1. The purpose of an organization structure

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• 1. The purpose of an organization structure
• 2. The meaning of "organizing" and
  "organization."
• 3. The distinction between formal and informal
  organization.
• 4. How organization structures and their levels
  are due to the limitations of the span of
  management.
• 5. The exact number of people a manager can
  effectively supervise depends on a number of
  underlying variables and situations.
• 6. The nature of entrepreneuring and
  intrapreneuring.
• 7. The key aspects and limitations of
  reengineering.
• 8. The logic of organizing and its relationship
  to other managerial functions.
• 9. That organizing requires taking situations
  into account.

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Organizing
Hows related to each other
What Part to Play
Supply of Needed Information
TOOLS
System of Roles
Coordinating Efforts
Performing in that role
to exist and be meaningful, it must incorporate
verifiable objectives
ROLES
clear idea of the major duties or activities
involved
Designing
Maintaining
an understood area of discretion or authority
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OrganizingA basic process of combining /
integrating Human / Physical / Financial
resources in productive interrelationship for the
achievement of enterprise objectives
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Definition of Organization

• Organization implies a formalized intentional
  structure of roles or positions

Effort Pooling towards designated objectives
through definition / division of activities /
responsibilities / authority
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identification and classification of required
activities
Organizing involves
Departmentation Manageable units Maximum possible
specialization
grouping of activities necessary to attain
objectives
Delegation Aptitude / Attitude Job Requirement /
Capabilities
Assigning responsibility with necessary
authority To a manager for each grouping
Synchronization Interrelationship between
different positions must be clearly defined From
whom ? To whom ?
Coordination in organizational Structure Verticall
y, Horizontally
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Organizational Structure Design
Who
Give what
Is to do
Results
What
Fitting various activities
Smoothly
Efficiently
Effectively
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intentional structure of roles in a formally
organized enterprise
Well defined jobs
Should not be flexible
Formal organization
Definite authority / responsibility
Channeled individual and group efforts
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Any joint personal activity without conscious
joint effort even through contributing
towards Joint Results
Loosely organized
Structure (membership), communication networks
(grapevine), and relationships behaviors and
norms) do not necessarily follow those of the
formal organization.
Informal organization
A network of personal / social relationships, not
established, required by FORMAL organization but
arising spontaneously
flexible
ill defined
Spontaneous
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What is a Department?

• The department designates a distinct area,
  division, or branch of an organization
• over which a manager has
• Authority
• for the
• performance of specified activities

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Organization Level and Span of Management
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Organization with Narrow Span
Levels 4 Span of Control 3 Total Employees
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Variety of non-recurrent problems, involving
non-programmed strategic decisions

• Disadvantages
• Too much involvement in subordinates work
• Many levels / higher cost
• Excessive distance between top and lowest level

• Advantages
• Close supervision
• Close control
• Fast communication between levels

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Organization with wide span
Levels 3 Span of Control 7 Total Employees
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For Recurrent, repetitive and routine problems

• Disadvantages
• Overloaded superior / decisional bottleneck
• Superiors loss of control
• Requires exceptional quality managers

• Advantages
• Superiors are forced to delegate
• Clear policies are required
• Subordinates must be carefully selected

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Problems with organizational levels
Expensive
Complicated Planning / Controlling
Complicated Communication
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Principle of the Span of Management

• The principle of the span of management states
  that there is a limit to the number of
  subordinates a manager can effectively supervise,
  but the exact number will depend on the impact of
  underlying factors

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Operational-management position a situational
approach

• Classical theory
• No. of subordinates3-8
• Operational management theory

No. depends of many underlying factors

1. What to supervise complexity and variety of the
   subordinates work
2. Which tools are used
3. Quality of manager and subordinate
4. Degree of interaction

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Difference Between an Intrapreneur and an
Entrepreneur

• An intrapreneur is a person who focuses on
  innovation and creativity and who transforms a
  dream or an idea into a profitable venture by
  operating within the organizational environment
• The entrepreneur is a person who does similar
  things as the intrapreneur, but outside the
  organizational setting

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Definition of Reengineering

• "...the fundamental rethinking and radical
  redesign of business processes to achieve
  dramatic improvements in critical contemporary
  measures of performance, such as cost, quality,
  service, and speed.

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Key Aspects of Reengineering

• Fundamental rethinking of what the organization
  is doing and why.
• Radical redesign of the business processes
• Reengineering calls for dramatic results
• The need for carefully analyzing and questioning
  business processes

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• Nurses form a very important group - the largest
  single technical group - of personnel engaged in
  patient care in hospitals next to doctors,
  consuming approximately one-third of hospital
  costs.
• because.

