A

Summer Training Project Report

On

The Study of Service Quality in Healthcare

(Quality Department) at JK Fortis, Udaipur
Submitted in partial fulfillment for the award of two years full time
Master’s in Business Management
(2018-2020)

By

Akshita Singhvi

Faculty Guide: Company Guide:

Dr Kulvinder Kaur Dr Amrit Kaur

FACULTY OF MANAGEMENT
Pacific Academy of Higher Education and
Research Pacific Hills, Airport Road,
Pratapnagar Extension,
Udaipur 313001
 Certificate

This is to certify that Akshita Singhvi has successfully completed her summer training
project entitled The Study of Service Quality in Healthcare (Quality Department)
under my supervision at JK Fortis, Udaipur for the partial fulfillment of Master of Business
Administration Program for academic session 2017-19.

Date: Signature of faculty supervisor

Place Name of faculty supervisor

 Declaration

I, hereby declare that the work embodied in my Summer Training Project, entitled The
Study of Service Quality in Healthcare (Quality Department), is my own bonafide
work carried out by me under the supervision of Dr Amrit Kaur. This work is original
representation of my 45 days internship at JK Fortis, Udaipur. I have fulfilled all the
requirements, mandatory for the completion of the summer training program.

Date:

Place: Signature of Student:

 ACKNOWLEDGEMENT

Satisfaction and Euphoria that accompany the successful completion of any work would
be incomplete, unless we mention the names of those people as an expression of gratitude,
which made it possible, whose constant guidance and encouragement served as bacon
light and crowned our efforts with success.

I acknowledge my gratitude with sense of reverence to the almighty God and those who
have contributed and spared time for the completion of this project. Their valuable
guidance and wise direction has enabled me to complete my project in a systematic and
smooth manner.
With profound sense of gratefulness, I acknowledge my sincere thanks to the management
of Fortis JK Hospital, Udaipur, India as well as my College, Pacific Institute of
Management, Udaipur, India for giving me an opportunity to under- take this project in
their esteemed organization.

I am very much indebted to Dr Amrit Kaur (Quality Manager-HR), Fortis JK Hospital,

and my Faculty guide, Dr Kulvinder Kaur, Pacific Institute of Management, Udaipur,
India who extended me whole hearted support for completion of this project report and
benevolent guidance during the training period. I also thank to my college Principal for
giving me chance to get such an experience and giving me chance to get an industrial
experience.

Akshita Singhvi
 Preface:

This report represents the study of Balance between speed and quality. It includes the
study of service quality in healthcare. Through this report, an analysis is done on what are
the major drawbacks in two areas of the healthcare services that is,” The discharge
process(Time motion study)” and “Audit on peripheral cannulation” and further
implementation of standards are being done. The organization for this study is a
multispecialty Hospital, JK Fortis, Shobhagpura Circle, Udaipur.
Chapter 1 intoduces with the company and the department assigned which has helped me
complete my training with full support and guiding path.
Chapter 2 marks the introductory chapter about the work done during these 45 days tenure,
starting with project 1 that is,”Study on Discharge Process”. Starting from the brief
introduction of what discharge actually is and how it is performed to the steps involved in
my discharge process study. The project 2 is now introduced that is,”Study on Peripheral
Cannulation” which is linked with Thrombophlebitis (an inflammatory process causing
blod clot to form and block the vein) along with the reasons of the same, the VIP(Visual
infusion phlebitis) score, as well as the steps involved in cannulation (safe practice of
cannulation to avoid the occurrence of thrombophlebitis).
Chapter 3 includes the analysis part. Here comes the Research methodology of both the
projects and it includes the background base of the study, objectives, scope, data analysis
and the required intervention.
Chapter 4 is all about the result part that is what thi study has actually shown. This
includes the finding, interventions required and the post intervention results. This chapter
is whole soul of the study.
Every study is incomplete if it does not let yu incorporate some learnings so the next
chapter is all about the learnings and gains I have incorporated while my study.
Besides this study, I have done certain other works in the organization in order to learn
more and gain more experience. The next chapter is ablout all the other works done at the
organization.
 List of tables and figures:

Figure 2.1 Pie chart representing complaints regarding discharge process.

