Management Practices at Shifa International

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TABLE OF CONTENTS

I PART 1 SOMETHING GENERAL ABOUT SHIFA INTERNATIONAL P #¶s HOSPITAL 1 I.1 ORGANIZATION¶S BRIEFING I.1.1 THEIR HISTORY I.1.2 THEIR MISSION I.1.3 THEIR VISION I.1.4 THEIR ETHICAL GOALS I.1.5 THEIR VALUES I.1.6 THE DECOMPOSITIONING I.1.6.1 THE MEDICAL AFFIARS DEPARTMENT I.1.6.1.1 DEPARTMENT OF MEDICINE I.1.6.1.2 DEPARTMENT OF SURGERY I.1.6.2 OFFICE OF CHIEF OPERATING OFFICER I.1.7 ORGANIZATION DECOMPOSITIONING CHART II PART 2 MANAGEMENT PRACTICES AT SHIFA INTERNATIONAL HOSPITAL II.1 MANAGEMENT FUNCTIONS AT SHIFA INTERNATIONAL II.1.1 PLANNING II.1.2 ORGANIZING II.1.3 LEADING II.1.4 CONTROLLING II.1.4.1 EXECUTIVE MANAGEMENT COMMIITTEE II.2 DIVERSITY MANAGEMENT AT SHIFA II.3 ETHICAL MANAGEMENT PRACTICES AT SHIFA II.4 CENTRALIZED MODE OF MANAGEMENT II.5 MARKETING STAGE II.6 MANAGEMENT SKILLS II.7 SCIENTIFIC MANAGEMENT II.8 SHIFA AS AN OPEN SYSTEM II.9 SOCIAL RESPONSIBILITY AT SHIFA INTERNATIONAL II.10 SHIFA STAKE HOLDERS II.11 VANGUARD ORGANIZATION II.12 TYPE Z MANAGEMENT STYLE AT SHIFA HOSPITAL II.13 INTERORGANIZATIONAL CULTURE AT SHIFA II.14 THEORY Y II.15 EMPLOYEES¶S DEPARTMENTAL ROTATION II.16 FACILITIES AT SHIFA II.17 EMPLOYEES SHIFT 1 1 1 1 1 2 2 2 2 2 3 3

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III PART 3 ELEMENTS OF MEGA ENVIRONMENT III.1 CHAPTER 1 ECONOMIC ELEMENT III.1.1 PRESENT NATIONAL SCENARIO III.1.2 DISTRICT GOVERNMENT SYSTEM III.1.3 DEPENDENCE III.1.4 PAKISTAN ECONOMY III.1.5 BUSINESS ACTIVITES III.1.6 THE EMERGING POTENTIAL III.2 CHAPTER 2 TECHNOLOGICAL ELEMENT III.2.1 MANAGEMENT INFORMATION SYSTEMS III.2.2 INTERNET ACCESS III.2.3 INFORMATION MANAGEMENT TRAINING III.2.4 COMMUNICATIONS III.2.5 ONLINE APPOINTMENT III.2.6 ONLINE PHARMACY III.2.7 ONLINE PAYMENT III.3 CHAPTER 3 INTERNATIONAL ELEMENT III.3.1 INTERNTIONAL LEVEL COMPETITORS III.3.1.1 ARGENTINA III.3.1.2 AUSTRALIIA III.3.1.3 AUSTRIA III.3.1.4 BAHRAIN III.3.1.5 BARBADOS III.3.1.6 BELGIUM III.3.1.7 BRAZIL III.3.1.8 CANADA III.3.1.9 COLUMBIA III.3.1.10 CUBA III.3.1.11 CZETCH REPUBLIC III.3.1.12 CHILE III.3.1.13 CHINA III.3.1.14 COST RICA III.3.1.15 CROATIA III.3.1.16 CYPRUS III.3.1.17 DEMNARK III.3.1.18 EGYPT III.3.1.19 FINLAND III.3.1.20 FRANCE III.3.1.21 GERMANY

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III.3.1.22 GREECE III.3.1.23 HAITI III.3.1.24 HONGKONG III.3.1.25 HUNGARY III.3.1.26 ICELAND III.3.1.27 INDIA III.3.1.28 IRELAND III.3.1.29 ISRAEL III.3.1.30 ITALY III.3.1.31 JMAICA III.3.1.32 JORDAN III.3.1.33 JAPAN III.3.1.34 KENYA III.3.1.35 LEBANON III.3.1.36 LITHUANIA III.3.1.37 KOREA III.3.1.38 MALAYSIA III.3.1.39 MALTA III.3.1.40 MEXICO III.3.1.41 NETHERLANDS III.3.1.42 NEWZEALAND III.3.1.43 NICARAGUA III.3.1.44 NIGERIA III.3.1.45 NORWAY III.3.1.46 OMAN III.3.1.47 PANAMA III.3.1.48 PARAGUA III.3.1.49 PERU III.3.1.50 PHILLINPES III.3.1.51 POLAND III.3.1.52 PORTUGAL III.3.1.53 SUADI ARABIA III.3.1.54 SOUTH AFRICA III.3.1.55 SPAIN III.3.1.56 SWEEDEN III.3.1.57 SWITZERLAND III.3.1.58 TAIWAN III.3.1.59 THAILAND III.3.1.60 TURKEY III.3.1.61 UK III.3.1.62 UKRAINE III.3.1.63 UNITED ARAB EMIRATES III.3.1.64 VIETNAM III.3.2 INTERNATIONAL ORGANIZATIONS III.3.2.1 WORLD HEALTH ORGANIZATION III.3.2.2 WHO INTERNATIONAL DIGEST O F HEALTH LEGIALATION

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III.4 CHAPTER 4 SOCIOCULTURAL ELEMENT III.5 CHAPTER 5 LEGAL POLITICAL ELEMENT III.5.1 THE PAKISTAN MEDICAL RESEARCH COUNCIL III.5.2 NATIONAL HEALTH SURVEY OF PAKISTAN III.5.3 NATIONAL INSTITUTE OF HEALTH, ISLAMABAD III.5.4 PAKISTAN COLLEGE OF SURGEONS & PHYSICIANS III.5.5 HEALTH SERVICES ACADEMY, ISLAMABAD III.5.6 PRIVATE MEDICAL INSTITUTIONS IV PART 4 ELEMENTS OF TASK ENVIRONMENT IV.1 CHAPTER 6 LABOR SUPPLY IV.1.1 EMPLOYEES AT INTERNAL MEDICINE IV.1.2 EMPLOYEES AT CRITICAL CARE IV.1.3 EMPLOYEES AT SECTION OF INFECTIOUS DISEASES IV.1.4 EMPLOYEES AT PSYCHIATRY SECTION IV.1.5 EMPLOYEES AT NEUROLOGY SECTION IV.1.6 EMPLOYEES AT DERMATOLOGY SECTION IV.1.7 EMPLOYEES AT CARDIAC SURGERY SECTION IV.1.8 EMPLOYEES AT GENERAL SURGERY SECTION IV.1.9 EMPLOYEES AT DENTISTRY SECTION IV.1.10 EMPLOYEES AT ENT SECTION IV.1.11 EMPLOYEES AT OPHTHALMOLOGY SECTION IV.1.12 EMPLOYEES AT UROLOGY SECTION IV.1.13 EMPLOYEES AT ANESTHESIOLOGY SECTION IV.1.14 EMPLOYEES AT PEDIATRICS SECTION IV.1.15 EMPLOYEES AT OTHER BRANCHES IV.2 CHAPTER 7 CUSTOMERS & CLIENTS IV.3 CHAPTER 8 SUPPLIERS IV.4 CHAPTER 9 COMPETITORS IV.4.1 AGA KHAN HOSPITAL KARACHI IV.4.1.1 SOMETHING GENERAL IV.4.2 SHAUKAT KHANUM CANCER HOSPITAL AND RESEARCH CENTER IV.4.3 FUTURE COMPETITORS IV.4.3.1 SAHARA FOR LIFE TRUST IV.4.3.2 QIH¶S (QUAID-I-AZAM INTERNTIONAL HOSPITAL)

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IV.5 CHAPTER 10 GOVERNEMENT AGENCIES IV.5.1 CENTRAL BOARD OF REVENUE IV.5.2 CAPITAL DEVELOPMENT AUTHORTY IV.5.2.1 THE COMPLETED PROJECTS IV.5.2.2 THE CONTINUED PROJECTS IV.5.3 THE INCOME TAX IT IV.5.4 PAKISTAN MEDICAL & DENTAL ASSOCIATION IV.5.5 BAHRIA UNIVERSITY IV.5.6 OTHER PROJECTS OF SHIFA IV.5.6.1 SHIFA COLLEGE OF MEDICINE IV.5.6.2 SHIFA COLLEGE OF NURSING IV.5.6.3 TAMMER I MILLAT FOUNDATION V PART 5 PROJECT SCHEDULING & MANAGEMENT V.1 MANAGEMENT ACTIVITIES V.2 GANTT CHART FOR MANAGEMENT ACTIVITIES APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F REFERENCES

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I PART 1 SOMETHING GENERAL ABOUT SHIFA INTERNATIONAL HOSPITAL I.1 ORGANIZATION¶S BRIEFING I.1.1 THEIR HISTORY The Hospital was founded by a group of doctors who were working in USA. It was incorporated on Sept 29, 1987, as a private limited company and converted into a public limited company in 1989. The hospital is listed in Karachi, Lahore and Islamabad stock exchanges. The project was stated by a group of professionals working in USA. I.1.2 THEIR MISSION To provide good quality medical care in medicine and surgery to all patients in a caring and compassionate manner by an outstanding team of health care professionals in an atmosphere conductive to values and practice of good medicine. I.1.3 THEIR VISION Shifa International Hospital is established to provide the highest quality of medical care to the people of Pakistan. Their objective is to achieve e a high class quality goal in many factors:       Medical Expertise Clinical Excellence State of the Art Technology Caring people Preventive Medicine Healthcare Management

I.1.4 THEIR ETHICAL GOALS They include:      Consumer satisfaction Service quality Sustain long term viability To improve competitive position To improve work environment

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I.1.5 THEIR VALUES They Include:       Respect Compassion Integrity Efficiency Excellence Transparency

I.1.6 THE DECOMPOSITIONING The whole hospital operations are decomposed into two main wings.  The Medical Affairs  Support Services The Medical Affairs department is headed by MD (Medical Director) and the Support Services department is headed by COO (Chief Operating Officer). These two departments have been further decomposed into many departments and sub departments. I.1.6.1 THE MEDICAL AFFAIRS DEPARTMENT It includes the other departments like: I.1.6.1.1 DEPARTMENT OF MEDICINE This further includes section like:        Section of Internal Medicine Section of Pulmonolgy Section of Cardiology Section of Infectious diseases Section of Nephrology Section of Neurology Section of Radiology

