Rockland Hospitals aim for excellence in operations through quality management. They seek to comply with quality standards, continually improve health and safety, and enhance staff competence. Their vision is to deliver high quality medical services through a team of caring professionals. They measure quality using the five dimensions of service quality: reliability, responsiveness, assurance, empathy, and tangibles. For each dimension, they have identified specific quality standards and targets across different stages of inpatient and outpatient care. This includes standards for patient registration, diagnostics, surgery, post-care, billing, and more. The goal is to achieve excellence by meeting these quality measures.

1. 1
Excellence in Operations
Topic: Excellence in Hospital Operations: A Quality perspective: For increasing the
profitability in Tertiary Care Hospital.
Presented To: Prof Dr B A Metri.
By: Group: 4
Group Members: Bidyut Kumar Mana 15XPGDM09
Mauricio Venegas 15XPGDM19
Rahul S Deshpande 15XPGDM25
Rajesh Kumar 15XPGDM26
Shivang Mandloi 15XPGDM31
Tapas Kesarwani 15XPGDM42

2. 2
Sr.No Topic Page. No
1 Introduction & Management Summary 3
2 Attaining Excellence through Quality in Healthcare Delivery
(Quality Accreditation).
4
3 Excellence in Operations through Quality Management at
Rockland Hospitals.
4-10
4 Quality Measures Utilized at Rockland Hospitals. 12
5 Highlights of NABH (National Accreditation Board for
Hospitals) Standards Contributing to Quality Measures.
13
6 Highlights of NABL Accreditation (National Accreditation Board
for Testing and Calibration) Standards Contributing to Quality
Measures.
13-16
7 Excellence through Quality various operations wise perspective. 16-30
8 Conclusion. 31

3. 3
Introduction & Management Summary:
Our project report concerns with the excellence in healthcare- hospital industry. This industry is
the corner stone of every nation’s progress and an extremely prime indicator of its developmental
status. Then excellence in healthcare or hospital is attained by achieving desired quality standards
specified by the hospital (Rockland Hospitals). The cost of quality in the service industry is the a
prime factor because availing the services of the hospital is very high involvement decision which
requires due diligence, evaluations and exhaustion all the options before moving onto the last
option of resorting to the hospitals services. There are different perspective in which excellence
in hospitals is to evaluate right from the human resources, equipment, treatment given, infections
control, responsiveness towards medical emergency, operations costs and availability of the
services at any given point of day and year. A multipronged approach that puts physicians—and
clinical care—at the heart of performance transformation efforts can help hospitals and health
systems deliver more financially sustainable, patient-oriented, and physician-friendly care. As a
result, many hospitals (and the health systems they are often part of) have undertaken operational
improvement programs, such as lean transformations, Six Sigma projects, and rapid improvement
events. Although some of these programs have helped the hospitals reduce costs, few have
achieved substantial or long-term impact— in large part because most of them focused on
nonclinical operations and did not seek the active involvement of physicians. Yet clinical care
accounts for a significant portion of operational expenditures at most hospitals. Without significant
changes to how clinical care is delivered, hospitals will not be able to achieve the 5- to 10-percent
reduction in operational costs that most experts believe is needed to cope with today’s economic
challenges. Involving physicians in operational performance improvement efforts is therefore
crucial. A provider that wants to lower its operational costs by 5 to 10 percent would have to reduce
its nonclinical variable costs by an average of about 30 percent if it left clinical operations off the
table. This level of savings is unrealistic for most hospitals. The current study reinforces the
observation that increasing cost pressures force hospitals to implement structural changes. The
results of this study, however, also highlight that better cost management will not be sufficient and
that there is a need to prepare for the intensifying competition for patients, qualified personnel and
partners. A strategic turnaround needs to be based on a financially and operationally sound and
sustainable situation. This is not a given for many hospitals, which requires them to address basic
issues in parallel to developing a strategic transformation program. While many hospitals have
already undertaken important cost reduction efforts in recent years, there still remains substantial
potential for further improvement. However, this requires structural changes in order to prevent
lower quality levels and/or an unacceptably high workload for staff. Thus our study focuses on
the cost reduction and at the same time involving and the actual clinical care to with the support
cost reduction approach. The various factors were studied involved in the hospital operations.
These involved the non-clinical and clinical aspects of the healthcare delivery systems ranging
from patient handling to infection control, medical & surgical procedures, waste management, in-
house pharmacy and finally discharge.

4. 4
Attaining Excellence through Quality in Healthcare Delivery (Quality
Accreditation):
In healthcare excellence is achieved through achieving the quality goals of the hospitals as
discussed earlier. It through excellence the hospital will increase its revenue and realize the
revenue stream for itself, the excellence in-turns depends on the quality of the service provided;
thus we can righteously say that the revenue generated by the hospital is directly dependent on the
quality of services it provides to the patient community.
To assess the service offered by the hospital various boards and agencies have been developed for
the service quality benchmarking among various hospitals. Among the various agency or bodies
the two main bodies which govern the quality of the service provided are the National
Accreditation Board of Hospitals (NABH) and the National Accreditation Board for Testing and
Calibration Laboratories (NABL).
National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board
of Quality Council of India, set up to establish and operate accreditation program for healthcare
organizations. The board is structured to cater to much desired needs of the consumers and to set
benchmarks for progress of health industry.
The National Accreditation Board for Testing and Calibration Laboratories (NABL) undertakes
the assessment and accreditation of Testing and Calibration Laboratories, in accordance with the
international standard ISO / IEC 17025 and ISO 15189.

