Introduction of project:

We are going to prepare a project for the subject of Total Quality Management. This subject deals with the study of Zero defects, continual improvement, and elimination of waste in organization to increase its quality. The major important strategic tool in total quality management is benchmarking. Benchmarking should be a reference or measurement standard for comparison. It is a tool for performance assessment and continuous improvement in an organization performance. So the organization that is assigned to us is Aziz Bhatti shaheed Hospital Gujrat. By using benchmarking technique we want to improve hospital performance, quality, customer satisfaction and providing some suggestions in the areas where it lack.

Importance of health sector and contribution of our work for this sector:
The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Thats why health sector play a major role in maintenance of health or make a healthy environment. In the development of any country is necessary that their people must use their skills effectively or properly do their work in better manner and make planning for their better future. This can be achievable if the people of that country are in good health. For a healthy society need good hospitals those deal with people and provide proper guidance for improving their health. Our project will help Aziz Bhatti Shaheed Hospital to improve its services in orthopedic department. If hospital apply best in class methods then their patient will become more satisfied, generate positive word of mouth. Our project describes continual improvement, best workers performances, how internal customers are satisfied, and ways to improve performances as well as the suggestions for organization improvement where they are in lack.

History:
The DHQ Hospital Gujrat was established in 1963 and renamed in 1966 as Aziz Bhatti Shaheed Hospital, Gujrat. The hospital has 400 beds. It is the Government hospital that full fills the health care needs of local people as well as people of neighbouring districts and towns such as Bhimber, Mandi Bahauddin and Wazirabad. It has been attached with the Nawaz Sharif Medical

College as the teaching hospital. This hospital is also providing routine care services to the prisoners of District Jail, Gujrat. The Pakistan Medical and Dental Council have recognised the hospital for house-job training. The hospital has the departments of Emergency, ENT, Gynaecology, Medicine, Obstetrics, Ophthalmology, Orthopaedics, Surgery, Paediatrics, TB/Chest Cardiology and Urology.

Introduction of orthopaedic department:

In Aziz Bhatti Shaheed Hospital orthopedic services provide treatment of the skeletal system, its joints, muscles, and associated structure. Orthopedic primarily concerned with the handling of all types of trauma cases and road traffic accident. There are mostly legal issues involve in the fighting so medical causality officer deals with these issues and patient are treated in emergency department stopping their blood, shock recovery and then transfer them to the related department. The department of orthopedic has 32 beds. It provides emergency care for patients of muscular skeletal trauma. Two doctors are available in this department: Dr. Tallab and Dr. Wazahat Hussain. They are doing orthopaedic surgery of patient like joint replacement surgery, entering the plates in body etc. Major activities in this department are checking of outdoor patient, surgeries and ward visit. This department deals with general operations and not for specialized operations due to lack of technology. for

Major competitor and their introduction:

Gujrat hospital on Bhimber Road Gujrat City hospital Bashir Hospital Bukhari Diagnostic Center Ali Children Hospital Doctor Hospital Fauji Foundation Medical Center Wahid Trust Hospital Ishaq Eye Hospital

Critical success factors:

Speed: Check almost 105 to 110 patients in 5 hours. Quality: With in limited resources they provide quality services that increase the satisfaction level of their patient 24- Hour services: They provide 24-hours ward service with in three shifts.

Detail of Current process (flow chart):

10:00 to 11:00 am
Doctors (orthopedic dept.)

Ward visit Outdoor patient

Daily morning Monday, Wednesday, Thursday, Saturday Tuesday, Friday

8:00 to 2:oo pm

Surgeries

Flow chart of medical services for outdoor patient: Patient Arrive

Patient in the system No Take appointment

yes

doctor available No

yes

Patient with doctor

Waiting room Check up/ treatment

Take prescription

Patient leaves

Decision

Process

Start/end

Assets/resources of the department:

Human resource: 2 doctors 2 ward servant 3 staff members 1 dresser 3 sweepers 1 peon Physical resources: Outdoor: 21 visitor chairs 4 benches, 1 stature, 1 X-Ray scanner, 5 chairs, 1 cupboard in doctor office Indoor: 2 wards for female and male both include 17 beds for female and 15 for male Doctor office for Talib Hussain & Wazahat Hussain Warraich

Identify external and internal customers:

Internal customers: Internal customers include their employees. Those are 2 doctors 2 ward servant 3 staff members 1 dresser 3 sweepers 1 peon External customers: Their external customers mostly include Gujrat area people as well as other districts and towns such as Bhimber, Mandi Bahauddin and Wazirabad people. Due to lack of modern technology and funds specialized

cases did not deal here and quality of service is little bit low. Mostly average or low income people are from external customers.

