Normal Laboratory Values
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Saturday, November 30, 2013
Skill Development for Health Care Provider
Indian Health sector is now facing serious problem of lack of trained and skill health care provider. A report by CII mentioned that India currently require additional 1,00,000 hospital beds each year and shortage of 1.4 million doctors and 2.8 million nurses. According to CII Techopark Knowlege Report shortage of Paramedics is 261,500.
So a sincere effort is required by all stakeholders to take initiatives to fill up this gap.
Government of West Bengal under State Medical Faculty have designed several paramedical courses .http://www.smfwb.in/
I will regularly post teaching materials for Paramedics.
Indian Health sector is now facing serious problem of lack of trained and skill health care provider. A report by CII mentioned that India currently require additional 1,00,000 hospital beds each year and shortage of 1.4 million doctors and 2.8 million nurses. According to CII Techopark Knowlege Report shortage of Paramedics is 261,500.
So a sincere effort is required by all stakeholders to take initiatives to fill up this gap.
Government of West Bengal under State Medical Faculty have designed several paramedical courses .http://www.smfwb.in/
I will regularly post teaching materials for Paramedics.
Monday, November 4, 2013
EVALUATION OF HOSPITAL SERVICES
Services provided by a
hospital incorporate elements which can be examined objectively, subjectively
or both. Every enterprise is actively concerned with quality assurance by
determining the quality of commodity it produces and keeping in touch with
consumers to secure their maximum satisfaction. As a result of advances in
medical technology, introduction of high technology and other sophisticated elements,
some vital issues are being raised such as : what is the quantum of output and
degree of excellence of hospital
service? What is the cost of operating the hospital? Is the hospital
spending more because of inefficiency of hospital operation? Could the same
quality of medical care be made available at lesser costs? What is the extent
of patient’s satisfaction? What is the final outcome or end result in terms of
indices like recovery rate, partial recovery rate, death rate, complication
rate etc?
However, due to diverse nature of day to
day activities, large number of variables and subjectivity results are
difficult to measure in hospital services. By its very nature, a great part of
hospital output will always be intangible. Therefore, the measurement of
tangible and intangible outcomes must go hand in hand, and no watertight
compartmentalization can be made between them. Because of this the evaluation
process has greatly depended upon qualitative judgments in addition to
quantified data in most instances.
Evaluation of hospital is a challenge
because of the variation in the intensity of care, equipment, personnel, and
facilities in different types of hospitals. One cannot be sure that the
instruments of evaluating services in hospitals could be made as sensitive,
valid , accurate and specific as one finds in industry where accomplishments
can be measured in terms of an accountable unit , viz., rupees and entirely by
financial tools like profit and loss statement and balance sheet. Because of
this multidisciplinary nature, medical care in hospitals does not lend itself
to simple and direct units of measurement .What one can measure are therefore
certain components or characteristics of it from which one can draw inferences
and implications.
WHY EVALUATION
The last stage of management
process, i.e. evaluation is designed to measure efficiency and effectiveness of
the services after planning, organizing, directing and controlling. No organisation
worth its name can survive and progress unless it overcomes its shortcomings
and builds upon its performance. One cannot substitute form for substance and
appearance for reality for all the time.
Sophisticated technology in
high-tech hospitals is equated with high quality care in minds of both public
and the providers, and high costs and quality are considered synonymous. Nothing
can be farther from the truth.
Considered from all aspects,
there are three main reasons which warrant objective evaluation of hospitals.
- It is to safeguard interests of the recipients of
hospital care. A layman cannot possibly judge for himself whether the care
he is receiving is judicious and scientific. He has insufficient
protection against malpractices, exploitation and inefficiencies of
hospital’s medical staff and systems. Hence, it is the moral and legal
obligation of the administrative and professional authorities to ensure
that hospitals render safe and efficient medical services to patients.
Besides, the legal accountability of the hospitals cannot also be
overlooked.
- It is to locate inadequacies and shortcomings of
the hospital staff, its plant and machinery and what is most important,
it’s working systems. Apparently, the hospital’s end results cannot be
good if there are no proper facilities or appropriate technical
environment in which the physicians can work.
- It is to provide the authorities, viz. governing
body, board of trustees or owners a sound appraisal system of evaluating
the effectiveness of managerial staff at various levels , hospital
administrators and individual physicians , and furnish valid facts and
data to regulate their future
development.
