LEARNING OBJECTIVES
1.
2.
3.
4.
5.
6.
7.
8.
9.
The purpose of an organization structure
The meaning of "organizing" and "organization."
The distinction between formal and informal organization.
How organization structures and their levels are due to the
limitations of the span of management.
The exact number of people a manager can effectively supervise
depends on a number of underlying variables and situations.
The nature of entrepreneuring and intrapreneuring.
The key aspects and limitations of reengineering.
The logic of organizing and its relationship to other managerial
functions.
That organizing requires taking situations into account.
Organizing
A basic process of combining / integrating
Human / Physical / Financial resources in
productive interrelationship for the
achievement of enterprise objectives
Definition of Organization
Organization implies a
formalized intentional
structure of roles or
positions
Effort Pooling towards designated objectives through
definition / division of activities / responsibilities /
authority
identification and
classification
Organizing involves
of required activities
necessary to attain objectives
Departmentation
Manageable units
Maximum possible specialization
Assigning responsibility
with necessary
authority
Delegation
Aptitude / Attitude
Job Requirement / Capabilities
grouping of activities
To a manager for each grouping
Coordination in
organizational
Structure
Vertically, Horizontally
Synchronization
Interrelationship between different
positions must be clearly defined
From whom ?
To whom ?
Organizational Structure Design
Who
Give what
Is to do
Results
What
Fitting various activities
Smoothly
Efficiently
Effectively
intentional structure of
roles in a formally
organized enterprise
Well
defined
jobs
Should
not be
flexible
Channeled
individual and
group efforts
Formal
organization
Definite
authority /
responsibility
Any joint personal activity
without
conscious joint effort
even through contributing towards
Joint Results
Loosely
organized
flexible
Informal
organization
Structure (membership),
communication networks
(“grapevine”), and relationships
behaviors and norms) do not
necessarily follow those of
the formal organization.
A network of personal / social
relationships, not established, required
by FORMAL organization but arising
spontaneously
ill defined
Spontaneous
What is a Department?
The department designates a distinct area,
division, or branch of an organization
over which a manager has
Authority
for the
performance of specified activities
Organization Level and Span of
Management
Levels = 4
Span of Control = 3
Total Employees = 40
Organization with Narrow Span
Variety of non-recurrent problems, involving nonprogrammed strategic decisions
Advantages
•Close supervision
•Close control
•Fast communication
between levels
Disadvantages
•Too much involvement in
subordinate’s work
•Many levels / higher cost
•Excessive distance between
top and lowest level
Levels = 3
Span of Control = 7
Total Employees = 57
Organization with wide span
For Recurrent, repetitive and routine problems
Advantages
•Superiors are forced to
delegate
•Clear policies are
required
•Subordinates must be
carefully selected
Disadvantages
•Overloaded superior /
decisional bottleneck
•Superior’s loss of control
•Requires exceptional quality
managers
Principle of the Span of Management
The principle of the span of
management states that there is a limit
to the number of subordinates a
manager can effectively supervise, but
the exact number will depend on the
impact of underlying factors
Operational-management position: a situational approach
Classical theory:
No. of subordinates:3-8
Operational management theory:
No. depends of many underlying factors:
1. What to supervise: complexity and variety of the
subordinate’s work
2. Which tools are used
3. Quality of manager and subordinate
4. Degree of interaction
Difference Between an Intrapreneur and an Entrepreneur
• An intrapreneur is a person who focuses on
innovation and creativity and who transforms
a dream or an idea into a profitable venture
by operating within the organizational
environment
• The entrepreneur is a person who does
similar things as the intrapreneur, but outside
the organizational setting
Definition of Reengineering
• "...the fundamental rethinking and radical
redesign of business processes to achieve
dramatic improvements in critical
contemporary measures of performance,
such as cost, quality, service, and speed.“
Key Aspects of Reengineering
Fundamental rethinking of what the organization is doing and why.
Radical redesign of the business processes
Reengineering calls for dramatic results
The need for carefully analyzing and questioning business
processes
Nurses form a very important group - the
largest single technical group - of personnel
engaged in patient care in hospitals next to
doctors, consuming approximately one-third
of hospital costs.
because….
• Nursing care is required for the prevention of
disease and for promotion of health.
• The nursing care of sick patients a. in the interest of his or her mental and
physical comfort.
b. by reason of the disease from which he or
she is suffering.
