Content of JAHA Vol No. 28 Issue No.2 [ July-Dec. 2016]

Journal file:

Editorial - JAHA Vol No. 28 Issue No.2 [ July-Dec. 2016]

To analyse the emerging business models and identify best practices which are contributing to sustainable development of healthcare. Literature review from published articles has been done to study various models and presented through this paper. The healthcare sector in India is undergoing a phase of reform propelled by rapid economic growth. There has been a significant growth in the healthcare sector over the past few years and is expected to reach USD 280 billion by 2020. 
The main growth is seen in low costs hospitals in Tier II, Tier III cities and rural India. Innovations that build on technology, ICT as well as private-public partnerships (PPP) are relatively more successful and a number of good examples can be found on the ground.
These along with specialized care hospitals represent the next generation of low cost rural healthcare and are developing quite rapidly.
The focus has now also come on process optimization, standardization and inclusive models to ensure long term sustainability and cost effectiveness.
The paper attempts to identify some of the best practices adopted by the emerging business models in healthcare which are contributing to improved health outcomes with low cost and at the same time, remaining sustainable.
Key words —Sustainable Development, Emerging Business models, Value in healthcare etc.
There is no research report from Kerala studying the relationship between quality of patient care and the available human resources.
The aim of the present study was to find out the patient load in the hospital, human resources availability, deaths in hospitals and the relationships within them.
The number of OP registrations, beds provided and admissions made during every financial year from 1997 April 1st to 2006 March 31st were gathered from hospital records. The number of doctors, nurses and nursing assistants were gathered from the attendance register and pay rolls. Number of deaths in the hospital during every study year was collected from the hospital registers. The gathered data was analyzed and graphs generated.
There was noticeable rise in the number of OP attendance from 1997-1998 to 2006-2007. The beds, doctors, nurses, nursing assistants and admissions also increased, but it was small. During the same period, the death rates remained almost same with minor fluctuations. The increases in the number of various parameters didn’t synchronize with any other parameter and the mortality was not influenced by any of them. The rise in OP number was noticeably high.
The system appeared to be maintaining the quality of work and standard in care, adapting to a setting of crunching resources. This could be the result of committed and skilled work of staff at different levels which remain unrecognized. Need for establishing a referral system and following norms in post creations are highlighted.
Handoff is the process of transferring information, authority and responsibility for a patient during transition of care. Both written and verbal handoff are important and each has different purpose. The objective was to study handoff scenario in Sher-i-Kashmir Institute Medical Sciences (SKIMS), Srinagar.
An observational cum record based method was used to study hand off scenario. The study revealed that quality of handoff was good in intensive care area and inpatient areas as compared to emergency medicine. The quality of patient handoff and chances of miscommunication were associated with number of patients under care during shift, number of reporting physicians, duration of handoff and environment. There is a need for introduction of standardized handoff.
Construction, operation and maintenance of biomedical waste management system can contribute to a significant part of the expenses of a hospital. The study aims to analyse the various costs involved in biomedical waste management at a tertiary care teaching hospital in India. Retrospective study was conducted to analyse data for one-year time period.  In addition to the direct costs, indirect costs like cost incurred for training of staff, procurement of personal protection equipment and administration of vaccination were also considered. Total cost incurred for management of biomedical wastes in the hospital amounted to Rs.7.17 per bed per day. The procurement of plastic bags, sharps containers and waste bins for collection of waste contributed to 56.2% of the total cost. Outsourcing cost for final disposal and salary of staff involved in collection & transport of wastes contributed 22.3% and 15.3% respectively. Training of staff, administration of vaccinations and purchase of personal protection equipment for staff together contributed to 6.2% of the total cost.The data obtained from this study can serve as guidance for hospital planners and administrators in planning and operating biomedical waste management services in hospitals.
Gujarat is the first state in India to initiate active perusal of quality improvements in the public healthcare facilities including Primary Health Centers (PHCs), Community Health Centers (CHCs), District Hospitals & Medical Colleges. To attain the vision of creating the network of finest public health care institutions providing preventive, promotive, curative and rehabilitative health care services  with the state of art technology, easy accessibility, affordability and quality throughout the state & beyond. Gujarat is also the only state to set up the District & State Quality Assurance cell to bring productivity and effectiveness in health care delivery system. State Quality Improvement Programme of Department of Health and Family welfare of Government of Gujarat proposes to develop and institutionalize the use of the field based, practical and feasible indicators in quality assessment transforming the existing supervision practices into a more standardized and structured process. A pool of health care professionals in the public health sector trained in the implementation of health care quality standards has been developed for the same. The basic principal is that any sustainable change in terms of institutionalization of Quality Assurance (QA) will come from within the system and not from outside. It is hoped that interventions from demand side (for example, community and individuals demanding better services) will also put pressure on the system to deliver quality services which will in turn give impetus for investing in QA. 
