Amity MBA Assignment Semester 3 Hospital administration

Hospital Organization (EDL 339)

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MODULE I : HEALTHCARE ORGANIZATIONS IN INDIA

While tourism is a major source of income for any country, medical tourism is a comparatively new trend. In recent times, medical tourism has become a way for several third-world countries with high-end medical facilities to provide medical services to patients from across the world. These services are usually made available at a less than 60% cost than at developed countries like the USA. India, with its huge pool of medical graduates, and the availability of world-class medical facilities in several hospitals in its important cities, is fast emerging as the destination of choice for medical tourism. The Indian Government has made several policies to encourage medical tourism, bringing in special processing of medical visas and providing hospital with incentives for taking in international patients. Taking advantage of this situation, several corporate hospitals in India have set up entire departments to deal with international patients, and provide the not only with the required treatment, but also pre and post medical care support services including visa processing, pickup from the airport, providing accommodation support, and end-to-end medical care including counseling and rehabilitation support. Several reputed hospitals have acquired in international Joint Commission International (JCI) certification which assures foreign patients of quality of the medical services. The Apollo Group of Hospitals is one of the pioneers in the area of medical tourism. The first hospital in India to receive the JCI accreditation, the Apollo Group now has six branches that have the JCI accreditation. The group has a special International Wing that takes care of medical tourists. The services provided by the Apollo hospitals to patients coming in from other nations include tele-consultation with experts for diagnosis and possible cures, video-conferences with patients where required, help in providing visa, pick up from the airport, support in providing suitable accommodation to the patient and their attendants, medical facilities and services, nursing, and counseling and rehabilitation services. They also have translators available, who can help them communicate with the doctors and attendants in the hospital. A counselor is made available, who can provide orientation to the patients and guide and help them whenever required. The Apollo group of hospitals treats more than 50000 foreign patients from 55 countries annually. Apollo Chennai also runs a Wellness Center on its premises, which offers holistic healing services such as Ayurveda, yoga, aromatherapy, meditation, pranic healing and music therapy to its international patients, as part of a special recovery package. Medical tourism in India is estimated to grow to USD 9 billion by 2020. With the high-end services provided to its international patients, Apollo is set to play a very important role in cornering a sizeable portion of the business.

Question 1: “When a person travels to a different country for medical treatment, it is called:”

Select one:

a. Tourism

b. Sight-seeing

c. Medical tourism

d. Insurance planning

Question 2

Popular treatments opted by medical tourists include:

Select one:

a. “Heart, bone and hip replacement”

b. Cosmetic surgeries

c. Skin grafting and oncology

d. All of the above

Question 3

The advantages of coming to India for medical treatment include:

Select one:

a. “Healthcare personnel well-versed in English, leading to reduced language barriers”

b. Growing compliance with international quality standards

c. Both of the above

d. None of the above

Question 4

The Apollo group is a pioneer in the area of medical tourism. Which of the following statements supports the given statement?

Select one:

a. The Apollo group of hospitals treats several international patients regularly.

b. Apollo group was the first in India to receive JCI accreditation

c. Apollo group provdes teleconsultation to patients

d. All of the above

Question 5

What aspects of treatment are covered under medical tourism packages?

Select one:

a. Pre-screening of the patients medical condition

b. Teleconference and/or video conference for consultation between patient and the specialist doctor

c. “Actual medical treatment, nursing, counselling and rehabilitation”

d. All of the above

Question 6

What steps is the Indian government taking to promote medical tourism?

Select one:

a. Providing easy ways to process visas under the category of medical tourism

b. Providing incentives to hospitals treating international patients

c. Both of the above

d. None of the above

Question 7

Why do people prefer to travel to other countries for medical treatment?

Select one:

a. The required treatment is not available in their home country

b. The available treatment is very expensive in their own coountry

c. There is a long waiting time for the start of the medical procedure required

d. All of the above

Question 8

Why does the government encourage medical tourism?

Select one:

a. It promotes the doctors and health facilities of the country throuoghout the world

b. Medical tourism brings in lots of revenues for the country

c. It helps the country improve its infrastructure

d. For the goodwill it creates

Question 9

Why is India a preferred destination for medical tourists?

Select one:

a. India has high-end medical equipment and skilled doctors available

b. The cost of medical treatments in India is much cheaper compared to the USA or UK

c. “India also provides for alternate medical treatments like Yoga, Ayurveda and pranic healing”

d. All of the above

Question 10

Why is JCI accreditation important?

Select one:

a. It is an international accreditation that assures the quality of services provided by the hospital

b. It looks good for the hospital to show international accreditation

c. It is not important. It is just an additional certificate

d. All of the above

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MODULE II : HOSPITALS AS ORGANIZATIONS

Key performance indicator (KPI) is defined as a quantifiable measure used to evaluate the success of an organization, employee, etc. in meeting objectives for performance.

The standards for any industry do not remain the same over time. As times change and demands rise, there is a subsequent rise in the healthcare needs. Due to this, the standards of patient care are pushed to a new high. KPIs in a hospital help track operational effectiveness and help understand how the hospital is performing. KPIs aid in assessing operations and setting goals within a hospital.

Some key performance indicators for a hospital are:

Staff-to-Patient Ratio: A deficit in staff directly affects the quality of patient care. A good ratio could help in better handling of patients.

Patient Wait Time: Longer wait times mean lower patient satisfaction scores. Minimizing the wait time makes patients feel well-attended to.

Average Length of Stay: Lengthy hospital stays could be due to administrative oversight or post-operative complications. A hospital should ensure that the stay of the patient is minimum besides making sure that they are not being prematurely discharged.

Occupancy: This shows the average number of patient rooms in use at one time, giving an idea of how small or how big the facility is compared to its actual demand.

Claim Processing: The time and amount being spent on processing a claim and the rate of claim denial should be considered and kept as low as possible.

Medication Errors: The number of errors in treatment, medication, dosage, etc. is to be well documented to measure the flaws in treatment procedures and their incidence.

Patient Follow-Up: This measures the follow-up done to know the patient’s improvements after his/her visit to the facility.

Trainings: This helps track the amount of training provided in each department.

Patient Satisfaction: Various tools like surveys, feedbacks, etc. are used to understand the overall patient satisfaction as it can serve as a great marketing tool for a hospital.

Media Mentions: Keeps track of how often the hospital is mentioned in the media and also whether the mention is positive or negative.

While these are the mainstream KPIs that could be used by hospitals, there are other KPIs which can be considered trying. These include – number of educational programs, number of preterm births, number of educational programs, patient confidentiality, number of partnerships with advocacy groups, childhood immunizations, etc.

All KPIs should be subject to the SMART criteria, i.e., the KPIs should have a Specific purpose, have a Measurable value, be Assignable, Realistic and have outcomes seen within a predefined Time period.

KPIs should be aimed at improving efficiency of the hospital and maintaining quality of patient care and operations. They play an important role in the performance measurement process by helping to identify and appropriately measure levels of service performance. The National Standards for Safer Better Healthcare recognizes the use of KPIs as part of the process to systematically monitor, evaluate and continuously improve the quality of care.

Question 1: KPIs should to subject to _______ criteria.

Select one:

a. SMART

b. NSSBH

c. NABI

d. HIMT

Question 2

Longer patient-wait time results in _______.

Select one:

a. Improved hospital performance

b. Reduced patient satisfaction

c. Better marketing

d. Better patient care

Question 3

Media mentions should be evaluated for what reason?

Select one:

a. To publicize on social media

b. To increase the count of mentions

c. To add them to the hospital bulletin for everyone to see

d. To keep track of what positives and negatives are being mentioned

Question 4

The KPI for claim processing should help in

Select one:

a. Increasing rate of claim denial

b. Reduce time and amount spent on claim processing

c. Not giving the discharge summary on patient s exit

d. Increase the bill amount of the patient

Question 5

What does a deficit in patient care result in?

Select one:

a. Increased hospital performance

b. Decreased pressure on staff on board

c. Increased patient care

d. Decreased patient care

Question 6

What does KPI stand for?

Select one:

a. Knowledge Process Interface

b. Key Performance Indicators

c. Knowledge Protocol Indicators

d. Knowledge Process Investigation

Question 7

What is to be done to the medication errors that take place within the hospital?

Select one:

a. Document them all

b. Oversee them

c. Repeat them

d. Blame the patient

Question 8

What should ideally be done to know the patient s improvements after his/her visit to the facility?

Select one:

a. Follow-up by hospital staff

b. Wait for patient s re-visit

c. Estimate the well-being

d. None of the above

Question 9

What should KPIs be aimed at?

Select one:

a. Reducing quality of healthcare

b. Having a deficit in staff

c. Improving efficiency

d. Increasing patient stay at the hospital

Question 10

Which one of the following recognizes KPI use to improve the quality of care?

Select one:

a. National Standards for KPI in Hospitals

b. National Performance Monitor Board

c. National Standards for Safer Better Healthcare

d. Quality Control Board

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MODULE III: ORGANIZATIONAL DESIGN

A network organization is best defined as an organization formed by intersecting and cross-cutting linkages between several separate organizations, usually connected on a project basis. One of the organizational design is networks, and it can be found in many areas of healthcare. In a study by A. Willem and P. Gemmel, they focused on two governance aspects of health care networks, i.e., governance structure (structures for collaboration) and governance mechanisms (coordination in networks), and attempt was made to search answers to questions such as:

• Which kinds of governance exist in health care networks?

• Which kind of governance is assumed to be preferable for health care networks?

To study if the three kinds of governance mechanisms can be found together or independently, a case study was done. It also focused on whether a governance structure is associated with a particular governance mechanism, and lastly whether there are effective configurations of governance structure, governance mechanisms, and network attributes. Three types of governance mechanisms are markets, hierarchy, and relational governance, and the relational model is typically associated with networks.

Relational governance refers to synchronization based on trust, reciprocity, and universal norms and values that are rooted in the relationships between the network partners. The sample consisted of 22 healthcare networks in Flanders. Most networks were of psychiatric care, disabled, the elderly or those in palliative care.

Based on the data, six out of the 22 cases were classified as effective. Qualitative data revealed that goals differ, even within a similar category of care. For instance, “Psychiatric care networks 1 and 2” were both perceived as effective, but the first network’s main objective was improving care while the second network’s was developing additional care. “Psychiatric care network 2” did not adequately reach its goals, although it was still perceived as effective. Objectives in the networks ranged from cooperation and patient referral to integrated care and establishing new services.

A balance in governance mechanisms might be preferable. Hierarchical governance mechanisms may be important for the success of healthcare networks if combined with relational and contractual governance mechanisms.