Functions of nursing services are:
1.
2.
3.
4.
5.
Clinical
Technical
Caring relationship
Administrative
Educational
It is observed that 50% or more of her time will
be spent on non-nursing functions like
a. Clerical
b. Answering telephones
c. Supervise indent of drugs
d. House keeping, etc
staffing
The number of nurses required to man the nursing
services in a hospital depends on many factors,
• Number of beds in a hospital
• The type of hospital and the prevailing medical practice,
including kinds of treatment and medications given and tests
and services required for the patients.
• Pattern of assignment of nurses - based on functional
method, case method or teach method.
• The type and the number of emergency cases coming into
the hospital.
• Available labour - saving devices, automation,
mechanization, centralization
• Level of competence based on - qualification, experience,
efficiency and sincerity.
Work allocation
Patterns of assignment: the tasks of the nursing unit
are carried out by 3 accepted patterns of assignment,
depending on the training, experience and the rules of a
particular institution.
1. Functional method: The tasks are divided among the staff.
2. Case method: Each nurse is assigned one or more cases.
3. Team method : Under this system the nursing staff is divided into
teams each of which is guided by an experienced nurse. The team
leader is responsible to the ward sister and she organizes the nursing
care for her group of patients.
4. Group Assignment method: one nurse is assigned to a group of patient
to provide total nursing care.
5. Primary nursing method: the primary nurse assumes 24-hour
accountability for the care, planning and evaluation. When on duty on
a shift, the primary nurse herself assumes responsibility for providing
total care. Other functions of primary nurse is the coordination of
nursing activities with physician and other health professionals.
Physical dependency of patients
This is an important factor in assessing the
workload. The patients can be classified under
the following headings:
a. Totally ambulant
b. Partially bedfast
c. Bedfast but not helpless
d. Partially helpless
e. Totally helpless
Indices of hospital nurses
The nursing time provided per patient per day
is the most useful and realistic index, since it
takes into account
Occupancy rates,
working hours, and
days absent from work.
To find out the average number of working
days
per year by a nurse:
Earned leave
30 days
Sick leave
10 days
Casual leave
14 days
Weekly off
85 days
Non-working days 139 days
Total working days in year 365 days
Therefore total working days is 226 days
To find out the average number of hours
worked
per year by a nurse
Average number of working days per year X
Average number of working hours
226 x 8 = 1808 nursing hours
To find out the total number of nursing hours per
day
The hours worked per year by a nurse X total number of
nurses
For example
Total bed capacity of hospital
= 500
Required number of nurses = 217 nurses (as per
INC norms
1808 x 217 = 361736
To find out the number of nursing hours per day
Total number of nursing hours per year 365
361736 365 991.21 nursing hours per day
To find out the number of nursing hours per
Patient
991  500 = 1.98 nursing hours per patient
per day approximately
Duties of different categories of nursing staff
Director of nursing
The nursing director has very little or no technical
duty to perform. The work is mainly administrative
and conceptual.
1.
2.
3.
4.
5.
6.
7.
Supervision - working pattern
Maintaining discipline
Planning diff. services
Preparing policies to upgrade the routines.
Participating in recruitment of staff
Organizing for academic purposes.
Arrange (in-service) training programmes.
Sister-in-charge
Sister-in-charge is the administrative head of the
ward/section. Therefore the duties are based on
responsible attitude and supervision.
1. Maintaining cleanliness and orderliness in the ward.
2. Supervising housekeeping activities.
3. Supervise staff nurse, nurse-aides, labour staff, patients.
4. Maintaining inventory.
5. Accompany senior clinician during their rounds/ discussion
and actively participate in taking and implementing the
decisions.
Staff Nurse
This category is the most active. The duties they
are expected to carry out are
1.
General and routine care of patients as per clinicians instructions. She is an
active bridge between treating clinician and patients.
2.
To assist clinician.
3.
Assist or independently perform certain procedure like a. collecting blood, b.
catheterization of bladder, c. giving IV fluids, d. first aid.
4.
Assist actively at ante natal clinic, post natal clinic, diabetes, asthma, etc.
5.
Educational activity like health talk, counseling, etc.
6.
Attend outdoor activities.
7.
Admit and discharge patients.