Figure 2.2 Graphical representations of written and verbal feedbacks regarding the
discharge process.
Figure 2.3 Time taken for the discharges.
Figure 2.4 Overall TAT for discharge in comparison to cashless & cash patients.
Table 3.1 Analysis of average time taken in both cashless and cash discharges.
Table 3.2 Analysis of summary preparation in relation to average time taken for
discharge.
Table 3.3 Reasons of delay in housekeeping response and Room cleaning.
Table 3.4 Average time taken in the whole discharge process.
Table 3.5 Reasons of delay in billing process.
Table of Contents
Acknowledgement ........................................................................................................................... (i)
Preface ............................................................................................................................................. (ii)
List of Tables and Figures............................................................................................................... (iii)
Index............................................................................................................................................... (iv)
Chapter 1. Introduction of the Healthcare sector and the company .................................................... 5
1.About the healthcare Industry .................................................................................................. 6
2. About Quality of services……………………………………………………………………
3.About Quality of Services in Healthcare Industry in India ………………...........................
4.Introduction of the Company…………………………………………………………………
5.Synopsis of the Company……………………………………………………………………
6.Department of Internship……………………………………………………………………
7.Bibliography…………………………………………………………………………………
Chapter 2. Description of the projects and work done……………………………………………….
1.Theoritical explanation about the Project 1……………………………………………………
2.Objective of study…………………………………………………………………………….
Importance of Study………………………………………………………………………..
Scope of Study……………………………………………………………………………..
Limitations of study……………………………………………………………………….
3.Background and base for the study……………………………………………………………
4.Steps involved in the study of Project 1………………………………………………………
5.Overview of the work done…………………………………………………………………..
6.Theoritical explanation about the Project 2……………………………………………………
7.Objective of Study……………………………………………………………………………
Importance of Study………………………………………………………………………….
Scope of Study……………………………………………………………………………….
Limitations of Study…………………………………………………………………………
8.Situation and Background of the Study………………………………………………………
9.Steps involved in the Study of Project 1……………………………………………………..
10.Overview of the work done………………………………………………………………….
Chapter 3.Analysis and Interpretation………………………………………………………………
1.Analysis of Project 1………………………………………………………………………..
i.Objective under consideration……………………………………………………………
Method of data collection………………………………………………………………..
Type of data……………………………………………………………………………..
Analysis of te data collected…………………………………………………………….
2.Analysis of Project 2…………………………………………………………………….
i.Objective under consideration………………………………………………………….
ii.Method of data collection……………………………………………………………..
iii.Type of data……………………………………………………………………………
iv.Analysis of data collected……………………………………………………………
Chapter 4.Findings,conclusions,suggestions……………………………………………………
1.Findings of Project 1…………………………………………………………………..
i.Intervention required…………………………………………………………………
ii.Post-intervention results…………………………………………………………….
iii.Conclusion…………………………………………………………………………..
2.Findings of Project 2……………………………………………………………………
i.Intervention required………………………………………………………………….
ii.Post-intervention required…………………………………………………………….
iii.Conclusion…………………………………………………………………………..
Chapter 5.Learnings…………………………………………………………………………..
i.Learnings of Project 1……………………………………………………………….
ii. Learnings of Projevt 2………………………………………………………………
Chapter 6. Other work done at the company………………………………………………….
1.Emotional Intelligence Test…………………………………………………………..
i.About emotional intelligence……………………………………………………….
 ii.About the questionnaire on Emotional Intelligence…………………………………….
iii.Conclusion of the EQ test……………………………………………………………….
2.NABH Training Education………………………………………………………………
i.About NABH……………………………………………………………………………
ii.Chapters Covered under NABH…………………………………………………………
iii.Training on Hand Hygene…………………………………………………………….
iv.Traing on management of vulnerable patients………………………………………..
3.Mock drill of CODE PINK………………………………………………………………
i.About all the codes in Hospital…………………………………………………………
ii.About Code Pink Mock Drill……………………………………………………………
iii.Conclusion……………………………………………………………………………….
References…………………………………………………………………………………………
 Chapter 1
Introduction of the Healthcare Sector and the Company

About the Healthcare Industry

1.What is the Healthcare Sector?