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• Nursing care is required for the prevention of
  disease and for promotion of health.
• The nursing care of sick patients -
• a. in the interest of his or her mental and
• physical comfort.
• b. by reason of the disease from which he or
• she is suffering.

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• Functions of nursing services are
• Clinical
• Technical
• Caring relationship
• Administrative
• Educational

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• It is observed that 50 or more of her time will
  be spent on non-nursing functions like
• Clerical
• Answering telephones
• Supervise indent of drugs
• House keeping, etc

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staffing

• The number of nurses required to man the nursing
• services in a hospital depends on many factors,
• Number of beds in a hospital
• The type of hospital and the prevailing medical
  practice, including kinds of treatment and
  medications given and tests and services required
  for the patients.
• Pattern of assignment of nurses - based on
  functional method, case method or teach method.
• The type and the number of emergency cases coming
  into the hospital.
• Available labour - saving devices, automation,
  mechanization, centralization
• Level of competence based on - qualification,
  experience, efficiency and sincerity.

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Work allocation

• Patterns of assignment the tasks of the nursing
  unit
• are carried out by 3 accepted patterns of
  assignment,
• depending on the training, experience and the
  rules of a
• particular institution.
• Functional method The tasks are divided among
  the staff.
• Case method Each nurse is assigned one or more
  cases.
• Team method Under this system the nursing staff
  is divided into teams each of which is guided by
  an experienced nurse. The team leader is
  responsible to the ward sister and she organizes
  the nursing care for her group of patients.
• Group Assignment method one nurse is assigned to
  a group of patient to provide total nursing care.
• Primary nursing method the primary nurse assumes
  24-hour accountability for the care, planning and
  evaluation. When on duty on a shift, the primary
  nurse herself assumes responsibility for
  providing total care. Other functions of primary
  nurse is the coordination of nursing activities
  with physician and other health professionals.

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Physical dependency of patients

• This is an important factor in assessing the
• workload. The patients can be classified under
• the following headings
• Totally ambulant
• Partially bedfast
• Bedfast but not helpless
• Partially helpless
• Totally helpless

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Indices of hospital nurses

• The nursing time provided per patient per day is
  the most useful and realistic index, since it
  takes into account
• Occupancy rates,
• working hours, and
• days absent from work.

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• To find out the average number of working days
• per year by a nurse
• Earned leave 30 days
• Sick leave 10 days
• Casual leave 14 days
• Weekly off 85 days
• Non-working days 139 days
• Total working days in year 365 days
• Therefore total working days is 226 days

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• To find out the average number of hours worked
• per year by a nurse
• Average number of working days per year X
  Average number of working hours
• 226 x 8 1808 nursing hours

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• To find out the total number of nursing hours per
• day
• The hours worked per year by a nurse X total
  number of nurses
• For example
• Total bed capacity of hospital 500
• Required number of nurses 217 nurses (as per
  INC norms
• 1808 x 217 361736

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• To find out the number of nursing hours per day
• Total number of nursing hours per year ??365
• 361736 ?365 ??991.21 nursing hours per day
• To find out the number of nursing hours per
• Patient
• 991 ? 500 1.98 nursing hours per patient
  per day approximately

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• Duties of different categories of nursing staff
• Director of nursing
• The nursing director has very little or no
  technical
• duty to perform. The work is mainly
  administrative
• and conceptual.
• Supervision - working pattern
• Maintaining discipline
• Planning diff. services
• Preparing policies to upgrade the routines.
• Participating in recruitment of staff
• Organizing for academic purposes.
• Arrange (in-service) training programmes.

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• Sister-in-charge
• Sister-in-charge is the administrative head of
  the
• ward/section. Therefore the duties are based on
• responsible attitude and supervision.
• Maintaining cleanliness and orderliness in the
  ward.
• Supervising housekeeping activities.
• Supervise staff nurse, nurse-aides, labour staff,
  patients.
• Maintaining inventory.
• Accompany senior clinician during their rounds/
  discussion and actively participate in taking and
  implementing the decisions.

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• Staff Nurse
• This category is the most active. The duties they
• are expected to carry out are
• General and routine care of patients as per
  clinicians instructions. She is an active bridge
  between treating clinician and patients.
• To assist clinician.
• Assist or independently perform certain procedure
  like a. collecting blood, b. catheterization of
  bladder, c. giving IV fluids, d. first aid.
• Assist actively at ante natal clinic, post natal
  clinic, diabetes, asthma, etc.
• Educational activity like health talk,
  counseling, etc.
• Attend outdoor activities.
• Admit and discharge patients.