Problems faced:
1. Shortage of nurses due to
a. improper ratio of nurse : patient
b. recruitment policy
c. non availability
d. migration to other hospitals e. increase in
requirement.
2. Dissatisfaction
3. Absenteeism : particularly for night duty.
4. Unionization
5. Deterioration in standard of performance
Professional Hazards:
1. Risk of infection
2. Stress and burn out
3. Backache due to prolonged standing and
walking on hard surface.
4. Fatigue due to shift duties.
5. Improper behavior of some patients,
relatives, labour staff and even doctors.
6. Frustration.
Functions of CSSD
1. Receiving and sorting the soiled material used in the
hospital
2. Determining whether the items should be reused or
discarded.
3. Carrying out the process of decontamination or
disinfection prior to sterilizing.
4. Carrying out specialized cleaning of equipment and
supplies.
5. Inspecting and testing instruments, equipment and linen.
6. Assembling treatment trays, instrument sets, linen packs,
etc.
7. Packaging all materials for sterilizing.
8. Sterilizing.
9. Labelling and dating materials.
10.Storing and controlling inventory.
11.Issuing and distributing.
Functions of CSSD
1. To maintain an uninterrupted supply of
bacteriologically safe supplies at all times.
2. To undertake studies for improvement of
sterilization practices and
3. Processing methods to provide supplies
economically.
4. To impart training to hospital personnel in
safe hospital practices.
5. To participate in hospital infection control
programme.
Receipt
Accounting, Sorting
Cracked/
broken
Unserviceable
Torn/punctured
Gloves
Needles &
Syringes
Instruments
Washing, Cleaning, Drying
Gloves
Syringes
&
Needles
Gauze &
Dressings
Instruments
Packs
Packing
Awaiting sterilization
Autoclaves
Sterilization
Dry ovens
Check for Sterility
Sterile storage
Issue
Sterility
Not ok
Shelf-life
expired
The sequence of events is as follows:
1. Materials are received into the department
from various users.
2. All used materials are cleaned - prelimary
cleaning before sending the articles to CSSD.
3. Clean materials are inspected, assembled and
packed, ready for sterilization.
4. After sterilization, they are either stored in a
sterile storage area or distributed directly as
required.
Location
• The location of CSSD should be convenient
to its principal consumers.
• Preferably sited close to OT & wards.
• Doors should have the following strong
colours to signify the different zones to
which they give access.
Red
- denotes contaminated zone
Yellow - denotes clean zone
Green - denotes sterile zone
Space
A minimum of 7 sq ft on a per bed basis ( with
100 sq ft for the smallest hospital) is considered
essential for planning a CSSD with scope for
future expansion and growth.
Up to 100 beds
Up to 200 beds
Up to 300 beds
300 and above
10 sq ft per bed
9 - 10 sq ft per bed
8 - 9 sq ft per bed
7 - 8 sq ft per bed
In planning a CSSD, following concept may be kept in mind
Room
Nature
of work
Space in
%
Wash room in which
everything is washed up
Dirty
10
Work room in which all
packaging is undertaken
Clean
26
Syringe & instrument
processing room
Clean
9
Unsterile pack store
Clean
4
Bulk store
Clean
11
Sterile store
Sterile
16
Miscellaneous rooms
Clean
19
Autoclaves
Clean
5
Staffing
One qualified superintendent - In-charge of the dept.
CSSD supervisor - senior nurse (traditionally).
In-service trained CSSD attendants
CSSD assistants - Semiskilled workers
CSSD technicians
Sweeper.
A 500-bedded teaching hospital has the
following staff.
Technologists
5
Technical assistants 4
Nursing aides
4
CSSD attendants 4
Equipments
• Autoclaves
• Dry oven
• Gauze cutter
• Ultrasound washer
• Needle flushing device
• Ethylene oxide sterilizer
• Soaking sinks
• High pressure water jets.
Autoclaves
• Saturated steam under pressure is the safest and
dependable method of sterilization.
• Minimum time for sterilization by autoclaving
process is 121°C in 15 min.
• sterilization checks for quality control.
• Sterility indicators
– Mechanical indicators
– Chemical indicators
– Biological indicators
• Shelf life
Chemical sterilization
Ethylene oxide (EO) - used for heat-sensitive and
moisture-sensitive materials like rubber, plastics and
fibre glass.