The healthcare sector consists of companies that provide medical services, manufacture
medical equipment or drugs, provide medical insurance, or otherwise facilitate the
provision of healthcare to patients

2.Understanding the Healthcare sector

The healthcare sector is one of the largest and most complex in the U.S. economy,
accounting for close to a fifth of overall gross domestic product (GDP), according to the
OECD. Some of the highest-quality care in the world can be found in the U.S., but in
terms of the population's overall health the U.S. lags other wealthy, developed countries.
Life expectancy is 78.8 years, according to the OECD, below the club's average of 80.6
(the OECD's 35 members are mostly rich, industrialized countries in Europe and North
America).

3.Drugs

Drug manufacturers can further be broken down into biotechnology firms, major
pharmaceuticals firms, and makers of generic drugs. The biotech industry consists of
companies that engage in research and development to create new drugs, devices and
treatment methods. Many of these companies are small and lack dependable sources of
revenue. Their market value may depend entirely on the expectation that a drug or
treatment will gain regulatory approval, and FDA decisions or rulings in patent cases can
lead to sharp, double-digit swings in share prices. Examples of (larger) biotech firms
include Gilead Sciences Inc. (GILD) and Celgene Corp. (GELG).

4.Medical Equipment

Medical equipment makers range from firms that manufacture standard, familiar products
– scalpels, forceps, bandages, gloves – to those that conduct cutting-edge research and
produce expensive, high-tech equipment such as MRI machines and surgical robots.
Medtronic plc (MDT) is an example of a medical equipment maker.

5.Managed Healthcare

Managed healthcare companies provide health insurance policies. The "Big Five" firms
that dominate the industry are UnitedHealth Group Inc. (UNH), Anthem Inc. (ANTM),
Aetna Inc. (AET), Humana Inc. (HUM) and Cigna Corp. (CI).
 About Quality of Service in Healthcare Sector

Customer satisfaction is the most important parameter for judging the quality of service
being provided by a service provider to the customer. Positive feedback from the customer
leads to the goodwill of service providers in the market, which indirectly expands their
business, whereas negative feedback makes it shrink. This theory is also applicable to
health care providers. Nowadays, patients are aware of their rights in terms of health care
services and the quality of health care services being delivered to them. There are various
tools or indicators which are set to provide the quality of services for patients without any
acquired infection. In this article, literature review has been done to study various tools
given by distinct authors and customer satisfaction and quality indicators given by health
organizations to measure quality in the health care sector.

About Quality of Service in Healthcare Industry in India

India’s health care sector provides a wide range of quality of care, from globally acclaimed
hospitals to facilities that deliver care of unacceptably low quality. Efforts to improve the
quality of care are particularly challenged by the lack of reliable data on quality and by
technical difficulties in measuring quality. Ongoing efforts in the public and private
sectors aim to improve the quality of data, develop better measures and understanding of
the quality of care, and develop innovative solutions to long-standing challenges. We
summarize priorities and the challenges faced by efforts to improve the quality of care. We
also highlight lessons learned from recent efforts to measure and improve that quality,
based on the articles on quality of care in India that are published in this issue of Health
Affairs . The rapidly changing profile of diseases in India and rising chronic disease
burden make it urgent for state and central governments to collaborate with researchers
and agencies that implement programs to improve health care to further the quality agenda.

Introduction of the Company-JK Fortis,Udaipur

Strategically located at Shobhagpura in Udaipur, Fortis JK offers superlative care in wide

range of specialties including Cardiology, Cardiac Surgery, Orthopedics, Neurosurgery,
Minimally Invasive Surgery, Obstetrics and Gynecology, Endocrinology, Pediatrics to
name a few. With one-third of total beds dedicated to critical care across specialties and
first-of-its-kind ‘CritiNext’ facility in the state, ensure comprehensive and compassionate
care to all critically ill patients.

Also, Fortis JK Hospital brings the standard operating procedures, protocols, safety
standards and best practices that are of an international level.

