1. INTRODUCTION TO
HOSPITAL MANAGEMENT

2.  Material & Equipment Management
 Blood Transfusion Services
 Laboratory Services
 NABH Accreditation
 Legal Framework
 Radiology Services

3. Story # 1
It's a fine sunny day in the forest and a lion is
sitting outside his cave, lying lazily in the sun.
Along comes a fox, out on a walk.
Fox: "Do you know the time, because my watch is
broken"
Lion: "Oh, I can easily fix the watch for you"
Fox: "Hmm... But it's a very complicated
mechanism, and your big claws will only destroy it
even more“

4. Lion: "Oh no, give it to me, and it will be fixed"
Fox: "That's ridiculous! Any fool knows that lazy
lions with great claws cannot fix complicated
watches"
Lion: "Sure they do, give it to me and it will be
fixed"

5. The lion disappears into his cave, and after
a while he comes back with the watch
which is running perfectly. The fox is
impressed, and the lion continues to lie
lazily in the sun, looking very pleased with
himself.

6. Soon a wolf comes along and stops to watch the
lazy lion in the sun.
Wolf: "Can I come and watch TV tonight with
you, because mine is broken"
Lion: "Oh, I can easily fix your TV for you"
Wolf: "You don't expect me to believe such
rubbish, do you? There is no way that a lazy lion
with big claws can fix a complicated TV“
Lion: "No problem. Do you want to try it?"

7. The lion goes into his cave, and after a
while comes back with a perfectly fixed
TV. The wolf goes away happily and
amazed.

8. : Scene :
Inside the lion's cave. In one corner are
half a dozen small and intelligent looking
rabbits who are busily doing very
complicated work with very detailed
instruments. In the other corner lies a huge
lion looking very pleased with himself.

9. : Moral :
IF YOU WANT TO KNOW WHY A
MANAGER IS FAMOUS; LOOK AT THE
WORK OF HIS SUBORDINATES.

10. Management Lesson
In the context of the working world :
IF YOU WANT TO KNOW WHY
SOMEONE UNDESERVED IS
PROMOTED; LOOK AT THE WORK
OF HIS SUBORDINATES.

11. Story # 2
It's a fine sunny day in the forest and a rabbit is
sitting outside his burrow, tippy-tapping on his
typewriter. Along comes a fox, out for a walk.
Fox: "What are you working on?"
Rabbit: "My thesis."
Fox: "Hmm... What is it about?"
Rabbit: "Oh, I'm writing about how rabbits eat
foxes."
Fox: "That's ridiculous ! Any fool knows that
rabbits don't eat foxes!"

12. Rabbit: "Come with me and I'll show
you!"
They both disappear into the rabbit's
burrow. After few minutes, gnawing on a
fox bone, the rabbit returns to his
typewriter and resumes typing.
Soon a wolf comes along and stops to
watch the hardworking rabbit.

13. Wolf: "What's that you are writing?"
Rabbit: "I'm doing a thesis on how rabbits eat
wolves."
Wolf: "you don't expect to get such rubbish
published, do you?"
Rabbit: "No problem. Do you want to see why?"
The rabbit and the wolf go into the burrow and
again the rabbit returns by himself, after a few
minutes, and goes back to typing.

14. Finally a bear comes along and asks, "What are
you doing?
Rabbit: "I'm doing a thesis on how rabbits eat
bears."
Bear: "Well that's absurd ! "
Rabbit: "Come into my home and I'll show you"

15. : Scene :
As they enter the burrow, the rabbit
introduces the bear to the lion.

16. :Moral:
IT DOESN'T MATTER HOW SILLY
YOUR THESIS TOPIC IS; WHAT
MATTERS IS WHOM YOU HAVE
AS A SUPERVISOR.

17. Management Lesson
In the context of the working world:
IT DOESN'T MATTER HOW BAD
YOUR PERFORMANCE IS; WHAT
MATTERS IS WHETHER YOUR BOSS
LIKES YOU OR NOT.

18. MATERIAL MANAGEMENT

19. DEFINITION
EQUIPMENT, APPARATUS
AND SUPPLIES PROCURED,
STOCKED AND UTILISED BY
AN ORGANISATION

20. TYPES OF STORES
BROAD CATEGORIES
CONSUMABLES NON CONSUMABLES

21. TYPES OF MEDICAL STORES
 EXPENDABLE STORES
 DRUGS
 DISPOSABLES
 LAB REAGENTS
 X RAY FILMS
 MEDICAL GASES
 IV FLUIDS
 NON EXPENDABLE STORES
 EQUIPMENT & SPARES