Effective sterilization by EO depends upon the
Following:
Concentration of gas: 450mg/litre or higher
Temperature exposure: 49 to 63°C and 30 to 37.8°C
Packing: The type of wrapping used should be penetrable by
ethylene oxide and water vapour.
Polyethylene is commonly used for wrapping.
Period of exposure: The time ranges from 110 to 260 min. up to 12
hours may be required.
Sterilization process
After the sterilizer chamber is sealed and the
controls set, sterilization process goes through
the following phases:
1.
2.
3.
4.
5.
6.
7.
Warming the chamber
Evacuating residual air to partial vacuum.
Introduction of moisture to ensure that it penetrates
wrappings and material.
Introduction of EO.
Raising the temperature(if required)
Exposure for the required time.
Release of chamber pressure.
Ultra sonic cleaner
• Ultrasonic cleaner cleans by bombarding the item
with sound waves.
• These tiny shock waves will knock debris off
nooks and corners of instruments that are not
easy to reach.
The list of items and special trays commonly
processed in the CSSD are:
Instruments
Dressings
Sponges
OT linen
Special packs
Gauze and cotton materials
Gloves
Bowls and trays
Standardization of surgical packs
The aim is to have a standard surgical pack containing all
the items required for that procedure by the operating
surgeon.
Some of the Special trays and sets to be processed by
CSSD are as follows:
•
•
•
•
•
•
•
•
•
•
Lumbar puncture set
Sternal puncture set
Catheterization set
Bladder wash set
Liver biopsy set
Fine-needle aspiration cytology set
Suturing set
Thoracic aspiration set
Incision and drainage set
Tracheostomy set.
Laundry Services
• It is a centralized function coming under the
housekeeping department taking care of all
activities from purchase to linen management
to laundry to condemnation
• Linen Management will vary based on the
climate, culture, systems and procedure of
the individual organization
Hospital can go for
• Inside laundry services - with adequate machineries
• Inside laundry services – Manual wash by dhobi
• Outside laundry services – On contract basis
Functions of laundry department
• Collection or receiving soiled and infected linen
• Processing soiled linen through laundry equipment.
This includes sorting, sluicing and disinfecting,
washing, extracting, drying, conditioning ironing,
pressing and folding
• Inspection and repair of damaged articles, their
contamination and replacement
• Distributing finished linen to the respective user
departments
• Maintenance and control of active and back-up
inventions and processed linen
• Maintaining all type of registers
Organizing laundry department
• Manpower requirement
• Duties and responsibilities of linen in - charge housekeepers
• Recruitment and selection of dhobi
• Management information system
• Equipments – selection, care
• Linen – selection, care, stain removal procedure
• Work procedure
• Stain removal procedure
• Management issues
Tips
• Stock the linen materials in 1:3 ratio
• Each day the bed sheet is dusted and the side is changed when the bed is
made. This way both sides of the sheet is used. On the third day the bed
sheet is changed
• Use all faded and damaged fabrics for dusting and cleaning windows,
furniture etc
Diet service
objective
• To provide individualized nutritional care to the
patients using normal diet or need based special
type of diet.
• Service needs to be organized for
o Hospital staff
o Outdoor patients
o Visitors
o Patient’s attendants i.e. relatives.
Different types of food services include
following:
1.Patient food service.
2.Cafeteria or mess for the employees.
3.Cafeteria or mess for the students in teaching
hospitals.
4.Coffee shop
5.Vending machines.
6.Special meals for meetings, guests and functions.
•
Patient food service
1. Purchasing food items as per specification
and in predetermined quantity.
2. Planning menu for different types of patients
as per their
a.
b.
c.
d.
•
Age
Nutritional needs.
Ability to consume eg. Unconscious patient, infants, etc
Disease requiring restrictions.
Disease requiring special diet
• Different types of menu
• Full diet
• Light diet
• Soft diet
• Liquid diet
• Salt-free diet
• Chilly free diet/bland diet
• High protein diet
• High carbohydrate diet
• Diabetic diet
• Special diet (eliminating certain substance)
Dietary habits of patients should be taken.
3. Ensuring hygienic method of cooking.
4. While cooking nutritive value and palatability
do not get adversely affected.
5. Supervising food distribution.
6. Supervising consumption by patients on random
basis.