5. 5
Excellence inOperations through Quality ManagementatRocklandHospitals:
Vision:
"To use multi-disciplinary approach with ethical practices by a team of highly responsive, caring
and efficient professionals with a constant focus on excellence in delivering medical services in
patient care, continuing medical education, scientific knowledge and deliver a benchmarked
quality medical care” is the vision statement of the Rockland Group of Hospitals.
To achieve this vision Rockland Hospitals have developed some quality objectives such as
follows:-
-To constantly comply with all applicable statutory and regulatory requirements.
-To steadily adhere to operational protocols of the institute and enhance patient
satisfaction.
-To continually improve health and safety of the patients, visitors and staff
members.
-To promote on the job training and enhance competence of the staff.
-To constantly enhance infrastructure utilization.
Introduction:
Rockland group of hospitals provides international standard, seamless & integrated
healthcare services across all the units of group. Highly qualified and trained doctors,
nurses, adjunct staff and best-in-class professional expertise ensure that Patient avail the
latest in medicine & surgery. Rockland hospitals network is designed to serve the entire
gamut of medical needs through a network of specialized healthcare facilities across Delhi,
Dwarka and Manesar. Rockland Hospitals provide a broad range of in-patient and
outpatient health care services to match the needs of both domestic and overseas patient.
In- Patient Services include medical, surgical and rehabilitation services. Out-patient
services include emergency services, day procedures, diagnostic and assessment services,
and therapy services.

6. 6
It has played a pioneering role in defining quality standards for the Indian Health Care Industry
by bringing the thought leaders of the industry on one platform to set the standards for Quality,
Technology and Management of Health Care in India. Rockland played an important role in
drafting the NABH standards for ensuring certification of quality standards in India. NABH
Certification pilot project was carried out in Rockland in 2005. A dedicated team of doctors
contributed to setting quality standards for the Indian Health Care industry and today NABH
certification is recognized by various organizations as a basis for pricing and accreditation.
Rockland has set the trends of using appropriate technology and management practices suited to
Indian conditions to ensure that the cost of health care does not go as high as it is in the developed
countries. Rockland Hospital has set the trend for environmentally friendly buildings
matching international standards in India
In 1988, Parshuraman, Valarie Zeithmal, and Leonard Berry had defined the five dimensions that
apply across service quality standards through research. Their research has identified the five
service dimensions of service quality that apply across a variety of service context. We have
identified the quality in hospital operation in all dimensions. The Rockland hospital service divided
in Outpatient and Inpatient category. The services in Rockland hospital category are divided in
two parts (outpatient department and In-Patient dept.). All the service quality in each category is
measured in all five service dimensions which are as follows:-
1) Reliability: - It is ability to perform the promised service dependably and accurately.
Rockland hospital outpatient dept. service consists easy and fast response to the patient and
guide them to process of treatment access, Depth of knowledge and comprehension of the
patient’s condition by the responsible Medical staff and Ability to clearly explain and
communicate the right information with the patient by the OPD Medical Staff. The hospital
Inpatient service quality in this dimension consists with
 When patient visits the hospital the first encounter registration/ Inquiry Desk it provides
easy and friendly conversation availability at the counter 24 x7 hours&365 days
 During Diagnostics/ Doctors consultation it provides trustworthy genuine opinion
provider though sound medical knowledge of medical staffs and doctors

7. 7
 During Operation Theatre and Surgical Procedure, It provides highly experienced team of
operating surgeons, Reliable paramedics and medical staff with strong experience in
patient handling and sound knowledge in medicine
 In post patient care issue, It provides Trustworthy and no fraudulent bills submissions,
 In billing and Discharge service it provides Trustworthy and no fraudulent bills
submissions , and also True billing generation and reliability of the treatment administered
Responsiveness: - This dimension of service represents the willingness to help customers and
provide prompt service. Rockland hospital outpatient service category provides willingness and
preparedness to render service to the patient, Front office staff is cooperative, helpful and guide
them responsible way as soon as possible and also Medical and non-medical staff are approachable
to the patient’s personal problems. The hospital in-patient service in this dimension provide many
services. Some of them are:-
 When patient visits the hospital the First Encounter Registration/ Inquiry Desk that the
Patient receives the attention of medical staff at the earliest/ immediately
 During Diagnostics/ Doctors consultation it provides immediate response towards patient's
problem.
 During Operation Theatre and Surgical Procedure, It provides efficient team of surgeons
able to handle all kinds of medical emergencies
 In post patient care issue, it provides immediate resolution of any situations, conditions,
emergency, queries or issues.
 In billing and Discharge service it provides Responsiveness towards patient's TPA
provider and future queries and also responsiveness towards patients discharge vitals and
discharge procedural demands.
3) Assurance: - This dimension of service providing employees knowledge and courtesy and
their ability to inspire trust and confidence. In outpatient service category, this hospital
provides services in Caring every individual patient give right information which are
included of Patient Registration, Doctor Information, Monetary & Time information by all