Productivity is the relationship between
resources used and results produced, i.e. the input-output ratio. A periodic
assessment of the services will show the existing state of affairs, and
therefore scope for corrective action to quality assurance.
Quality assurance aims at establishing
programme for monitoring and evaluation
the quality of care, but is not synonymous with use of sophisticated procedures
and invasive technology. Quality assurance entails cost-effective approaches
for optimum utilization of resources and establishing ongoing quality control
programme.
WHAT IS EVALUATION?
Evaluation has been defined as the process of determining the degree of
success in achieving predetermined objectives. It is also defined as
“Measurement of action against accepted criteria and interpretation of
relationships amongst them.” Appraisal, assessment ,progress reporting,
progress assessment, and review and analysis are some of the terms which have
been used synonymously with evaluation.
Evaluation one of the final
tasks in the process of management
What to Evaluate ?
In hospitals and healthcare, there
are five indicators through which the quality of medical care and services can
be assessed.
- The organization
- The process
- The content
- The outcome
5.
The impact
Traditionally, these can be
grouped into three categories, viz. the means (structural factors), the
methods(process factors), and the end results(outcome factors).
Evaluation of the “Means”
Evaluation of the “means”
covers the inputs, ascertaining whether the hospital has been provided
With optimum quantity and right quality of
staff and physical facilities as in the shape of buildings, equipment, drugs,
diet and supplies. Evidently, if the means are inadequate, the quality of the
hospital services should be of low standard. Basically, this is an evaluation
of the “organization.” The inputs that
go into the various productions of medical care are the men (various categories of personnel), money, materials and machines. Effective utilization of these
resources determines the organization’s effectiveness.
The quality assurance committee has to
ensure that there has to be a basic minimum infrastructure regarding space,
equipment, physical facilities and staff requirement. The type of organization
needed for each department or service that is the authority-responsibility
relationship, coordination and the budget has to be tailored to the need of
each department keeping in view the overall hospital objectives.
Evaluation of the “Methods”
Evaluation of the “method” is
determining whether there is an effective utilization of the available human
and material resources and whether the hospital’s policies and working
procedures are sound and judicious. Understandably, if the hospital’s
functioning and administration is poor , then the quality of its care cannot be
of good standard. This is an evaluation of “process” and” content” of the
hospital care.
The quality assurance committee lays down the
standing instructions for various procedures, patient documentation, and other
records. The evaluation is carried out through many standing subcommittees like
tissue, utilization, therapeutic, nursing and infection control.
Evaluation of the “end-results”
Evaluation of the “end-results”
means judging the effectiveness or ultimate outcome of the benefits derived by
individual patients and the community from the hospital. This is an evaluation
of the “outcome” and “impact”.
Evaluation studies of each of the above five
aspects of a hospital’s operation, i.e. the organization. Process, content,
outcome and impact can be a very complex process. For example, the evaluation
of organization and process requires detail analysis with the help of operations
research techniques and qualitative methods. On the other hand, a lot of
subjectivity is involves in evaluating the range, quality and quantity of
services provided by the hospital.
It is not always possible, or even
necessary, that evaluation of all the above should be carries simultaneously,
although the need for such simultaneous evaluations apparent in the overall
context. But since the objectives, and the derivative objectives of hospitals
are not available in clear terms, sometimes what is only possible is evaluation
of output both in terms of qualitative and quantitative determinants, and
evaluation in terms of cost and utilization.
Evaluation of Structure
Organizational structure:
1. Centralized or decentralized
2. Unity of command
3. Span of control of key
functionaries
4. Authority and
responsibility
5. Delegation
6. Coordination
7. Governing and executive
body
Physical facilities:
A. General
1. Location of hospital
2. Roads and parking space
3. Circulation
B. Departmental
1. Indoor
2. Outdoor
3. Emergency
4. Operation theaters
5. Radiology
6. Laboratory
7. Pharmacy.
8. CSSD.
9. Laundry
!0.Dietary
11. Blood bank
12. Medical record.
Human
Resource:
Medical Staff
1. Organizational hierarchy
2. Number of medical staffs
3. Qualification and training
5. Promotional avenues
6. Behavior and attitude
7. Job satisfaction.
Nursing and Technical/paramedical staffs
1. Number.
2. Qualification and Training
3. Promotional avenues
4. Behavior and attitude
5. Job satisfaction.
6. Grievances Procedure
UTILIZATION
Various indices are commonly used in assessment of hospital
utilization but taken singly none of them can give a proper picture of
utilization.
