMS (9-10 feb2012)

• Random time monitoring for

allotment of bed started• List of empanelled TPA displayed

12 Admissions

Department

is under CCTV

coverage

allotment of bed started

• Scanner/Emailing System/

Photocopier Machine Installed

• Time monitoring report started TPA

(time taken for final approval)

• Patient handbook “Guidelines to avail TPA

services “provided to patients

• Financial counseling desk is now functional

from 8am to 8pm

13Bio

chemistry

• Kryptor

(Brahms)

• DXC-800

(Beckman)

• The Phlebotomy section of CIC is

open till 9pm (instead of 8pm)

• The Phlebotomy section of the CIC is

now open on Sunday from 8 to 12

• Adenosine Deaminase (ADA)

• Angiotensin I- Converting Enzyme

(ACE)

• Dehydroepiandrosterone Sulfate

(DHEA-S)

• Soluble Transferring Receptor (STFR)

• During NABL Audit in Jan2011, assessors

raised non-conformance regarding paucity

of space, request has been made for

additional space in the Deptt

• Two Large Fully Automated Analyser (CX-5

and LX-20) replaced by large DXC-800

• Research Project sanctioned to consultants

• PhD student enrolled through IP University

• One of our consultants recognized as PhD

supervisor by IP University

S

no

Dept New Equipment New Procedure/

Service /Tests

New staff/Any Other

14 Anesthesiolog

y

(Pain &

Perioperative

Medicine)

�Pediatric fiberoptic scope

�Ozone therapy machine

�Ultrasound machine for

nerve blocks/ venous

access

�Four nerve stimulators

�Two ECG machines for 6th

& 7th postoperative area

�New test-ultrasound guided

vascular and nerve access started

�New PAC form introduced

�Consolidated consent form

introduced

�‘PAC guidelines’ introduced

�Post-doctoral certificate course in ‘Pain

Management’

�Regular morbidity and mortality meetings

and implementation of safety counter

measures discussed and implemented

�Organized two anesthesia updates on

‘Anesthesia & preoperative Care” and

‘Anesthesia for organ transplantation”

S no Dept New Equipment New Procedure/

Service /Tests

New staff/Any Other

15 Neurology

department

� Improvement in patient care

� Continuous effort has been

taken to improve care

� 2 DNB Residents were recruited

� Poster presented in European

Neurology Conference

16 Fire and

safety

department

� FM 200 Flooding System-For

Safety of Telecom Equipment

and Server Room installed and

functioned

� CO2/ flooding system-installed

for Safety Of Electrical High

Tension (HT) & Low Tension

� Guest Relation Assistance

(GRA) With “May I help you”

badge are being posted at

certain clinical areas

� Security Officer/Supervisors are

meeting with certain patients and

attendants when after admissions

and at discharge time

Tension (HT) & Low Tension

(LT) Panels & Transformers

Room Against Any Fire

Incidents

17 Histopatholo

gy

� Automated

immunohistochemistry

strainer has been installed wef

1st July 2012 (Bio Genex

automated slide strainer ((Bio

Genex i6000)

� Immune histo chemistry

procedure has ben altered

and is now based on

automated method

� Nine new antibodies for

immune histo chemistry are

added ( Imp-3, Amacr, CD-

34,CD-30,CD-21,CD-31,INI-

1,IDH-1,CD-133)

� Disposable blades used for block

cutting are reused in the grossing

to save the cost of blades

� Introduction on automated

method for immunohistochemistry

for superior quality result

S no Dept New Equipment New Procedure/

Service /Tests

New staff/Any Other

18 Critical care &

emergency

medicine

� Department conducting 4 ACLS

Workshops

� Department conducting 5th certificate

courses in critical care nursing of which 4

modules have been completed

Among diagnostics, USG guidelines are being

used for putting central venous catheters in

difficult situation

19 Cardiology � Verifications of medicine dosages in the

treatment charts by the doctors to

confirm that correct dosages and

medicines are dispensed to patients

� Regular meetings of consultants with the

resident doctors in order to-resident doctors in order to-

1. To find out lacunas in patient care and

improvement in patient care accordingly

2. Improvement in the response time of

doctor

20 Endocrinology � Department had conducted conference

in Dhaka (Nov 2011)

