Academy of Hospital Administration, Kolkata Chapter

20/08/2022

AHA Excellence Award
Hospital Administration is a hidden profession. No one is aware of its existence till something goes wrong and everyone then starts blaming them as inefficient and incompetent. The practitioners of hospital administration tirelessly work round the clock developing, implementing, and monitoring the systems and processes to keep patients safe and ensure that they receive effective, efficient, equitable, timely and safe care within the constraint of resources.
A modern hospital is a highly complex and hazardous organisation like a nuclear power plant, an aircraft carrier, or a space programme. Despite the vigil exercised by the administrators, errors and negligence do happen. A look at the publication “Landmark Judgements on Consumer Law and Practices, 2008-2020” by the Ministry of Consumer Affairs showed that many cases reached the Apex Judicial Body and the Consumer Forum where penalty was awarded against the hospitals and the doctors. One can only imagine what would have happened had there been no administration.
Yet these silent and the unsung people, are never in the limelight. To set things right, the Academy of Hospital Administration, Noida – the only recognised forum of hospital administrators in India – took a bold step to reverse the situation. They instituted awards in various subspecialties of hospital administration and brought it to the consciousness of the top policy making and professional bodies of India like Niti Aayog, IMA, NHSRC and others the contributions that these administrators make in today’s healthcare delivery systems in India through an award ceremony held on 13 August 2022 at the AHA House, Noida. The awards are named as AHA excellence awards.
In keeping with the Indian ethos, the various awards are named in an innovative way after some prominent Indian mythological and historical personalities. The list of the awards is:
VHISMA - The Lifetime Achievement Award
VIKRAMADITYA - The Great Administrator Award
MAHARAJA RANJIT SINGH - The Great Leader Award
CHATRAPATI SHIVAJI - The Great Entrepreneur Award
VARAHAMIHIRA - The Great Pioneer Award
CHANAKYA - The Great Strategist Award
CHANDRAGUPTA - The Young Administrator Award
DRONACHARYA - The Great Guru Award
ATREYA - The Great Quality Assurer Award
AHILYABAI HOLKAR - The Humanitarian Administrator Award
McGIBONY - The Great Hospital Administration Award

Two video clips of YouTube is attached to get a glimpse of the award ceremony:
https://youtu.be/a2bpQX3SKEI
https://youtu.be/wJsQ3QNgu4A

AHA Excellence Awards in Hospital Administration were presented by the Chief Guest Dr V K Paul, Member Niti Aayog.Guest of Honour. Dr J N Shrivastava, (Advis...

28/04/2022

Perioperative Management of the Surgical Operating Department

Operating department is costly to build, operate and maintain. It consumes about 40% of the hospital budget and also contributes 60% to hospital revenue. Surgery is a team effort. A highly trained staff needs to work in a coordinated, cooperative, synchronised, and choreographed manner to produce a satisfactory outcome.

Surgical environment is overly complex with sophisticated technology, numerous interactions between staff and the stressful operating room environment. The chief surgeon is the leader of the operating team. He/she needs to create a harmonious team where each team member is free to voice his/her concern without any fear of intimidation or bullying about an issue which may jeopardise patient safety. Often the personality, aura and authority of the leader and the hierarchical culture of the operating room prevent such free and fair communication. This is detrimental to patient safety. To circumvent, the adoption of Crew Resource Management techniques used in commercial aircraft which is also a highly hazardous and high-stress operation has been recommended.

Surgeons usually lack team-building skills. During the medical curricula, both in undergraduate and post-graduate training in medical colleges, physicians are never exposed to management topics. They pick up certain behavioural patterns as they go on in their profession. It is essential that surgeons be exposed to the organisation’s systems and business processes and be part of the decision-making processes of the organisation. The surgeons need to be ready for this responsibility. Many professional bodies like the American College of Surgeons and Royal College of Surgeons have recommended innovative methods of training, e.g., simulation-based leadership training.

It is not easy to motivate the surgeons to undergo such training. This is because of the organisational complexity and also the method of compensating the surgeons. A value-based payment model to compensate surgeons has been proposed.

Efficiency of operation of the operating department is recommended to improve revenue generation, reduce waiting time and control cost. A scoring system to determine operating room efficiency has been proposed.

In order that the operating room maintains a safe, pleasant, and sustainable operating room facility, the facility management of the hospital along with the operating department is required. It would provide better customer, staff experience, and improve their productivity.

These aspects have been discussed in the presentation on “Surgical Operating Department – Part 11”. The presentation can be viewed at medicahospitals.in/about-medica/aha-kolkata

This is the final part of the presentation on this series.