8. 8
receptionist and also Patients & relatives feel relaxed and assured while services are being
provided.
Hospital Service Standards for In Patient Department in this dimension are as follows:-
 When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the
service perception which Instil confidence in patient that doctors are available and will
shortly attend them or assurance of specialist in case of an emergency
 During Diagnostics/ Doctors consultation service perception Instil confidence in patient
and understand his/her main problem.
 During Operation Theatre and Surgical Procedure, It provides assurance of the nurses and
medical support staff while the surgeon is under process
 In post patient care issue, It’s service Instil confidence in patient after undergoing medical
procedure and assurance of the success of the treatment and speedy recovery
 In billing and Discharge service it provides Assurance of best possible rates and discounts
given to the patient and the assurance of trust and honest hospital billing generation system
And Assurance in best possible treatment has been offered and performed and the patient
can lead a normal healthy life while following the routine advised by the doctors. And the
most important one to assure the patient if any problem they are here to address their any
difficulties whether medical or otherwise
4) Empathy: - This dimension of service represents caring, individualized attention to
customers. In outpatient service category in this dimension Rockland provides following
services:-
- Sincere compassion shown by sympathizing with the needs of the patients and patient
relatives.
- Provision of individualized care by being sensitive and flexible to the patient’s needs.
- Doctors and medical staff treat patients with love and affection.
Hospital Service Standards for In Patient Department in this dimension are as follows:-
 When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the
service in Caring attitude towards patient's concerns and soft caring tone of conversation
 During Diagnostics/ Doctors consultation service it empathize highly patient centered
service attitude.
 During Operation Theatre and Surgical Procedure, It provides Patient centered and
concerned team of operating doctors and anesthesiologist.

9. 9
 In post patient care issue, it provides Empathetic attitude and behavior towards the patient
concern and his/her relatives.
 In billing and Discharge service it provides empathetic attitude towards the patient for
incurring expense towards the medical treatment and at the same time instilling positivity
in him/her. And also it provides Caring, empathetic and friendly attitude towards the patient
and wishing him all the best in life.
5) Tangibles: - This dimension of service represents appearance of physical facilities,
equipment, Personnel and Communication material. In outpatient service category, this
hospital provides services like
- Cleanliness of hospital surroundings.
- Comfort brought about by the hospital environment with adequate utility to the
patient in waiting area.
- Functionality of hospital equipment and medical instruments.
- Application of Modernized hospital equipment and medical devices.
Hospital Service Standards for In Patient Department in this dimension are as follows:-
 When patient visits the hospital the First Encounter at Registration/ Inquiry Desk that the
tangible service provide Comfortable waiting room/ availability of patient gurney in case
of emergency.
 During Diagnostics/ Doctors consultation service this dimension of service represents
Proper prescription for the disease at hand/ Life-saving drugs at stand-by. Availability of
the life support systems and radiology.
 During Operation Theatre and Surgical Procedure, It provides tangible services in
Maintenance of Highly sterile environment and strict disinfection protocol adherence, all
the necessary life-saving at hand and well maintained and calibrated equipment
 In post patient care issue, it provides tangible services in Proper medication and at proper
time, healthy food and extremely efficient housekeeping services.
In billing and Discharge service it provides tangible services in proper documents of the bills,
details of the treatment given and reports and CDs for future reference and also in proper
documents of the bills, details of the treatment given and reports and CDs for future reference.

10. 10
S.No Encounter RATER Service Standard
Target /
Goal
Reliability Easy and friendly conversation availabilkity at the counter 24/7/365 95%
Assurance
Instil confidence in patient that doctors is available and will shortly attend
them/ assurance of spcecialist in case of an emergency
95%
1Patient visits the hospital First Encounter Registration/ Inquiry DeskTangible Comfortable waiting room/ availability of patient gurney incase of emergency. 100%
Empathy
Caring attitude towards patient's concerns and soft caring tone of
conversation.
95%
Responsiveness Patient receives the attention of medical staff at the earliest/ immediately 100%
Responsiveness Immediate response towards patient's problem. 100%
Reliability Trustworthy genuine opinion provider. Sound medical knowledge 100%
2 Diagnostics/ Doctors consultation. Assurance Instil confidence in patient and understand his/her main problem 100%
Tangible
Proper prescripation for the disease at hand/ Life saving drugs at stand-by.
Availability of the life support systems and radiology.
100%
Empathy Highly patient centred attitude. 100%
Tangible
Maintenance of Highly sterile environment and strict disinfection protocol
adherence, all the necessary life saving at hand and well maintained and
calibarated equipments
100%
Empathy Patient centred and concerned team of operating doctors and anesthesiologist 100%
3 Operation Theatre and Surgical Procedure Reliability Highly expereinced team of operating surgeons. 100%
Responsiveness Efficient team of surgeons able to handle all kinds of medical emergencies 100%
Assurance
Assurance of the nurses and medical support staff while the surgeon is under
process.
100%
Reliability
Reliable paramedics and medical staff with strong experience in patient
handling and sound knowledge in medicine.
100%
Assurance
Instill confidence in patient after undergoing medical procedure and
assurance of the success of the treatment and speedy recovery.
100%
4 Post Patient Care Tangible
Proper medication and at proper time, healthy food and extremely effcient
housekeeping services.
100%
Empathy
Empathetic attitude and behavior towards the pateint concern and his/her
relatives.
100%
Responsiveness
Immediate resolution of any situations, conditions, emergency, queries or
issues
100%
Reliability Trustworthy and no fraudulent bills submissions. 100%
Assurance
Assurance best possible rates and discounts given to the patient and the
assurance of trust and honest hospital billing generation system.
100%
5 Billing/Payment Tangible
Proper documents of the bills, details of the treatment given and reports and
CDs for fututre reference.
95%
Empathy
Empathetic attitude towards the patient for incurring expense towards the
medical treatment and at the same time instiling positivity in him/her.
90%
Responsiveness Reponsiveness towards patient's TPA provider and future queries 100%
Responsiveness
Reponsiveness towards patients discharge vitals and discharge procedural
demands.
100%
Tangible
Handing out thourough and detailed documentations of the treatments,
billings and payments and follow up schedules.
100%
Discharge Reliable True billing generation and reliabiity of the treatment administered 100%
Empathetic
Caring, empathetic and friendly attitude towards the patient and wishing him
all the best in life.
100%
Assurance
Assurance best possible treatment has been offered and performed and the
patient can lead a normal healthy life while following the routine advised by
the doctors. And the most important one to assure the patient if any problem
they are here to address their any difficulties whether medical or otherwise.
100%
Rockland Hospital Service Standards for In Patient Department starting with OPD registration