7. Taking feedback from patients.
8. Avoiding wastage by not preparing excess food
and preventing pilferage.
9. Avoiding shortage – particularly for new
patients.
10. Counseling patients on special diets.
11. Training nurses, students and interns
• SITE, AREA & DESIGN
It is necessary to have certain policies before
deciding their details
1. Foods consumed outside
a. Information is got at the time of admission.
b. Wastage is avoided
c. Attendants food pass can be issued
2.
Vegetarian/ Non-Veg
This policy decision will enable diet dept. in
a. Purchase of raw material
b. Organizing separate area for cooking veg & Non-veg
meals.
• Ground floor is desirable
1.Receipt of raw materials
a. Checking,
b. Weighing
c. Temporary storing before shifting
2.Storage area
a. Godown or storeroom for non-perishable items like
grains, oil, etc.
b. Cold storage for perishable items milk, vegetables, etc. –
refrigerator, cold room.
3. Preparation area
a.
b.
c.
d.
e.
Sorting out
Washing vegetables
Washing utensils
Slicing, peeling, chopping, grinding
Mixing
4. Cooking area
a. Large size steam cooker.
b. Cooking gas
c. Special diet area
5. Serving and transportation of cooked food
depends on
a. Hospital policy
b. Geographical area
c. Vertical / horizontal /both.
ｷ Mobile hot food carrier
ｷ Containers of adequate size
ｷ Nurse in the ward will arrange to get food served.
6. Cleaning area
a. Utensils cleaning
b. Dish washer
• Staffing pattern
•
•
•
•
Manager – qualified dietitian
Dietitians – 2 or 3
Clerical staff – paper work & inventory
Cooks – one/100 beds. Health check-up, food
handlers.
• Helpers
•
Problems
1.
2.
Patient satisfaction
Wastage
i. Cooking more than necessary
ii. Less consumption due to
a.
Poor taste
b.
Becoming cold
c.
Poor appetite due to illness
d.
Home food/eatables
3.
Shortage
i.
ii.
iii.
iv.
4.
5.
Diet sheet has not been submitted on time.
Sudden new admissions
Cooking less than necessary
Pilferage by staff.
Theft
Fraud in materials management.
•
•
•
•
•
•
•
Outsourcing dietary
Cafeteria or mess for employees
Cafeteria for students
Coffee shop
Vending machines
Special meals for guests or for functions.
Diet committee – regular rounds, taste of
food is checked.
The basic function of a laboratory service is:
1. To assist doctors in arriving at or confirm a diagnosis.
2. To assist in the treatment and follow-up of patients.
3. The laboratory not only generates prompt and reliable
reports, but also to function as a storehouse of reports
for future references.
4. To carry out urgent tests at any part of day or night and
therefore provide serve 24 hours a day,
5. And in big hospitals, the laboratory also assists in
teaching programs for doctors, nurses and laboratory
technologists.
Types
of
laboratories
1. Hematology
Hematology includes the study of etiology, diagnosis, treatment,
prognosis, and prevention of blood diseases. The lab work that
goes into the study of blood is performed by a Medical
Technologist.
2. Microbiology
Microbiology is the study of microorganisms, which are
unicellular or cell-cluster microscopic organisms
3. Clinical chemistry
Clinical biochemistry is the area of pathology that is generally
concerned with analysis of bodily fluids.
4. Histopathology
Histopathology (from the Greek histos (tissue) and
pathos (suffering)) refers to the microscopic examination
of tissue in order to study the manifestations of disease.
5. Routine urine and stool analysis
Functional planning
1. Determine approximate section wise
workload.
2. Determining services to be provided.
3. Determining area and space requirement to
accommodate equipment, furniture and
personnel in technical, administrative and
auxiliary functions.
4. Dividing the area into functional units, viz
hematology, biochemistry, microbiology,
histopathology, urinalysis, etc.
5.Determining the number of work stations in each
functional unit/division and deciding the linear bench
space allotted for each work station.
6. Determining the major equipment and appliances in each
unit. This is generally classified into:
i) Technical equipment peculiar to certain work
stations.
ii) Other equipment and appliances e.g.
(refrigerators, hot air ovens, centrifuges) that can
be jointly used by different work stations or units.
7. Determining the functional location of each section in
relation to one another, from the point of view of flow of
work, technical work considerations, auxiliary areas and
administrative efficiency.