Management of Fortis JK Hospital

1.Col HS Bhagat(Facility Director)

2.Dr Tarun Vyas(Medical Superintendent)

3.Dr Mani Bhatnagar(Assistant Medical Superintentendent)

 Synopsis of the Company

Vision-Saving and enriching lives.

Mission: To be a globally respected healthcare organization known for clinical excellence

and patient care.

Values-Patient centricity,integrity,teamwork,ownership,innovation.

Department of Internship

Quality Department

A quality department is not a single person or employee within your organization. It refers
to all of the people who are connected with your organization, directly or indirectly.
Quality department is also the function in an organization that deals with the people and
issues related to people such as Patient safety issues, patient complaints, quality of the
services as well as quality of the service providers.

Quality staff is also responsible for advising hospital staff about the impact on patients and
organizational services regarding the efficient working as well as finding the loopholes of
the organization. It is often predictable that decisions are driven by more easily measurable
processes such as finance and accounting.

Quality department evolved from the term: personnel, as the functions of the field, moved
beyond paying employees and managing employee benefits.

A quality department is not a single person or employee within your organization. It refers
to all of the people who are connected with your organization, directly or indirectly.
Quality department is also the function in an organization that deals with the people and
issues related to people such as Patient safety issues, patient complaints, quality of the
services as well as quality of the service providers.

Quality staff is also responsible for advising hospital staff about the impact on patients and
organizational services regarding the efficient working as well as finding the loopholes of
the organization. It is often predictable that decisions are driven by more easily measurable
processes such as finance and accounting.

Quality department evolved from the term: personnel, as the functions of the field, moved
beyond paying employees and managing employee benefits.

Scope

QUALITY ASSURANCE SYSTEM- Quality assurance is a range of activities (including

review, evaluation, surveillance, appraisal and monitoring) which collectively comprise the
intelligence gathering arm of quality assurance. These are: Quality consists of doing those
things necessary to meet & exceed the needs & expectations of those we serve & doing
those right things right every time. Review is the process of critical reflection used by
clinicians wishing to assess their own (or their peers) performance* Audit is the activity of
review when conducted on a continuous and routine basis. Evaluation is one-off
assessment of the impact of a service on indices of health Surveillance is routinely repeated
evaluation Appraisal is ad hoc data collection and analysis by management in relation to
health care delivery Monitoring is ongoing appraisal

Bibliography

www.google.com

www.fortisjkhospital.com
.

Chapter 2
DESCRIPTION OF THE PROJECTS AND WORK DONE

Theoritical Explanation on Project 1- The Study on Discharge Process

What does,”Discharge from Hospital” mean?

Discharge from the hospital is the point at which the patient leaves the hospital and either
returns home or is transferred to another facility such as one for rehabilitation or to a
nursing home. Discharge involves the medical instructions that the patient will need to
fully recover. Discharge planning is a service that considers the pa tient's needs after the
hospital stay, and may involve several different services such as visiting nursing care,
physical therapy, and home blood drawing.

Types of Hospital Discharges

1.Discharge on advice- Discharge when the doctor approves of it.
2.LAMA-leave against medical advice.
3.Discharge on request-discharge when patient wants to seee some other doctor.
4.Transfer-Transfer in some other healthcare organization due to unavailability of certain
kind of needed services in that hospital.

Steps in the Discharge Process:

1.The doctor has to write discharge orders in your chart.
2.He has to review all your medications and list what you should be taking at home .
3.The doctor gives the order to the nurse with any prescriptions he wrote .

4.The nurse must call your family doctor or the primary doctor on call and make an
appointment for your follow up visit.

5.Any equipment or supplies you may need for home care need to be arranged with an
outside agency.

6.Financial arrangements are reviewed and finalized.

7.Transportation is confirmed.

8.Discharge instructions are prepared and printed.

9.You are updated on any delays encountered with the above arrangements.

10.The nurse will review all your discharge instructions with you.

11.The nurse will ask you for your feedback on the discharge plan and discuss any
concerns or questions you may have.

12.Your understanding of the instructions will be confirmed.

