AHA Journal - JAHA Vol 31 No.1 [Jan-June 2019 Issue]

It is a matter great pleasure & pride for me to present Vol. 31, No.1 (Jan-June 2019) of JAHA. With this issue, we have entered the 31styears of continuous publication of this journal which has attained a reputation of being the oldest journal on Hospital Administration in India. Also, rigorous peer review process has ensured that the original research is honed and crystallized before being accepted for publication.

This issue offers varied range of articles covering patient safety in operation theatre, assessment of quality in laboratory services through performance indicators, hospital infection control, inventory management by ABC & VED Analysis, Planning and costing of medical gas manifold for a 300 bedded hospital; comparative study of two Pvt. healthcare organizations of India; & some more issues specific to the realm of Hospital Administration such as   reporting system of communicable diseases in healthcare facilities.
I am certain you will find the articles contained herein, very interesting & educative. The journal is available for AHA members online at http://ahaindia,org/journal.
We request  the Hospital Administration Fraternity to contribute in this academic step by sending, as much as possible, research papers/articles/case studies, etc.
Your valuable feedback is always welcome to make the journal more effective in addressing the needs of the hospital administration community.

[Dr Hem Chandra]
Executive Editor

  1. Cover page
  2. Editorial
  3. Contents
  4. Mission AHA
Introduction: Surgical complications are one of the major causes of morbidity and mortality among patients. It has been estimated that at least half of the complications that occur are avoidable through strong patient safety culture in healthcare systems. Implementation of Surgical Safety Checklists is a significant step towards achieving safe surgery practices. Successful execution of Surgical Safety Checklists needs high level interaction among social, cultural, and operational reasons in the health system which emphasizes on teamwork in carrying out preparatory stages of surgery, safe anaesthesia, for proper monitoring of the patient and advance preparation to identify anaesthetics or life threatening problems, prevention of surgical site infection and measurement of surgical care for the creation of indicators to measure the processes and outcomes of surgical care. Successful carryout of patient safety practices will pay out not just in terms of quality patient care but also in keeping healthcare economics under control. Objectives: The study focused on to assess Surgical Safety Practices in a tertiary care hospital in compliance with the standards specified by World Health Organization (WHO). Method: A retrospective study was conducted for a period of three month to evaluate the surgical safety checklists in patient’s medical records. Total of 500 patient surgical records were randomly selected and screened to evaluate the compliance of Surgical Safety Checklist with the standards mentioned by WHO. A checklist was developed to confirm the details entered in the sample records. Results & Conclusion: It was observed that there was an about 90% adherence to the standard Surgical Safety Practices set by WHO. However details pertaining to administration of antibiotic prophylaxis, anticipated critical events by surgeons, anaesthetists and nurses; noticing equipment problems, name and signature of the concerned members should be confirmed and marked in the respective columns of the checklist to achieve complete compliance to WHO standards. Thus, the current study had evaluated the surgical safety practices and identified the areas that needed attention in order to ensure patient safety during surgeries.
Keywords: Surgical Safety Checklist, WHO, Patient Safety, Surgery, Healthcare Quality
ABSTRACT: Operational efficiency is a concept that holds increasing importance to Cardiac Cath Labs. Identifying inefficiencies in cath lab care delivery can save time, maximize production and minimize costs.  Using quality indicators such Turn Around Time (TAT), Door to Needle (D2N) time, and Door to Balloon (D2B) Time and Quality Improvement(QI) tools as DMAIC model, PDCA and Congruence Model, help to identify the bottlenecks in the overall management of cath lab. Staff members’ engagement and their satisfaction in all roles are important and help in their taking pride in providing high-quality patient care.
Keywords: Congruence Model, Door To Needle Time, Door To Balloon Time, DMAIC Tool, Employee Engagement, PDCA Model, PDSA Cycle, Turn Around Time
Introduction: Handling of Biomedical Waste by Housekeeping Staff is a very critical function in Hospitals, role of which is to create clean, hygienic & infection free areas required for the speedy recovery of the patients and also ensuring their safety. Collection & transportation of BMW requires trained manpower in accordance with BMWM Rules 2016. Therefore, keeping this in mind, a study was conceptualised to assess the Knowledge, Attitude & Practice of Housekeeping Staff w.r.t. key HIC Parameters & BMWM Rules 2016 at a Tertiary Healthcare Teaching Institute in India. 
Methodology: An Interventional, Longitudinal study was conducted from 21st Nov. to 21st Dec. 2017 at SGPGIMS. Convenience sampling method was utilised and a sample of 350 Housekeeping Staff was taken. Response rate was 57.14%. Assessment tool was prepared in Hindi language for better understanding by target population. Data analysis was done using SPSS 22. 
Results: It was observed that increase in knowledge of housekeeping staff about hand hygiene was from 26% to 69%(p= 0.00), Awareness about accidental needle stick injury was raised from 40% to 78%(p=0.00), Attitude towards use of PPE was observed to have been better. (Mean change from 2.15 to 3.17), Knowledge about BMW Management & practice regarding proper disposal according to colour coding was observed to have raised from 49% to 70%(p=0.000) & 26.5% to 73.5% (p=0.000) respectively. Overall Knowledge & Practice have been better by 15 to 60%. (p<0.000) Mean score of Attitude also improved to a fair level.
Discussion: Result depicts significant increase in knowledge, attitude & Practices of housekeeping Staff regarding BMWM post-intervention. Conclusion: These In-service Training Programs are effective in augmentation of knowledge; attitude & practices of housekeeping Staff & will repeat to compliance with BMWMR 2016
Keywords- KAP, Housekeeping Staff, HCP, HIC, BMWM Rules 2016, PPE, NSI
Title : A Study of Pharmacy and analysis of inventory management by ABC and VED  in a  Tertiary care  Teaching hospital 
The aim is to critically analyze inventory of Pharmacy with selective inventory control techniques of ABC and VED matrix.
Methods: A Retrospective study was carried out  for a period of 6 months . cost, quantity  and cumulative value  has been  analyzed  using  ABC and VED matrix.
Results :  Out of total 2641 items, 10.14% were “A” items with 69.98% of annual expenditure. 16.62% of “B” items consume 19.99%  and  73.22% of “C” items had 10.02% of expenditure. 5.11% Vital (V) items, 28.06%  Essential (E) items and 66.83% Desirable (D) items had 27.15%, 34.23% and 38.61% of total expenditure. ABC and VED matrix  categorized  I, II, III  constitute 13.18%, 35.21% and 51.61% respectively .  
Recommendations:  The top management should focus on category I items. Frequent internal audit, ordering systems and issue of items needs close monitoring. ABC and VED matrix is more useful along with other inventory control techniques. 
Key words ;  ABC – VED matrix , Analysis , inventory , top management 
Patient safety practices among nurses  in the Maternity Units of a Tertiary 
Introduction: This cross sectional descriptive study assessed the patient safety practices of registered nurses working in the Maternity Units of a tertiary care centre. A total of 80 registered nurses were selected for the study using purposive sampling technique and were observed on their patient safety practices, using an observational check list  in areas of drug management, equipment management, disposable supply management, infection control, patient identification, safety and security protocols, effective communication and records &  reports. 
Results: Only 11.25% of the registered nurses participated in the study were found to fall in the ‘Acceptable’ category for patient safety practices. The rest of the subjects exhibited varying levels of patient safety practices in areas under observation. To be categorized as ‘Acceptable’, out of the total 112 observations, a subject needs to score ‘Ýes’ to 90 or more observations.  Rest of the participants scored Ýes’ to less than 90 of the patient safety practices under observation, rendering them to be categorized in ’Non Acceptable’ level for patient safety practices.  
Conclusions:There is tremendous scope for improvement in the patient safety practices among registered nurses under study, which is the need of the hour to bring down  the maternal and neonatal mortality and morbidity rates in India substantially. The factors interfering with the safety practices must be looked into and corrective measures can be taken to significantly improve the safety practices for improving the patient outcome.
Planning & Cost Estimation For Medical Gasses Manifold Services For A 300 Bedded Hospital
Medical gases are as important as the medication to patient. Installation of hospital medical gases manifold services requires substantial amount of financial resources. In India, approved codes and standards for medical gasses manifold systems are not available & facilities here are based on prevalent norms as found in other countries. This has led to conflict in various types of systems as cost varies from one standard to another. 
Medical gasses manifold procurement in most public sector hospitals is through the open tender system. For a hospital administrator it become imperative to know what fraction of the budget should be allocated to the medical gases manifold or in an existing hospital planning for piped supply of medical gases how much budget is required.  The present article provides a  methodology for Capital costing of Manifold Services. In the study the cost for per bed and per outlet for the service has been worked out, considering the requirements of a 300 bedded new hospital facility.        

