Change Management in Hospitals

Hospital is considered to be the most   complex structure  than any other organisation . There are many different departments in the hospitals which are interlinked directly or indirectly   and thus  they  interact with each other through a formal or informal communication channel.  Also, The hospital interact with many customers   internal as well as external.  With different stake holders the departments in hospital may act in ignorance to each other or may be completely contrary to each other. In such system introducing and managing change becomes a tedious task.

Change typically encompasses introduction of new or unfamiliar team structures, processes, procedures or technologies or new ways of working. Hospital Managers   face two problems consistently. First is to have smooth operational   functioning and other is the change management . The operations management can be dealt effectively by laid down policies, protocols and Standard operating procedures. But the change management becomes a challenging job for them.

Few things necessary  for change management in a hospital  are -
• Positive leadership- An effective leader should change the  paradigm  much in advance .Those who themselves practice the change are much effective in creating a vision .the Change only operates the environment of trust mutual respect where the staff feels valued . and they are being heard. Their  problems should be addressed and their questions are answered.

• Communication-  Effective communication  makes the objective clearer and more coherent . The message should clearly percolate in the staff that the change is for the betterment of the organisation. For example if the Hospital is in process of implementing EMR and going paper less it should be communicated to the clinicians that  EHRs will allow clinicians to access the right patient information at the right place at the right time.

• Outcomes - Managers  must be able to paint a vibrant picture for employees as to what future changes will look like. At the same time the outcomes should be addressed   which helps them understand how the changes are helping them professionally as well  as personally.

• Route-An effective change management system should lay our  guidelines lines  and show a clear route of achieving the change. The plan should include phases and deliverables in each phase of change. It is always a good idea about having a pilot study or a small trial of the solution or process.

• Identify stake holders – Managers should identify the key persons responsible for implementing the change. Identify each persons role, expectations from them and create a pool of innovators who will be ready to implement change .

Ms . Neha Bhagatkar

Assistant Professor 

MBA –HHM ( SIHS)

References-

1. www.ncbi.nlm.nih.gov  
2. www.who.int
3. Change Managementin Health Care Robert James Campbell, EdD
4. Managing Change in the NHS - Valerie Iles and Kim Sutherland

Rational Use of Drugs in Hospitals

The bacterial drug resistance has followed the advent of antimicrobial therapeutics like a faithful shadow. Today the world authorities are though basking in the glory of about the discovery of entirely new group of antimicrobials, the drug resistance is increasing at a galloping pace. Before seventies, genetic materials were the only ways for the bacteria to become resistant but in the last couple of decades the infectious multiple drug resistance through bacterial plasmids has emerged as a growing menace. In the hospital practice Gram negative bacteria have assumed the new heights of resistance not only to a few newer antibiotics at a time, but to almost all the older generation of antibiotics simultaneously.  Unless the medical fraternity gets united to stop the indiscriminate and irrational use of drugs and implement the proper strategies, a day may not be far away to throw us back to the pre antibiotic era.

Guidelines:

1. In order to stop the indiscriminate use of drugs it is essential to select and continue antibiotics based on the drug sensitivity reports..

2. Prophylactic use of antibiotics before surgery needs to be discouraged.

3. Antibiotics can be avoided in noninvasive diarrheas.

4. Simple penicillin group of drugs are still the best drugs to treat infections such as sore throats caused by Beta-hemolytic streptococci.

5. The patients with multiple drug resistant bacterial infections need a special care in the units to avoid cross infections from them.

6. Antibiotic usage policies need to be formed for every hospital but can work only with the cooperation with the clinicians.

7. The recent laboratory data on the susceptibility patterns can be used to start the antibiotics empirically before the drug sensitivity reports reach the clinicians.

8. The third generation and more recent antibiotics may be used for the patients, only if routine drugs are found resistant as per the laboratory report.

9. As a general approach in emergency, a combination of aminoglycoside and cephalosporin may be tried till the availability of the culture sensitivity results.

10. Some of the drugs could be kept as only reserve drugs to avoid the emergence of drug resistance in a given hospital. With the reluctance of the use of the furadantin for UTI, in the recent years, in hospitals, the incidence of resistance for the same has gone down dramatically.