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• Problems faced
• Shortage of nurses due to
• a. improper ratio of nurse patient
• b. recruitment policy
• c. non availability
• d. migration to other hospitals e. increase in
  requirement.
• Dissatisfaction
• Absenteeism particularly for night duty.
• Unionization
• Deterioration in standard of performance

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• Professional Hazards
• Risk of infection
• Stress and burn out
• Backache due to prolonged standing and walking on
  hard surface.
• Fatigue due to shift duties.
• Improper behavior of some patients, relatives,
  labour staff and even doctors.
• Frustration.

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Functions of CSSD

1. Receiving and sorting the soiled material used in
   the hospital
2. Determining whether the items should be reused or
   discarded.
3. Carrying out the process of decontamination or
   disinfection prior to sterilizing.
4. Carrying out specialized cleaning of equipment
   and supplies.
5. Inspecting and testing instruments, equipment and
   linen.
6. Assembling treatment trays, instrument sets,
   linen packs, etc.
7. Packaging all materials for sterilizing.
8. Sterilizing.
9. Labelling and dating materials.
10. Storing and controlling inventory.
11. Issuing and distributing.

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Functions of CSSD

1. To maintain an uninterrupted supply of
   bacteriologically safe supplies at all times.
2. To undertake studies for improvement of
   sterilization practices and
3. Processing methods to provide supplies
   economically.
4. To impart training to hospital personnel in safe
   hospital practices.
5. To participate in hospital infection control
   programme.

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Receipt
Accounting, Sorting
Cracked/ broken
Unserviceable
Torn/punctured
Washing, Cleaning, Drying
Gloves
Instruments
Needles Syringes
Packing
Syringes Needles
Gloves
Gauze Dressings
Instruments
Packs
Awaiting sterilization
Sterility Not ok
Sterilization
Autoclaves
Dry ovens
Shelf-life expired
Check for Sterility
Sterile storage
Issue
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• The sequence of events is as follows
• Materials are received into the department from
  various users.
• All used materials are cleaned - prelimary
  cleaning before sending the articles to CSSD.
• Clean materials are inspected, assembled and
  packed, ready for sterilization.
• After sterilization, they are either stored in a
  sterile storage area or distributed directly as
  required.

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• Location
• The location of CSSD should be convenient to its
  principal consumers.
• Preferably sited close to OT wards.
• Doors should have the following strong colours to
  signify the different zones to which they give
  access.
• Red - denotes contaminated zone
• Yellow - denotes clean zone
• Green - denotes sterile zone

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• Space
• A minimum of 7 sq ft on a per bed basis ( with
  100 sq ft for the smallest hospital) is
  considered essential for planning a CSSD with
  scope for future expansion and growth.
• Up to 100 beds 10 sq ft per bed
• Up to 200 beds 9 - 10 sq ft per bed
• Up to 300 beds 8 - 9 sq ft per bed
• 300 and above 7 - 8 sq ft per bed

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In planning a CSSD, following concept may be kept
in mind
Room Nature of work Space in
Wash room in which everything is washed up Dirty 10
Work room in which all packaging is undertaken Clean 26
Syringe instrument processing room Clean 9
Unsterile pack store Clean 4
Bulk store Clean 11
Sterile store Sterile 16
Miscellaneous rooms Clean 19
Autoclaves Clean 5
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• Staffing
• One qualified superintendent - In-charge of the
  dept.
• CSSD supervisor - senior nurse (traditionally).
• In-service trained CSSD attendants
• CSSD assistants - Semiskilled workers
• CSSD technicians
• Sweeper.
• A 500-bedded teaching hospital has the
• following staff.
• Technologists 5
• Technical assistants 4
• Nursing aides 4
• CSSD attendants 4

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• Equipments
• Autoclaves
• Dry oven
• Gauze cutter
• Ultrasound washer
• Needle flushing device
• Ethylene oxide sterilizer
• Soaking sinks
• High pressure water jets.