Networks can be perceived as competent despite lack of trust, or inflexibility; but some characteristics, such as low levels of legitimacy or relational governance, seem to be occurring more often among the less effective networks

In the most effective networks balanced combination of relational, contractual, and hierarchical governance was observed, but such balance was absent in seven out of 16 cases of less effective networks. It was concluded that in a complex healthcare environment, network effectiveness could be increased by a balanced combination of governance mechanisms.

Question 1: “In a complex healthcare environment, network effectiveness could be increased by: “

Select one:

a. Markets

b. Balanced combination of governance mechanisms

c. Hierarchy

d. Relational governance

Question 2

“In hospitals, which type of departmentation is common?”

Select one:

a. By Function

b. By Committee

c. By Geographical location

d. All of the above

Question 3

“Which organizational structure ensures improved coordination between the departments, flexibility and responsiveness to customer requirements?”

Select one:

a. Matrix structure

b. Functional structure

c. Divisional structure

d. None of the Above

Question 4

Relational governance refers to synchronization based on:

Select one:

a. Trust

b. Reciprocity

c. Universal norms and values

d. All of the above

Question 5

What are the basic organization designs?

Select one:

a. Bureaucratic model

b. Team model

c. Matrix model

d. All of the above

Question 6

What are the disadvantages of bureaucracy?

Select one:

a. Maladaptive

b. Rule-bound

c. Overly cautious and unproductive

d. All of the above

Question 7

What are the governance aspects of health care networks?

Select one:

a. Governance structure (structures for collaboration)

b. Governance mechanisms (coordination in networks)

c. Both of the Above

d. None of the Above

Question 8

What are the types of governance mechanisms?

Select one:

a. Markets

b. Hierarchy

c. Relational governance

d. All of the above

Question 9

What variables should be taken into consideration when planning organizational design?

Select one:

a. Degree of Environmental Stability

b. Control

c. Nature of work

d. All of the above

Question 10

Which structure minimizes or eliminates organizational boundaries?

Select one:

a. Boundaryless Organisations

b. Network Organisations

c. Both A and B

d. None of the Above

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MODULE IV : HOSPITALS AND ORGANIZATIONAL STRUCTURE

Horizontal Integration:  Apollo Health had acquired Nova Specialty Hospitals and relaunched it as Apollo Spectra in 2015. Nova Specialty had a chain of 11 short-stay surgery centers spread across eight cities, and post-acquisition it added 45 modular OTs, 350 patient beds were providing inpatient and outpatient facilities. The combined turnover was estimated to be around INR 115 – 125 crore for the year ending March 2015. Apollo also introduced preventive health checks and sugar clinics in the new centers. The exclusive surgery center model minimizes hospital-acquired infections resulting in the elimination of unnecessary hospitalization and thereby leading to remarkable medical outcomes.Vertical Integration:According to Mckinsey and Company, Vertical integration is a risky strategy and is complex, expensive, and hard to reverse. It can be profitable and fruitful only if done after a careful and detailed analysis. Example of a transformative merger is the USD 69 billion deal between pharmacy giant CVS Health and insurer Aetna. CVS has 9,700 retail pharmacies and 1,100 walk-in clinics, and generated USD 177.5 billion in net revenue in 2016, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise which is a middleman between pharmaceutical manufacturers and dispensers like pharmacies.  After its purchase of Aetna, the third largest health plan in the US, aims to reduce medicine prices and push for the most effective treatment choices, to achieve more competitive insurance premiums. By joining forces with CVS, Aetna can take advantage of its roughly 10,000 clinics to have a greater reach to people, while the gain of Aetna’s 22 million members would be a significant boon to CVS’ Minute Clinics. CVS/Aetna merger will also discourage new ventures coming from Amazon or other players. About 97 percent of Aetna’s shareholders and 98 percent of CVS shareholders are in favor of the merger, but the final approval is still on hold as U.S. Department of Justice wants CVS Health and Aetna to each provide detailed information.Apollo Hospitals entered in a retail pharmacy business that caters to the wellness market, along with the therapeutic medicine supplies to the patient population, also including skin care, cosmetics, beauty and other healthcare related products. Presently 2400 plus Apollo pharmacies function and Apollo is aiming at 2,000-plus pharmacy outlets in the next three to four years.

Question 1: A horizontal service-line leadership after a horizontal Integration

Select one:

a. help to avoid capital and other resource duplication

b. Improves market capture

c. promote performance improvements and achieve efficiencies

d. All of the above

Question 2

A hospital merging with a retail pharmacy is the example of:

Select one:

a. Horizontal Integration

b. Vertical Integration

c. Neither of A or B

d. Both A and B

Question 3

Hospital tie up with an Insurance company is an example of:

Select one:

a. Horizontal Integration

b. Vertical Integration

c. Neither of A or B

d. Both A and B

Question 4

Merger between CVS and Aetna is an example of

Select one:

a. Horizontal Integration

b. Vertical Integration

c. Neither of A or B

d. Both A and B

Question 5

Top companies in Health Care and Market Research — Navicure and ZirMed are merging. What type of integration is this?

Select one:

a. Horizontal Integration

b. Vertical Integration

c. Neither of A or B

d. Both A and B

Question 6

Vertical integration

Select one:

a. is easy to implement

b. is always profitable

c. Can be done without risk analysis

d. “is a risky strategy which is complex, expensive, and hard to reverse”

Question 7

What is important aspect to look into during a horizontal integration plan?

Select one:

a. Staff availability

b. Governance Structure

c. Revenue Generation

d. Location

Question 8

What is required before any merger or acquisition?

Select one:

a. Revenue Generation

b. Adequate analysis of risks

c. Personnnel

d. Stakeholders Interest

Question 9

What is the most valuable tool for achieving coordination in hospitals

Select one:

a. Structure

b. Planning

c. Personnel

d. Expertise

Question 10

Which of these is an example of horizontal Integration?

Select one:

a. A hospital merging with another hospital providing similar or more services

b. A hospital merging with a retail pharmacy

c. A Hospital opening branches in different cities

d. A hospital opening centers in different countries

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MODULE V : ORGANIZATIONAL STRUCTURE AND HOSPITAL PERFORMANCE

Various models of organizational structure exist. A matrix model is one where employees are answerable to two management structures: one, the project manager, and other, the functional manager controlling specific activities like manufacturing, finance, or marketing. Some advantages of this model are:

•         Reduction in management layers

•         Break down of traditional department barriers

•         Clarity in tasks and goals

•         Improved coordination between the departments

•         Efficient use of resources

•         Flexibility and responsiveness to customer requirements

•         Quick decision making

However, this model is not easy to implement and can generate conflicts. 

John Hunter Hospital was commissioned in January 1991 in Newcastle. Stimulated by competition and changing health environment,  the hospital was planned on the model of decentralization of allied health services, mainly physiotherapy department.  To cope with the external pressures and fulfill external demand, Matrix Management Model (MMM) was implemented from the inception.  Rather than being employed by a physiotherapy department, physiotherapists were assigned to one of six patient care divisions (PCDs):

1.       pediatrics

2.       obstetrics and gynecology

3.       medicine

4.       surgery

5.       anesthesia and intensive care, and

6.       emergency medicine

Physiotherapists and other allied health staff had dual lines of reporting, one to the chairperson of the respective PCDs and other to the director of physiotherapy.

Initial benefits were enhanced team approach to patient care, increased staff satisfaction in clinical matters and improved continuity of care. But the hospital started facing issues, especially in its recruitment process.  Recruitment to a position spanning two PCDs required permission from the chairman, the business managers in both PCDs and the general manager. This was a complex and time-consuming procedure, leading to recruitment delays.  The problem intensified due to lack of interest by the involved administrators, and lack of recognition of the importance of the position.  Missing clarity on role definition among managers of PCDs and physiotherapy and a lack of recruitment experience added to the issues.

Another concern was staff development, especially for the physiotherapists rotating between PCDs. PCDs were not ready to bear the cost of courses or conferences, especially if it was considered irrelevant to that PCD. If the physiotherapist was permanently to the particular PCD, it would take up the costs, but this was creating jealousy among staff as all PCDs were not able to afford training costs. 

The complexity of service planning, quality improvement, and human resource management, the lack of authority over the budget for both salaries and wages and goods and services were some of the problems faced by the hospital.  The lack of authority over the goods and services budget resulted in inefficiencies in ordering, inability to obtain required goods and didn’t allow the hospital to benefit from economies of scale. The hospital was also finding it difficult to hire a permanent Head of the Department.

In February 1995, John Hunter Hospital undertook a strategic planning process.  A new division – Clinical Support Services was setup, with centralization various services into clinical departments based on professional lines of responsibility.  Post restructuring, the hospital saw:

•         Improved efficiency in its recruitment process

•         Savings and efficient purchases due to budgetary control

•         Resourceful use of time as less time was consumed by cumbersome administrative processes

•         More time was spent on professional issues and clinical care

Question 1: A manager s perspective on change concentrates on

Select one:

a. Quality

b. Return on Investements

c. Employee Satisfaction

d. None of the Above

Question 2

After how many years of inception the hospital decided to restructure

Select one:

a. 4

b. 3

c. 10

d. 5

Question 3

Individual change management focuses on

Select one:

a. Employee Satisfaction

b. Return on Investements

c. Quality

d. None of the Above

Question 4

John Hunter Hospital was following which organizatinal structre at inception?

Select one:

a. Decentralized

b. Matrix

c. Both of the Above

d. Centralized

Question 5

Possible outcomes of change could be

Select one:

a. Employees resist the change

b. Valued personnel leave the organization

c. Productivity declines

d. All of the Above

Question 6

Restructuring may be done to

Select one:

a. Improve care quality

b. Increase patient turnover

c. Expand services

d. All of the Above

Question 7

The healthcare industry is currently undergoing mass-scale changes everywhere primarily because of:

Select one:

a. Rising costs of healthcare

b. Disparity in healthcare access

c. Both of the Above

d. None of the Above

Question 8

The success of the change depends on

Select one:

a. Employee Satisfaction

b. Improved Quality

c. Increased Rvenues

d. All of the Above

Question 9

This structure was in favour of physiotherapists

Select one:

a. Agree

b. Disagree

c. Partially

d. Mostly

Question 10

What were the challenges faced by the hospital

Select one:

a. Recruitment Delay

b. Ambiguity in Roles

c. Dissatisfied physiotherapists

d. All of the Above

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ASSIGNMENT 2

The North East Ambulance Service (NEAS), a Foundation Trust of the UK’s National Health Service (NHS), received NHS Foundation Trust status in 2011. Foundation Trusts were created to allow decisions to be made by local organizations and communities, free from central government control and able to decide how best to spend the Trust’s income, based on the needs of the local community. The NEAS delivers front-line services from 61 stations across 3,230 square miles. The NEAS serves a population of over 2.7 million people offering emergency response services and a patient transport service, which provides pre-planned non-emergency transport for patients travelling for outpatient appointments in the region. A hazardous area response team is trained to deal with major incidents and delivers specialist response services. The NEAS responds to over 360,000 emergency and urgent incidents each year. With over 2,000 staff, 500 vehicles, and nearly 10 million miles travelled per year, the NEAS is an essential service in UK’s North East.