11. 11
Rockland Hospital Service Standards for OPD registration
Encounter RATER Service Standard Target
/ Goal
Reliability  Easy and fastresponse tothe patientandguide themtoprocessof
treatmentaccess.Depthof knowledge andcomprehensionof the
patient’sconditionbythe responsibleMedical staff.
 Abilitytoclearlyexplainandcommunicatethe rightinformation
withthe patientbythe OPD Medical Staff.
95%
Assurance  All receptionistinOPDhelptocare everyindividual patientgive
rightinformationwhichare includedof PatientRegistration,Doctor
Information,Monetary&Time information.
 Patients&relativesfeel relaxedandassuredwhile servicesare
beingprovided.
95%
OPD Service Standard
Measurement
Tangible  Cleanlinessof hospital surroundings.
 Comfortbroughtaboutby the hospital environmentwithadequate
utilitytothe patientinwaitingarea.
 Functionalityof hospital equipmentandmedical instruments.
 Applicationof Modernizedhospital equipmentandmedical devices.
95%
Empathy  Sincere compassionshownbysympathizingwiththe needsof the
patientsandpatientrelatives.
 Provisionof individualizedcare bybeingsensitive andflexible tothe
patient’sneeds.
 Doctors and medical staff treatpatientswithloveandaffection.
90%
Responsiveness  Willingnessandpreparednesstorenderservice tothe patient.
 Front office staff iscooperative,helpful andguide themresponsible
wayas soonas possible.
 Medical and non-medical staff are approachable tothe patient’s
personal problems.
100%
What do the quality measures inform us?
-Whether or not hospitals / providers are providing care in a timely manner
-Whether or not the care provided is safe and effective
-Whether or not health care delivery is patient centred
-The experience, knowledge and success rate of treating particular diseases / conditions

12. 12
-Data and information regarding our quality and outcomes.
Quality Measures Utilized at Rockland Hospitals:
In the year 2010, Rockland received NABH accreditation and registered as NABH accredited
hospital on June 12 2010. After the rigorous hard work and continuous efforts for the last few
years, Rockland finally established the highest standards of quality and fulfilled all the
requirements of NABH. All departments put in their efforts to maintain the quality standards as
per the norms of ISO and NABH. The first Surveillance Audit of ISO 9001: 2008 was also carried
out successfully in February 2010.
The hospital management closely monitors the quality of the care and services provided at the
hospital. Most importantly, the hospital maintains a very close relationship with their patients.
They listen to what their patients and families have to say. The information and feedback they
gather is used to develop lasting, positive change in the way the hospital delivers care. The tools
they use to check and measure performance include:
 Phone and mail-in surveys regularly conducted with patients and families
 Clinical outcomes (how patients are doing following care / treatment)
The hospital's goal is to provide patients and families with meaningful information to make
informed decisions about their healthcare and to make data available on the quality of the services
they provide in the annual report. To maintain quality and measure the quality, the hospital
complies with the standards set for hospitals and healthcare providers by NABH & international
standards ISO 9001:2008.

13. 13
Highlights of NABH (National Accreditation Board for Hospitals) Standards
Contributing to Quality Measures:
Rockland Hospital Qutub has earned the prestigious accreditation from National Accreditation
Board for Hospital & Healthcare Providers. The NABH accreditation is a recognition of their
commitment to provide Safe and Quality of care to their patients.
 Time for initial assessment of indoor and emergency patients.
 Life sustaining Equipment Down time.
 Percentage of Possible contrast related reactions.
 Patient Satisfaction index.
 Re-exploration rate.
 Infection rates like UTI, RTI, SSI, IVD etc.
 Turnaround time for issue of blood and blood components.
 Patient rights and education.
 Patients cared for by the organization undergo an established initial assessment.
Highlights of NABL Accreditation (National Accreditation Board for Testing
and Calibration) Standards Contributing to Quality Measures:
The labs at Rockland Hospital Qutub has earned the prestigious accreditation from National
Accreditation Board for Testing and Calibration Laboratories (NABL) in the field of medical
testing. The NABL accreditation ensures that their labs continuously conforms to the stringent
International Standards for Medical Testing and is also a recognition of our commitment to provide
quality care to our patients.
All 3 units of Rockland Hospitals were assessed & accredited in accordance with the Standard ISO
15189: 2003Medical Laboratories - particular requirements for Quality & Competence for their
facilities in the field of Medical Testing.