22. LIFE CYCLE CONCEPT
SHORT LIFE LONG LIFE

23. PRESERVATION REQUIREMENT
STORE REQUIRING UPTO
2-100 C TEMP
STORE REQUIRING ABOVE
100 C BUT LESS THAN 30
STORE REQUIRING LOW
TEMP AND NO HUMIDITY
NO RESTRICTION OF TEMP

24. CATEGORISATION OF DRUG ITEMS
 Tablets
 Capsules
 Injections
 Liquids (Syrups)
 Ointments
 Drops
 Powder
 Fluids

25. FUNCTIONS OF STORES
MANAGEMENT
 MATERIAL PLANNING & PROGRAMMING
 NEED ASSESSMENT
 FORCASTING THE LEVEL OF
INVENTORIES
 SCHEDULING ORDERS
 BUDGETING
 AVAILABILITY OF FUNDS
 PLANNING AS PER CASH FLOW
 CAPITAL/REVENUE BUDGET
 PURCHASING
 RECEIPT & INSPECTION

26. FUNCTIONS OF STORES
MANAGEMENT
 STOCKING & DISTRIBUTION
 INVENTORY CONTROL
 COST REDUCTION
 VALUE ANALYSIS
 DISPOSAL

27. INDENTING OF STORES
 PERIODICITY
 DAILY
 WEEKLY
 MONTHLY
 ANNUAL
 SUPPLEMENTARY INDENT
 EMERGENT INDENT

28. TYPES OF PURCHASES
 Rate Contract
 Running Contract
 Stockless Purchasing (Just in Time)
 Repeat order

29. INVENTORY CONTROL

30. INVENTORY CONTROL
 INVENTORY
“THE QUANTITY OF GOODS OR
MATERIALS ON HAND” (WEBSTER)
“IDLE RESOURCE OF ANY KIND
PROVIDED THAT SUCH A
RESOURCE HAS AN ECONOMIC
VALUE” (FRED- HANSSMAN)

31. IMPORTANT TERMINOLOGIES
USED IN INVENTORY CONTROL
 LEAD TIME
 BUFFER STOCK (SAFETY –
STOCK OR RESERVE STOCK)
 REORDER LEVEL
 ECONOMIC ORDER
QUANTITY
 INVENTORY CONTROL
COSTS

32. INVENTORY CONTROL TECHNIQUES
 ABC Based on annual usage value
 VED Vital, Essential & Desirable
or
 VEN Vital, Essential & Non-Essential
 SDE Scarce, Difficult & Easily available
or
 SAP - Scarce, Available & Plenty

33. INVENTORY CONTROL TECHNIQUES
 FSN Fast, Slow & Non- moving
 HML High, Low & Medium cost
 XYZ Value of Items in Store
 GOLF Source of Supply
 SOS Nature of Supply
 MUSIC-3 D Multi Unit Selective Inventory
Control
 MBASIC- Multiple basic selective
inventory control

34. ABC Analysis
(Based on Usage Value)
Equal attention to all items - expensive.
Basic analysis to identify & prioritise areas of attention
Based on Pareto Analysis - Vilfredo Pareto
10 % item accounts for 70% of value -’A’
20 % item accounts for 20% of value -’B’
70 % item accounts for 10 % of value -’C’

35. Vital
V E D Analysis Essential
Desirable
Scarce
S D E Analysis
AP Available
Difficult
Easily
Plenty
Scarce items -Not easily available
-Requires source development
-Long lead time
-Difficult to manufacture
-Few manufacturers

36. BLOOD
TRANSFUSION
SERVICES

37. BLOOD BANK
 Blood bank means, a centre within
an organisation or an institution for
 Collection,
 Grouping,
 Cross-matching,
 Storage,
 Processing &
 Distribution of Whole human blood or
Human blood products from selected
human donors.

38. CATEGORIES OF BLOOD BANK
 Category-I
 3-7 units of blood/bed/year
 100-400 bedded hospital
 <5000 units collected
 Category-II
 -8-15 units of blood/bed/year
 400-1000 bedded hospital
 5001-20,000 units collected
 Category-III
 >16 units of blood/bed/year
 >1000 bedded hospital
 >20,000 units collected

39. DRUGS & COSMETIC ACT 1945
 Part X B, amended in 1999.
“Requirements for collection, storage,
processing & distribution of whole
human blood, human blood
components by blood banks &
manufacture of blood products”.

40. DEFINITIONS
 Apheresis
 Autologous Blood
 Blood components
 Blood products
 Donor
 Professional donor
 Replacement donor

41.  Apheresis-process by which blood drawn from
a donor, after separating plasma or platelets or
leucocytes, is retransfused simultaneously into
the said donor.
 Autologous blood- the blood drawn from the
patient for re-transfusion into himself later on.
 Blood components-means a drug prepared,
obtained, derived or separated from a unit of
blood drawn from donor.