In 2015, NEAS found itself facing several challenges that were impacting staff engagement.

The key challenges were 1) a 24/7 working pattern, resulting in a 168-hour week which conflicted with the day time working hours of managers, 2) less time given to team meetings as staff were not based at a dedicated site, 3) communicating with staff was challenging because they were constantly mobile, and 4) the high demand for services left staff with little time for becoming involved in staff engagement activities.

To address these issues the trust initiated several improvement measures to bring about a positive change. The range of initiatives included restructuring, changes to the management, new strategic partnerships, and a review of their values and internal culture.

To begin with, the NEAS redefined its vision and values. The mission and vision of the NEAS were articulated based on interviews with stakeholders and on staff feedback.

The NEAS also took an active decision to make improvements to staff engagement in other ways too, one of which was by restructuring its operational management teams. The trust introduced frontline managers to support ambulance crews. When ambulance crews are exposed to distressing and stressful situations, the frontline manager is available to provide guidance and relevant support services, and to offer counselling. The crew does no longer have to process and deal with difficult experiences independently.

Alongside the restructuring, the NEAS also reviewed its organizational culture. The findings identified several issues that needed to be addressed. These included a greater focus on employee welfare, improvements in policy and procedures to embed quality care and safety deeper into the culture. The staff was involved in helping to shape the new vision, mission and values. Team-building activities were improved and a leadership program focusing on building a compassionate culture was initiated. Thanks to the numerous engagement interventions, scores yielded by the annual staff survey and the staff friends and family test (FFT) improved.

Question 1: “As seen in the NEAS case, restructuring may affect:”

Select one:

a. Staff engagement

b. Staff recruitment

c. Working patterns

d. None of the above

Question 2

“Before the restructuring, the challenges facing the ambulance crew included: “

Select one:

a. Frequent team meetings

b. Less demand for services

c. A 24/7 working pattern

d. All the above

Question 3

“In a restructuring, articulating or redefining the mission and vision is the exclusive responsibility of:”

Select one:

a. Senior Manager

b. Staff

c. Operational Management Team

d. None of the above

Question 4

“In the NEAS context, which of the following can be considered a change management initiative?”

Select one:

a. Introduction of a leadership program

b. Team-building activities

c. Annual staff surveys

d. All the above

Question 5

Frontline managers have the ultimate responsibility for ensuring:

Select one:

a. The right number of ambulances are available

b. Investigating and dealing with complaints

c. The well-being of ambulance crew

d. None of the above

Question 6

The clinical care manager (CCM) role was created to:

Select one:

a. Offer counselling in distressing situations

b. To go on duty with the staff and have conversations about work

c. Offer support and guidance in stressful situation

d. None of the above

Question 7

The objective of the NEAS restructuring was:

Select one:

a. To add resources

b. To improve front-line services

c. To reduce the time spent by staff on the road

d. To enhance staff engagement

Question 8

The operational management team was restructured by:

Select one:

a. Adding new resources

b. Downsizing

c. Adding new station officers

d. Creating a new role

Question 9

Which of the following activities may be used for an effective restructuring?

Select one:

a. Proactive change management measures

b. Strategic partnerships

c. Changes in the management structure

d. Articulating a mission and vision statement

Question 10

Which of the following statements is true? Restructuring is:

Select one:

a. A strategy for dealing with organizational troubles in a real-life environment.

b. The obvious impact of troubles in an organization.

c. A reaction to increased workloads.

d. A strategy to enhance management s decision-making skills.

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Hospital Planning (EDL 341)

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Module I : Guiding Principles

Case Study

SIMUL8 Studio is a simulation tool and a visual and interactive online platform, which imitates the processes of an existing or proposed system. Simulation can accurately represent the real processes by adding timings and rules around the tasks, resources, and constraints.

By using a virtual representation to test the impact of process changes and ‘what if’ scenarios, simulation helps get an overview of impact of change on the whole system. It has enabled organizations to improve processes rapidly, increase efficiency and reduce costs.

Benefits of Simulation

• It is less expensive than real life experimentation

• Possible to test diverse ideas under the same situations

• Establishes long-term impact of process changes

• Simulation provides impartial insight to assist process improvement

• Determines the potential results of random events

• Simulation allows thinking about every aspect of a process and this rethinking can sometimes result in improved operations

Isle of Wight NHS Trust, an integrated acute community mental health and ambulance health care provider in England, used BED. P.A.C. simulation software for bed management. Their primary objective was to deviate from the spreadsheets planning and be able to handle the variation that exists in reality. Answers for some other questions were also needed: effect of winter pressures on inpatient beds, the effect on inpatient bed utilization of reducing delayed discharge patients, the downstream capacity constraint of community nursing beds, how to use short-term predictions to show where inpatient bed capacity problems may arise over the next seven days.

Arrivals of elective and emergency patients across each specialty were analyzed and these forecasts along with 12 months of historical data of arrivals, length of stay and discharge times were uploaded to the software. The BED.P.A.C. automatically created daily patient arrival patterns and profiles of the typical length of stay depending on time and day of arrival and specialty. The results illustrated hourly capacity for emergency and elective beds separately, and also where patients would need to be shifted to avoid waiting times.

Bed.P.A.C.’s results were shared with the clinical staff and discussed to investigate “what if” scenarios. The detailed and highly sophisticated results increased enthusiasm of the clinical staff and encouraged effective and productive discussions towards improvement. The confidence intervals provided for each scenario were critical in showing the level of risk with the bed planning choices and the vulnerability to fluctuations in demand.

The simulation showed that the Isle of Wight required more beds to meet the present demand; these beds could be the hospital beds, or community or patients’ bed at home with appropriate support. BED. P.A.C. helped achieve the right balance between acute and community care. Other benefits included increased bed capacity for medical patients by approximately 17%, increase in community bed capacity through redesign of existing surplus capacity and increase in home-care packages

The Isle of Wight chose Bed.P.A.C. over alternative bed planning and management tools because it was rapid, engaging, as the ‘what if’ scenarios were visually compelling and easily comprehended by the clinical staff, and enhanced level of detail and accuracy. The Isle of Wight now has a full suite of detailed system performance metrics with confidence intervals provided for every result giving confidence in their analysis and ensuring buy-in from clinical staff. Also, it means they have substantial evidence to generate and have the difficult conversations that must happen to produce the right plan for optimal hospital performance.

Question 1: “The costs of permissions/approvals, architectural design falls under the category of “

Select one:

a. Hard costs

b. Soft Costs

c. Financing Costs

d. Other Costs

Question 2

A successful hospital is based on

Select one:

a. good planning

b. good design and construction

c. good administration

d. All of the Above

Question 3

Results of the simulation

Select one:

a. lead to productive solutions

b. motivated clinical staff

c. reduced uncertainity

d. All of the Above

Question 4

SIMUL8 has enabled organizations to:

Select one:

a. improve processes

b. increase efficiency

c. reduce costs

d. All of the Above

Question 5

Simulation can accurately represent the real processes by adding timings and rules around ___________.

Select one:

a. tasks

b. resources

c. constraints

d. All of the Above

Question 6

the BED.P.A.C. was used to meet what challenges?

Select one:

a. Bed Capacity Planning

b. Inadequate Staff

c. Increased Costs

d. None of the Above

Question 7

he first phase in planning for a hospital invovles

Select one:

a. Needs Assesment

b. Defining a plan

c. Both A and B

d. None of the Above

Question 8

What are the pressures of change

Select one:

a. To reduce cost and increase efficiency

b. extend care to remote areas

c. provide a Multi-disciplinary Approach

d. All of the Above

Question 9

What is SIMUL8?

Select one:

a. Simulation tool

b. Software program

c. Excel datasheeet

d. None of the Above

Question 10

Which program was used by the Isle of Wight NHS Trust?

Select one:

a. SIMUL8 Professional

b. BED. P.A.C.

c. Scenario Generator

d. None of the Above

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MODULE II

The global increase in demand for healthcare services raises the+B3:B8 need to minimize expenditures on “non-core” activities like maintenance and operations with a subsequent rise in the demand for high-level built-facilities.  The increased competitiveness in the healthcare business puts considerable pressure on hospitals to enhance facility management. For efficient facility management, proper facility planning is the key.  Over the last four decades, facilities management has witnessed significant development, owing to five global trends –

1.       Increased construction costs

2.       Studying effects of space on productivity

3.       Increased performance requirements

4.       Contemporary bureaucratic and statutory restrictions

5.       Recognition that performance of facilities is highly proportional to maintenance

A facilities planning committee in a hospital should be responsible for developing strategic facilities plan to determine the best occupancy options while meeting the department’s changing needs. Financial impact is a major consideration for any facility planning. The impact of facility decisions, financial analysis and cost effectiveness should be long-term tasks for any health care set up.

Facility planning involves various tools of planning for successful outcomes. The three key outputs of facility planning involve strategic facility plan, master plan and annual facility plan. Of all, the strategic facility planning (SPF) plays a key role as it aims at developing a flexible and implementable plan based on the specific and unique considerations of the individual business. The four main aspects of SPF include understanding, analyzing, planning and acting. The SPF identifies the type, quantity and location of spaces required to fully support the organization’s business initiatives. The master plan provides a framework for the physical environments that incorporate the buildings. The master plan develops the natural conditions and constructed infrastructure and systems at the functional, aesthetic and temporal levels. The annual facility plan deals with developing a comprehensive plan each year to address the new or changing priorities and focus on departmental initiatives.

Building Performance Indicator (BPI) is also a key component of facility planning. This aims to compute the actual physical performance score for each system in a given building and the entire facility. This provides a physical performance indicator to be measured on a 100-point rating scale. This procedure acts as a physical assessment mechanism that monitors the building, its systems and components.

SWOT Analysis is another planning tool used to strategically evaluate the strengths, weaknesses, opportunities and threats in the facility. Strategic Creative Analysis (SCAN) is another process for strategic planning, decision making and analyzing case studies.

