46
Medicine
Dr Madhav
Madhusudan
Singh
Dr Pradeep
Srivastava
ABSTRACT
It has become essential for healthcare providers to understand and measure structure, process and outcome of OPD service and its gaps, so that any
perceived gap in delivery of service is identied and suitably addressed. A study was conducted at a super speciality public hospital to ascertain any
service gap between structure, process and outcome in respect of the hospital outpatient department (OPD) services.
Method : The study were conducted at Public Super speciality hospital by designing a checklist study on structure , process and outcome in OPD of
the hospital, using the IPHS Standards as the survey instrument. The checklist has been empirically evaluated in the hospital environment and has
been shown as a reliable and valid instrument in that setting. The checklist was designed to measure OPD Services about service provided using 118
Service elements, using a qualitative , structured checklist by direct observation by researcher .
The study concludes that signicant gaps in structure, process and outcome existed in the delivery of the hospital OPD services, which need to be
addressed by focused improvement efforts by the hospital management.
KEYWORDS
Hospitals, Outpatients, Evaluation , Structure , Process , Outcome
3. EQUIPMENTS & INSTRUMENTS b Is there a transport facility from main road to the Yes
a The facility has adequate number of Yes facility, in case it is at signicant distance?
equipments along with instruments as stated in c Adequate sign postings are available at various strategic Yes
ME Scale of CH. locations so as to guide the patients to the facility.
b The equipments are in functional order and No (Roughly 9. AVAILABILITY OF STAFF
have an up time of 98%. 40% a At least 01 medical ofcer and 01 nurse are available at Yes
Equipments all times in the facility.
found non-
b Facility is guarded by Security personnel 24X7. Yes
functional )
c Available staff are immunized and insured for health/ Yes
c There is appropriate mechanism for repair, Yes hospitalization.
maintenance and two year renewable AMC of
all the equipments. 10. EVALUATION OF PATIENT 6
d The instruments used are adequately Yes a All patients undergo assessment with privacy and Yes
disinfected, sterilized and kept in good working dignity.
condition. b The nurse carries out assessment in terms of noting the Yes
e Utilization of equipments is monitored on No vitals, height and weight of the patient in a pre-
regular basis. designated area of the OPD.
f Organization has resources for ensuring skill No c Medical ofcer documents the ndings of the patient in Yes
based training on use/ handling of equipments. a denite area in the OPD.
4. MANPOWER & STAFFING d Advice for medication and investigation is documented Yes
a The stafng norms as stated in govt scale for Yes in predened areas of the card.
hospital are maintained. e. The documentation is legible, timed, dated, named and Yes
b Roster for doctor and nurses is displayed. No signed by the medical ofcers.
c Disaster Management drill SOP Avlb Yes f The instruction is communicated to the patient in an Yes
understandable (verbal and written) manner.
5. DRUGS
g A record of all such assessments is maintained (for time Yes
a Availability of drugs and surgical consumable No ( Only 60
limits as per regulations) in the facility.
are ensured. % of total
inventory 11. CARE OF PATIENTS
available ) a The staff is courteous, humane and empathetic. Yes
b Availability of drugs is displayed along with No b Care is commensurate with the amenities available. Yes
expiry dates. c Care is provided in manner in which dignity and privacy Yes
c Medical Ofcers prescribe drugs based on the No of patient is maintained.
available formulary or essential drug list. d Organization has Care, Admission, Referral and Yes
Discharge Policies.
e Organization has written SOPs on Care. No
d Medicines dispensed have clear instruction on Yes
dose and schedule for consumption purposes. f Organization has written Consent Policy. Yes
6. TRANSPORT & AMBULANCE g Care is comprehensive in nature i.e. preventive, Yes
a There is at least one ambulance. Yes promotive, curative and rehabilitative in nature.
b Driver for the same is available at all times. Yes h Documentation for all procedures carried out in the Yes
c Ambulance is in working condition at all times. Yes facility is mentioned in the case records.
d Emergency drugs available in the ambulance. NO (In A&D j All the instruction by the medical ofcer is legible, Yes
Dept) dated, timed, named and signed.
e Basic resuscitation kit available in the NO (In A&D k Patient's condition is communicated to the family Yes
ambulance. Dept) members.
f The Stretcher trolleys and wheel chairs are in Yes l In case of death, a death summary is given to the No
working condition all the times. patient's family.
7. COMMUNICATION FACILITIES m An informed consent is obtained for patients undergoing Yes
any procedures.
a The centre has adequate stationary for written Yes
communication. n A list of procedures for which informed consent to be No
obtained is available in the facility.
b At least 2 telephone connections are available Yes
in the facility at all times. o The consent forms are in vernacular/local language. No
c Arrangements for a public address system Yes (Only
available. in
English
d Organization uses Signboards, Posters or/ and Yes )
wall painting displaying the activities and
services (along with timings) at the facility and p Consent is obtained either by the medical ofcer or the Yes
the important contact numbers at prominent nurse.
sites in the campus. These are in local 12. CONTROL OF INFECTION
language. a Infection Control Policy is available. Yes
e Campaigns for National Health Programs are Yes b Identied/ ear marked resources (0.5% Sodium No
displayed in the form of wall painting or Hypochlorite etc.) for infection control are available.
boards.
c Written protocols on cleaning of the infection prone Yes
f Lay out map of the facility and signage is in Yes areas and equipments used in patient care are available.
vernacular and symbols to address the needs of
vulnerable patients. d The facility takes all precautions to control infection. No
e Adherence to standard precautions is maintained by all No
Process assessment staff.
