The document provides an overview of operational management in healthcare administration. It discusses key topics like the definition and importance of operational management, parts of operational management including gap analysis and problem improvement. It also covers trends in operational management, best practices for hospitals, challenges in healthcare operational management, and examples of operational management at BPKIHS including clinical services provided like OPD, inpatient, emergency services and support services like laboratory, radiology etc.

1. Operational Management in
Heath Administration
Presentation by:
Dr. Sonali Shah
MDHA-2018
SPH and CM, BPKIHS

2. Overview
• Operational Management- Definition, Role, Importance
• Parts of OM
• Health Care Operational Management
• Trends in OM
• Operational management in Nepal
• Challenges and solutions in HCOM
• Best practices for Hospital to succeed
• HOCM in BPKIHS

3. Introduction
Operations Management :
• Business function dealing with the management of all the processes
directly involved with the provision of goods and services to
customers.
• It is the design, operation, and improvement of the processes and
systems that create and deliver the organization’s Health care services.
• The goal of operations management is to provide more effectively
and efficiently the Health care services.

4. Introduction
• A Hospital is a highly challenging work place. There are numerous
bottlenecks that deteriorates the productivity & efficiency of the
Healthcare services delivered.
• Brand reputation of a Hospital depends on how quick they resolve
the issues raised without compensating the quality and patient
satisfaction. Spontaneity to untangle any situation is possible only
with a strong “Hospital Operations team”.
• Operations management team is responsible for managing all
operational process of the Hospital which includes all clinical &
non-clinical departments to have a smooth working environment.

5. Implementation
Gap analysis-
PARTS OF OPERATIONS MANAGEMENT

6. Parts of Operations Management
• Gap Analysis
• a useful tool for all active organizations to examine the running system
judiciously, for finding out the probable areas where more attention is
required so that the organization becomes more dynamic.
• Problem Improvement
• The process entails the assessment of the present condition and tally the same
with the projected stage making the Hospital system more effective.
• Implementation
• The process of implementing the new strategy into the Hospital system to
vanish the gaps (includes knowledge sharing, training & setting quality
indicators) and checking its efficiency

7. Role of Operational management
The private sector entrepreneurs operating healthcare facilities are focused
on effectively achieving following key goals to manage the healthcare
infrastructure efficiently. Achievement of these goals is more critical for the
public healthcare sector facilities operator given the higher % of public
sector spending globally.
 Improve Operational Effectiveness
 Improve the quality of services in a time bound manner
 Reduce medication Errors
 Improve clinical effectiveness

8. Role of Operational management
 Use Business Intelligence and Data Analytics
 Improve financial and administrative performance
 Reduce readmissions
 Enhance member/ patient satisfaction

9. Trends Affecting Operations Strategy Decisions
Two major trend that have significantly impacted the role of operations
strategy within an organization
• Globalisation :Competition in most industries has intensified significantly in
recent years, and this trend towards hyper-competition is expected to
continue. At the same time, globalisation provides new opportunities for
companies in the form of new, previously untapped markets, for their
products as well as new sources for raw materials and components at
significantly lower costs . This movement towards a single world economy
has occurred for several reasons, including continued advances in
information technology that facilitate the rapid transfer of data across
vast distances.

10. Trends Affecting Operations Strategy Decisions
• Technology :Three factors that are significantly affecting the way in
which business is being conducted: Connectivity, Speed and
Intangibility. They suggest that the combination of all three is causing
changes to occur in business at such a rate that managers can only
view business today as a blur. All three factors are directly related to
advances in technology. Connectivity refers to the fact that virtually
everyone is now connected electronically, be it through e-mail, the
Internet, the telephone, or the fax.

12. Technology in operations management
• Hospitals are busy places. Both staff and equipment are constantly on
the move. That high rate of movement makes it challenging to keep
accurate manual records of equipment use, sterilization, and
maintenance schedules. And even a single missed cleaning cycle can
have serious consequences from an infection-control perspective.
• RTLS data combined with status information from the systems used to
manage the asset addresses this issue.

13. Technology in operations management
• This application involves not just keeping track of patients and
caregivers, but also rooms and equipment. By tagging equipment and
rooms with IoT-enabled sensors, hospitals can receive real-time
information on the availability and status of both portable assets and
patient spaces. This is a critical component of building a smooth
patient flow to reduce wait times, by increasing utilization rates and
ensuring that rooms are turned over quickly.