Any discussion on utilization can not be precise unless the
terms that are used uniformly
understood.
DEFINITIONS
Hospital Beds-Beds
which are staffed and equipped for round the clock care of patients.
It includes- observation beds, beds for sick and premature
infants.
It excludes-
1. Bassinets used for healthy new born
2. Beds in labour room.
3. Recovery room beds
Bed Complement- It
is the number of authorized or sanctioned beds.
Hospital Death- It
does not include death in causality.
Dead Bed Space- This
refers to beds un occupied in a hospital due to a rigid compartmentalization of
nursing units among specialties. This may be up to 15% in large hospital.
Daily Ward Census-
It is conducted either at mid night or mid day. Studies have revealed that the difference
between midnight census and
mid day census of less than 2 Percent.
Bed Days/ Patient
Days- A full day is counted when admission is before mid day and discharge
is after mid day. It is generally accepted that the day of admission is counted
and the day of discharge is ignored in counting.
Utilization Indices
Average Daily Census
or
Average Daily Bed
Occupancy
Average daily census denotes the daily load of patients over
a given period, and is obtained by adding up the daily census for the period in
question, and dividing it by number of days in that period. It can also be
calculated based on discharges, by adding up the number of days in hospital for each discharged patient
during a period and dividing the figure by the number of days in that period. The
differences in the figures obtained by the two methods are insignificant.
Average daily census indicates pressure on hospital beds on a day to day basis.
Bed occupancy rate
Bed occupancy rate indicates d the relationship between
availability and utilization of hospital beds and facilities. It is expressed
as percentage by either of the following two methods.
1. Ratio of actual patient days to the maximum possible
patient days during a given period
2. Ratio of the average daily census to the bed complement.
BOR = Average daily census/Bed complement*100
Optimum bed occupancy rate for most hospitals is considered
to be between 85 and 90 percent, wherein the remaining 15 to 5 percent beds are available foe
undergoing maintenance, change of linen and being generally readied for
incoming patients.
A high occupancy
rate indicates stretching and over utilization of services resulting in
probable dilution of the quality of care, while as a low rate is indicative of
underutilization of facilities. Usually smaller hospitals have lower occupancy
than larger hospitals. In many public hospitals, because of the perpetual
shortage of beds, patients are put on the floor when a regular bed is not
available in which case the occupancy rate goes up to 110 or120 percent.
To find out the
load of work in different areas, occupancy rate should be worked out ward wise,
specialty and unit wise.
Bed Turnover Rate
(BTR)
Bed turnover rate gives the number of discharged per
hospital be over a given period of time , i.e. how many times a bed was turned
over during the period , say a year .It is directly related to the average
length of stay(ALS) and the bed turnover interval(BTI)
BTR = Total number of patients discharged (including
deaths)/Bed complement
Bed Turnover Interval
It denotes the average time in days elapsing between the
discharge of one patient and the admission of the next on that bed, i.e. the
time a bed remains vacant between admissions. It is obtained by subtracting the
actual no of hospitalization days from the given potential number of
hospitalization days in a given period , and dividing the resultant figure by the
number of discharges in the same period. For example, for a 300-bedded
hospital,, the potential hospitalization days in a year are 300*365=1,09500. If
the actual totaled-up hospitalization days are 98,00 , and the number of
discharges during the year are 5,680, then
BTI = 1.09500-98.200/5,680=1.9, which means
That each bed remained vacant during the year for an average
1.9 days between one discharge and the next admission on that bed.
The turnover interval
will be zero when bed occupancy rate is 100 percent but will become negative
when the occupancy rate goes over 100 percent. Generally, if BTI is more than
2, it is considered very high and indicates low demand or defective admission
procedures. Ideally, BTI should be around 0.5 day. Too long or too short BTI
are both undesirable. In order to be meaningful, BTI should be calculated
separately by wards and specialties
Average length of stay
Average length of day (ALS) is the average period in the
hospital per patient admitted, i.e. the average number of days in service
rendered to each inpatient.