14. 14
-Highly developed medical Infrastructure.
 The driving force behind our success is our ability to assimilate modern medical
technologies with a highly developed medical infrastructure built to meet international
standards.
 Our hospitals are equipped with the most recent and advanced medical instrumentation
needed to support the best standards of healthcare treatment.
 All our specialties embrace neatly maintained operation theatres, critical care, inpatient
rooms, outpatient areas and consultation rooms, with high focus on infection control,
supported by patient centric nursing and support staff to ensure holistic care.
.
-State-of-the-art Operation Theatres (OT) equipped with the latest equipment and laminar airflow
systems, to maintain internationally accepted sterility norms that minimize the risk of infection
-64 Slice CT, High-end MRI, Neuro-navigation Surgical Systems
-Diagnostic & Therapeutic procedures covering Angioplasty, Stenting, Atherectomy, and Intra-
Aortic balloon Pump Insertion and Pacemaker Insertions
-Cardiac Catheterization Suites for Pacemaker Insertions
-Neuro-physiology, specialized physiotherapy, Comprehensive Rehabilitation services
-Our Clinical Expertise
 Our clinical Expertise is committed to providing patients with a comprehensive range of
tertiary and secondary care services backed by state of the art technology, infrastructure
and trained clinicians. We have a pool of highly skilled and experienced doctors with
international affiliations .They have earned their knowledge and education from some of
the top universities in the country and across the world. In fact, most of our doctors had
already worked in the top international patient care centers in the US, UK, and Australia.
Our senior doctors regularly take part in various international meetings/CME as both
speakers and visitors. This in turn helps them in staying updated with the most advanced
treatments across their specialties. Additionally we have a dedicated team to cater to the
needs of our International Patients.
-Strong Facility Support:
-Highly skilled, specially trained and dedicated team of Nursing and Paramedical professionals
-Use of Implants that are of internationally accepted quality
-Imported prostheses and consumables

15. 15
-Foolproof procedures and processes for Blood Transfusion
-Exhaustive tests for unexpected antibodies from donors and patients
-Compatibility testing.
Excellence through Quality various operations wise perspective:
OPD Care:
Patients' waiting time has been defined as "the length of time from when the patient entered the
outpatient clinic to the time the patient actually leaves the OPD". Whether it's a time used for
registration of patient, routine doctor's appointment, emergency room treatment,
laboratory/diagnostic test, procedures, receiving the results of various tests, waiting happens to just
about everyone seeking medical care. It's often one of the most frustrating parts about healthcare
delivery system. Waiting times for elective care have been considered a serious problem in many
health care systems since it acts as a barriers to efficient patient flows. OPDs is considered as the
window to hospital services and a patient's impression of the hospital begins at the OPD. This
impression often influences the patient's sensitivity to the hospital and therefore it is essential to ensure
that OPD services provide an excellent experience for customers. It is also well-established that 8-10
per cent of OPD patients need hospitalization.
Step 1:- Employee will take time attend the patient within 5-7 minutes after His /Her arrival to our
health care organization.
Step 2:-If patient is disabled or not able to walk or move, we have to provide a wheel chair to the
patient with the help of ward boy and patient attendant.
Step 3:-The above thing is done within 3-4 minutes after patient is attended by front office
executive.
Step 4:- If patient is having past history of his/her treatment, ask him/her for a previous /past
treatment file and ask him/her to sit in lobby.
Note- Whenever they talk to any client or patient or relatives we have to be very calm. Always
maintain a smiling face as we are the front office executive. We have to maintain the voice pitch
whenever we having conversation with patient & relatives.
Step 5:- Ask the patient for referral slip if the patient is from WCL or Raymond or any companies
(we have to take care that the corresponding company is empanelled with us).
Step 6:- Register them with OPD register with Name, Address, Age, Telephone No., i.e., all the
details as per our OPD form. (As a mandatory element)

16. 16
Step 6A:- Executive take registration charges from patient then give a receipt to the patient and
same time register the patient in hospital HIS with registration number.
Step 7:- Then calculating the time from register & coordination with doctor we have to tell the
patient the estimated waiting time, i.e., for how much time they have to wait for their turn to come.
Step 8:- When the patient’s turn comes to be examined by the doctor, call the name of patient by
PAS (Public Address system)With the help of ward boy or patient attendant move the patient from
lobby to OPD chamber with the patient past treatment file and current OPD file with 2 to 3 OPD
empty sheets attached.
Step 10: executive have to take care that, don’t interrupt between the patients or relatives while
they having a conversation but also we don’t have to move from OPD chamber as we have to be
the OPD attendant. Note: - Hospital have policy to take care of privacy of patient, in that while
examination of patient by the doctor only Doctor, OPD attendant And OPD sister will only present
in the chamber.
Step11:- If the patient is a lady, then strictly no male is allowed to be present in OPD chamber.
NOTE: - Hospital having a “Do Not Disturb” board to hang on the door to avoid unacceptable
disturbance to the doctor while they examine the patient.
Step 12:- If the doctor advises the patient for X-Ray, ECG, TMT, dressing, minor surgeries etc we
have to shift the patient to relevant department/chamber/room, before start any other procedural or
relevant treatment take the patient’ file to accountant and ask for total amount/fees of the patient
request the patient to pay the amount. Don’t talk loudly or in a uncouth language/ manner with
the patient or relatives or client as we create the first impression of hospital.
320 patient data was collected and analysis are used to identify defects in processes and reduce
variation Respondents of this study included selected patients, staffs and doctors in the diffrent
department of hospital. This is the first step that refers to defining the goals of the project. Process
improvement goals may be aimed at increasing market share, the output of a particular department,
bringing about improved employee satisfaction as well as customer satisfaction and so on. The goal
has to align the customer demands and the strategic goals of the organization. Data mining methods
can be used to find prospective ideas for project implementation. In other words, businesses are
designing a road map for achieving the targets and goals of the organization.
Measurables
1. Total waiting time for a consult.
2. Time taken for laboratory result.
3. Time taken for laboratory and ECG result.
As is evident from the above diagram, 64% of the patients had to wait for more than 3 hours for a
consultation with 24% of patients waiting anywhere between 2 hours to three hours.
Only 6% of patients could have their consultation within one hour. This clearly indicates that
majority of patients are not satisfied with the present waiting time. Customer expectation to see

