Bihar Industries Association - Study on Role of Hospital Information Systems in Medical Services


STUDY ON  Role of Hospital Information Systems in Medical Services Development


CASE STUDY  : Study & Analysis of District Hospitals in a State in India with the purpose of improving overall performance and patient care


4 Ways to Improve Support Service Delivery in Acute-Care Hospitals


  AbstractGrowing communications industry, Telecommunications   and Informatics, the world will face new revolution every day .Information and communication technologies Revolution have significant effects in all parts of economic, social, political and national security .One of the most

important areas of application of information technology, health care field is in this research using library methods and especially using of atabases Plumbed, Cochrane, Embase and the Search engines, this article is perused .The paper introduces information systems; some of the required standards for systems implementation and deployment solutions are presented for electronic health network in the country. Index TermsHospital information systems, telemedicine,medical development.


In 1990’s Very profound and important changes were happened in medical devices and equipment. Technology development in the field of data processing, rising levels of hospitals staff expertise, patient expectations, changes in how the service and its models and the different methods of insurance repayment, has been caused huge change in hospital workflow .In health care organizations, trial and error work are wrong and irreversible because of its role in determining and promoting the health of human society .

Therefore, management based on correct, accurate and timely information and enjoyment of an information management system has a special importance .The only way to collect, store, communicate, and offer large amounts of information is using the computer in such a manner that obviate the needs of consumers.

 Importance of computer and information on global development process is well known .General principle is that a computer and information technology is pervasive that effects on the practical aspects of social life .Nowadays, a computer has become key tool for development [1]. A great

goals of national health care system, is not possible without using of the computer and using new technology for ease and accuracy in collection, classification, archiving, retrieval and processing of data .Overall the computer in health centers (hospitals) can be used the following methods.

Manuscript received July 20, 2012; revised September 20, 2012.

 S  Aghazadeh and A. Aliyev are with the Institute of IT, Azerbaijan National Academy of Sciences, Baku, Azerbaijan and Urmia university of Medical Sciences, Iran (Tel.: +98-914-347-3886, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.). M. Ebrahimnezhad is with the Urmia university of Medical Sciences, Iran (e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.).

 First Method

 Preparation of software that performs functions separately :In this method, each person or department administer feels commensurate with the appropriate knowledge, understanding and the need for computer and entrepreneurial it, and regardless of issues such as specialized information State any impact on clinical findings on treatment process and the need for integration of patient information in hospitals, uses a Stand Alone Software. For example, in various duties in hospital units are done by different people during patient treatment, such as admission and discharge patients that is done in admission, is done transfer of patients between wards, visit and determining the therapeutic actions and orders are issued by physicians and

are run by Nursing services, performing diagnostic procedures and matters such as settlement and others .As you can see, all of these actions is performed separately for each patient and is similar in all patients. If for these actions is used separate software’s, in fact any duty may be done faster and better, but on different actions of treatment and their impact on patient's entire treatment process, will create less accelerate probably because the

different systems have no relationship to each other, and if the relationship between dispersed systems is not done rapidly, the desired goals in the hospital information management will not do.

 In this way, in every part, Suit the needs of them, software is provided with capabilities and its features .The format of the software, operating system and programming language will be completely different and incompatible with each other, most likely the software have been designed and prepared by different people in different intervals without regard to the necessary connection between them, and even in terms of used hardware will be incompatible completely .

 Thus the use of computer software for doing hospital measures, possibility of create networks and exchange patients information, there isn’t even in the future, and since being dispersed information in different systems cannot help to solve hospitals problems, therefore evolution with time and new systems development, management will be forced to change the existing systems, and this means loss of data, costs, and time is a dynamic management system.

 The Second Method

 Hospital Information System implementation (HIS): In this method, using the computer, all therapeutic, and management and financial actions of patient is done by comprehensive software that is made up of different parts .

All therapeutic actions, medication orders and diagnostic services are sent to clinical and Para clinical and administrative centers such as accounting, pharmacy, Review the Role of Hospital Information Systems in Medical Services Development

 Aghazadeh, A. Aliyev, and M. Ebrahimnezhad

International Journal of Computer Theory and Engineering, Vol. 4, No. 6, December 2012 866

 warehouses, and other units through the system and submitted their response is received .  Therefore the start time and end all actions will be identified and followed in the system. in this method will not be delayed between communication of systems like the first method, ultimately therapeutic patient will be exchanged faster and with broader communication between

workstations of different treatment patient and therapeutic factors, and will be taken to avoid a patient data entry form overlapping .The system efficiency is, reducing patient treatment time through the introduction of blind spots in its treatment process. This reduction in total lead time reduces costs of treatment patients and the country's health system and will increase

health care quality and patient satisfaction .Also in this system, that any act is done in treatment patient field by a person will be identified and investigated exactly, so the control issue in medical environments is possible to management easily.