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

14/04/2022

Design of an Operating Department

Gone are the days when surgery used to be performed in public places under the full glare of an appreciative, curious and somewhat scared audience as if they were about to watch a horror movie. Surgeons would come to the arena like a hero in a white coat smeared with dried and caked blood stains on it, as a sign of their experience. The criteria of a good surgeon were how quickly he could perform the operation like an amputation on a yelling person pinned down by muscle men. After the operation when the audience burst into applause, the surgeon would accept the accolade with a gentle bow. Nothing was known then about the antisepsis, hand washing, germ theory of disease and anaesthesia.

A picture of an operation theatre preserved in the Royal College of Surgeons Museum in England shows an operation theatre with gallery for people to watch. The operating table was at the centre of the theatre. The term “theatre” for an operating room originated from this early theatre like appearance of the room where surgery was performed. The term is in use in the European countries.

The things started changing with discoveries of germ theory of disease by Louis Pasteur, antisepsis by Joseph Lister, handwashing by Ignaz Semmelweis, X-ray by Conrad Rontgen, use of ether anaesthesia by William Morton, blood grouping for transfusion by Landsteiner and the first antibiotic, penicillin by Alexander Fleming. With rapid discoveries of many technologies, today’s operating room is a technological jungle.

The objectives of designing an operating suite are to ensure patient safety, infection prevention, efficiency, and productivity.

The factors that determine the size, shape and space allocation for an operating department depend on technology, equipment footprint, circulation, staffing and ergonomics. Keeping in view these factors, a universal standard design is not suitable for all kinds of procedures. Thus, hybrid operating rooms, digital operating rooms, integrated operating rooms, modular operating rooms and organ specific operating rooms, such as cardiothoracic operating room, neurosurgery operating room, orthopaedic operating room and so on have evolved. As the surgical procedures for different body parts and use of different technologies like minimally invasive surgery, robotics assisted surgery, organ transplantation, gene therapy and so on became specialised so the design of the operating room also became specialised.

These topics have been discussed in the presentation “Surgical Operating Department – Part 10”. The presentation can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

02/04/2022

Planning & Designing an Operating Suite

Operating room is a high-risk environment. Risks are lurking everywhere. A mishap is about to happen. The surgical team is under heightened stress. Therefore, an environment that contributes to a conducive environment that lessens stress, prevents accidents, smoothens workflow, does not produce cognitive overload and aids every subsystem of the complex and dynamic system to function in an integrated manner must be the goal of operating room design.
The specific issues that need to be paid attention to are aesthetics; space assignment; good flow of patient, staff, material and information; maximising support with minimum staffing level, ergonomically designed proportional space allocation with inbuilt flexibility and adaptability to future changes in technology.
A large number of diagnostic, visualization, therapeutic, monitoring and information management equipment – both fixed and mobile are used in an operating room. Thus, making the operating room a technological jungle where wires and cables crisscross the floor, trips and slips may create unsought consequences. Providing some services through ceiling mounted pendants or booms with their advantages and disadvantages have been offered as a solution. The Equipment footprint, number of staff, circulation, ergonomics, necessity to maintain sterility of the operating field determine the total square footage of an operating room. Also, the body system involved in the operating procedure with its technological support may determine the size of the operating room. Thus, a cardiothoracic or an orthopaedic operating room need larger space. Careful analysis of these aspects is needed for determining the optimal size of an operating room. It is not easy to find an architect adept in fast changing medical technology for designing an efficient operating room while balancing the patient safety needs and the needs of the operating staff. A knowledgeable hospital administrator with a penchant for hospital design may have to step in to aid the architect.
Operating suite is a high cost and high revenue area of a hospital. All over the world nearly 200 million surgical procedures are performed each year. In some countries there is a long waiting list of patients waiting for an elective surgical procedure. A balance needs to be struck between the available resources and the number of operating rooms to be provided in a hospital.
These are the aspects discussed in the presentation on “Surgical Operating Department – Part 9”. There are two sections in the presentation. Section 1 of the presentation can be viewed at: medicahospital.in/about-medica/aha-kolkata

24/03/2022

Operation theatre (operating room) – Retained Surgical items and Surgical Site infection.
Retained surgical items in the surgical wound or body cavity is a dreaded patient safety issue. Unintended retained foreign body is an uncommon, and unwanted complication wherever surgery is performed but is present in all settings. Worldwide over two hundred million surgical procedures are performed each year. All incidences of retained surgical items (RSI) are not reported. The reported incidence of RSI is only 0.01% to 0.001%. Though rare, the outcome could be from mild to severe including death
There are many risk factors in RSI events, such as: emergency surgery, prolonged surgery, multiple operating teams, unplanned change in surgical procedure, obesity and so on.
Prevention strategies include procedural such as surgical counts and technological such as RFID or barcode tagging of soft surgical items and instruments.
Surgical site infection (SSI) is another complication of surgery or any invasive procedure. Incidences of SSI is much higher in low- and middle-income countries (LMIC) than in developed countries. In LMIC, SSI affects up to one-third of patients undergoing surgical procedures.
Many preventive measures have been recommended. It may include structural aspect like access control, ventilation system and other aspects like aseptic precautions, sterilization and disinfection, perioperative patient preparation, housekeeping, pre-incision prophylactic antibiotic administration and so on.
These two patient safety issues have been discussed in the presentation, “Surgical Operating Department – Part 8”. The presentation can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