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• Autoclaves
• Saturated steam under pressure is the safest and
  dependable method of sterilization.
• Minimum time for sterilization by autoclaving
  process is 121C in 15 min.
• sterilization checks for quality control.
• Sterility indicators
• Mechanical indicators
• Chemical indicators
• Biological indicators
• Shelf life

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• Chemical sterilization
• Ethylene oxide (EO) - used for heat-sensitive and
• moisture-sensitive materials like rubber,
  plastics and
• fibre glass.
• Effective sterilization by EO depends upon the
• Following
• Concentration of gas 450mg/litre or higher
• Temperature exposure 49 to 63C and 30 to 37.8C
• Packing The type of wrapping used should be
  penetrable by
• ethylene oxide and water vapour.
• Polyethylene is commonly used for wrapping.
• Period of exposure The time ranges from 110 to
  260 min. up to 12
• hours may be required.

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• Sterilization process
• After the sterilizer chamber is sealed and the
• controls set, sterilization process goes through
• the following phases
• Warming the chamber
• Evacuating residual air to partial vacuum.
• Introduction of moisture to ensure that it
  penetrates wrappings and material.
• Introduction of EO.
• Raising the temperature(if required)
• Exposure for the required time.
• Release of chamber pressure.

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• Ultra sonic cleaner
• Ultrasonic cleaner cleans by bombarding the item
  with sound waves.
• These tiny shock waves will knock debris off
  nooks and corners of instruments that are not
  easy to reach.

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• The list of items and special trays commonly
• processed in the CSSD are
• Instruments
• Dressings
• Sponges
• OT linen
• Special packs
• Gauze and cotton materials
• Gloves
• Bowls and trays

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• Standardization of surgical packs
• The aim is to have a standard surgical pack
  containing all the items required for that
  procedure by the operating surgeon.
• Some of the Special trays and sets to be
  processed by
• CSSD are as follows
• Lumbar puncture set
• Sternal puncture set
• Catheterization set
• Bladder wash set
• Liver biopsy set
• Fine-needle aspiration cytology set
• Suturing set
• Thoracic aspiration set
• Incision and drainage set
• Tracheostomy set.

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Laundry Services

• It is a centralized function coming under the
  housekeeping department taking care of all
  activities from purchase to linen management to
  laundry to condemnation
• Linen Management will vary based on the climate,
  culture, systems and procedure of the individual
  organization

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• Hospital can go for
• Inside laundry services - with adequate
  machineries
• Inside laundry services Manual wash by dhobi
• Outside laundry services On contract basis

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Functions of laundry department

• Collection or receiving soiled and infected linen
• Processing soiled linen through laundry
  equipment. This includes sorting, sluicing and
  disinfecting, washing, extracting, drying,
  conditioning ironing, pressing and folding
• Inspection and repair of damaged articles, their
  contamination and replacement
• Distributing finished linen to the respective
  user departments
• Maintenance and control of active and back-up
  inventions and processed linen
• Maintaining all type of registers

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Organizing laundry department

• Manpower requirement
• Duties and responsibilities of linen in -
  charge housekeepers
• Recruitment and selection of dhobi
• Management information system
• Equipments selection, care
• Linen selection, care, stain removal procedure
• Work procedure
• Stain removal procedure
• Management issues

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Tips

• Stock the linen materials in 13 ratio
• Each day the bed sheet is dusted and the side is
  changed when the bed is made. This way both sides
  of the sheet is used. On the third day the bed
  sheet is changed
• Use all faded and damaged fabrics for dusting and
  cleaning windows, furniture etc

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Diet serviceobjective

• To provide individualized nutritional care to the
  patients using normal diet or need based special
  type of diet.
• Service needs to be organized for
• o Hospital staff
• o Outdoor patients
• o Visitors
• o Patients attendants i.e. relatives.

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• Different types of food services include
  following
• 1.Patient food service.
• 2.Cafeteria or mess for the employees.
• 3.Cafeteria or mess for the students in teaching
  hospitals.
• 4.Coffee shop
• 5.Vending machines.
• 6.Special meals for meetings, guests and
  functions.

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• Patient food service
• Purchasing food items as per specification and in
  predetermined quantity.
• Planning menu for different types of patients as
  per their
• a. Age
• b. Nutritional needs.
• c. Ability to consume eg. Unconscious patient,
  infants, etc
• d. Disease requiring restrictions.
• Disease requiring special diet

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• Different types of menu
• Full diet
• Light diet
• Soft diet
• Liquid diet
• Salt-free diet
• Chilly free diet/bland diet
• High protein diet
• High carbohydrate diet
• Diabetic diet
• Special diet (eliminating certain substance)
• Dietary habits of patients should be taken.