ALS = Number of Inpatient days care during the year/Total
number of discharges and deaths
The formula is quite satisfactory in acute general hospitals
with a quick patient turnover, but is unsatisfactory where there is
considerable difference between the number of patients admitted and those
discharged during the year, e.g. in chronic disease hospitals
In this calculation
of ALS, the day of admission is included, but the day of discharge is excluded.
The ALS in influenced by the following factors.
1. Patient
characteristics. such as sex, age and also educational and socio-economic
status.
2. Disease
characteristics. Chronic disorders and certain other diseases will account
for longer hospital stays.
3. Hospital
characteristics. Teaching and research hospitals tend to have longer ALS
than others. Cumbersome admission and discharge procedures of the hospital also
influence ALS.
In most acute care
general hospitals, the ALS varies from 8 days to 15 days. Reduction of ALS from
15 to 10 days in 500-bedded hospital means that the hospital can service over
6,000 additional patients during the year. Wardwise, unitwise, diseasewise,
doctorwise and specialitywise studies of ALS are more useful than overall ALS
for the hospital.
OUTPATIENTS AND OTHER SERVISES UTILIZATION STATISTICS
Outpatient Services
Outpatient services data is extracted from the registers
maintained at the registration counters in the outpatient department, specialty
clinics and casualty services. The data will be useful to the extent that these
registers contain comprehensive information columns. Commonly used statistics
pertaining to outpatient services are as follows.
- Number of new cases
- Number of repeat cases
- Specialitywise break-up cases
- Unitwise break-up cases
- Age and Sex distribution of cases
- Diagnostic statistics
1. Daily Average outpatient
attendance
Total number of outpatient attendance during the period/Number of OPD
working days during the period
2. Average outpatient attendance
per patient (Average duration of the spell of sickness treated in OPD)
Total number of outpatient attendance/Total number of new cases
Surgical services
1. Total number of operations
2. Break-up of major and minor
operations. There is still no unanimity among the surgeons about the nature of
the operation, i.e. major or minor. Some hospital consider any operation
requiring general anesthesia as major where as others consider the time
duration as main variable in deciding whether an operation is major or minor.
It is suggested that combination of both, i.e. the type of anesthesia the time
duration should decide whether an operation is major or minor.
Laboratory
Services
1. Total number of examinations
2.
Break-down of types, viz. Haematology
·
Biochemistry
·
Routine urine
·
Microbiology
·
Histopathology
Imaging Services
1. Number
of Radiographs done
2. Break-up
of radiographs by sizes of the films
3. Number
of special examinations, e.g. barium studies, urographies
4. Number
of Ultrasonographies
5. Number
of CT scan studies
ECG and EEG
1. Number of ECG and EEG
2. Number of emergency ECG
Minimum cases required for
Installation of imaging services:
Rule of thumb: 1.3 to 1.5 X
rays examn/hosp bed/week will be reqd (0.18 to 0.20 examinations/bed days).
* One X ray for every 2.5 to 3 OPD patients.
* Approx % of examinations by type: Chest - 40%, GI Tract - 20 to 25%, Extremities - 15%, Head & neck - 7.5%,
Spl procedures – 3 to 5%, Others - 15 to 20%.
* One X ray for every 2.5 to 3 OPD patients.
* Approx % of examinations by type: Chest - 40%, GI Tract - 20 to 25%, Extremities - 15%, Head & neck - 7.5%,
Spl procedures – 3 to 5%, Others - 15 to 20%.
•
Estimating number of Diagnostic Rooms
–
Rule of thumb: 1.3 to 1.5 X rays exams/hosp
bed/week
–
0.18 to 0.20 examinations/bed / day
–
One X ray for every 5- 6 OPD patients
–
One X ray for every 2.5- 3 emergency patients
( Laufmann)
•
Estimated mean time for a radiological
examination – 13.3 mins
CT SCAN
1 scanner for 1.5 lac
population, 2500 scans / yr, 300 bedded hospitals (BIS).
* WORKLOAD: Head (65%), Abdomen (18%), Thorax (45),
Pelvis (6%), Limbs (7%).
* WORKLOAD: Head (65%), Abdomen (18%), Thorax (45),
Pelvis (6%), Limbs (7%).
MRI-1000 to 2000 scans / year.