Besides having the right tools for facility planning, setting up the plan in the right manner plays a key role in paving the way for successful planning outcomes. Some major steps in planning are:

•         Document the primary objectives to be addressed in the SFP

•         Evaluate sites, zoning, costs, labor, competition and all factors critical for success

•         Conduct financial and risk analysis to focus on finding the maximum value

•         Develop alternatives with recommendations and priorities

•         Develop a process for marketing the recommended SFP to gain management approval

•         Obtain financial and other approvals needed to launch the action phase

Question 1: “In the case study, maintenance and operations are termed as _______ activities. “

Select one:

a. Non-core

b. Key

c. Crucial

d. Significant

Question 2

“____ acts as a physical assessment mechanism that monitors the building, its systems and components.”

Select one:

a. Strategic Facility Planning

b. Annual facility planning indicator

c. Core plan

d. Building Performance Indicator

Question 3

BPI in the case study stands for?

Select one:

a. Bill Price Index

b. Building Performance Indicator

c. Blood Pressure Increase

d. British Phonographic Industry

Question 4

How many global trends have influenced facilities management over the last four decades?

Select one:

a. 6

b. 5

c. 4

d. 10

Question 5

What does SCAN stand for?

Select one:

a. Simplified Computing Analysis Network

b. Strategic Creative Analysis

c. Sample Copy for Assessment and Negotiation

d. Sample for Clinical Assessment and Negotiation

Question 6

What does SWOT stand for?

Select one:

a. Strategic Wellbeing Of Towers

b. Seller s Write-Off Trust

c. “Strengths, Weaknesses, Opportunities and Threats”

d. Source Worked Organic Traffic

Question 7

Which of the following aims at developing a flexible and implementable plan based on the specific and unique considerations of the individual business?

Select one:

a. Strategic facility plan

b. Master plan

c. Annual facility plan

d. Core plan

Question 8

Which of the following aims to compute the actual physical performance score for each system?

Select one:

a. SWOT

b. SCAN

c. KPI

d. BPI

Question 9

Which of the following is NOT a part of the four aspects of strategic facility planning?

Select one:

a. Understanding

b. Analyzing

c. Constructing

d. Planning

Question 10

Which of these provides a framework for the physical environments that incorporate the buildings?

Select one:

a. Strategic Facility Planning

b. Master Plan

c. Annual facility plan

d. Core plan

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MODULE III: OPERATIONAL PLANNING

Besides having great doctors, it is the equipment in any hospital that helps provide high-quality patient care. The advancements in technology have paved a way to simplify complex procedures and minimize the associated risks. Procuring high-quality equipment and maintaining them within the facility is often a costly affair. Yet, proper planning can help minimize the cost and improve operational efficiency, while lack of planning could result not only in wastage of money, but also lower standards of patient care. Many healthcare leaders across the globe are searching for innovative care delivery models that ensure lowering of costs with a concurrent improvement in quality.With an increase in the incidence of heart disease in Indian lifestyle, many patients refrain from taking appropriate treatment owing to the costs associated with it. According to a study done in the early 2000s, around 2.4 million Indians required a heart surgery annually, but only 60,000 received it. Hospitals today should be focusing on minimizing costs and optimizing productivity. An example of one such hospital is Narayana Health, which combines innovative technology and a highly efficient delivery system across its 31 tertiary hospitals in 19 cities.With a tight focus on efficiency, Narayana Health has achieved savings through the smart use of equipment and telemedicine, connecting around 800 centers to be the world’s largest telemedicine network. Using technology with proper planning has paved the way for this system to treat more than 53,000 patients through telemedicine. In its new spread to the Caribbean, hospital leaders at Narayana Health are trying the use of solar power and importing of supplies from India to run their operations cost-effectively. With such measures being implemented, this health system has performed 12 percent of all cardiac surgeries in India, resulting in patient outcomes that rival those in the United States. Technology helps surgeons quickly develop expertise and work towards better patient outcomes. According to a report by Narayana Health, there have a 1.4 percent mortality rate in the first 30 days of coronary artery bypass graft surgery compared to 1.9 percent in the US.Going by its technology and equipment planning, Narayana Health has added the following as part of its new equipment during 2016-17:

• Da Vinci Surgical Robotic System at MSMC Hospital, Bengaluru. It is used to facilitate complex surgeries, using minimally invasive approach.

• Surgical Operating Microscope with vascular and tumor fluorescence, Model Pentero 900, Make Carl Zeiss for SRCCNH Hospital, Mumbai.

• Low radiation biplane Cath lab system at SRCC Hospital, Mumbai. This will greatly help safety and efficiency of pediatric catheterization.

• A new 128 Slice CT scanner at Jaipur Hospital and SRCC Mumbai each to upgrade the diagnostic services to the next level.

• Installed digital LINAC Accelerator at NSH Howrah to treat cancer patients with external beam radiation technology.With all the latest technology and equipment in place and costs of procedures being minimal, Narayana Health reports a total comprehensive income of rupees 830 million and an increase of 314.5% over the years 2015-16.

Question 1: About how many people in India required heart surgery in the early 2000s?

Select one:

a. 5 million

b. 2.4 million

c. 3.6 million

d. 1 million

Question 2

Advancements in technology have what benefits for hospitals?

Select one:

a. They simplify complex procedures and reduce risk

b. They speed up the treatment of diseases

c. They attract international patients

d. They reduce probability of humar errors in diagnosis

Question 3

How can technology help surgeons?

Select one:

a. Technology helps surgeons quickly develop expertise and work towards better patient outcomes

b. It helps minimize the cost of surgery

c. Sugeons can earn more per operation

d. None of the above

Question 4

How does telemedicine help to reduce cost of medical care?

Select one:

a. Medical experts are able to connect to patients virtually and help them

b. “Actual physical travel of patients and doctors is avoided, thus leading to cost savings”

c. Diagnosis can be done virtually by sharing of reports online

d. All of the above

Question 5

How has Narayana Health benefitted with the correct use of technology?

Select one:

a. It has seen an increase in the incidence of heart disease in India

b. “It has achieved savings through the smart use of equipment and telemedicine,”

c. It is able to treat more international patients

d. It is aiming for lower standards of patient care.

Question 6

What are some ways in which technology has become embedded into hospital structure?

Select one:

a. Telemedicine

b. Hospital Management Systems

c. Imaging equipment like MRIs

d. All of the above

Question 7

What are the challenges of implementing advanced technology is hospitals?

Select one:

a. Patient data is likely to get compromised

b. healthcare workers are more focused on technology and less on patient care

c. Healthcare workers may resist the new processes and refuse to learn how to handle the new technology

d. “Patients face problems, as they have less faith on technology”

Question 8

What has Narayana Health used to connect about 800 hospitals globally?

Select one:

a. Branding

b. Web technology

c. Telemedicine

d. OTC treatment

Question 9

What was the percentage of increase in the comprehensive income of Narayana Health over the years 2015-16?

Select one:

a. 388%

b. 100%

c. 314.50%

d. 50%

Question 10

Why is operational efficiency of paramount importance for a hospital?

Select one:

a. So that all equipment is utilized to the maximum

b. It reduces expenses and helps provide better patient care

c. So that the time spent by healthcare workers is more productive

d. It helps in better planning for patients diagnosis and treatment

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MODULE IV : TECHNOLOGY PLANNING

Pharmacy is the health care service that comprises art, practice and profession of choosing, preparing, storing, compounding and dispensing medicine and medical devices, advising healthcare professional and patients on their safe, effective and efficient use.

The key components of physical planning of a hospital pharmacy include –

•         Location

•         Size

•         Lighting

•         Storage Area

•         Prescription Area

Location of a hospital pharmacy is ideally on the ground floor of the hospital with storage preferably in the basement. The pharmacy should be readily accessible from the elevator and all areas of the hospital. Every hospital pharmacy should have a separate OPD unit to serve OPD patients. This can ideally be done by having a window access facing outwards for OPD patients and OTC prescription customers, while the main opening could be faced within the hospital facility.

The essential constituents of various areas in a pharmacy include – storage cabinets, standard counters, glass storage shelves, sectional drawer cabinets, cupboards, desk, computer, telephone, list of available drugs and information board.

WHO states that the doctor-population ratio in India is about 1:1218. People appear to rely on alternative health-care professionals, chemists, traditional medicine practitioners, faith healers, etc. to meet their health needs and reduce personal costs. Pharmacists play a crucial role in health care in the community.

With the physical requirements being on one side, a pharmacy can effectively run only in the presence of a qualified pharmacist. The pharmacist working within a hospital pharmacy should be responsible for effective dispensing of drugs. Thorough checking of prescription details should be done in order to avoid dispensing errors.

In a cross-sectional study conducted in Bengaluru in 2016, it was seen that about 19% of pharmacists check for all particulars on the prescription, like patient particulars, date of prescription, drug name, drug dose, frequency, signature of the doctor and registration number of the doctor, before dispensing drugs. The study also showed that the most commonly dispensed OTC drugs were analgesics, contributing to about 90% of all drugs being dispensed. Drugs like antipyretics, antihistamines, antacids follow with 68%, 49% and 46% respectively. Dispensing of drugs without prescription appeared to be common in residential areas compared to commercial areas.

Proper storage and timely discarding of drugs should be done in order to ensure patient safety and drug efficacy. In the study, it was seen that 97% of pharmacies had a refrigerator but 31% of these did not have a power back-up. With frequent power cuts in India, the drugs that are meant to be stored in cool temperatures will be exposed to temperature fluctuations without a power back-up, putting the efficacy of the drug and patient safety at risk. It was also revealed through the study that 62% pharmacies conducted a check for nearing expiry drugs on a monthly basis.

When functioning within a hospital, pharmacy is a major contributing factor towards patient health and safety. As most of the inmates of the hospital depend on the in-house pharmacy for medications, it becomes the responsibility of the pharmacist to dispense drugs with minimal or no errors at all.

Question 1: Does a hospital pharmacy serve only the admitted patients?

Select one:

a. “No, it serves OPD patients as well.”

b. “Yes, that is why a hospital pharmacy is set up”

c. “Yes, a hospital pharmacy serves only patients who undergo surgery”

d. Hospital pharmacy only provides the medicines as ordered by doctors in particular wards; it does not sell directly to patients.

Question 2

Effective dispersal of drugs can be done when:

Select one:

a. The pharmacist checks the expiry date on the drugs he is dispensing

b. The pharmacist checks the prescription thoroughly before dispersing

c. “Drugs are stored safely in the pharmacy, in dry and cool conditions”

d. All of the above

Question 3

The essential parts of a pharmacy are:

Select one:

a. storage cabinets

b. multiple dispersal counters

c. Information about available drugs

d. All of the above

Question 4

What kind of dispensing errors might occur in a pharmacy?