14. Technology in operations management
• The applications for asset management solutions in the healthcare
field now extend far beyond their traditional role of locating. These
tools are now viewed by many hospitals as an integral part of a
facility’s operations and patient care. By capturing and analyzing data
across the full spectrum of the facility’s staff, patients, equipment,
and physical space, real-time asset management technologies enable
hospitals to understand their daily operations in an entirely new way.
With highly granular information at hand, hospitals can implement
new practices to ensure greater efficiency, higher quality of care, and
a superior experience for each patient.

15. Best Practices for Hospital for Patient Care
Step one: Measurement
The improvement process begins with a baseline of performance. The best
managers know how to assimilate this baseline satisfaction measurement with
other measurement systems. For instance, a best-practice emergency department
director does not simply know that her patients are dissatisfed with waiting times.
She also knows the current average wait times for various steps in the process at
different times of day. Good lab managers know the average time it takes from the
submission of an order to receipt of results by the ordering physician.

17. Best Practices for Hospital for Patient Care
• Step two: Share Data
It is not enough for the manager alone to be familiar with patient
satisfaction results. All employees must know their current level of
performance. Managers must post patient satisfaction results for the
entire staff to see and hold ongoing discussions on performance and
expectations for improving scores.

18. Best Practices for Hospital for Patient Care
• Step three: Prioritisation/Focus
Hospital employees are busy. Nurses, for example, deal with
increased patient volumes and staffing shortages at the same time.
Developing 10 or 20 separate action plans for different areas of
improvement is not feasible, so those areas must be prioritised and
those that have the most impact must receive the lion’s share of
focus.

19. Best Practices for Hospital for Patient Care
• Step four: Action Plan
• The actions taken to improve patient satisfaction must be specifc,
measurable, actionable, and timely. Simply saying “we will do a better
job” is not enough. Staff members,as well as managers, should
prioritise and develop action plans. Some behaviour that needs to be
implemented may seem simple, such as asking patients if they need
anything else before leaving the room. However, if such scripts,
protocols, and procedures are imposed from above, rather than
developed by staff members at the workgroup level, employees may
be less likely to follow them.

20. Best Practices for Hospital for Patient Care
• Step five: Implement
Planning has no impact if it does not result in action. Implementation
is a task for the entire workgroup. If not everyone buys in and
participates, the action plans are doomed to failure.
Step six: Stay the Course
• Success is long-term, sustainable improvement.Hence, no action
plan is ever seen through to completion. Workgroups should pick
their top priorities, maintain focus until they achieve success, and
only then identify the next area for improvement.

21. Best Practices for Hospital for Patient Care
• Step six: Stay the Course
• Success is long-term, sustainable improvement. A common factor in
failures observed is tendency of workgroups to change priorities each
time they receive new patient satisfaction results. Hence, no action
plan is ever seen through to completion. Workgroups should pick
their top priorities, maintain focus until they achieve success, and
only then identify the next area for improvement.

22. Best Practices for Hospital for Patient Care
• Step seven: Measure and Adjust
How do workgroups know that they’ve succeeded? They must have
specifc , measurable objectives and ongoing measurement to
determine if they are achieving these objectives over time.
Continuous patient satisfaction measurement provides trended data
showing change over time, which allows workgroups to modify their
strategies as needed.

23. Operational management in Nepal
• Government of Nepal along with Ministry of Health and Population
Curative services Division collaborated with Nick Simons Institute and
developed Hospital Management Strengthening Program on 8th
Feb,2015.
• There are a number of specific standards, guidelines and tools
developed to address the need to improve and strengthen the
government hospitals .
• This checklist for Minimum Service Standards for District Hospital has
been developed to bring together all the previous standards,
guidelines, tools and other documents that are related to the quality
of hospital services

24. Hospital Management Strengthening Program

25. Hospital Management Strengthening Program
• Service standards are based on major 8 areas. They
1. Governance
2. Organizational Management
3. Human Resource Management
4. Financial Management
5. Information Management
6. Quality Management
7. Clinical Management
8. Hospital Support Services Management

26. Clinical Management
• OPD
• Emergency Service
• Pharmacy
• Clinical Laboratory
• Maternity Services
• Dressing and Injections
• Routine Procedures
• Surgical Services
• Anesthesia Services
• Diagnostic Services
• Specialized Services

27. Hospital Support Services
• CSSD
• Laundry
• Housekeeping
• Repair & Maintenance
• Hospital Waste Management
• Power System
• Safety and Security
• Transportation and Communication
• Hospital Medical Store
• Hospital Canteen
• Information, Education and Communication (IEC)

28. How to Use This Checklist
• The checklist is developed to measure the existing situation of the
hospital against the standards, it will help to understand the gaps and
make a plan to fulfill those gaps in order for hospital to achieve the
desired standard.
• Each section is to be read carefully. There are list of standards and
the supporting indicators for each standard. If hospital meets the
indicators, ‘1’is marked in the column of ‘Score ’. This process is to be
completed for all the indicators.
• For Scoring add the total score and convert it into total percentage.