•
LAB: Avg
-8 to 20 lab tests in ALS of 10 days
Saturday, September 7, 2013
Financial Health of A hospital
Financial health of hospital
Financial indicators used by financial executives to assess the financial status of a hospital:
Financial indicators used by financial executives to assess the financial status of a hospital:
Bed occupancy (percentage).
This indicator is a measure of the volume and utilization of
inpatient services.
total patient days / [total beds x 365]
Average length of stay (days).
This indicator describes the average stay of all or a class of inpatients
discharged over a given period. It is used as an indicator of efficiency in
containing inpatient service costs.
total patient days / total discharges
Operating margin (percentage).
This profitability indicator shows income derived from patient care operations. It is used to assess the extent to which the
organization is using its financial and physical assets to generate a profit.
(total operating revenue - total operating expense) / total operating revenue x 100
A hospital's operating margin percentage is
one of the most important indicators of financial viability. The operating
margin should be positive.
Current ratio. This liquidity indicator shows the
number of times short-term obligations can be met from short-term creditors.
Because it provides an indication of the ability to pay liabilities, a high
ratio number is one way short-term creditors evaluate their margin of safety.
total current assets / total current liabilities. A current ratio over 1 is desirable.
Cash on hand (days). This solvency
indicator measures the number of days an organization can pay its cash
operating expenses if none of the accounts receivable were collected. This
liquidity indicator shows the minimal survival period of an organization.
(cash on hand + market securities) / ([total operating
expense - depreciation expense] / 365)
Accounts receivable (days).
This indicator is a measure of the efficiency of the collections function.
(accounts receivable - allowances for uncollectible) /
(total operating revenue / 365)
Average payment period (days).
This indicator is a measure of how efficiently an organization pays its bills.
total current liabilities / ([total operating
expense + total other expense depreciation] / 365)
Inpatient gross revenue (percentage).
Hospital revenue typically consists of inpatient and outpatient services. This
measure reflects inpatient revenue as a percentage of total.
total
inpatient revenue / total patient revenue
Monday, July 19, 2010
Saturday, May 15, 2010
CONFLICT RESOLUTION AT HOSPITAL
- CONFLICT RESOLUTION AT HOSPITAL
CONFLICT INEVITABLY occurs in all work settings because people have different needs, preferences, and values. With the rapid changes in health care delivery and market systems, the opportunity for conflict is increasisng day by day.
In the recent there is undesirable trend of people’s intolerance with hospital managements and doctors. Even small time local leaders and municipal councillors throw their weight around exhibiting their political clout and influence.. Smashing hospitals or holding dharnas has become the norm today .Doctors should understand that we are living in troubled times
The need of the hour is the diffusion of tension and hurt feelings.
But somehow, a poor communicative tendency of the medical profession has been its bane. Not only doctors, but all medical and para medical staff down the line have operated on the premise that what they say is to be obeyed and final. They find it unnecessary to offer explanations.
In changing times, this is patently uncorrect, however right they may be.
This problem is so significant that it is reported that hospital administrator has to spend 20 percent of his official time to deal with this.
Types of conflict:
Ø Intra individual
Ø Interpersonal
Ø Inter group
Ø Organizational
Ø Client Hospital
Outcome of Conflict
FUNCTIONAL
v Improves quality of decision
v Stimulates creativity and innovation
DYSFUNCTIONAL
v Increased absenteeism
v Decreased job satisfaction
v Sabotage
v Strike
v Physical aggression
Conflict Stages
It has become common to describe conflicts as passing through a series of phases
LATENT CONFLICT
EMERGENCE
ESCALATION
STALEMATE
DE-ESCALATION
RESOLUTION
PEACEBUILDING AND RECONCILIATION
"LATENT" CONFLICT STAGE. -The potential for conflict exists whenever people have different needs, values, or interests.
EMERGENCE- The conflict may not become apparent until a "triggering event" leads to the of the obvious conflict.
RESOLUTION- Emergence may be followed quickly by or it may be followed by
ESCALATION- Emergence may be followed quickly by which can become very destructive.
Actual conflicts usually do not follow a linear path. Rather, they evolve in fits and starts, alternatively experiencing progress and setbacks toward resolution.. Escalation may resume after temporary stalemate or negotiation. Escalation and de-escalation may alternate. Negotiations may take place in the absence of a stalemate. However, these models are still useful
Delineating different stages is also useful in efforts to resolve conflict. By recognizing the different dynamics occurring at each stage of a conflict, one can appreciate that the strategies and tactics for participants and interveners differ depending on the phase of the conflict.
