Current Issue Volume 6, Number 1 , January-June 2018

EDITORIAL
Shakti Kumar Gupta, Sunil Kant

Medical Research at Crossroads

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:iv-v]



Medical education and research in India is in a state of metamorphosis wherein there is a paradigm shift from conventional rigid methodology to need-based issues. The present state of medical research in India is in quagmire owing to some being industry-driven, some for academic accomplishments, with very few actually addressing the felt needs of our country. The health of any country is unique and customized research can only address plethora of challenges arising in our ecosystem. Medical education presently is focusing on developing healthcare resources where primary stress is on superspecialization. This has to be revisited and the old concept of family physicians be ushered in, which will ease the load from the superspecialists, and health care can permeate to deep interiors of our society. While graduates generally possess reasonably sound knowledge of medical science, they are generally found deficient in performance of clinical skills and clinical competence. The application of evidence-based medicine has taken a backseat, because of constraints of basic research outcomes.


GUEST EDITORIAL
Hamid Shirazi Agha

The Deoxyribonucleic Acid of Health care Delivery Institutions

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:vi-viii]



I have an admiration for hospitals, particularly through a lens of administration. In fact, my fascination with health care delivery institutions started as a student in medical technology in 1986. Over the years, the feeling grew stronger when my interactions with hospitals took place in different capacities. Upon graduation, I became an employee, years later a supplier of medical devices and research systems, then a patient, and a family or friend of a patient who was visiting, and finally, as an economic development official to facilitate greater adoption of innovation (from the private sector or academia) into hospitals. These exposures have taken place in different countries, on different continents, in both public and private sectors and also in civilian and army hospitals.


ORIGINAL ARTICLE
Janet Sweety, Sudhakar Kantipudi, P Naveen Kumar

Improving Scan Reporting Time using Lean and Six Sigma

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:1-5]



Hospitals are always looking for ways to improve their processes and systems to provide benefits for all the stakeholders. Radiology department is one of the revenue-generating areas in the hospital where short waiting times and positive experience represent important drivers of patient satisfaction. Quality of care has been given a major focus by hospital and health care organizations across the country. Computed tomography (CT) and magnetic resonance imaging (MRI) are the two important modalities contributing to the revenues through radiology. Since the scan time being low, the significance for more revenue by increasing the patient load will add more value to the services. Certain non-value activities may lead to improper functioning of the department. Lean and Six Sigma tools have been used in this study to identify such activities. This led to reversal of negative performance indicators, streamlining the processes, and regaining the patient satisfaction in this hospital.

Objectives: Streamline mapping of workflow to implement Lean and Six Sigma and to improvise the present performance of Radiology Department.

Materials and methods: Prospective study with direct observation of workflow. A total of 120 patients were observed for a period of 1 month, to identify the time taken. Failure mode effect analysis (FMEA) was used to identify potential steps for failure, and their effects.

Results: Number 490 is the maximum risk priority number (RPN) for report approval and preparation; 920 minutes was the average time taken for CT scan approval and 834 minutes was the time for MRI scan approval.

Conclusion: The radiologists were pointing that lesser number of monitors were available for report preparation.

Keywords: Customers process mapping, Inputs, Lean and Six Sigma in healthcare, Outputs, Process, Radiology services, Supplier, Total quality management.

How to cite this article: Sweety J, Kantipudi S, Kumar PN. Improving Scan Reporting Time using Lean and Six Sigma. Int J Res Foundation Hosp Healthc Adm 2018;6(1):1-5.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Arvind Kushal, Shakti K Gupta, Manju Mehta, Madhav M Singh

Study of Stress among Health Care Professionals: A Systemic Review.

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:6-11]



Stress is any action that places special physical or psychological demands upon a person, anything that can unbalance his individual equilibrium. Work-related stress is a potential cause of concern in health care workers and is associated with decreased job satisfaction, days off work, anxiety, depression, sleeplessness, medical errors, and near misses. To compare stress levels in different groups of health care worker and identify causes of stress, we conducted a survey-based study at a super-specialty public sector hospital at Delhi NCR.

Keywords: Health status, Medical practitioners, Stress, Stress management, Work stress.

How to cite this article: Kushal A, Gupta SK, Mehta M, Singh MM. Study of Stress among Health Care Professionals: A Systemic Review. Int J Res Foundation Hosp Healthc Adm 2018;6(1):6-11.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Sujeet K Sinha, Anil K Gupta, Ray Pallab, Madaan Nirupam

A Study on Utilization of Blood Culture Reports in the Emergency Department at a Tertiary Care Teaching Hospital in North India

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:12-16]



Introduction: It is invariably observed that blood cultures are more often ordered because the patient has fever or the admitting physician wants them for any expectation of clinical impact. As a result of such practice, unnecessary blood culture is being ordered with negative financial impact on hospital as well as the patients. The indication for obtaining blood cultures from patients in the Emergency Department (ED) is even less clear. This study was done to study the utilization of blood report in the emergency department of a tertiary care teaching hospital in north India.

