Submitted to:

Prof. J.P. Saxena

Submitted By:
109F
03 Harsha Agarwal
109F
28 Gangesh Gunjan
109F
35 Potnuru Krishna Chaitanya
109F
38 Pranav Pravin
109F
41 Arun Singh Jat
109F
50 Rohit Narain
109F
56 Akanksha Mishra

[FACILITY
MANAGEMENT IN
HOSPITALS]
A study of the various hospital management functions and how facilities in
hospitals are being managed now-a-days. The report also covers the various
soft wares which are being used to manage the facilities, staff, doctors and
the patients in the hospital.
 TABLE OF CONTENTS

Table of Contents.............................................................................................2

Introduction.....................................................................................................3

Location Analysis.............................................................................................8

Hospital Management Systems......................................................................10

Patient Management......................................................................................15

Utilization management.................................................................................19

BIBLIOGRAPHY...............................................................................................21

[2]
 INTRODUCTION

Hospital Management is a new theory in management faculty. Earlier a

senior doctor used to perform the role of a hospital manager. However,
nowadays everything demands a specialist. Almost all the things related to
hospital have changed, evolved and become more complicated. Many
categories concerning medical sciences and hospital have altered totally.
There are various types of hospitals today, including ordinary hospitals,
specialty hospitals and super specialty hospitals. The categories are
regarding to the types of facilities they offer to the people. Eligible
professionals are needed for the smooth operating of a hospital. Various
courses and training programs have been developed to find out eligible
hospital managers. New realities are placing pressures on the healthcare
industry, and how patient care is delivered.

Rising hospital management costs, an aging population, a shortage of

healthcare workers, challenges in accessing services, timely availability of
information, issues of safety and quality, and rising consumerism are some

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of the facts of today’s healthcare system. The industry has reached a point
of chasm, where they need to decide how services could be delivered more
effectively to reduce costs, improve quality, and extend reach. The critical
questions facing the industry today include: how can we effectively manage
hospitals and provide enhanced services without placing additional burden
on a system already pushed to its limits; how can we provide care in a cost-
efficient manner at a time when healthcare spending is rising; and how do
we most efficiently use our resources and support front-line staff in order to
reduce medical errors and enhance quality of care.

Hospitals must deliver high-quality care, comply with regulatory

requirements and enhance patient satisfaction while trying to reduce costs
and enhance efficiencies. They can improve performance through a
Performance Management Analysis tool that continuously integrates
transactional and analytical data across domains, departments and service
lines. The tool enables superior decision-making, planning and execution.

Enhanced real-time performance is based on superior operational planning

and execution, real-time performance monitoring and improvement, and
capacity and resource optimization. It demands better workflow
management, performance monitoring and sophisticated business
intelligence on a real-time basis.

These are just a few questions facing the industry. It looks bleak, but there’s
hope. There are new information technologies available to help. Information
technologies that enable immediate, information-rich communications and
provide easy-to-use collaborative tools are increasingly becoming a vital part
of today’s healthcare.

With the increased dependency of insurance claims to pay for hospital bills
and complications in medical procedures caused by omission of critical
information, it has been ever more crucial to understand patients’ history
before they are admitted or further treatment is required. This report also
talks in brief about patient management which is an integral part of new
hospital management systems. Patient management now is available at
national level in some countries with the issue of smart card, and medical
chips which practically have all of the patients’ medical history.

[4]
The next part of the report deals with Utilization management and how it is
been improves upon to provide for better and more efficient operations in
the organization. Utilization management is the evaluation of the
appropriateness, medical need and efficiency of health care services
procedures and facilities according to established criteria or guidelines and
under the provisions of an applicable health benefits plan. Typically it
includes new activities or decisions based upon the analysis of a case.

Utilization management describes proactive procedures, including discharge

planning, concurrent planning, pre-certification and clinical case appeals. It
also covers processes, such as concurrent clinical reviews and peer reviews.