 Generally we can define hospital information system:

 Hospital information system (HIS) is comprehensive software for patient’s information integration for sending and exchange comprehensive patient’s information between wards and other medical centers in order to expedite the process of patient care, improve quality, increase satisfaction

and reduce costs [2].


 Goal of Hospital Information System (HIS) is supporting hospital activities in the levels of practical, Tactical, and strategic .In other words, goal of hospital information system (HIS) is using of computers and communications equipment for collecting, storing, processing, readout, and

communication between patients cares with administrative data on all hospital activities and comply needs of all consumers system .In academic hospitals, also research and training support is one of the hospital information system (HIS) goals. Generally the main goals hospital information system (HIS) can be summarized in the following:

  • Improving staff efficiency
  • To remove duplication and unnecessary procedures
  • Using computers as work tools
  • Statistics and data mining techniques faster and more accurate
  • Improving quality of health care status of
  • To create a modern working methods and systems and standardized hospital
  • Data communication systems, medical engineering
  • Data communication between hospitals and medical centers in
  • The country reaching a distributed database in the country and make its relationship with the World Health Networks
  • Promote community health

 History of Hospital Information System (HIS)

Reports relating to the use of computers returns to support clinical data management activities in 1950, Although most early systems were created to provide financial and repayment goals, but they was the founder of modern

electronic records.Until 1960, hospital information system (HIS) emerged and probably the first hospital information system, data systems was Technician that was created in the system of nursing stations. The first time it was created in a hospital Kamynv, Mountain in December 1971 (EI Camino, Mountain (Created [3])).


Many countries including European countries have moved toward automation hospital information system since the early 1980 .This system developed significantly until now, and it has been an integrated system and with the inner core that called electronic medical records (EMR) from one

inconsistent system [1]. Using hospital information system (HIS)was introduced in Iran in 1378 and was launched in the hospital anymore, Mashhad, Yazd, and Zanjan be as a pilot project for the first time. Thus, in 1380 the country's first e-hospital, carried out in the 313-bed hospital Imam Hussein of Shahrood, to the national pilot with the cost of 800 million Rials .One of the positive results of the implementation of electronic information system was 12 percent reduction of medication in this hospital [4].

 The Importance and Necessity of Establishing Hospital Information System (HIS)

 Due to extensive changes in medical technology and increased expectations of patients, in the twenty-first century hospitals that lacks hospital information system (HIS), they have nothing to say and will not have the ability to compete with other hospitals [2].

 The most important necessity and reasons for hospital information system automation are Inefficiency manual procedures, the growth of medical research in the world, insurance industrial development and changing reimbursement techniques to the centers of contracts, new methods of medical education, medical facilities great achievement, and increasing professional in Employees and development how hospital catering and management, growing health costs, increased patient expectations, the associated need for medical centers and medical professionals together and etc. [5]-[6]. Also a good management information system is necessary to evaluate the quality of care for patients [7]. So the reasons for using these

systems can be summarized as follows:

 Generation of alert and Reminds: HIS systems help with the creation of Wake series warning messages to remind doctor in diagnosis. For example, patient has an abdominal pain that is may be 45 diseases that have the same symptoms but doctor remembers only 10 of them.

 Critical Pathway of Decisions: HIS systems help a doctor in serious cases. In very serious cases, that there isn’t the opportunity for doctor to decide, these systems help the doctor and bring his response quickly in emergency cases. .

Automatic reporting: one of advantages and performances of HIS systems is that can be provided report of patient’s diagnostic - care information

automatically by them.

Reduce cost: HIS systems effect very significant in reducing the costs. So if you have detection algorithms in the system, you won’t need to review

Problem Oriented of patient. In this case you won’t require performing additional tests and etc.

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Access to diagnostic information – care of patient with a PC: using of the appropriate Work station, physician can access patients and hospitals easily

from your location or where he/she is present. · Suitable Administration: One of the benefits of HIS systems is that allow the patient to call the hospital network from home and reserve time to meet with the doctor. Thus make an Appointment is much easier.

  • Reducing errors: because all data have been collected in one place, fewer mistakes occur.
  • Better Managing &Following :patient management and follow patient can be done better in these systems .Therefore, accessing to previous information of patient will be better.
  • Data Presentation T-standardization, better communication of information and decrease the time.


