Hospital Administration Diploma Program PDF

DIPLOMA PROGRAMM IN HOSPITAL ADMINISTRATION INTERNATIONAL SCHOOL ----------------OF---------------- SKILL DEVELOPMENT KOCHI– 682033 KERALA, INDIA MODULE – IV A 1 Dear Student, This text book...

DIPLOMA PROGRAMM IN HOSPITAL ADMINISTRATION INTERNATIONAL SCHOOL ----------------OF---------------- SKILL DEVELOPMENT KOCHI– 682033 KERALA, INDIA MODULE – IV A 1 Dear Student, This text book shall be an eye opener into the exciting world of Hospital Administration. This module essentially covers the fundamental concepts and shall be the first climbing step to the higher modules. Academic Department ISSD 2  CONTENT 1 An overview of Health and hospital administration 2 Quality and accreditation 3 Hospital information system -Basic 4 Monitoring and improving patient satisfaction 5 Responsibilities of Hospital administration. 6 Basics of Computer 3  UNIT- 1 AN OVERVIEW OF HEALTH AND HOSPITAL ADMINISTRATION ❖ Meaning of Health Administration Health administration, health care administration, health care management, or hospital management is the field relating to leadership, management, and administration of public health systems, health care systems, hospital and hospital networks in all the primary, secondary and tertiary sectors. Healthcare administrators plan, direct, and coordinate medical and health services for organizations and businesses. As a healthcare administrator, manages the benefits of employees as well as bridges the gap between benefits and physicians. These needs require a broad background in business skills and specialized knowledge of the healthcare field. ❖ Nature, Scope And Significance Of Health Administration Health care administration, also often called health administration and medical administration, involves making both daily and long-term decisions that reflect the healthcare systems' business strategies. Health administration is the practice of managing, leading, overseeing and administering the operation if dynamics, complex health care entities including hospitals, long term care facilities, health care systems, nursing homes, pharmacies and health insurance providers. The importance of health care administration includes helping a facility operate daily, providing programs for the public, training new employees and helping every patient. ❖ Role of Hospital Administration: Hospital Administrators are responsible for organizing and overseeing the health services and daily activities of a hospital or healthcare facility. Healthcare administration is the management of all the non-clinical functions involved in operating a healthcare facility, from day-to-day 4  operations to staffing to budgeting and finance to long-term strategic planning to ensure the success of the healthcare provider or system. ❖ What Is a Healthcare Administrator? Healthcare administrators work behind the scenes to make large-scale decisions for the healthcare facility or institutions. They deal directly with policy and budgets to create better patient experiences and ensure the safety of guests and staff. Healthcare administrators have in-depth knowledge of the regulatory framework in patient care. Their responsibilities are entirely different from the responsibilities of a doctor or physician. While physicians manage patients directly, healthcare administrators oversee the facility itself, and usually have a bachelor's degree or master's degree in healthcare administration. ❖ How to Become a Healthcare Administrator Healthcare administrators regularly interact with doctors, nurses, surgeons, and technicians. They direct the operation of healthcare organizations and rarely meet directly with the patients in the healthcare facility. An administrators' duty is to shape the policy that runs the facility and improve the patients’ experience. Healthcare administration careers are essential to successful and efficient healthcare facilities. Due to the constant need for healthcare facilities, from hospitals to nursing homes, healthcare administration is a vital, stable job for those interested in improving healthcare policy. Healthcare administration may involve the oversight and management of: An entire healthcare system Specific facilities, such as physician’s practices, hospitals, and home health agencies Specific departments or units, such as critical care units, emergency departments, and cardiac care units Specific clinical areas, such as nursing, physical therapy, and cardiology Specific areas, such as staffing, facility administration, admissions, and finances. 5 ❖ Principles Of Health Administration There should be sound National health policy Sound health administrative structure may be designed for the implementation of the health policy There should be integration of preventive and curative services at all administrative levels. There should be centralized directions and decentralized actions. Planned health program should be based on priority and must meet health need of people. Ensure basic health services available, accessible and acceptable to the people. Health consciousness should be fostered through health education and by providing opportunities for participation of people in the health programs. Doctors should be trained to act as social physician as well as to promote healthy living of people. Nursing personnel and other allied health personnel should provide community-oriented education. New categories of health personnel are provided training to provide proper service to people. All the system of medicine must be encouraged to provide decent health care to people. Utilize community resources and encourage local participation in health programs at the village level. There should be provision for staff development programs. ❖ OBJECTIVES To promote awareness of health care among all sections of the people. To promote awareness among functionaries involved in Health and Hospital Management. To promote research in the field of Health and Hospital Management, to improve the efficiency of Health Care delivery Systems. 6  To promote the development of high-quality hospital services and community health care. To promote a forum for the exchange of ideas and information among health and hospital planners, academicians, administrators, various statutory bodies and the public for the improvement of Hospital and Health Care delivery Systems. To develop norms and standards for accreditation of the Health Care Organization and adopt means of evaluation of such institutions, to improve the quality of health care in the community. To provide opportunities for training and research in all aspects of Hospital Services Health Care Delivery System and Health Care Administration. To update the knowledge and skill of the Health & Hospital Administrators and other personnel involved in the management of health care organizations through continuous education and research. To promote and grant recognition to research in the fields of Health and Hospital Management and to grant awards, scholarship and assistance in other suitable forms to meritorious individuals and institutions. To act as Advisory /Consultative Body, in the best interest of community and country, to Central and State Governments, Public Sector Undertakings, Health Care Delivery Organization, Public Health & Health System Development, Teaching and Training Organization and any other Health related allied organization, when need so arises or services are asked for. To help in preparation of SOPs, Manuals, Literature and Books on Health Care Management, Quality & Accreditation, Health Care Technology, Health Care Industry related subjects, Textbooks for Health Management Courses for benefit of the Students & Faculty, Hospital and Health Care Organizations and Academic Institutions. To undertake Professional Consultancy in the field of Health System Management, Quality & Accreditation, Health Technology Assessment, Medical Tourism, Disaster Management, Health Care Delivery Organization, Public Health Facilities & Services for overall improvement of the facilities. To conduct inter hospital/ Institution awards competition on various parameters to bring competitiveness for improving healthcare quality & training. 7  To recognize and felicitate the individuals who have made exceptional and significant contributions in the field of Health and Hospital Management in general and to the Academy in particular. INDICTORS FOR MEASURING IMPACT OF HEALTH CARE ADMINISTRATION Health indicators are quantifiable characteristics of a population which researchers use as supporting evidence for describing the health of a population. Typically, researchers will use a survey methodology to gather information about a population sample, use statistics to generalize the information collected to the entire population, and then use the statistical analysis to make a statement about the health of the population. Health indicators are often used by governments to guide health care policy or to make goals for improving population health. CHARACTERISTICS A health indicator which will be used internationally to describe global health should have the following characteristics: 1. It should be defined in such a way that it can be measured uniformly internationally. 2. It must have statistical validity. 3. The indicator must be data which can feasibly be collected in a reasonable amount of time. 4. The analysis of the data must result in a recommendation on which people can make changes to improve health. ❖ The indicators used to measure health status Indicators (disease specific mortality, morbidity and disability), determinants of health (biological risk factors and health behaviors) and health systems (surgical procedures, medication use, use of health services). 