13.Only after all of the above has been completed, will it be time to head to the car,
and even then, it is our policy that we help you all the way to and into your vehicle.

Introduction:

1. Project on discharge Process:

To some extent, the throughput of the healthcare facility can be measured based on “bodies
on beds.”Given that consideration, one of the key efforts that we may need to pursue to
improve operational performance is to get a new patient into a bed or room as quickly as
possible after the prior patient is able to be discharged. This process is known as patient
room turnover.
This state’s about the crucial step, that is the discharge process and thus the whole
management of timeliness as well as efficiency comes into play.
This is very important as it promotes Patient’s experience as well as Patient’s perception
Management.
 What is involved in improving patient turnover?
1. Assessment of Current state
2. Measurement of the length of the process.
3. Measuring it’s depth by analyzing its individual steps.
4. Considering Front and back ends of the process.

2. Study of peripheral cannulation:

There were cases of Thrombophlebitis being recorded in the Hospital Quality department
and for the same the in patients services were being recorded keeping in note about their
cannulation sites and their VIP scores.

Aim of the Study:

• To find out the causes of delay in discharge process.
• To study the imbalance between the time and motion, to improve speed and
efficiency of the discharge process.
• To standardize the discharge process.
• To eliminate waste processes.
• To find and figure out the reasons and causes of Thrombophlebitis.

Tools of Utilizations:
5s: 1. Sorting
2. Setting up in order
3. Shine
4. Standardize
5. Sustain

Project 1
Study on discharge Process
1. Background:
Talking about the Patient room turnover and discharge process, the research was done to
minimize the gap between expectations and reality on the basis of the past data. The
process was observed for 6 months (Dec. 2018 to May 2019) and accordingly
interpretations were recorded and analyzed.
The conclusions from the analysis became the base for doing this research further and they
are as follows:
1. The feedback included both Positive as well as Negative response.
2. The overall ratio of positive into negative response was approx. 5:1 that is 82% gave
positive response whereas the rest 18% reacted negatively.
3. The negative reactions were recorded in both ways that is verbally as well as in written
as a feedback.
4. Written feedback included 34% of the general complaints under which complaints
regarding the discharge process were also included.

, 0, 0%
General, 34, 6%
Nursing , 7, 1%
GDA, 6, 1%
Positive , 512, Negative, 109, Doctor, 8, 1%
82% 18%
F&B, 17, 3%
Billing, 6, 1%
PCS, 1, 0%
Pharmacy, 8, 1%
TPA, 1, 0%
Maintenance, 3,
House1%keeping,
18, 3%

Figure 2.1

5. Verbal Complaints in feedback:

The verbal complaints were as follows:
1. The LOS was more.
2. Discharge education Gap.
3. Patient was not willing to get discharged.
4. Delay in cross consultation.

4
4
3.5
3
2.5
2
1.5 1 1 1
1
0.5
0
Discharge is Discharge Patient is not Delay in cross
time taking education willing for consultation
gap discharge
Written Feedbacks Verbal complaints

Dec 2018 to May 2019 Dec 2018 to May 2019

Figure 2.2

1. Gap between ideal discharge duration and actual discharge duration:

The standard discharge time taken is 120 minutes; this did not match the reality of
the duration of discharge process.
Whatever was the reason but this process got delayed and did not match or was not
even close to the standard discharge time.

Time Taken for Discharge

300
250
200
150
100
50
0
1 2 3 4 5 6
OVERALL 231 213 223 237 215 213
CASH PATIENT 183 205 270 271 260 259
BENCHMARK 120 120 120 120 120 120

OVERALL CASH PATIENT

BENCHMARK Linear (OVERALL )
Linear ( CASH PATIENT) Linear (BENCHMARK)

Figure 2.3

Due to these reasons, the process has to be continued to fill these gaps and further research
was conducted in support of the past problems and solutions.
The analysis of cashless as well as cash patients in comparison to the Overall TAT for
discharge was done and the graphical patterns observed are as follows:

Figure 2.4

5. Method of data collection:

The data is collected through direct observation of the whole process that is from the
intimation of discharge till the room release time and next patient receival time as well as
retrospective assessment.