 Properties and characteristics of hospital information system (HIS) as follows:

  • It acts based on standard.
  • It doesn’t make any mandatory in existing manual system, but it matches itself with these systems.
  • It acts based on "medical events" and is independent of the cycle of moving patients [12].
  • Using this system, the previous manual and the current trend does not change much .
  • It keeps the old computer systems and promotes and improves their futures.
  • It offers the best solution for coordination between different lines of work and different units in the hospital
  • It coordinates all wards and hospital system.
  • It increases the quality of decision making and managerial.
  • It includes rich knowledge-based medicine databases such as SNOMED and ICD-10 [13].
  • The data entry are required to type in only 2 %of cases and in 98 %cases, for data entry, clicking method is used by the help of the mouse.
  • Operation is very simple and completely visual and user-friendly.
  • Smart cards are used for identification and control of hospital staff access to patient records (to enhance security) .
  • It is equipped with video conferencing system between health care professionals.[11]
  • It is equipped with knowledge-based intelligent system for diagnosis and treatment.
  • It provides Access to information via the Internet to communicate with the mobile phone.
  • Filing and retrieval of medical information dense is possible to easy access to the complex and stratified set of data.
  • It is equipped with open standards for the implementation of local language.
  • It allows to people’s common use of medical information recorded and Protocol Guide electronically.
  • Using multimedia technology, audio and video recording various Information is possible in it [8].

 Standard HL7 (Health-Care Level 7)

Standard HL7 is accepted standard (protocol) in the world that provides the common language for information exchange and electronic patient records in both domestic and abroad .This world standard is recognized by the Common Market of Europe in 1992and Central Office in 1994 by ANSI and the WHO [1].

 Mission of HL7

HL7 is an international forum with health care that its goal is working with professionals and health scientists to create standards for information exchange, management,  and integration of electronic health information .HL7 strives that we use of such standards within and between health care

organizations to increase efficiency and effectiveness of health care activities such a manner that is in favor of all[5].In other words goal of HL7 is facilitating communication in configuration Health Care [9]. The features of a hospital information system (HIS) software such as HL7 must to have

till act successfully ,include following:

  •  The software should be able to make a separate computerized record (EMR / CPR) for every admitted patient [10].
  • System has accepted standard for transferring medical information between different medical centers.
  • Software is designed Based on Object Oriented Technology, it means that different layers (different tasks) can be run separately from each other and be implemented, so it can implement in various center of health systems.
  • System could support Interface (hardware interfaces) of advanced devices such as radiography; MRI, CT scan, etc.
  • The Software has capabilities of Tele Communication & Tele Medicine.
  • The software must be able to support multimedia capabilities (Multimedia).
  • Level of computer user’s access to file system is classified based on each individual task in patient treatment and position.
  • Software persuades users to use it or is User Friendly.
  • Standard Numbering and archive systems are predicted in it.
  • System works in the network and covers all clinical and Para clinical units.
  • Data confidentiality is guaranteed by certain methods [8].


HL7 Standard has a lot of flexibility information exchange  in the types of the hardware and software infrastructure. Also it has a closely coordination with other accepted standards of medical informatics, and can be used in all health care environments.


 We require planning based on opportunities and threats of the way and self-strengths and weaknesses to develop this industry within the country. A group of major and noticeable obstacles are considered in the way of development, have the effect of possible factors that are related to space

management outside the country and their management is not

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 easy. Some of these obstacles and challenges we expressed in:

 Large investment and intense competition among developed countries reduce technology life in the arena and the competition has been heavier.

 Due to requests from the local market using the most advanced products in the world to provide medical services, offering products in this arena requires standards in manufacturing products of the world. In addition to the above, Informatics Technology has features generally that encourages the countries in the world to investment in this sector. Medical informatics industry includes three areas: software, hardware and medical services. The areas of medical informatics as artificial intelligence applications in medicine, remote medical services, will be a good background for planning and investment in its product offering in the sector due to the research stage.


 Considering the role of governments in order to developing, two Applicable and production parts in the informatics field should create infrastructure items. Thus, a comprehensive understanding of infrastructure planning of

the form is very necessary in the beginning of this section. [14]

 Security Infrastructure

 Privacy and protection of digital information is infrastructure Developing member of Medical Informatics that prevent abuse and invasion of people privacy. Collection of items that should be considered include: network’s

equipment security, secure operating system, electronic signature, identification center and etc.

 Business Infrastructure

 Weakness and lack of proper systems for financial interaction under the network will prevent interest in the public for providing services through the network. Therefore, other cases of infrastructure of application development and the industry growing of medical informatics are an infrastructure business including: electronic banking, electronic money and etc.