8. ACCESS TO FACILITY f Mopping (by latest available disinfectants) of all areas No
a The facility is easily assessable by approachable all Yes of the facility is carried out at least twice a day.
weather roads.
g Availability of running tap water for hand washing of Yes c Training for behavioural change communication is Yes
staff is maintained 24 hours a day. carried out and documented.
h The hospital environment is kept clean from litters, pest No d Training on all aspects of various national health Yes
and stray animals. programs is carried out.
j Adequate lighting arrangement and cross ventilation Yes e Evaluation of all such training is documented. No
present in all areas. f Several cash and non-cash incentives are given so as to Yes
k Sanitation of the toilets and hygiene of the staff is Yes constantly motivate the staff.
maintained. g Training is provided on both theoretical as well as Yes
l Adequate amount of disinfectants is available for Yes practical aspects.
disinfection purposes. h There are policy on encouragement and appreciation of Yes
m The facility is washed with soap and water regularly and Washed performers through incentives and awards.
a documentation there of is maintained. but no 17. LICENSES & STATUTES
records a All licenses e.g. Narcotics, Waste management, BARC, No
availabl AERB, re safety etc. as applicable are available in the
e hospital.
13. HOSPITAL WASTE MANAGEMENT
b Statutory requirements concerning patient and staff Yes
a Hospital waste generated is managed in accordance with No yet safety and welfare are met.
the Biomedical waste management and handling rules to
2016 implem OUTCOME STANDARDS
ent 18. Utilization Indices of the Centre
b General waste is collected in black bags. Yes a Recording of all parameters as stated in the monitoring Yes, but
c The sharps are subjected to deep burial and a pit for the Yes section of the Hospital is maintained. centrally
same is available with in the hospital premises b Data of utilization of OPD, Referral services (to & from Yes, but
according to the dimensions specied by the BMW the facility), ambulance services, MLC cases are centrally
rules 2016. analysed and maintained for continuous quality
d Facilities for syringe and needle destruction are Yes improvement
available and practiced. c Documentation & reporting of hospital statistics Yes, but
e Chemical treatment of plastics is carried out by using Yes centrally
freshly prepared bleaching lotion. 19. Statistics
f A site for composting of biodegradable waste is No a Statistics in terms of OPD attendance, is documented Yes
available with in the hospital premises. and reported
g Annual report is submitted to the competent authority Yes b Statistics for OPD published every quarterly Yes, but
by 31st January every year. monthly
h Accidental spillage of waste is reported and handled as Yes 20. Patient & Employee Satisfaction Survey1,2,3
per the BMW Guidelines. a On-going mechanism of conducting employee No
j Segregation of wastes is done in maximum of 3 bags Yes satisfaction survey is present.
(Black, Yellow & Blue). b Grievance Redress Policy and mechanism are in place. Yes
k Organization has resources to train all health personnel Yes c Organization has in use feedback mechanism like use of Yes
on handling BMW as per regulations. feedback forms, suggestion forms to be dropped in
suggestion/ complaint boxes at identied places.
14. RIGHTS & RESPONSIBILITIES OF PATIENTS
21. Health Information System
a Rights and responsibility of the patients are in Yes a Reporting of all the details is done through a web based Yes
accordance with Hospital Policy health information system to the army authorities on a
b A mechanism for grievance redressal is in place and No daily, weekly, monthly and annual basis.
practiced. b Health Information System tools are available Yes
c All redressal mechanisms are documented. Yes
d The patients have the right to their privacy, information Yes During the survey following observation were found which
and disease condition that shall not be disclosed to require urgent attention :
others. Landscaping was not done in OPD Area.
e Citizen charter and rights of the patients are displayed in No Accommodation (Semi-Full furnished) facilities (as per grades)
local language and are universal for the state. for the core staff i.e. MO, Nurse, and Pharmacist was not available.
There was 24X7 availability of electricity and potable water
15. RIGHTS & RESPONSIBILITIES OF STAFF
supply with identied alternate sources. There was no alternative
a The healthcare providers respect the patient's rights. Yes sources.
b Staff can demonstrate reasonable skill to provide care to Yes Attendants' lounge (temporary stay facility) were not provided
the patients. within the campus.
c Staff is entitled to all the benets (immunization, Yes The 60 % equipments were in functional order and have an up time
healthcare cover through insurance, semi to fully of 98%.
furnished staff quarters as per entitlement and Utilization of equipments were not monitored on regular basis.
availability, its maintenance and security) due to them Organization has resources for ensuring skill based training on
by virtue of their employment. use/ handling of equipments. But not utilized .
Roster for doctor and nurses were not displayed.
d Healthcare providers are immunized for Hepatitis, Yes Availability of drugs and surgical consumable were not ensured.
Tetanus etc. Only 60 % of total inventory available .
16. TRAINING, DEVELOPMENT & MOTIVATION OF Availability of drugs not displayed along with expiry dates.
STAFF Medical Ofcers were not prescribing drugs based on the available
a The organization arranges for continuous update of Yes formulary or essential drug list.
knowledge and skills of the staff. Emergency drugs were not available in the ambulance.
Basic resuscitation kit were available in the all ambulance.
b Periodic training programs on the subjects of waste Yes Organization don't have written SOPs on Care.
management, infection control, communication etc. are In case of death, a death summary were not given to the patient's
carried out and documented. family.
The study revealed that, most of the standard operating procedure are
not followed on ground. Though the documentation part was up to the
mark but the area of concern lies with awareness and implementation
of policies and procedures among the healthcare providers. The
hospital had structural gaps i.e. building is old & requires attention.
The utilization rate of various departments of OPD was adequate. Most
of the patients were found just satised with the services received5.