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Question: Discuss about the Operations of Ward Management. Answer: Introduction: The study deals with the operations of ward management in Yashoda hospital. This hospital is one of the renowned hospitals in India. The hospital has its headquarters in Hyderabad[1]. Starting from the background of the hospital, the various operations of ward management in the hospital is the part of the discussion. The objective of the ward management operations is to provide the best facility and patient care service. It includes providing patient centered care, provision of atmosphere that promotes quick healing and prevent infections, accidents and medical errors. The paper will discuss the operation strategy of the hospital, process layout, inventory management, material requirement planning and scheduling of the management activities. Ward management is important to ensure availability of adequate equipments and supplies. It helps to clear shortages, defects in the equipments, check supplies, and ensure safe handling of materials. Ward management is required for continuous improvement of the patient unit that includes orientation, comfort ability of the patient, food system, and patient care. The wardroom management is important for proper categorization of the wardrooms, allocation of rooms or beds to the patients, maintenance of the wardroom status, tracking of patient information and preparing discharge information and maintenance of the handover details[2]. Background of the hospital Dr. G. Surender Rao established Yashoda hospital in Hyderabad, in 1989. It has many branches in different parts of India. The hospital extends its services upto south Asia. This hospital has three independent branches. The total number of beds in the hospital is 1750 with three heart institutes. The employee strength is 2200, where 700 comprise of specialized doctors and 1500 comprise of nurses. Te hospital offers offer 24X7 services on emergency. The hospital is known for best quality patient care. As per the WEEK- NELSON survey of the best hospitals 2015, Yashoda hospitals rank number one in Hyderabad[3]. The hospital is an education hub and offers wide range of specialty courses in medical research and education. The hospital is attached with the college and the nursing school. The hospital has set a benchmark in 28 years[4]. It has efficiently used technology in patients management and for availability of necessary equipments in every ward room. The hospital provided excellent accommodation (rooms, beds, food and pharmacy). The hospital also has facility of standard private room, VIP suite (separate living and dining room etc), shared rooms (2 beds), standard private rooms, spacious intensive care units with special critical care beds. For convenience of the patients and visitors the hospitals provides 24 hours Automated Teller Machine[5]. Operation Strategy: Efficiency vs. Responsiveness of Yashoda Hospital: The main purpose of the operation strategy of the Yashoda hospital is to ensure that all the resources that are available with the organization are used in proper manner to provide full assistance to the patients. It is common for all healthcare organization to face the operational management challenge to deal with the issues of resource management and patient satisfaction. Effective operational management is one of the best ways that can help to improve upon the efficiency and responsiveness of the hospital towards the needs of the patients[6]. The overall efficiency of the operational activity of the Yashoda hospital has been improving due to the strict level of working protocol that the hospital follows. Moreover, being one of the top super-specialty hospitals of its region, it is essential for the hospital groups to provide efficient and high level of medical care with the help of 24/7 emergency medical service. In the recent days, few of the important issues that are encountered by the health care organization is due to the limited budget and increased cost of the healthcare, which are the matters of economic crisis in the hospitality industry. Application of the process flow solution is one of the best ways to manage with the operational activity of the hospital that has also helped to improve upon the reputation of the organization[7]. With the help of this process in the management activities, it is possible for the organization to reduce the overall time that is spent by individual patients for getting treatment. He nce, it can be said that with reduced time that is needed, it is possible for the organization to improve upon the overall responsive time. The efficiency of the organization also depends on its ability to deal with accurate needs of the patients. The Yashoda group has to control wide number of hospitals and has to manage the resource effectively that will help them to properly manage the resources and also hospital working staffs. Effective calculation methods has been applied that can ultimately help to improve upon the overall rate of profit