 Legal Infrastructure

 Laws and regulations relating to activities in the information age are necessary to medical informatics in developing countries. Because of without clear and determinant rules, chaos will hinder development. For

example: the court network, cyber laws and etc.

 Social and Cultural Infrastructure

 The main audience of information technology is human resources and if it resists changes in the development, we cannot achieve the desired results. Therefore, training and culture building is continued needs for promotion of

scientific and intellectual development of the population information technology. Increased knowledge and skills of medical specialists in the field and against the increased awareness and create social acceptance for the productivity of services at national and regional levels is necessary and

irrefutable [3].

 Technical Infrastructure

 Medical equipment in addition to communication and information tools will provide technical infrastructure of medical informatics in this age. Appearance of electronic tools with the ability of the individual records from birth to death will provide Admitted for the use of powerful and intelligent processing tools that these tools be made responsible for everyday works with a non-creative nature. Among these tools we can Point to consulting physician Technology as a medical help in the diagnosis and treatment is known. Another group of tools, a powerful database is that will be very significant role in speeding up service delivery and cost reduction, including technologies, strong database of medical information is. That can be part of them took advantage of the following:

 Hospital management information systems: these systems are a kind of management information systems (MIS) those issues in the covers information such as administrative and financial information for financial management and information systems, reimbursement and other administrative.

 clinical information systems and medical care: These systems have databases that apply the types of patient information To multimedia including several individuals critical parameters (EMG, ECG, EEG) medical images (CT, MRT), medical sounds and system has the ability to collect and registration, search and retrieve this information and provides power to the diagnosis and treatment by a physician despite a powerful tool to process and improves.

 Health information systems: Main features of these systems will be their vast in collecting, recording and retrieving information that will provide monitoring the underlying health of the community and timely and appropriate response to natural factors and abnormal impaired health community.

 Virtual reality: Another new and important debate is the concept of virtual reality in the process of getting information in human societies. The talk covers all materialist concepts around us and it has the capability that simulate many part of the physical world interactions. Also A virtual reality in medicine has widespread application for example simulating anatomy and physiology human body as a laboratory sample, will provide the ability to do any tests and medical research. Simulating Types of laboratories and educational and training environment, will provide the rapid growth of knowledge to in the future world, workers do the knowledge-based works.

 Telemedicine: in the information age, Experts and facilities distribution and services from all over the world will not require spending a lot of time and then place will lose its importance. In this age of new areas such Telemedicine will find significance that will be the medical care field and will provide services should be close to medical standards. Otherwise the status of service will have problems. In the subset of Telemedicine topics, we can offer remote consultation, remote surgery, remote capture and other

remote services [15].

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 Standardization Infrastructure

 With Complexity and structure expanded medical services, increasingly, need to develop automated information systems and create communication flow within and between organizations increases. Create an efficient communication is possible in the context of standardization and coordination

and development in the standardization will be necessary. Standards provide effective Infrastructure in order to compete effectively if between producers and consumers will result to agree common standards; in the technology propagation process occurs acceleration. Also standardization in facilitate and funding research and innovation have a key role and because of clarify, provides investment environment that provide needs of financial .in other hand, it facilitates the participation of sector investment and provides infrastructure of development finance by medical informatics industry.


 According to the aim of efficient developing the Medical Informatics industry, in this article were addressed definition of the concepts, information systems, standards, development ,medical informatics industry in the country, the role of government and infrastructure. So we hope that the administrators of medical services take an effective step towards the development of medical services with playing a role in development of the informatics industry and presenting standardization.

  Case Study 3: Study & Analysis of District Hospitals in a State in India with the purpose of improving overall performance and patient care

 A study and an in-depth review of nine District Hospitals in a State in India was performed involving their structural organization and operational framework in their efforts to provide secondary healthcare services to the people in the districts and the region. The assessment also brought to the forefront gaps in delivery of healthcare services and to provide practical recommendations for further strengthening the system. The ultimate aim of this study was to recommend a road map for the up gradation of the District Hospitals through a logically achievable, phase-wise program leading to accreditation (ISO and subsequently NABH).

 A survey team was constituted to conduct site visits to nine District Hospitals after discussions with senior officials of the State Health Society. Vital quantitative information was collected using a facility survey checklist based on IPHS norms. FFHI, MQESP norms were also included just as a baseline reference. Interview schedules for administrative, medical, nursing staff of the DHs, those of clients and other stakeholders were also conducted. The information obtained was further validated and verified through qualitative observations conducted by our hospital planning and management expert team during visits to the DHs. The study was conducted in two parts.  Client surveys were conducted where most respondents gave their views willingly. Many felt neglected by the healthcare providers and were resigned to accept the abysmal conditions of the facilities and paucity of services. It was evident that they had very few options as far as free healthcare delivery was concerned and their perception of good, quality facilities and services was limited only by their lack of exposure to quality alternatives.