Need of the study: It was a common perception among the emergency medicine physician that they did not get blood culture reports on time from the Microbiology Department. The reports are either misplaced or received late as desired by the physician. A pilot study was done to check the hypothesis. Totally seventy blood culture samples were sent from the medical emergency ward and surgical emergency ward over a 3-week period. It was observed that 25% of total blood culture reports did not reach the physician.

Aim and objective: (1) To study the utilization of blood culture report in emergency, (2) to design an intervention for timely availability of blood culture reports, and (3) to Study the impact of the intervention on the utilization of blood culture reports.

Materials and methods: The study was cross-sectional, record-based prospective study, supplemented with interview of treating doctors. All patients admitted in the emergency ward (one each from medical and surgical) were followed up for 3 months. An Intervention was done personally by the researcher to ensure that all the test reports reach the patient file within 6 hours of its generation.

Observation: Out of total 104 blood culture reports sent in preintervention, change in treatment according to culture report was done only in 7.6%. In postintervention, it increased to 9.9%. It was found that the clinician did not narrow down treatment even when the cultures are positive. About 77.1% of positive blood culture reports get wasted in preintervention and 54.5% in postintervention.

Conclusion: There was ample loss of hospital resources in respect of money as well as manpower if even a single blood culture report is not utilized.

Keywords: Blood culture, Emergency department, Intervention, Utilization.

How to cite this article: Sinha SK, Gupta AK, Pallab R, Nirupam M. A Study on Utilization of Blood Culture Reports in the Emergency Department at a Tertiary Care Teaching Hospital in North India. Int J Res Foundation Hosp Healthc Adm 2018;6(1):12-16.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
P Naveen Kumar, Shivakumar, Uttham Sharma

A One-year Observational Study on Hand Hygiene Practices in an Open Intensive Care Unit of a Large Teaching Hospital in India

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:17-21]



Health care-associated infection (HCAI) is the commonest complication affecting hospitalized patients. The infection sources in a hospital are personnel, hospital’s inanimate environment, and self-infection. Direct transmission accounts to 70% of infection transfer. Bacteria, fungi, and viruses have been reported as causative agents in HCAIs, and many infections are polymicrobial. Effective safety management in the 21st century involves keeping an eye on human factors and highly reliable organizations can identify and capture potential hazards before they show themselves as accidents. One method of achieving this is by measuring the level of safety through “leading” indicators. An active surveillance to measure the adherence to hygiene of hands of employees is conducted by the infection control nurses randomly in the critical areas in this hospital. Hand Hygiene Moment Observation Form taken from the original World Health Organization (WHO) 5 Moments “Observation Form” is used for observation. The compliance among nurses is greater compared with doctors in the intensive care unit (ICU), 64.44 to 60.74%. During the said period, the number of infections incidence in ICU compared with overall hospital’s infections was 62.98%. The nurses had 7 opportunities and doctors had 10 opportunities to wash hands during 1-hour period, and the average time spent for washing was 8 seconds by doctors and 14 seconds by nurses.

Keywords: Hand hygiene of health care workers, Health careassociated infections, Infection control nurse, Patient safety, World Health Organization observation form study.

How to cite this article: Kumar PN, Shivakumar, Sharma U. A One-year Observational Study on Hand Hygiene Practices in an Open Intensive Care Unit of a Large Teaching Hospital in India. Int J Res Foundation Hosp Healthc Adm 2018;6(1):17-21.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Arvind Kumar, Birakta Debbarma, Anup Singh, Kuldeep Kumar, Anupam K Singh, Prayas Sethi, Arvind Kumar, Lalit Kumar, Shakti K Gupta

Level of Satisfaction in Patients attending Government Health Facilities of AIIMS, New Delhi, Outreach Outpatient Department, Badsa, Jhajjar, Haryana, India

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:22-30]



Customer satisfaction is an individual feeling of pleasure or disappointment resulting from comparing a product/service’s perceived performance or outcome in relation to his or her expectations. Outpatient department (OPD) in any hospital is considered to be a shop window of the hospitals. Our study aims to extract patient’s satisfaction through structured questionnaire covering all dimensions like interpersonal manner of health service providers, accessibility, physical environment, and quality of medical care. It was a cross-sectional questionnairebased study conducted at the All India Institute of Medical Sciences (AIIMS), New Delhi, outreach OPD, over 2 years from November 2014 to February 2016 and included 402 participants. The satisfactions divided into low, medium, and high were found in 17.91, 67.66, and 14.42% respectively. Medium satisfaction was similar in almost all qualification and occupation groups, which could be a subject of perception. Income-wise, upper class had highest level of satisfaction. Among the five divisions of questionnaire, accessibility to health care facility raised some concern from patient point of view, probably this being an outreach OPD. Other four factors like availability of medical resources, interpersonal manner, behavior of health care personnel, and physical environment of health care facility drew similar attention from the participants. The AIIMS outreach OPD can be taken as one of the steps in improving the outreach facility.