S

no8


Service /Tests

New staff/Any Other

21 Cardiac surgery � New pulse oxymeters

installed

� New investigation-Fibroscan,

HRM manometry initiated

� HVPG is established for

portal pressure monitoring

� The number of procedures and

admissions has increased by 20% as

compared to last year

� The department needs additional staff

for improvement in the services

22 Molecular

genetics lab

� 2D ECHO machine has

been procured for

better assessment

during surgery

� Deptt Also in the

� Minimal invasive cardiac

surgery

� Surgery for chronic pulmonary

embolism

� Extended septal myectomy

� Entire staff has been trained to provide

compassionate care to the patients

process of acquiring

Minimal Invasive

Instruments

(for HOCM)

23 Gastroenterolo

gy &

Hepatology

� Two PCR-Machine

GeneAmp PCR

System 9700

obtained

Two research projects have been

sanctioned by ICMR-

1. Molecular characterization of

familial

hypercholesterolemia in

Indian population

2. Genetics studies in Indian

patients with autosomal

dominant polycystic kidney

Ongoing projects-

1. Progressive familial intra hepatic

cholestatis (PFIC)

2. Severe Combined immune deficiency

(SCID)

S

no


Service /Tests

New staff/Any Other

24 Denta

l

� Training of junior residents

� Unable to do any improvement due to

lack of staff and equipments

25 OPD � In newly made Pediatric

cardiology department a new

ECHO machine installed

� A new appointment system

launched to reduce waiting

time for appointment5; all

telephonic appointments are

given through telephone

exchange, where 6 operators

are sitting All data saved on

system

26 � 3 Bedded pediatric emergency

having paediatrition round the

� In MLC cases one MLC copy is

attached with the admission

� Patient advised ECG and ABG by the

doctor’s in emergency will be free of having paediatrition round the

clock has been started in the

main emergency department

� A new cash counter opened in

the emergency department As

per single window system

� 4 infusion pump of B-Braun

installed in emergency

� One AMI profile cartridge based

cardio panel machine installed

in emergency department

This machine gives result of

CKMB,CPK and TROP-I within

20 min

attached with the admission

file and send to the respective

ward/ICU etc when the

patient is admitted As it may

be required by the patient or

the TPA desk for medical

Insurance or other purposes

doctor’s in emergency will be free of

cost for the 1st time, repeat advice for

the same test, will be billed as per semi

paying charges except for patient

having BPL card, or poor patient

# Variables

1 Physical facilities in approach, waiting area, admission, billing etc.

2 Nursing services

3 Doctor services

4 Diagnostic services as in laboratories and imaging

5 Treatment related services

OPD Patient Satisfaction

5 Treatment related services

60

80

100

In-patient Satisfaction

0

20

40

Key Performance Indicators

Quality Management Cell is encouraging and

coordinating the collection of approximately 77

Key Performance Indicators relevant to various Key Performance Indicators relevant to various

departments throughout the Hospital


Following is the list of Key Performance Indicators being monitored

in Sir Ganga Ram Hospital:

Sl

No

Key Performance Indicator Department Category

1 Time for initial assessment for Nursing In-patient 1 Time for initial assessment for IPD by Doctors

Nursing In-patient indicator

2 %ge of cases where initial nursing assessment is done within 30 minutes

Nursing In-patient indicator

3 %ge of medication error Nursing Care/ medication related indicator

4 %ge of adverse drug reactions Nursing Medication related indicator


Sl

No

Key Performance

Indicator

Department Category

5 Urinary Tract Infection

Rate

Nursing HAI In-patient

indicator

6 RTI / VAP Rate Nursing HAI In-patient

indicatorindicator

7 CRBSI Nursing HAI In-patient

indicator

8 SSI Nursing HAI In-patient

indicator

9 Incidence of Falls Nursing Pt safety Indic

10 Incidence of Bed Sores Nursing Care related Indic

11 Time Taken for Discharge Nursing Process Indic


Sl

No

Key Performance Indicator

Department Category

12 Sentinel/ Incidents Nursing/

All Depts

Safety/ System Indic

13 Re-exploration Rate OT Invasive Procedure Indic

14 Utilization Rate OT Resource Utilization Indic14 Utilization Rate OT Resource Utilization Indic

15 %ge of contrast related reactions

Imaging Medication related Indic

16 %ge of transfusion reactions

Blood Bank Transfusion related Indic

17 %ge of medical records not having disch Summ

MRD Documentation Indic

18 %ge of Med Rec with incomplete initial assess

MRD Documentation Indic


Sl

No


19 %ge of Med Rec having no evidence of financial counseling done

MRD Process related indic

20 %ge of Med Rec having incomplete initial assessment

MRD Documentation related Indicincomplete initial assessment

by nursesrelated Indic

21 %ge of Med Rec with incomplete front sheet

MRD Documentation related Indic

22 % of Med Rec with incomplete consent form


23 % of Med Rec with incomplete discharge summary



SlNo Key Performance Indicator Department Category

24 BOR MRD Resource utilization

25 ALOS MRD Resource utilization

26 % of consumables rejected before prep of GRN

Receiving Procurement Indic

27 Out-patient satisfaction Index

OPD Pt satisfaction Indic

28 In-patient satisfaction Index PRO/QMC Pt satisfaction Indic

29 Employees Attrition Rate HR Emp Satisfaction Indic

30 Employee Absenteeism Rate

HR Emp Satisfaction Indic


Sl

No


31 % of employees aware of rights and responsibilities

HR Training related Indic

32 No of security related incidents including thefts

Security Safety Indicincidents including thefts

33 Incidence of Needle Stick Injury

Staff Physician

Safety Indic

Intravascular Device Infection

Rate Year 2011Month Intravascular Device

Infection Rate/ 1000

catheter days

January 285

February 192

March 088

2.85

2.5

3

Intravascular Device Infection Rate / 1000 catheter days

March 088

April 180

May 198

June 156

July 153

August 182

September 080

October 157

November 131

December 170

1.92

0.88

1.801.98

1.56 1.53

1.82

0.8

0

0.74

00

0.5

1

1.5

2

2.5

Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11

Surgical site infection rate

Sl No MonthSurgical site

infection rate

1 January 2011 000%

2 February 2011 000%

3 March 201 000%

4 April 2011 000%0.06%

Surgical site infection rate

4 April 2011 000%

5 May 2011 005%

6 June 2011 000%

7 July 2011 000%

8 August 2011 000%

9 September 2011 000%

10 October 2011 000%

11 November 2011 000%

12 December 2011 000%

0.00%