17. 17
doctor within 60 minutes of Registration/Encounter. It was found that routine lab test and ECG
results are critical information for a cardiac medical consultation. Patients were waiting for either the
lab test or both lab test and ECG.
To assess this measurable the time taken for the blood test results and ECG results were collected
separately in the measure phase:
1. Time to complete the Blood Test.
2. Time to complete the Blood Test and ECG.
Infection Control Management:
Purpose:
To maintain standards in infection control measures and minimize hospital infection in patients
and staff. To define policy and procedure regarding hospital acquired infections in the hospital.
High risk areas
 Operation Theater
 Intensive care unit
 Recovery room
Institute have established committee which look after infection control activities around the
institute. The committee meet in every month with past one month report and discussed issue of
each month happened in before the meeting. The objective the committee is minimize the risk of
infection to patients, staff and visitor, maintain surveillance over hospital acquired infections. The
committee responsible for to develop and implement preventive and corrective program in specific
situations where infection hazards exist and identify the roles and responsibilities of keep
personnel involved in the prevention and control of infection.

18. 18
Infection control Process
Maintenance of sound habits in personal hygiene and individual responsibility in infection control
by training the staff throughout the organization. Monitoring and investigating infectious diseases,
potentially harmful infectious exposures, and outbreaks of infections among personnel. Providing
care to personnel for work-related illnesses or exposures. Identifying infection risks areas related
to employment and instituting appropriate preventive measures. Surveillance activities for tracking
and analyzing appropriate infection rates. Providing feedback regarding these rates on regular basis
to top management, medical and nursing staff.
Regular visit to the all clinical areas to make sure that the patients with particular infection receives
an appropriate treatment in regard to the isolation precaution, and the type of treatment. To make
sure that, the staffs are educated and updated with the protocols in relation to the infection control.
To advise and supervise the work of staff for the best infection control practices like Bio-Medical
waste management, Hand washing, Isolation throughout the hospital. To arrange special teaching
session to the staff and even for specific group of patients pertaining to the infection control and
prevention. To collect data of patients with infections that require isolation precaution and use of
specific antibiotics.eg; MRSA To conduct clinical audit as a member of Infection control
committee member, to make sure that, the infection control and prevention. To updates his/ her
knowledge by participating in the clinical governance meeting.
To share her or his concerns to the Director or the microbiologist in order to get an idea and for a
possible solution. In the hospital situation, any outbreak of infection is normally informed by the
Head of the microbiology or virology department. The information will then be cascaded to the
local unit/ward through the infection control nurses and infection control link nurses.

19. 19
Process Chart-1.
Process Chart-2

20. 20
Infection Control Measurement:
Proper Hand wash technique (Refer policy and procedure for hand wash NUR/SOP/VER1).
Isolation /Nursing barrier techniques (Refer policy and procedure for Isolation /Nursing barrier
NUR/SOP/VER. Appropriate pre and post exposure prophylaxis (Refer policy and procedure for
pre and post exposure prophylaxis HR/SOP/VER1) Sterilization Technique (Refer policy and
procedure for Sterilization OT/SOP/VER1) Proper Bio- Medical waste management (Refer policy
and procedure for Bio- Medical waste management HK/SOP/VER1) Proper Equipment cleaning
(Refer policy and procedure for Equipment cleaning HK/SOP/VER1) Laundry and linen
Management (Outsourced) Kitchen sanitation and food handling (Outsourced) Engineering
control Programme (Refer policy and procedure for Engineering control Programme
ENG/SOP/VER1). They regularly basis sensitization programme for staff. In service training
programme for staff. Surveillance programme (Refer policy and procedure for Surveillance
Programme NUR/SOP/VER1.
Analysis Infection Control:
To analyses the report they use Histogram method, Pareto analysis and route cause analysis. After
due analysis of every month report they structured it through quality assurance and continuous
monitoring. AQ department define the key indicators to monitor the clinical structures, processes
and outcomes.

21. 21
Biomedical Waste Management:
Handling and Segregation of bio-medical waste is done at the point of generation/source and is put
into a different color bags in same color bins. The “Bio Medical Waste Management and Handling
Biomedical waste is the leading cause for spreading of nosocomial infections in the hospital.
Improper maintenance of Biomedical Waste may lead to increased risk of blood born; air born and
needle prick injuries in the Staff as well as the patients and their attendants. For Proper treatment
and Disposal of Biomedical Waste in the facility following steps should be ensured.
Biomedical Waste Management In-charge responsible maintain the hospital west management
with the committee.
Roles and Responsibilities Biomedical Waste Management of committee includes following but
not limited to
 Daily inspection of waste segregation and reporting.
 Supervising the maintenance of registers.
 Ensure availability of equipment’s like needle cutters, autoclaves and sterilizers, waste
carrying trolleys, personnel protective gears (masks, apron, gloves etc) and other materials like
bleaching solution or hypohloride solution.
 Ensuring availability of color coded bins and bags as per Biomedical Waste Management and
Handling Rules, 1998.
 Formation of Monthly and Annual reports.
 Maintain records about various categories of waste generated in the hospital, if outsourced
maintaining the records of the receipts and other documents related to Biomedical Waste
Management.
Protocols for Mercury Spillage:
 Remove everyone from the area that has been contaminated with mercury.
 Keep the heat below 200 C and ventilate the area.
 Put on face mask in order to prevent breathing of mercury vapor.
 Remove all jewelry from hands and wrists.
 Use Personal Protective Equipment while handling mercury.
 Cardboard sheets should be used to locate and push the spilled beads of mercury together
 Mercury should be placed carefully in a container with some water. Never us a broom or
vacuum cleaner. It should be disposed of at hazardous waste facility or given to a mercury-
based equipment manufacture.
Protocols for cleaning Spillage of Blood
 Wear Gloves
 Pour, without splashing, a disinfectant appropriate for the size and surface contaminated,
e.g.
 Isopropyl alcohol, Dakin’s or house hold bleach 1: 100 dil or 1: 10 dilution.
 Place absorbent paper (e.g. news / tissue paper over the spill. Allow a contact time of 20
minutes.
 Wipe up the spill. Put absorbent paper in the yellow bag. Wash hands (with gloves on).