8. Identifying the units that are likely to expand, for locating
them in such a manner which will permit smooth
expansion.
9. Identifying the electrical and plumbing requirements for
each area/work station. Independent electric circuits are
required for electronic equipment items. Location of
sinks and wash areas are vital for efficient performance
of work stations.
10. Considering utilities, - lighting, ventilation
(forced or normal exhaust, air-conditioning
and air hygiene) and isolation of equipment or work
stations.
11. Working out the most suitable laboratory space unit
(LSU), which is a standard module for work areas.
A standard module facilitates rearrangement of work units
with least disruption and minimal structural changes.
Organization
1. Centralized
• It avoids duplication of purchases of
expensive equipment.
• Avoids duplication of personnel.
• Easy to monitor working and quality control
• Automation will not be underutilized.
• There can be delay in transporting samples
and issue of reports.
2.
•
•
•
•
•
•
•
•
•
•
•
Decentralized
Transportation
Dispatch
Can cater to the specific needs of certain areas e.g.
ICCU, premature nursery
Results can be easily logged on to the ward
Duplication of equipments
Requires additional technical staff.
Lack of uniformity in procedures and conflicts.
Supervision difficulty
Quality control
Multiple lines of authority
Transfers to other area may disturb the services.
Workload
• An admitted patient undergoes anywhere
between 8 and 20 laboratory tests on an
average during his or her hospitalization
period.
• In 1990, in a teaching hospital, laboratory
tests averaged at 20 tests per patient in
medical ward during an ALS of 10 days, giving
a ratio of 2 tests per day, excluding
radiographic investigations or other tests
carried out in specialized laboratories.
• A 100-bedded hospital with a 10 days ALS will
treat 365 ÷ 10 = 36.5 (37 pts)/bed in a yr,
• 37 x 100 = 3700 total patient in a year which
means that the hospital laboratory will have
to carry out 3700 x 8 = 29,000 tests to
3700 x 20 = 74,000 tests during the year.
Location
• Preferable on the ground floor and accessible to the
wards.
• Depends upon the size of the hospital and its outpatient
set up, the laboratory can be situated.
• Outpatient sample collection.
– The design should include waiting room for patients,
venepuncture room, and specimen toilets.
– Provision should be made for containers with appropriate
preservatives, for correct labeling of samples, and for keeping
record of each patient.
• Primary space
– The space utilized by technical staff for the primary
task of carrying out professional work.
– This space is expressed in terms of LSU.
• Secondary space
– The space utilized for all supportive activities.
– Administrative space, viz. offices for the pathologist
and other, rest and locker rooms, staff toilets, etc.
should be considered separately from secondary
space.
• Circulation space
– The space required for uncluttered movement of
personnel and materials within the dept. between
various technical work stations, rooms, stores and
other auxiliary and admin. Areas.
Schedule of accommodation of hospital laboratory
Departments
Space required
Primary space
Hematology
 General hematology
 Blood transfusion
 Office desk/ admin
3.5 LSU
1.5 LSU
0.5 LSU
5.5 LSU
101.75sq m
Clinical chemistry
 Processing and preparation
 Special and general tests
 Office desk/ admin/ reagent stores
1.5 LSU
3.0 LSU
1.0 LSU
5.5 LSU
101.75 sq m
Microbiology
 General bacteriology
 Media preparation
 Office desk/ admin
3.5 LSU
1.0 LSU
0.5 LSU
5.0 LSU
92.50 sq m
Histopathology
 Specimen preparation
 Section cutting and staining
 Frozen section/ special techniques
 Cytology
 Office desk/ admin
1.0 LSU
0.5 LSU
0.5 LSU
1.0 LSU
0.5 LSU
3.5 LSU
64.75 sq m
Urine and stool
0.5 LSU
TOTAL
9.25 sq m
370.00 sq m
Departments
Space required
Secondary space
Patient area
 Waiting area
Consulting, examination, venepuncture, etc.
Patient toilet (specimen toilet)
40 sq m
30 sq m
10
80 sq m
Office and staff
 pathologist office and laboratory
General office: assembling, labeling, storing, distribution of reports
Staff locker and rest room
 staff toilet
30
60
40
10
140 sq m
25
60
30
10
20
20
10
TOTAL
175 sq m
395 sq m
Supply and processing
 chemical preparation
Central glass washing
Sterilization
Distilled water still
Store: general and glassware
Store: chemical
Disposal and cleaning
Circulation space
Approximately 30 % of the total of primary and secondary space
Layout
• A simple, basic layout of spaces and equipment which
can be supplemented or modified to suit different
requirements is likely to be more efficient.