0.01%

0.02%

0.03%

0.04%

0.05%

0.06%


Month Incidence of bedsores after admission

January 2011 014%

February 2011 007%

March 2011 000%

April 2011 005%

May 2011 003%

June 2011 002%

Incidence of bedsores after admission

June 2011 002%

July 2011 000%

August 2011 002%

September 2011 002%

October 2011 002%

November 2011 000%

December 2011 005%

0.14%

0.07%

0.00%

0.05%

0.03%0.02%

0.00%

0.02% 0.02% 0.02%

0.00%

0.05%

0.00%

0.02%

0.04%

0.06%

0.08%

0.10%

0.12%

0.14%

0.16%

Jan

uary

20

11F

ebru

ary

201

1

Mar

ch 2

011

Ap

ril 2

01

1

May

201

1

Ju

ne 2

011

Ju

ly 2

011

Au

gust

2011

Sep

tem

ber

201

1

Oct

ob

er 2

011

No

vem

ber

2011

Dec

em

ber

2011

Incidence of bedsores after admission

Percentage of Transfusion ReactionMonth Percentage of Transfusion Reaction

Jan-11 023%

Feb-11 013%

Mar-11 010%

Apr-11 025%

May-11 006%

Jun-11 008%

Jul-11 000%Jul-11 000%

Aug-11 003%

Sept-11 000%

Oct-11 006%

Nov-11 011%

Dec-11 009%

0.20%

0.13%0.10%

0.25%

0.06%0.09%

0.07%

0.03%0.00%

0.06%

0.11%0.09%

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%


Percentage of Transfusion Reaction

Average Length of Stay

SNo Month Average length of stay (in Days)

1 Jan-11 356

2 Feb-11 341

3 Mar-11 347

4 Apr-11 333

5 May-11 353

6 Jun-11 336

7 Jul-11 341

8 Aug-11 344

9 Sep-11 3489 Sep-11 348

10 Oct-11 354

11 Nov-11 346

12 Dec-11 345

Average length of stay (in Days)

3.56

3.41

3.47

3.33

3.53

3.363.41

3.443.48

3.54

3.46 3.45

3.2

3.253.3

3.35

3.43.45

3.53.55

3.6

Jan-

11

Feb-

11

Mar-

11

Apr-

11

May-

11

Jun-

11

Jul-

11

Aug-

11

Sep-

11

Oct-

11

Nov-

11

Dec-

11

Average length of

stay (in Days)

Month Bed occupancy rate

January 2011 9584%

February 2011 9799%

March 2011 9891%

April 2011 9716%

May 2011 9872%

June 2011 10027%

July 2011 9910%

August 2011 10402%

September 2011 10482%September 2011 10482%

October 2011 10050%

November 2011 10386%

December 2011 10429%

Bed occupancy rate

95.84%

97.99%98.91%

97.16%98.72%

100.27%99.10%

104.02% 104.82%

100.50%

103.86% 104.29%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

102.00%

104.00%

106.00%

Janu

ary

201

1Fe

bru

ary

2011

Mar

ch 2

011

Ap

ril 2

011

May

201

1

June

201

1

July

201

1A

ugus

t 201

1S

epte

mb

er 2

011

Oct

obe

r 20

11N

ove

mbe

r 20

11D

ece

mbe

r 20

11

Bed

occupancy

rate

Month Percentage of Incidence of Fall

January 2011 004%

February 2011 004%

March 2011 007%

April 2011 000%

May 2011 002%

June 2011 000%

July 2011 000%

August 2011 000%


October 2011 000%

November 2011 000%

December 2011 003%

0.04% 0.04%

0.07%

0.00%

0.02%

0.00 0.00 0.00

0.02%

0.00 0.00

0.03%

0.00%0.01%0.02%0.03%0.04%0.05%0.06%0.07%0.08%

Janu

ary

201

1F

ebru

ary

201

1

Mar

ch 2

011

Ap

ril 2

011

May

201

1

Jun

e 20

11

July

201

1A

ug

ust

201

1S

epte

mb

er 2

011

Oct

ob

er 2

011

No

vem

be

r 2

011

De

cem

ber

201

1

Percentage of Incidence of Fall

ANALYSIS OF TIME TAKEN BY DOCTORS FOR

INITIAL ASSESSMENT JANUARY – DECEMBER 2011Total cases: 1502

Up to 30 min Up to 60 min Up to 90 min Up to 120 min Up to 180 min

No of cases 1425 76 0 1 0

Percent cases 9487 506 000 007 000

0

200

400

600

800

1000

1200

1400

1600

Up to 30

min.

Up to 60

min.

Up to 90

min.

Up to 120

min.

Up to 180

min.