29. Information management
• Computerized patient registration is done using a standard software
• Referral records are kept using the standard form and register.
• There is a separate room and adequate space to store the medical records.
• All patients' records are kept in individual folders in racks/kept digitally
maintaining privacy.
• There is a set of functional computer and printer to store the medical
records and chairs
• There is at least a set of one table and one chair per staff in the room.
• Hospital services utilization reports are developed and reported using the
standard HMIS form (HMIS 9.4).

30. Information management
• Hospital services utilization statistics are analyzed at least every trimester
(once in 4 months)
• Social marketing activities are being conducted (billboards, ads in FM, TV,
pamphlets, banners, mobilization of FCHVs, via websites etc.) to promote
hospital
• A separate help desk/reception is available
• separate staff to run the help desk is available.
• An information officer is specified to communicate with patients, their
relatives, media and other stakeholders.
• There are appropriate signs to show the directions of service delivery
rooms.

31. Challenges
• Some of the operational challenges that need to be addressed on a
priority basis.
• Improve and optimize planning and scheduling.
• Maximization of bed management and usage of hospital facilities.
• Understanding of Inpatient diagnosis and procedures with their
cost.
• Streamlining and optimizing utilization of operation theatre.
• Streamlining and optimizing utilization of various assets including
high-tech equipment.

32. Challenges
• Wait time for patients at various departments and processes.
• Medication error.
• Average length of Stay vis-à-vis cost for the patient.
• Improved and efficient processes.
• Waste, fraud and abuse of resources.

33. Today’s Hospitals Facing Major Challenges
Maintaining
patient safety
Technology
upgradation
Hospital
security

34. Possible Solutions
• The administrative team of the Hospital plays a vital role in
streamlining administrative as well as non-clinical operational
process flows.
• The ultimate destiny of every Hospital is to “render quality service at
low-cost”.
• The Hospital first seeks to find the severity of the issue. Then, they
frame methods to approach problems and to figure out the
obstacles.

35. Possible Solutions
• But the major importance & focus is given in solving the clinical
issues by medical departments. Where, a Hospital seeks expertise
to find a persistent solution making a complete change in the
operations for the other non-clinical barriers.
• The expert opinion assist in achieving operational efficiency that
contributes to the success which leads the organization towards a
healthy growth

36. Operations management in BPKIHS

37. Clinical Services
• OPD
• In patient
• Emergency
• OT and minor procedure
• Laboratory
• Radiology
• Public health and social services

38. OPD Services
• Out Patient Department (OPD) Services at BPKIHS runs daily from Sundays
to Thursdays (Full time) and on Fridays (half day). The OPD runs for half a
day on selected Public Holidays too.
• Patients get services through General OPD and Special OPD at BPKIHS.
• OPD Services are provided for general check-up and comprehensive care;
Pediatric and adult chest, heart, gastro-hepatic, neurological and
endocrinology; general and specialized surgery; female health problems
and obstetrics care; skin and sexually transmitted diseases; mental health
issues and de-addiction; pre-anaesthesia check-up Orthopaedic check-up
and surgery; head, neck, ear and nose clinic; eye clinic and whole range of
oral and maxillofacial services.

39. In patient services
• Inpatient hospital services has the huge infrastructure, ample bed facility
and quality and experienced doctors and staffs.
• With over 40,000 admissions per year and a bed occupancy rate of nearly
70%, the ward gets busy all the time, nevertheless quality ensued.
Residents stay at the wards all the time for the patient care and Ward
rounds are held twice a day from faculties.
• Separate Ward blocks for Internal Medicine, Surgery, Paediatrics, Obstetrics
and Gynaecology, Psychiatry and Maternal and Child Health Care (MCH) are
present in BPKIHS along with a multicomplex for Orthopaedics, ENT,
Dermatology, Ophthalmology and Oral Surgery. There is Intensive Care
Units (ICU) for paediatrics (PICU), Neonates (NICU), Maternal (MICU),
Deluxe (DICU) and general. Separate Coronary Care Unit (CCU) and Medical
ICU also runs as Inpatient Service. Tropical Ward (part of Medical ward)
provides care and treatment for tropical disease.