22. 22
 Remove gloves.
 Wash hands.
Rockland Hospital Biomedical West Management Do’s
Segregate waste as soon as it is generatedinto differentcategoriesofwaste. ̞̚Yes
Collectthe waste in properlylabeledspecificcolorcoded coveredbins. Yes
Keepsame color bags in the bins. Yes
Cleanregularly withsoap and water and disinfectthe bins. Yes
Collectthe domesticwaste (eatables,wrappers,fruitpeels,papersetc., in greenbin). Yes
Use dedicatedwaste collectionbins/trolleys/wheel barrowsfor transporting waste. Yes
Transport waste through a pre- definedroute and time withinthe hospital. Yes
Mutilate and disinfectthe needle soonafter administrationof injection. Yes
Mutilate and disinfectsolidwaste (plasticwaste) as soon as it is generated. Yes
Always disinfectthe sharps and the solidwaste with eitherhypochlorite solutionor Bleaching
powderbefore disposing.
Yes
Disinfectneedle andsolidwaste (plastic) after mutilation. Yes
Dispose body parts inyellowbin. Yes
Dispose waste within48 hours. Yes
Always use protective gears while handlingthe waste Yes
Rockland Hospital Biomedical West Management Don’t’s
Never mix infectious and non- infectious waste No
Never mix plastic wastes with the waste which goes for incineration. No
Never overfill the bins. No
Never store waste beyond 48 hours. No
There should not be any spillage of waste on the way of transport. No
Avoid transport of waste through crowded areas. No
Do not put infectious waste into general waste. No
Don’t dispose waste sharps with other wastes. No
Don’t dispose the solid waste and sharp waste without mutilation and disinfection. No
Overloading of the Bags and the bins should be avoided. Colour coded bags to be replaced
when
No

23. 23

24. 24
Quality in-house Pharmacy:
Rockland effective medication delivery process care policy for the patients and the hospital
pharmacists has been maintaining effectively and reflects their responsibility and accountability.
The systematic approach to the delivery of in-house pharmacy involves the following four steps,
as depicted in figure
 Step 1: Assess the patient’s medicine therapy needs and identify actual and potential drug
therapy problems (DTP)
 Step 2: Develop a care plan to resolve and/or prevent the DTPs
 Step 3: Implement the care plan
 Step 4: Evaluate and review the care plan

25. 25
Follow Up, Monitoring, and Evaluation
1. Hospital pharmacy only ward round is a visit made by a group of pharmacists to hospital
inpatients to review and follow up their progress in achieving the goals of therapy. Pharmacy
only morning sessions (POMS) are organized to discuss selected patient cases and to get
updated information on patient management. Pharmacy only rounds (POR) and morning
sessions aim to facilitate better patient care by ensuring appropriate medicine use wherein each
pharmacist has a key role and responsibility. The pharmacy team should decide the number of
rounds and morning sessions that should be conducted per week.
2. The multidisciplinary team (MDT) round is conducted by health care providers to share their
contributions to cases and patient-specific issues. MDT facilitates better patient treatment and
appropriate medicine use wherein each health professional plays his/her role and
responsibility. As a member of the health care team, the pharmacist should be actively involved
in MDT activities.
Quality OPD Pharmacy:
Infrastructure:
The Drug Dispensing Counter (Pharmacy) located in basement near the Out Patient Department and
it outsourced by the hospital.
Human Resource:
1. 10 Pharmacists should be present during each shift.
2. 5 ward boy or helper to bring the medicines from the drug store as per the need.
Services:
 The Pharmacist checks the availability of the drugs prescribed by the doctors.
 If the Drug is available the pharmacist provides the prescribed medicines and makes an entry into
the records pertaining to the quantity of the drug.
 At the end of the shift the pharmacist makes an entry of the total medicines dispensed and
reduces the same from the stock book in pharmacy inventory software.
 They followed First in First out (FIFO) principle which help them identify the stock for moving
the drugs in stock.
 They maintain the buffer stock of drugs as per the patient load.
 24X7, pharmacy service available in the hospital.
 The most important List of the “Drugs Available” are displayed outside the pharmacy and
updated periodically.
 Before the medicines are dispensed the date of expiry checked by pharmacist. While disbursing
the medicines, the pharmacist explain the dosage and timing of drugs.