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1. Ensuring hygienic method of cooking.
2. While cooking nutritive value and palatability do
   not get adversely affected.
3. Supervising food distribution.
4. Supervising consumption by patients on random
   basis.
5. Taking feedback from patients.
6. Avoiding wastage by not preparing excess food and
   preventing pilferage.
7. Avoiding shortage particularly for new
   patients.
8. Counseling patients on special diets.
9. Training nurses, students and interns

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• SITE, AREA DESIGN
• It is necessary to have certain policies before
• deciding their details
• Foods consumed outside
• a. Information is got at the time of admission.
• b. Wastage is avoided
• c. Attendants food pass can be issued
• Vegetarian/ Non-Veg
• This policy decision will enable diet dept. in
• a. Purchase of raw material
• b. Organizing separate area for cooking veg
  Non-veg meals.

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• Ground floor is desirable
• 1.Receipt of raw materials
• a. Checking,
• b. Weighing
• c. Temporary storing before shifting
• 2.Storage area
• a. Godown or storeroom for non-perishable items
  like grains, oil, etc.
• b. Cold storage for perishable items milk,
  vegetables, etc. refrigerator, cold room.

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• 3. Preparation area
• a. Sorting out
• b. Washing vegetables
• c. Washing utensils
• d. Slicing, peeling, chopping, grinding
• Mixing
• 4. Cooking area
• a. Large size steam cooker.
• b. Cooking gas
• c. Special diet area

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• 5. Serving and transportation of cooked food
  depends on
• a. Hospital policy
• b. Geographical area
• c. Vertical / horizontal /both.
• ? Mobile hot food carrier
• ? Containers of adequate size
• ? Nurse in the ward will arrange to get food
  served.
• 6. Cleaning area
• a. Utensils cleaning
• b. Dish washer

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• Staffing pattern
• Manager qualified dietitian
• Dietitians 2 or 3
• Clerical staff paper work inventory
• Cooks one/100 beds. Health check-up, food
  handlers.
• Helpers

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• Problems
• Patient satisfaction
• Wastage
• i. Cooking more than necessary
• ii. Less consumption due to
• a. Poor taste
• b. Becoming cold
• c. Poor appetite due to illness
• d. Home food/eatables
• Shortage
• i. Diet sheet has not been submitted on time.
• ii. Sudden new admissions
• iii. Cooking less than necessary
• iv. Pilferage by staff.
• Theft
• Fraud in materials management.

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• Outsourcing dietary
• Cafeteria or mess for employees
• Cafeteria for students
• Coffee shop
• Vending machines
• Special meals for guests or for functions.
• Diet committee regular rounds, taste of food is
  checked.

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• The basic function of a laboratory service is
• To assist doctors in arriving at or confirm a
  diagnosis.
• To assist in the treatment and follow-up of
  patients.
• The laboratory not only generates prompt and
  reliable reports, but also to function as a
  storehouse of reports for future references.
• To carry out urgent tests at any part of day or
  night and therefore provide serve 24 hours a day,
  
• And in big hospitals, the laboratory also assists
  in teaching programs for doctors, nurses and
  laboratory technologists.

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Types of laboratories

• 1. Hematology
• Hematology includes the study of etiology,
  diagnosis, treatment, prognosis, and prevention
  of blood diseases. The lab work that goes into
  the study of blood is performed by a Medical
  Technologist.
• 2. Microbiology
• Microbiology is the study of microorganisms,
  which are unicellular or cell-cluster microscopic
  organisms
• 3. Clinical chemistry
• Clinical biochemistry is the area of pathology
  that is generally concerned with analysis of
  bodily fluids.

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• 4. Histopathology
• Histopathology (from the Greek histos (tissue)
  and pathos (suffering)) refers to the microscopic
  examination of tissue in order to study the
  manifestations of disease.
• 5. Routine urine and stool analysis

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Functional planning

1. Determine approximate section wise workload.
2. Determining services to be provided.
3. Determining area and space requirement to
   accommodate equipment, furniture and personnel in
   technical, administrative and auxiliary
   functions.
4. Dividing the area into functional units, viz
   hematology, biochemistry, microbiology,
   histopathology, urinalysis, etc.

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• 5.Determining the number of work stations in each
  functional unit/division and deciding the linear
  bench space allotted for each work station.
• 6. Determining the major equipment and appliances
  in each unit. This is generally classified into
• i) Technical equipment peculiar to certain work
• stations.
• ii) Other equipment and appliances e.g.
• (refrigerators, hot air ovens,
  centrifuges) that can
• be jointly used by different work stations
  or units.