I.1.6.1.2 DEPARTMENT OF SURGERY      General and Vascular Surgery Section Orthopedic Surgery Section Urology Section Pediatric Surgery Section Cardio Surgery Section

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Neurosurgery Section ENT Section Plastic Surgery section Anesthesia Section Dental Surgery Section Gynecology Section Emergency Room

I.1.6.2 OFFICE OF CHIEF OPERATING OFFICER It includes departments like:             Admin& General Nursing Administration Accounts &Finance Pharmacy Patient Services Material Management & Purchase Bio- medical Management Information Systems Maintenance and Plant Operations Human Resources Marketing Services Housekeeping

I.1.7 ORGANIZATION DECOMPOSINING CHART (MAIN BODIES)

Hospital Administration

Office of Medical Director

Office of Chief Operating Officer

Emergency Department

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II PART 2 MANAGEMENT PRACTICES AT SHIFA INTERNATIONAL HOSPITAL Since Shifa is an organization where different people work for a pre-defined goal. The management practices adopted at Shifa include: II.1 MANAGEMENT FUNCTIONS AT SHIFA INTERNATIONAL II.1.1 PLANNING The Chairman of the Hospital, Dr. Zaheer Ahmed has a goal before him. He has a plan to extend the hospital business activities all around the year. He thinks that 2005 was a profitable year for them. Their earnings increased up to 53 %. Secondly, he has a vision to provide the best medical health care facilities to the people of Pakistan. II.1.2 ORGANIZING Different people from different backgrounds are working at Shifa. Their HR department is responsible for hiring employees and giving them specific jobs. Mr. Shahzad Choudry, Senior Manager HRD is dealing with all these. II.1.3 LEADING Every section has a head to lead the other employees under him/her. There is one Head consultant and under him/her, two or more assistant consultants are working. Since there are many sections and each of these sections has the same level of Hierarchy. II.1.4 CONTROLLING To assure the quality of the services at Shifa, different committees have been formed. These committees make sure that the rules are not being violated. The services are quality oriented. Different quality assurance committees at Shifa include: II.1.4.1 EXECUTIVE MANAGEMENT COMMITTEE        Quality Assurance Committee Nursing Quality Assurance Committee ER Committee Internal Audit Committee Waste Management Committee Social Welfare Affairs Committee Pharmacy Committee

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The QA department is involved in developing and implementing effective quality based management systems, and quality improvement programs. It aims at developing solutions which are quality based and patient satisfaction. II.2 DIVERSITY MANAGEMENT AT SHIFA The diversity is in:

Traditions

Race

Culture Gender

Work Groups

Diversity

Subcultur e

Work Places

Ethics

Style

Religion

Figure 1

II.3 ETHICAL MANAGEMENT PRACTICES AT SHIFA People at Shifa believe in:       Respect Compassion Integrity Efficiency Excellence Transparency

II.4 CENTRALIZED MODE OF MANAGEMENT AT SHIFA It is clear from the data given above that there is a strong centralized management at Shifa International Hospital. The CEO and Chairman is the main person. The MD & 11

COO come under the CEO. Then there is a long hierarchy chain of command at different departments and Sections. Different sections have a head and under that head many consultants and senior consultants are working. This chain of command shows that there is a strong centralized management at Shifa International. II.5 MARKETING STAGE Right now, Shifa is a totally customer oriented organization. It started as a private sector unit in 1987. Its main concern in on customer satisfaction and care, in a compassionate way. It is right now in the prosperity stage. II.6 MANAGEMENT SKILLS Since it is a very huge organization, different employees come here with different skills. For example, Dr. Zaheer Ahmed the CEO & Chairman of the company has a mission before him. Different doctors at different levels have key knowledge skills according to their field of specializations. (MD, FCPS, or having any other degree). These also have a relationship with the assistants or subordinates at different levels. For example a doctor from one department has a good relationship with the employees at the radiology or any other department. He has to see the reports of the patients. This depicts a level of human skills. II.7 SCIENTIFIC MANAGEMENT Obviously we find a scientific management at Shifa. People with different jobs are working and their jobs are broken down into specific routines. There workers are fully trained and selected on a merit basis. Then they have a relationship among themselves to make sure that they are working in the proper manner. Each person is responsible foe performing his own task which is designated to him. Each person is ware of his/her job. We also find bureaucratic management at Shifa where there is an implicit set of formalized rules and regulations. Each employee has to follow the set of rules. The organization has a well defined hierarchy. Every one knows that he or she is responsible to whom. Obviously, highly qualified doctors are selected and then trained. II.8 SHIFA AS AN OPEN SYSTEM Obviously, Shifa is an open system. It is using its HR, financial and other resources, through managerial and technological abilities, to provide best medical care to the people. The system is providing services to patients. To get a feed back from the environment and stay in touch with the media, Shifa has a magazine named Shifa News International. The editor is Mr. Amer Farooq. The feed back and certain FAQ¶s from the readers are encouraged in the ³LETTERS TO THE EDITOR ³Section of the magazine. The ³MEDIA PRINTING & RELIGIOUS ³department is there for this purpose. They also keep on arranging different seminars on different health related topics to create awareness among the general public.

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II.9 SOCIAL RESPONSIBILITY AT SHIFA INTERNATIONAL The Shifa people are well aware of their social responsibilities. In the recent earth quake in Pakistan, Shifa contributed a lot. The Tammer millat Foundation of Shifa International Hospital has announced to adopt 2,000 children orphaned in the devastating earthquake that struck Pakistan and Azad Kashmir on October 8. MUSLIMS, the Voice of Muslims America 18th Nov, 2005 The Tameer-e-Millat Foundation has decided to initiate a complete rehabilitation program for the affected children in a residential environment," said TMF chairman Dr. Zaheer Ahmad while announcing the first major initiative in Pakistan's private sector for the rehabilitation and resettlement of those children who lost every thing in the disaster. The unprecedented initiative has been named "Tameer-e-Jannat (Building of heaven). He informed Muslims Weekly over telephone from Islamabad, Pakistan, that Tameer-eJannat is aimed at providing standardized living, brought up, education and training to 2,000 children initially for a period of 12 years. He added that if the required support and funding was available, the TMF might adopt as many as 10,000 of these orphans. "We are offering µSponsor a Child' program to the well off and God-fearing individuals, families and institutions," said Dr. Zaheer while explaining the way his organization intends to raise funds for the project. Every sponsor, he said, will be asked to donate $1000 / child annually for 12 years to provide him/her all needs of life including quality education. Dr. Zaheer Ahmad, it may be recalled, is a respected Pakistani doctor who has spent all his life in the service of humanity. He set a new precedent in Pakistan's history in the 1980s, when he founded Shifa Hospital in Islamabad. The state of the art hospital, costing hundreds of millions of dollars, today is one of the best medical facilities in Pakistan which offers diverse and quality services. In later years, Dr. Zaheer also founded Shifa Foundation which helps the deserving patients in Pakistan and the Tameer-e-Millat Foundation. Tameer-e-Millat Foundation has extensive experience in the education sector. Currently, it is running over 380 schools in rural areas of Pakistan where over 20,000 students are receiving education. The TMF says that because of its strong credentials, it is capable of shouldering this huge task. Daily Mail The Prime Minister also appreciated the administration of Shifa International for taking care of over 100 injured from the affected areas and for providing them excellent care. He said the patients informed that they were well looked after. ³Every individual has an important role in tackling this enormous challenge that confronts the nation. It has shown the capacity of the entire country to cope with such calamities,´ he said. He also lauded the role of NGOs, individuals, national and multinational organizations and international community for reaching out to the people affected by this tragedy.² APP

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³Pak Tribune´ ISLAMABAD, November 09(Online): Prime Minister Shaukat Aziz has said estimate of earth quake loss will be released on Thursday adding that the estimated loss will be presented in donors¶ conference on November 19. The Prime Minister was talking to journalists here Tuesday in Shifa International Hospital where he had gone to inquire about the health of those injured in killer quake. Health minister Dr Naseer Khan and secretary health Syed Anwar Mehmood also accompanied the Prime Minister. Earlier, the Prime Minister inquired about the health of injured quake survivors and distributed Rs 10000 each in cash among them. "We pay tributes to private hospitals, which are providing free treatment to the injured survivors", prime minister underscored. Besides we express gratitude to over sixty countries, which had extended help. The spirit demonstrated by the world countries particularly people of Pakistan in helping the quake affectees is unprecedented, he remarked. Shaukat Aziz noted that treatment process of the injured people was moving ahead. Serious patients are being shifted here from the field hospitals. Health ministry has been directed to make rapid arrangements for wheel chairs and artificial limbs for disabled patients, he indicated. They also keep on organizing different seminars on different health related topics to create awareness among the general public. They also re-constructed the ³NALA´ passing behind the main building. They had to suffer due to the wrong engineering planning of CDA. They had to lose 40 millions. But the reconstruction was self financed. II.10 SHIFA STAKE HOLDERS The social stake holders at Shifa are:      Shareholders Customers Employees society Local community

II.11 VANGUARD ORGANIZATION A vanguard organization is one which pays its social responsibility along with its other operations. A few companies or organizations in the world have attained this status up till 14

now. Shifa tended to play its social duty during the 8th Oct earth quake of Pakistan. It contributed money, looked after patients and provided free medical treatment to them. It has proved it self in the queue of vanguard organizations. They are also keen about their environment. The Shifa people have planned to make the green belt before the hospital more beautiful, as it would make the capital more beautiful. They have passed this plan from CDA and started working on it. They have one more plan to build a public park for general public and the patients as well. They are well aware of their social responsibility. II.12 TYPE Z MANAGEMENT STYLE AT SHIFA Type Z theory of management is there where there is a medium pace career and workers are given some relaxation and some decision making ability is also given to them. The workers are allowed to some extent to make their own decisions in Theory Z management style. Obviously, when there is problem where the senior doctor or head is not present, the junior level doctors are allowed to take their own decision. They can solve the problem encountered. When the senior manager is not available, then the junior level manager is given the privilege to make his own decision. II.13 INTER ORGANIZATIONAL CULTURE AT SHIFA The inter-organizational culture at Shifa is relaxing. There is a dress code for the nursing staff, ward boys, house keeping department and for the security guards as well. However, the doctors are to wear the white coat. The surgical staff has to wear blue-green dress. They also provide different types of training to newly hired as well as the old employees to make them more aware about different scenarios and situations. II.14 THEORY Y Theory Y implies that the workers are highly motivated and hard working. They are fully trained and using their full potential in achieving their goals. This is the assumption used at Shifa Hospital. The workers are fully trained personnel in their field of specialization. Each and every one of them is equally responsible for the improvement and work. Different tasks are assigned to different workers and they are there to perform these. The Hospital provides a 24 hour service, ensuring that the workers (doctors) are working at their full. II.15 EMPLOYEES¶ DEPARTMENTAL ROTATION Employees are subject to departmental rotation after 3-4 years based on their experience, to increase their skills and knowledge. The employees at junior levels face more rotation. II.16 FACILITIES AT SHIFA Shifa is right now providing, transport, allowances, bonuses, dividend to their share holders. It also gives shields and certificates to the best performers. Different job

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incentives are also rewarded according to the efficiency and effectiveness of the employees.  Shifa Card  Shifa Lab Pickup Point. II.17 EMPLOYEES SHIFT Right now, 3 shifts at Shifa:  7am -3pm  3pm-11pm  11pm -7am The employees can work in any shift which they find comfortable to work in.

