Cover Page, Editorial & Content - Vol. 31, No.2 [July - Dec. 2019 & Vol. 32 No. 1 [Jan to June 2020] - combined issue

Vol. 31, No.2 [July - Dec. 2019 & Vol. 32 No. 1 [Jan to June 2020] - combined issue

Journal file:
Effect of HR interventions based on Biometric Attendance System records to improve employee absenteeism
First & Corresponding Author: 1Dr(Major) Meeta Tyagi, Senior Consultant (Hosp. Management), PMU, AIIMS, New Delhi. 
ABSTRACT:  This study examined the impact of monitoring biometric attendance on employee absenteeism.  The study was carried out in a public sector tertiary care hospital. One of the departments of the hospital, was continuously facing issues regarding unavailability of staff at the work place, which was affecting the performance of the department. It was therefore imperative to carry out this study with a view to assess the extent of problem of absenteeism, to identify the system related causes and to address the causes. The study is observational and descriptive. Data collection was carried out in two phases. In the first phase, the retrospective data of biometric attendance of the employees, duty rosters and leave records were collected and analysed using statistical package of social sciences (SPSS). The results were discussed with the administrative authorities. The leave and attendance monitoring protocols were redefined. In second phase, same data after introducing the protocols was collected. Chi square test of significance was applied to the difference of proportions. The difference in proportion was statistically significant for the availability of staff (p= 0.0006), absence without leave( p<0.0001) and   late arrivals ( p= 0.031). The difference in proportions was not statistically significant for absence with leave  and for early leavers.  It was recommended that organization should use the biometric attendance for the calculation of effective working hours and calculation of monthly salary, to improve discipline. The staff should be incentivised for working additional hours, which will encourage them to remain on the job and improve their performance.
Absenteeism; absence; attendance; digitization; digital technology; biometric attendance system(BAS); discipline; human resource (HR)practices; human resource management (HRM); Healthcare Organizations
Assessment of patient safety culture: A Review
Correspondening Autor: Purnima Gupta Bhoi – Faculty Hospital Management, KiiT School of Public Health, Bhuwaneshwar
Background: Culture assessment is one of the critical aspects of patient safety that displays an important role for improving quality and patient safety in healthcare. A number of articles on assessment of patient safety culture using various tools have been published in the last ten years (2009 -2018). This paper will explore the overall patient safety grade in different healthcare setting as documented in the articles reviewed.  
Objectives: The aim of this study is to explore the areas of theme, overall patient safety score and the study design of published research on patient safety culture assessment in literature published in last ten years, English language journals.
Methods: Varied databases were used to find English articles that were relevant to patient safety and safety culture assessment in various kind of healthcare settings. Using the Medline database, we identified and reviewed fourteen articles that assessed patient safety culture in various countries. No ethics committee approval was necessary for this review.
Results: Our review included fourteen studies that assessed patient safety culture of the healthcare organisations. All articles included in this study used Hospital survey on patient safety culture (HSOPSC), a tool developed by Agency for Healthcare Research and Quality (AHRQ). All the included studies on patient safety culture were conducted in the following kind of institutions: General hospitals, teaching hospitals, private hospitals and primary healthcare. 
Conclusion: This study shows that the most popular theme for patient safety culture research was the overall assessment of patient safety culture. All kind of healthcare institutions are now conducting the safety culture assessment to improve the patient safety and overall quality of care. 
Key words: Patient safety, patient safety culture, hospital safety, culture of safety, assessment of safety culture.
Corresponding Author- Professor  & HOD of Hospital Administration &  Addl. Medical Superintendent, SDM College of Medical Sciences & Hospital, Dharwad , Email :
Off late more and more Indian hospitals are migrating towards use of disposable textiles in the operation theatre, though many Western hospitals are reverting back to reusables.  Cost is a major issue in decision making, since maximising operational saving is critical for any hospital.  There are conflicting study reports on the subject, hence cost per operation of reusable textiles was done in operation theatre of a teaching hospital. At first glance it appears that disposable textiles are more cost effective.  However to determine the true cost, we must look beyond the initial purchase price. Study was done in a hospital having 750 beds, with 85% bed occupancy and performing average 40 major operations per day.  Cost arrived at was compared with the cost of disposable textiles available in the market.  Average cost of washing the linen in in-house laundry was Rs.3.14/- including fixed and variable cost.  Average linen used per operation was 22 no.s and hence the average laundry cost per operation was Rs.69/-.  Average cost of sterilisation in CSSD per cubic feet was Rs.66.68/- and average cubic feet of linen per operation was 1.7.  Hence the sterilisation cost per operation was Rs.113.36/-.  Total laundry cost and sterilisation cost per operation was Rs.182.36/-.  Compared to the lowest quotation of Rs.695/- for the same mix of 22 disposable linen, reusable was 280% economical.  On an annual basis, use of disposable textiles in operating room will add a staggering Rs.60 lakh additional expenditure to the hospital, apart from its occupational health, environmental impact, and warehousing.  75% of users rated reusable as more comfortable to wear.   Disposable OR textiles would add annually 20 tonnes of additional solid infections waste, if used exclusively. From the analysis it is concluded that reusable textiles are far less expensive than the disposable perioperative textiles, apart from their sustainability benefits.