To further explain the process of facility management in a hospital we need

to understand route which the patient takes on the next page.

The patient first feels a need for healthcare service. This may be due to
various internal or external factors. After the need is felt, he needs to assess
if it is an emergency or not. After which he would call an ambulance or go to
the hospital himself.

After reaching the hospital he need to either take an appointment or if there

is an emergency needs to get to the emergency ward and get admitted. If
hospitalization is needed, he would then have to fill up forms and
documentation before he is allotted a ward/room/bed. Incase no
hospitalization is required he can go to the doctor at the appointed time to
get himself checked up.

The doctor, as the requirement may be, will prescribe a number of tests
which the patient would have to get done. These tests may be done in house
at the hospital, or they might be required to be done at specialist test labs.
The results of which would then be shown back to the referring doctor.

The doctor would then decide if the patient is in need of an operation or if

just medications would be good enough to treat him. In case of operation
being required, the hospital would assign a surgeon to the patient who would
study the case, and then with consultation with the patient decide upon the
time and procedure of the operation. Also, the operation theater would be
needed to be booked.

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After the operation is over the doctor would schedule regular checkups and
prescribe the medications for the patient. The bill would then be generated
once the patient is certified to be discharged from the hospital.

These being the broad outlines, other complication in the procedure need to
be taken care of. For example Insurance claim needs to be accounted for and
adjusted at the time of admission and at the time of billing.

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 Patient feels the need for medical care

YES
Is it an emergency?

NO

Conduct test
Call ambulance Drive down Provide result

YES

Fill forms for NO

Is hospitalization neccesary? Test requiered?
hospitalizaton
YES

Doctor Examine
NO results

Doctor Examines
Refer to OPD
patient

Prescribe medication NO
Detail Checkups, Is operation requiered?
Brief Attendents (In-patient)

YES

Book
Discharge Generate Bill
Operation Theater
Take to Ward

Post operation checkup

& Operate
Schedule routine checkup

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 LOCATION ANALYSIS

Access to a properly functioning public hospital is crucial everybody. People

are not normally driven to locate to an area with an above average hospital
system, but will be less likely to move if the hospital service is adequate. The
best location for public infrastructure, including hospitals, varies due to
changes in society and demographics. Theories abound about how to
generate the necessary settings to ensure urban centers develop and
improve in a sustainable fashion. The ultimate goal is to ensure that any new
development that occurs is a step forward.

Prime considerations for the siting of new hospitals are:

• Locate close to the majority of people to be served, to minimize access

problems.

• Locate so that emergency and trauma services are accessible fastest

by the residents most likely to use them.

• Locate to minimize parking and traffic impacts on surrounding

neighborhoods.

• Locate to maximize public transport access, particularly for workers,

visitors and outpatients.

The site selection criteria should also include the following points.

• The site is substantial enough to permit the optimum number of

patient beds per floor, to facilitate efficient use of staff and
equipment/resources.

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 • The site can accommodate appropriate parking, and minimize parking
of patient, visitor and staff vehicles so as not to negatively impact the
environment around the premises.

• The site is zoned to accommodate support services complementary to

hospitals (pharmacies, medical offices etc.) so that as few as possible
need to occupy the main site.

• The site is designed so that there can be floor-to-floor relationships

among its individual structures.

• The site can be designed to produce a healing environment for

patients, preferably with an outdoor view from patient rooms and
outdoor access to gardens or parks.

• The site is free of environmental risks to its patients, staff and

neighbors.

The location must have following points

1. Site access: Road network, emergency vehicles, public and staff

parking, public transport, pedestrian/bicycle access.

2. Proximity: Proximity to current locations of allied health and

community services,, shops, cafes, doctor surgeries, staff residences
etc.

3. Economic: Impact on business activity through relocations of services

and trade-offs with other development or land use options.

