CHALLENGES TO HOSPITAL ADMINISTARTOR

TEAM -3

TEAM MEMBERS
Dr.Nutan Panda-Introduction & Internal Challenges Dr.Kalpesh Solanki-External Challenges Mr.Shrish Kumar-Technological challenges

RAPID CHALLENGES
Rapid development in med. technology Increase health awareness of people Rapid urbanization Increase demand for better facilities Active participation of media Legal involvement in hospital affair Maintaining peaceful environment Increased political interference Better and quick communication facilities Competitive private health care facilities Increase in senior citizens Higher level of consumers expectations

The American College of Healthcare Executives (ACHEs) annual survey

ISSUES Financial challenges Healthcare reform implementation Governmental mandate Patient safety and quality Physician-hospital relations Care for the uninsured Patient satisfaction Personnel shortage Technology Capacity Governance Issue for not-for-profit status Disaster preparedness 2010 77% 53% 32% 31% 30% 28% 16% 11% 10% 6% 3% 2% <1% 2009 76% 53% 30% 32% 25% 37% 15% 13% 7% 7% 2% 1% 1% 2008 77% 26% 43% 32% 41% 22% 30% 9% 16% 2% 1%

Lack of infrastructure Lack of adequate manpower Lack of motivation of staff Apathy of doctor/nurses Union activities Financial constraints Logistic mgt. Over crowding Internal Security

INTERNAL

HOSPITAL ADMINISTRAT ION

EXTERNAL

TECHNOLOGICAL AND NEW CONCEPTS

Municipality Consumer forum(CPA) Right to information Legal issues Water supply Electricity Public relation Media Political influence

Competitive Health Care Quality management NABH Patient safety Robotic surgery Modern Investigations( CT, MRI etc.) High level of Consumer expectation Shortage of technical manpower

Technology mgt. Fixed org.structure Manpower mgt.

Quality mgt.

INTERNAL CHALLEN GES

Power craze

Cost containment

Competitive market

Leadership motivation

Modern IT

BMW management

EXTERNAL CHALLENGES

Consumer Protection Forum

Right to Information

OVER CROWDING

SERVICE EXPANSION

QUALITY OF CARE
PATIENT

NEW TECHNOLOGY

PATIENT SATISFA CTION

HOSPITAL ORGANIZATIONAL CHALLENGE

Dual Authority Legal bindings Product is a service cannot be quantified Variable and uneven care need, standard not be comparable Crave for modern technology in operation and invest Matter of life and death ,needs immediate decision Nature of duties varies for Doctor, Nurses and other technical staff Service is personalized professional and highly skilled

INTERNAL CHALLENGES

INTERNAL CHALLENGES
OVERCROWDING:- In public hospital it
is due to non-denial of admissions to deserving patients irrespective of availability of vacant beds,medicolegal or otherwise poor or rich and disaster victims.

Consequences of overcrowding :Risk of poor hygiene Shortage of drugs, linen & consumables Increase noise level Reduce personalized attention Make everyone irritate

Solutions to overcrowding
There should be proper sitting arrangements outside the O.P.Ds. Visitors time should be there to meet the patients in the wards. Number of visitors per patients should be limited. Visitors should have to take visitors pass before meeting the patients. There must be security guard outside the wards and I.C.Us.

LACK OF ADEQUATE MANPOWER

HEALTHCARE POSITION HIERARCHY

HR challenges in healthcare
A growing number of healthcare professionals are retiring An increasing number of aging baby boomers requiring care Fewer younger people are choosing the profession:
Shift in view of profession from high tech to low tech Shift from a secure & prestigious profession to chaotic & unstable Many more employment options for women to choose from Healthcare workers have less connection with patients due to shift to shorter-stay hospital systems Shift from mass-production society to information society makes the 24/7 schedule demands less attractive

High Nurses turnover Ratio Retention of Good qualified and skilled physician for longer time

SOLUTIONS
Providing them better work environment Providing rewards, incentives etc. Providing better career opportunities Maintaining proper professional and personal life

Lack of Motivation
Monotonous type of work Stressful Lot of expectation

Solutions
Provide the nurses shifting duties into different wards Provide them a recreation hall Motivate them by recognizing the NURSE OF THE MONTH and give them a certain TOKEN OF HONOUR . And judge their promotions through this process Form small groups by taking a experience nurse and few new and inexperience ones Provide the nurses adequate breaks and rest hours so that their job doesn't get monotonous