6. Type of data: Primary Data

7. Steps involved in Data Collection:

The whole process of data collection was divided into approx. 20 steps:
1. Discharge intimation by the doctor.
2. Discharge initiation at the ward.
3. Start time of medication return.
4. End time of medication return.
5. Starting of discharge summary preparation by JR.
6. Ending of discharge summary preparation by JR.
7. Time for receiving request for billing.
8. Time when attendant is informed about his bill.
9. Time when attendant paid his bill.
10. Time when the billing process ends.
11. Time of completion of discharge documents.
12. Time of completion of discharge education.
13. Time when patient is ready to leave.
14. Time when the patient actually left.
15. Time when the room is emptied with previous patient’s items.
 16. Time taken to inform the HK for cleaning.
17. Time when the HK actually came for cleaning.
18. Time when the surface cleaning is done.
19. What all surfaces are cleaned?
20. Time when the room is cleaned.
21. Room release time.

Project 2
Study on Peripheral cannulation

About Peripheral cannulation

Intravenous (IV) cannulation is a technique in which a cannula is placed inside a
vein to provide venous access. Venous access allows sampling of blood, as well
as administration of fluids, medications, parenteral nutrition, chemotherapy, and
blood products. [1]
Veins have a three-layered wall composed of an internal endothelium surrounded
by a thin layer of muscle fibers that is surrounded by a layer of connective tissue.
Venous valves encourage unidirectional flow of blood and prevent pooling of blood
in the dependent portions of the extremities; they also can impede the passage of
a catheter through and into a vein

Procedure Steps

Step 01

Introduce yourself to the patient and clarify the patient’s identity. Explain the procedure to the
patient and gain informed consent to continue. Inform that cannulation may cause some
discomfort but that it will be short lived.

Step 02

Ensure that you have all of your equipment ready as follows:

 Alcohol cleanser.

 Gloves.

 An alcohol wipe.

 A disposable tourniquet.

 An IV cannula.

 A suitable plaster.

 A syringe.

 Saline.
  A clinical waste bin.

Step 03

Sanitise your hands using alcohol cleanser.

Step 04

Position the arm so that it is comfortable for the patient and identify a vein.

Step 05

Apply the tourniquet and re-check the vein.

Step 06

Put on your gloves, clean the patient’s skin with the alcohol wipe and let it dry.

Step 07

Remove the cannula from its packaging and remove the needle cover ensuring not
to touch the needle.

Step 08

Stretch the skin distally and inform the patient that they should expect a sharp
scratch.

Step 09

Insert the needle, bevel upwards at about 30 degrees. Advance the needle until a
flashback of blood is seen in the hub at the back of the cannula

Step 10

Once the flashback of blood is seen, progress the entire cannula a further 2mm, then fix the needle,
advancing the rest of the cannula into the vein.

Step 11

Release the tourniquet, apply pressure to the vein at the tip of the cannula and
remove the needle fully. Remove the cap from the needle and put this on the end of
the cannula.

Step 12

Carefully dispose of the needle into the sharps bin.

Step 13

Apply the dressing to the cannula to fix it in place and ensure that the date sticker has been
completed and applied.

Step 14

Check that the use-by date on the saline has not passed. If the date is ok, fill the syringe with saline
and flush it through the cannula to check for patency.

If there is any resistance, or if it causes any pain, or you notice any localised tissue swelling:
immediately stop flushing, remove the cannula and start again.

Step 15

Dispose of your gloves and equipment in the clinical waste bin, ensure the patient is comfortable
and thank them

Conclusion

An extension to this procedure may to set up an IV drip.