Employees (total no of employees in department, their positions, salaries, timings, duties, shifts, who is immediate boss? Who assigns duties and responsibilities
There are 12 total employees in this department. Positions: There are two doctors, three staff members, one dresser, two ward servants, three sweepers and one peon. Salaries: The salary of the peon, ranges 9000 to 12000 depend on their service period. The salary of the assistant of the doctors is 15000. The salary of nurses is 25000 and above. The salary of seniors members is around 55000 to 65000. The salary of the doctor is 1 lac and above according to their service time/ experience.

Timings: The timing hours of doctor are 8 a.m. to 2 p.m. There are two shifts of peon timing hours of one peon is 8 a.m. to 2 p.m. And second peont is 3 p.m. to 9 p.m. Nurses and sweeper have three shifts of there duties: morning, evening and night and every employee work 8 hours. The duty of doctor is checking outdoor patient and surgery. Nurses duty is to provide medicine to patient that is admitted in hospital. Peon has the duty of security and checks every one that is entered in the hospital. Assistant of the doctor record the entries of patients. Sweepers have the duty to clean hospital. Ward servant handle the work that is take place in the ward like doze timing etc. Dr. Wazahat Hussain is the immediate boss of the department. He is also assigns the responsibilities and duties of all employees.

Volunteers, students, internees role in department:

This hospital does not provide the proper facility of intern ship so there is no internee in the hospital at that time. There was only one internee in this hospital last year and the duration of his internship was four to six month but there is no internee in this department. The internee helped seniors for their routine work, reduce the burden of employees and treat every one equally.

How quality of product/service is ensured?

Dr. Wazahat Hussain Warraich assigns duties to their employee according to their capabilities. Also there is proper check and balance on these duties those assigned by their supervisor (Dr. Wazahat Hussain Warraich). They also increase their quality by daily visiting the ward & ask the patient about their problems. So in this way they provide better solution about their problem that increases their quality services.

How problems are being resolved?

Lack of staff lack of beds lack of equipment lack of specialist lack of medicines lack of financial resources

Solution: Government should offer new vacancies for staff and specialist as well. Government should provide budget for this department on continuously basis and MS should not miss manage these resources. There must be medicine facility at one spot that should fulfill requirement of all departments in this hospital. There must be proper utilization of department space.

Problems face by employees (process owners) in current process:

The biggest problem of process owners is lack of financial resources. Government do not provide sufficient funds and MS (Medical Superintendent) miss use all the resources. So in this department doctors do not have innovative machines for surgeries, blades, plates, threats, medicine, nuts and proper medicine for surgery. Doctors do pre operating activities about 2 to 3 days before surgery and tell their patient for proper nuts size, blades, plates etc. These things are mostly brought from Lahore so more time required. There is lack of specialist in this department for operations, poor quality medicine, poor quality of X-Rays so doctors can not identified proper area and cause for treatment.

Outlook of the facilities, employees look (uniform, card etc):

There is proper uniform that is assign to all employees but employees do not wear it. Doctors mostly wear dress pent, sweeper and assistant mostly wear shalwarqamiz and nurses wear white shalwarqamiz with white upper and dophata. We do not see any card that is wear to any employees.

External customer: Average no of customers per month and per day:

Average no of customers per day are 105 to 110. Average no of customers per month 1800 to 2000.