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• 7. Determining the functional location of each
  section in relation to one another, from the
  point of view of flow of work, technical work
  considerations, auxiliary areas and
  administrative efficiency.
• 8. Identifying the units that are likely to
  expand, for locating them in such a manner which
  will permit smooth expansion.
• 9. Identifying the electrical and plumbing
  requirements for each area/work station.
  Independent electric circuits are required for
  electronic equipment items. Location of sinks and
  wash areas are vital for efficient performance of
  work stations.

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• 10. Considering utilities, - lighting,
  ventilation
• (forced or normal exhaust, air-conditioning
• and air hygiene) and isolation of equipment
  or work
• stations.
• 11. Working out the most suitable laboratory
  space unit
• (LSU), which is a standard module for work
  areas.
• A standard module facilitates rearrangement of
  work units with least disruption and minimal
  structural changes.

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Organization

• Centralized
• It avoids duplication of purchases of expensive
  equipment.
• Avoids duplication of personnel.
• Easy to monitor working and quality control
• Automation will not be underutilized.
• There can be delay in transporting samples and
  issue of reports.

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• 2. Decentralized
• Transportation
• Dispatch
• Can cater to the specific needs of certain areas
  e.g. ICCU, premature nursery
• Results can be easily logged on to the ward
• Duplication of equipments
• Requires additional technical staff.
• Lack of uniformity in procedures and conflicts.
• Supervision difficulty
• Quality control
• Multiple lines of authority
• Transfers to other area may disturb the services.

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Workload

• An admitted patient undergoes anywhere between 8
  and 20 laboratory tests on an average during his
  or her hospitalization period.
• In 1990, in a teaching hospital, laboratory tests
  averaged at 20 tests per patient in medical ward
  during an ALS of 10 days, giving a ratio of 2
  tests per day, excluding radiographic
  investigations or other tests carried out in
  specialized laboratories.

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• A 100-bedded hospital with a 10 days ALS will
  treat 365 10 36.5 (37 pts)/bed in a yr,
• 37 x 100 3700 total patient in a year which
  means that the hospital laboratory will have to
  carry out 3700 x 8 29,000 tests to
• 3700 x 20 74,000 tests during the year.

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Location

• Preferable on the ground floor and accessible to
  the wards.
• Depends upon the size of the hospital and its
  outpatient set up, the laboratory can be
  situated.
• Outpatient sample collection.
• The design should include waiting room for
  patients, venepuncture room, and specimen
  toilets.
• Provision should be made for containers with
  appropriate preservatives, for correct labeling
  of samples, and for keeping record of each
  patient.

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• Primary space
• The space utilized by technical staff for the
  primary task of carrying out professional work.
• This space is expressed in terms of LSU.
• Secondary space
• The space utilized for all supportive activities.
• Administrative space, viz. offices for the
  pathologist and other, rest and locker rooms,
  staff toilets, etc. should be considered
  separately from secondary space.
• Circulation space
• The space required for uncluttered movement of
  personnel and materials within the dept. between
  various technical work stations, rooms, stores
  and other auxiliary and admin. Areas.

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Schedule of accommodation of hospital laboratory
Departments Primary space Space required
Hematology General hematology Blood transfusion Office desk/ admin 3.5 LSU 1.5 LSU 0.5 LSU 5.5 LSU 101.75sq m
Clinical chemistry Processing and preparation Special and general tests Office desk/ admin/ reagent stores 1.5 LSU 3.0 LSU 1.0 LSU 5.5 LSU 101.75 sq m
Microbiology General bacteriology Media preparation Office desk/ admin 3.5 LSU 1.0 LSU 0.5 LSU 5.0 LSU 92.50 sq m
Histopathology Specimen preparation Section cutting and staining Frozen section/ special techniques Cytology Office desk/ admin 1.0 LSU 0.5 LSU 0.5 LSU 1.0 LSU 0.5 LSU 3.5 LSU 64.75 sq m
Urine and stool 0.5 LSU TOTAL 9.25 sq m 370.00 sq m
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Departments Secondary space Space required
Patient area Waiting area Consulting, examination, venepuncture, etc. Patient toilet (specimen toilet) 40 sq m 30 sq m 10 80 sq m
Office and staff pathologist office and laboratory General office assembling, labeling, storing, distribution of reports Staff locker and rest room staff toilet 30 60 40 10 140 sq m
Supply and processing chemical preparation Central glass washing Sterilization Distilled water still Store general and glassware Store chemical Disposal and cleaning 25 60 30 10 20 20 10 TOTAL 175 sq m 395 sq m
Circulation space Approximately 30 of the total of primary and secondary space
84
Layout

• A simple, basic layout of spaces and equipment
  which can be supplemented or modified to suit
  different requirements is likely to be more
  efficient.
• The structure, equipment and finishes should
  permit the original space allocation and the
  layout to be changed while the building is in
  use, with minimum disturbance.
• Flexibility for use is needed so that areas can
  be converted from secondary to primary space and
  vice versa in the interest of rearrangement for
  expansion or change.