Situation and Background:

• From past two months, there were 20 cases being reported of thrombophlebitis in
hospital as far as In-patients are concerned.
• The audit sheet was thus prepared to figure out the exact cause of
Thrombophlebitis.
• The study on Peripheral Cannulation included the study of VIP score of the patient
along with the site of cannula, the type of IV fluids and antibiotics being given to
the patient, along with the ionotropes and sterilisation of the cannula site.
 CHAPTER 3
Analysis and interpretation of both the projects:

1. Data Analysis of project 1: Study of Discharge process

1. Percent of the types of discharges (TPA/Cash) along with the average time taken in both
the specific categories.

Type of discharges Numbers Average time taken

(TPA/Cash) Patients
1. Cash 68% 246 minutes
Planned 6 236 minutes
Unplanned 11 252 minutes
2. TPA 32% 420 minutes
Unplanned 8 420 minutes

Grand Total 25
Table 3.1

2.The following analysis shows that there is no specific impact of the Discharge Summary
preparation in the Imbalance of the discharge process and thus it can be concluded that the
discharge process is independent of the preparation of the discharge summary.

Summary prepared Numbers Average time taken for

before intimating discharge
Yes 40% (10) 315 minutes
No 60% (15) 320 minutes
Table 2.2

3. Reasons of delay in HK response and Room cleaning:

Reason of delay in House Number Average time taken

Keeping Response and for Discharge
Room Cleaning
Immediate response of 8(32%) 465 minutes
HK
Lack of HK staff 15(60%) 396 minutes
Call not reverted by HK 1(4%) 445 minutes
Convulsion 1(4%) NA
Grand Total 25
Table 3.3
4. The process was studied with steps and time taken:

Average time taken

Time taken for discharge process to 304 minutes
complete
Time taken for the initiation of the 9 minutes
discharge process.
Time taken for billing process to 113 minutes
complete
Time taken for discharge summary 13 minutes
preparation.
Time taken for the medication 8 minutes 9 seconds
return
HK reverts 9 minutes 30 seconds
Time from billing end to room 155 minutes
release
Table 3.4

5.Reasons of Delay in Billing Process:

Reasons of Delay in Billing Numbers Percentage

Process
Delay in Billing Process 3 12%
Delay in Billing Process and 1 4%
Delay by Patients
Delay by attendant after 5 20%
information
Delay in information by Nursing 2 8%
staff
TPA Approval 6 24%
Wrong entry of Doctor’s visit 1 4%
No delay 7 28%
Grand total 25
Table 3.5

 Other points analyzed:

1. Delay in Billing process
2. Patient side delays
3. Reasons of Housekeeping Delays

2. Analysis of project 2: Study on Peripheral cannulation

1. The analysis showed the following results:
2. Use of Potassium Chloride at the Fore arm or hand vein caused swelling and redness and
thus contributing to an increase in VIP score and shooting up its value to 2.
3. The sterilisation also played and important role as the staff did not sterilise their hand
before cannulation thus letting the cannula site to be contaminated and caused shoot up of
the VIP score.
4. Antibiotics like Zostum were also observed to cause and increment in the VIP score coz
of their way of infusion.
5. Patient side delays were also observed coz even after staff noticed the increased VIP
score and insisted the patient for changing the cannula still the patient was not ready to get
their cannula changed.

CHAPTER 4:
Findings, conclusions and suggestions

1. Project 1: Study on Discharge process:

1. Intervention required:

• Discharge process to be planned one day prior.

• The intimation of discharge should be given in order to reduce the time lag due to
the following reasons:
1. Delay due to delayed closure of process in the billing department.
2. Delay due to lack of arrangement of the payment immediately by the patient
attendant.
3. Delay due to improper communication at the time of simultaneous discharges.
4. Delay because HK was not communicated in advance about the discharged
room.(Since usually the HK staff is limited on the floor therefore they should be
communicated about their tasks at least before the specific time so that even they
can plan their work accordingly).
5. Patient side delays should be avoided.

2. Post intervention results:

• After the amendments in the process of Discharge were done, the Results were as
follows:
1. Discharges as far as possible were planned a day prior.
2. The personnel in the Billing Department in night shift was asked to do all the past
calculations during the stay of the patient in the Hospital so that the next day when
the actual discharge has to be done, there were no such delays from the billing
department side.
3. Attendant was informed about the discharge one and if possible two days prior so
that they can have enough time to arrange the estimated cash required to be paid at
the time of discharge.
4. House Keeping staff on a particular floor was increased so that there is no delay at
the time of Discharge process.
5. Effective communication training to the staff was given.
The average Discharge time was thus being successfully reduced from 304 minutes to
220 minutes. Although the process is still to be checked on and improved by the
quality department.