Select one:

a. Fake prescriptions may be fil;led up if the pharmacist does not check the prescription details carefully

b. “Wrong medicine with a similar name, or a wrong dosage may be dispersed”

c. Medicines that are beyond the expiry date may be issued to patients

d. All of the above

Question 5

What percent of antacids were dispensed by pharmacists without a prescription?

Select one:

a. 68%

b. 46%

c. 49%

d. 74%

Question 6

What role do pharmacists play in the Indian healthcare sector?

Select one:

a. They do not play any part in healthcare sector other than dispensing medicines at the pharmacy

b. “They are informal prescribers of medicines for small ailments, as healthcare is expensive in India”

c. They provide regular medical advice in the absence of a doctor

d. People repy more on pharmacists than on a MBBS doctor

Question 7

Where does dispensing of drugs without prescription appear to be common?

Select one:

a. Residential areas

b. Commercial areas

c. Medical camps

d. Hospitals

Question 8

Which of the following is NOT a key component of the physical planning of a hospital pharmacy?

Select one:

a. Location

b. HVAC

c. Lighting

d. Size

Question 9

Which of these are most commonly dispensed without a prescription?

Select one:

a. Antacids

b. Antipyretics

c. Analgesics

d. Antihistamines

Question 10

Which of these is an ideal location of a hospital pharmacy?

Select one:

a. First floor

b. Ground floor

c. Cellar

d. Outside the building

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MODULE V : STRATEGIC PLANNING

Knowledge management, established as a discipline in 1991, is defined as the process of capturing, developing, sharing, and effectively using knowledge. Knowledge management efforts typically concentrate on strategic objectives such as improved performance, competitive advantage, innovation, the sharing of lessons learned, integration, and continuous improvement. Knowledge management it facilitates decision making, stimulates innovation and helps learn from past experiences. A proficient integrated healthcare knowledge management information system (HKMIS) is used in many countries to manage this information. A perfect HKMIS is a triad of three disciplines — Medicine, ICT, and Management.

National Health Management Information Systems (HMIS) was developed by Ministry of Health, Government of Pakistan, in collaboration with the provincial healthcare departments and international agencies during 1990-93 and HMIS was institutionalized in all the provincial healthcare headquarters of the country. Despite all the efforts, this system was not working to its full potential and some of the challenges faced were:

• Reports generated by the facility based HMIS received low priority

• Poor monitoring

• Facility staff looked upon HMIS as an additional workload

Additionally, the scope was limited to the Primary Level healthcare facilities and no data from inpatient/hospital, private care facilities or from the health facilities other than Provincial Health Departments were captured.

A SWOT analysis was done on HKMIS deployed in two public sector healthcare organizations of Pakistan. Hospital A had 1025 healthcare professionals with a total count of 1800 employees in 36 departments. Hospital B had 1225 healthcare professionals with a total count of 2100 employees in 32 departments, with in-patients (A>30000, B>25000 per year) and out-patients (A>1000000, B>900000 per year). Data was collected through various methods, including interviews. Some of the questions revolved around understanding among staff regarding terminologies like knowledge management, HKMIS, and the role, importance and benefits of technology in hospitals, weaknesses of existing HKMIS, opportunities and strategies to improve existing HKMIS and salient threats faced by HKIMS.

Strengths included betterment in:

• Provision of health care services

• Data maintenance and medical errors

• Data storage

• Confidentiality of sensitive information

• Fast communication between stakeholders

• Cost savings

• Access to accurate and relative information

• Productivity of end users

• Availability of timely data and reduced possibility of data loss

• Paperless environment

• Quality and originality of documentation and reporting

Weaknesses included a lack of

• Top management commitment and seriousness

• Competent staff

• Specific and professional training programs

• Professional reporting structure

• E-health services

• Access to internet and collaborative tools/applications

• Interest and professional ethics in learning new systems

• Proper recording of healthcare data

• Accountability and transparency

• Sufficient hardware and software maintenance staff

• Motivation or reward criteria

• Interoperability between service providers and increased costs of IT adoption

Opportunities included improvements in:

• Reporting and data presentation capabilities

• Quality of healthcare services

• Effective and efficient resources utilization procedures

• Support for knowledge management and decision making

• Patients trust and satisfaction

• Human resource management

• Proactive healthcare practices

• Costing and budget analysis for enhanced funds utilization

• Allocation of resources for supporting IT infrastructure

• Unification and integration of Public and Private sector health records

• Training programs and facilities, public awareness and community support programs.

Threats:

• Ineffective and inefficient governance

• High staff turnover rate due to political interventions

• Undue transfers and postings of professional staff

• Patients perceptions on privacy and confidentiality of health data

• Load shedding and electrical surges

• Rapid changes in technology and IT systems

• Unreliable and unrealistic system and reporting requirements

• Data under security and hacking threats

• End users resistance to systems change and implementation

The SWOT analysis brought many external and internal factors to light. Definite steps can be taken to use HKMIS to its full potential and reap its benefits by exploring the opportunities and mitigating the effects of recognized weaknesses and threats, leading to improved quality of care.

Question 1: ” .. is an excellent tool to use in order to identify a performance goal for improvement, identify partners who have accomplished these goals and identify applicable practices to incorporate into a redesign effort.”

Select one:

a. Benchmarking

b. SWOT analysis

c. Balance Scorecard

d. Gap/Capability Analysis

Question 2

A perfect HKMIS is a mix of

Select one:

a. Medicine and ICT

b. ICT and Management

c. “Medicine, ICT and Management”

d. Medicine and Management

Question 3

How did the case study help in the use of HKMIS?

Select one:

a. It gave a list of areas of improvement and the strengths of the HKMIS program

b. It helped build a willingness to implement HKMIS

c. The threats to HKMIS imlementation showed the futility of implementing it

d. None of the above

Question 4

It’sessential for a hospital to take into account the existing organizational structure as well as external factors to determine where it needs to improve its performance or where it needs to focus.

Select one:

a. Sometimes

b. Always

c. Depends on circumstances

d. No

Question 5

Knowledge management efforts typically concentrate on

Select one:

a. improved performance

b. Competitive advantage

c. innovation

d. All of the Above

Question 6

Strategic planning enables an organization to

Select one:

a. Plan its future in an orderly and systematic way

b. ensures that a hospital remains relevant and responsive to patient and community needs

c. Maintain the salaries of its employees at good levels

d. All of the Above

Question 7

What was the outcome of the SWOT analysis?

Select one:

a. Recognised Gaps

b. Discovered Opportunities

c. List Strengths

d. All of the Above

Question 8

Which methods help identify weaknesses in the system

Select one:

a. SWOT Analysis

b. Gap Analysis

c. Both of the above

d. Benchmarking

Question 9

Which tool gives direction to an organization’s future?

Select one:

a. SWOT Analysis

b. Benchmarking

c. Market Analysis

d. All of the above

Question 10

Why was the SWOT analysis done at the public sector hospitals?

Select one:

a. Poor monitoring

b. No data from patner hospitals

c. facility staff looked upon HMIS as an additional workload

d. All of the Above

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ASSIGNMENT 2

In January 2001, a great many hospital buildings across Gujarat were affected during a catastrophic earthquake. Hospital facilities were housed in seismically vulnerable structures and were badly damaged or destroyed. About 167,000 persons were injured and needed immediate medical attention. Emergency medical response was seriously affected and the existing healthcare system in most of the affected regions failed when it was needed most. The widespread damage to hospital buildings and other structures also resulted in significant loss of medicines, supplies, and other medical equipment.

Among the buildings destroyed was the 281-bed Civil Hospital of Bhuj, the largest hospital of the Kachchh district, designated as referral hospital to treat the medical needs of about 1 million people. Collapse of the hospital building killed 172 people (including doctors and para-medical staff) and disrupted all medical services.

One of the lessons learned were that the infrastructure of health care facilities must be earthquake resistant. The new 300-bed hospital, designed with assistance from New Zealand earthquake engineering and completed in 2003, was fitted with a lead-rubber base-isolation system. The 280 lead-rubber bearings were part of the building’s foundations, allowing the structure to remain virtually stationary during an earthquake. The new 30,000m²-hospital was the first building in India to be fitted with the technology and is reputed to be able to withstand a force 10 tremor on the Richter scale.

In the aftermath, the National Disaster Management Authority (NDMA), the Government has formulated comprehensive National Disaster Management Guidelines: Hospital Safety (February 2016). A key objective is to ensure structural safety of hospitals (especially of critical facilities). The provisions laid down are the minimum required standards that shall be adhered to by all healthcare facilities and address both internal and external disasters that are likely to affect hospitals.

The guidelines observe that it is not simply the structural resilience but also operational resilience of hospitals that needs to be addressed. The February 2016 guidelines on Hospital Safety were therefore developed with the vision that all hospitals in India will be structurally and functionally safer from disasters. The usual reason for hospitals being put out of service during emergencies is functional collapse wherein elements that allow a hospital to operate on a day-to-day basis are unable to perform during emergency. These include labs, operating theatres, medical records, medical services, and the administrative process, etc.

The structural components of a healthcare facility comprise the design of buildings, resilience of material used etc. are. The guidelines on structural safety have noted that the Base Isolation System is an expensive technology option, though it is effective to counter the ill-effects of a strong earthquake.  The guidelines provide that it may be adopted in important hospitals in seismic zones IV and V, and shall be adopted only when the safety of the hospital building is established by 1) Analytical methods (recommended in the guidelines) and 2) Full scale experimental testing of the base-isolation devices demonstrating that they are capable of resisting expected strong earthquake shaking.

It has also been found that making new hospitals and health facilities safer from disasters is not costly and incorporating mitigation measures into the design and construction of new hospitals accounts for less than 4 percent of the total investment. On the other hand, retrofitting hospital structures is a time-consuming and lengthy process.

The following structural systems have been prohibited for use in new hospitals: 1) Flat-slab buildings, with or without structural walls 2) Pre-stressed floor systems 3) Precast constructions (with natural or man-made materials), in part or whole of the structure 4) Pre-engineered structures in part of the whole of the structure 5) Large cantilever structures and long span structures and 6) Unreinforced masonry buildings.