Strategies to ensure high compliance of NABH in a multi speciality hospital in Pune city
Coressponding Author Kasturi Shukla, Assistant Professor, MIT- World Peace University, Pune (Maharashtra)
Introduction: NABH is the board established which can assure the quality of the services and patient safety aspects in the hospitals. The quality of service in Hospitals is incomplete without the cooperation of the Healthcare workers within the Hospital. Hence, the study focuses on the compliance related to the Knowledge, Attitude and Practice towards the NABH standards by the healthcare workers across various departments within Hospital. 
Materials and Methods: In the study, 5 patient-centered chapters of the NABH standards were considered and the knowledge, attitude and practice towards the standards and policy was observed. Observations were noted with help of open ended questions based on the SOP of the Hospital, relevant records checked to assess compliance with the NABH standards. A sample population of staff (Managers, nurses, technicians and Healthcare staff) was randomly selected and observations were noted with help of checklist.
Results: Compliance that was observed in various department considering the NABH standards are Intensive Care Unit (ICU) 95%, Operation Theatre (OT) 96%, Emergency room (ER) 97%, Pharmacy and Stores 95%, Central sterile supply department (CSSD) 100%, Radiology 100%, Laboratory 98%, Kitchen 81% and Biomedical waste handling 72%. Introduction of regular monitoring and daily meeting of the respective heads was recognised as a means to prevent such events. 
Conclusion: The hospital needs  to focus more on regular monitoring towards the infection control practices and meeting among the managers on daily basis to have a control over the quality that the organization is aiming at. 
Keywords: Accreditation, National Accreditation Board for Hospitals and Healthcare Providers, Compliance, staff attitude, KAP.
How Beneficial is the Governmental Financial scheme (NIAF) for a beneficiary at an apex tertiary care hospital?
Corresponding Author: Dr. Nishant Sharma - Senior Residen Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi
Introduction: Rashtriya Arogya Nidhi Scheme (RAN) was conceived with aim to provide a safety net for India’s poor population in terms of social, economic and moral support by helping eligible families with cash benefit for their health need.
Aim: To assess the beneficiary satisfaction and utilization pattern of the financial aid received under the aegis of Rashtriya Arogya Nidhi (RAN) scheme and to study the perception of beneficiary regarding delivery of RAN scheme.
Aim:To assess the beneficiary satisfaction and utilization pattern of the monetary benefit received under the Rashtriya Arogya Nidhi (RAN) scheme and to explore the perception of beneficiary regarding delivery of RAN scheme.
Materials and Methods: This is a mixed method research where both quantitative surveys and qualitative in-depth interview were conducted. The survey was conducted among 113 randomly selected beneficiaries of Rashtriya Arogya Nidhi scheme belonging to economically weaker section and suffering from major life-threatening diseases.
Results:The mean age of the study participants was 31.23 years. Majority of participants (98%) were satisfied with the overall scheme, though few of them expressed their dissatisfaction with the amount of grant received and its delivery process. Among the study subjects, 69.9% had already incurred out of pocket expenditure prior to the receipt of the grant. ESRD, Hematological cancer and renal transplant were the main diseases for which grants have been sanctioned.
Conclusion: Financial assistance to the deprived empowers them and improves their self-esteem, independence, and overall quality of life. With increasing proportion of non-communicable chronic diseases amongst the Indian population, it is important to study the effectiveness of such schemes so that corrective measures can be taken toincrease its accessibility to the disadvantaged section of the society.
Keywords: Rashtriya Arogya Nidhi, Impact evaluation, Financial burden, Healthcare expenditure, Financial Protection Scheme
Healthcare in India is very important. With 1.3 billion population to cater, it is huge task. And most important is service offered to patients in India. So many hospitals have come up and there is need to give right organization structure to hospital so that we have more satisfied patients. 