42.  Blood products- means a drug
manufactured or obtained from pooled
plasma of blood by fractionation, drawn from
donors.
 Donors-A person who voluntarily donates
blood after he has been declared fit after a
medical examination, for donating blood, on
fulfilling the criteria, without accepting in
return any consideration.

43.  Professional donor-A person who
donates blood for a valuable
consideration, in cash or kind, for any
source, on behalf of the recipient
patient and includes a paid donor or a
commercial donor.
 Replacement donor- A donor who is
a family friend or a relative of the
patient recipient.

44. PREMISES OF BLOOD BANK
The premises of Blood bank consists of the following
different segregated sections:
 Donor Recruitment Area
 Bleeding Complex
 Medical Officer’s Room
 Laboratories
 Issuing Counter
 Teaching Facilities
 Refreshment Area
 Stores
 Sterilization and Washing room

45. PHLEBOTOMY
 Bleeding should be smooth and painless
 Strict aseptic procedure to be followed and all
disposables used.
 Venipuncture site should be free of skin lesions
 Donor bag, sample tube, and donor record should
be properly identified and labeled before drawing
blood.
 Each bag should be examined for defects and
anticoagulants
 Thorough mixing is essential.

46. TESTS ON DONORS BLOOD
 ABO and Rh typing for confirmation
of donor’s blood group and antibody
screening.
 Every donor’s blood must be tested
for:
 HIV I and II
 Hepatitis B & C
 VDRL
 Malaria

47. STANDARD COLOR LABELS
Group Color of label
O
A
B
AB

48. Flow of Donor
Donor Registration and Examination Room
Interview, Rh , Blood group, Weight , Hb of the patient
If suitable If unsuitable Reject Donor
Phlebotomy done & collection of pilot tubes for processing
Refreshment Room & observation Sent home

49. LABORATORY SERVICES

50. ROLE AND FUNCTION OF LAB
 Attend to ailing patients
 Carry out investigations asked
 Prompt issue of accurate result
 Provide diagnostic information to
physician for further management

51. FUNCTIONAL COMPONENTS OF
LABORATORY
 HISTOPATHOLOGY
 Organ, tissue, cell examination
 CLINICAL PATHOLOGY
 Examination of body fluids-blood, urine,
sputum, stool, pleural & peritoneal fluids
 MICROBIOLOGY
 Examination of bacteria, viruses, parasites etc.
 HAEMATOLOGY
 Examination of blood and blood components
 BIOCHEMISTRY (CHEMICAL PATH.)
 Examination of chemical substances e.g. hormones,
enzymes, etc.
 CLINICAL RESEARCH LABORATORIES

52. TYPES OF LABORATORY
 OPD SERVICES
 WARD SERVICES
 EMERGENCY SERVICES
Round the clock services
Restricted Emergency
Services

53. NABL
NATIONAL ACCREDITATION
BOARD FOR TESTING AND
CALIBERATION LABORATORIES

54. ACCREDITATION
 Laboratory accreditation is a
procedure by which an authoritative
body gives formal recognition of
technical competence of testing and
or calibration for a laboratory to
carry out specific tests. This is
based on third party assessment
against set standards.

55. NABL
 NABL accreditation is a formal
recognition of the technical
competence of a testing or
calibration laboratory for a specific
task following ISO/IEC 17025
Standard.
 Medical lab ISO 15189:2003
 This is based on third party
assessment.

56.  National Accreditation Board for
Testing and Calibration Laboratories
(NABL) is an autonomous body under
the aegis of Department of Science &
Technology, Government of India, and
is registered under the Societies Act.
 NABL website is updated continuously
with respect to status of accredited
laboratories and their scope of
accreditation.

57. TYPES OF LABORATORIES
 Small lab. 100 patients/day
 Medium lab. 100-400 pts./day
 Large lab. >400 pts./day

58. Scope of Accreditation
 Clinical Biochemistry
 Clinical Pathology
 Haematology and Immunohaematology
 Microbiology and Serology
 Histopathology
 Cytopathology
 Genetics
 Nuclear Medicine (in-vitro tests only)

59. NABH
ACCREDITATION

60. National Accreditation Board for
Hospitals & Healthcare Providers (NABH)
is a constituent board of Quality Council
of India, set up to establish and operate
accreditation programme for healthcare
organizations.
The board while being supported by all
stakeholders including industry,
consumers, government, have full
functional autonomy in its operation.

61. DEFINITION OF ACCREDITATION
A public recognition of the achievement
of accreditation standards by a
healthcare organization, demonstrated
through an independent external peer
assessment of that organization's level of
performance in relation to the standards.