Structural Elements of all new hospital structures shall be made of Reinforced Concrete and/or Structural Steel, except for structures in seismic zone II, where Reinforced Masonry may be used. Structural Walls shall be made of Reinforced Concrete (RC) and provided in select bays running through the full height of the building, irrespective of choice of material of the basic structural system adopted for the hospital, namely RC or Structural Steel. Structural walls made of steel plates or timber may be allowed in the construction of hospitals only in Seismic Zone II. Even then, safety of such hospital buildings with steel plate or timber structural walls shall be established by a) analytical methods and b) full-scale experimental testing of structural walls.

The provisions are applicable to all healthcare facilities in the government sector and their equivalent counterparts in the private sector. Smaller facilities may choose to adapt relevant sections of the guidelines as per their context and local conditions.

Question 1: Precast constructions

Select one:

a. may be adopted only in new buildings

b. are prohibited in new buildings

c. may be adopted is seismic zone II

d. may be adopted only after full-scale experimental testing

Question 2

Reinforced masonry

Select one:

a. may be used only in new buildings

b. is prohibited in new buildings

c. may be used in seismic zone II

d. may be adopted only after full-scale experimental testing

Question 3

Retrofitting hospital structures to make them safe during a disaster

Select one:

a. is a less expensive option than building a new hospital based on the new structural recommendations

b. accounts for less than 4 percent of the total investment of a new hospital

c. is costlier and time-consuming

d. is prohibited

Question 4

Structural walls in hospitals shall be made of

Select one:

a. reinforced concrete (RC) and/or structural steel

b. steel plates or timber if safety has been established

c. “unreinforced masonry, if safety has been established by full-scale experimental testing “

d. none of these

Question 5

Structural walls made of steel plates or timber may be allowed in

Select one:

a. the construction of hospitals only in Seismic Zone II

b. Retrofitting of existing hospitals

c. Government hospitals

d. Private hospitals

Question 6

The following structural systems are recommended in new hospitals

Select one:

a. pre-stressed floor systems

b. pre-engineered structures in part of the whole of the structure

c. flat-slab buildings

d. reinforced concrete

Question 7

The NDMA guidelines (2016) provide that lead-rubber base isolation systems:

Select one:

a. Are prohibited in new buildings

b. May be adopted in seismic zones IV and V

c. May be adopted only in seismic zone II

d. Are permissible only where existing buildings require structural changes

Question 8

The NDMA guidelines address

Select one:

a. earthquake-resistance only

b. fire-resistance and non-structural vulnerabilities only

c. external disasters only

d. both external and internal disasters

Question 9

The NDMA guidelines are not applicable to hospitals in:

Select one:

a. the government sector

b. the private sector

c. smaller facilities

d. hospitals not in seismic zones

Question 10

The overall safety of a health facility is determined by:

Select one:

a. “structural elements, eg. building design, etc”

b. “non-structural elements, eg, architectural finishes inside, equipment, etc”

c. both structural and non-structural elements

d. earthquake-resistance and fire resistance

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Hospital Functions and Services (EDL 340)

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MODULE I : HOSPITAL FUNCTIONS AND SERVICES

“The mortality rate for patients treated at teaching hospitals is 25 percent lower than that of patients in regular hospitals,” reports an extensive study published in the New England Journal of Medicine. Likewise, the American Journal of Obstetrics & Gynecology states in one of its studies that there is no increased risk for negative outcomes in surgeries performed by residents, except for a slightly prolonged operative time. According to a data analysis published in the Journal of Maternal-Fetal and Neonatal Medicine, the risk of rectal injuries was present following labor and delivery regardless of operator status. This study, involving over 17,000 women, showed that the complications of labor and delivery did not increase if the patient was treated by a resident instead of an attending physician. The findings published in Surgical Laparoscopy & Endoscopy have drawn similar conclusions, noting that resident surgeons did not pose a threat to safety of patients. While most patients consider resident involvement a risk to surgery at teaching hospitals, many medical professionals claim residents to be extremely beneficial. Vascular Surgeon, Jon Schellack has been working with surgical residents for 25 years. According to him, a better environment is created for patients and doctors through the residency program. “The medical students and the residents are very inquisitive, always looking up the patient’s problem, diagnosing, researching, challenging me and asking me questions,” he says. Stephen Yang, a professor of surgery and oncology at the Johns Hopkins University School of Medicine, in his paper published in 2008, states that the mortality rates were low and complications were lesser at teaching hospitals. Jarret Brashear, a third-year general surgery resident, says he has never had a patient reject his care because he was a resident. He adds that the residents are always supervised when performing procedures, and patient safety is the priority. Philip Young, a gynecologic surgeon and clinical professor of reproductive medicine at the University of California-San Diego School of Medicine says that a good private hospital will provide the same care as a good teaching hospital, except a teaching hospital has more resources and is better at taking care of oddball things. As per the US New Best Hospitals 2014-15, the top five hospitals in the U.S. were Mayo Clinic, Massachusetts General Hospital, Johns Hopkins, Cleveland Clinic and UCLA Medical Center. All of these hospitals were the ones that had surgical residency programs. In a study that evaluated over 1.5 million patients, a 10 percent reduced risk of mortality was seen in teaching hospitals for the three most common health problems like heart attack, heart failure and pneumonia. Professor of surgery at Harvard Medical School and vice president of the Massachusetts General Hospital for Quality and Safety, David Shahian, who evaluated the outcomes of these 1.5 million patients says, “Residents are qualified medical doctors and every teaching hospital has professional doctors constantly available.” Through the studies conducted globally, it can be noted that teaching hospitals have better care facilities and services. It is evident through these studies that resident surgeons pay close attention to patient safety and are effective at their procedures of patient handling. Talking about the quality of care in teaching hospitals, Shahian says “training of residents is much more closely supervised than it was decades ago.” Resident involvement always adds to the quality of care, he adds.

Question 1: “According to the article, what is less at teaching hospitals?”

Select one:

a. Patient care

b. Mortality and complications

c. Facilities and equipment

d. Resident doctor performance

Question 2

“In a hospital, the highest risk of martality of patients is due to:”

Select one:

a. hospital acquired infections

b. incomepetence of doctors

c. “heart attack, heart failure and pneumonia”

d. All of the above

Question 3

“While performing any medical procedure, the highest priority is:”

Select one:

a. Teaching the procedure to resident doctors

b. Reducing the time and money involved in the procedure

c. Patient safety

d. All of the above

Question 4

How is patient safety ensured in a teaching hospital?

Select one:

a. “Resident doctors are always supervised, so scope of errors is reduced”

b. “Medical students and residents are very inquisitive, and so thoroughly understand the patient’s problems to provide the best care”

c. “Teaching hospital has more resources available, so issues can be taken care of quickly”

d. All of the above

Question 5

Many studies conducted across the globe have shown that teaching hospitals

Select one:

a. are not fulfilling the need they were designed for.

b. have higher rates of patient mortality.

c. have more doctors than requiured.

d. have better care facilities and services

Question 6

Supervision of resident doctors in a teaching hospital:

Select one:

a. is not required.

b. is more closely supervised that a few years ago.

c. is done by the peer group

d. is a rule.

Question 7

The top rated 5 hospitals in the USA are all:

Select one:

a. teaching hospitals.

b. private hospitals.

c. inaccessible to common man.

d. ones with t he best equipment and resources

Question 8

What advantages does a teaching hospital provide to resident doctors?

Select one:

a. “Resident doctors are able to take care of several patients with different complaints, and thus are prepared to handle any disease condition effectively”

b. Resident doctors are allowed to handle all complicated and emergency cases

c. Resident doctors are available 24/7 in a teaching hospital

d. There are no specific advantages

Question 9

Why is it beneficial to have resident doctors present during a surgery?

Select one:

a. They will be able to learn effectively

b. Patient priority is taken care of

c. resident surgeons pay close attention to patient safety and are effective at procedures of patient handling.

d. All of the above

Question 10

Why would a patient refuse to get treated by a specific doctor?

Select one:

a. “If the patients feel that the doctor is not competent enough, they may refuse to allow that doctor to treat them”

b. Patients cannot refuse the services of any doctor

c. Patients prefer to go to doctors referred by their family and friends.

d. None of the above

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MODULE II : CLINICAL SERVICES

Emergency services, across the globe, play a significant role in saving lives of patients who need urgent medical assistance. Emergency Medical Services (EMS) took off in India in the year 2005, before which ad-hoc emergency providers were the hospitals and their respective taxis. This service, otherwise known as the “108 Ambulance Service Project” is aimed to ensure emergency care to the rural as well as urban India. Starting then, there has been much effort in building various services to minimize life risk during accidents. Various policies have been coming up, ideas kept pouring in and strategies are being laid by the government as well as the private healthcare providers to attend to emergencies and save lives.

In one such effort, the Tamil Nadu government has installed an app-based system in ambulances to reach any emergency within a set time of 3 minutes. This feature announced by the Tamil Nadu Health Systems Project (TNHSP) officials, will work like the app-centered system used by cab aggregators like Ola and Uber. With the help of this app, the ambulances can track the accident spot in no time and thereby reduce the average response time.

In a similar approach, Telangana Chief Minister K. Chandrasekhar Rao launched a unique Bike Ambulance Service in early 2018. This service is aimed at providing services at the accident spot itself. Mr. Rao flagged off 50 bike ambulances, in an effort to allow services to reach the victims faster through narrow routes. The Telangana government is also ready to increase the budget for the medical and health in its next budget session. “Apart from giving better education and good health services to the poor, there is no other priority,” said the CM as he talked of the plans and priorities for the state.

In another advancement brought across by a startup company in Vishakapatnam, an Internet of Things (IoT) device is all set to be installed in some of the major traffic junctions across the city. This device is a first of its kind system that creates geo-fencing to identify any ambulance within 500 meters radius from the traffic signals and triggers an alert in the traffic junction box to turn the lights green to allow the ambulance to pass through. Greenline Labs of Visakhapatnam, the startup that brought across this idea, has created a technology called Emergency Response Automation (ERA) to create the geo-fencing.

With many such efforts being made to make emergency services quickly available for victims of accidents, there is surely going to be an improvement in emergency care in India. Traffic has so far been identified as the major setback in making ambulance and emergency services reach within the stipulated time, leading to loss of many lives. Such approaches to minimize the reach-time of ambulances are sure to bring emergency services within closer reach for accident victims and aid in saving lives, given that the quality of treatment is maintained.

Question 1: “In case of an accident occurring, what should the onlookers do?”

Select one:

a. Call a taxi or autorickshaw and transport victim to the nearest hospital

b. Call 108 or alternate number for an ambulance

c. Call the police and let them handle everything

d. Do nothing

Question 2

“Recently, a bike-ambulance service was launched. In which state was this launched?”