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 4. Social and Cultural Environment: Suitability in relation to
surrounding uses, streetscapes, “fit” (architecture and height), impacts
on and by neighbouring development (e.g. noise, traffic, view impacts,
hours of operation), attractiveness to staff/patients, safety or persons)

5. Natural Environment: Impact on the environment and making the

most of natural features.

6. Statutory: Existing planning, zoning, building height limitations,

heritage etc.

7. Sustainability of services: Ability to function efficiently during the

redevelopment process.

8. Size: sufficient size to include optimum design, parking, potential

collocation of private hospital, commercial opportunities, public open
space and ongoing development potential.

9. Physical attributes: Shape, geology, heritage, consideration of

natural hazards. Most of these aspects need to bebe dealt with during
the design process.

10. Future expandability: Possibility for adjoining properties to be

acquired and used if future development required.

HOSPITAL MANAGEMENT SYSTEMS

A hospital manager is in a way responsible for administrative dealings of the

hospital. He accepts the charge of various aspects of hospital management
and health administration reverencing to the patients and healthcare.

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Hospital Management Systems (HMS) have been designed to streamline the
business practices of hospitals and clinics. HMS ensures optimum use of the
medical records of patients. Being patient-centric, the system makes it
possible for all disparate files on a patient to be housed in a centrally located
system, ensuring retrieval and management of files effortless. Plus, easy
integration ensures a faster start up.

Hospitals are large and complex organizations, yet they function largely
without sophistication and technology inherent in other large businesses.
The most sophisticated of technologies used for the management of
hospitals comprise of computer systems running some type of database
software which is used to scheduling of appointments, tracking patient data
and medical history and keeping track of the attendance of the staff.

Healthcare operations management integrates quantitative and qualitative

aspects of management to determine the most efficient and optimal
methods of supporting patient care delivery. Operations management helps
hospitals and health systems understand and improve labor productivity,
reduce waiting lines, shorten cycle times, and generally improve the
patient’s overall experience—all of which helps to improve the organization’s
financial health.

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Hospital Management System not only provides an opportunity to the hospital to
enhance their patient care but also can increase the profitability of the
organization. This would enable to improve the response time to the
demands of patient care because it automates the process of collecting,
collating and retrieving patient information.

Hospital Management System includes:

1. Patient Registration

2. Appointment Scheduling

3. Admission Discharge Transfer

4. Bed Management

5. Wards Management Module

6. Patient Relations

7. Doctors Workbench

8. Nursing Workbench

9. Operation Theater

10. Electronic Medical Record

11. Clinic Specialties

12. Laboratory Information System

13. Radiology Information System

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 14. Pharmacy (Chemists)

15. Central Sterilized Supply Department

16. Blood Bank

17. Housekeeping/Laundry

18. Equipment Maintenance System (EMS)

19. Healthcare Packages

20. Patient Billing

21. Insurance and Contracts Management

22. Management Information System (MIS)

23. Hospital Administration

24. Roster Management

25. Financial Accounting

There are some of the benefits of HMS. They are:

• Enables hospitals and doctors to better serve their patients: As

an integrated hospital management system makes it easier for a
doctor to know the schedules and availability of the various facilities of
the hospital, like the operation theater, wards and also it can integrate
to send test results directly to doctors. This in turn translates into a
better quality of service for the patients.

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• Improved quality of patient care: With the patients’ accurate
medical records available to the doctors and medical staff, it becomes
easier for the doctor to treat a patient in accordance to the history of
the ailment the patient is suffering.

• Increased nursing productivity: As the hospital staff had access to

the doctor’s notes about the patient, they might be able to better
serve him/her with personalized care.

• Reducing the time spent by staff filling out forms, freeing

resources for more critical tasks: As most of the tasks are
automated in case software is used for management of the hospital,
the staff may not necessary be involved in mundane tasks. This would
free them up for more critical tasks like tending to emergencies.

• Real-Time information: The Hospital Real-Time Performance Monitoring

solution from Infosys presents real-time information to the user, as and
when events occur, thus providing an opportunity to recognize and
respond to event/trends early and shape outcomes proactively.