8 ⮚ DEATH RATE Meaning Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time The term mortality refers to the total deaths that occurred particularly on a large scale such as in a population or geographical area. It is usually depicted in the form of mortality rate. According to the mortality rate definition, an index of the number of deaths each year or a specified time interval in a defined population is called mortality rate. It is typically expressed in population units, such as deaths per 1,000 people for a recall period (or specified time frame). Death rate and its measures Calculating a Mortality Rate The mortality rate formula used for the calculations as per the available statistics is: Formula: Mortality Rate = (No of Deaths / Total Population x 1000) / 365 In hospital 1. Gross Mortality rate = Total number of death happened in the hospital in a period/ Total number of death discharges during that period X 100 Note: All the death (including deaths in emergency and ICU) shall be counted. In denominator all type of discharges shall be considered 2. Net mortality rate = Total number of death that happened after 48 hours of admission of the patient/ Total number of death and discharge during that period X 100 Note: Death happening within 48 hours of discharge should also be counted in numerator 9  3. ICU specific Mortality rate= Total number of death in ICU patients in a period/ Total number of patients discharged from ICU in that period X 100 Note: On similar lines, condition specific or specialty specific death rates can also be calculated, such as maternity mortality rate etc. ⮚ INFANT MORTALITY RATE Infant Mortality rate is the number of resident newborns in a specified geographic area (country, state, county, etc.) Dying under one year of age divided by the number of resident live births for the same geographic area (for a specified time, usually a calendar year) and multiplied by 1,000. Calculation: 1. Number of Resident Infant/ Deaths Number of Resident Live Births X 1,000 Examples: 1,300 infant deaths in 2008 among state residents 150,000 live births in 2008 to state residents 1,300/150,000 x 1,000 = 8.7 infant deaths per 1,000 live births in 2008 among state residents In hospital Infant mortality rate = Total number of infant deaths at hospital in a period/ Total number infant discharges and death during that period X 100 ⮚ PREVALENCE OF A DISEASE Prevalence, referred to as prevalence rate, is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period. Prevalence is a measure of disease that allows us to determine a person's likelihood of having a disease. Therefore, the number of prevalent cases is the total number of cases of disease existing in a population. 10 The prevalence is calculated by dividing the number of persons with the disease or condition at a particular time point by the number of individuals examined. PREVALENCE IMPORTANT The prevalence and incidence of a disease are among the most fundamental measures in epidemiology. Prevalence is a measure of the burden of disease in a population in a given location and at a particular time, as represented in a count of the number of people affected. The disease has the highest prevalence Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1 million), and diabetes (2.0 million including kidney disease deaths caused by diabetes). What increases the prevalence of a disease? Prevalence increases when new disease cases are identified (incidence), and prevalence decreases when a patient is either cured or dies Types of prevalence ⮚ Point prevalence: The number of cases of a health event at a certain time. ⮚ Period prevalence: The number of cases of a health event in reference to a period, often 12 months. ⮚ Lifetime prevalence: The number of cases of the health event in reference to the total lifetime. Formula: Point prevalence= Number of cases in a defined population at one point of time /Number of people in a defined population at the same point in time. 11 Uses of prevalence ⮚ Helps to estimate the magnitude of health problem / disease in community. ⮚ Identify potential high-risk population. ⮚ Useful for administrative & planning purposes. Limitation of prevalence ⮚ Can be viewed as a slice through the proportion of population, at point in time. ⮚ Not take into account the duration of disease ⮚ Only answer " who has and who do have" "How many" at present. ⮚ Not answer "When & How likely the disease develop". Be not suit for etiological studies. Factors affecting prevalence Increased by Decreased by ❖ Longer duration of the disease ❖ Shorter duration of the disease. ❖ Prolongation of life of the ❖ High case - fatality rate from patients without cure. disease. ❖ Increased in new cases (increase ❖ Decrease in new cases in incidence) (decrease in incidence) ❖ In-migration of cases. ❖ In - migration of healthy ❖ Out - migration of healthy people. people. ❖ Out- migration of cases ❖ In - migration of susceptible ❖ Improved cure rate of cases. people. ❖ Improved diagnosis facilities (better reporting). 12 ⮚ INCIDENCE Incidence is the number of newly diagnosed cases of a disease. An incidence rate is the number of new cases of a disease divided by the number of persons at risk for the disease. Incidence is an important rate; it is the proportion of people (at risk) who develop disease during a specific time period. Formula: Incidence rate= number of new cases of disease in a given time period/total person time at risk during the follow up period. Three key elements: ⮚ Only new cases included in numerator ⮚ Total population at risk in the denominator ⮚ Time element - period over which new cases developed Two main types of Incidences ⮚ Cumulative Incidence ⮚ Incidence Rate (incidence density) Characteristics of incidence ⮚ Address the question how far the condition is. ⮚ A measure of risk of disease but must be for a specific time period. ⮚ Express the risk of having outcome for the population at risk not for single person. ⮚ Population should be free of disease at the beginning of the study. Use of incidence ⮚ Describes the risk of disease occurrence overtime. ⮚ Useful in planning for preventive measures; as to prepare resources to combat events. ⮚ Compare the risk of the disease between two or more populations. 13 ⮚ Since the incidence rates are affected by any factor and detect the risk factors. Importance of incidence It is helpful: ⮚ In pathogeneses ⮚ To find disease distribution ⮚ To control disease ⮚ In preventive and therapeutic measurements ⮚ In health policies making CHALLENGES OF HEALTH AND HOSPITAL ADMINISTRATION The technological advances in the field of medical sciences have outstripped our social, economic and political policies and have provided the clinicians with newer aids for diagnosis and treating illnesses. Demand from the clinicians as well as the community to provide newer technological capabilities in the hospital and health service system. It has been noted that at least half of the last decades' increase in medical costs is attributable to high technology medicine, particularly diagnostic & surgical procedures. Despite the high cost, the commercial firms and corporate bodies are launching state of the hospital with latest medical technology with economic returns and are proliferating. This proves the increasing level health care awareness among the people and utilization of such services by the people from private sector also. It indicates that there is increasingly more and more dominance by consumer rather than providers or procedures in medical practice Hospital including to provide more and more fragmented services in one discipline or other; rather than a holistic institution of health care with 14 multi-disciplinary medical team like Eye, ENT, General Surgery etc., resulting it to be a profit-oriented business establishment. Patient service challenges Quality care Patient satisfaction New Technology Service Expansion Over Crowding Internal challenges Quality Management Cost containment and financial constraints Leadership Motivation Modern Information Technology Competitive market Power craze Manpower management Technology management Fixed organizational structure External challenges Bio medical Management Regulation Consumer Protection Right to information Legal issues & Ethical factors Public relations Political influence Strategies to meet the challenges ⮚ Technological Advancements ⮚ Power sharing ⮚ Awards and punishment ⮚ Increase Efficiency ⮚ Improve patient safety and care 15 ⮚ Developing Modern Hospital Information system ⮚ Marketing of hospital service ⮚ Leadership Motivation ⮚ Carrier Development ⮚ Reorientation Training for staffs ⮚ Restructuring ⮚ Clear cut responsibilities UNIT -2 QUALITY MANAGEMENT ❖ What Is Quality? To the ordinary person, quality is how good something is. This may be a service e.g. canteen service or a product eg. wrist watch. A person's judgement about a service or product depends on what he expects of it or from it. Some of the words used to describe quality are: Beautiful or attractive Durable Meeting standards Healthy Value for money Although different words are used to explain quality, we would define it as the extent to which a product or service satisfies a person or a group i.e. how much satisfaction the person gets from the service. ❖ What is Quality of Care? When we say quality of care, we mean healthcare activities that we in the medical, nursing, laboratory fields etc. perform daily to benefit our patients without causing harm to them. Quality of Care demands that we pay attention to the needs of patients and clients. We also have to use methods that have been tested to be safe, affordable and can reduce deaths, illness and disability. Furthermore, we are expected to practice 16 according to set standards as laid down by clinical guidelines and protocols. With Quality of Care we do the right things at the right time. We see to patients promptly, make the right diagnosis and give the right treatment. With quality of care we keep on improving on our standard of services till excellence is attained. Components of Quality Health Services Quality health service has several parts. We need to understand these in order to improve quality of care. The parts are listed in the box below. We shall look briefly at each of the parts. Access Technical competence Equity Effectiveness Efficiency Continuity Safety Interpersonal Amenities Relations 1. Access to Service Everyone should have access to quality health care. Access refers to the ability of the individual to obtain health services. Some of the factors that can affect access are: a) Distance: e.g. where health facility is sited far away or it is difficult to get transport to the facility access to quality health care becomes a problem. b) Financial: e.g. where people cannot pay for the services provided. c) Culture, beliefs and values: The services provided may not be in line with the culture, beliefs and values of some people. 2. Technical Competence Technical competence as an indicator of quality assurance implies that we should have adequate knowledge and skills to carry out our functions in order to provide quality service. E.g. one must go to a nursing school and pass the nursing examinations before she can work as a nurse. Even though we are no longer in school, we have to continue to update our knowledge by reading health books and attending in-service training workshops etc. As health professionals, we should also know our limits, that is, know what we can do and what we cannot do. With respect to what we cannot do, we are expected to refer them to other centres or personnel who are more 17 competent to handle them. Our practice should also be guided by laid down standards and guidelines e.g. Standard Treatment Guideline. 3. Equity Quality services should be provided to all people who need them, be they poor, children, adults, old people, pregnant women, disabled etc. Quality services should be available in all parts of the country, in villages, towns and cities. 