Select one:

a. Telangana

b. Tamilnadu

c. Karnataka

d. Delhi

Question 3

Emergency Medical Services (EMS) is otherwise known as ______ in India.

Select one:

a. Bike Ambulance Service

b. Emergency Response Automation (ERA)

c. 108-Ambulance Service

d. Geo-Fencing Services

Question 4

How can digital technology help in EMS?

Select one:

a. Several apps can be developed to help in emergency medical services

b. Technology helps the government in tracking the services

c. Tracking of patients is easier using technology

d. Technology has no role to play in emergency services

Question 5

What challenges does an emergency medical service provider face?

Select one:

a. “Locating the patient becomes a challenge, due to haphazard city planning”

b. “Coverage of area for ambulance services is limited, keeping in mind the size of India”

c. Bad road conditions and traffic slow down the ambulances.

d. All of the above

Question 6

What is the importance of ambulance services?

Select one:

a. Ambulances are used to transport patients from one place to another

b. Hospitals can get more number of patients when they run an ambulance service

c. “Ambulance has medically trained personnel who can immediately start treatment of patients in emergency situations, while transporting them to hospitals”

d. Ambulance services are not necessary

Question 7

What is the logic in fitting ambulances with app-based systems?

Select one:

a. Apps are not required to be installed for ambulances

b. Apps can help the ambulance to be located by the hospital

c. It sounds hi-tech

d. App-based systems help the ambulances navigate the routes better and reach the patient quickly

Question 8

Which of the given statements is false?

Select one:

a. “The Emergency Medical Services in India run under the name “”108″” in most Indian cities.”

b. Rural areas do not require provisions for emergency medical care

c. The Indian government and some provate firms are making efforts to improve emergency medical services in the country.

d. Several digital technologies are being used to improve the emergency medical services provided to patients

Question 9

Which of the given statements is true?

Select one:

a. Emergency Medical Services can be a substitute for providing first aid to accident victims

b. Ambulance services are only run by corporate hospitals

c. Emergency medical services provide first aid to patients in emergency situations and ensure they get appropriate medical treatment at the earliest

d. Emergency medical services work only in urban areas

Question 10

Why is speed a necessity for an ambulance?

Select one:

a. “Ambulances have to typically travel long distances, thusm they need to be fast”

b. There is no deendancy on speed in operating an ambulance

c. “Due to bad road conditions and traffic, ambulances cannot travel fast.”

d. “Am ambulance needs to reach the patient in time, so that treatment can start immediately”

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MODULE III: CLINICAL SUPPORT SERVICES

Established in the year 1983, Apollo Hospitals is Asia’s largest healthcare group and India’s first corporate hospital. Ever since its entry into the private healthcare sector, Apollo Hospitals has ventured into diverse platforms of the healthcare ecosystem, which includes hospitals, pharmacies, primary care, and diagnostics. Besides these mainline services, Apollo Hospitals has its significant presence in health insurance services, medical colleges, e-learning, nursing, hospital management, and research foundation, among others.Apollo Pharmacy, a part of Apollo Hospitals, is the first and the largest branded pharmacy network in India. The company had about 2,742 outlets by the end of September 30, 2017, and has accelerated its expansions to reach the target of 3,000 stores by mid-2018. Its International Quality Certification, the genuineness of medicines, round-the-clock operations, 24×7 customer support and over 400 self-branded products are a few of its notable qualities. The online portal of Apollo Pharmacy, www.apollopharmacy.in, has more than 4000 products in widespread categories like OTC medicines, baby care, personal care, health foods, vitamins and supplements, etc. The retail outlets are well-stocked with medicines, OTC drugs, and FMCG products. The outlets are equipped with computerized systems and competent pharmacists. Providing the ease of shopping to its customers, Apollo Pharmacy features online ordering and home delivery options for a wide range of OTC and FMCG products. It also features an option to upload prescriptions to order prescription medicines.The nationwide distributors of Patanjali Ayurved, the Pittie Group, recently announced its distribution arrangement with Apollo Pharmacy. With this move, the latter group will ensure the availability of the Patanjali products across all the Apollo Pharmacy stores in the country. “This tie-up with Apollo pharmacy will enhance the reach of Patanjali. It is another step towards our mission of providing high-quality products to every Indian consumer,” said Aditya Pittie, CEO of Pittie Group.The logistics unit of Flipkart, called Ekart, has also tied-up with over 300 outlets of Apollo Pharmacy. Ekart will use these outlets to drop-off shipments to be picked up by the customers. These pick-up points will be displayed to the customer while he places the order. The ordered products will be delivered to the Apollo Pharmacy outlet by the Ekart delivery personnel, after which the customer is alerted with a four-digit pin to pick up the product. The receiving store of Apollo Pharmacy keeps the shipment for five days, after which it returns the product upon pick-up failure. An undisclosed amount will be paid to Apollo by Ekart for keeping these shipments.With healthcare being the need of the hour, Apollo is sure to take its services ahead to match the rising demands and improve its reach further.

Question 1: ABC VED matrix helps a pharmacy to:

Select one:

a. Categorize the drugs in the pharmacy

b. Have a proper control over its supplies

c. Meet the drug requirements of the hospital

d. Monitor the exact usage of the drugs and quantities

Question 2

Apollo Pharmacy provides which of the following features to its customers?

Select one:

a. Online ordering of medicines

b. Home delivery of medicines

c. 24/7 operations

d. All of the above

Question 3

Apollo Pharmacy sells What type of products?

Select one:

a. Critical drugs

b. General and medical supplies

c. “OTC drugs, medicines and FMCG personal care products”

d. All of the above

Question 4

Inventory control in the pharmacy is very important because:

Select one:

a. It is a major portion of the hospital’s annual budget

b. Hospitals need to keep a tight control on the pharmacy

c. Hospitals need to monitor each and every drug usage

d. None of the above

Question 5

Non-availability of which of the following would immediately affect the operation of a hospital?

Select one:

a. Essential items

b. Vital drugs

c. Desirable items

d. Emergency drugs

Question 6

Pittie Group is the nationwide distributors of:

Select one:

a. Patanjali Ayurved

b. Flipkart

c. Apollo Pharmacy

d. FMCG Products

Question 7

Products sold by Patanjali can be classified under which category?

Select one:

a. Essential items

b. Vital drugs

c. Desirable items

d. Emergency drugs

Question 8

The largest branded pharmacy in India is:

Select one:

a. Patanjali Ayurved

b. Pittie Group

c. Apollo Pharmacy

d. Apollo group

Question 9

Why is a good pharmacy important for a hospital?

Select one:

a. “A pharmacy purchases, stores, and distributes drugs, medicinal preparations and chemicals to patients”

b. Tracking of all medications is possible

c. It is possible to investigate pharmaceutical problems arising in the use of medications

d. All of the above

Question 10

Why is Apollo Pharmacy is tying up with other distributors like Patanjali?

Select one:

a. To improve its market presence

b. To reach a greater number of customers and improve its brand identity

c. To gain goodwill in the market

d. To avoid competition

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MODULE IV : ANCILLARY SUPPORT SERVICES

The World Health Organization states that 85% of hospital wastes are non-hazardous, 10% are infectious and 5% are non-infectious (but included in hazardous wastes). About 15% to 35% of the total hospital waste generated is considered as infectious waste. These wastes threaten the public since hospitals are situated in the heart of the city. Therefore, medical waste must be disposed of properly. Waste generated in the process of healthcare includes scalpels, blades, hypodermic needles, gloves, clothes, bandages, discarded body fluids, human tissues and organs, PVC products, chemicals and radioactive wastes. Inadequate management of such biomedical waste can be associated with risks to patients, healthcare workers, sanitation workers, communities, the general public and the environment.

The Indian government has recently updated the regulations regarding biomedical waste management in the country, to bring in better processes to manage the various types of biomedical waste generated.

A study was done to observe and assess the proportions and quantities of different constituents of wastes, their handling, storage, treatment and disposal methods in different health-care settings in two different cities: Pune and Bhopal. The study aimed to observe and assess the processing systems for biomedical waste disposal, including the hazards associated, the development of new waste management plans, policies, and protocols, establishing recommended training programs.

Pune is the second largest city in the state of Maharashtra and the eighth largest metropolis in India with a total population of 5,92,00,000 as per 2017 census. The total hospitals in the city are around 1000 that cater to around 3,500 patients daily. As per a study done in June 2011, Pune has a 19.58% share in BMW generated in the state of Maharashtra; a total of 5000-8000kg/day of bio-waste is generated in the city, and this includes corporation run hospitals that generate almost 2,000kg of bio-waste every day. The bio-medical waste is collected from all the hospitals and healthcare facilities in Pune and treated at the Kailas Crematorium plant.

As per the Medical Waste Rules, 1998 Amendment, it is obligatory for all the clinical establishments in the city to get an authorization from the Maharashtra Pollution Control Board (MPCB). Approximately about 1,200 kg biomedical waste is transported every day to towns located over 140 km from Pune. A survey was conducted at ten hospitals from Pune city revealed that more than 55% of the hospital employees are not aware of the adequate collection, handling, and treatment of the biomedical waste. About 45% of owners of the healthcare facility are found to be ignorant, and 62% of respondents do not consider biomedical waste management as a serious issue.

Bhopal: In a study conducted in Bhopal in 2011, of the approximately 245 hospitals in Bhopal city, 32 hospitals are governed by the State Govt., four by the Central Govt., while 209 are private hospitals. Bio-medical waste generated at Central Govt. hospitals is 556 kg/month, State Govt. hospitals is 7937 kg/month and in private hospitals it is 12,224 kg/month.

Safe and effective measures for biomedical waste management are not only a legal necessity but also a social responsibility. There is a need for education as to the hazards associated with improper waste disposal. Lack of concern, awareness, motivation, and high cost factors are some of the problems faced in proper biomedical waste management. A major stymie to the practice of waste disposal is apathy to the concept of waste management. Healthcare providers should always try to reduce the waste generation in their clinic or at the hospital on a day-to-day basis. Proper collection and segregation of bio-medical waste is very important.

Question 1: “As per the Medical Waste Rules, 1998 Amendment, is it necessary for all the clinical establishments in the city to get their authorization?”