for the organization. The model of process flow that is being incorporated that can ultimately help to deal with the process of increasing the efficiency of the hospital groups that can help them to make use of the recourses that are allocated to the organization[8]. The principal of Lean production is one of the effective techniques that the hospital applies in the healthcare department that can help to deal with the overall challenge of lower productivity within the centre. One of the effective processes of the dealing with that of the less variability and limited resources within the organization is to make use of the concepts related to the Just-in-time (JIT)[9]. With the help of this JIT principal, it is possible to improve upon the overall time that is needed to deal with the operational management activity. This can ultimately help to deal with the labor force that is needed in the overall management activity with the operational function[10]. One of the main factors that has allowed the Yashoda hospital group to be one of the most effective and improved healthcare organization of the region is due to the fact that they have less waiting time for the patient within the emergency department. This can ultimately help to improve upon the rate of patient flow within the organization. The overall time taken for discharge of the patient is also one of the essential components that can help to decide upon the efficiency and responsiveness of the hospital. Maintenance of the operation ward and schedule for the doctors Yashoda hospital currently has 15 specialist surgeons, who operate in the operation theater. The hospital also has five operation theaters. The hospital currently maintains a fixed schedule that helps them to deal with the pressure and the challenge of the work schedule that the management of the hospital maintains. Doctors Operation theater 1 Monday, Tuesday Operation theater 2 Monday, Thursday, Friday Operation theater 3 Tuesday and Thursday Operation theater 4 Saturday Operation theater 5 Wednesday Neurosurgeon Cardiac Surgeon Orthopedic Surgeon Nephrologists Gynecological Surgeon General Surgeon Thoracic surgeon Colon and Rectal Surgeon Gnat Chart Nurse Resource Management The purpose of the nursing resource management is to deal with the cost of the between the overall quality of staffing and the decisions that are being implemented within the ward of the hospital. It is possible to provide the best quality of nursing care for the Yashoda hospital with the help of proper allocation of the nursing resource. Nurse resource planning is an area of interest for management decisions and an appropriate model of resource planning would be required for achieving the desired quantity and quality of skilled personnel in the specific nurse job positions at the time they are needed. The Human Resource Planning model to be applied to Yashoda hospital would be based on the Analytic Hierarchy Process (AHP). Yashoda hospital can be affected by a number of social, economic and regulatory variables while undertaking resource allocation; these perspectives suggest that the use of a modeling methodology like AHP. The AHP model would yield priorities for factors and a human resource forecast of changes in demand and supply of nursing staff. The AHP is a flexible model that has been found to be effective in decision-making aand planning environments. It offers the ability to structure the issue in a hierarchal form as viewed by the decision makers. The method can be used for either objective or subjective ev aluation, permitting consideration of qualitative factors. AHP is known to be a structured method for organizing and analyzing decisions that are complex in nature. Once the hierarchy of nurses is built, the decision makers would systematically evaluate the different elements by undertaking a rigorous comparison. While making the comparisons, they would use the data for coming to a decision. The essence of this model is that human judgments can be used for undertaking the whole planning process[11]. It is essential for the hospital to plan for the resources that can be used for the efficient resources. In the context of the present days, the hospitals are effective while increasing the efficiency of the labor that can help them to reduce the overall cost and expenditure. The hospitals have also aimed to improve upon the nursing effective ability of the nursing labor that can be achieved by properly using the statistical records of the nurses. This can ultimately help them to allocate the duty of the nurses according to their past records and performance. The nursing cost and quality is one of the major issues that have been encountered by most of the hospitals in the recent days. Hence, with the use of the statistical model, which is a part of the quantitative model of nursing, it is possible to make optimum use of the resources. It can be also said in the context that most of the resources within the nursing department needs to have the ability to maintain the nursing staffs an d also the equipments