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• A few large sinks which are capable of being
  moved without undue inconvenience are both more
  economical and more convenient than a larger
  number of small fixed sinks.
• A fixed layout of services and equipment can be
  designed to be conveniently used in a number of
  alternative ways providing that working methods
  can be adapted or modified to fit the layout.
• Open planning with a suitable arrangement of bays
  permits a higher ratio of usable bench length to
  floor area.

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• Administrative and auxiliary areas
• Waiting room
• Venepuncture cubicle
• Specimen toilet
• Pathologists office
• Glass washing and sterilizing unit
• Staff locker room and toilet

87
Utility services

• It include water, gas and compressed air system.
• The need for uninterrupted functioning of these
  systems and the probability of future expansion,
  careful study is necessary in designing them for
  safety and efficiency.
• Piping system color, coding or labeling, non
  corrosive to facilitate safety purposes and
  repairs.
• Arrangement of laboratory benches removable
  panels between the benches.

88
Internal design and fitments

• Work benches
• Lighting
• Service spine
• Storage
• Partitions
• Dust
• Air-conditioning/exhaust
• Working surface
• Flooring

89
Staffing

• The hospital laboratory service should be under
  the control and direction of a doctor with
  qualifications in pathology.
• He becomes the overall in charge quality
  control, standardization and administration.
• Should be a part of the regular medical staff of
  the hospital.

90

• The number of medical laboratory technologists
  (MLT) and laboratory technicians will depend
  upon
• The number of samples per day
• The range of tests to be performed under various
  sections, viz clinical chemistry, hematology,
  microbiology and histopathology.
• Emergency service and
• leave reserve.

91

• They perform all technical procedures in
• Various section,
• Prepare reports of completed investigations,
• Check and maintain equipment and
• Request for necessary supplies and materials.

92

• Tests performed annually per medical technologist

Laboratory unit Tests
Hematology 13,400
Urinalysis 30,000
Serology 11,520
Biochemistry 9,600
Bacteriology 7,680
Histology 3,840
Parasitology 9,600
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Equipment

• The following is a list of the important items of
  equipments and instruments in a general hospital
  laboratory
• Robot cell counter
• Centrifuge
• Microhematocrit centrifuge
• Refrigerators
• Blood bank refrigerator
• Water still
• Pressure sterilizer
• Pipette washer
• Flame photometer
• Spectrophotometer
• Hot air oven
• Incubator
• Calorimeter
• Analytical balance
• Blood gas analyzer
• Autoanalyzer.

94
Policies and procedures

• Laboratory samples
• Sample receiving
• Request forms
• Time of accepting specimens
• Containers
• Identification of specimens
• Reports
• Records
• Blood bank service
• Outpatient samples
• HIV
• Liaison with clinicians
• Technicians motivation
• Cross-training of technicians
• Laboratory waste disposal
• Optimal utilization of laboratory service.

95
Emergency service

• It is the area of service in the hospital, where
  quick and competent care can save lives and also
  reduce the severity and duration of illness.
• The casualty department provides the first
  impression which should be a positive one.
• The relationship of the casualty with other
  departments and wards should be close.

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• Definition
• The casualty services provide immediate
  emergency,
• diagnostic and therapeutic care to patients with
• Injuries by accidents, suicidal, homicidal, etc.
• Sudden attacks of illness or exacerbation of the
  disease.
• These patients require immediate attention
• and treatment.
• Emergency patients receive resuscitation and
• life-saving treatment.

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• Functions
• Attend to all the patients brought to casualty
  decide appropriate management which includes
• - Immediate resuscitation.
• - First aid
• - Emergency investigations
• - Hospitalization
• - Referral to specific specialty by calling down
• the concerned doctor.
• - Observation of patient to decide whether the
• patient can go home and attend appropriate
  OPD
• - Reassurance and short counselling.