3. Innovative strategies and hand holdings:

• The biggest strategy is the interest in improving care transitions, thereby enhancing
quality and safety performance and evidence based health outcomes relating to
readiness and more specifically to accountability measures of performances of the
Hospitals.
• The biggest agenda is to take the initiatives to improve outcomes to provide insight
on current practices in healthcare organisations.
• The biggest focus was on real time innovation rather than research.
• The study aimed and still aims to show that outstanding outcomes can be achieved
through evidence based innovation and to encourage all the people of that
healthcare organisation to pursue quality improvement efforts in this sector.

2. Project 2: Study on Peripheral Cannulation

1. Intervention Required/Corrective Actions:

• Instead of infusing Potassium Chloride from hand vein, External Juglar vein was
being used as the cannulation site and it was given from the infusion pump instead
of giving it through hand.
• The staffs were given training on all the steps of peripheral cannulation and thus the
part of sterilisation and patient safety was also taught to them.
• Antibiotics like Zostum were given through infusion pump at a very slow rate of
.02ml/min due to their inflammatory action.
• Patients who were having high VIP score were being educated by the doctors about
thrombophlebitis and its consequences and thus were made comfortable before
changing the cannula.

2.Post Intervention results:

 Potassium Chloride was infused through external jugular vein instead of hand vein.
 All the staff became more cautious while cannulation and took care of all the steps of
the cannulation.
 Antibiotics like Zostum were given through infusion pump rather than injecting them
through hand.
 Not only the staff, but also the patients were being made aware about the
thrombophlebitis and VIP scores with the help of printed charts being pasted in the
patient premises.

3. Innovative strategies and Hand Holdings:

 • The biggest strategy is the interest in improving care transitions, thereby enhancing
quality and safety performance and evidence based health outcomes relating to
readiness and more specifically to accountability measures of performances of the
Hospitals.
• The biggest agenda is to take the initiatives to improve outcomes to provide insight
on current practices in healthcare organisations.
• The biggest focus was on real time innovation rather than research.
• The study aimed and still aims to show that outstanding outcomes can be achieved
through evidence based innovation and to encourage all the people of that
healthcare organisation to pursue quality improvement efforts in this sector.

Learning’s at the company while studying and completing both the

projects:

Project 1: Study of discharge process

• Effective communication and collaboration among staff, environment services,

transportation teams should be there.
• Structured operational excellence approach should be used and adapted to ensure
that the set quality parameters are achieved.
• Implementing the early target checkout time.
• Utilizing the bed tracking system.
• Creating a standard operating procedure for room cleaning.
• Efficiency and timeliness are the hallmarks of this process, allowing for a seamless
transition.

Project 2: Study on peripheral cannulation

• Education is very important and it should be a two way process, that is, it should
involve the staff as well as the patients of the healthcare institution.
• As far as quality is concerned, even a small loop hole can affect the working of the
whole organisation.
• Any organisation undergoing certain types of accreditations should first prepare
their staff, both mentally and physically for the coming amendments and challenges
they are going to face coz when a team come in your organisation for inspection, it
requires a team of the organisation also for their own organisation’s inspection.
• Quality is something Intangible, it cannot be seen but it can be felt and measured.
• With the advanced growth in the healthcare sector and being the fastest growing
sector, only quality maintenance and assurance can take these healthcare institutes
towards golden seal in the globe.

“Coz even building is a part of the healing process”

 Other work done at the Company

1. Calculated the Emotional Quotient of the employees working in that organization

with the help of a specially designed questionnaire on Emotional intelligence by Dr
NK Singh and Dr Dalip Chadda.
Source of the questionnaire: www.google.com

2. Designed various, “scope of services” charts and formats.

3. Gave training to the staff regarding NABH (National Accreditation Board for Hospital
and Healthcare Providers) chapters on topics like:

1. Biomedical waste segregation,

2. Hand hygiene,

3. Management of vulnerable patients.