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III PART 2 ELEMENTS OF MEGA ENVIRONMENT III.1 CHAPTER 1 ECONOMIC ELEMENT III.1.1 PRESENT NATIONAL SCENARIO Presently Pakistan has a short fall in the context of private sector based hospitals. The population rate in Pakistan is expected to grow at a rate of 2.5% per year. Almost 31% percent population of Pakistan has been declared poor by PRSP (Poverty Reduction Strategy Papers) in 1999. The poverty level has increased up to 32.1 % in 2002. One is considered to be poor if his per capita income is less than Rs. 1800. Planning Commission of Pakistan has got its own standards. A per capita income of about Rs. 670 per month makes a person less poor. Due to the rise in commodity prices and inflation, health care was moving beyond the range of people earning up to Rs. 10,000 per month. The PRSP program was launched to jot down the factors and efforts to change the further process. Federal Budgetary allocation for the health sector has been launched from Rs. 4 million to Rs. 6 million during the year 2004-05. III.1.2 DISTRICT GOVERNMENT SYSTEM The district government system provides ground for increase in development at the local level. The NGO¶s and other local agencies including WHO have implemented health care programs for the community. III.1.3 DEPENDENCE But there is still a dependence on private practitioners. Most of the people go to private dispensaries and hakims, instead of going to the doctors. The availability of doctors and time is another constraint for the people of Pakistan. Presently, Pakistan is facing a reduction tendency in health care hospitals in the private sector. As birth rates go high, and death rates go slow, Pakistan has to move ahead in health care privatization. Since Shifa International Hospital is a private sector based hospital, the days it was being launched, most of the market experts were of the view not to go for a private sector hospital. The government hospitals were much more in fashion. But the investors went for implementing the idea and the result was a positive one within 7-10 years. Pakistan is a developing country, and building a private sector hospital in this regard was an encouraging sign for investors in this sector. It provided a better health care facility and an increase in the governmental revenue. The appendices in the end show that the hospital has earned revenue in millions from the year 2000. III.1.4 PAKISTAN¶S ECONOMY

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The Pakistan¶s economy has gained more strength in the past few years. The data from different market experts predict that Pakistan¶s economy has attained a growth rate of 8% this year. The key indicators of the economy are agriculture, industry and services sectors, which show strong performances. III.1.5 BUSINESS ACTIVITIES The business activities of Shifa International hospital have expanded throughout the year. The net revenues for the year have reached Rs. 921 million approximately. III.1.6 THE EMERGING POTENTIAL Today, Pakistan is the world¶s ninth most populous country with a population exceeding 140 millions. During the past few years, Pakistan has seen a pace of development. The open markets outside and inside do play a vital role. Even there is a demand in the expansion of health care markets as well. Diversification in this regard is required as well. Health care facilities also need to have a change and go beyond limits. Most recent trading on local share market has been there to record the high inflation and changes in price levels. Shifa has already many investors and share holders and made its way through the market economy. The following data relates to Shifa Hospital, Islamabad.

Figure 2

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Figure 3

Figure 4

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Figure 5

Figure 6

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III.2 CHAPTER 2 TECHNOLOGICAL ELEMENT III.2.1 MANAGEMENT INFORMATION SYSTEMS MIS at Shifa is being used. It is a network of computer based information supported by manual procedures by computer professionals. To provide concurrent, up to date and accurate information to patients any time. The information may be required in decision making, and research purposes as well. MIS supports and facilitates the needs of all the information users at Shifa Network and helps them in carrying out their tasks. MIS at Shifa provides work flow automation, in-house development of oracle based software, dictation server and clients for medical record transcription, intranet, internet security, automation of lab diagnostic equipment data entry, DICOM imaging standard for cardiology and radiology and implementation of LDAP. Its future plan is to develop market healthcare related software. The objective if MIS includes:       Timely and quick access to the information related to the patient and hospital Improved Data accuracy Balance of appropriate security levels Continual Re evaluation of Critical Information Systems Improve Information Sharing among different departments knowledge based information for patients and staff

III.2.2 INTERNET ACCESS The 24 hour internet access with user authentication facility is also available at Shifa International Hospital. It has:      Dedicated ISDN line LINUX based proxy server for user Router based hardware protection 128 K capacity Centralized anti virus software

III.2.3 INFORMATION MANAGEMENT TRAINING MIS is responsible for sharing and ensuring that all staff members who use information systems and software packages are trained in using the systems. Different courses are arranged for the staff which is not computer literate, from time to time to make them computer literate. All newly hired employees associated with information systems have to go through on job information systems training.

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III.2.4 COMMUNICATIONS The Shifa International Hospital has aimed to improve communication to ensure good customer service. There is a level of communication between the employees and the customers. Telephone facility is available in each ward and room. Reception operators are there in each department. Fax and PCO services are also available for patients as well as visitors. A new component namely, on the top of line Apollo PABX system has also been installed and put into use. III.2.5 ONLINE APPOINTMENT This service is allowed to the authorized users who have a login. It is restricted to everyone. III.2.6 ONLINE PHARMACY They are trying to make it online. This process is still under construction. III.2.7 ONLINE PAYMENT They are trying to make this facility on line as well. This project is also in its development process.

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Figure 7

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III.3 CHAPTER 3 INTERNATIONAL ELEMENT These elements include foreign competitors. International laws, international hospital federations etc. These factors influence the working of an organization. These are the factors which exist in the outside countries of Pakistan. III.3.1 INTERNATIONAL LEVEL COMPITETORS III.3.1.1 ARGENTINA  Hospital de Clinicas Jose de San Martin, Universidad de Buenos Aires (UBA) - Buenos Aires, Argentina  Hospital Francisco Santojanni - Buenos Aires, Argentina  Hospital Municipal de San Miguel - San Miguel, Provincia de Buenos Aires,  Republica Argentina  Hospital de Niños 'Dr. Ricardo Gutierrez' - Buenos Aires, Argentina  Hospital Manuel Belgrano - Buenos Aires, Argentina  Hospital de Niños 'Pedro Elizalde' - Buenos Aires, Argentina  Hospital Regional Rio Gallegos - Rio Gallegos, Santa Cruz, Argentina  Hospital Virtual de Moron - Buenos Aires, Argentina  Servico De Quirofano - H.R.R.G. - Rio Gallegos, Santa Cruz, Argentina III.3.1.2 AUSTRALIA  Australian Medical E-Services Directory (Australian Hospital Index, and more!)  The Austin and Repatriation Medical Centre - Melbourne, Victoria, Australia  Avon Health Service - Northam, Western Australia  Bendigo Hospital - Victoria, Australia  Canberra Hospital - Canberra, Australian Capital Territory, Australia  Cape Hawke Community Private Hospital - Forster, Australia  Flinders Medical Centre - Adelaide, Australia  Freemasons Hospital - Melbourne, Victoria, Australia  Fremantle Hospital & Health Service - Fremantle, Western Australia, Australia  Stawell District Hospital - Victoria, Australia  Swan Hill District Hospital - Swan Hill, Victoria, Australia  Sydney Adventist Hospital - Sydney, Australia  Sydney Hospital / Sydney Eye Hospital - Sydney, Australia III.3.1.3 AUSTRIA  Community Hospital Neunkirchen (surgical dept). - Austria  General Hospital Kirchdorf (Radiology Dept) - Kirchdorf, Austria  General Hospital Vienna - Vienna, Austria

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Krankenhaus St.Josef - Braunau am Inn, Upper Austria, Austria Krankenhaus Frohnleiten - Styria, Austria Kurbad Althofen - Carinthia, Austria Moorheilbad - Harbach, Austria Privatklinik Althofen - Carinthia, Austria Privatklinik Dobling - Vienna, Austria Privatklinik Josephstadt - Vienna, Austria Sanatorium Villach - Carinthia, Austria Wiener Privatklinik - Vienna, Austria

III.3.1.4 BAHRAIN  Bahrain Defence Force Hopspital - Riffa, Bahrain III.3.1.5 BARBADOS  Queen Elizabeth Hospital - Bridgetown, St.michael, Barbados III.3.1.6 BELGIUM  Index of Belgian Hospitals (Belgian Health Forum) - Belgium  Academisch Hospitaal van de Vrije Universiteit Brussel AZ-VUB - Brussels, Belgium  A.Z. St. Dimpna - Geel, Belgium  Cliniques Universitaires Saint-Luc - Brussels, Belgium  Elisabeth Ziekenhuis - Sijsele-Damme, Belgium  Europe Hospitals (St.-Elisabeth - 2 Alice - St-Michel) - Brussels, Belgium  General Hospital Middelheim - Antwerp, Belgium  Heilig-Hartziekenhuis - Roeselare, Belgium  Hopital Ambroise Pare - Mons, Belgium  Hopital Universitaire Saint Pierre - Brussels, Belgium III.3.1.7 BRAZIL             Clinica Sao Vicente - Rio de Janeiro, Rio de Janeiro, Brazil Hospital Barra D'Or -Rio de Janeiro, RJ, Brazil Hospital Beneficência Portuguesa de São Paulo - São Paulo, SP, Brazil Hospital Copa D'Or - Rio de Janeiro, RJ, Brazil Hospital das Clínicas da UFMG - Belo Horizonte, MG, Brazil Hospital das Clínicas da UFPE - Recife, PE, Brazil Hospital de Clinicas da UFPR - Parana, Brazil Hospital das Clinicas da FMUSP - Sao Paulo, Brazil Hospital das Clínicas da UFRGS - Porto Alegre, RS, Brazil Hospital das Clínicas da Unicamp - Campinas, SP, Brazil Hospital do Cancer - AC Camargo - Sao Paulo, SP, Brazil Hospital da Criança - São, SP, Brasil

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Hospital Dona Helena - Joinville, Santa Catarina, Brazil Hospital Israelita Albert Einstein - São Paulo, SP, Brazil Hospital e Maternidade Sco Camilo - Sco Paulo, Brazil Instituto Nacional do Cênce - Rio de Janeiro, RJ, Brazil Hospital Sao Marcos - Teresina, Piaum, Brasil Hospital São Paulo - São Paulo, SP, Brazil