 The healthcare providers were quite forthcoming with their views. Their perspective of the hospital was mainly directed to their immediate, yet perennial problem of lack of specialists, nursing and paramedical staff and the pressures of managing large and growing number of patients. Opinion of some hospital staff was not always spontaneous and at times muted. The survey was perceived as a faultfinding mission by some of them rather than a need assessment study.

 Paucity of healthcare manpower across the State was reflected quite clearly in the DHs and they required a resolute capacity building of their staff. Availability of adequate and timely clinical services including emergency medicine needed to be strengthened. In addition, well-designed and frequently executed training programmes were a perceivable need for better patient care.  

disaster preparedness, referral linkages and record keeping. The medical stores were computerized and inventory was managed adequately. However, the hospital did not have a general store for various non-medical items. disaster preparedness, referral linkages and record keeping. The medical stores were computerized and inventory was managed adequately. However, the hospital did not have a general store for various non-medical items.

It was observed that the DH received a large number of patients in the OPDs. A majority of these belonged to the economically challenged strata of the society. In this the female patient load was also sizeable. Whilst there are very few options for the `free’ category of patients, those willing to pay ‘fee for service’ preferred to visit private clinics and nursing homes owing to better quality and promptness in delivery of healthcare services when compared to the Government facilities. They were discontent with the long waiting periods in OPDs due to shortage or lack of doctors, unpredictable situation of availability of medicines and often an indifferent response from the healthcare staff.

 The inpatient numbers were not commensurate with the outpatient load. A limited number of patient related medical services coupled with the above mentioned restrictive factors appeared to be the primary reason for this anomaly. The types and levels of services offered at the DH needed to be increased not just from the patient demand perspective but also to be able to meet the IPHS norms.

Considering that the hospital had been FFHI certified, it had already established some necessary features also required under IPHS. Plans were afoot to upgrade this hospital to 300 beds for which sums had already been sanctioned. This implied adding more clinical services along with the commensurate medical specialists and requisite medical technology. It was suggested that it would be prudent to add beds in a phased manner such that all associated facilities and services are established in keeping with the IPHS norms.

 The large campus of this DH could be better utilized with provisions for staff residential facilities. Housing for staff came out to be one of the main drivers for attracting qualified and experienced medical (specialists), nursing and paramedical staff.

 Although the overall campus was fairly well maintained in parts, it needed better maintenance in some other areas with a more vigil security staff to prevent trespassing and unwarranted littering. As a sequel to this a more concerted and effective BMW management was also a definite need.

Despite the gaps in infrastructure and other components of service delivery mechanisms, the District Hospital had one distinct advantage in the form of the support from hospital authorities and the fact that they had completed FFHI accreditation process. As a result most of the gaps could be addressed and the DH could ready itself to meet with IPHS norms fairly quickly.

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Quality management in healthcare: the case of a South Indian hospital

 The healthcare industry presents a very dynamic and uncertain

environment in which “quality issues” have occupied a central


 As healthcare organizations are becoming more and more complex, old models of quality assurance, relying on provider-based preset standards are insufficient to solving quality problems. Concepts of total quality management (TQM) and continuous quality improvement (CQI) have taken a central role in healthcare quality management. By adopting the concepts of TQM or CQI, a healthcare institution can move away from an inspection-oriented quality improvement system

to one that orients itself to a systematic transformation of an organizational culture through a roll-out plan involving customer focus, key-process monitoring, data-driven tools and techniques, and team empowerment. In order to determine an organization's level of quality management and continuous improvement, many have used Malcolm Baldrige National Quality Award (MBNQA).

 Quality initiatives in Indian hospitals As hospitals in India are not

 only growing in number but in size, complexity and the types of services provided, there is an ever-growing  need for professional management of hospitals. A number of private and corporate hospitals are constantly innovating and improving the technical/clinical and service aspects like never before in order to provide world-class quality. In the absence of an accrediting body for hospitals, leaders in the industry are looking at different approaches like accreditation from organizations abroad and hospital grading by commercial organizations in India to improve quality and attract new markets.