, because most conflicts pass through similar stages at least once in their history.
Conflict Resolution –It should be resolved as soon as the optimum level is crossed and before the dysfunctional consequences start occurring.
Different approaches-
Thomas`contingency approach-
Avoidance-lose and lose
Competing-win and lose
Collaboration-win and win
Accommodation-Lose and Win
Compromising-
Guidelines for management
Listen, empathize, and avoid communication triangles
Pay attention to how you respond to complaints.
People in conflict tend to complain to a third party, rather than dealing directly with each other.
Resist the pull to participate in conflict-escalating communication triangles.
Stay calm while the complainant expresses his or her concern, and listen actively. Pay no attention to profanity, tone of voice, or insults.
Fighting creates drama, which in this sense is unwelcome in the workplace
Don't fight. While it is important to stand up for yourself, avoid being combative
Reflect what you hear, and show empathy for the speaker
Express regret that this conflict has happened, but don't use inflammatory words, and don't assume a collusive posture.
Use the "firm adult" component of your personality, Speak in a monotone. Quote facts and figures
Confront offenders with data, authority, and compassion
Try to maintain the stance of someone who will facilitate resolution of the conflict, not that of a rescuer or persecutor of any party.
Ask what the person would like you to do to resolve the problem. Stay focused on the specific problem at hand and state your intention to do all that you can to facilitate resolving it. Only commit to doing what is doable.
Steps to Resolution
Disengage
Tense confrontations typically polarize positions and prevent reasoned analysis and discussion. The crucial first step is therefore to disengage management and customers from the immediate conflict. Defusing the emotion tension of a direct confrontation enables all interested parties to regain their intellectual bearings.
Untangle.
Once management and thecustomers have been disengaged, they each must identify and discuss the sources of their dissatisfaction. What previously appeared to be a tangle of intractable grievances will yield, with discussion, a number of discrete, well-defined problems.
Clarify.
After the central problems have been identified, management and the customer must clarify their own goals and establish priorities.
* Providing high-quality health care.
* Maintaining a financially stable institution.
Constrain.
The hopes and expectations of management and customer must be constrained by what is feasible in the real world. The hospital's professional culture and financial circumstances are especially important factors to consider at this stage.. Each must come to understand the various tradeoffs and compromises involved in the choice of one alternative over another.
Engage.
After management and customer have adjusted their expectations to reality, they are ready to engage in discussions covering the full range of issues relating to the crisis
Accommodate.
Any stable agreement will require accommodate each other's needs. Agreement must be reached through a consensus founded on mutual respect, understanding, and recognition of the legitimate values and goals of all interested parties..
Implement.
The process of implementing the agreement between management and the professional staff will vary from one hospital to another. At one extreme, implementation may involve extensive reorganization of services, departments, facilities, and so on. At the other extreme, implementation may require reltaively minor adjustments; periodic checks with management and the professional staff will suffice to determine whether implementation is progressing smoothly and as expected
CONCLUSION
Spending an extra minute explaining facts and employing tact can save the day. And if necessary, a deceitful diplomatic ego pampering to diffuse the situation.
Many potentially hostile situations can be avoided or defused early with copious communication The biggest problem in any large organization is the lack of adequate communication...up, down, and horizontally
Tuesday, April 6, 2010
CHALLENGES FACING HEALTH INDUSTRY
CONSUMER AWARENESS
Improved socio- economic status due to a rise in the standard of living, improvements in education , increased awareness of public and easier access to medical care has led to high expectations and demands from the consumer of hospital services.
This revolutionary change in people's mindsets has made consumers aware of their needs and demands, which have led to the evolution of a consumer-oriented market resulting in the need for evaluation of customer satisfaction.. Medical services at public and private hospitals have been under increasing strain to meet the expectations particularly because the medical care has come to the ambit of "service" under the "Consumer Protection Act." This has necessitated regular monitoring of the quality of servic
SUGGESTIONS
Develop Customer Relationship Management (CRM)
CRM is a business strategy to select and manage customers to optimize long-term value. It requires a customer-centric business philosophy and culture to support effective marketing, sales and service processeses in the hospital by the management .