FINANCIAL CONSTRINTS
FINANCIAL CHALLENGES Medical insurance reimbursement Bad debts Increasing costs for staff, supplies, etc. Inadequate funding for capital improvements Managed care payments Other commercial insurance reimbursement Revenue cycle management (converting charges to cash) Emergency department Competition from specialty hospitals 88% 70% 70% 63% 51% 42% 37% 30% 20%

SOLUTIONS
Outsourcing as a method of reducing capital cost and getting economies of scale: AREA OF OUTSOUCING
Housekeeping & waste disposal Laundry Biomedical equipment maintenance Food and beverages CSSD Blood bank Pharmacy Consignment purchase IT both hardware and software Security

Equipment leasing

INTERNAL SECURITY
High rate of pilferages
Drugs Kitchen cutlery Linen

Thefts of staff and patient belongings Outsider gang members Visitor thefts Threats against patients or staff Crimes of opportunity.

SOLUTIONS
No-tech. Policies & procedures Training & supervision Security awareness in the staff Low-tech Locks Barriers Good lighting Landscaping

Solutions cont.
High tech
Alarm systems Access control systems Photo identification CCTV Two-way voice communications Weapons screening systems. NEW EMERGING TECH. Can enhance security even more Patient locators Video pursuit software Delayed egress hardware Active asset control systems Enterprise-wide systems Digital video Pager alarms

EXTERNAL CHALLENGES
BY-DR KALPESH SOLANKI

EXTERNAL CHALLENGES
MUNICIPALITY AND PCBs CONSUMER FORUMS/RTIs WATER SUPPLY/ELECTRICITY PRs/MEDIA LEGAL ISSUES POLITICAL INFLUENCE

MUNICIPALITY AND PCBs

Health hazard Hospital waste Environmental pollution

Hospital Infection like HIV,Hepatitis Air pollution Water pollution

WAYS TO MEET THIS CHALLENGE SHORTTERM/MEDIUM TERM

All hospitals above a certain minimum bed strength should install incinerators All health institutions should have a manual on waste handling procedure and those made responsible for it should be provided a training for it Strict supervision should be done by Directors/MS over waste disposal

WAYS TO MEET contd

No private health establishment should be allowed to function until and unless they have developed proper waste disposal system. Care should be taken that unscrupulous elements are not involved in recycling the waste.

WAYS TO MEET THIS CHALLENGE LONG TERM LEGAL MEASURES: The MoEF has framed the BIO MEDICAL WASTES (Management and Handling) Rules,1998 for the purpose. Compliance should be enforced. Allocation of resources(both Central and State Governments) for an integrated programme of biomedical waste management. Closer co ordination between the various state/administrative agencies.

LONG TERM Contd..

There can also be a comprehensive integrated and commonly managed system of final disposal of wastes by a group of hospitals in a particular region. Involvement of NGOs in the form of a well directed public awareness campaign. Structured training programmes in the form of short term/diploma courses/OJT in waste management for all concerned staff members.

CONSUMER FORUMS AND RTI

The support that the medical professionals render to us is the noblest. Stark changes in the points of view DOCTOR IS NO MORE A GOD. PATIENT IS JUST A CONSUMER OF MEDICAL GOODS AND SERVICES.

WAYS TO PROTECT THE INTERESTS OF SERVICE PROVIDERS

Group Medical Indemnity Insurance scheme for all personnel. This will economize on expenditure incurred by the legal department in contesting consumer claims. Periodic Medical and Death Audits to streamline existing practice and point out any deficiencies/inadequacies in service. Regular in house staff training/CME programmes for updating knowledge and keeping in touch with current trends and protocols.

WAYS TO PROTECT THE INTERESTS OF CONSUMERS

Assurance that the hospital observes transparency in maintaining hospital records and vital patient data. Ready availability of these. Periodic interaction between Hospital Administration, Medical Professionals and patients to reach a consensus so as to keep the consumers complaints at a minimum.

WATER SUPPLY AND ELECTRICITY

Ensure judicious use of these resources by staff/patients by putting placards/sign boards at relevant places in the hospital about the importance of their conservation. Organize felicitation/recognition programmes for departments/sections in the hospitals that are using these resources efficiently and economically. Adopt innovative, cost efficient and relatively simple energy solutions like Light emitting diodes (LEDs)at all exit signs, CFLs instead of incandescent lamps, occupancy sensors etc.

