Everyone worked independently towards common objective!! Patients Clinician • How long do I have to wait • Reports of the patients are not to see the doctor available during the round • Long lines at every counter • Nurses are always busy; not • Waiting in ER for bed enough time for the patients Everyone • Come again in the evening • Patients medication delayed blames to collect reports • Beds not available • Discharge time is very high the • Equipments / Break-down • When will the surgery start • Infection Rates System • Very few nurses y Hospital LEARNINGS OF A System Management Other staff • Patients are always complaining • Everyone blames us about services • Lot of paper work • No budget for more man power HOSPITAL CLINICIAN ADMINISTRATOR • Pharmacy delays; medicine & equipments out of stock • Optimum utilization of services • Reports not available • How to prevent equipment • Shortage of GDAs breakdown Dr ASHOK V CHORDIYA • Housekeeping not • Patient Satisfaction responding Director Fortis Hospital Noida SPECIAL INITIATIVES Define Drivers for Engagement 1. Operating System (FOS) 2. Clean Hospital Project (‘Sparkling’) Clinician Enhanced Enhanced 3. Patient Care Initiatives Patient Management & satisfaction Administration 4. Lean Sigma – ‘5 S’ Project Nursing / Paramedical Staff WHAT IS HOSPITAL OPERATING SYSTEM? WHY A HOSPITAL OPERATING SYSTEM? Standardizes all patient facing Common platform processes: Enhanced Capability • Patient-centric patient management Effective experience patient management management • Consistent Operating System • Efficient Optimum Standardized resource Processes • Reliable utilization • Repeatable Performance management • Replicable 1
Fortis Operating System by looking at the overall hospital OBJECTIVE processes in 3 dimensions • Processes within the department • Patient flow processes • Performance • To ensure uniform high quality of management system – scorecard and review customer facing processes across process Fortis hospitals • Hospital Performance management system Enable Fortis to Wards Diagn ‐ scale up its network OPD ICUs OT ER • Beds ostics To embed best practices in faster and at the operational operational efficiency efficiency to to yield yield right quality bottom-line impact Admissions • To facilitate performance management across all sites Discharge through use of a standardised cascade (scorecards at different levels) of metrics, tools and templates OVER ALL PERFORMACNE REPORT CARD WE USED DMAIC FOR IMPLEMENTING FOS Every patient Delighted 42 / 51 82 % Asset Metric Unit Apr '09 May' 09 June' 09 Target OPD Patients waiting beyond 15 mins of appnt % 14% 14% 14% <5% PHC %age PHCs completed within defined TAT % 61% 72% 76% 90% A I I Service ER Pts with LOS > 4 hrs in triage % 2% 1% 2% <5% D M C Score 18/24 on time 75 % ER Ambulance response outside 10 mins % 2% 3% 2% <10% Define Measure Analyze Improve Control Wards Discharges before 11 am % 46% 46% 45% 75% IPD ALOS Days 4 4 4 OT & Cath Lab Procedure / Surgeries starting within 30 mins – Define the – Measure the – Analyze and – Identify and – Track and review % 91% 90% 93% 90% of scheduled time process problem identify the gap implement progress Short lead test completed with in 1hour 30 Lab Med % 87% 89% 90% 90% mins solutions USG reports within 15 mins Radiology % 77% 78% 79% 90% X ray reports within 30 mins X-ray reports within 30 mins Benefits of sticking to the rigor Asset Metric Apr '09 May' 09 June' 09 Target • In-depth understanding of the processes in the asset OPD Calls Dropped % 4% 3% 3% <5% ER Ambulance calls turned back % 1% 1% 0% <5% Service Score – 12/12 • Data collection and analysis enables identification of areas of waste and 100% IPD Admissions denied % 0% 0% 0% 0% for all variability OT & Cath Lab Surgeries rescheduled % 4% 4% 3% <5% • Ideas for improvement come backed with data ruling out scope for denial / Asset Metric Apr '09 May' 09 June' 09 Target action by gut-feel ICUs % Step downs planned % 77% 78% 81% 80 Patients with final bill more than 5% of Billing % 12% 11% 10% <5% • Enables out-of-the-box thinking as ideas can be substantiated by showing estimate Wards % discharges planned % 76% 81% 80% 80% Predicta improvement in areas of waste identified during the initiative Wards Length of discharge process Mins 132 132 147 120 Score – 12/15 ble 80% service House keeping TAT for room cleaning post discharge Mins 25 25 24 30 76% 78% 82% 9 = 1 = 2 = 3 Score Highlights of Project “Cleanest Hospital” What is ‘CLEAN’? Re ‐ define? ‘Patient Safety’ Only Sparkling or Infection free ? Project ‘Cleanest Hospital’ 2