that are needed within the hospital management[12]. Process Layout of Yashoda Hospital Being one of the reputed hospitals of the local region, it is important for the Yashoda hospital to use effective flow process that can help to reduce the overall time that is needed to complete the overall process of treatment. Soon after the patient gets admitted, the present working staff within the hospital will record all the medical data of the patient. The information related to the diagnosis of the patient can help the workers to decide upon the total time that will be needed to discharge of the patient. The patient is then kept under treatment, using the fixed protocol of system that is decided by the management groups of the hospital. After the patient is being admitted in the hospital, it is possible for the physicians conduct effective physical assessment and multidisciplinary history, which is done with the assistance of the nurse. The detail information related to the time of discharge of the patient is also kept within the record that also includes the information related to the decisions that are needed during the time of crisis. The final section of the process layout consists of the functional assessment that can help to decide upon the overall future plan for any particular patient depending upon their situation. The use of the AHP model is also one of the useful methods that have been adopted by the hospital to implement the crucial decisions taken from the side of the management. In order to implement the model, the hospital has to fix upon their organizational goal. This will help the hospital to select their leader or manager depending upon their individual experience. The decisions that are implemented by the hospital are done after careful consideration and consultation with all the members of the management. In order to have effective management system within the overall hospital, it is important to follow the hierarchical system of order to deal with the overall complex management system. The performance of each of the workers can also be evaluated with the help of the Analytic hierarchy process. The Yashoda Hospital has implemented the AHP model that has helped them to monitor the performance at all levels of the healthcare hospital. The model has also helped to suggest ways to impro ve the overall working capability at each level within the healthcare unit. As one of the patients is discharged early, it is subsequently possible for the hospital to provide admission for the subsequent patients and is thereby possible for the hospital to provide with effective healthcare service to the society. The protocol of the hospital also allow the patient to provide their feedback that can help to improve upon the overall service quality of the hospital service. Inventory Management of Yashoda Hospital The management of the Yashoda hospital uses the techquies of Just-in-time (JIT) methods that can help to deal with the overall customer demands and to improve upon the level of profit for the hospital. There are various parameters within the JIT that can help the hospital to optimize the overall cost effective ratio of incoming and to optimize the level of profit within the organization[13]. Purchasing cost: The cost of per bed is Rs. 10000 with the current purchasing methods and JIT purchasing. Ordering cost: The cost of per order is Rs. 15000 for both purchasing methods. Opportunity cost: The management of the hospital has decided upon the 10% rate of return of investment that can be applied for both capital and inventory purchases. This amount accounts for the minimum amount of requirement that is needed to be invested. This parameter is the measurement of overall cash flow of the hospital that can help to decide upon the profit level. Average inventory: This can be defined as the average inventory value that can be achieved within a certain period of time. Average inventory divided by 2 can help to calculate the overall inventory sales percentage that can be calculated under the principles of JIT. Carrying cost: This parameter includes the cost of insurance and storage of per unit of bed. Total carrying cost in this case is Rs. 1000 per unit. Total cost Current JIT Purchasing cost Cost Unit Rs. 10,000 100 Rs. 100,000 100,0000 Ordering cost Cost Order Rs. 15,000/order 100 Rs. 150,000 Rs. 15,000/order 1,000 Rs. 150,0000 Opportunity cost Cost Inventory 10% Rs. 10,000/ unit 100 Rs 160,000 10% Rs. 10,000/ unit 15 Rs. 160,000 Carrying cost Cost Inventory Rs. 1000/ unit Rs.1000 Rs 100,000 Rs 1000/unit Rs 100 Rs. 1,000 Total Cost Rs. 510,000 Rs. 436,000 Hence, it can be said that the overall cost JIT and with its application, it is possible or the hospital to save Rs.74, 000 in the overall expenditure. Safety stock management is also one of the important parts of the resource allocation that has helped the Yashoda Hospital to deal and fulfill the needs of the patients. The stocks that are maintained during the time of emergency can help in dealing with the critical cases. The method of LIFO (Last in