• The structure, equipment and finishes should permit the
original space allocation and the layout to be changed
while the building is in use, with minimum disturbance.
• Flexibility for use is needed so that areas can be
converted from secondary to primary space and vice
versa in the interest of rearrangement for expansion or
change.
• A few large sinks which are capable of being moved
without undue inconvenience are both more economical
and more convenient than a larger number of small fixed
sinks.
• A fixed layout of services and equipment can be designed
to be conveniently used in a number of alternative ways
providing that working methods can be adapted or
modified to fit the layout.
• Open planning with a suitable arrangement of bays
permits a higher ratio of usable bench length to floor
area.
•
•
•
•
•
•
•
Administrative and auxiliary areas
Waiting room
Venepuncture cubicle
Specimen toilet
Pathologists office
Glass washing and sterilizing unit
Staff locker room and toilet
Utility services
• It include water, gas and compressed air system.
• The need for uninterrupted functioning of these systems
and the probability of future expansion, careful study is
necessary in designing them for safety and efficiency.
• Piping system – color, coding or labeling, non corrosive –
to facilitate safety purposes and repairs.
• Arrangement of laboratory benches – removable panels
between the benches.
Internal design and fitments
•
•
•
•
•
•
•
•
•
Work benches
Lighting
Service spine
Storage
Partitions
Dust
Air-conditioning/exhaust
Working surface
Flooring
Staffing
• The hospital laboratory service should be
under the control and direction of a doctor
with qualifications in pathology.
– He becomes the overall in charge – quality
control, standardization and administration.
– Should be a part of the regular medical staff of the
hospital.
• The number of medical laboratory
technologists (MLT) and laboratory technicians
will depend upon:
– The number of samples per day
– The range of tests to be performed under various
sections, viz clinical chemistry, hematology,
microbiology and histopathology.
– Emergency service and
– leave reserve.
• They perform all technical procedures in
– Various section,
– Prepare reports of completed investigations,
– Check and maintain equipment and
– Request for necessary supplies and materials.
Tests performed annually per medical technologist
Laboratory unit
Tests
Hematology
13,400
Urinalysis
30,000
Serology
11,520
Biochemistry
9,600
Bacteriology
7,680
Histology
3,840
Parasitology
9,600
Equipment
•
The following is a list of the important items of equipments and instruments in
a general hospital laboratory:
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
Robot cell counter
Centrifuge
Microhematocrit centrifuge
Refrigerators
Blood bank refrigerator
Water still
Pressure sterilizer
Pipette washer
Flame photometer
Spectrophotometer
Hot air oven
Incubator
Calorimeter
Analytical balance
Blood gas analyzer
Autoanalyzer.
Policies and procedures
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Laboratory samples
Sample receiving
Request forms
Time of accepting specimens
Containers
Identification of specimens
Reports
Records
Blood bank service
Outpatient samples
HIV
Liaison with clinicians
Technician’s motivation
Cross-training of technicians
Laboratory waste disposal
Optimal utilization of laboratory service.
Emergency service
It is the area of service in the hospital, where
quick and competent care can save lives and also
reduce the severity and duration of illness.
The casualty department provides the first
impression which should be a positive one.
The relationship of the casualty with other
departments and wards should be close.
Definition
The casualty services provide immediate emergency,
diagnostic and therapeutic care to patients with:
• Injuries by accidents, suicidal, homicidal, etc.
• Sudden attacks of illness or exacerbation of the
disease.
These patients require immediate attention
and treatment.
Emergency patients receive resuscitation and
life-saving treatment.
Functions
1.
Attend to all the patients brought to casualty & decide
appropriate management which includes
- Immediate resuscitation.
- First aid
- Emergency investigations
- Hospitalization
- Referral to specific specialty by calling down
the concerned doctor.
- Observation of patient to decide: whether the
patient can go home and attend appropriate OPD
- Reassurance and short counselling.
2. Carry out medico-legal formalities.
3. Maintaining up to date list of critically ill
patients for the purpose of
- issuing one visit pass to relatives.