26. 26
Hospital in Patient Department:
The Rockland Hospital presently serving 110 beds with different specialty wards included of
Emergency Bed (5), ICU (20), Cardiac Bed (20), General Bed (50), Neonatal Bed (10) and
Neurology Bed (5). Nightingale types of beds are aligned perpendicular to the wall and Cabin type:
4-10 beds are kept in the cabin which reduces nosocomial infection. The distance between two
beds should be 6ft from the center of the beds. This is required for two reasons mainly, one for the
free movement of the trolleys/ wheelchairs and secondly to reduce nosocomial infection.
The Inpatient department activities includes of
1. Admission of Patients
2. Treatment of the patient
3. Investigations.
4. Operation
5. Information of Medico Legal cases to Police.
6. Physiotherapy
7. Counseling
8. Discharge.
Admission Process and treatment care:
Before admission the doctor must have examined the each and every patient .He should give
clinical diagnosis, advise investigations and prescribe treatment on the case sheet so that the
treatment can be started. All admissions are done in registration counter where all the entries be
filled. After admission in the wards, ward coordinator entry made in the ward register clearly
indicating the time and date of admission in the ward. Meanwhile the treatment will started. The
treatment given should be entered into the records.
Patients transferred to the hospital with I.V.line and indwelling catheter will changed with new,
on arrival into the Hospital. At the time of admission patient should be provided fresh linen. Patient
linen changed every day or as and when it is soiled. Care generally taken that soiled linen to protect
transmit infection to other wards. Aseptic techniques are to be followed. All invasive procedures
by doing nursing staff only after wearing gloves and following universal precautions. During shift
change the nursing staff give a detail description in regards to condition of the patient and the
treatment being given in the handover register. Infected Patients are treated in the Isolation room
as far as possible. During the rounds by the consultant the instruction given by the consultant take

27. 27
care thoroughly recorded. If the patient is absconding from bed for more than 30 minutes the same
should be recorded and reported to the authorities. For pathological investigation, sample are taken
from the ward and be sent to the laboratory for investigation. The reports of the same sent by the
laboratory to the wards / collected from laboratory for further course of treatment. The non-
ambulatory patients are shifted for radiological investigations like X – ray, USG CTScan by wheel
chair or stretcher which are situated in basement. Before discharge the patient and relatives made
aware about his present condition further treatment and medications to be followed as well as about
his follow up visit details. The condition of the patient as well as detailed summary of the case as
regards to the procedures done, investigations and treatment provided in the hospital at the time of
discharge properly mentioned in the discharge summary by the doctor. After the patient has been
discharged the file should be sent to the Medical Records Department for storage. If the patient
wants a copy of the records the photocopy of the same may be given.
Out Patient
Department
Emergency
Department
In Patient
Registration
Admission Ward
Referred
Surgery
Treatment&
Invetigation
LAMA
/Discharging
Death

28. 28
In Patient Discharge Process at Rockland hospital:
Discharge planning is the development of an individualized discharge plan for the patient prior to
leaving the hospital, to ensure that patients are discharged at an appropriate time and with provision
of adequate post-discharge services. Discharge planning is a complex process that seeks to
determine the appropriate level of services required by the patient and then match the patient to an
appropriate site of care. This process ideally begins at the start of the hospitalization. The hospital
case manager should be involved as soon as it is clear that the patient will require services at home,
or will require transfer to an alternative level of care.
When it has been determined that a patient is medically ready for discharge, the treating doctor
determine the appropriate site of care involve medical, functional, and social aspects of the
patient's illness. The patient’s acute and chronic medical conditions, potential for rehabilitation,
and decision-making capacity must be taken into account. In order for the patient to be deemed
safe and ready for discharge to home or to a non-acute environment (rehabilitative, transitional, or
chronic care), a provider must take into account a number of factors beyond the medical
determinants. These factors include:
Patient cognitive status.
Patient activity level and functional status
The nature of the patient's current home and suitability for the patient's conditions (eg, presence
of stairways, cleanliness)
Availability of family or companion support
Ability to obtain medications and services
Availability of transportation from hospital to home and for follow-up visits
Availability of services in the community to assist the patient with ongoing care.
Post-Discharge of hospital:
Obtain and self-administer medications.
Perform self-care activities
Eat an appropriate diet or otherwise manage nutritional needs
Follow-up with designated providers

29. 29
Discharge Process Flowchart
Discharge
Plaining
Doctor
Confirmation
Pament
Post Discharge
Instruction
Trtetment
Summary
Patient Exit
hospital
Medication
reconciliation

30. 30
Conclusion:
Today Hospitals are being forced to develop a better understanding of what service quality means
to the patient and how it could be best measured. A key factor in designing and delivering quality
services is the need to understand the patient’s requirements and needs in order to provide services
which meet those needs as per the resources available. While patients of hospitals are making
decisions based on their perceptions of the quality and satisfaction with hospitals, health care
managers need to understand how patients evaluate health services. If health care providers
understand what attribute patients and their relatives use to judge the hospital quality, steps may
be taken to monitor and enhance the performance of those areas. There is tremendous scope to
improve the OPD services of a public or private hospital. More than a decade ago, two landmark
reports: The World Health Report (2005) and the Institute of Medicine’s crossing the Quality
Chasm (2001), called for the realignment of incentives to balance the competing goals of cost
containment and quality improvement. Both reports concluded that responsiveness to citizen’s
expectations was a valued and desired outcome of health care performance. Through use of
various quality theories and the latest QC tools we can see that the excellence in hospital services
can be obtained through a quality initiative. As per the mentioned desired percent of the target
goals Rockland Hospitals are working towards this objective of service quality excellence in its
operations. This ultimately results in reduce cost of operations and increase in the profitability.
Because of the quality gurus Philips B Crosby saying DRIFT ie “Do it right the first time”, this
will reduce the repeat cost of service delivery and negative cost of quality and saving would be
done in established in service quality recovery (Medical Negligence penalty levied on hospital for
wrong deliverance of the service).