62.  The standards for hospitals have been
drafted by the Technical Committee of
NABH and contain complete set of
standards for evaluation of hospitals for
grant of accreditation.
 The organization is evaluated against
100 standards and 512 objective
elements contained in 10 chapters.

63. Particulars Standards OE
1 Access, assessment & continuity 15 78
of care (AAC)
2 Patients Rights & Education 05 30
(PRE)
3 Care of Patients (COP) 18 104
4 Management of Medication 13 61
(MOM)
5 Hospital Infection Control (HIC) 09 46
6 Continuous Quality 06 39
Improvement (CQI)
7 Responsibility of Management 05 25
(ROM)
8 Facility Management & Safety 09 43
(FMS)
9 Human Resource Management 13 47
(HRM)
10 Information Management 07 41
System (IMS)

64. PREPARING FOR ACCREDITATION
Step 1 Obtain a copy of NABH standards
Step 2 Carry out self assessment on the
status of compliance with the NABH
standards
Step 3 Ensure that NABH standards are
implemented and integrated with the
hospital functioning
Step 4 Obtain a copy of application form
Step 5 Fill & submit the application form in
NABH office
Step 6 Pay the accreditation fee.

65. ACCREDITATION PROCESS
Step 1 Application for accreditation
( submitted by the Healthcare Organisation)
Step 2 Acknowledgement for accreditation
(by NABH secretariat)
Step 3 Pre assessment visit ( by Assessor )
Step 4 Final assessment of hospitals
(by Assessment Team)
Step 5 Scrutiny of the assessment report
(by NABH secretariat)
Step 6 Recommendation for accreditation
(by Accreditation Committee)
Step 7 Approval for accreditation
(by Chairman NABH)
Step 8 Issue of accreditation certificate
(by NABH secretariat)

66. Application fee Annual
Accreditation
fee
Upto 100 beds Rs. 25,000/- Rs. 1,00,000/-
101-300 beds Rs. 50,000/- Rs. 1,50,000/-
>300 beds Rs. 50,000/- Rs. 2,10,000/-

67. LEGAL ASPECTS OF HEALTHCARE
AN OVERVIEW

68. Statutory Obligations
 There are about 85 licenses and
statutory obligations which are
applicable to hospitals, but all of
them might not be applicable to all
hospitals.

69.  Building Permit
 NOC from Chief Fire Officer
 Bio-medical Waste Management
 Radiation protection Certificate in respect of
all X-rays & CT Scanners from BARC
 Narcotics & Psychotropic substance Act
 Consumer Protection Act
 Dentist Regulations
 Drugs & Cosmetics Act
 Employees Provident Fund Act
 ESI Act

70.  Code of Medical Ethics
 Indian Nursing Council Act
 MTP Act
 Minimum Wages Act
 National Building Code
 Payment of Gratuity Act
 Pharmacy Act
 PNDT Act
 Registration of Births & Deaths Act
 License for Blood Bank
 Transplantation of Human Organs Act

71. Radiology Services

72. RADIOLOGY SERVICES
 TYPES
 X-RAYS
 ULTRASOUND & COLOUR DOPPLER
 COMPUTER ASSISTED TOMOGRAPHY
 MAGNETIC RESONANCE IMAGING
 POSITRON EMISSION TOMOGRAPHY
 MAMMOGRAPHY
 NUCLEAR IMAGING

73. CAT SCAN

74. MRI MACHINE

75. ULTRA SOUND IMAGE

76. RADIATION HAZARDS
 BIOLOGICAL EFFECTS OF
RADIATION HAZARDS
 TYPES OF CELLS OF BODY/ DOSE
 SOURCE OF RADIATION
 ACUTE RADIATION EFFECTS
 CHRONIC RADIATION EFFECTS

77. RADIATION PROTECTION
 WALL THICKNESS ONE MM OF LEAD
EQUIVALENT
 8-12 CM CONCRETE/ 12-15 CM
BRICK
 WITHIN X-RAY ROOM TWO HIGH
RISK AREAS
 WALL BEHIND CHEST STAND
 WALL OF DARK ROOM

78. RADIATION SAFETY MONITORING
 CONTINUOUS MONITORING
 RADIATION DOSIMETERS
 RADIATION PROOF APRON
 PROTECTIVE GLOVES

79. APPLICATIONS OF NUCLEAR
MEDICINE
 IMAGING OF VARIOUS ORGANS
 THYROID FUNCTION STUDIES
 CENTRAL NERVOUS SYSTEM
 ABSORPTION STUDIES IN G I
TRACT
 NUCLEAR HAEMATOLOGY
 RENAL FUNCTION STUDIES
 NUCLEAR CARDIOLOGY- STRESS
THALLIUM

80. ?