• Increased quality of healthcare and patient safety: It enables clinicians to

significantly improve clinical outcomes while reducing mortality, length
of stay (LOS) and avoiding the increased costs associated with treating
complications. Real-time performance monitoring is an extra safety net
to protect the patients against adverse events.

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 PATIENT MANAGEMENT

Patient Management provides the functions you need to manage inpatient

and outpatient intake from pre-admission/pre-registration through discharge.
Customer-defined value tables and edits throughout the patient access
workflows help hospital staff ensure accurate data collection.

• Positive first impression - While the registrar function is often an

entry-level position with significant turnover, it is the first face of your
organization to patients, who expect answers to all kinds of questions.
Patient Management will help you have a positive interaction with your
patients.

• Simplified patient information access - Patient Management

provides a variety of look-up queries to help staff determine if the
patient has previously visited your facility. Look ups such as name,
approximate name, medical record number, patient status, and
attending doctor are used most often in the registration area.

• More accurate claims - In today’s revenue cycle environment, where

contract and denial management applications are relatively common,
registration offers the best opportunity for improving claims – by
collecting accurate patient and insurance information.

• Interfacing with ancillary systems - As the master ADT system for

your HIS, Patient Management will forward all admission, discharge,
and transfer information to your many ancillary systems. If your
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 ancillary systems are authorized to modify demographic or other
specialty updates, the updates can be returned to INVISION via
standard two-way interface support.

Case Management

Case management is a managed care technique. It is a procedure to plan,

seek, and monitor services for different social agencies and staff on behalf of
the patient. Usually one agency takes primary responsibility for the patient
and assigns a case manager, who coordinates services, advocates for the
client, and sometimes controls resources and purchases services for the
client. The procedure allows many workers in the agency, or in different
agencies to coordinate their efforts to serve a given client through
professional teamwork, thus expanding the range of needed services
offered.

One does not have to be a nurse to function as a case manager.

Occupational therapist's and social workers have clinical components in their
background. Occupational therapist does in particular have a holistic
approach, making their function as case managers particularly client-
centered, which is beneficial to the outcomes of the client. From a bird's eye
view, the CM position is broken down into a few components. 3/4 of the
workday is spent doing utilization review, and the other quarter is actual
discharge planning.

Most nurse case managers work in hospitals or at health maintenance

organizations; some function as independent consultants.

Case management focuses on delivering personalized services to patients to

improve their care, and involves four steps:

1) Referral of new patients (perhaps from another service if the patient has relocated to a
new area out of previous derestriction or if client no longer meets the target of previous
service, such as requiring a greater level of care.

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 2) Planning & delivery of care

3) Evaluation of results for each patient & adjustment of the care plan

4) Evaluation of overall program effectiveness & adjustment of the program

Functions of Case Management in Health Care

Health insurer and HMO setting

Case managers working for health insurers and HMOs typically do the
following:

1. Check benefits available;

2. Negotiate rates with providers who are not part of the plan's network;

3. Recommend coverage exceptions where appropriate;

4. Coordinate referrals to specialists;

5. Arrange for special services;

6. Coordinate insured services with any available community services; and

7. Coordinate claims with other benefit plans.

By identifying patients with potentially catastrophic illnesses, contacting

them and actively coordinating their care, plans can reduce expenses and
improve the medical care they receive. Examples include identifying high-
risk pregnancies in order to ensure appropriate pre-natal care and watching
for dialysis claims to identify patients are risk of end-stage renal disease. The
amount of involvement an insurer can have in managing high cost cases
depends on the structure of the benefit plan. In a tightly managed plan case
management may be integral to the benefits program. In less tightly

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managed plan, participation in a case management program is often
voluntary for patients.