- replying telephone calls.
- decide acceptance or rejection of transfer of
patients from other hospitals.
- assist intra hospital transfer.
• Following category of case can be labeled as medico legal :
• 1. Cases of injuries and burns the circumstances of which suggest
commission of an offence by some one.
• 2. All Vehicular, factory or other unnatural accident cases specially
when there is likelihood of patient’s death or grievous hurt.
• 3. Cases of suspected or evident sexual assault.
• 4. Cases of suspected or evident criminal abortion.
• 5. Cases of unconsciousness where its cause is not natural or not
clear.
• 6. All cases of suspected or evident poisoning/intoxication.
• 7. Cases referred from court or otherwise for age estimation etc.
• 8. Cases brought dead with improper history creating suspicion of an
offence.
• 9. Any other case not falling under the above categories but has legal
implication.
4. Carryout services of non emergency nature as
per the policy of the organization.
5. Maintain list of doctors on emergency duty,
their availability and alternative arrangements if
they are busy.
6. Disaster preparedness for mass casualties.
Site, Area and Design
•
•
•
•
Ground floor
Proper sign board with illumination
Other human traffic restricted
Entrance pattern
Compound
gate
OPD
Casualty
Inpatient
Services
Important areas of casualty
1. Reception or Enquiry Counter
•
•
•
•
•
Sign boards with proper direction
Enquiry counter
Entrance to the casualty area should be
broad enough to permit two ambulances
The entrance area should be covered.
‘No parking’ board.
2. Waiting area for the relatives
• Should be spacious with adequate light and
ventilation.
• Adequate sitting accommodation
• All utility services should be provided
• Public address system to call relative of
patient to inform about patient’s condition.
• Small statue of God/ Meditation hall.
3. Space for trolleys and wheel chairs
• Immediate arrangement of wheel chair or trolley
depending on the condition of the patient.
• Based on work load, 4 - 6 trolleys/ wheel chairs
are required.
• Transferring of critical patients into other areas.
• ‘Intensive care trolley’ should be there.
• Trolley and wheel chair - parked in orderly
fashion.
• Soiled trolley should be kept clean always.
4. Space for security staff and police constable
• Casualty is likely to get victims of assaults, riots,
group rivalry, etc. so the security needs to be
vigilant.
• Entries should be restricted.
• Cubicle with glass walls permitting visibility of
hospital waiting area, compound & building
entrance.
• It is essential to have police constable counter
either at the waiting hall or by the side of the
entrance.
5. Space for administrator and night
superintendent
6. Space for patient brought dead
- procedural formalities
- in the event of disaster
- labeling is done
- sent to mortuary
- either to relatives or to police.
Facilities for management
1. Examination room - first aid
2. Treatment room - minor procedures
3. Observation area - depending upon the patient
condition
4. Storage space - linen, consumable items,
dressing material, I.V fluids, equipments
5. Fixtures: electrical connections, medical gas
connection and vacuum connections.
6. Other support services: lab, radiology, blood
bank, OT/table for infected and uninfected
cases.
Staff required
1. Senior physician/surgeon/orthopedic surgeon
who should be in-charge
2. Casualty officers - depending upon the size of
the hospital.
3. Orientation given on emergency care and
service.
4. Specialist doctors may be called as and when
necessary.
5. Nursing staff - round the clock.
6. Labour staff - for cleaning, shifting, carry
messages, samples, reports, etc.
Maintenance of record
1.
2.
3.
4.
Case register - all patients
Register for medico-legal cases
Police intimation register
Call book- to requisition services of doctors
from different specialties
5. In/out register for resident doctors.
Records/registers are required for:
1. Court case
2. Compensation to injured patients
3. Insurance
4. In the event of complaint
5. Medical audit.
Problems faced
1. Poor upkeep of premises and poor level of
cleanliness
2. Shortage of doctors on duty due to rapid
turnover.
3. Waiting for specialist opinion.
4. Casualty officer unable to take decision.
5. Inadequate staff.
Continued..
6. Waiting for investigation report
7. Sudden shortage of certain items during
heavy attendance.
8. Pressure for hospitalization in public
hospitals for non medical reasons.
9. Incomplete/ poor documentation in MLC
10. Conflicts due to poor public relations and
stress due to nature of work.