4. Effectiveness We are interested in the type of care that produces positive change in the patient's health or quality of life. We therefore use treatments that are known to be effective, for example, giving a child with diarrhoea Oral Rehydration Salt (ORS) 5. Efficiency Efficiency is the provision of high quality care at the lowest possible cost. We are expected to make the best use of resources and avoid waste of our scarce resources. We waste resources by prescribing unnecessary drugs stocking more drugs than is required and making them expire buying supplies and equipment we do not use What happens when we stock more drugs than is required? 6. Continuity Continuity means that the client gets the full range of health services he/she needs, and that when the case is beyond us, we refer him/her to the right level for further care. Continuity may be achieved by the patient seeing the same primary health care worker or by keeping accurate health records so that another staff can have adequate information to follow up the patient. 7. Safety Safety means that when providing health services, we reduce to the barest minimum injuries, infections, harmful side effects and other dangers to clients and to staff. In providing quality care, we should not put the patient's life at risk. For example, we should not give unsafe blood to patients and thereby infect them with HIV/AIDS. 8. Interpersonal Relations It refers to the relationship between us and our clients and communities, between health mangers and their staff. We should how respect to our clients; 18 feel for our patients; not be rude or shout at them; not disclose information we get from patients to other people. These will bring about good relations and trust between the clients/communities and us. Clients consider good interpersonal relationship as an important component of quality of care. 9. Amenities These are features that can be provided by our health facilities to make life comfortable and pleasant for clients. They contribute to clients' satisfaction and make clients willing to use our services. For example, comfortable seats, television sets, music, educational materials, educative video films, etc. at the OPD and wards. Perspectives of Quality The health staff, health manager, clients and communities are all stakeholders in service delivery. Each of these groups may expect different things from health services. 1. The Patient/Client Research done in various parts of the country shows that our patients/clients want services that: are delivered on time by friendly and respectful staff; are safe, produce positive result and that they can afford; provide them with adequate information about their condition and treatment; provide them with all the drugs they need; give privacy. are within their reach (distance) and given in a language they can understand. 2. The Health Staff Provider The health provider can provide quality care if he/she has: adequate knowledge and skills. enough resources- staff, drugs, supplies, equipment and transport etc, safe and clean workplace, opportunity to regularly improve himself/herself.is well paid and rewarded for good work. 3. The Health Care Manager The health care manager sees quality care as: managing efficiently the resources of the health facility, health staff achieving set targets, health staff being regularly supported and supervised, having adequate and 19 competent staff to provide care, staff being disciplined, providing enough resources for work. Accreditation is a process in which an entity, separate & distinct from the health care organization, usually nongovernmental Assesses the healthcare organization to determine if it meets a set of requirements (standards) designed to improve the safety and quality of care. Accreditation is usually voluntary. It has gained world wide attention as an effective quality evaluation and management tool. ⮚ BENEFITS OF ACCREDITATION Improve public trust Provide a safe and efficient work environment Negotiate with sources of payment Listen to patients & their families ,respect their rights & involve them in the care process as partners Create a culture that is open to learning Establish collaborative leadership & continuous leadership ❖ Introduction to JCI Joint Commission International (JCI) was founded in the late 1990s to survey hospitals outside of the United States. JCI, which is also not-for- profit, currently accredits facilities in Asia, Europe, the Middle East, and South America. A count of JCI-accredited hospitals worldwide (as listed on the JCI website till 2015) shows 820 hospitals in 47 & above countries. 21 hospitals in India. JCI stands for Joint Commission International. It is US based , not for profit accreditation body , which sets & addresses standards for the healthcare providers level of performance in key functional areas , such as patient rights , patient treatment & infection control. JCI’S mission is to improve the quality of healthcare in the international community by providing worldwide accreditation services JCI standards would lead us to improved patient care, safety & path of continuous quality improvement. This would strengthen patient, third party and insurer confidence and would provide us a competitive edge. 20  JCI accreditation is the gold standard for quality as it reflects the provision of the highest level of patient care & patient safety. ❖ JCI ACCREDITATION. JCI accredits 8 types of healthcare programs:- 1. Hospitals 2. Academic medical center hospitals 3. Ambulatory care facilities 4. Clinical laboratories 5. Home care facilities 6. Long term care facilities 7. Medical transport organizations 8. Primary care centers JCI 5th Edition : Effective from 1st April 2014 Consists of four sections ¬ Section 1 consists of accreditation participation requirements APR ¬ Section 2 Patient centered standards 1. IPSG 2. ACC (Access to care and continuity of care) 3. PFR (Patient and Family Rights) 4. AOP (Assessment Of Patients) 5. COP (Care Of Patients) ambulatory 6. ASC (Anesthesia and Surgical Care) 7. MMU (Medication Management and Use) 8. PFE (Patient and Family Education) Section 3 consists of Health care organization management standards 1. QPS (Quality improvement and Patient Safety) 2. PCI (Prevention and Control of Infections) laboratory 3. GLD (Governance, Leadership and Direction) for hospitals and academic medical institutions 4. FMS (Facility Management and Safety 5. Staff qualification and education SQE 6. Management of Information MOI Section 4 consists of academic medical center hospitals standards. 1. Medical profession education MPE 2. Human subjects research Programs HRP JCI 5th Edition 5th edition of the Hospital Standards contains 285 Standards 21  1160 Measurable Elements REVISION OF STANDARDS: The standards will be revised and published at least every 3 years. JCI survey methodology: Thorough survey process becomes Operational: Typical survey team consists of a physician, nurse, and administrator. Surveyors evaluate various units within an organization and meet to discuss their finding. Surveys conduct a complete system analysis on integration and coordination of care processes. ACCREDITATION SURVEYS Interview with staff & patients & other verbal information On-site observations of patient care process by surveyors Policies, procedures, clinical practice guidelines, and other documents provided by the organization Scoring the Survey Results Each standard must have a scoring of at least 5 Each chapter must have a score of at least 8 All standards must together average for at least 9 All measurable elements are averaged to obtain the score for the standard Scoring Survey Results Each Measurable Element (ME) is scored Met (10), Partially Met (5), Not Met (0) All Standards are averaged to obtain the score of the chapter All Chapters are averaged to obtain the overall score ❖ NABH :-NATIONAL ACCREDITION BOARD FOR HOSPITAL AND HEALTHCARE PROVIDERS The NABH standards are updated every four years and now hospital implements 5th edition standards (April 2020). NABH standards focus on patient safety and quality of the delivery of services by the hospital in changing healthcare environment. NABH is given by an autonomous body set up by the Govt. of India known as QCI (Quality Council of India) which is the standard making board in India. 22 NABH mainly divides hospitals into two main divisions: - 1. SHCO (Small Health Care Organization) with less than 50 beds. 2. HCO (Health Care Organization) with more than 50 beds. Main NABH guidebook/ standards has 10 Chapters with 100 standards and 651 objective elements. Standard means a set objective for the performance. Elements comes under each standard and is used to monitor the performance. Out of 651 objective elements 102 are in core category which are mandatorily assessed during each assessment, 459 are in commitment category which will be assessed during final assessment, 60 are in achievement category which will be assessed during surveillance assessment and 30 are in excellence category which will be assessed during re-accreditation ❖ NABH STANDARDS PATIENT CENTERED STANDARDS a. Access, Assessment and continuity of care(AAC). b. Care of Patient(COP) c. Management of medication(MOM) d. Patient rights and education(PRE) e. Hospital Infection Control(HIC) ORGANISATION CENTERED STANDARDS a. Patient Safety & Quality Improvement (PSQ) b. Responsibility of Management(ROM) c. Facility Management and Safety(FMS) d. Human Resource Management(HRM) e. Information Management System (IMS NABH KEY PERFORMANCE INDICATORS Key Performance Indicators ( KPIs ) help to systematically monitor, evaluate, and continually improve service performance. By themselves, KPIs cannot improve performance. However, they do provide "signposts" that signal progress toward goals and objectives as well as opportunities for sustainable improvements. The Key Performance Indicators ( KPIs ) expected to be monitored by healthcare organisations: 23 1. Time taken for initial assessment The time shall begin from the time that the patient has arrived at the bed of the ward till the time that the initial assessment has been completed by a doctor. Formula: Sum of time taken for initial assessment / Total number of admissions 2. Number of reporting errors per 1000 investigations Formula: No. of reporting errors / no. of tests performed * 1000 3. Percentage of adherence to safety precautions by staff working in diagnostics Formula: No. of staff adhering to safety precautions / No. of staff audited * 100 4. Medication Errors Rate A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient or consumer. Formula: Total no.of medication Errors / Total no.of opportunities of medication Errors * 100 5. Percentage of medication charts with error-prone abbreviations Error-prone abbreviations shall be defined in consonance with the guidelines laid down by Institution for Safe Medication Practices. Formula : No. of medication charts with error-prone abbreviations / No. of medication charts reviewed * 100 6. Percentage of inpatients developing adverse drug reactions Adverse Drug reaction is a response to a drug which is noxious and unintended and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease or for the modification of physiologic function. Formula: No. of in-patients developing adverse drug reactions / No. of in-patients * 100 7. Percentage of unplanned return to OT Unplanned return to the OT is defined as any secondary procedure required for a complication resulting directly from the index operation during same admission. For example, post-operative bleeding, 24 debridement, secondary suturing, embolectomy, evaluation under anesthesia etc. Formula: No. of unplanned return to OT / No. of patients who underwent surgeries in the OT * 100 8. Percentage of surgeries where the organisation's procedure to prevent adverse events like wrong site, wrong patient and wrong surgery have been adhered to Formula: No. of surgeries where the procedure wa as followed / No. of surgeries performed * 100 9. Percentage of transfusion reactions Any adverse reaction to the transfusion of blood or blood components shall be considered as transfusion reactions. It may range from a mild allergic reaction ( including chills / rigors ) to life-threatening complications like TRALI and Graft Versus - Host disease. Formula : No. of transfusion reactions / No. of units transferred * 100 10. Standardized Mortality Ratio for ICU Standardized Mortality Ratio is the ratio of the observed or actual mortality and the predicted mortality for a specific time period. Formula : Actual deaths in ICU / Predicted deaths in ICU * 100 11. Return to the emergency department within 72hours with similar presenting complaints Formula: No. of returns to emergency within 72hours with similar presenting complaints / No. of patients who have come to the emergency * 100 12. Incidence of hospital associated pressure ulcers after admission ( Bed sore per 1000 patient days ) A pressure ulcer is localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction. Formula: No. of patients who develop new/worsening of pressure ulcer / Total No.of patient days * 1000 13. Catheter associated Urinary tract infection rate Formula: No. of urinary catheter associated UTIs in a month / No. of urinary catheter days in that month * 1000 25 14. Ventilator associated Pneumonia rate Formula: No. of "Ventilator Associated Pneumonia" in a month / No. of Ventilator days in that month * 1000 15. Central line associated Blood stream infection rate Formula: No. of central line associated Blood stream infections in a month / No. of central line days in that month * 1000 16. Surgical site infection rate Formula: No. of surgical site infections in a given month / No. of surgeries performed in that month * 100 17. Hand Hygiene Compliance Rate Formula: Total No. of hand hygiene actions performed / Total No. of hand hygiene opportunities * 100 18. Percentage of cases who received appropriate prophylactic antibiotics within the specified timeframe Formula: No. of patients who did receive appropriate prophylactic antibiotics / No. of patients who underwent surgeries in the OT * 100 19. Percentage of re - scheduling of surgeries Re - scheduling of surgeries includes cancellation and postponement ( beyond 4hours ) of the surgery. Formula: No. of cases re - scheduled / No. of cases planned * 100 20. Turnaround time for issue of blood and blood components Time taken to be calculated from the time the request is received in the blood bank till the blood is cross matched/reserved and available for transfusion. Formula: Sum of time taken / Total No. of blood and blood components cross matched / reserved 21. Nurse - patient ratio for ICUs and wards Formula: No. of nursing staff / No. of occupied beds 26 22. Waiting time for out - patient consultation Waiting time is a length of time which one must wait in order for a specific action to occur, after that action is requested or mandated. Waiting time for out - patient consultation is the time from which the patient has come to the concerned out - patient department ( it may or may not be the same time as registration ) till the time that the concerned consultant ( not the junior doctor/resident ) begins the assessment. Formula: Sum total Patient - in time for consultation / Total No. of out - patients 23. Waiting time for diagnostics Waiting time for diagnostics is the time from which the patient has come to the diagnostic service ( requisition form has been presented to the counter ) till the time that the test is initiated. Formula: Sum total Patient reporting time / No. of patients reported in diagnostics 24. Time taken for discharge The discharge process is deemed to have started when the consultant formally approves discharge and ends with the patient leaving the clinical unit. Formula: Sum of time taken for discharge / No. of patients discharged 25. Percentage of medical records having incomplete and/or improper consent Informed consent is a type of consent in which the healthcare provider has a duty to inform his/her patient about the procedure, its potential risks and benefits, alternative procedure or treatment with their risks and benefits so as to enable the patient to take an informed decision of his/her healthcare. Formula: No. of medical records having incomplete and/or improper consent / No. of discharges and deaths * 100 26. Stock out Rate of Emergency medications A stock out is an event which occurs when an item listed as an emergency medication by the organisation is not available upon the requested need date in the organisation. 27 Formula: No. of stock outs of emergency drugs / No. of drugs listed as emergency drugs in hospital formulary * 100 27. Number of variations observed in mock drills Mock drill is a simulation exercise of preparedness for any type of event. It could be event or disaster. This is basically a dry run or preparedness drill. For example, fire mock drill, disaster drill, Code Blue drill, Global pandemic preparedness drill. Formula: Total No. of variations observed in a mock drill 28. Patient fall rate ( Falls per 1000 patient days ) A fall is defined as "Loss of upright position that results in landing on the floor, ground or an object or furniture or a sudden, uncontrolled, unintentional, non-purposeful, downward displacement of the body to the floor/ground or hitting another object like a chair or stair". It is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level. Formula: No. of patient falls / Total No. of patient days * 1000 29. Percentage of near misses A near miss is an unplanned event that did not result in injury, illness, or damage - but had the potential to do so. Errors that did not result in patient harm, but could have, can be categorised as near misses. Formula: No. of near misses reported / No. of incidents reported * 100 30. Incidence of needle stick injuries Needle stick injury is a penetrating stab wound from a needle ( or other sharp object ) that may result in exposure to blood or other body fluids. Needle stick injuries are wounds caused by needles that accidentally puncture the skin. Formula: No. of parenteral exposures / No. of in-patient days * 1000 31. Appropriate handovers during shift change ( to be done separately for doctors and nurses ) - ( per patient per shift ) Formula: Total No. of handovers done appropriately / Total No. of handover opportunities * 100 28  32. Compliance rate to Medication Prescription in capitals Formula: Total No. of prescriptions in capital letters / Total No. of prescriptions * 100 ❖ JOB DESCRIPTION/ RESPONSIBILITIES of Hospital Quality Manager The Quality Manager in Hospital shall support the Quality Assurance Programme Cell at the hospital and be responsible for devising and establishing quality procedures, standards and specifications in Hospital. He/She shall promote Quality Improvement in all the process & procedures of the hospitals and share reports. Key Job Responsibilities: 1. Ensuring good quality non-clinical services like infection prevention, security, diet etc.; 2. Ensuring clean surroundings, OPD Areas, Wards, Labor Room, OT and Patient amenities and outsourced services; 3. Periodical assessment of hospitals on quality check list and arrive at a score for the facility; 4. Identification of gaps(Gap analysis), develop action plan under the guidance of in- charge of the hospital and monitor compliance; 5. Facilitate conduct of meeting Related to Quality certification; 6. Ensuring that the hospital meets all regulatory compliances such as BMW(waste management), Blood Bank/Storage license, AERB regulations(Radiation license), etc.; 7. Keep a record of non-functional equipments and time line for its repair along with AMC for all equipments; 8. Planning and work-out modalities towards upliftment, preventive maintenance of equipments and vehicles and modernization of hospital; 9. To institute and effective grievance redressal system both for employees and the patients; 10. Strengthen of Hospital MIS, KPI and report actions taken. 11. Co-ordinate in Assessing Authority. 29 12. Ensure the employees education on to quality standards. 13. Responsible to frame and organize the hospital committees. 30  CHAPTER - 3 HOSPITAL INFORMATION SYSTEM - BASIC ❖ INTRODUCTION Hospital information systems provide a common source of information about a patient's health history, and doctors schedule timing. The system must keep data in a secure place and control who can reach the data in certain circumstances. ❖ Hospital management information system is a computerized system that help in managing clinical, financial, laboratory, Inpatient, outpatient, pharmaceutical, etc. operations in a hospital. With the help of Hospital Management Information system, healthcare providers can focus more on providing quality healthcare to the patients. A hospital information system helps healthcare providers in streamlining their operations including managing patient health records (EMR/EHR), appointments, billing, diagnostics and much more. The major role of HIMS is to record information on health events and check the quality of services at different levels of health care. The importance of patient assessment is a part of the concept of giving importance to patient's views in improving the quality of health services. Hospital Information System benefits include enhancing patient satisfaction through improved communication; greater provider sensitivity towards patients; enhanced community awareness about the quality of services; and overall better use of services in the health system. Healthcare management software is a digitized system that helps in management of health information of patients in a healthcare facility 31. ❖ Components of a Hospital Management System 1. Appointment Management Managing appointments manually is not only tedious, but also increases the chance of making an error. Even in a recent study 68% of patients said they were more inclined to choose a hospital where they could schedule, modify, or cancel appointments online. A Hospital Management System enables us to add a scheduling option to hospital’s website, so that patients can easily schedule an appointment. Once the patient has booked an appointment, the Hospital Management System will match the patient’s illness to the doctor’s area of expertise. It will then assign them to the next available specialist or the one they prefer. It also updates the available slots in real-time to avoid any confusion at the hospital. The next step in appointment booking is to collect medical documents. An HMS with a patient portal is used to collect documents and share the patient history with the doctors well in advance. If the patient requires assistance at his/her house, the system will check the doctors’ availability for the remote visit and allocate accordingly. In this way, patients can 32 create a smooth and error-free process by digitizing the appointment booking process. 