Select one:

a. Authorization is not required

b. “Yes, it is obligatory to get the authorization “

c. Authorization is objected

d. None of the above

Question 2

“In cities with large population, the biomedical waste is commonly disposed: “

Select one:

a. To a common biomedical waste treatment plan

b. To a dump yard at the end of the city

c. In any of the open area/plot inside the city

d. In a waste bin within the hospital premises

Question 3

“The development of new waste management plans, policies and protocols helps in”

Select one:

a. Waste of time

b. Not helpful for disposal of wastes

c. Better biomedical waste disposal

d. None of the above

Question 4

About _________ of Hospital waste is considered as infectious waste in hospitals

Select one:

a. 60% to 70%

b. 40% to 50%

c. 15% to 35%

d. None of the above

Question 5

Bio-medical waste means

Select one:

a. “Any waste that is generated during the initial diagnosis, treatment, immunization of human beings or animals “

b. Waste produced during research activities during the production in hospitals and health camps

c. Waste produced at home

d. Both A and B

Question 6

Biomedical waste management rules are established because

Select one:

a. BMW poses a serious health hazard for people and the community

b. The quantity of waste generated is huge

c. There is a lack of concern regarding biomedical waste management

d. Hospitals are unsure of how to dispose of biomedical waste

Question 7

Important steps involved in the management of biomedical waste are:

Select one:

a. Handling

b. Segregation and collection

c. Disposal

d. All of the above

Question 8

Inadequate management of biomedical waste can be associated with

Select one:

a. No risk to healthcare workers

b. “Risk to patients, healthcare workers, sanitation workers, etc.”

c. Risk to the environment

d. Both B and C

Question 9

The problems that are faced in the proper management of hospital waste are:

Select one:

a. Cost factors

b. Lack of concern

c. Lack of motivation

d. All of the above

Question 10

Which of these are most important for safe biomedical waste disposal practices?

Select one:

a. Legal regulations

b. Education and training of healthcare workers regarding safe biomedical waste disposal practices

c. Availability of cost effective waste disposal methods

d. All of the above

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MODULE V : GENERAL SUPPORT SERVICES

In today’s technology-driven world, social media offers a great platform for building brands and marketing. Many industries take the support of Facebook, LinkedIn, Twitter, Pinterest, Google Plus, YouTube, Instagram, etc. Organizations are building a huge fan base on social media, thus leveraging the online platform to increase awareness about their products and services.      

In recent years, the healthcare industry has evolved in terms of its marketing strategies. Digital marketing and online presence have become its new tools. Earlier, online marketing was not a media of choice for many healthcare marketers, as there was a gap in understanding how social media can be integrated into their marketing strategies. Also, their concern about patient privacy and compliance with HIPAA regulations, etc. restricted them from using social media as a marketing platform. However, in recent times healthcare organizations have realized that these obstacles can be conquered easily.

Let us look at a case study about how a hospital utilized social media marketing to its advantage.

Shrikhande Hospital and Research Center is a 20-year-old IVF & Surrogacy center in Nagpur. Well-equipped with the most advanced technology in reproductive medicine, the hospital has a team of experts in Gynecology, Urology, and Embryology. It has 10000 embryo transplants to its credit. The organization wanted to tap into social media marketing and hence approached an expert company ‘Digital Skills’ for the same.

The prime objectives were to enhance the brand reach to netizens across various social media platforms, engage the audience, provide the right information to patients on pages, and drive traffic to the hospital website via social media. However, there were certain challenges. Most physicians think that social media is a waste of time and for practicing doctors direct advertising to promote their services is not feasible. It was challenging to visualize how an IVF & surrogacy center can make use of social media. Also, being a local set-up, the target audience was limited.

Digital Skills then came up with a strategy for better brand presence– build a digital ecosystem and focus on creating brand awareness. The message of good health and various disease prevention measures were posted on the social media, thus creating the image of a health conscious ecosystem. Also, promotions with crisp and engaging content were done on special days, festivals, and events.

The execution included a well-planned calendar for promotions, split into daily and monthly basis for each social media platform. Appropriate messages were created considering the target audience. Engaging updates were posted daily on social media. Special series of updates, contests, etc., were run on select days.

The result was a whopping 446% increase in brand reach. In just four months, the number of likes increased from 400 to 4500. Direct messages were received on Facebook, twitter and LinkedIn pages from patients across the world. There was 300% increase in clinic footfall by driving social media traffic to the website. The hospital was able to establish a self-brand within their peer community.

Question 1: “Earlier, what was the concern of healthcare marketers in using social media”

Select one:

a. Brand reachability

b. Cost

c. Patient’s privacy

d. Ease of use

Question 2

Shrikhande hospital marketed_______________ to the consumers?

Select one:

a. Goods

b. Services

c. Experiences

d. Events

Question 3

Shrikhande hospital opted for ________________ type of media

Select one:

a. Print Media

b. Display marketing

c. Electronic Marketing

d. Direct Selling

Question 4

The content created by Digital Skills on social media was ______________________

Select one:

a. Lengthy

b. engaging

c. non-informative

d. falsified

Question 5

The social media campaign helped in increasing the ______________________

Select one:

a. Brand reach

b. brand visibility

c. both of the above

d. None of the above

Question 6

The ultimate result of the social marketing was _______________

Select one:

a. Increase in footfall

b. decrease in trust

c. less brand awareness

d. all of the above

Question 7

What could the hospital establish within their peer community

Select one:

a. brand association

b. Self-brand

c. both of the above

d. none of the above

Question 8

What did Digital Skills company decided to build ________________________

Select one:

a. hospital

b. digital ecosystem

c. display marketing

d. direct market

Question 9

What was the primary objective of social media marketing for Shrikhande hospital?

Select one:

a. Increasing sales

b. Brand awareness

c. Health education

d. Social service

Question 10

What were the challenges noticed in healthcare digital marketing for Shrikhande?

Select one:

a. Limited local audience

b. Well-equipped

c. Cost

d. no proper guidance

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ASSIGNMENT 2

A study sponsored by the Directorate of Health Services, Government of Madhya Pradesh was conducted at a representative sample of public health facilities in MP to measure patient satisfaction about various components of patient department (OPD) services. One district was identified from each of the 8 administrative divisions in the state. To select OPD patients from each district, a sample of OPD patients were drawn from the public health facilities, i.e., district hospital (DH), civil hospital (CH), community health center (CHC), and primary health center (PHC). One DH, one CH, one CHC and one PHC were identified from each district. Thus, 561 OPD patients (47% male, 53% females) were covered from 32 public health facilities of the state. Of these, 45% belonged to the 16-30 years age group and 6% to the 0-15 year age group.The questionnaire covered information related to patient’s choice of health facility, registration process, perception towards availability of basic amenities, behavior of doctors and other staff, facilities available in pharmacy and dressing room.  Inexpensiveness and good infrastructure was one of the most cited reasons (83%) for choosing the public health facilities. The majority (81%) said that the main source of information about the hospital was family members/relatives. The time taken to reach the hospital was less than 15 minutes for more than half of the respondents (58%). Almost all the respondents did not find any problem in locating the hospital (93%) or locating different departments within the hospital (87%). One of the major reasons for choosing the public health facility was unavailability of other health facilities in the area.Registration counters were reported to be over-crowded by 64% OPD patients. This was observed more at the higher level health facilities (DCs) compared with lower level health facilities (PHCs). However, patients were happy with the behavior of registration clerks at all the facilities. It was found that respondents were more satisfied with the basic amenities such as seating arrangement for the patients and attendants, cleanliness, toilets, and drinking water at higher level facilities, i.e. district and civil hospitals as compared to community health centers and primary health centers. The main reason being the higher level facilities have better infrastructure than the lower health facilities.The sitting arrangements were found adequate by more than half of the respondents (54%) and 71% respondents found hospitals adequately cleaned. Regarding toilet facility, 44% respondents said it was available and clean, but 49% respondents said it was available but dirty. It was observed that the waiting time for OPD patients at the higher level health facilities is longer than the lower level health facilities, because of the high patient load at district and civil hospitals. Most of the patients (78%) at PHCs said that they have to wait less than 10 minutes for the doctor whereas in case of DH, CH and CHC; 54%, 52%, and 51% patients respectively said so. The majority of the patients (above 85%) have observed that doctor’s behavior was good at all the facilities and they also felt that the doctor has given adequate time to see the patients.Data revealed that the patients at lower level health facilities (CHC and PHC) were more satisfied with the queue system at the pharmacy than at the higher level health facilities (DH and CH). Most of the OPD patients also perceived that the behavior of the pharmacist was good particularly at the higher level facilities (DH and CH). Behavior of pharmacist was either good or satisfactory for all the OPD patients. Regarding the quality of drugs, OPD patients were happier at CHC and PHC as compared to DH and CH and the overall response to the quality of drugs was either good (64%) or satisfactory (33%) and only 3% considered it poor.

Question 1: Which of the following were the most cited reasons for which OPD patients chose a particular health facility?

Select one:

a. Inexpensiveness

b. Good infrastructure

c. Dressing room and pharmacy facilities

d. Good reviews

Question 2

Which of the following healthcare facilities comprise India s secondary healthcare?

Select one:

a. Community health center

b. Primary health center

c. District hospital and Civil hospitals

d. Only Civil hospitals

Question 3

Which of the following healthcare facilities comprise India s primary healthcare ecosystem?

Select one:

a. Community health center and primary health center

b. District hospital and Civil hospital

c. Only primary health centers

d. Corporate hospitals

Question 4

Which of the following has been seen to be the highest cause of decreased satisfaction with a hospital?

Select one:

a. Mismatch between patient s expectation and services received

b. Length of waiting list

c. Non-availability of medicines

d. Time given to the patient by doctor

Question 5

Which of the following factors influence choice of hospital?

Select one:

a. Proximity/time taken to reach the hospital

b. Word of mouth recommendations by family and friends

c. Unavailability of other health facilities in the area

d. All of the above

Question 6

The patients at higher level health facilities (DH and CH) were less satisfied on one aspect compared to the outpatients at lover level facilities. This was:

Select one:

a. Behavior of the pharmacist

b. Queue system at pharmacies

c. Quality of drugs

d. None of the above

Question 7

The higher waiting times at higher level facilities (district and civil hospitals) are attributable to?

Select one:

a. Non-availability of doctors

b. Inefficient registration processes

c. High patient load

d. Behavior of registration clerks

Question 8

Public health services can be improved by making them more responsive to people’s needs and expectations.

Select one:

a. TRUE

b. FALSE

c. True only in case of corporate hospitals

d. False in case of government hospitals

Question 9

Customer satisfaction with a hospital is most influenced by:

Select one:

a. Clinical outcomes

b. Non-clinical outcomes

c. Patient expectations

d. Both clinical and non-clinical outcomes

Question 10

“The main source of information about hospitals is through hospital staff, such as pharmacists and hospital clerks.”

Select one:

a. TRUE

b. FALSE

c. True in case of corporate hospitals

d. True in case of small hospitals of 50 beds or less

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