To Study the Reporting System of Communicable Diseases in Selected Healthcare Facilities of Bengaluru

Introduction: Surveillance and reporting of communicable disease is an important element to combat against the diseases and to control them. Sending complete and precise reports on time from the hospitals are the main challenges. IDSP is a scheme of surveillance of the disease under the Indian Ministry of Health and Family affairs. Among the 41 healthcare facilities selected for the study, both government and private sector have almost similar compliance rate of 68% and 67% respectively for the reporting system.
Methods: Bengaluru urban and rural districts were considered for the study.  A modified questionnaire and checklist from WHO generic questions were used for the data collection with sample size of 41 HCFs selected randomly using Microsoft excel. 
Results: It was observed that overall comparison of government and private sector healthcare facilities which included rural, urban and BBMP, the compliance rate for the reporting as per the parameters considered in the study was 68% and 67% respectively. Only 32% and 33% of government and private HCFs do not have a well-structured and functioning reporting system.
Conclusion The actual purpose of reporting a specific infectious disease is to trigger an appropriate public health response for the prevention and cure. To be effective, such reporting should be timely and accurate. In this study, it documents that the electronic reporting of the communicable disease surveillance data has improved timeliness and completeness provided there is a proper design, process and the components are constantly in working condition without any barrier.
Keywords: Surveillance, Reporting, IDSP - Integrated Disease Surveillance Programme, HCF - Health Care Facilities, Rural, Urban, Bruhath Bengaluru Mahanagara Palike 
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