III.3.1.8 CANADA  Regional Hospitals in Northwestern Ontario - Northwestern Ontario Locations, Northwestern Ontario, Canada  Alexandra Hospital - Ingersoll, Ontario, Canada  The Aphasia Institute - Toronto, Ontario, Canada  Atlantic Health Sciences Corporation - Saint John, New Brunswick, Canada  Avonlea Care Centre - Kelowna, British Columbia, Canada  Baffin Regional Health and Social Services Board - Iqaluit NWT Canada  BC Rehab - Vancouver, Canada  BC Women's Hospital - British Columbia, Canada  Brandon Regional Health Authority - Brandon, Manitoba, Canada  British Columbia's Children's Hospital - British Columbia, Canada  Burnaby Hospital Society - Burnaby, British Columbia Canada  Calgary Regional Health Authority - Calgary, Alberta, Canada  Capital Health Authority - Edmonton, Alberta, Canada  Centenary Health Centre - Scarborough, Ontario, Canada  Centenary Health Centre (Pharmacy) - Scarborough, Ontario, Canada  Centre Hospitalier Pierre-Boucher - Longueuil, Quibec, Canada  Chedoke-McMaster Hospitals - Hamilton, Ontario, Canada  Children's & Women's Health Centre of British Columbia - Vancouver, BritishColumbia, Canada  Children's Hospital of Eastern Ontario - Ottawa, Ontario, Canada  Saskatoon City Hospital - Saskatoon, Saskatchewan, Canada  Shouldice Hospital - Ontario, Canada  Sir Mortimer B. Davis-Jewish General Hospital - Montreal, Quebec, Canada  St. Mary's Hospital Center - Montreal, Quebec, Canada  Sunnybrook Health Science Center - Toronto, Ontario, Canada  Surrey Memorial Hospital - Surrey, British Columbia, Vancouver, Canada  Trillium Health Centre - Mississauga, Ontario, Canada  University Health Network - Toronto, Canada  University of Alberta Hospital - Edmonton, Alberta, Canada  Vancouver Hospital and Health Sciences Center - Vancouver, British Columbia, Canada  Vancouver General Hospital (Emergency Medicine) - Vancouver, British Columbia, Canada  Vancouver Island Health Authority - Victoria, British Columbia, Canada  Victoria General Hospital - Winnipeg, Manitoba, Canada  West Park Hospital - Toronto, Canada

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Whitehorse General Hospital - Whitehorse, Yukon, Canada III.3.1.9 COLUMBIA  Clinica De Occidente S.A. - Cali, Valle, Columbia III.3.1.10 CUBA        Centro de Restauraci²n Neurol²gica - Havana, Havana City, Cuba Centro de Retinosis Pigmentaria - Havana, Havana City, Cuba Cl¶nica Central Cira Garc¶a - Playa, Havana City, Cuba Hermanos Ameijeiras - Havana, Havana City, Cuba Hospital Alcivar La Peninsula - La Libertad, Guayas, Ecuador Medicina Tropical Pedro Kour¶ - La Lisa, Havana City, Cuba U.S. Naval Hospital - Guantanamo Bay, Cuba

III.3.1.11 CZECH REPUBLIC  Charles University Hospital - Pilsen, Czech Republic  Jablonec nad Nisou General Hospital - Jablonec nad Nisou , Bohemia part, Czech republic III.3.1.12 CHILE  Clinical Hospital (University of Chile) - Santiago, Chile  Clinica Las Condes - Santiago, Chile III.3.1.13 CHINA  The First Affiliated Hospital of Nanjing Medical University - Nanjing, Jiangsu, P.R.China  Guang An Men Hospital - Beijing, China  Peking Union Medical College Hospital - Beijing, China  Suzhou Medical College Hospitals - Suzhou, China III.3.1.14 COSTA RICA  Hospital San Juan de Dios (Pathology) - San Jose, Costa Rica III.3.1.15 CROATIA  Clinical Hospital Split - Split, Dalmacija, Croatia  Klinicka Bolnica Osijek - Osijek, Slavonia, Croatia

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III.3.1.16 CYPRUS  Larnaca General Hospital (Surgical Unit) - Larnaca, Cyprus III.3.1.17 DENMARK         Aarhus University Hospital - Denmark Bispebjerg Hospital - Copenhagen, Denmark County Hospital at Sankt Elisabeth - Denmark Hillerød Sygehus - Hillerød, , Denmark Hvidovre University Hospital - Copenhagen, Denmark Odense University Hospital - Denmark Privathospitalet Hamlet - Frederiksberg, Denmark Total Health Services of Frederiksborg County - Frederiksborg County, Denmark

III.3.1.18 EGYPT  Nasser Institute Hospital - Cairo, Cornich El Nile, Egypt  Almoassat Hospital - Alexandria, Alexandria, Egypt III.3.1.19 FINLAND  Kuopio University Hospital - Finland  Tampere University Hospital - Tampere, Finland III.3.1.20 FRANCE                  Assistance publique-HÔpitaux de Paris (AP-HP) - Ile de France, France Amiens University Hospital - Amiens, France Angers University Hospital - Angers, France Broussais University Hospital - Paris, France Claude Bernard University Hospital - Lyons, France EPS Ville Evrard - Seine St Denis, France Grenoble University Hospital - Grenoble, France Henri Poincare University Hospital - Nancy, France Hopital Europeen Georges Pompidou - Paris, France Limoges University Hospital - France Missionsaerztliche Klinik - Academic Teaching Hospital - Wuerzburg, Bavaria, Germany Nantes University Hospital - Nantes, France Necker University Hospital - Paris, France Reims University Hospital - Champagne, France Rennes University Hospital - Rennes, France Rouen University Hospital - France Saint-Antoine University Hospital - Paris/Jussieu, France

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Tourcoing Hospital (Department of Intensive Care and Infectious Diseases) Tourcoing, France  University Hospital Wuerzburg - Wuerzburg, Bavaria, Germany III.3.1.21 GERMANY  Academic Teaching Hospital Juliusspital - Wuerzburg, Bavaria, Germany  Academic Teaching Hospital Hannover Nordstadt (Department of Anesthesiology and Intensive Care) - Hannover, Germany  Carl von Hess Krankenhaus - Hammelburg, Germany ( German version)  Department of Dermatology and Allergy - Biederstein, Germany  Frauenklinik Rheinfelden - Rheinfelden, BW, Germany  Johann Wolfgang Goethe University Hospital (Department of Infectious Disease) - Frankfurt am Main, Germany  Klinikum Darmstadt - Darmstadt, Germany  Klinikum Wahrendorff GmbH - Hannover, Niedersachsen, Germany  Marienkrankenhaus - Bergisch Gladbach, NRW, Germany  Ulm Military Hospital - Ulm, Germany  University of Bonn Medical Center - Bonn, Germany  University Hospital - Magdeburg, Germany.  University Hospital "Bergmannsheil" - Bochum, Germany  University Hospital of Frankfurt (Department of Pediatrics) - Frankfurt, Germany  University of Regensburg Hospital (Pharmacy) - Germany  Urologische Klinik Bamberg - Bamberg, Germany  Vinzenzkrankenhaus Hannover - Hannover, Germany  Wittgensteiner Kliniken AG - WKA - Bad Berleburg, , Germany III.3.1.22 GREECE  Metropolitan Hospital - Neo Faliro, Athens, Greece III.3.1.23 HAITI  Hopital Albert Schweitzer - Deschapelles, Haiti III.3.1 .24 HONG KONG         Adventist Hospital - Hong Kong, China Castle Peak Hospital - Hong Kong Hong Kong Hospital Authority - Hong Kong Hong Kong Sanatorium & Hospital - Happy Valley, , Hong Kong Prince of Wales Hospital - Hong Kong Queen Mary Hospital - Hong Kong St. Teresa's Hospital - Hong Kong Tuen Mun Hospital- Tuen Mun, New Territories, Hong Kong

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Tung Wah Group of Hospitals - Hong Kong III.3.1.25 HUNGARY  Szent János Kórház (Saint John's Hospital) - Budapest, Budapest, Hungary III.3.1.26 ICELAND  Landspitalinn (National University Hospital) - Reykjavik, Iceland  NLFI Health and Rehabilitation Clinic - Hveragerdi, Iceland III.3.1.27 INDIA                       Apollo Hospitals - India Amrita Institute of Medical Sciences - Cochin, Kerala, India Arasan Eye Hospital - Erode, Tamilnadu, India BSES MG HOSPITAL - MUMBAI, (BOMBAY), MAHARASTRA, INDIA Arasan Eye Hospital - Erode, Tamilnadu, India BKL Walawalkar Hospital and Diagnostic Centre - Shree Kshetra Dervan, Tal. - Chiplun, Dist. - Ratnagiri, Maharashtra, India lark County Memorial - Jeffersonville, Indiana Community Hospital Of Bremen - Bremen, Indiana Culver Union Hospital - Crawfordsville, Indiana Dr. U Mohan Rau Memorial Hospital - Chennai(Madras), Tamilnadu, India Neo Clinic - Aurangabad, Maharashtra, India Escorts Heart Institute & Research Center - New Delhi, India Fayette Memorial Hospital - Connersville, Indiana Good Samaritan - Vincennes, Indiana Goshen General Hospital - Goshen, Indiana King Edward VII Memorial (K. E. M.) Hospital - Mumbai, Maharashtra, India Lilavati Hospital - Bandra, Maharashtra, India Logansport Memorial Hospital - Logansport, Indiana Lutheran Hospital - Fort Wayne, Indiana Marion General Hospital - Marion , Indiana Narayana Hrudayalaya - Bangalore, Karnataka, India Om Hospital - Dombivli East, Thane, Maharashtra, India

III.3.1.28 IRELAND       Beaumont Hospital - Dublin, Ireland Blackrock Clinic - Dublin, Ireland Coombe Women's Hospital - Dublin, Ireland Galvia Private Hospital - Galway, Ireland Mater Misericordiae Hospital - Dublin, Ireland Mater Private Hospital - Dublin, Ireland

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Merlin Park Hospital - Galway City, County Galway, Ireland  St. James's Hospital - Dublin, Ireland  University College Hospital - Galway, County Galway, Ireland III.3.1.29 ISRAEL          Hillel Yaffe Medical Center - Hadera, Israel addasah Hospital ± Israel Laniado Hospital - Netanya, Israel Rambam Medical Center - Israel Rabin Medical Center - Petah-Tikva, , Israel Schneider Children's Medical Center - Petach Tikva, Israel Shaare Zedek Medical Center - Jerusalem, Israel Soroka Medical Center - Beer Sheva, Israel Tel-Aviv Sourasky Medical Center (Ichilov) - Tel Aviv, Israel