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• Carry out medico-legal formalities.
• Maintaining up to date list of critically ill
  patients for the purpose of
• - issuing one visit pass to relatives.
• - replying telephone calls.
• - decide acceptance or rejection of transfer of
• patients from other hospitals.
• - assist intra hospital transfer.

99

• Following category of case can be labeled as
  medico legal
• 1. Cases of injuries and burns the circumstances
  of which suggest commission of an offence by some
  one.
• 2. All Vehicular, factory or other unnatural
  accident cases specially when there is likelihood
  of patients death or grievous hurt.
• 3. Cases of suspected or evident sexual assault.
• 4. Cases of suspected or evident criminal
  abortion.
• 5. Cases of unconsciousness where its cause is
  not natural or not clear.
• 6. All cases of suspected or evident
  poisoning/intoxication.
• 7. Cases referred from court or otherwise for age
  estimation etc.
• 8. Cases brought dead with improper history
  creating suspicion of an offence.
• 9. Any other case not falling under the above
  categories but has legal implication.

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• Carryout services of non emergency nature as per
  the policy of the organization.
• 5. Maintain list of doctors on emergency duty,
  their availability and alternative arrangements
  if they are busy.
• 6. Disaster preparedness for mass casualties.

101

• Site, Area and Design
• Ground floor
• Proper sign board with illumination
• Other human traffic restricted
• Entrance pattern

Compound gate
Inpatient Services
Casualty
OPD
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Important areas of casualty

• Reception or Enquiry Counter
• Sign boards with proper direction
• Enquiry counter
• Entrance to the casualty area should be broad
  enough to permit two ambulances
• The entrance area should be covered.
• No parking board.

103

• 2. Waiting area for the relatives
• Should be spacious with adequate light and
  ventilation.
• Adequate sitting accommodation
• All utility services should be provided
• Public address system to call relative of patient
  to inform about patients condition.
• Small statue of God/ Meditation hall.

104

• 3. Space for trolleys and wheel chairs
• Immediate arrangement of wheel chair or trolley
  depending on the condition of the patient.
• Based on work load, 4 - 6 trolleys/ wheel chairs
  are required.
• Transferring of critical patients into other
  areas.
• Intensive care trolley should be there.
• Trolley and wheel chair - parked in orderly
  fashion.
• Soiled trolley should be kept clean always.

105

• 4. Space for security staff and police constable
• Casualty is likely to get victims of assaults,
  riots, group rivalry, etc. so the security needs
  to be vigilant.
• Entries should be restricted.
• Cubicle with glass walls permitting visibility of
  hospital waiting area, compound building
  entrance.
• It is essential to have police constable counter
  either at the waiting hall or by the side of the
  entrance.

106

• 5. Space for administrator and night
  superintendent
• 6. Space for patient brought dead
• - procedural formalities
• - in the event of disaster
• - labeling is done
• - sent to mortuary
• - either to relatives or to police.

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Facilities for management

1. Examination room - first aid
2. Treatment room - minor procedures
3. Observation area - depending upon the patient
   condition
4. Storage space - linen, consumable items, dressing
   material, I.V fluids, equipments
5. Fixtures electrical connections, medical gas
   connection and vacuum connections.
6. Other support services lab, radiology, blood
   bank, OT/table for infected and uninfected cases.

108
Staff required

1. Senior physician/surgeon/orthopedic surgeon who
   should be in-charge
2. Casualty officers - depending upon the size of
   the hospital.
3. Orientation given on emergency care and service.
4. Specialist doctors may be called as and when
   necessary.
5. Nursing staff - round the clock.
6. Labour staff - for cleaning, shifting, carry
   messages, samples, reports, etc.

109
Maintenance of record

• Case register - all patients
• Register for medico-legal cases
• Police intimation register
• Call book- to requisition services of doctors
  from different specialties
• In/out register for resident doctors.
• Records/registers are required for
• Court case
• Compensation to injured patients
• Insurance
• In the event of complaint
• Medical audit.

110
Problems faced

1. Poor upkeep of premises and poor level of
   cleanliness
2. Shortage of doctors on duty due to rapid
   turnover.
3. Waiting for specialist opinion.
4. Casualty officer unable to take decision.
5. Inadequate staff.

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• Continued..
• Waiting for investigation report
• Sudden shortage of certain items during heavy
  attendance.
• Pressure for hospitalization in public hospitals
  for non medical reasons.
• Incomplete/ poor documentation in MLC
• Conflicts due to poor public relations and stress
  due to nature of work.