Employee customer ratio:

Employee customer ratio shows one employee handles how much patient Employee customer ratio= Patients/employee =110/12 =9.167 or 10

Facilities available for customers:

For the purpose of guidance the employee outside the doctor room provides help to patient regarding ward location, doctor office etc. There are 21 seats for patient outside doctors room and within doctors room there are 5 seats, bench and one stature for patients. Doctors visit the wards daily from 10 a.m to 11 a.m. And the patient relatives visit the ward since morning to night 10 p.m. There are electric cooler of water for patient and only one people is allowed to stay with patient.

Major problems faced by customers and their reasons:

Major problems include waiting for surgery, limited medicine for surgery, bought surgery nuts, threats, and slabs by patients themselves, lack of bed facility. The hospital do not has specialized equipment for surgery so patients cannot avail these services in this hospital. Patient must go to Lahore or Islamabad for these services. Reason for these problem lack of financial resources, lack of specialized doctors, mismanage of funds and improper utilization of space.

How much time customer waits for different services?

Patients wait for beds until the earlier patient discharged. Only 10 to 15 minutes comes for in one patient so next patient in the room wait for this time. For surgery there are 3 day require for doctors for pre operating activities so patient must wait three days.

Benchmarking Organization:
Shifa International Hospitals Ltd Islamabad

Business sector:
The Hospital was incorporated on September 20, 1987 as a Private Limited Company and converted into Public Limited Company on October 12, 1989.

Reason of selection benchmark:

We select Shifa International Hospital as a benchmark because it provides best quality services to their patients in a cost effective way. Now after more than one and a half decade Shifa International Hospital proudly stands as a symbol of quality healthcare with its own brand name "SHIFA". Hospital has medical expertise, clinical excellence, state of the art technology that effectively and efficiently provides best customer services. Factors that contribute hospital quality and performance include caring people, preventive medicine and health care management. Hospitals orthopedic department is filled with best trained, qualified and experience staff. This department handles general as well as specialized cases like arthroscopy, joint replacement etc. Its major focus is on customer satisfaction, improve quality of its services, competitive position and continuously improve process and system. Hospitals upper management is fully committed and working hard to apply effective change. So Aziz Bhatti Hospital can increase their service quality, customer satisfaction and competitive position if it will consider the policies and method of Shafa international hospital Islamabad in its orthopedic department as well as in whole organization.

Data source (sources-internal, published, external or original research):

We used internal source as well as published material for getting data about the organization. Internally we get data Mr. Waqar and Sajjad Hassan. We also used hospital website to get data that help us to conclude our result.

Contact person:
Waqar M. Jan / ORTHOPEDICS Sajjad Hassan Orakzai / ORTHOPEDICS

Check list of topic:

What is hospital service delivery speed? How hospital provides Quality of service to its customers? What type of resources Shifa International hospital has in its orthopedic department? How many customers have in its orthopedic department? What is the timing of customers visit? What specific dress its employees wear? What type of facilities available to customers in orthopedic department?

Past history positives:

The Shifa International hospitals orthopedic department provides general as well as specialized operation facility to its customers. It provides treatments of musculoskeletal conditions such as bone and joint injuries, degenerative joint diseases etc. The department provides a 24 hour trauma service for the hospital, managing all orthopedic trauma and injuries such as fractures and dislocations. It also coordinates the management and rehabilitation of patients after injury. The department is being managed by 3 consultants and a full fledge team of well-trained staff to cater to patients. Cost effective quality medical care are available to all patients. They also ensure ethical practice of medicine in their department. The history of Shifa showed that its consultants, management and staff are fully devoted and provides best customers services to its patients to become more competitive.