The core objective of the Quality Assurance Cell (QAC) is to facilitate the improvement of systems and processes of service delivery in the healthcare facilities as per the standard technical protocol to meet the laid down standards (e.g. Swachhata Mission / Kayakalp / NABH / NQAS / NABL / IPHS/ MCI / GOI guidelines) as appropriate; to establish & develop quality management systems at the hospital level, leading to enhancement in service quality and leading to Quality certifications by the Quality assurance cell; to implement & monitor quality of MCH services at health; and to undertake such other GOI / State initiatives entrusted with the QAC from time to time (e.g. MDR, MCTS etc.).
Quality, healthcare, standards, safety, training, MDR, MCTS
Introduction: With healthcare quality and safety gaining importance, concept of patient’s rights and responsibilities is becoming imperative to ensure ethical service provision. This study evaluates patient’s awareness about their rights and responsibilities.
Methods: The study was done in a 112-bed NABH accredited multi-specialty hospital of Mumbai during May-July’ 2015. Admitted patients were interviewed through a 25-item questionnaire comprising 15 questions on awareness about rights and 9 questions on awareness of responsibilities. 1 question was asked about ‘source of information’ for rights and responsibilities.
162 patients consented to participate and were included (age range: 20-79 years; 53% males). In regard to rights, highest awareness was observed for ‘requesting communication in a suitable language’ (99%), ‘asking doctor about requisite information’ (94%), ‘knowing name of illness’ (91%), ‘choosing a doctor’ (80%), and ‘second opinion consultation’ (85%). Only 50% knew that they can ‘participate in treatment decisions’, 51% demanded ‘complete information regarding surgery’ and 55% were aware that that they have a ‘right to access their clinical records’. 49% signed the consent forms without reading it. Awareness regarding responsibilities was >95% for all factors like ‘abide by rules’, ‘pay for medical services’, ‘giving complete medical history’ and ‘inform doctor for complications’.
Patient empowerment begins with awareness of rights. As awareness for rights was low for some of the major factors like participating in treatment process, signing consent without proper information, patient education needs overemphasis. With the crusade for ethics gaining momentum, hospital must focus on empowering patients through increasing awareness about their rights.
Background: Hypertension is a common disease in adults but its seeds are sown in young age. Therefore, detecting, tracking and targeting pre-hypertensive among youngsters is the most cost effective intervention to reduce incidence of hypertension in adults. Database of blood pressure distribution is must to define/ redefine cut off points of hypertension and revise epidemiological and management guidelines. Objective: To document prevalence of pre/ hypertension and distribution of systolic and diastolic blood pressure amongst adolescent and its association with anthropometric determinants. Methodology: This cross-sectional study covers 152 volunteer from a medical school between 17 to 19 years. Ensuring quality by minimizing measurement errors, data was collected by faculty on a pre-designed proforma and entered in MS Excel. Mean with standard deviation (SD) and median with 5th and 95th percentile for both systolic and diastolic blood pressures as per few demographic determinants such as age, sex and overweight/ obesity parameters such as body mass index (BMI), absolute waist circumference (AWC) and waist hip ratio (WHR)  were calculated. Prevalence rate (%) of pre/ hypertension with 95% confidence interval (95% CI) as per JNC 7 was calculated. Results: Prevalence rates for hypertension and pre-hypertension in the study were 9.2 and 44.7 percents respectively. There were more pre-hypertensive amongst males (54%) than females (34%). There was no one obese as per BMI (> 29.9). However, as per AWC and WHR 3.4 and 9 percent females were obese respectively while none of the male was obese as per these two criteria. All obesity parameters were found linked with prevalence of pre/ hypertension. Similar relationship existed with distribution of systolic and diastolic blood pressure but was more pronounced with systolic blood pressure (SBP). 
Significant number of pre- hypertensive in adolescents (44.7%) especially in males (54%) suggests the need of detection and application of specific protection, to reduce the incidence of hypertension during their adulthood.  Obesity is nil as per the BMI, minimal as per AWC (3.4%) and WHR (9%); overweight too as per BMI is seen in 11.8% only. Hence focus of preventive strategies shall target the modifiable factors other than obesity. 
Key words: Adolescent, prevalence of hypertension, distribution of blood pressure, anthropometric determinants 
Article file
Total word counts: 3190
Abstract: 347
No of tables 3

News and Other Misc- JAHA Vol No. 28, Issue No.2 [July-Dec. 2016]


Academy of Hospital Administration Western Regional Chapter (Pune) in collaboration with Armed Forces Medical College, Pune organized the 4th edition of Flagship National Conference SASH - 2016, Safe and Sustainable Hospital on 11th, 12th and 13th November 2016 at Armed Forces Medical College.
The theme of the conference – “Innovations and Update in Hospital & Healthcare Administration” was carefully chosen after much due diligence by members of organizing committee.