First out) is one of the effective ways that has helped the hospital management to operate with the available resources that are available. With the help of the LIFO methods, the hospital is able to clear out their older stocks of medicine and thereby ensure that there is no loss of resources encountered by the hospital. Few of the important stocks that include the equipments and medicine needed during the time of emergency service at the hospital ward. Allocation of the bed for the patient is also one of the essential tasks that are decided upon by assessing the condition of the patient during the time of admission. There are over 500 general beds and almost 100 ICCU beds. It is important for the care workers and nurses to ensure all the beds are equipped with most of the essential equipments like oxygen and saline water supply. The following gnat chart has been uses to represent all forms of activities are the part of the nursing activities: Activities Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Policy making Involvement of nurse in the formulation of the policies Strategic planning for allocation of nursing workforce Fixing of the duty hours of nurse Financing of the resources Nursing resource allocation Fixing up the medicinal resources Material requirement Planning Material requirement planning refers to the production planning,scheduling, andinventory control system. Material requirement planning can be conducted by hand however; in some cases, software system is used[14]. In short, it is the scientific technique to control the flow of the materials form their purchase to its use by patients or any other destination. It is the new concept in the health industry. It was developed during Second World War in USA[15]. This scientific technique helped to make excellent progress in productivity. This concept was introduced in India during sixties. This technique was proved to facilitate efficient patient care. Material planning in hospital is important as huge amount of money is invested on materials. Further, there is growing number of complex medical and non-medical items, lack of better availability, and maintenance of cod chains for vaccines[16]. Yashoda hospital conducts material requirement planning with the aim to ensure right quantity of supplies and of right quality at lowest possible cost. It intends to maintain a continuous supply of the hospital materials, ensure high inventory turnover, avoid wastage, and reduce the capital and recurring expenditure. A sample material planning is given below- For example the estimation of vaccines and logistics for pregnant women will include- The headcount of the pregnant women in the given ward multiplied by the total number of wards will give the total number of pregnant women. Knowing the annual target one can estimate the monthly target dividing by 12. The result can be multiplied by 2, to know the beneficiaries per month. The result can be multiplied with 1.33 and then dividing by 10 give the requirements for vaccine vial. The initial steps to identify the material requirements are- Identifying the required items- to ensure that the hospital have the essential drugs as mentioned in the WHOs guidelines. These drugs are considered indispensable for the health needs Estimation of demand- it includes estimating the future demand of a particular item. There may be a change or fluctuations in requirement. Estimating the future demand means to notice the time trend over period of two three years[17]. Purchase of required material as per the demand and procurement- Yashoda hospital has purchase policy that allows effective decision-making. Purchase procurement is the strategic activity for acquisition of materials for consumption and delivery of services. Yashoda hospital is engaged in centralised purchasing. It minimises the cost due to enabled quality control. Inspection and quality control for maintenance, repairs, and condemnation. The aim of inspection is to ensure compliance to the ISO standards of quality. The hospital purchases materials that bear such certification. It will eliminate the unethical practice of supplies. Goods are tested after the purchase and evaluated for its function. The role of the quality control inspector is to prepare a detailed material receipt note[18]. Appropriate storage of materials- The Yashoda hospital has several spacious rooms for separate storage of the medical and non-medical items. This place is free from rodents. All the drugs are arranged in alphabetical order. These drugs are then placed in the respective ward as per the patients condition and prescription. The Material requirement planning is based on the below given formulation. It is the optimal control problem. In the above given equation x refer to local inventory, (state) zthe order size- control, dis local demand, c is the variable order cots k is the fixed order costs, h is the local inventory holding costs and () is theHeaviside function[19]. Conclusion In the conclusion statement, it can be said that with the help of effective operational