III.3.1.30 ITALY                    Azienda Ospedaliera Papardo - Messina, Sicily, Italy Azienda Ospedaliera Policlinico - Bari, Puglia, Italy Bologna Public Health Departments - Bologna, Italy Careggi Hospital of University of Florence - Florence, Italy Cattinara Hospital - Trieste, Italy Ceccarini Hospital - Riccione, Italy Cuneo Health System (Lung Cancer Study Group) - Cuneo, Italy Fondazione Salvatore Maugeri - Clinica del Lavoro e della Riabilitazione Pavia, Italy General Hospital of Brescia - Brescia, Italy Hospitaller Order of St. John of God - Italy H San Raffaele - Milano, Italy Mauro Leonardis - Roma, Italy Orthopedic Institute Gaetano Pini - Milan, Italy Ospedale Civile di Desenzano Del Garda - Desenzano Del Garda, Brescia, Italy S.Camillo Zonal Hospital - Treviso, , Italy San Giovanni di Dio Hospital - Florence, Italy Azienda Sanitaria di Modena - Modena, Italy Azienda Sanitaria Ospedaliera Molinette - Northern Italy United States Naval Station Hospital - Naples, Italy

III.3.1.31 JAMAICA  University Hospital West Indies - West Indies, Kingston, Jamaica  St. Josephs hospital - Kingston, Deanery road, Kingston, Jamaica

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III.3.1.32 JORDAN  -Jordan Hospital- Amman, Jordan  Speciality Hospital - Amman, , Jordan III.3.1.33 JAPAN  Akashi Tsuchiyama Hospital (ATMH) - Hyogo, Japan  Chidoribashi General Hospital (Rehabilitation) - Hakata-ku, Fukuoka-city, Japan  Fukae Nagasaka Clinic - Ogaki-cho, Fukae, Hiroshima, Japan  International Medical Center of Japan - Toyama, Shinjuku-ku, Tokyo, Japan  Osaka University Hospital - Osaka, Japan  Tokyo Medical University Hospital - Shinjuku, Tokyo, Japan  University of Tsukuba Hospital - Ibaraki, Japan III.3.1.34 KENYA  The Mombasa Hospital - Mombasa, Coast Province, Kenya  Ojele Memorial Hospital - Suna , Migori, Kenya III.3.1.35 LEBANON     American University of Beirut Medical Center - Beirut, Lebanon Hospital Al Koura - Al Koura, Lebanon Sahel Hospital - Beirut, , Lebanon Hopital Libanais Geitaoui - Beirut, Lebanon

III.3.1.36 LITHUANIA  Klaipeda Hospital - Klaipeda, Lithuania III.3.1.37 KOREA  Samsung Medical Center - Seoul, South Korea III.3.1.38 MALAYSIA        Damai Service Hospital (HQ) - Kuala Lumpur, Federal Territory, Malaysia Ipoh Specialist Hospital - Ipoh, Perak, Malaysia Johor Specialist Hospital - Johor bahru, Johor Bahru, Malaysia Klang Valley Orthopaedic & Trauma Center - Malaysia KPJ Healthcare Berhad - Kuala Lumpur, Kuala Lumpur, Malaysia Kuala Lumpur Hospital (KLH) - Kuala Lumpur, Malaysia Pantai Medical Center - Kuala Lumpur, Wilayah, Malaysia

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III.3.1.39 MALTA  St Luke's Hospital - Guardamangia, Pieta, Malta III.3.1.40 MEXICO           The American British Cowdray Medical Center, I.A.P. - Mexico City, Mexico Ameri+Med Hospitals - Puerto Vallarta, Mexico hildren's Hospital of the State of Sonora - Hermosillo, Sonora, Mexico Fundacion Clinica Medica Sur - Mexico City, Mexico Hospital General Dr. Manuel Gea Gonzalez - Mexico City, Mexico Hospital San Jose-ITESM de Monterrey - Monterrey, Nuevo Leon, Mexico Instituto Mexicano de Psiquiatria - Mexico City, Mexico Instituto Nacional de la Nutricion Salvador Zubiran - Mexico City, Mexico Sanatorio Español - Torreón, Coahuila, México Spanish Hospital - Mexico City, Mexico

III.3.1.41 NETHERLANDS        The Digital Hospital - The Netherlands Free University Hospital - Amsterdam, The Netherlands Westeinde Hospital - The Hague, The Netherlands University Hospital of Leiden - Leiden, The Netherlands University Hospital of Rotterdam - Rotterdam, The Netherlands University Hospital St Radboud - Nijmegen, The Netherlands Ziekenhuis Centrum Apeldoorn - The Netherlands

III.3.1.42 NEW ZEALAND       Ascot Integrated Hospital - Auckland, Auckland, New Zealand Canterbury District Health Board - Christchurch, , New Zealand Capital Coast Health - Wellington, New Zealand Healthcare Hawkes Bay - New Zealand New Zealand Hospitals Online - New Zealand Waikato District Health Board - Hamilton, Waikato, New Zealand

III.3.1.43 NICARAGUA  Baptist Hospital - Managua, Nicaragua III.3.1.44 NIGERIA  Parklande Specialist Hospital - Surulere, Lagos, Nigeria

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III.3.1.45 NORWAY       Aker University Hospital - Oslo, Norway. Namdal Sykehus - Namsos, Norway National Hospital (Rikshospitalet) - Olso, Norway The Norwegian Radium Hospital - Oslo, Norway university hospital of Trondheim - Trondheim, Norway Vestfold Hospital Trust - T¿nsberg, Horten, Larvik, Sandefjord, Vestfold, Norway

III.3.1.46 OMAN  The Royal Hospital, Ministry of Health, Sultanate of Oman - Al Ghubra, Muscat, Oman III.3.1.47 PANAMA  Centro Medico San Judas Tadeo - Panama, Republic of Panama  Hospital Nacional - Panama City, Republic of Panama III.3.1.48 PARAGUAY  Centro Medico Bautista - Paraguay III.3.1.49 PERU  Children's Hospital of Lima - Lima, Peru  Hospital Apoyo Iquitos - Iquitos, Maynas, PERÚ  Maison de Sante - Lima, Peru III.3.1.50 PHILIPPINES  De La Salle University Medical Center - Dasmarinas, Cavite, Philippines  Lorma Medical Center - San Fernando City, La Union, Philippines  National Kidney and Trnsplant Institute - Quezon City, Metro-Manila, Philippines  Philippine General Hospital (University of the Philippines) - Manila, Philippines  University of Santo Tomas Hospital - Manila, Philippines  St. Luke's Medical Center - Quezon City, Metro Manila, Philippines III.3.1.51 POLAND  Lodz Medical University - Lodz, Poland  Ludwik Rydygier State Hospital - Torun, Poland  Panstwowy Szpital Kliniczny Nr4 - Lublin, Poland

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Wojewodzki Szpital im. A.Falkiewicza - Legnica, Poland III.3.1.52 PORTUGAL      Hospital Distrital de Faro - Faro, Portugal Hospital Feira Min-Saude Portugal Hospital de Santa Cruz - Carnaxide, Portugal Santa Maria Hospital - Lisbon, Portugal Hospital de Sao Teotonio - Viseu, Portugal

III.3.1.53 SAUDI ARABIA  Al Hada & Taif Military Hospitals - Taif, , Saudi Arabia  Dr. Erfan and Bagedo Hospital - Jeddah, Western, Saudi Arabia  Dr. Sulaiman Al Habib Medical Center - King Fahad-Olaya, Riyadh, Saudi Arabia  King Faisal Specialist Hospital & Research Centre - Riyadh, Saudi Arabia  Abha Private Hospital - Abha, Aseer, Saudi Arabia  King Abd.Aziz Medical City - Riyardh, Saudi Arabia  King Khalid Eye Specialist Hospital - Riyadh, Central, Saudi Arabia  Saudi German Hospital - Jeddah, , Saudi Arabia  Security Forces Hospital Program - Riyadh, Central region, Saudi Arabia  Singapore  East Shore Hospital - Singapore  Gleneagles Hospital - Singapore  Kandang Kerbau Hospital (Singapore Women's & Children's Hospital) Singapore  Mount Elizabeth Hospital - Singapore  National Skin Centre - Singapore  National University Hospital - Singapore  Singapore General Hospital - Singapore  Tan Tock Seng Hospital - Singapore III.3.1.54 SOUTH AFRICA       Constantiaberg Oncology Unit - Plumstead, South Africa East Cape Oncology Unit - Centrahill, South Africa Medi-Clinic - South Africa Netcare - south africa Panorama Oncology Unit - Panorama, South Africa Pretoria-Oos Private Hospital and The Pretoria Orthopaedic & Neuro Institute - Pretoria, South Africa  Pretoria Urology Hospital - Pretoria, South AfricA

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III.3.1.55 SPAIN                       Clinica Moncloa - Madrid, Spain Clinica Universitaria de Navarra - Pamplona, Navarra, Spain Corporación Parc Taulí - Sabadell, Catalunya, Spain Fundación Hospital Ver¶n - Verín, Orense (Galicia), Spain Fundacion Hospital Alcorcûn - Alcorcón, Madrid, Spain Hospital de Albacete - Albacete, Castilla-La Mancha, Spain Hospital de Basurto - Bilbao, Bizkaia, Spain ospital de Cabueñes - Gijon, Asturias, Spain Hospital de Cruces - Barakaldo, Bizkaia, Spain Hospital De Figueres - Figueres, Girona, Spain Hospital de Galdakao - Galdakao, Bizkaia, Spain Hospital de Gran Canaria - Canary Islands, Spain ** List of Hospitals in Canary Island. Hospital Carlos Haya - Spain Hospital Centro Medico La Zarzuela - Madrid, Spain Hospital de Laredo - Laredo, Cantabria, Spain Hospital General Yagüe - Burgos, Castilla-León, Spain Hospital Obispo Polanco - Teruel, Aragin, Spain Hospital de Sagunto - Valencia, Spain Hospital San Agustin - Spain Hospital San Jorge Insalud Huesca Huesca - Spain Hospital Sierrallana - Torrelavega (Cantabria), Spain

III.3.1.56 SWEDEN          Akademiska sjukhuset, Uppsala University Hospital - Uppsala, Sweden Karolinska Institute - Stockholm, Sweden Linkoping University Hospital - Sweden Malmö University Hospital - Malmö, Skåne, Sweden Orebro University Hospital - Orebro, Sweden Ostra Hospital (Department of Geriatrics) - Goteborg, Sweden Sahlgrenska University Hospital - Gothenburg, Sweden S:t Görans Sjukhus - Stockholm, Kungsholmen, Sweden University Hospital of Umea - Sweden