PRO INTERACTIVE (3 + 46) ZONING OF THE HOSPITAL STAFF DEPLOYMENT DYNAMIC (2 + 31) ARNA (1 + 8) G M E N GENERAL (0900 TO 1730 H) - 02 ZONE 6 – 5 th FLOOR - 3 3 2 MORNING (0700 TO 1530 H) - 35 EVENING (1300 TO 2100 H) - 30 ZONE 5 – 4 th FLOOR - 3 3 2 NIGHT (2100 TO 0700 H) - 18 ZONE 4 – 3 rd FLOOR 2 - 3 3 G M E N G M E N ZONE 3 – ICU ZONE 3 ICU ZONE 9 OT ZONE 9 - OT - 3 3 3 3 2 2 1 1 3 3 2 2 1 1 ZONE 2 – 1 st FLOOR ZONE 8 – OPD 1st - 3 2 2 - 3 3 - FLOOR ZONE 1 – G/FLOOR ZONE 10 - ATRIUM ZONE 7 – OPD G/FLOOR 2 - 3 3 1 - 2 1 - 3 2 - 5 ZONE 11 BASEMENT P 1 - 6 4 G 1 M 18 E 17 N 11 NIL M 8 E 6 N 6 G 1 M 9 E 7 N 1 ZONE 12 PUBLIC AREA GRAND TOTAL - 85 ACCOUNTABILITY OF HK SUPERVISORS TO BE ENSURED CLEAN PATIENT ROOM CHECK LIST INFECTION FREE PATIENT ROOM CHECK LIST DATE: ‐ FLOOR: ‐ SUP: ‐ DATE: ‐ FLOOR: ‐ SUP: ‐ Room Room Remarks Area to check Points to be checked Area to check Points to be checked Room Infection check Remarks Main door Polish/Paint/Chipping/Door handle/Door closer/Hinges/ Locks Main door Polish/Paint/Chipping/Door handle/Door closer/Hinges/ Locks Random sampling to be done Walls and ceiling Corner/Dust and stain free Walls and ceiling Corner/Dust and stain free Random sampling to be done Patient bed Dust free ‐ bed wiping/Clean linen/Paint/Mattress Wiping Patient bed Dust free-bed wiping/Clean linen/Paint/Mattress Wiping Random sampling to be done Water tray Flask ‐ clean/Glass cleaning/Tray cleaning Water tray Flask-clean/Glass cleaning/Tray cleaning Random sampling to be done Phone Dust free/Telephone sticker/Wire dust free/Disinfectant used Phone Dust free/Telephone sticker/Wire dust free/Disinfectant used Random sampling to be done Polish/Paint/Door hinges and Knob/Lock And keyHangers/Pt. Dress Polish/Paint/Door hinges and Knob/Lock And key Hangers/Pt. Dress clean/ Rod Almirah clean/Inside clean/Attendant Linen clean Almirah clean/ Rod clean/Inside clean/Attendant Linen clean Random sampling to be done Food trolley Clean-Stain and Dust free Food trolley Clean ‐ Stain and Dust free Random sampling to be done Foot stool Clean-Stain and Dust free Random sampling to be done Foot stool Clean ‐ Stain and Dust free Bed side locker Clean-Stain and Dust free Random sampling to be done p g Bed side locker B d id l k Clean ‐ Stain and Dust free Cl St i d D t f Patient bell Clean-Stain and Dust free Random sampling to be done Patient bell Clean ‐ Stain and Dust free blind-working/Blind clean/Ledges/ Lock-in place/Window sealed/Glass smugge blind ‐ working/Blind clean/Ledges/ Lock ‐ in place/Window Room window and streak free Random sampling to be done Room window sealed/Glass smugge and streak free Attendant couch Upholstery-condition/ No sagging Random sampling to be done Attendant couch Upholstery ‐ condition/ No sagging TV Working with all Channels/Dust free/ Wire Clipped/Height for Viewing Working with all Channels/Dust free/ Wire Clipped/Height for Random sampling to be done TV Viewing Room Curtain Track smooth move/ All hook Intact/Curtain Clean Random sampling to be done Room Curtain Track smooth move/ All hook Intact/Curtain Clean Lights and switches Working Random sampling to be done Lights and switches Working Wall clock Working Random sampling to be done Wall clock Working Waste bins Garbage bag liner/Clean-Inside and outside Random sampling to be done AC Thermostat-on when Occupied/Grills-Clean and Dust free Waste bins Garbage bag liner/Clean ‐ Inside and outside Random sampling to be done Floor Clean/shining/No Spots/Clean Skirting AC Thermostat ‐ on when Occupied/Grills ‐ Clean and Dust free Random sampling to be done Fire sprinkler Working/No paint marks Random sampling to be done Floor Clean/shining/No Spots/Clean Skirting INFECTION CONTROL COMMITTEE Untidy Store Tidy Store S. N. Name Designation Title 01. Dr. Mrinal Sircar HOD & Sr. Consultant ‐ Critical Care Chairman 02. Dr. Ravneet Kaur Consultant ‐ Microbiologist Convener 03. Dr. Ashok V Chordiya Facility Director Member 04. Dr. Adarsh Koppula HOD & Sr. Consultant ‐ CTVS Member 05. Dr. Dushyant Nadar Consultant Urology Member OPD Chamber of Doctors 06. Dr. Manoj Singhal HOD & Sr. Consultant ‐ Nephrology Member 07. Dr. Mary Abraham HOD & Sr. Consultant ‐ Anesthesia Member 08. Dr. Usha Gupta Consultant Clinical Pharmacologist Member 09. Ms. Neena Yadav Deputy Nursing Superintendent Member 10. Ms. Kuttyamma Infection control Nurse Member 11. Mr. Ravi Adhlakha Chief Engineer Member 12. HOD Housekeeping HOD Housekeeping Member 3
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