03/03/2022

Medication Safety and Surgical Fire in the Operating Room

Medication saves lives as well as it has the potential to kill or produce adverse health events. Today, there are over 8000 generic medications available as per the WHO International Non-proprietary Names and with the multiple brand names for a popular medication, the number of available names of drugs are mind boggling. This creates an environment where Look-alike and Sound-alike drugs are not uncommon. Errors can easily happen.

The Operating Room environment is highly stressful. To reduce medicine related errors, various methods are adopted. Some of these are: Computerised Prescriber Order Entry, Bar Code Technology, a dedicated operating room pharmacist and satellite pharmacy, minimizing verbal orders, heightened awareness of risks and so on

A surgical fire, though rare, is devastating for patients, the staff and the hospital. In the USA, there are about 600 surgical fires reported each year. No data from India is available. Three things are required together to cause fire. These are oxygen, fuel and ignition sources. All these are available in plenty in the operating room. The surgical fire risk increases when operating in the upper chest using supplemental oxygen.

These Operating Room safety aspects have been discussed in the presentation on “Surgical Operating Department – Part 7. The presentation can be viewed at the URL: medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

24/02/2022

Safety in the Operating Room

Patent safety is a global concern. Patients rely and unconditionally depend on hospitals in the belief that no harm shall come to them. But the reality is different.

Hospitals are highly complex organisations. More complex an organisation is, the probability of harm occurring is higher. Within the hospital setting, the operating rooms are more complex. The complexity arises from the multiplicity of steps and interactions required to perform a surgical procedure.

Today’s operating rooms are also technological marvels. With highly complex equipment and instrumentation and high demand on staff’s cognitive ability, the margin of safety may be jeopardised.

However, there are many inbuilt safety measures of the equipment, high levels of training of staff and the hospital operating room functions as a well-oiled machinery with its emphasis on systems and processes.

No single point of failure can cause patient harm. For the harm occurring and reaching the patient, multiple failures are required.

In healthcare, an additional domain is the patient. This added component with their behaviour and disease makes healthcare more risk prone.

Some examples of risks are: Malfunctioning of Implanted Electrical Devices such as pacemakers, implantable cardioverter defibrillators and so on. They may malfunction when other electrical devices such as diathermy are used.

Surgery may be conducted on the wrong patient, wrong site, wrong procedure due to identification error. Patients may be burnt due to movement when a monopolar diathermy pad may get displaced and touch a metal surface.

Retained surgical objects in the wound could be a safety issue, though procedures have been developed to prevent such events.

WHO has developed a safe surgery checklist. If meticulously followed, it may avert many mishaps. Hospital accreditation bodies insist on its implementation, though some barriers still exist.

Some aspects of Safety in the OR is the subject matter of discussion in the presentation “Surgical Operating Department – Part 6. It can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

10/02/2022

Instrumentation in the operating room
Surgical instruments are the extension of surgeons’ hand. Instruments are for facilitating operating procedures. Instruments provide mechanical advantages to the surgeon. The instruments are designed for ease of operation as well as for preventing patient injury.
Surgical instruments may be categorised based on their function. These may be for: cutting, clamping, retracting and as an accessory or ancillary instruments
Besides, there are some instruments that use various forms of energy such as electricity, light and sound
As the surgical technology is advancing, so the instrumentation. There are specific instruments for minimally invasive surgery, robotic assisted surgery, laser surgery, micro-surgery and so on.
A basic surgical instrument used for cutting, holding, dissecting etc has several parts. These parts have distinctive names which should be known by everyone working in the surgical department as well as by those responsible for care, maintenance and reprocessing.
Surgical instruments are costly. They must be handled with care to prevent their damage.
For a newbie, the plethora of surgical instrumentation with their varieties of names, it may be intimidating.
The surgical instrumentation has been presented in “Surgical Operating Department – Part 5”
The presentation can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