Many Indian hospitals are getting ISO certification and the Apollo Group of Hospitals in its efforts to position itself as an Indian MNC in

global healthcare is undergoing the US Joint Commission on Accreditation of Healthcare organizations (JCAHO) certification process. However, external reviews rarely generate wholly new knowledge, are found to be more confirmatory than revelatory, and do not usually lead to major changes in policy, strategy or practice. Industry leaders in India are also voicing their concerns about the usefulness of ISO and JCAHO certification for Indian hospitals. While the TQM philosophy has its roots in manufacturing and industry, it is based on many  techniques, which could easily be transferred to the healthcare setting. The MBNQA is widely used as a model for improvement and currently thereare newly established criteria for performance excellence that have been specially tailored for healthcare providers. The seven criteria are:

  • leadership,
  • strategic planning,
  • customer and market focus,
  • measurement,
  • analysis and knowledge management,
  • human resource focus, and
  • process management and business results.

 As such, its underlying theoretical framework is of critical importance, since the relationships it portrays for the different criteria convey a message about the route to competitiveness. It was therefore judged that the MBNQA healthcare criteria would provide a good framework to analyze quality management practices in the case hospital.

Executive Summary | 1ExecutiveSuary

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Hospital profile

 This 350-bed multi/super specialty private hospital is located in a non-metro city of South India and is run by a charitable trust. The hospital

was established in 1975 as a modest 40-bed hospital with a staff of three doctors and 12 nurses, now it can boast of over 20 specialty

departments and a total staff of about 1,200 including 150 doctors specialized in various fields and 600 nursing staff. The hospital offers a wide range of medical and surgical specialty areas, and all the support services of a modern super specialty hospital.

 “Strategic development process and implementation is obviously a great plus for the hospital considering its growth,

positioning in the region and the range of services.”

 This hospital is forefront in adopting quality practices. Today it is one of the best hospitals in the region and is known for its excellent technical and professional service capabilities as well as its ever-expanding specialty care areas. It is the fourth hospital in the country to have obtained ISO 9002 certification for rendering quality medical care.

 Quality performance based on Baldrige criteria Leadership

 The hospital has effectively implemented leadership's vision even though it has a topdown structure at the outset. Allocation of resources, setting up of systems, formal daily meetings with various level managers and proper communication indicate management commitment for continuous improvement. Result oriented work culture with appropriate systems/mechanisms to facilitate achievement of organization goals is promoted. There is a clear indication of good governance practices with legal, human resource and finance functions of the organization.

 Strategic planning

 Strategic planning areas include setting up high quality standards, improving organ transplant/donor availability, education of Insurance companies for customizing medical insurance schemes and tapping the international market (also referred to as medical tourism), expanding to Dubai. Strategic development process and implementation is obviously a great plus for the hospital considering its growth, positioning in the region and the range of services.

 Customer and market focus

 A number of open communication channels interfacing patients/families, suppliers, community and staff are used to ensure patient satisfaction. Regular referrals to other hospitals, technology/knowledge and responding to social causes help optimize knowledge about the market and other customers. Well-planned physical infrastructure and artifacts and a clean/hygienic ambience support the services. A general customer friendly environment and

Helpful front desk staff further adds to value the service aspects of care.

 Measurement, analysis and knowledge management

 Measurement, analysis and knowledge management of medical care procedures and outcomes are given primary importance. Mortality and morbidity data analysis along with medical records, department records and summary of results are maintained. Accessibility, security and confidentiality issues of information are strictly adhered to. However, data for various processes and performance measures is rather limited due to a heavy patient load and excess work demands. This is an area of weakness for the hospital; however, an IT based hospital information system is being developed.

 Human resource focus

 Human resource development is judged to be highly effective based on training, continuous learning and professional development activities carried out in this hospital. Customers, coworkers and senior colleagues' feedback constitute an important component of

performance appraisal, done every six months. Staff orientation, continuous medical education and professional development programmes’ are  the major efforts in training and skill development. Rewards, monetary and otherwise, are used for motivating staff. Nursing staff attrition is higher than that of doctors, but the HR department tries to analyze and understand reasons, and minimize attrition through different benefits. Some challenges like staff retention, motivation, transparency and procedures continue to exist. However, this is one of the best-reported areas of hospital performance and

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highlights the importance of human resource development in quality management.

 Process management and business results

 Standard operating procedures (SOPs) for emergency, laboratory, routine admissions and registrations, etc., are in place. Feedback to

improve healthcare processes is an important feature. Doctors' inputs, latest information from medical journals and management inputs are used for improving care processes. Measurement and data analysis for healthcare processes and outcomes are rather basic and needs improvement. Support processes like pharmacy, central sterilization, diet and nutrition, etc., are very well streamlined with other processes. Safety and security processes are standardized. There is an active disaster management team, and rules and hazards are clearly displayed for various equipments used in the hospital. Overall process management is judged to be good; however, improvements such as incorporating data analysis into improving care processes are needed.