According to experts, One rupee spent on advertising yields Rs. 250 in revenues.
One rupee spent on customer services yields Rs. 2500 in revenues.
HIGH STAFF TURNOVER
Health is also very labour-intensive – the proportion of the total spent on staff is much higher in health than in most manufacturing industries and in many service industries.
There is a proven link between having talented employees and overall business performance.
Attrition levels, even in the Indian context, currently range at 18- 25 per cent per annum. This makes the situation worse as hospital normally run with 60 to 75 per cent staff keeping in mind the fluctuations in occupancy.
Hospitals with high employee turnover (21 percent or more) had a 36 percent higher cost per discharge than hospitals with turnover of 12 percent or less.
Solution:
RISING COST
The cost of medical care has risen dramatically in the last decade.
This hospital is really costly is the commonest complaint voiced by a patient when he avails the services of a hospital. The average prices being charged by tertiary hospitals grew by 15 per cent annually from 2001-02 to 2005-06. This has been taken quite seriously by payor /insurance company, it is being monitored by them.
The insurance companies will apply serious pricing pressures on the providers. Therefore, only the lowest cost provider will manage to For a hospital to increase the output, it is very important that it provides Quality healthcare at a very affordable price and that is
possible, only if the cost containment mechanism is in place and the strict compliance with the cost containment protocols is practiced.
Solution:
Implement Cost containment measures:
ØHuman resource interventions
ØEnergy saving interventions
ØMaterial management interventions
USE OF MORE TECHNOLOGY
The importance of technology in today's healthcare delivery cannot be overstated, the ancient science of diagnosing most illnesses by the pulse of the human being has been replaced by advanced radiological and pathological diagnosis. In fact, technology is going to be the key differentiator between hospitals. Medical equipments constitutes 60% of total hospital budget. But required care is not given before installation and after installation.
Solution:
A WELL-PLANNED HOSPITAL POLICY ON ACQUISITION,
UTILIZATION AND MAINTENANCE OF MEDICAL
EQUIPMENT NEEDS TO BE ESTABLISHED.
NEED OF MARKETING
Healthcare services have changed tremendously. Gone are the days when doctors were very few and patients were treating them like gods. With increase in competition, the role of healthcare marketing has increased.
It is becoming difficult for hospitals these days to depend on mere word of mouth promotion to attract patients. Hospital managements are putting extra effort in carving a brand image of the hospital and improving hospital’s visibility.
Solution:
Plan your strategy on following Basic mix of Marketing
•Product/ Service
•Price
•Place
• Person
•Promotion
•Persons delivering the services
LACK OF TRAINED MAN POWER
The hospital utilizes widely divergent groups of professionals, semi-professionals and nonprofessionals. It represents high interdependence among services.
A hospital’s success is largely dependent on the quality of work of its employees. The HR role is the most crucial in a hospital as it is more people oriented and intensive rather than equipment oriented. There is a shortage of quality and quantity of human resource in our hospitals.
There is a huge shortage of trained healthcare professionals, estimated to be a deficiency of 4,50,000 doctors and 1.2 million nurses by 2012 (Source: FICCI-Ernst & Young Report 2007).
Solution
To Deliver consistent and quality healthcare services to ensure customer satisfaction in the fast-expanding and highly- competitive healthcare industry train and update the existing
staff at various levels of patient care:
Soft Skills
Leadership
Internal Team-building
Technical training
COMPETITION
Today, the healthcare industry is moving from monopolistic position to a competitive position.
Compared to a few private institutions primarily in the form of charitable trusts and small nursing homes, recently a number of large sized Indian companies have ventured into healthcare delivery.
Solution:
Turnaround strategies are relevant, and important tool for Meeting the competition
Turnaround strategies can be categorized into three different, but inter-related approaches.
These are:
Market-based strategies
Internal strategies
Quality-centric strategies.
Consumer Awareness
Rising Cost
Use of more Technology
Competition
Need of Marketing
Lack of trained manpower
High staff turnover (Attrition)
CONSUMER AWARENESS
Improved socio- economic status due to a rise in the standard of living, improvements in education , increased awareness of public and easier access to medical care has led to high expectations and demands from the consumer of hospital services.