28/01/2022

Surgical Modalities
Surgeons are in the quest of improving the surgical outcome of the patients. This they want to achieve by minimizing hospital stay, small incisions to reduce the healing time, less bleeding and so on.
Technical advancement, better instrumentation, advanced information technology and automation all converged to achieve many of these objectives.
Many surgical modalities have evolved to have better access and visualization of surgical field. This enabled surgeons to perform more and more complex surgical procedures.
Some of the modalities that evolved are laparoscopic surgery, robotic assisted surgery, microsurgery and so on.
Laparoscopic surgery or Minimally Invasive surgery initially started with gall bladder operations, but now endoscopic surgical procedures have been adopted in many fields including cardiovascular surgery, ENT, Gynaecology and other surgical disciplines.
Robotic surgery is gradually making its mark in almost all surgical field. The da Vinci, named after an Italian Painter, who conceived of the robotic systems, surgical robot is now in its 4th generation. The Intuitive Surgical company is the inventor of this system. The high capital and maintenance cost of the system prohibits its widespread use all over the world. Most of these robotic systems are used in the USA. India also has about 70 installations. The cost of surgery by surgical robot is about 2 lakhs rupees more in comparison to the traditional method of surgery.
Microsurgery is another area which has helped growth of surgical technology for delivering hitherto inaccessible surgical care in many surgical disciplines. Availability of better quality surgical microscopes, improved optics and newer source of illumination has helped in its advancements.
These modalities of surgery are the subject of discussion in the presentation of “Surgical Operating Department – Part 4”.
It can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

21/01/2022

Surgical Modalities

Many surgical innovations have been made in response to the need to provide better patient care in terms of faster recovery, less pain, less bleeding, better access and better outcome. In 1990’s laparoscopic surgery and thereafter minimally invasive services were developed. It started with cholecystectomy and then extended to almost all surgical disciplines. The techniques continue to develop and refine.

As with many innovative technologies, the laparoscopic surgery needs a thorough training in the instrumentation, its safety in use, its care and risks.

There are various types of laparoscopes used for various purposes for diagnosis and treatment. In general, a laparoscope has several components and several systems. This knowledge is essential for all those working in the minimally invasive operating room and also for those who are working in the supervising capacity.

These aspects have been discussed in part 3 of the presentation on the surgical operating department.

The presentation can be viewed at url: medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

06/01/2022

Patient Journey through the Operating Room

With the advancement in medical sciences and simultaneous availability of high end technology more and more difficult and complex surgical procedures are performed. A modern operating room environment is highly complex. In a complex environment errors are not uncommon. The minor slips and mistakes or deviation from processes may jeopardize patient safety.

There are many factors that contribute to the OR environment. These include, the physical environment such as noise and light, human factors such as ergonomics, and surgeon related factors such as fatigue and stress.

How a patient reaches the surgical table for an operating procedure follows a well laid out steps. At each step the health care workers perform certain well-rehearsed processes so that the patient journey is safe and reasonably stress free for the patient. Psychological support is important for the patient and all HCWs including the surgeon play important roles.

For ensuring patient safety, various procedures and protocols have been laid down. This includes patient identification, review of patient’s medical records, sign-out procedures and so on.

How the patient is transported, transferred on to the operating table and positioned on the operating table are all important for preventing injury to the patient.

The surgeon needs a better accessibility to the part to be operated upon. The surgeon determines the patient's position on the operating table. The patient positioning such that while providing better accessibility also avoids injury to skin, nerves, blood vessels, bones and muscle.

Various patient positioning includes positioning such as, supine, Trendelenburg, Fowler’s and so on.

These aspects have been discussed in the presentation on “Surgical Operating Department – Part 2” and can be viewed at medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...

30/12/2021

Surgery was the first discipline that emerged in the history of medicine. That was out of the need to treat injuries and war wounds. The history of the development of surgery through the ages is fascinating. In the earlier days surgery was not performed in any particular designated place. Even roadside performance where people can assemble in large numbers to appreciate the skills of surgeons was often preferred. Surgeons acknowledged the appreciation of the audience by a polite bow. Later a theatre-like room with a gallery where people could sit and watch the surgery was used. Thus the name ‘theatre’ came into being.

Gradually, with the progress in scientific knowledge and technology, the development of the operating room was also taking place.

In the United Kingdom, the Fellow of the Royal College of Surgeons had their origin in barber surgery. The doctors who were fellow of the Royal College of Surgeons were not prefixing their names with the abbreviation ‘Dr’ before their name.

The impetus of development of today’s surgical attire also reflects the development in scientific knowledge of causation disease as Luis Pasteur propounded the doctrine of germ theory of disease.

The development of surgical gloves was, however, not a result of science but because of a tender feeling of love of a surgeon.

Operating Theatre.
This fascinating history of development of surgery, operating theatre and surgical attire have been incorporated in the presentation on Surgical Operating Department - Part 1. The presentation can be viewed at Medicahospitals.in/about-medica/aha-kolkata

History of Hospital Administration in India In India, the hospitals were being traditionally managed by clinicians retaining their responsibility for patient care. These clinicians rarely had any training in management. As a result the hospitals were not managed as well as one would like it to be. T...