PUBLIC RELATIONS AND MEDIA ADDITIONAL CHALLENGES FOR HOSPITAL PR

Understanding patient confidentiality and privacy. Ability to communicate thoughts and ideas effectively and accurately. Analytical and problem solving ability. Knowing the hospital structure, departments and support group. Familiar with the community where the hospital is located. Writing skills and ability to handle different types of media.

POLITICAL INFLUENCE
Ensure that the hiring of employees in a hospital is kept free of political influence as far as possible. The administration must develop the ability to use the incumbent political influence for the betterment of hospital services. Development of a patient centric approach rather than an influence centric one.

COMMUNITY CARE RIGHTS AND LEGAL ISSUES

COMMUNITY CARE RIGHTS: 1. Preparation of MLC 2. Notification of births and deaths 3. Notification of Infectious disease 4. Notification of Unnatural deaths 5. Conducting medical examination 6. Issue of fitness & medical certificate 7. Conducting post-mortem 8. Notification of all accidental cases 9. Proper completion of case sheets(medical records) 10. Age determination by court orders 11. Furnishing medical opinion on court orders LEGAL ISSUES :1. Compliance of MTP Act 2. Compliance of PNDT Act(Sex determination) 3. Compliance of BMW Act 4. Consumers Protection Act 5. Right to Information Act 6. Issue of disability certificates 7. Organ transplantation Act 8. Artificial Insemination Act 9. Custody of mentally ill patients 10. Food Adulteration Act 11. Ethical issues

TECHNOLOGICAL CHALLENGES

BY- Mr SHRISH KUMAR

TECHNOLOGY

RRobotic Surgery

Technology
1. Purchase of equipments2. Today hospital has major expenditure(more than 40percent) in the purchase of equipments. 3. Equipment should be of good quality with affordable cost. 4. Equipment should be purchase from known manufacturers. 5. Issue of tenders. 6. While purchasing a witten letter should be taken from manufacturers for the after sales service. 7. CMC- Comprehensive maintainance contract. 8. AMC- Annual maintainance contract.

Technology
Latest technology should be used like C.T. Scan, M.R.I.(3 Tesla), Lithotriptor, Endoscopy etc. Patients should be informed about the uses of the latest technology. Staffs should be given training time to time so as to use the latest technology. Proper coordination between the management and owner (trustees) about the ues of latest technology.

Shortage of technical manpower

Indian technician in demand all over world Due to brain drain we have acute shortage We should restore the technician by giving them advanced training We should involve them in meeting related to technology

BIOMEDICAL DEPARTMENT
Maintaing Bio-medical departments. Having a good bio-medical department reduces the cost of hospital. Faster service in case of equipments breakdown. Helps in the purchase of proper equipments. Should be located near the O.T.

Controlling the infection in O.T.

Special care should be taken while cleaning of the O.T. O.T. Should be clean in a proper way after every cases. O.T. Must be fumigated at least once a weak. Sterile equipments must be wrapped with a sterile cloth. Whosoever entering the O.T. must clean his/her hands with disinfectants. All the material used must be disposed properly if disposable. C.S.S.D. Must take proper care in cleaning of equipments coming to it. Every equipments must be autoclaved or should be placed in Eto or sterrard. Decomposable should not be used as reusable. While retuning the instruments to respective departments equipments must be packed in plastic bags.

PATIENT SAFETY
Prevention from fire safety
Fire doors Fire drills Awareness Training

Prevention from over prescription of doctors

Medical Audit

ISO (International Organization for Standardization)

ISO standards contribute more to a company's economic sustainability than ever before. An increasing number of manufacturers and business customers will not even do business with a supplier that is not ISO certified. ISO certification is now effectively a requirement of doing business in the European Union, even though it is not a legal mandate. The biggest advantage of ISO certification is the perspective of a third party assessment. This makes it easier to implement new systems, hire personnel, and understand changes.

STRATEGIES TO MEET THE CHALLENGES

Clear cut responsibility Restructuring Reorienting training Career development Leadership and motivation Marketing of hospital services Hospital infection control practice Relationship with outside agencies Technological advancement Power sharing Awards and Punishment Increase efficiency Improve patient safety and care Developing modern MIS