33 2. Patient Management After the patient onboarding is completed, the patient is moved to an IPD or OPD. The patient management module of HMS caters to the needs of the inpatient and outpatient department. It captures and stores the medical history, treatment required, details of their previous visits, upcoming appointments, reports, insurance details, and more. It generates unique admissions numbers for each patient to easily manage admissions, discharges, and transfers. It also builds a comprehensive discharge summary to ensure smooth discharge. At the same time, it records and generates related documents, e.g., consent forms for electronic signature. When you start collecting and storing details on an HMS, default also eliminates the need to get these details on every visit. HMS enables doctors and staff to focus more on the treatment than administrative work. Now, if you wish to automate other activities like patient communication, consider integrating your HMS with marketing automation software. It will enable you to automate communication with patients and doctors. You can send appointments and lab test reminders, or follow-ups, and build meaningful long-lasting relationships. 34 3. Facility Management To provide a smooth experience for patients, it is essential for staff to have easy access to necessary hospital records. A facility management module of HMS helps you to maintain records of bed availability, occupancy status of rooms with specialized care, and more. It collects all such information and makes it readily available to the receptionist. If a hospital has multiple facilities, then an HMS connects them to provide an overall picture. For example, doctors can access patient data from any hospital. Patients can visit any hospital according to their convenience, as all the records are available online. 4. Staff Management The staff management module provides a concrete solution to the HR department. It contains records of hospital staff, job description, service domain, and other vital details. It helps you to know your staff without going through a heavy bundle of files. Additionally, it enables us to plan the hiring process based on the requirements of the hospital. 5. Supply Management A hospital cannot afford to be short of medical supplies. Not having the medicine at the right time or a minor delay in re-fill can lead to severe results. The supply management component of the HMS tracks the availability of medical stocks. It helps you calibrate the minimum quantity of supplies required without any hassle. It records the purchase date, quantity consumed, and supplier details. This way, you can calculate or predict the next purchase and reorder before the stock falls short. It also provides the details of the medicine available so that doctors can prescribe the ones in stock. 6. Financial Management The financial management component of an HMS deals with the financial affairs of your hospital. It calculates, stores, and presents the billing information to the patients. Additionally, it also records the expenses incurred by the hospital, revenue data, and other financial details of the hospital. This consolidation saves you the trouble of analyzing a colossal pile of record books. 35 7. Insurance Management An HMS’ insurance management component records and stores patients’ insurance details. On requirement, it presents the policy number, insurance company, and other associated information. The software makes it easy to fetch these details, making insurance validation easier. 8. Laboratory Management The laboratory management features show the details of various lab tests patients take. It furnishes reports when needed and maintains all records collectively. The doctors can easily access it. It also notifies the doctor and the patients when the results are ready. 9. Report Management Report Management module, records and stores all the reports generated by the hospital. In the case of financial reports, it analyzes performance metrics to check the business profitability. It also provides a comparison between performance reports for different years. An authorized person can access the reports whenever required. Furthermore, you can use healthcare dashboards to present in an easy-to- read format. 10. Vaccination Management A vaccination model keeps track of all the completed or upcoming vaccinations. It updates you about upcoming vaccinations and books a slot with the doctor. It also sends timely reminders to parents to ensure they don’t miss the slot. 11. Support Management Patient satisfaction is of utmost importance for any hospital. This segment records data like inquiries, complaints, requests, and feedback from patients. It also ensures that they handle these requests and problems appropriately and at the soonest. You can automate the feedback collection process to reduce the staff’s workload, and everyone could fill out the feedback form. 36 ❖ Benefits of a Hospital Management System 1. Enhanced communication between the patient and the hospital 59% of millennials are willing to switch doctors for better online access. An HMS will improve communication between patients and hospitals by allowing patients to access their medical records, book appointments, receive reminders, and communicate online with their doctors and nurses. You will have improved patient engagement, a reduction in waiting times, and increased patient satisfaction. 2. Secured hospital data An HMS helps you keep hospital data safe and secure. You can limit and provide access to authorized personnel only. Make sure to look HIPAA Compliant software for PHI security. 3. Improved access to patient data You can have easy entry to all patient-related data on a system using an HMS. You can also access data such as patient history, doctors engaged, test results, billing information, and many more with just a few clicks. 37 4.Reduced turnaround time Streamline your hospital workflows by automating routine tasks like appointment or inventory management. This reduces the time and effort required to perform these tasks and the turnaround time. It also allows hospital staff to focus on more critical patient care areas. 5. Cost-effectiveness Implementing an HMS can lead to significant cost savings for hospitals. It helps by reducing administrative overheads, improving resource allocation, and minimizing the wastage of medical supplies. An HMS can also optimize revenue streams by ensuring timely billing and reducing claim denials. 6. Intelligent analytics with automatically generated reports An HMS can provide valuable insights regarding operations by generating real-time reports on various metrics, such as patient flow, occupancy rates, and revenue generation. This enables you to make data-driven decisions, improve processes, and optimize resources. 7. Centralized administrative control An HMS helps build a centralized platform for managing operations, allowing hospitals to streamline their administrative processes. It ensures consistency across departments. This can improve efficiency, reduce errors, and better overall patient care. 8. Reduced medical errors An HMS can help reduce medical errors by providing doctors and nurses with up-to-date patient information. It minimizes the risk of misdiagnosis, incorrect treatment, or adverse drug interactions. 9. Reduced readmissions and rehospitalization rates An HMS can also reduce readmissions and rehospitalization rates by ensuring timely follow-ups. This improves patient outcomes and reduces the risk of complications. 38 ❖ Important Features of Health Information Systems ⮚ Patient Portal The patient portal is an important feature of the Health Information System. It is a platform, like the electronic health record, but what makes it different is that these patients can have secure online access to their medical records, scheduling doctor appointments, communicating with the doctor, checking medical bills, and processing payment online. All they need is a smart device to avail themselves of the maximum benefits of the feature. Instead of following the age-old process of scheduling a doctor’s appointment, they can just log in to their account in the patient portal, have a look at the availability of their doctors and make an appointment as per their convenience and doctor’s availability. After scheduling the appointment, they can check the bill and make the payment or set the details for future payments. The popularity of the patient portal is increasing day by day because it improves accessibility for patients and maintains transparency between the patients and their treatment processes. Therefore, hospitals opt for this to improve their patient satisfaction level and build themselves as reliable ones. ⮚ Medical Billing Online medical billing feature manages all the billing tasks in less amount of time than usual. Gone are the days when hospitals used to spend a major amount of time managing all the appointments and billings. Now with the medical billing feature, patients’ billing, insurance details, patient tracking, and payment process – everything can be handled with efficiency. You can even receive a notification alert if there is any delay or other issues in payment so that you can take action accordingly.. ⮚ Patient Scheduling Just like the patient portal, with patient scheduling patients can schedule their own appointments by simply logging into their respective accounts. This way they neither have to wait in line in front of the doctor’s chamber or clinic nor need to call the clinic again and again to make an appointment. All the facilities will be available 24/7 with just a tap away. They can even match their convenience with the availability of the doctor and book appointments accordingly. This feature is beneficial for the care 39  providers as well. They can assign their staff, test rooms, and specialty apparatus (if needed). ⮚ E Prescribing This software in Health Information Systems speeds up the complete prescription process, usually done by the staff members of the medical practitioner’s office. They can send and fill the prescriptions of every patient to the pharmacies online. Also, they can track the entire process and take any action if needed. This