Dr. (Brig) Anil Pandit

Professor- MBA (HHM)

Towards Clinical Excellence

Clinical excellence in a hospital involves care pathways leading successful achievement of clinical outcomes. Patient nowadays has become more aware and lays a high value on a clinical outcomes. The Clinical outcomes along with the financial and operational outcomes are the key performance indicator for a hospital. The systematic critical review of the quality of clinical practice by a multidisciplinary team is the key to improving outcomes. Satisfactory achievement of the clinical outcomes ensures high quality of medical care and helps sustenance of the organisation in the long run.

The following narratives describe the three pillars in clinical excellence-

1. Clinical performance indicator
2. Clinical audit
3. Clinical risk assessment  & management

1. Clinical performance indicators

Clinical indicators quantitatively measure the clinical process outcomes. These indicators do not directly measure the quality of services but they serve as tool to bring out the potential problems requiring improvements. Based on the outcomes investigations can be carried out.

Examples of clinical indicators are re-admission rates , Hospital acquired infections, surgical re- exploration rates. These indicators can be collected on a monthly basis and trends in the data can be observed and analyzed.

 2. Clinical audit

 Clinical Audit is a well-established method of reviewing clinical practice against agreed standards with the aim of identifying areas for improvement in quality of care.

The NHS in United Kingdom has defined Clinical Audit as “The systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources and the resulting outcome and quality of life for the patient” (Swage, 2000;Wright & Hill, 2003).

Stages of clinical audit

1. Preparing for audit – This includes involving users , selecting a topic , identifying purpose and defining the requisite skills.

2. Selecting the criteria-The criteria form the tool by which the quality of care is measured. Criteria includes  deciding the parameters critical to quality.

3. Measuring performance- It consists of planning the data, identifying users, sampling users and finally, handling data

4. Making improvements -This stage is most critical in Clinical audits to demonstrate actual changes and make concrete improvements in care delivery.

5.Sustaining improvement-Any improvements made as follow-up actions in clinical audits must be monitored, evaluated, maintained and reinforced within the hospital.

3. Clinical risk assessment and management

From a clinical perspective patient safety involves ensuring safety in clinical procedures and managing risk associated with the delivery of healthcare. This involves identification of the risk associated with the clinical processes and suggesting possible ways to prevent them .This uses tools like FMEA( Failure mode and effects analysis ) and RCA( Root cause analysis) . FMEA is an effective tool to analyze  clinical  procedures critically. It helps identifies potential failure modes in the current procedures, assesses the effects of the failure modes, then prioritizes the failure modes in order to redesign, implement and monitor the new procedures.

Root cause analysis (RCA) gives a retrospective analysis and is carried out after a sentinel event or near miss has occurred. The purpose of RCA is to identify the underlying causes of any variation in care pathways leading to adverse events.

Ms. Neha   Bhagatkar

Assistant Professor

SIHS 

PLANNING OF A HEALTHCARE FACILITY

Healthcare delivery has evolved from an erstwhile insulated physician – patient setup involved in the treatment of specific ailment/disease into its present form which is essentially hospital based. The complexities of such a hospital based multi- disciplinary, integrated and comprehensive healthcare delivery system demands that the physical facilities of hospitals are designed scientifically. Rising costs of healthcare, increasing “ consumer ’’ awareness , quality consciousness and increase in number of specialties , each with their specific design needs, requires healthcare planners and managers to involve themselves actively in planning physical facilities of hospital along with architects/ Hospital planning team.

Scientifically planned, aesthetically designed and appropriately equipped hospitals have become the strategic need for any organization or community. The realization of this strategic imperative requires inputs from a number of knowledge based streams. The participation of Doctors, Engineers, Architects, Town Planners, Equipment Manufacturers and Lawyers are just the tip of the proverbial iceberg. Comprehensive planning and designing of facilities justify the involvement of a large number of specialists from different fields.

Rapid advancements in technology, especially in diagnostics and surgical procedures, require the planning of health facilities be flexible. This ensures that future expansions/ alterations are cost effective and can be done with least disturbance to day to day operations. Flexibility would make it possible for new additions to be functionally dovetailed to the existing facilities.

The intangible benefits of healthcare facility planning are numerous and remain difficult to measure. Client and staff satisfaction, communication, facilitation, efficiency of processes and quality of care are just some of the intangibles that benefit from scientific facilities. This facet is further compromised by the need for cost containment and cost awareness a balanced perspective therefore seems the most desirable outcome.