No. of cases

Percent cases

Month Incidence of needle stick injury

Jan-11 001%

Feb-11 002%

Mar-11 000%

April-11 -

May 2011 -

June 2011 003%

July 2011 002%

August 2011 001%


October 2011 001%

November 2011 001%

December 2011 000%

0.01%

0.02%

0.00% 0.00% 0.00%

0.03%

0.02%

0.01%

0.03%

0.01% 0.01%

0.00%0.00%

0.01%

0.01%

0.02%

0.02%

0.03%

0.03%

0.04%


Incidence of needle stick injury

SNo Month Training Man days

1 April 2010 22395

2 May 2010 1173

3 June 2010 2344

4 July 2010 1274

5 August 2010 2122

6 September 2010 945

7 October 2010 1877

8 November 2010 1632

9 December 2010 8319 December 2010 831

10 January 2011 1151

11 February 2011 1037

12 March 2011 805

Training Mandays

223.95

117.3

234.4

127.4

212.2

94.5

187.7163.2

83.1115.1103.7

80.5

0

50

100

150

200

250

Apr

il 20

10M

ay 2

010

June

201

0Ju

ly 2

010

Aug

ust 2

010

Sep

tem

ber

201

0O

cto

ber

201

0

No

vem

ber

2010

De

cem

ber

2010

Janu

ary

201

1

Feb

ruar

y 20

11M

arch

201

1

Training

Mandays

Customer Requirements

(Voice of the Customer)

Take Home Message

Process Design is a:

• Orderly Way Of Obtaining Information & Presenting

• Shorter Solution Cycle

• Considerably Reduced Non-value Adding Costs

• Fewer Rectifications / Modifications• Fewer Rectifications / Modifications

• Reduced Chance Of Oversights

• Environment Of Teamwork

• Consensus Decisions

• Preserve Everything In Writing, documented

Factors Limiting Quality

• Human Error is not eliminated completely

• Individual Patients have different set of problems which need to

be addressed individually at every level

• Antidated System Breakdowns happen despite preventive

maintenance of equipment and small errors in the system need

to be taken care of to prevent not just major catastrophes but

also the inconvenience due to small breakdownsalso the inconvenience due to small breakdowns

• Differing Background of Care providers (wardboys, nurses,

doctors and the other staff) comes from differing training and

caliber so system does not work same with every individual

• Guidelines followed in letter, not always in spirit - adherence

has to be strict, correct and exact; systems followed only to

maintain records and data without actually improving quality will

lose credibility

Unlike some industries where system is designed

according to a predefined requirement, with high

control over processes and fair amount of certainty

over the result, healthcare systems cannot predict all

kinds of diseases - just when the system is stabilizing You cannot Fight Nature:

You cannot fight Nature

kinds of diseases - just when the system is stabilizing

some new disease evolves and we need a new system

with new parameters!!!

You cannot Fight Nature:

In medicine, we are not dealing with man-made

machines but with God-made individuals

Each patient has a different problem, a different

psyche, different combination of problems, different

Medicine is not just a Science

psyche, different combination of problems, different

responses to the same treatment and at times no

response at all……

• It is just not enough to fill questionnaires and institute the

right treatment protocols for it is like saying – all rich men are

happy as we are all running after money-that is not actual

prosperity

• We need to still hold a hand, listen to a patient to gauge the

Systems may be necessary

but not sufficient

• We need to still hold a hand, listen to a patient to gauge the

untold subtle nuances of the disease and sieve out the

psychological from the physical disease

• We cannot just measure customer satisfaction by the orderly

services or the revenue generated but sometimes it is just the

“ tear of gratitude” or “the smile on the face of a parent of a

sick child”

• It is a world of tangible to intangible……

It is Just the Beginning, in Continuum …

Dr TBSBuxi Chairman, CT & MRI Sir GangaramHospital · Chairman, CT & MRI Sir GangaramHospital New...

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