strategic management, it is possible for the Yashoda hospital to provide with effective healthcare service to the society. Th 3e effectiveness of the hospital groups is increased due to the fact that they are able to provide with swift service to the patient and their family. This also decreased the overall responsive time for the patient and they are able to discharge the patient in much shorter period of time. The hospital also follows a certain process protocol that helps them to ensure that the overall process of admission of the patient and their discharge can be done effectively so that the overall time of patient treatment can be reduced significantly. With the help of effective inventory planning and material requirement planning, it is possible for the hospital group to improve upon their business profit level. One of the most effective ways that the hospital applies in the inventory management is the process of Just-in-time that can help them to save money for the process of expenditure. References: "Critical Care At Yashoda Hospital."www.yashodahospitals.com. N.p., 2017. Web. 29 July 2017. 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Langabeer II, James R., and Jeffrey Helton.Health care operations management. Jones Bartlett Publishers, 2015. Motaghi, Monika, et al. "Optimization of Hospital Layout through the Application of Heuristic Technique (Diamond Algorithm) in Shafa Hospital (2009)."International Journal of Management and Business Research1.3 (2011): 133-138. Odell, Mandy. "Detection and management of the deteriorating ward patient: an evaluation of nursing practice."Journal of clinical nursing24.1-2 (2015): 173-182. Ptak, Carol, and Chad Smith.Orlicky's Material Requirements Planning 3/E. McGraw Hill Professional, 2011. Uthayakumar, R., and S. Priyan. "Pharmaceutical supply chain and inventory management strategies: optimization for a pharmaceutical company and a hospital."Operations Research for Health Care2.3 (2013): 52-64. Wagner, C., et al. "The use of on-site visits to assess compliance and implementation of quality management at hospital level."International Journal for Quality in Health Care26.suppl_1 (2014): 27-35. Wu, Ing-Long, and Pi-Jung Hsieh. "Understanding hospital innovation enabled customer-perceived quality of structure, process, and outcome care."Total Quality Management22.2 (2011): 227-241. "Yashoda Hospitals."www.yashodahospitals.com. N.p., 2017. Web. 29 July 2017. Odell, Mandy. "Detection and management of the deteriorating ward patient: an evaluation of nursing practice."Journal of clinical nursing24.1-2 (2015): 173-182 "Yashoda Hospitals."www.yashodahospitals.com. N.p., 2017. Web. 29 July 2017 Chaudhuri, Jaydip Ray, et al. "Clinical outcome of Guillain-Barr syndrome with various treatment methods and cost effectiveness: A study from tertiary care center in South India: Yashoda GBS Registry."Neurology Asia19.3 (2014). "Critical Care At Yashoda Hospital."www.yashodahospitals.com. N.p., 2017. Web. 29 July 2017. Langabeer II, James R., and Jeffrey Helton.Health care operations management. Jones Bartlett Publishers, 2015. Haux, Reinhold, et al.Strategic information management in hospitals: an introduction to hospital information systems. Springer Science Business Media, 2013. Wu, Ing-Long, and Pi-Jung Hsieh. "Understanding hospital innovation enabled customer-perceived quality of structure, process, and outcome care."Total Quality Management22.2 (2011): 227-241 Motaghi, Monika, et al. "Optimization of Hospital Layout through the Application of Heuristic Technique (Diamond Algorithm) in Shafa Hospital (2009)."International Journal of Management and Business Research1.3 (2011): 133-138. Uthayakumar, R., and S. Priyan. "Pharmaceutical supply chain and inventory management strategies: optimization for a pharmaceutical company and a hospital."Operations Research for Health Care2.3 (2013): 52-64 Heizer, Jay.Operations Management, 11/e. Pearson Education India, 2016 Rondeau, Kent V., and Terry H. Wagar. "Human resource management practices and nursing turnover." Journal of Nursing Education and Practice 6.10 (2016): 101. Baum, Richard, Dimitris Bertsimas, and Nathan Kallus. "Scheduling, revenue management, and fairness in an academic-hospital radiology division."Academic radiology21.10 (2014): 1322-1330. Heizer, Jay.Operations Management, 11/e. Pearson Education India, 2016. Kerzner, Harold.Project management: a systems approach to planning, scheduling, and controlling. John Wiley Sons, 2013. Langabeer II, James R., and Jeffrey Helton.Health care operations management. Jones Bartlett Publishers, 2015. Odell, Mandy. "Detection and management of the deteriorating ward patient: an evaluation of nursing practice."Journal of clinical nursing24.1-2 (2015): 173-182. Wagner, C., et al. "The use of on-site visits to assess compliance and implementation of quality management at hospital level."International Journal fo Quality in Health Care26.suppl_1 (2014): 27-35. Ptak, Carol, and Chad Smith.Orlicky's Material Requirements Planning 3/E. McGraw Hill Professional, 2011.