way the whole process becomes quick, safe, and error-free. ⮚ Remote Patient Monitoring This is another promising feature of Health Information Systems, enabling access to patients’ details easy, helping care providers deliver good health care to the patients, and minimizing severe condition expenses. Remote Patient Monitoring (RPM) is really useful for patients who are suffering from chronic health issues. Doctors use the information collected through RPM for monitoring patients’ health status. Also, with these details, they can foretell or put a stop to situations that would or else need serious medical intervention. Other than chronic health care, RPM is helpful for other cases as well, such as care for senior citizens, care after discharging a patient, treatment for behavioral health and substance abuse, etc. ⮚ Master Patient Index Master Patient Index is quite popular across many hospitals and large organizations of medical practices. With this technology, one needs to feed the patients’ information once. After that, it gets connected to multiple databases and as a result, this data can be useful in the future for other lab tests and clinical departments. There will be no need to feed the data manually every time. The ease of access to patient’s details is the most important benefit of using the Master Patient Index. Also, it is completely automated, reduces the possibility of errors, and improves the safety of the information. ⮚ Wrapping it up, Health Information Systems will continue to bring changes in healthcare services. With the assistance of robust systems in hospitals and medical procedures, not only will the efficiency of the professionals be increased but also their work will become 40  easier and more organized. As a result, they put focus on giving better care to the patients and improving patient engagement and satisfaction. In a nutshell, HIS offers a win-win situation for both the patients and the healthcare providers when it comes to improving care delivery services. ❖ TYPES OF CLINICAL INFORMATION SYSTEMS: A. ELECTRONIC HEALTH RECORD (EHR) Electronic health record (EHR) is the systematized collection of patients and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information. For several decades, electronic health records (EHRs) have been touted as key to increasing quality care. Electronic health records are used for other reasons than charting for patients; today, providers are using data from patient records to improve quality outcomes through their care management programs. EHR combines all patients' demographics into a large pool and uses this information to assist with the creation of "new treatments or innovation in healthcare delivery" which overall improves the goals in healthcare. Combining multiple types of clinical data from the system's health records has helped clinicians identify and stratify chronically ill patients. EHR can improve quality care by using the data and analytics to prevent hospitalizations among high-risk patients. EHR systems are designed to store data accurately and to capture the state of a patient over time. It eliminates the need to track down a patient's previous paper medical records and assists in ensuring data is up-to-date, accurate and legible. It also allows open communication between the patient and the provider, while providing "privacy and security". "It can reduce the risk of data replication as there is only one modifiable file, which means the file is more likely up to date and decreases risk of lost paperwork and is cost efficient. Due to the digital information being 41 searchable and in a single file, EMRs (electronic medical records) are more effective when extracting medical data for the examination of possible trends and long-term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHRs and EMRs. Comparison With Paper-Based Records While there is still a considerable amount of debate around the superiority of electronic health records over paper records, the research literature paints a more realistic picture of the benefits and downsides. The increased transparency, portability, and accessibility acquired by the adoption of electronic medical records may increase the ease with which they can be accessed by healthcare professionals, but also can increase the amount of stolen information by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by large-scale breaches in confidential records reported by EMR users. Concerns about security contribute to the resistance shown to their adoption. When users log in into the electronic health records, it is their responsibility to make sure the information stays confidential, and this is done by keeping their passwords unknown to others and logging off before leaving the station. Handwritten paper medical records may be poorly legible, which can contribute to medical Errors're-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication. Medication is an intervention that can turn a person's status from stable to unstable very quickly. With paper documentation it is very easy to not properly document the administration of medication, the time given, or errors such as giving the "wrong drug, dose, form, or not checking for allergies" and could affect the patient negatively. It has been reported that these errors have been reduced by "55-83%" because records are now online and require certain steps to avoid these errors. Electronic records may help with the standardization of forms, terminology, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs that 42 have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs. Usefulness for patients Sharing their electronic health records with people who have type 2 diabetes helps them to reduce them blood sugar levels. It is a way of helping people understands their own health condition and involving them actively in its management. They could also be useful in research, enabling various scientific analyses and novel tools B. LABORATORY INFORMATION MANAGEMENT SYSTEM (LIMS) A laboratory information management system (LIMS), sometimes referred to as a laboratory information system (LIS) or laboratory management system (LMS), is a software-based solution with features that support a modern laboratory's operations. Key features include—but are not limited to—workflow and data tracking support, flexible architecture, and data exchange interfaces, which fully "support its use in regulated environments". The features and uses of a LIMS have evolved over the years from simple sample tracking to a enterprise resource planning tool that manages multiple aspects of laboratory informatics. 43 There is no useful definition of the term "LIMS" as it is used to encompass a number of different laboratory informatics components. The spread and depth of these components is highly dependent on the LIMS implementation itself. All LIMSs have a workflow component and some summary data management facilities but beyond that there are significant differences in functionality. C.RADIOLOGICAL INFORMATION SYSTEM A radiological information system (RIS) is the core system for the electronic management of imaging departments. The major functions of the RIS can include patient scheduling, resource management, examination performance tracking, reporting, results distribution, and procedure billing. RIS complements HIS (hospital information systems) and PACS (picture archiving and communication system) and is critical to efficient workflow to radiology practices. 44 Basic features Radiological information systems commonly support the following features: ⮚ Patient registration and scheduling ⮚ Patient list management ⮚ Modality interface using worklists ⮚ Workflow management within a department of radiology ⮚ Request and document scanning ⮚ Result entry ⮚ Digital reporting (usually using Voice Recognition (VR)) ⮚ Printable like patient letters and printed reports ⮚ Result transmission via integration or e-mailing of clinical reports ⮚ Patient tracking ⮚ Interactive documents ⮚ Creation of technical files ⮚ Modality and material management ⮚ Consent management D.COMPUTERIZED PHYSICIAN ORDER ENTRY Computerized physician order entry (CPOE), also known as computerized provider order entry or computerized practitioner order entry, refers to the process of a medical professional entering and sending medication orders and treatment instructions electronically via a computer application instead of on paper charts. 45 TEN USES OF COMPUTERS IN HOSPITALS 1. Maintain Patient Information Patient information is kept organized, safe, and readily available on a computer. In an emergency, medical staff need quick access to patient 46 records. There are fewer risks of data loss or mismatching while using a computer. 2. Monitor Patients Hospitals now utilize computers to keep track of vital signs like heart rate and blood pressure. Additionally, the computer monitoring system gathers helpful patient data. It is possible to retrieve this data for future use in research or other purposes. 3. Medical Research To understand more about a certain ailment, clinicians may now search medical databases. The ability of medical staff to obtain and apply knowledge is being improved using computers in healthcare. 47 4. Inventory Knowing what medications are on hand is crucial for a patient's therapy. The rehabilitation process might be slowed down if a doctor prescribes a medication that is out of stock, thus it is essential to keep an inventory list up to date. In the meanwhile, inventory control is crucial for hospitals and medical facilities. Therefore, inventory managers can track stock levels thanks to computers. 5. Use in Surgical Procedures Computers can perform multiple tasks with precision, so the use of computers in operating rooms can save lives. For completing complicated treatments, surgeons rely on computers. 48 ❖ Use of Computer in a Hospital. ⮚ Medical Equipment and Imaging Computers are widely used to operate medical machinery that conducts crucial medical tests including ultrasonography, CT scans, MRIs, blood tests, etc. Doctors also utilize computers to display their findings and describe the illness and course of therapy. Computers may be used for 3D Modelling and drawing. ⮚ Communication The use of computers for communication amongst healthcare professionals helps the staff and makes their job easier because they are sometimes quite 49  busy. Healthcare staff can communicate in real-time chat on a computer to share important information. It is preferable to receiving texts or post-it notes. ⮚ Telemedicine The act of treating patients remotely while neither the patient nor the practitioner is present physically is considered to be telemedicine. Doctors may now connect with patients and other medical personnel thanks to computers and cell phones. During natural calamities, telemedicine is crucial as well. 50 ⮚ Customer Services Hospitals now use automated systems like Artificial Intelligence (AI) to provide regular customer services to the patients (like payments, making demands, and complaints). ⮚ Online Payment Hospitals now make use of online payment portals to enable patients to pay their hospital bills online. This reduces the chances of errors, and the task is performed in minimum time. 51 ❖ Health Information Manager Health information managers (HIM) organize, oversee, and protect patient health information data which includes symptoms, diagnoses, medical histories,test results, and procedures. The exact job description depends on the professional’s job title. However, there are some everyday tasks that most health information managers do. Below are some of these daily duties: 1. Implement health information systems and processes to ensure the complete and accurate documentation of medical records. 