 Organizational performance results are  comparable to any multi-specialty hospital in India. The hospital's reputation and good quality

services have been a major attraction to different groups of customers. In terms of referral within and outside, the relationships with various groups of customers are judged to be very positive. The patients show preference and return to the same consultant, which is seen as a good sign of customer loyalty. The hospital is reported to be a profit making venture. It has entered the field of cardio thoracic surgery in the last three years and it has already broken even at the end of two years.

 Superior performance

 The analysis of quality management using MBNQA criteria of the case hospital demonstrates that committed leadership is a driver for management accountability and creation of environment for empowerment and organizational agility. The hospital has effectively

implemented the leadership's vision even though it has a top-down structure at the outset. Human resource development is judged to be

highly effective based on training, continuous learning and professional development activities. Customer focus has resulted in high customer loyalty, which is a positive change in a traditional healthcare system that is primarily provider based. Measurement, analysis and knowledge management and information technology based hospital information systems is an area of weakness for the case hospital. Also, there is a very limited amount of information for

benchmarking hospital performance in India and that in itself poses challenges for comparisons among hospitals in the country. Though the hospital has made good efforts towards subsidizing the availability of medical care to patients in the lower end of economic

scale, areas of social equity are still a difficult proposition to be achieved by a private healthcare provider owing to costs of high technology medical care. Overall, this case hospital is judged to be

performing at a good level. The hospital has followed the lead of other leading sectors in implementation of TQM, and the rich experience and knowledge of quality management available with this hospital really provides lessons to other hospitals in India and abroad in achieving superior performance. □ July 2007.

 This is a shortened version of “Quality management in a healthcare organization: a case of South Indian hospital”, which originally appeared in The TQM Magazine, Volume 19 Number 2 2007.

 The authors are Usha Manjunath, Bhimaraya A. Metri and Shalini Ramachandran. Executive


Executive Summary | 3Organizational Structure of a Hospital

 Organizational Structure refers to   levels of  management within a hospital.

 Levels allow efficient management of hospital departments. The structure helps one understand the hospital’s chain of command. Organizational structure varies from hospital to hospital

 Large hospitals have complex organizational  structures   Smaller hospitals tend to have much simpler organizational structures

 Grouping of Hospital Departments ithin the Structure:

 Hospital departments are grouped in order to promote efficiency of facility.

    Grouping is generally done according      to similarity of duties Common Categorical Grouping:

  •  Administrative Services .
  • Informational Services .
  • Therapeutic Services .
  • Diagnostic Services .
  • Support Services
  • Administrative Services

 Hospital Administrators

  Vice President(s), Executive Assistants, Department Heads .

  •  Business people who “run the hospital”
  • Oversee budgeting and finance .
  • Establish hospital  policies  and procedures .
  • Often perform public relation duties .
  • Informational ServicesDocument and process information


 Admissions .

  1. Billing & Collection .
  2. Medical Records .
  3. Computer Information Systems .
  4. Health Education .
  5. Human Resources .

 Therapeutic Services

  • Provides treatment to patients .

           Includes following departments:

 Physical Therapy - treatment to improve large muscle mobility .

  1. Occupational Therapy - treatment goal is to help patient regain fine motor skills .
  2. Speech/Language Pathology -identify, evaluate , treat  speech / language disorders .
  3. Respiratory Therapy - treat patients with heart & lung disease .

       4-  Medical   Psychology - concerned with mental well-being  of patients .

       5. Social Services  - connect patients with community

        resources(financial aid,etc.)

      6. Pharmacy - dispense medications

     7.   Dietary - maintain nutritionally sound diets for patients

      8.  Nursing - provide care for patients

      9.-Sports Medicine - provide rehabilitative services to           athletes .

Diagnostic Services

 Determines the  cause  (s) of illness or injury .


  1. Medical Laboratory - studies body tissues .
  2.  Medical Imaging - radiology, MRI, Ultra Sound
  3. Emergency Medicine -   provides  emergency diagnoses &        treatment

 Support Services

 Provides support for entire hospital


  1. Central Supply - orders, receives, stocks & distributes equipment & supplies .

       2. Biomedical Technology - design, build repair, medical equipment .

       3.Housekeeping & Maintenance - maintain safe, clean      environment

 4 Ways to Improve Support Service Delivery in Acute-Care Hospitals

It is no secret that hospital leaders are looking for creative ways to contain costs while improving performance outcomes in non-clinical support departments such as housekeeping, food services and patient transportation. It's also no secret that technology is revolutionizing healthcare and can be the linchpin in dramatically improving these desired outcomes. Yet there is a gap between this knowledge and actual results — all which boils down to the way in which hospitals apply it systematically.