Keywords: Outreach outpatient department, Patient satisfaction, Questionnaire.

How to cite this article: Kumar A, Debbarma B, Singh A, Kumar K, Singh AK, Sethi P, Kumar A, Kumar L, Gupta SK. Level of Satisfaction in Patients attending Government Health Facilities of AIIMS, New Delhi, Outreach Outpatient Department, Badsa, Jhajjar, Haryana, India. Int J Res Foundation Hosp Healthc Adm 2018;6(1):22-30.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Arushee Bhatnagar, Shakti K Gupta, Vikas Hanumanthappa, Nitin Garg

A Study on Aftereffects of Holi: Color Injury, Ocular Trauma, and Assault at a Tertiary Care Ophthalmic Center in North India

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:31-36]



Introduction: India is known for its diverse culture and religions which are indeed famous for their variety of festivals. The presented study deals with one such festival called Holi and its hazardous ocular effects at Tertiary Care Ophthalmic Center In North India.

Aim: To study the demographic and clinical profile of patients visiting ophthalmologic emergency tertiary care ophthalmic center during Holi in New Delhi.

Objectives:
• To study the pattern of normal patient flow in the emergency department of RPC.
• To study the demographic and clinical profile of patients visiting Emergency Department during Holi.
• To study the trend of Holi cases over the years.

Materials and methods: The data were collected by conducting direct interviews with patients and from medical records of the patients visiting the Emergency Department of RPC from March 1 to 5, 2018 (i.e., 5 days). These 5 days were chosen so that it could cover the pre-Holi day, Holi day and post-Holi day. Data of total 210 patients who visited the Emergency department of RPC, AIIMS, New Delhi, were taken. Statistical data were analyzed using Microsoft Excel.

Results and discussion: An increase in awareness among people shows a substantial decline in number of color injury, complications, traumatic eye injuries, and assault cases from the year 2016. Men (20) were more affected than women (9), with most common being among the youth (21 years ± 10). No change in routine cases was recorded in normal patient flow to the casualty, but a sudden spike in cases of color injury (29) was observed during the study period. Sooner the patient reported, better was the prognosis.

Keywords: Chemical injury, Emergency, Holi, Ocular injury, Ocular trauma, Substance abuse.

How to cite this ar ticle: Bhatnagar A, Gupta SK, Hanumanthappa V, Garg N. A Study on Aftereffects of Holi: Color Injury, Ocular Trauma, and Assault at a Tertiary Care Ophthalmic Center in North India. Int J Res Foundation Hosp Healthc Adm 2018;6(1):31-36.

Source of support: Nil

Conflict of interest: None


EXPERT VIEW/REVIEW PAPER
Kamal Gulati, Shakti K Gupta, Vikas Madhukar, Chitra Sarkar

Importance of Medical Leadership Development: A Global Perspective with Special Reference to the Indian Healthcare System

[Year:2018] [Month:January-June] [Volumn:6 ] [Number:1] [Pages:42] [Pages No:37-42]



Medical leadership has in the last decade assumed great importance globally. The reason for this is the proven link between effectiveness of leadership and improved clinical outcomes. With increasing demands for delivering high quality patient care at lower cost, physicians are expected to embrace leadership roles. Traditionally, medical schools do not teach leadership either at undergraduate or postgraduate levels. Also efforts to develop leadership skills among ’in service’ professionals are minuscule and not very effective due to lack of structured leadership development programmes. This causes a significant “leadership gap” in medicine across a wide range of organizations. In order to bridge this gap, many countries viz. UK, USA, Canada etc. have designed specific leadership models and are conducting leadership development programs at various career stages of doctors to address the needs of the changing healthcare systems. However, not much work has been done in India in this direction. It is high time that medical schools and organizations in India begin to formalize leadership training at all stages of medical education and career. It will be prudent to design a leadership development programme targeting the needs of Indian doctors with special reference to the rapidly expanding Indian healthcare sector. This will help to create more doctors who are not only skilled as “competent physicians” but also as “competent physician-leaders”. This article analyzes the leadership competencies critical for medical doctors and methods to develop them as well as reviews the important medical leadership models and programmes available globally.

Keywords: Canmeds, Competencies, Leadership, Leadership models/frameworks, Management, National Health Service, The Health Care Leadership Alliance, Training and development, UK-Faculty of Medical Leadership and Management.

How to cite this article: Gulati K, Gupta SK, Madhukar V, Sarkar C. Importance of Medical Leadership Development: A Global Perspective with Special Reference to the Indian Healthcare System. Int J Res Foundation Hosp Healthc Adm 2018;6(1):37-42.

Source of support: Nil

Conflict of interest: None


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