2. Work with various medical staff, including nurses and doctors, to improve the quality and accuracy of patient data. 3. Code (or collaborate with coders) to ensure secure and bug-free systems for managing health information. 4. Perform regular audits to ensure the health information department, techniques, and processes comply with guidelines (as well as federal and state laws). 5. Collaborate with compliance officers that regularly track audits and denials from third-party auditors and insurance companies and find trends in the data. 6. Organize and analyze health information for better utilization, process improvement, preparing reports, and research purposes. These are only some of the tasks carried out by health information managers. Depending on the specific sub-field we end up in, we may have more specialized duties. 52  UNIT-4 MONITORING AND IMPROVING PATIENT SATISFACTION ❖ Introduction Patient satisfaction is a relative phenomenon, which has been around since 1960’s but active research on the topic was initiated in late 1970’s and early 1980’s. This led to the replacement of the idea of 'quantity of life' by a more patient centred concept of 'quality of life'. Patient satisfaction embodies the patients perceived need, his expectations from the health system, and experience of health care. This multidimensional concept includes both medical and non-medical aspects of health care. Patient satisfaction is a measure of the extent to which a patient is content with the health care which they received from there health care provider. Patient satisfaction is concerned with how patients evaluate the quality of their healthcare experience. It is increasingly being assessed in surveys of healthcare settings, as a marker of quality of care, along with other dimensions of quality such as access, relevance to need, effectiveness, and efficiency. Patient Satisfaction is an important metric to measure overall healthcare quality. With the help of Patient Satisfaction Surveys, constant measuring of Patient Satisfaction and improving Patient Experience can be achieved. It is a valuable tool to capture Patient Feedback without much effort. Patient satisfaction was assessed by a questionnaire developed with patients which collected information about the time spent at appointments, travel costs and perceptions of quality of service etc., Patient satisfaction surveys are an important way to measure how your patients feel about their experience with your practice. Satisfied patients are more likely to recommend your practice to others, and they are also less likely to file complaints. Patient satisfaction is one of the most important parameters of quality. The measurement of patient satisfaction is an important tool for research, administration, and planning. 53  1.Client satisfaction is a crucial index for determining the quality services and the way in which they are provided by medical staff. Satisfaction with the physicians, nurses, equipment, housekeeping, billing, and food services were the main determinants of overall satisfaction in hospitalized patients. 2.The patient satisfaction is of paramount importance in ensuring better quality on the way to total quality management, because the patient (customer) is the one who decides the quality, who accepts the goods/services, who makes the other to accept it, who decides your market strategies, who gives correct feedback about the performance of the hospital, and makes success the program of total quality management. 3.Patient satisfactions are an indicator of how the patient has perceived the other qualitative aspects of care and can be used as a proxy measure of those aspects. 4.Patient satisfaction is a pre-requisite for achieving the goals of healthcare as it influences the patient’s decision to follow prescribed treatments and seek professional healthcare in the future. Patients can assess the quality of care, they receive as they pay attention to all components of care — the science of medicine, the art of care, and the amenities of care. 5.Hospital satisfaction questionnaire asked respondents general questions relating to reception/administration, hospital cleanliness, signage, hospital food, etc. Patient satisfaction survey is important from the view of improvement of quality of services and to attain the maximum satisfaction of the in-patients. ❖ Objectives of patient satisfaction 1. Health care institutions are primarily patient centric. 2. Patient satisfaction is the strongest determinant of hospital functioning. 3. Ultimate goal of the hospital is satisfaction of its customer. 4. Not only to satisfy and cared for patients and families, but also positive outcome for the staff, the community and health organisation. 5. Patient satisfaction depends on workers motivation, dedication and duty towards the patients. 54  ❖ IMPORTANCE OF MEASURING PATIENT SATISFACTION Patient Satisfaction is an important metric to measure overall healthcare quality. With the help of Patient Satisfaction Surveys, constant measuring of Patient Satisfaction and improving Patient Experience can be achieved. It is a valuable tool to capture Patient Feedback without much effort. 1. To provide top-tier Patient Care services Measuring Patient Satisfaction helps the hospital to know the areas of improvement and focus to provide better patient care services. Achieving high levels of satisfaction is directly dependent on the high- quality patient care services provided by the team of specialized doctors and hospital staff. The entire staff must treat patients with warmth from the receptionist who schedules the appointment, doctors providing the right treatment, to the nurse taking vital stats of the patients. What hospital do to improve Patient Care services? ❖ Follow the correct way to diagnose the illness timely ❖ Increase and improve access to physician 55  ❖ Suggest the right treatment ❖ Offer cost-effective treatment plans ❖ Provide quality care post-discharg 2. To know the performance of the Hospital Staff It’s important to keep a pulse on hospital staff’s performance at frequent intervals. Happy staff will provide better patient care. If patients are not pleased with their visit, there’s a probability that patients will opt for services from another provider. Therefore, it’s imperative to listen to the patients, which will make them feel empowered. What can the hospital do to improve staff performance? ❖ Create a workable and friendly atmosphere for staffs ❖ Ensure hospital staff understand their responsibilities ❖ Conduct hospital employee satisfaction surveys 56  ❖ Motivate non-performers to improve their performance ❖ Reward best-performers 3. To know miffed and angry Patients Every hospital comes across a situation where they have to deal with angry patients. It’s a daunting task to deal with such a patient and especially when they take out their frustrations on hospital. Patients can be upset because of numerous reasons like delay in appointments, long patient wait times, wrong diagnosis and treatment, lack of quality care, and a lot more. And, if hospitals don’t address their issues, they might even receive legal threats from patients. Hospitals can’t ignore such situations, so it’s better to learn how to deal with patients. As a care provider, hospitals need to 57  recognize the warning signs and take control of the situation before it gets worse. And need to create best practices and follow them to handle agitated patients. What can hospitals do to deal with angry patients? ❖ Take a deep breath and try to remain calm ❖ Collect all the details about the patient’s disease and treatment given to them ❖ Spend quality time with patient to find out reasons behind their outburst ❖ Show empathy and try to resolve their issues ❖ Avoid indulging in any arguments and defend against threats ❖ Protect legally by carefully documenting clinical and administrative complaints 4. To improve Patient Experience Most doctors have a short span of time in which they need to complete numerous tasks from catching up with patients, understanding 58  their concerns, and providing the relevant treatment. In such situations, it would be difficult for doctors to address all the issues of the patients. Without getting answers for specific queries like did we provide the desired care? Did we give the right advice? It would be difficult for hospitals to improve the Patient Experience. One of the best ways to improve it is by engaging with the patients and addressing their issues promptly after every interaction. 59 What hospital can do to improve Patient Experience? ❖ Implement a centralized hospital information system to streamline hospital processes – patient registration, appointment scheduling, generating bills, publishing lab test reports setting up reminders, etc. ❖ Focus on each patient and deliver personalized patient care ❖ Reach out to patients and engage with them on different channels ❖ Conduct Patient Surveys to collect valuable feedback ❖ Try to understand how patients perceive the quality of care given ❖ Discuss with stakeholders and employ quality measures 5. To improve Patient Retention It’s more cost-effective to retain old patients than to get new patients. Returning patients will result in greater ROI {Return on Investment} and happy patients can be hospital best advocates. They will keep coming back to opt for services and even recommend the hospital to their friends and family. Apart from providing quality care, employ some of the best patient retention strategies to make the patients feel valued.. 