41. Emergency Services
• The Emergency Department at BPKIHS provides care to patients with
urgent medical condition.
Care is provided 24 hours a day, serving more than 40,000 patients a
year.
The Emergency at BPKIHS is currently the largest in Nepal and
provides state-of-the art urgent care to the citizens of the eastern
region of Nepal and the surrounding areas of India. The manpower of
over 100 personnel from HOD to Helpers makes rational for its daily

42. OT and minor procedure Services
• OT services (major, intermediate, minor and Day-care OT services)are provided by
the department of General Surgery under Gastrointestinal surgery, Open Urology,
Pediatric surgery, Neurosurgery, Endourology surgery and Laparoscopy Surgery.
• Major Operations are performed in ten sessions in major OT and 4 sessions per
week in day care OT. Laparoscopic surgeries are routine in this institute and lap
assisted surgeries are becoming more common now. Endourology services are
now in full swing with procedures like: cystoscopy, optical internal urethrotomy,
TURBT, TURP, Ureteroscopy and Intra-corporal shock wave lithotripsy (ICSWL).
• Minor OT procedures under department of Dermatology are skin biopsies,
electrocautery, molluscum needling, pairing, intralesional steroid, chemical
peeling/cautery etc
• Cardiology, hepato gastric surgeries are also performed.

43. Laboratory Services
• Fully automated clinical chemistry analyser (Roche Hitachi Cobass C3-11) has been installed in
CLS for routine chemistry test, therapeutic drug monitoring and immunoassay. Biochemical tests
like TFT, TSH, fT3, fT4, PSA etc.
• In the laboratory, through the department of Microbiology, various bacteriological, parasitological,
mycological, mycobacterial and serological tests are also done along with the CD4
• Histopathology, Cytopathology (FNAC/USG Guided FNAC/CT guided FNAC/PAP
Smears/Fluids/Sutum/BAL), Hematology (CBC, Urine for RE and Ketone Bodies, Bence Jones
Protein, Pregnancy ELISA, Semen Analysis, Body fluid analysis, AEC, ESR,

44. Radiology Services
• Radio-diagnostic services at BPKIHS run through advanced digital
radiological equipments. Services provided are digital X-rays,
Mammogram, IVU, MCU/RGU, Venogram, Barium Studies, T-tube
cholangiogram, Sinogram, Fistulogram, HSG, USG, CT Scan, MRI,
Sialogram and Doppler services.

45. Public Health and Social Services
• The public health section has been entrusted with the responsibility
of coordinating the field activities of various departments. In addition,
coordination with governmental as well as non-governmental
organisations is also the responsibility of the unit. A calendar of
operations is prepared and the field activities are launched according
to the schedule. Multi departmental outreach clinics are also
conducted at the community level.
• The four main avenues of work of this unit are: - Strengthening the
district health system - Teaching district program facilitation - Field
Based academic activities - Other community based and social service
activities

46. Non-clinical Services
• IT Department
• General administration section
• Medical Record section
• Store section

48. IT Department
• BPKIHS has taken fast pace to upgrade information technology in the
institute.
• High speed internet services are provided to promote research,
teaching-learning activities and day to day functions.
• Hospital management information system software are implemented
in various departments.
• MiDas app is used patient registration
• QHMS for administration

49. General Administration Section
• It deals with basic logistics services and support to all the faculties
and staffs at BPKIHS. The major activities carried out are
• Hospitality management
• Transportation
• Forest and sanitation
• Security

50. Medical Record Section
The major activities of this section are as follows:
• Daily OPD census collection.
• Management and distribution for DOTS and MDR TB patients.
• Compilation and assembling of records and data.
• Maintain death register for research and mortality review.
• Perform medico legal work related to court and administration; such
as health certificate, illness certificate, insurance certificate , birth &
death certificate.

51. Store Section
• It plays a vital role in providing day to day requirement for running of
hospital & lab services, departments & units round the clock.
• All the activities of store are fully automated and controlled through
store management Software(Qstore).
• It has three major units viz: General store ,Medical store& Dental
store
• Demand order(DO) are generated as per orders and sent to
concerned authorities.
• Goods purchased are only received through Goods Received
Note(GRN) and after Quality Control approval.

53. Conclusion
• The healthcare Operations team must be able to provide direction and
guidance to organizations about roles, responsibilities, and functions The
leader must devise and revise strategies everyone can understand and
follow.
•“Decisions made by healthcare managers not only focus on ensuring that
the patient receives the most appropriate, timely, and effective services
possible, but also address achievement of desired performance targets.”
• Ultimately, decisions made by an individual manager affect the
organization’s overall performance so, work with a team