Flow chart of Shifa International Hospital Ltd:

Patient Arrive

Patient in the system

Take appoint ment

doctor available No

yes Patient with doctor

Waiting room

Check up/ treatment

(Patient in the critical situation) Shift in the ward

Take prescription

Recover

Patient Leave

Patient leave

Decision

Process

Start/end

Critical performance measures of benchmarking partner:

Shifa International Hospital has strong image in customers mind. It has better performance due to highly qualified & experienced doctors, latest technology and enough resources that meet the patient requirements. Hospital orthopedic department has three consultant and provides 24 hours services. It provides different general as well as specialized service like Management of fractures, Joint replacement, Management of upper/lower limb injuries, Arthroscopy, Muscle biopsy, Management / correction of limb deformities. It has ward as well as separate rooms for patient. Average no. of patient is 2500 in one month that show their customer satisfaction. Their timing for consultant with doctor is from 8 am to 11 a.m. Shafa international has more staff than Aziz Bhatti Hospital that is specialized in their work. Hospital have sufficient finds that they are utilize in proper place and in proper way that increase their efficiency in process and service quality but charges in Shifa international hospital little higher that Aziz Bhatti hospital. Gap analysis: This step involves analyzing the data collected, discovering to what degree present performance lags behind the best in each area and combining the best features from the best practices into an ideal process. The correct implementation of this step will result in a clear picture of your processes in comparison with others in your business or industry.

For outdoor checkup Aziz Bhatti Hospital has two consultant, Dr. Tallab and Dr. Wazahat Hussain while Shafa International has three consultant that check their patients properly . They give more attention and accurate advise due to division of work.

Aziz Bhatti Hospital has less staff like sweeper, ward servant and peon etc while Shafa International Hospitals has one peon, 2 sweepers and necessary ward servant better than Aziz Bhatti Hospital. So more staff for necessary work better contribute to provide services to its patients. In Aziz Bhatti Hospital customer visit time is 8 a.m to 2 p.m. While in Shafa International Hospital customer visit time is 8 a.m to 11 a.m because more trained and experience consultant are available here. In Aziz Bhatti Hospital physical resources like chairs, X-ray scanner, benches, stature etc. are less than Shafa International Hospital. Aziz Bhatti Hospital has two wards for male and female but in Shafa International Hospital has wards as well as separate rooms that are available for customer demands. So patients do not wait for services until bed is empty. Aziz Bhatti Hospital 's orthopaedic department provides only general operation facility to its patients and for specialized operations patients go other hospitals while Shafa International Hospital provides

general as well as specialized operations facilities. These specialized operation facilities at one place increase customer satisfaction and well trained doctors increase service quality. In Aziz Bhatti hospital there is pre operation activities for operations because operation screws, blades, plates, threats, nuts and proper medicine for surgery is not available in Gujrat so these things bring to other big cities while in case of Shafa International Hospital mostly all necessary equipment is available. In Aziz Bhatti Hospital there is lack of new technology like X- ray facility, X-ray scanner and operation machines while in Shafa International Hospital there is modern technology in operations machines, best X-ray and X-ray scanner facility so doctor easily understand the problem for treatment. In Aziz Bhatti Hospital, Ms does not utilize the funds of government in better way but in Shafa International Hospital government funds utilize efficiently so customer spend a little on operation equipments and medicine etc. Aziz Bhatti Hospital does not utilize their department place effectively so there are less beds for patients while Shafa International Hospital utilizes there space and also develop separate room facilities for patients to provides best services. So best features include increase consultant, increase staff members, increase technology, proper utilization of space, proper utilization of government funds, best technology, better equipment and medicine, sufficient physical resources and general as well as specialized operation facilities. These all features make a best process and provide quality services to its customers.

Gaps (positive or negative):

There is a negative gap because Best in class (Shafa International Hospital) performance Aziz Bhatti Hospital Gujrat

Shafa International Hospital almost leads in all area to Aziz Bhatti Hospital in its orthopaedic department.

Gap is widening or narrowing along with reasons:

The gap between performances of Aziz Bhatti Hospital and Shafa International Hospitals orthopaedic department is widening.

Reasons:

 The gap is widening because Shafa International Hospital is best in almost all services that it provide in its orthopaedic department than Aziz Bhatti Hospital. Shafa International has more consultant than Aziz Bhatti Hospital. It has better technology in process like X-ray facility-ray scanner than Aziz Bhatti Hospital. Shafa International Hospital has proper utilization of government funds.

It has separate rooms for patients as well as wards but Aziz Bhatti Hospital has only two wards for patients.