60 What can hospitals do to improve Patient Retention? ❖ Create a comfortable and inviting atmosphere in the hospital ❖ Inform the patients in advance about the treatment procedure ❖ Surpass patient’s expectations and provide the best treatment ❖ Conduct follow up surveys after the visits ❖ Educate and inform the patients Factors that affect patient satisfaction Patient satisfaction often relates to: ❖ The expectations that a patient has of the care team ❖ Treatment plans ❖ Effective communication between patients and providers ❖ Wait times ❖ The facility environment and culture 61 ❖ PATIENT SATISFACTION SURVEY Patient satisfaction surveys capture self-reported patient assessments of multiple touchpoints during their medical care experience. Depending on what aspect of patient satisfaction is being measured, examples may include responsiveness of staff, clinician communication, technical skill, and hospital environment. Patient satisfaction surveys can be created and administered in-house, but many hospitals rely on third-party providers with experience in developing, administering and interpreting statistically valid patient satisfaction surveys. A patient satisfaction survey is a set of questions used to collect feedback from patients to measure their satisfaction with the quality and care of the healthcare service provider. The patient satisfaction survey questionnaire helps assess basic metrics across patient care that aid medical institutions in understanding the level of care provided and pitfalls in service. Six underlying metrics which patient satisfaction should be measured on are: ❖ Quality of medical care ❖ Interpersonal skills displayed by medical professionals ❖ Transparency and communication between care provider and patient ❖ Financial aspects of care ❖ Access to doctors and other medical professional ❖ Accessibility of care A patient satisfaction survey can be administered anytime during an electronic medical record (EMR) or an electronic health record (EHR). It 62 can be completed via mobile, physical copies of the survey, website, POS device, computers in waiting rooms, or any other medium. 63  Patient Satisfaction Survey Dear patient, We are interested in knowing what you think about our services. Your performance by completing this brief (5min) survey regarding your visit. Thank you for taking time to share your experience with us. Date of your Appointment: Please circle your response How satisfied Very Sa Ve Extre are you with the dissatisfied tisfied ry mely following? Satisfied satisfied 1. Ease of making 2 3 4 5 appointment for checkups (physical exams, well visits, routine follow-ups appointments)? 2. The comfort of 2 3 4 5 the reception area? 3. Ease in 2 3 4 5 contacting your doctor? 4. The comfort of 2 3 4 5 the examining room(s) 5. How was the 2 3 4 5 cleanliness of the Hospital? 6. Waiting time 2 3 4 5 in our office? 7. The courtesy 2 3 4 5 of the staffs 8. What is your 2 3 4 5 opinion on cost of treatment? 9. How was our 2 3 4 5 diagnostic service. 10. The quality of 2 3 4 5 the care you have received 11. Your overall opinion 2 3 4 5 on our services 64  ❖ PATIENT SATISFACTION SURVEYS BENEFIT FOR PATIENTS AND HOSPITAL Patient satisfaction surveys are an important way to measure how the patients feel about their experience with the practice. Satisfied patients are more likely to recommend the hospital to others, and they are also less likely to file complaints. Earning and maintaining high patient satisfaction scores benefits medical organizations and the patients in several ways. ⮚ Patient loyalty and retention Patients have more choices regarding their healthcare than ever before. Satisfied patients are more likely to be loyal patients. This not only means that they’ll schedule the necessary checkups, follow-ups, and other necessary appointments, but they’re more likely to keep them. Satisfied patients are also excellent ambassadors for hospitals. They tell their friends and family about good experiences as well as bad ones with their friends and family. ⮚ Increased profitability Satisfied patients ultimately lead to increased profits for hospitals in several ways. First, satisfied patients show up for their appointments, which means that hospitals don’t lose money on dead hours during the day. Second, they also provide excellent reviews and patient satisfaction survey results, leading to new patient acquisition and improved insurance reimbursement. 65 ⮚ Enhanced staff morale Creating a patient-focused culture doesn’t have to come at the expense of employee satisfaction. In fact, taking steps to involve and motivate your staff is a critical part of delivering outstanding patient care. Healthcare settings are often high-stress environments. Training and empowering the employees enables them to perform their jobs to the best of their abilities and makes them feel valued and increases staff retention. Experienced staff know how to deliver attentive service, patient-focused service, helping to boost patient satisfaction scores. ⮚ Higher productivity Investing in training and software to improve the patient's experience can also increase staff and provider productivity in the organization. For example, if hospitals implement secure online appointment scheduling and patient messaging, staff may spend as much as 50% less time on the phone with patients. As a result, staff can perform additional tasks, allowing us to run a leaner office. Additionally, when hospital reduces the patient no-show and late cancellations, hospital have less dead time in scheduling and can maximize the patient time and related billing. ⮚ Reputation Satisfied patients can enhance your reputation in several ways. First, HCAHPS scores are public, specifically so people can learn about the physicians they can see and make an informed choice about their health care. Second, positive scores make the organization much more attractive options. 66  Additionally, hospitals can use automated messages to ask patients for feedback after their appointments. Some programs include follow-up questions with easy-to-follow links to ask satisfied patients to leave reviews on hospital Google Business profile or other platforms. And finally, happy patients will recommend the hospital to friends and family. When it comes to referrals, word-of-mouth is the gold standard. ⮚ Better clinical outcomes for patients Satisfied patients are also typically more compliant, which means they’re more likely to get better or effectively manage chronic health issues. As a result, they feel better and like hospital treatment and care makes a difference to their wellness and quality of life. This also leads them to remain loyal to hospital and show up for their appointments, creating a cycle of patient satisfaction benefits. ❖ WAYS TO IMPROVE PATIENT SATISFACTION How Can Patient Satisfaction Be Improved? Highly effective strategies for improving patient satisfaction scores revolve around creating an environment in which patients have a positive overall experience with all members of their medical team. 8 creative ways to increase patient satisfaction 1. Ensure timely follow-ups. 2. Focus on communication between providers and patients. 3. Maintain transparency with patients. 4. Prioritize short wait times. 5. Strive to implement procedures to educate patients about treatment plans. 6. Utilize feedback from patients to analyze patient satisfaction metrics. 7. implement technological support systems for greater facility efficiency. 8. Improve the facility environment and culture ⮚ Develop Rapport Fear often gets in the way of a patient’s ability to retain key clinical information, including self-care instructions. Practitioners who spend a few minutes engaging with patients before beginning their clinical treatment help establish a sense of trust with their patients. By allaying their patients’ fears early on, these healthcare professionals ensure their patients are 67  empowered with the information they need to take charge of their own health. ⮚ Make it Personal Healthcare professionals who try to maintain eye contact with their patients—rather than distractedly looking at computer screens and charts— demonstrate their dedication to the patient. Some practitioners may choose to have a medical scribe in the room for this very reason, allowing them to “listen with their eyes” while the scribe takes notes. Saying a patient’s name also helps individualize and personalize the patient experience, as does asking questions like, “What matters to you?” ⮚ Educate the Patient Receiving a new diagnosis or an update to an existing one can be frightening. Using non-medical language and teach-back methods helps improve communication and increase a patient’s understanding of their health condition. Providing patients with written documentation that they can take home with them is also important and will help further alleviate feelings of confusion or unease. Create a positive patient experience by educating the patients about their health and how to improve it. Helping the patient understand how their body works and why making certain choices can improve or detract from their health gives them informed agency over their bodies. They feel like the hospital is their partner in health instead of another person telling them what they should be doing differently. ⮚ Ensure Cleanliness No patient wants to receive care in an environment that doesn’t feel safe and sanitary. Practicing cleanliness in all areas of the institution, from the waiting room to the physician’s office, helps protect patients and put them at ease. ⮚ Upgrade Outdated Systems When it comes to improving the patient's experience, upgrading outdated internal systems is key. Even small updates to appointment scheduling platforms, waiting room signage and systems, and nurse call buttons can have a significant impact on patient satisfaction. 68 ⮚ Be Punctual Punctuality demonstrates a practitioner’s respect for a patient’s busy schedule. If an organization is having difficulty seeing patients in a timely manner, they may need to examine their scheduling process and/or staffing needs. ⮚ Set Expectations Healthcare providers can help set expectations by keeping all the information on their website, patient portal, and printed collateral up to date always. Including an FAQ section on printed and digital material that addresses how to refill prescriptions, receive care after hours, and schedule appointments also plays an important part in aligning patients’ expectations with their experiences. ⮚ Go digital Hospitals can do just about anything with a few taps on our phones, from paying our bills to booking a vacation. Digitizing your practice can create efficiencies for your staff and patients that improve everyone’s experience. The right software lets digitize every step of the patient's journey, from booking an appointment to paying their deductibles. ⮚ Decrease waits times Decreased the amount of time that patients spend in waiting rooms. Plan to eliminate time spent traveling to and from appointments, eliminating stress and attendance barriers for many patients. Patient registration paperwork also contributes to longer wait times. Hospitals can use a secure online program to allow the patients to complete and submit their registration paperwork before their appointment, further reducing time spent in the waiting room. 69 ⮚ Deliver patient-focused care Patients’ health and well-being should be at the center of everything the hospital and the staff do. Patient-focused care takes into account the patients’ values and individual preferences, as well as their health needs. Education and tech