To survive, each hospital needs to have a unique strategy (or a USP: unique selling proposition) that gives it competitive advantage. These strategies have been categorized in literature as cost leadership (CLH) or differentiation (DIFFH). A cost leader hospital (CLH) gives health services at least possible cost whereas a hospital with differentiation strategy (DIFFH) gives better healthcare at a higher cost (typically to higher income class group patients). An example is CLH may give ‘generic’ drugs whereas a DIFFH may give ‘non-generic’ drug; a DIFFH may serve tailor made food to cater to the nutrition needs of patients, and so on. 
Here we give relationship between strategy and structure of hospitals having different strategies, i.e., pure cost leadership (CLH) and pure differentiation (DIFFH) by a simple theoretical argument. And we wish to see if it is valid in real life by. For this we conduct a pilot study of one CLH and one DIFFH in Kanpur city. 
Study Design: 
In administration, structure has been reported to be measured on five dimensions: standardization, specialization, centralization, formalization and complexity of work flow CWF (see Pugh et al. 1968). 
We show that these structure dimensions have different values for hospitals having different strategies (CLH and DIFFH). Formalization is high in both CLH and DIFFH hospitals; and this may be due to increased emphasis on ‘evidence based treatment’ in the healthcare and also to keep a record of treatments given to patients to take care of any future litigations. Also we note that specialization is low in CLH hospitals and is high in DIFFH hospitals. Specialization in CLH hospitals is very low where as it is very high in super specialty hospitals. This is totally different than the framework provided for strategy and structure for manufacturing and services by Miles and Snow (1978). 
For CLH hospitals the standardization, centralization continues to be high; and CWF is low. For DIFFH hospitals the standardization and centralization is low and CWF is high. This is same as the framework provided for strategy and structure for manufacturing and services by Miles and Snow (1978). 
Study Setting: 
We do extensive literature review in the field of administration to identify the research gap. Later we give our theoretical arguments that are different ones than given in literature. A small study of 2 hospitals is undertaken to give support to our propositions. 
Materials and Methods: 
In order to verify our theoretical framework we conducted a pilot study of two hospitals in Kanpur. One of them was a CLH and the other one was DIFFH. Strategies pursued were observed. Structure was observed by several visits to these two hospitals as observer and as patient. 
Results and Conclusions: 
We found that the cost leader hospital in our sample had high standardization and high centralization; and low complexity of workflow. And the hospital with differentiation strategy had high standardization and centralization; and low complexity of workflow. This is as per the framework available in literature (Miles and Snow 1978). 
We found that the cost leader hospital in our sample had high formalization and low specialization. And the hospital with differentiation strategy had high formalization and high specialization. This is contrary to the framework available in literature (Miles and Snow 1978). This is the new theoretical contribution we make. 
These findings have important implications for hospital administration. It will help management of hospitals to choose right structure (for hospitals) that is aligned to their strategies so that the patients get the most efficient and effective healthcare. 
Corresponding Author - Assistant Professor, NITTE School of Architecture 
Planning spatial requirements for various services in relationship to the number of active beds in a hospital is a big challenge. Often it either falls short or excess for the workload.  Consequently former leads to deterioration in the quality of care, whereas later may lead to underutilisation of resources. With this in mind, critical analysis of defined space provided for various services in a tertiary care teaching hospital is done by measuring each area. This is expressed in Sq.ft/bed and is compared with the prevailing standard thumb rules of planning. For a 750 bedded facility with 85% occupancy, 630 Sqft/bed was the space provided with circulation space at 37% of the total usable area which are well within the recommended standards. On gross allocation of space, wards accounted for 45%, OPD 13%, Diagnostic/therapeutic area 18%, Services 13% and Administration @11%, of the total area. Comparing them to the standard guidelines, space provided was found adequate for all departments except area provided for services, which fell short by 5%. Space provided for CSSD, Laundry, Pharmacy, Dietary departments were 3.3, 3.7, 6 and 13.3Sqft./bed respectively.  This is much below the rule of thumb requirement of 6, 10, 9.4 and 15sqft/bed respectively for the above areas. This is evident by the acute shortage of space faced by these departments. Areas like Emergency, Pharmacy, MRD, Laboratory and Radiology witnessed rapid expansion in the last 10 years. Space provided for ambulatory care & diagnostic services were found to be 109 and 63 Sqft/bed; whereas, standards being 108 & 64.5 Sqft/bed respectively. Thus it is conclusive to say that prevailing standard rule of thumb is a useful tool while planning a hospital and in deciding where rapid expanding departments are to be located, so that further expansion is easily possible.
AHA Updates 2019- 2020
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