Now that Medicare reimbursements are directly tied to both clinical outcomes and patient perception of service, it is more important than ever to maximize support service resources and ensure effective patient interaction. Below are four strategies for all support service disciplines that will affect immediate and meaningful change for any hospital, whether it's via technology or simply reshaping their processes and systems.

1. Leverage the "cloud"

Mobile, cloud-based technologies have advanced dramatically in the last several years, and are now being applied in support-services management. Hospitals and medical professionals have already begun to embrace the use of hand-held devices with regard to clinical care, and bringing this technology to support services can help to optimize communication and improve service delivery in the following ways:

  •  Smartphone’s and tablets can be utilized by EVS team members to improve cleaning quality assurance — as well HCAHPS outcomes and bed turnover times.
  • Food service team members can employ tablets with customized mobile apps to quickly and accurately process patient dietary requests and reduce costs associated with food waste.
  • Mobile apps can also improve patient transportation by leveraging a "crowd-sourcing" philosophy, which can increase overall efficiency per transport by significantly reducing the number of phone calls made to complete each transport, and in some cases, eliminate the need for a dispatcher all together.
  1. Increase department leaders' presence on hospital floors
    By automating paperwork via mobile, cloud-based technologies, leadership can significantly reduce time spent on office tasks, since routine reporting tasks can be performed and analyzed "on-the-go." This provides a greater opportunity for leaders to identify inefficiencies with regard to waste streams, linen usage, patient room turnover times, transport requests and patient meal delivery. After all, easily-rectified actions, such as improper disposal of non-regulated waste in red bags, poor separation of recyclable materials, incorrect patient meal orders, lags in patient room discharge cleaning, clinical staff members conducting patient transports and inefficient linen management can cost a hospital hundreds of thousands of dollars each year.  

    Armed with mobile, cloud-based technologies, support service leadership can spend more time coaching their team members, performing quality assurance checks, proactively communicating with hospital clinicians and personally engaging with each patient multiple times during their stay.
  2. Systematically educate and prepare front-line team members for patient interaction
    Aside from nursing, housekeepers, food service employees and patient transporters have more interaction with patients than any other hospital employees. Yet, they are often not prepared — nor trained — for that responsibility.  At hospitals achieving the highest rates of support service patient satisfaction, formal, carefully-designed systems are in place to educate these team members, review their performance and report outcomes.

    Providing foundational training — and holding front-line employees accountable to that training on a daily basis — is essential. This helps to ensure desired outcomes and demonstrates that department leaders are committed to the success of each team member. Fundamentally, a formal support service training program should include the following elements: 
  • A formal hospitality training program to establish key best practices for desired results inclusive of prescribed patient service techniques.
  • Daily documented patient-interaction rounding to observe how well team members utilize prescribed patient service techniques.
  • Clearly identifiable, up-to-date patient satisfaction results, by unit, posted in team member common areas 24/7.
  • Daily training huddles prior to each shift, designed to educate, publicly recognize outstanding team member performance and report departmental patient satisfaction scores .
  • Systematic, formal online developmental materials for ongoing education.
  1. Foster a culture of service

The team members most effective in their support service roles clearly understand their role in the healing process. They recognize and embrace their responsibilities in ensuring patient satisfaction, and they welcome the clearly defined expectations by which they are both held accountable and receive positive recognition. In "laying the groundwork" for a service-centric culture, one must establish several elements to ensure success: 

  • Define a process to recruit individuals who possess the desired qualities of a "service-focused" team member;
  • Implement a formal candidate "self-selection" process to ensure that each applicant fully understands departmental service expectations and "buys in" prior to applying; and
  • Develop a formal reward and recognition program that publically recognizes team members for performance that makes a difference in a patient's stay.

Developing systems to proactively recruit and hire the best people, reinforce key objectives through training and consistently reward team members for making a positive difference with their work will pave the way to greater patient satisfaction outcomes.

The goal: Outstanding support service results
Experience has proven that patient satisfaction outcomes are correlated to the way support service disciplines are managed. With properly-placed managers leading well-trained and properly-resourced teams, results improve, and when the appropriate systems are applied in conjunction with technology, exceptional outcomes become not only achievable, but predictable. 

Bobby Floyd is the chief operating officer of HHS, a firm that has been providing support service management solutions for healthcare facilities since 1975.





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