Health care provider setting

Case managers working for health care providers typically do the following:

1. Verify coverage & benefits with the health insurers to ensure the provider is
appropriately paid;

2. Coordinate the services associated with discharge or return home;

3. Provide patient education;

4. Provide post-care follow-up; and

5. Coordinate services with other health care providers.

Employer setting

Case managers working for employers typically do the following:

1. Verify medical reasons for employee absences;

2. Follow up after absences from work due to poor health;

3. Provide health education;

4. Assist employees with chronic illnesses; and

5. Provide on-site wellness programs.

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 UTILIZATION MANAGEMENT

Utilization management is the evaluation of the appropriateness, medical

need and efficiency of health care services procedures and facilities
according to established criteria or guidelines and under the provisions of an
applicable health benefits plan. Typically it includes new activities or
decisions based upon the analysis of a case.

Utilization management describes proactive procedures, including discharge

planning, concurrent planning, pre-certification and clinical case appeals. It
also covers processes, such as concurrent clinical reviews and peer reviews,
as well as appeals introduced by the provider, payer or patient.

As pre-certification and concurrent review of cases grew, utilization

management spun out of utilization review.

While not synonymous, health care professionals tend to use the terms as
interchangeable. The difference is utilization management is forward looking
and intends to manage health care cases efficiently and cost effectively
before and during health care administration. Utilization review is more
backward looking considering whether health care was appropriately applied
after it was administered.

Health care organizations are looking to case management, clinical paths, and other innovative
system changes to reduce over-utilization of services. However, these resource management
initiatives take time to design and implement. For example, facilities report that designing and
implementing even one clinical path can take from three months to one year. If your utilization
problems need attention immediately, several quick-fix solutions may be your best first course of
action.

Resource management education for staff can significantly change old habits without a major
outlay of dollars. If your staff still think resource management is the job of the utilization
manager and not theirs, it's time to change this attitude. At department staff meetings provide in
service presentations about resource management. Each employee should know how they

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personally impact the cost-efficiency of health care services and what they can do to minimize
lost revenue due to poor utilization. Employees must understand the goals of utilization
management and their individual role in making sure that:

• only appropriate patient care services are delivered

• services are provided in the most appropriate care setting

• the facility receives payment for services rendered

• less than optimal patient care outcomes and/or system inefficiencies are reduced

Both clinical and non-clinical staff should receive education about the facilities' utilization
management goals and how staff impact the organization's ability to achieve these goals. Share
reimbursement data with the staff — helping them to understand how payment schemes are
changing and the impact of new per diem or capitated reimbursement contracts.

Utilization management education must also include the physicians. Sharing charge and
reimbursement data with physicians helps them to appreciate the impact of their ordering pen.
Show them how their practice compares to that of their peers. Comparative cost reports provided
to physicians on a regular basis can heighten their awareness about charges. If physicians don't
know their practices differ from those of their peers, they can hardly be expected to change!
Even if you only have access to charge data, not cost data, that's OK. Comparing charge data
internally is valid.

Another way to reduce unnecessarily long lengths of stay is to educate physicians regarding post-
hospital patient care options. Until a few years ago heavy care patients could not be managed in
skilled facilities or by home health agencies. Physicians still laboring under the misconception
that heavy care patients must be hospitalized should be educated in the wide variety of out-of-
hospital treatment options available today. To ensure physicians are up-to-date in their
knowledge of non-acute service availability, case management staff should make regular
presentations at medical staff meetings. Similar awareness training should be provided to
physicians' office personnel.

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 BIBLIOGRAPHY

1. http://www.axissoftech.com/hospital_management_system.htm

2. www.medinous.com

3. http://www.acgil.com/products/hospital_management_system_001.htm

4. http://www.paramounthealthcare.com/body.cfm?id=67

5. www.goursoft.com

6. www.oosd-assignment-1.googlecode.com/files

7. http://www.medical.siemens.com/webapp/wcs/stores/servlet/

8. www.dynamicarray.com.au

9. www.mcres.com/mcrmm02.htm

10. www.paramounthealthcare.com/

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