This revolutionary change in people's mindsets has made consumers aware of their needs and demands, which have led to the evolution of a consumer-oriented market resulting in the need for evaluation of customer satisfaction.. Medical services at public and private hospitals have been under increasing strain to meet the expectations particularly because the medical care has come to the ambit of "service" under the "Consumer Protection Act." This has necessitated regular monitoring of the quality of servic
SUGGESTIONS
Develop Customer Relationship Management (CRM)
CRM is a business strategy to select and manage customers to optimize long-term value. It requires a customer-centric business philosophy and culture to support effective marketing, sales and service processeses in the hospital by the management .
According to experts, One rupee spent on advertising yields Rs. 250 in revenues.
One rupee spent on customer services yields Rs. 2500 in revenues.
HIGH STAFF TURNOVER
Health is also very labour-intensive – the proportion of the total spent on staff is much higher in health than in most manufacturing industries and in many service industries.
There is a proven link between having talented employees and overall business performance.
Attrition levels, even in the Indian context, currently range at 18- 25 per cent per annum. This makes the situation worse as hospital normally run with 60 to 75 per cent staff keeping in mind the fluctuations in occupancy.
Hospitals with high employee turnover (21 percent or more) had a 36 percent higher cost per discharge than hospitals with turnover of 12 percent or less.
Solution:
RISING COST
The cost of medical care has risen dramatically in the last decade.
This hospital is really costly is the commonest complaint voiced by a patient when he avails the services of a hospital. The average prices being charged by tertiary hospitals grew by 15 per cent annually from 2001-02 to 2005-06. This has been taken quite seriously by payor /insurance company, it is being monitored by them.
The insurance companies will apply serious pricing pressures on the providers. Therefore, only the lowest cost provider will manage to For a hospital to increase the output, it is very important that it provides Quality healthcare at a very affordable price and that is
possible, only if the cost containment mechanism is in place and the strict compliance with the cost containment protocols is practiced.
Solution:
Implement Cost containment measures:
ØHuman resource interventions
ØEnergy saving interventions
ØMaterial management interventions
USE OF MORE TECHNOLOGY
The importance of technology in today's healthcare delivery cannot be overstated, the ancient science of diagnosing most illnesses by the pulse of the human being has been replaced by advanced radiological and pathological diagnosis. In fact, technology is going to be the key differentiator between hospitals. Medical equipments constitutes 60% of total hospital budget. But required care is not given before installation and after installation.
Solution:
A WELL-PLANNED HOSPITAL POLICY ON ACQUISITION,
UTILIZATION AND MAINTENANCE OF MEDICAL
EQUIPMENT NEEDS TO BE ESTABLISHED.
NEED OF MARKETING
Healthcare services have changed tremendously. Gone are the days when doctors were very few and patients were treating them like gods. With increase in competition, the role of healthcare marketing has increased.
It is becoming difficult for hospitals these days to depend on mere word of mouth promotion to attract patients. Hospital managements are putting extra effort in carving a brand image of the hospital and improving hospital’s visibility.
Solution:
Plan your strategy on following Basic mix of Marketing
•Product/ Service
•Price
•Place
• Person
•Promotion
•Persons delivering the services
LACK OF TRAINED MAN POWER
The hospital utilizes widely divergent groups of professionals, semi-professionals and nonprofessionals. It represents high interdependence among services.
A hospital’s success is largely dependent on the quality of work of its employees. The HR role is the most crucial in a hospital as it is more people oriented and intensive rather than equipment oriented. There is a shortage of quality and quantity of human resource in our hospitals.
There is a huge shortage of trained healthcare professionals, estimated to be a deficiency of 4,50,000 doctors and 1.2 million nurses by 2012 (Source: FICCI-Ernst & Young Report 2007).
Solution
To Deliver consistent and quality healthcare services to ensure customer satisfaction in the fast-expanding and highly- competitive healthcare industry train and update the existing
staff at various levels of patient care:
Soft Skills
Leadership
Internal Team-building
Technical training
COMPETITION
Today, the healthcare industry is moving from monopolistic position to a competitive position.
Compared to a few private institutions primarily in the form of charitable trusts and small nursing homes, recently a number of large sized Indian companies have ventured into healthcare delivery.
Solution:
Turnaround strategies are relevant, and important tool for Meeting the competition
Turnaround strategies can be categorized into three different, but inter-related approaches.
These are:
Market-based strategies
Internal strategies
Quality-centric strategies.
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