III.3.1.57 SWITZERLAND        Cantonal Hospital - St. Gallen, Switzerland Clinique de Montchoisi - Lausanne, Switzerland InselSpital - Berne, Berne, Switzerland Hospital of Lausanne - Lausanne, Switzerland Kantonsspital, Ob/Gyn Ward - Liestal, Basel Land, Switzerland Kantonsspital Basel Universitätskliniken - Bale, Bale, Switzerland Ob/Gyn-Ward, SRO Hospital - Langenthal, Switzerland

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University Hospital of Bern - Bern, Switzerland University Hospital of Geneva - Geneva, Switzerland University Hospital of Zurich - Zurich, Switzerland University Insel Hospital Berne - Bern, Bern, Switzerland

III.3.1.58 TAIWAN       Jen-Ai Hospital - Taichung & Tali, Taichung, Taiwan Kaohsiung Medical College Hospital - Kaohsiung, Taiwan Mennonite Christian Hospital - Hualien, Taiwan National Taiwan University Hospital - Taipei, Taiwan Show Chwan Memorial Hospital - Changhwa City, Taiwan Veteren General Hospital - Taipei, Taiwan

III.3.1.59 THAILAND       Bangkok Hospital - Bangkok, Thailand Bangkok Phuket Hospital - Phuket, Phuket, Thailand Kluaynamthai General Hospital - Bangkok, Thailand Phyathai Phuket Hospital - Phuket, Thailand Thonburi Hospital - Bangkok, Thailand Trang Ruampat Hospital - Trang, Thailand

III.3.1.60 TURKEY          Ankara Numune Hospital - Ankara, Turkey Clinix Teshis Tedavi Merkezi - Istanbul, Turkey Dokuz Eylul University Hospital - Inciralti, Izmir, Turkey Ege University Hospital - Bornova, Izmir German Hospital (Universal Hospitals Group) - Istanbul,Turkey Haydarpafla Numune Hospital - Turkey International Hospital/ Istanbul - Istanbul, , Turkey Kaskaloglu Eye Hospital - Izmir, Turkey Meltem Birth and Children Hospital - Istanbul, Turkey

III.3.1.61 UK  Addenbrooke's Hospital (Medical Physics Dept.) - Cambridge, UK  Aberdeen Royal Infirmary (Aberdeen Medical School) - Aberdeen, Scotland, U.K.  Bath & West Community NHS Trust - Bath, Somerset, England, UK  Benenden Hospital - Cranbrook, Kent, UK  Birmingham Heartlands Hospital - Birmingham, UK  Blackpool Victoria Hospital - Blackpool, Lancs, UK  Bolingboke Hospital - London, UK  Brighton Healthcare NHS Trust - Sussex, UK

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Bristol Hospital - Bristol, UK British Hernia Center - London, UK BUPA UK Hospitals * Resource List * Chester and Halton Community NHS Trust - Chester, UK Christie Cancer Research Centre - UK Clementine Churchill Hospital - Harrow, Middlesex, England Coppettswood Infectious Diseases Hospital at the Royal Free - London, UK Countess of Chester Hospital NHS Trust - Chester, UK Devonshire Hospital - London, UK Dorset Health Commission - Ferndown, Dorset, UK Dudley Group of Hospitals (Department of Gastroenterology and Nutrition) West Midlands, U K Northampton General Hospital NHS Trust (Northamptonshire Centre for Oncology) - Northampton, Northamptonshire, UK Nottingham Healthcare NHS Trust (Finance Department) - Nottingham, UK Central Nottinghamshire Healthcare (NHS) Trust - Nottinghamshire, UK The Obstetric Hospital - Huntley Street, London, UK Pinderfields Hospitals NHS Trust - Wakefield, UK

III.3.1.62 UKRAINE  Lviv Regional Neonatal Center (Lviv Regional Clinical Hospital) - Lviv, Ukraine  Zhovkva Central District Hospital - Zhovkva, Lviv Region, Ukraine III.3.1.63 UNITED ARAB ERIMATES  Zulekha Hospital - Sharjah,United Arab Emirates  Universitario de Maracaibo - Maracaibo, Zulia, Venezuela III.3.1.64 VIETNAM  DialAsie Vietnam: International Hospital of Nephrology and Dialysis - Ho Chi Minh City, Vietnam III.3.2 INTERNATIONAL ORGANIZATIONS III.3.2.1 WORLD HEALTH ORGANIZATION Pakistan is a member of WHO. However, Pakistan is not a member of WMA (World Medical Association).

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III.3.2.2 WHO INTERNATIONAL DIGEST OF HEALTH LEGISLATION An Ordinance (No. XXVIII of 1997) further to amend the Unani, Ayurvedic and Homeopathic Practitioners Act, 1965. Dated 13 February 1997. (The Unani, Ayurvedic and Homeopathic Practitioners (Amendment) Ordinance, 1997). (The Gazette of Pakistan, Extraordinary, Part I, 13 February 1997, pp. 193-197) Pakistan Nuclear Safety and Radiation Protection (Treatment of Food by Ionizing Radiation) Regulations, 1996. S.R.O. 166(I) 96. Dated 7 March, 1996. These Regulations deal with, inter alias, the types of radiation to be used in treating food, licensing, the conditions governing treatment, packaging, re-irradiation, labeling, inspection, the issuance of certificates for irradiated food items, and the import and export of treated food. ³The Employment of Children Rules, 1995. S.R.O. 387(1) 1995. These Rules, made under Secs. 13 and 18 of the Employment of Children Act, 1991 include the following: 3. Notice of period of work; 4. Certificate of fitness; 5. Register of child workers; 6. Cleanliness in the place of work and its freedom from nuisance; 7. Ventilation and temperature; 8. Lighting; 9. Drinking water; 10. Latrines/urinals/washing/accommodations; 11. Precautions against fire; 12. Fencing of machinery; 13. First aid; 14. Notice of accident; and 15. Excessive weight. The Factories Act, 1934. As amended to 1997 This Act includes the following Chapters: III. Health and safety (including the following Sections: 13. Cleanliness; 14. Disposal of wastes and effluents; 15. Ventilation and temperature; 19. Lighting; 20. Drinking water; 21. Latrines and urinals; 23. Precautions against contagious or infectious diseases; 23-A. Compulsory vaccination and inoculation; and 32. Prohibition of employment of women and children near cotton openers); IV. Restrictions on working hours of adults; and V. Special provisions for adolescents and children. An Ordinance (No. XXVII of 1997) to provide for the protection, conservation, rehabilitation and improvement of the environment, for the prevention and control of pollution, and promotion of sustainable development. Dated 11 February 1997. (The Pakistan Environmental Protection Ordinance, 1997). (The Gazette of Pakistan, Extraordinary, Part I, 11 February 1997). An Ordinance (No. III of 2001) to provide for the establishment of the Pakistan Nuclear Regulatory Authority for regulation of nuclear safety and radiation protection in Pakistan and the extent of civil liability for nuclear damage resulting from any nuclear incident. Dated 22 January, 2001.´

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III.4 CHAPTER 4 SOCIO-CULTURAL ELEMENT Nothing much has to be discussed about the socio-cultural element of Shifa International Hospital. We have come to know that it is an equal opportunity employment place. Different women are serving at in different departments like Medicine, Radiology, Gynecology, Endocrinology, Dietitians and surgery as well. However, non Muslims also serve in the hospital. Most of the nursing staff is Christian. Ward boys are Christians. People from different parts of Pakistan serve here irrespective of their rank, or caste. (Punjabi, Bloch, Pathan or Sindhi). Since the hospital is a big corporation, consisting of many stock holders, many people serve here. Starting from very senior doctors to young fresh students. Shifa welcomes fresh people and is an equal opportunity place. People from different cultures serve in the hospital. It has created a name in the hospital industry. Basically, the management at Shifa believes in making a strong team of excellent professionals who are able to serve at their core with their best potential, irrespective of their age, sex, culture or gender. The staff they have right now has the best medical specialists from all over Pakistan. It has more than 100 extensively trained surgeons and physicians, form USA. They are all dedicated towards quality, comfort and safety of the patient. They team of professionals work with unity to ensure good customer health and satisfaction. The management at Shifa is handling all these diversifications in an excellent manner. Different shifts like morning and night shifts are working at Shifa. It motivates the workers to be a part of the team and perform well. The overall objective is to provide consumer satisfaction and good quality. Different departments work together in collaboration to attain a long term objective.

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III.5 CHAPTER 5 LEGAL POLITICAL ELEMENT Pakistan became an independent sovereign state on 14 August 1947. At the time of independence the territories that became Pakistan had one medical teaching college and attached hospital and one university at Lahore. The health care delivery system consisted of a few district and civil hospitals. As early as 1954 a Medical Reforms Commission was set up to advise the Government on the organization and structure of the medical services. One of the recommendations of the Commission was to establish a Medical Research Fund. In 1962 a subsequent Medical Reforms Committee recommended the establishment of the Pakistan Medical Research Council (PMRC), which was created under the Ministry of Health and assigned responsibility for promoting, organizing and coordinating medical research in the country, and for linking medical research to overall national socio-economic planning. Over the years, and especially in the 1980s, many commissions and committees were constituted to advise the Government on health sector reform and development. (See Annex I: Chronology of Health Sector Development in Pakistan). The Health Survey and Development Committee (Bhore Committee) was set up in 1946, just a year before partition of the subcontinent. The Committee¶s recommendations encompassed the concepts of universal access, equity, quality and community participation in the provision of health care, concepts that were to be incorporated in the recommendations of subsequent commissions and committees. However, to date they have eluded the kind of implementation envisioned. Under item 6 of the policy document - Resource development for health - communityoriented medical education, the Pakistan Medical and Dental Council, and nursing and paramedical staff development are listed. Under item 8 - Priority health programs - it lists the National EPI Program, the Prime Minister¶s Program for Family Planning and Primary Health Care, maternal and child health, reproductive health, the National ARI and Diarrhea Disease Control Program, Malaria Control Program, National Tuberculosis Control Program, National AIDS Control Program, nutrition, mental health, oral and dental health, Health Promotion and Health Education, School Health Program. Under item 22 - Health systems research (HSR) - the policy acknowledges the neglect of health research and promises to give it due importance, promote a research climate in academic institutions, and institutionalize HSR. II.5.1 Health research Institutions in Pakistan III.5.1 THE PAKISTAN MEDICAL RESEARCH COUNCIL (PMRC) The PMRC was assigned the functions of promoting, organizing and coordinating health research and linking it to national socio-economic development planning. To achieve its objectives, the PMRC adopted the strategy of establishing research centers in medical teaching institutions, where it was assumed the research capacity was concentrated. The Council has 18 such centers at present, located in major public sector undergraduate and postgraduate medical institutions.