The urgent need for planners of healthcare facilities to evolve planning protocols based on pragmatic, feasible and cost effective paradigms cannot be emphasized enough. Our country can ill afford a large expenditure on healthcare facilities, which subsequently fail into disuse or remain underutilized for a plethora of reasons.

Contemporary medical care facilities world over seem challenged by certain common contentious and threatening issues. Cost of medical care, dehumanization of care, ,highly evolving technology, exorbitant equity, accessibility and social conscience are some issues demanding immediate attention of planners. A common theme which seem to link all stakeholders relate to the healthcare facility, its plan, its design, its ability to support and sustain the care delivery and its contribution to cost, efficiency and quality.  

Dr. (Brig) Anil Pandit
Professor- MBA (HHM)

Jai Hari Vitthal : Our experiences during the Warkari event 2013

The wikipedia explains “Wari”as a religious movement within the bhakti spiritual tradition of Hinduism. It is geographically associated with the Indian states of Maharashtra and northern Karnataka. Pilgrimage to Pandharpur is called as Wari. The people who undertake a Vari are called Warkaris .Warkaris worship Vithoba (also known as Vitthal Krishna, an avatar (incarnation) of Vishnu), the presiding deity of Pandharpur. Every year, hundreds of thousands of Warkaris walk hundreds of miles to the holy town of Pandharpur, gathering there on Ekadashi (the 11th day) of the Hindu lunar calendar month of Aashaadha (which falls sometime in July). 

Jai Hari Vitthal

Continuing the same ancient tradition  and dedications lakhs of Warkaris entered Pune on

First of July 2013  spreading the waves of devotion and contentment. 

Glimpse of the Crowd

In consonance with the tradition of the wari , SIHS has built a tradition of serving Warkaris  every year. We the ‘Budding Managers’ of SIHS got the unique opportunity of exercising our managerial skills during the Warkari Event this yearAlong with the MBA students, students of Emergency medical services, Staff from Healthcare centre  also participated. We being the management students our task was to manage the crowd, whilst our EMS friends would tend to the ailments and medical issues of the Warkaris.

 

Team Symbiosis 

By 8.30 am students   took their respective ambulances along with the EMS staff. Finally after weaving through the crazy Pune traffic and the narrow City roads the ambulance came to a halt.

We quickly decided on a ‘Game plan’. We divided the people according to Gender and identified that the men would be tended to by the Gentlemen in our group while the Ladies, would handle the Ladies! 

Waiting..patient(ly) 

After the initial chaos things eventually settled and progressed smoothly. Everybody got acquainted and comfortable in their roles- The EMS students with their task of tending to the patients and us managing.

The learning experience gained from this event will be embedded in our minds all throughout our lives and the basic managerial skills were learnt here. From learning basic Marathi terms like ‘Kaku, Aushadh Payije?’(Aunty, do you need medicines?”  to major Life lessons asserting how lucky we are to be where we are, from basic bonding with our classmates to actually serve the public at a ground level; the experiences we shared is going to last us a lifetime.

Nothing gets done (in Pune) without the Vada Pav !

 The event of Warkari was successfully completed,with the earning of immense appreciation for Symbians everywhere, and lot of goodwill and good wishes of all the pilgrims, who were helped by our little humanitarian effort. The day left us feeling wonderful about having helped people in whatever way we could, gave us an opportunity to exercise our skills and make new friends while on the job. 

We are very fortunate to have been a part of such a mammoth event, which allowed exploring and discovering our capabilities, stretching ourselves while getting a break from classroom academics as well.

Career Avenues for MBA grads in the Pharmaceutical Industry

There are various facts and numbers available on the charts to sing laurels about the growth of Indian Pharmaceutical industry but what remains as the eye catcher for students of our fraternity is its paying ability. Being a sector which has huge profit margins and is always recession proof, the pharmaceutical industry shouldn't be neglected by those who wish to grow fast in the healthcare industry. As a matter of fact this sector grows even stronger each time the rupee falls as the exports form a major section of operation for the Indian pharmaceutical industry.

Facts and figures (Courtesy CCI report- March 2013)
The Indian pharmaceutical industry is expected to grow at 13% in 2013. India is now among the top five emerging pharmaceutical markets. There will be new drug launches, new drug fillings and Phase two clinical trials throughout the year. On back of increasing sales of generic medicines, continued growth in chronic therapies and a greater preparation in rural market, the domestic pharmaceutical market is expected to register a strong double digit growth of 13-14% in 2013.