Shafa International has best qualified, trained and experienced staff with sufficient human resource than Aziz Bhatti Hospital. Shafa International Hospital provides all kind of operation facilities in its orthopaedic department with less time than Aziz Bhatti Hospital.

Root causes:
Root causes involve: Lack of trained and experienced staff
lack of modern technology like efficient X- ray facility, X-ray scanner and operation machines

lack of beds facilities

lack of operation equipment like crews, blades, plates, threats, nuts etc

lack of specialist lack of financial resources

Suggestions for improvements:

Government should offer new vacancies for staff and specialist In Aziz Bhatti Hospital to meet its Human resource need. Government should provide budget for this department on continuously basis and MS should not miss manage these resources. There must be medicine facility at one spot that should fulfill requirement of all departments in this hospital. There must be proper utilization of department space and build more

wards as well as separate rooms for patients. Orthopaedic department of Aziz Bhatti Hospital must invest funds in new technology to better identification of diseases and their solutions. Aziz Bhatti Hospital should focus on orthopaedic specialist for conducting specialized operations. All staff members should pay reasonably. Proper training should be given to employees on continuously basis for improvement in service quality. Effect of positives or negatives of these suggested changes, in terms of cost, customer satisfaction level, employee performance, employee satisfaction level, process owners resistance or convenience and

management of the organization:

Due to increase in staff and specialist, new technology in process and increase in salaries the cost of the service will increase automatically. Customer satisfaction level will increase because they will get better quality services due to new technology, trained and experienced staff and specialists, specialized operation facility, getting all necessary medicine and operation equipment in one place and lees waiting time for service availability. When Aziz Bhatti Hospitals orthopaedic department hire trained and sufficient staff that meet our HR needs then performance of employees will increase. Through continuous training, employees performance will also increase. When employees get good salaries and department has sufficient employees for work then employees burden decrease and they will become satisfied. If Process owner receives necessary equipment and high quality machinery then they perform their duties on time and in more effective way. Proper training of process owners will also increase service quality.

Action plan
According to our research on both organizations and after comparing them there are some deficiencies which need to be removed immediately. For abolishing these deficiencies they are required to make some changes in the different areas of their department. To implement these changes and to get required results our

planning will be for 3 to 5 years. And the employees of department will be responsible and committed to complete their tasks and assignments in time. First of all they need to increase their staff members although they have general staff but not specialists. To fulfill the patients need they will have to create some new vacancies for specialists. The other change which is needed to bring of new technological equipments to satisfy their patients and to decrease the dependability. And the last but most important need to bring some more financial resources in department so they can fulfill the requirement of more beds for patients and the need of a medical store in the boundary of hospital. To measure the performance of employees their appraisal system is not fully established thats why employees are not fully committed with their duties and because absence of this commitment they get so much complaints from their patients. they handle almost 100 patients per day due to so much patients they cant pay attention each and every patient completely so, they need to increase vacancies of specialists, in this way they will easily handle all patients with full attention. On the basis of these changes our redefined goals will be: Continuously improve customer satisfaction. Continuously improve the quality of services and systems. Continuously improve the Hospitals financial performance and sustain long-term viability. Continuously improve the Hospitals competitive position. Continuously improve the Hospitals organization and work environment.

Now paths are so clear after redefining the goals. by achieving these goals: Their efficiency will improve. Employees commitment will increase. And most importantly patients will be satisfied. Redefining the positions and creating new vacancies: Will divide the authority among them. Burden of work will decrease. Their performance will increase. Departments efficiency will increase.

 Patients will be satisfied from doctors response. The revision of goals: Increase the good will. The cases that are referred to other hospitals will reduce. The good image will enhance the promotion efforts. To achieve goals it is necessary to: Establish a management committee. Clinical audit should be regular. Increase the commitment with goals. Management must understand the proposed goals and fully support them. management must communicate the goals to all affected employees in such a way as to obtain their full commitment

President

Vice President

Staff/ nurses

Assistant

Receptionist

Sweeper

Ward servant

Dresser

Basically organization must establish the performance management system and also implemented it. Clinical audit must be regularly checking the employees performance. They should priorities their needs like their financial needs and job vacancies should be on first priority.