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III.5.2 THE NATIONAL HEALTH SURVEY OF PAKISTAN (NHSP) The PMRC carried out the NHSP in collaboration with FBS and the National Center for Health Statistics (NCHS), USA, in 1990 ± 1994. The sample size of 80 primary sampling units of 30 households each was selected by the FBS within its sampling frame. The objectives of the survey were: y y y y To provide a general health profile of the people of Pakistan; To provide a health profile of high risk groups; To assess the utilization of health services; and To provide this data in a form relevant to the health program, policy and planning needs of the Government of Pakistan.

The model for the survey was the National Health and Nutrition Examination Survey (NHANES) of the NCHS, USA. III.5.3 NATIONAL INSTITUTE OF HEALTH, ISLAMABAD The National Institute of Health (NIH) was established in the early 1960s with the title of National Health Laboratories. The scope and functions of the Laboratories were expanded in the 1980s and the institution was renamed the National Institute of Health. Vaccine and diagnostics development are the major functions of the NIH, for which research was an essential requirement. The Institute has the largest number of health science personnel in the public sector, but in the field of research its contribution has been negligible, due largely to a lack of know-how. III.5.4 PAKISTAN COLLEGE OF SURGEONS AND PHYSICIANS (PCSP) This is a fully autonomous institution at the federal level, established with the objective of capacity building in specialized fields of medicine. The college trains for, and awards, fellowships in different specialties (FCPS). The Government recognizes the degree as equivalent to the memberships and fellowships awarded by the Royal Colleges in Britain and the equivalent awards of the American Board. III.5.5 HEALTH SERVICES ACADEMY, ISLAMABAD The Health Services Academy, Islamabad was established to train personnel in health management, public health and related subjects. The academy teaches and also undertakes HSR. The Academy is currently offering a one-year course for a Master¶s degree in Public Health and short courses in health management and administration. It has organized a field demonstration area for HSR. III.5.6 PRIVATE MEDICAL INSITUTIONS The private health sector¶s contribution to the GDP of the country exceeds that of the public sector. The National Health Survey of Pakistan has shown that 80% of curative care visits are to private health practitioners. Some very well equipped and high quality 42

hospitals have been established by the private sector, the notable ones being the Aga Khan University (AKU) Hospital, the Shaukat Khanum Cancer Hospital, the Al-Shifa Eye Trust Hospital and the Shifa International Hospital. The specialists in these hospitals contribute to the research effort, with the AKU especially in the forefront of medical research. However, their impact on the research environment has yet to be seen. In the field of capacity building, the private sector is a latecomer, but is expanding fast. Already there are three private sector medical universities (all in Karachi) and several medical colleges.

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IV PART 4 ELEMENTS OF TASK ENVIRONMENT IV.1 CHAPTER 6 LABOR SUPPLY Labor supply comprises those individuals which are employable by an organization. The people at Shifa are mostly USA qualified professionals who have an urge to serve the people at their most with an objective. Labor supply at Shifa International consists of: Dr. Zaheer Ahmed, Chairman & CEO Dr. Manzur Qazi, MD (Medical Director) Syed Illyas Ahmed COO (Chief Operating Officer) IV.1.1 EMPLOYEES AT INTERNAL MEDICINE NAME Dr. Mazhar A. Mufti Dr. Tara Jaffrey Dr. Amer Nazir Ahmed Dr. Sabeen Mufti Dr. Amjad Suhail Dr. Mohammad Ata Dr. Mahmud Majeed Dr. Mohammad Iqbal QUALIFICATION MD, DABIM, USA MD, DABIM USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA POSITION Consultant Consultant Consultant Consultant Consultant Consultant Consultant Consultant

IV.1.2 EMPLOYEES AT CRITICAL CARE NAME Dr. Syed Arif Hussian Dr. Mohammad Anwar Dr. Shazli Manzur Dr. Aftab Akhtar QUALIFICATION FRCP MD, DABIM, USA MD, DABIM, USA MD, DABIM, USA POSITION Consultant Critical Care & Pulmonary Consultant Critical Care &Pulmonary Consultant Critical Care &Pulmonary Consultant Critical Care &Pulmonary

IV.1.3 EMPLOYEES AT SECTION OF INFECTIOUS DISEASES NAME Dr. Mahmud Haider Dr. Kh. Sayeed Ahmed Dr. S. Nayyar Mahmud QUALIFICATION MD, DABIM MD, DABIM MD, DABIM POSITION Consultant Diseases Consultant Diseases Consultant

Infectious Infectious Infectious 44

Diseases IV.1.4 EMPLOYEES AT PSYCHIATRY SECTION NAME Dr. Rizwan Taj Dr. Fawad Kaiser Dr. Mohammad Amin Dr. Mohammad Habib QUALIFICATION MRCPych UK MRCPych UK FRCP Canada, DABPych, USA MRCPsych UK POSITION Consultant Psychiatry Consultant Psychiatry MD Consultant Psychiatry Consultant Psychiatry

IV.1.5 EMPLOYEES AT NEUROLOGY SECTION NAME Dr. Ali Hassan Dr. Arsalan Ahmed QUALIFICATION FCPS MD Neurology Pakistan POSITION Consultant Neurology Consultant Neurology

IV.1.6 EMPLOYEES AT DERMATOLOGY SECTION NAME Dr. Rezzan Khan Dr. Ikramullah Khan Dr. Rasheed Choudry Dr. Ahsan Hameed QUALIFICATION PhD Food & Nutrition MRCP, UK D. DERM, Pakistan FCPS , Pakistan POSITION Consultant Nutrition Consultant Dermatology Consultant Dermatology Consultant Dermatology

IV.1.7 EMPLOYEES AT CARDIAC SURGERY SECTION NAME Dr. Khalid Rasheed Dr. Munir Ahmed Dr. Javed Hayat QUALIFICATION FRCS, UK FRCS, IRE FRCS,IRE POSITION Consultant Cardiac Surgery Consultant Cardiac Surgery Consultant Cardiac Surgery

IV.1.8 EMPLOYEES AT GENERAL SURGERY SECTION NAME Dr. Tahir Hussain Dr. Mohammad Iqbal Dr. Mussadiq Khan Dr. Tahira Farooq Mirza Dr. Tahir Saleem QUALIFICATION FCPS, Pakistan FRCS UK MD DABS, FACS USA EMS USA FRCS DLS IRE POSITION Consultant General Surgery Consultant General Surgery Consultant General Surgery Consultant General Surgery Consultant General Surgery

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Dr. Mohammad Amir

FRCS UK, FRSP Pakisatan

Consultant General Surgery

IV.1.9 EMPLOYEES AT DENTISTRY SECTION NAME Dr. Shahid Mehmood Dr. Noeen Arshad QUALIFICATION BDS Pakistan BDS Pakistan, MSC UK POSITION Consultant Dental surgery Consultant Dental surgery

IV.1.10 EMPLOYEES AT ENT SECTION NAME Dr. Zafar Iqbal Dr. Zaffar Rabbani Dr. Zulfiqar Ali QUALIFICATION DLO Pakistan MCPS, FCPS Pakistan FRCS UK POSITION Consultant ENT Consultant ENT Consultant ENT

IV.1.11 EMPLOYEES AT OPHTHALMOLOGY SECTION NAME Dr. Farooq Afzal Dr. Kamran Hamid Dr. Zeba Matin QUALIFICATION FRCS, FRCO UK FRCS UK FCPS Pakistan, FRCS UK POSITION Consultant Ophthalmology Consultant Ophthalmology Consultant Ophthalmology

IV.1.12 EMPLOYEES AT UROLOGY SECTION NAME Dr. Ajaz Sami Dr. Saeed Akhtar Dr. Mian Khalid Akbar Dr. Asim Masood Choudry Dr. Mukhtar Nasir Dr. Kamran Majeed QUALIFICATION MD DABO USA MD DABO USA FRCS UK FRCS, D. USA MD DABO FACS USA FRCS UK POSITION Consultant Urology Consultant Urology Consultant Urology Consultant Urology Consultant Urology Consultant Urology

IV.1.13 EMPLOYEES AT ANESTHESIOLOGY SECTION NAME Dr. Harris Baig Dr. Mohammad Sami Iqbal Dr. Masooma Syed Dr. Bushra Noman Dr. Mohammad Iqbal Memon QUALIFICATION MD DABA USA MD USA MD USA FCPS Pakistan POSITION Consultant Anesthesiology Consultant Anesthesiology Consultant Anesthesiology Consultant Anesthesiology Consultant Anesthesiology

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Dr. Rashid Mehmood MD DABA USA Dr. Mohammad Asraf FCPS Pakistan Dr. Mohammad Nasir Ayub FCPS Pakistan Khan IV.1.14 EMPLOYEES AT PEDIATRICS SECTION NAME Dr. Rehana Syed Dr. Ejaz A. Khan Dr. Munir Iqbal Malik Dr. Iffat Fatima Zaman DR. Khawaja Ahmed Abbas Dr. Musarat Hussain Dr. Kamran Khattak Dr. Anwar ul Haq QUALIFICATION MD USA MD DAPB USA MD, DAPB USA MD USA DCH FRCP FRCPCH UK MD DAPB USA MRCP UK FCPS Pakistan

Consultant Anesthesiology Consultant Anesthesiology Consultant Anesthesiology

POSITION Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics Consultant Pediatrics

IV.1.15 EMPLOYEES AT OTHER BRANCHES Name Position Syed Munir Hussain GM Finance Bukhari Mr. Wazir Mohammad Manager Accounts & Finance Mr. Aqeel Mir Associate Manager Purchase Mr. Mohammad Shahid Assistant Manager Material Tanvir Management Mr. Mohammad Aslam Sr. Manager Patient services Shahzad Choudry Sr. Manager, Human Recources & Development Mr. Ahsan Hussain Manager MIS Ms Nuzhat Sultana Manager Nursing Mr. Anis Alam GM Allied Services Mr. A D Zia Manager Food & Nutrition Services Maj. R Qaser Rafiq Manager Bio Medical Services Mr. M Rafiq Choudry Sr. Manager Maintenance Mr. Afzal Ahmed Sr. manager Marketing Mr. Azmattullah Qureshi Manager Media

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Col. R Saeed Ahmed Mr. Amer Farooq

Associate Manager Security Editor Shifa Publications

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IV.2 CHAPTER 7 CUSTOMERS & CLIENTS Lists of customers of Shifa International Hospital are definitely patients. People having health problems and suffering from any illness are patients. Now there are two Categories of patients. Permanent Patients and short time patients. Short time patients include people suffering from Typhoid, Malaria, Cholera or any dentistry problem. Long term Patients include mothers on family way, Patients suffering from Cancer, Diabetes, Ulcer or High BP. These patients need to go for a check up after certain periods and are placed in the long term period. A person suffering from cancer undergoes many treatments (radiations) and a Diabetic has to check his sugar level after certain time. Kidney Dialysis patients also come in the long term category. They need to under go a dialysis after a certain period of time. Mothers on family way also need to go for a medical check up after several weeks. Patients of plastic surgery might not be the long term patients. They just make it once. Heart patients (Cardiology section) also need to go for a complete check up after some months. These are different categories of patients. There are certain patients who after recovering and discharging, may be prescribed a routine visits, in order to make sure that the relapse does not happen to them