Moreover, the increasing population of higher income group in the country will open a potential US$ 8 billion for multinational companies selling costly drugs by 2015. Besides the domestic pharma market is estimated to touch US$ 20 billion by 2015, making India a lucrative destination for clinical trials for global giants.

Advantage MBA HHM
The pharmaceutical industry is growing at a rapid rate in India and hence it is a very important component of the healthcare industry. In our curriculum special focus is being given to pharmaceutical industry with a subject of “overview of Pharmaceutical industry” in the second semester. With subjects like Principles & Practices of Management and Strategic Management our students are able to find a place in brand management and product management team in various pharma companies. On one hand subjects like Materials Management helps to acquire positions in Supply chain management team and on the other hand subjects like Health Regulatory Environment helps us fit in the IPR and Drug regulations team, opening doors for students in various departments. Sales being the crux of the pharma industry which reflects the outcomes of all departments, subject like Research methodology helps in analysing sales figures which helps us to excel in the department of sales as well. One advantage which the large number of doctors passing out from our college have is that they are looked upon for the Medical Education and Training department by the pharma companies which requires training the first line sales executives about the product and diseases which are discussed with the clients.

Pulling up socks
Since the heart and soul of the Indian Pharmaceutical industry lies in marketing their products, the main focus is sales! Branding & Marketing is the golden door to a high earning corporate lifestyle but the first step towards it shall and always remain to be sales. Having experience in sales in the healthcare industry will help you reach that high paying designation with ease.

So, students in first year who decide to do their internship in sales in a pharma company will be taking that first step towards polishing themselves to be picked up for the Product Management team.  As for students of the second year who didn't quite consider this while taking a decision for their internships the way forward lies in taking up an initial job in sales to start with. The taboo associated with the sales job makes it less lucrative but with high confidence I can say if it’s pharma it’s an up-hill task which is definitely high earning, both in terms of self esteem and monetary benefit.

Once having sufficient experience of sales in your bag, the journey is extremely exciting and rewarding. The combination of your sales experience coupled with the knowledge of above mentioned subjects will take you to places and how!

Afsheen J Irani

MBA Batch 2012-2014

Managing Materials through Perpetual Inventory System

Inventory is a very vital part of any hospital. It is  the major cost factor in any hospital. About 35- 40 per cent of the budgetary allocation is for procurement and management of Inventory. It is obvious that Inventory management holds a crucial key to the seamless functioning of the hospital which deals with human life every second. One of the most effective tool for the material management, which the material managers strongly advocate is the perpetual inventory system .

Perpetual inventory system is a technique of controlling stock items by maintaining  inventory records in a manner such that physical stock balances at any point of time matches with the stock in records. Records may be electronic or manual. The term perpetual inventory refer to the system of record keeping  and a continuous physical verification of the stocks, with reference to the store records.

  

The advantages of the perpetual inventory system are-

1) Allows setting up of accurate reorder levels : In a perpetual inventory system, changes in,   inventory levels are recorded in real time. This provides us with the information of when the   inventory is purchased and when it is sold. Regular inspection of the stock and cross verifying it with the stock in the HMIS ( Hospital Management Information System) provides exact stock levels and thus setting up of reorder levels(ROL) . It also prevents being out-of-stock and losing customers because of it.

 2) Prevents pilferages and shrinkages: In perpetual inventory system stock is verified physically very frequently  which in turn helps in the preparation of the provisional accounts .  It ensures a moral check on the store staff to maintain proper stock records. This masks any theft, shrinkage or even count  and remedial action can be taken quickly.

3) Creates More Accurate Interim Financial Statements : Because of continuous physical verification , inventory values do not change during the year. Both the inventory account on the balance sheet and the cost-of-goods-sold account on the profit and loss statement are incorrect throughout the year. A perpetual system keeps those balances correct and gives a more accurate set of financial statements throughout the year.

4) Better management of  Inventory Levels: The system exercises better control over all receipts and issues in such a manner so as to give a complete picture of both quantities and values of stock in hand at all times . This prevents a build-up of inventory that is not selling that can be costly to the business. Under the perpetual inventory system, the inventory levels are always correct and the inventory turnover ratio can be calculated correctly. The turnover ratio tells a business owner whether sales are slowing down or whether individual products are no longer selling quickly.

Ms. Neha   Bhagatkar

Assistant Professor

SIHS