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IV.3 CHAPTER 8 SUPPLIERS A group of suppliers would include those people who provide services to the Shifa Hospital to run its operations effectively. Since it a big hospital and the no. of suppliers would be a bigger one if mentioned all of them. However some of the suppliers are mentioned: DESCRIPTION A XRAY IMAGING EQUIPMENT CT Scanner Laser Imager Processor X-Ray Film processors Ultrasounds B CARDIAL EQUIPMENT Integris SC4000- Digital Angiography ECG & Stress Test ECHO-Cardiograpghy C KIDNEY CARE EQUIPMENT MFL 5000 HemoDialysis Equipment D OPERATING ROOM EQUIPMENT Multipurpose Operating Table Defiblirator Servo Ventilator Hanalus Operating Light System Operating Table Laparoscopic Equipment Plastic Surgery Equipment Ultrasonic cleaner Sterilizer 666 E RADIATION ENCOLOGY Linera Accelerator Simulator Cobalt 60 F NEUROLOGICAL EQUIPMENT EEG EMG G Other Equipment SUPPLIER NAME Toshiba Japan Kodak-USA Japan/Germany Toshiba Japan Phillips Holland USA Japan Toshiba Japan Phillips Holland Gambro Sweden Siemens Germany Siemens Elma Sweden Siemens Elma Sweden Siemens Elma Sweden Siemens Elma Sweden Storres Germany MISC Siemens Germany Siemens Germany Phillips Holland Toshiba Japan MDS Canada Toshiba Japan Toshiba Japan

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Pulmonary function analyzer Blood Gas Analyzer Hematology Analyzer Leica Microscope Video Endoscopes for Gastroenterology

Fukuda Denshi Co. NOVA USA Abbott USA LEICA Germany Olympus

These are the major equipment which helps Shifa People to run their system and impart health care services.

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IV.4 CHAPTER 9 COMPETITORS We find two competitors of Shifa International Hospital. IV.4.1 AGA KHAN HOSPITAL KARACHI IV.4.1.1 SOME GENERAL INFORMATION This provides high-quality patient care in a broad range of secondary and tertiary care services. This academic medical center¶s professional staff and facilities are among the best in the region. Modern patient care is made possible through collaboration between various health professionals and provision of state-of-the-art equipment to support diagnosis and treatment. Care is available to all patients in need. Services & Facilities at Aga Khan Operating Rooms: Main: 8 Lithotripsy and Day Care: 4 Obstetrics Labor: 2 Outpatient Services  Emergency  Consulting Clinics Medicine              Allergy Cardiology Dermatology Endocrinology and Diabetes Gastroenterology General Medicine Hematology Infectious Diseases Nephrology Neurology Oncology Pulmonary Rheumatology

Surgery  Cardio-Thoracic  Dental

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Ear Nose Throat General Surgery Maxillo-facial Neurosurgery Ophthalmology (Eyes) Orthopedics (Bones) Pediatric Surgery Plastic Surgery Urology including male infertility Vascular Surgery

Pediatrics            Cardiology Gastroenterology General Hematology and Oncology (Blood disease / cancer) Infectious Diseases Nephrology (Kidney) Physiotherapy Obstetrics/Gynecology and Infertility Psychiatry (Mental Health) Family Medicine Community Health Centre ± low cost walk-in clinics

Special Clinics                Anesthesia Breast Screening Cleft Palate Colostomy Dietary/Nutrition ENT Head and Neck Cancer Executive Clinic ± annual health screening programme. Family Planning Liposuction Lithotripsy (Stone in Kidneys) Nasal Allergy Physiotherapy Speech Therapy Stoma Care Surgical Day Care

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Diagnostic Services       Clinical Laboratory Blood Bank and Blood Products Clinical Chemistry Hematology Histopathology Microbiology

IV.4.2 SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTER, LAHORE

Figure 8

Services & Facilities Medicine Department The clinical areas include: Medicine Surgery Anesthesiology Medicine Pediatric Pharmacy Radiation Oncology Nuclear Radiology Pathology Nursing

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IV.4.3 FUTURE COMPETITORS IV.4.3.1 SAHARA FOR LIFE TRUST Outpatient Department  OPDs Ø Ø Ø Ø Ø Ø Ø Ø Internal medicine 20 beds Emergency/Trauma center Surgery Orthopedic Pediatrics Gynecology and obstetrics Cardiology Liver and Kidney clinic  Inpatient Department Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Obs/Gynae Ward Male medical ward Female medical -ward Male surgical ward Female surgical ward Pediatrics ward Paeds isolation ward Nursery Dialysis center Coronary care unit Intensive care unit Operation theaters Labor room Private rooms  Allied Facilities Ø Ø Ø Ø 4 state of the art and modern Operation Theatres. Dialysis unit Free medicine provided to all the poor and deserving indoor and outdoor patients. free catering for all indoor patients.

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Radiology Ø Ø Ø X-ray Ultrasound Color Doppler  Pathology Ø Ø 24 hours service laboratory Blood bank facility  Allied Services Ø Ø Ø Ø 24 hours free ambulance service for poor patients Laundry, Incinerator, and Mortuary Permanent staff accommodation Help Line managed by duty medical officer to respond to the queries of the callers.

IV.4.3.2 QIH¶S (QUAID-I-AZAM INTERNTIONAL HOSPITAL) It is one of the future competitors. It is right now in the process of construction. It is located near Frobles, Peshawar Road, RawalPindi.

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IV.5 CHAPTER 10 GOVERNMENT AGENCIES The government agencies, with which Shifa operates, are: IV.5.1 CENTRAL BOARD OF REVENUE Shifa International Hospital operates under CBR, for paying of its taxes and other bills. The taxes include income taxes, Dispense taxes and other miscleaous taxes. Since, under ordinance Act, some of the taxes are exempted and some have to be paid off. IV.5.2 CAPITAL DEVELOPMENT AUTHORITY Shifa is located in H-8/4 Islamabad. It is working on many extension projects like expansion of certain wards and construction of certain departments. All these plans have to be approved by CDA. Right now many under construction projects are: IV.5.2.1 THE COMPLETED PROJECTS Floor G-5 Under Deck IPD for Social work Block D Block E1 Block H1 Block H2 IV.5.2.2 THE CONTINUED PROJECTS Block H3 Block H4 Block H5 Block F2 &3 ( for radiology department) Block D1

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Figure 9

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IV.5.3 INCOME TAX IT It is also an income tax authority with which Shifa operates. IV.5.4 PAKISTAN MEDICAL & DENTAL ASSOCIATION The Shifa College of Medicine is recognized by PMDC and it was approved in 2003. The PMDC has the name of Shifa College of medicine in its approved lists of colleges. IV.5.5 BAHRIA UNIVERSITY, ISLAMABAD The Shifa College is affiliated with Bahria University for its BDS degree. The final BDS degree is awarded by Bahria University. The University also implements rules and regulations of PMDC to govern the professional MBBS examinations, syllabi and academic standard of the college. IV.5.6 OTHER PROJECTS OF SHIFA FOUNDATION HOSPITAL IV.5.6.1 SHIFA COLLEGE OF MEDICINE IV.5.6.1.1 THE VISION & MISSION The founders of Shifa college of Medicine opened doors in 1998. It has a mission to graduate doctors by the rule of scientific disciplines and knowledge based profession. Shifa College of medicine is a medical school which strives to be a center of excellence and rigor. It believes in preparing its students for the 21st century. IV.5.6.1.2 STRUCTURE The College has faculty heads and is headed by the Dean. It monitors and regulates the clinical activities of the students, compliances with the regulations of Bahria University and PMDC. It provides the best source of training and education. It is recognized by PMDC. It is also included in the world wide directory of WHO. It is also included in IMED (International medical Education Directory) and FAIMER (Foundation for Advancement of International Medical education & Research).

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Figure 10

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IV.5.6.2 SHIFA COLLEGE OF NURSING It is a project of Shifa Foundation, committed to health education and providing free health care to the needy. SCN is in collaboration with Shifa College of Medicine. The BSCN program is built on the premise that enables the nurse to make critical decisions and providing care to the people. It is following under the rules of PNC (Pakistan Nursing Council). A four year program which helps in basic nursing courses.

Figure 11

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Figure 12

IV.5.6.3 TAMMER MILLAT FOUNDATION TMF was established in 1987 by a group of USA living Pakistanis. The organization is a registered body. Since TMF is a charity based organization, all decisions related to planning and implementations of projects are taken by Board of Governors. The policy guide lines are also provided by BOG. It has recently launched an education program to help people in getting ideas and its main aim is to educate masses.

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Figure 13

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PART V PROJECT SCHEDULING & MANAGEMENT V.1 MANAGEMENT ACTIVITES The management activities included in our project were: Formation of group Selection of a team lead Proposal writing Data gathering Project planning Project costing Report writing and presentations

Activities Formation of Group Team lead selection Proposal writing Data gathering

Time Taken 1 day 1 day 1 day 3 days

Maximum Allotted NA NA NA NA

Time Performed By All of the group members All group members Sadaf Fayyaz Syed Alamdar Hussain & Malik Waqas Ali All of the group members All of the group members Malik Waqas Ali & Sadaf Fayyaz Sadaf Fayyaz Malik Waqas Ali All group members

Data Analysis Brainstorming & Group discussion Analysis of core modules Report Writing (Documentation) Report Monitoring & Proof Reading Presentation

3 days 4 days 3 days 4 days 1 day 1 day

NA NA NA NA NA NA

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V.2 GANTT CHART OF MANAGEMENT ACTIVITIES Activities (parallel) Group Formation Time Taken in Days Performed By D1 D2 D3 D4 D5 D6 D7 D8 All Group Members

Team Lead selection

All Group Members

Proposal Writing

Sadaf Fayyaz

Data Gathering

Syed Alamdar Hussian & Malik Waqas Ali All of the members & Core group

Data Analysis Brainstorming Group Discussion Analysis Modules of

All of the Group Members Malik Waqas Ali & Sadaf Fayyaz Sadaf Fayyaz Malik Waqas Ali

Report Writing (Documentation) Report Monitoring & Proof Reading Final Presentation and Project Demonstration

All of the members

group

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APPENDIX A

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APPENDIX B

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APPENDIX C

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APPENDIX D

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APPENDIX E

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APPENDIX F

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REFERENCES

www.globalhealth.org/ www.ama-assn.org/ama/pub/category/3345.html www.google.com.pk www.phrusa.org/ Shifa International Annual report, 2005 MUSLIMS, the Voice of Muslims America ³Pak Tribune´

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