Operations Management Project

PROCESS FLOW ANALYSIS AT BABY MEMORIAL HOSPITAL

Guide: Prof. Sanjay Jharkaria Group 4, Section A

DERRICK VIJAYAN (015) G ANANDKUMAR (017) MOLUCHANG AO (031) SABIR SALAM (041) SABITH SALIM (042) SHETH KALP CHETAN (047) SUSMIT DANDAPAT (056) TULASI PRABHAKARBABU (057)

Operations Management Project

Contents
Introduction ……………………………………………………………………………………………………………………..………. 2 BMH facilities…………………………………………………………………………………………………………………………….. 4 Departments ………………………………………………………………………………………………………………… 4 Laboratory facilities ……………………………………………………………………………………………………... 4 Operation Theatre .…………………………………………………………………………………………………….... 5 BMH Academy ……………………………………………………………………………………………………………… 6 Community services ……………………………………………………………………………………..……………… 6 Organization Structure ……………………………………………………………………………………………………………… 7 Major departments …………………………………………………………………………………………………………………… 8 Layout ………………………………………………………………………………………………………………………………………. 11 Treatment Flow ……………………………………………………………………………………………………………………….. 14 Process flow and calculation ……………………………………………………………………………………………….…… 17 Front desk and Reception …………………………………………………………………………………....…….. 17 Cash Counter ……………………………………………………..………………………………………………..…….. 18 Departments …………………………………………………….……………………………………….……..………… 19 Pharmacy …………………………………………………………..……………………………………………………….. 21 Recommendations ………………………………………………………..…………………………………………………………. 23 BMH Layout ……………………………………………………..…………………………………………………………. 23 Front desk and reception ………………………………..…………………………………………………………… 23 Cash Counter …………………………………………………..………………………………………………………….. 24 Departments …………………………………………………………………………………………………..…………… 25 Pharmacy ………………………………………………………………………………………………………..…………… 26 SAP Analysis and LAP synthesis …………………………………………………………………………………..……………. 28 References ……………………………………………………………………………………………………………………………….. 30

Indian Institute of Management Kozhikode

Page 2

Operations Management Project

Introduction
Baby Memorial Hospital is one of the leading multi specialty hospitals in Kerala. Baby Memorial Hospital (BMH) is located in Indira Gandhi Road, Calicut which is pretty much the heart of Kozhikode. It is in proximity of bypass road and the Main bus station thus very convenient to patients from near and far. The hospital was named in memory of Late. Mr. K.C. Varghese (lovingly called 'Baby'), father of Dr. K.G. Alexander, MD, the Founder Chairman. Dr K.G. Alexander combined his formidable spirit of entrepreneurship and a deep rooted commitment to ethical patient care to forge the foundation of this hospital. From humble beginnings in 1987, the hospital is now acknowledged by one and all as one of the best apical care institutions in Kerala. BMH has received various recognitions for its quality work. BMH is an NABH accredited ISO 9001:2000 and 14001:2004 accredited hospital. Started with 56 beds in rented premises, BMH today has its own eleven-storied building with more than 450 beds. It has all the Medical and Surgical specialties and super-specialties, headed by highly qualified and experienced doctors, most of whom are retired professors and heads of departments of various Medical Colleges in Kerala. A team of 100 doctors & 750 medical, Nursing, Para medical and Administrative staff work together here. This remarkable growth has been achieved in such a short span of time mainly due to the highly professional treatment and excellent nursing care ensured by the management. The hospital has an enviable reputation for its ethical and honest medical practices which also attracts the patients. BMH is on the fast track for modernization. State-of-the-art facilities for all the departments are constantly installed resulting in achieving a high level of sophistication. The Operation Theatre Complex has 14 fully equipped, international class operation theatres, which is the only one of its kind in the region. The stainless steel wall cladding, anti-static flooring and laminar flow air-conditioning system with micro filters ensure zero percent post-operative infection rates. There are separate, fully fledged ICUs for medical, cardiology, neurology, neurosurgery, neonatology, post-transplant and other post-operative and gynaecology and obstetrics cases with a total of 92 beds as well as a 24 hour Accident and Trauma Care Unit. BMH ranks amongst the top multi-specialty, tertiary care, referral hospitals in Kerala.

Indian Institute of Management Kozhikode

Page 3

Operations Management Project

BMH Facilities
DEPARTMENTS
The college at present has 29 departments and is set to add more in future 1. Anaesthesiology and critical care. 2. Cardiology. 3. Cardio thoracic care. 4. Child & Adolescent guidance. 5. Dental. 6. Dermatology. 7. ENT & Audiology. 8. Gastroenterology. 9. General Vascular & Laparoscopic Surgery. 10. Gynaecology & Obstetrics. 11. Internal Medicine. 12. Medical Oncology. 13. Nephrology. 14. Neurology. 15. Neurosurgery. 16. Ophthalmology. 17. Orthopaedics. 18. Paediatrics & Neonatology. 19. Paediatric surgery. 20. Plastic, Reconstructive & Micro vascular Surgery. 21. Physical Medicine & Rehabilitation. 22. Radio Diagnosis & Imaging. 23. Respiratory Medicine. 24. Reproductive Medicine & Laparoscopic Surgery. 25. Urology & Transplant Surgery. 26. Psychological Medicine. 27. Cosmetology. 28. Dental & Maxillo facial surgery. 29. Accident & Emergency unit.

LABORATORY SERVICES
BMH has one of the most reliable lab services in Kerala. Their facilities includes1. Fully automated Biochemistry Analyzer. 2. Blood gas analyzer (ABG). Indian Institute of Management Kozhikode Page 4

Operations Management Project 3. 4. 5. 6. 7. Coagulation Profile Analyzer. Automatic Cell Counter. Electrolyte Analyzer. Elisa reader. Modern Histopathology and Microbiology labs. 8. Blood Bank.

Operation theatre

The operation theatre of BMH is equipped with: 1. 2. 3. 4. 5. 6. Fourteen operating rooms. Stainless steel wall cladding. Zero percent post operative infection. Antistatic flooring. Laminar flow air conditioning system with hepa filters. Equipped with world class Multi-parameter Invasive and Non-invasive Monitors, Operating Tables, Anaesthesia Ventilators, Diathermies, C-arm Image intensifiers, Infusion Pumps etc. 7. A well equipped 20-bedded surgical ICU with most modern resuscitative facilities.

Indian Institute of Management Kozhikode

Page 5

Operations Management Project

BMH Academy
BMH also runs an academy which provides add on to the hospital management. The students also get world class facilities and exposure to all types of patients. The various courses that are available in BMH are: Post graduate course – DNB for Doctors  Currently offering in Urology, Anaesthesiology, General Medicine, Orthopaedics & Paediatrics  Soon to offer Plastic Surgery, Neurology, Obstetrics &Gynaecology.  Baby Memorial College of Nursing  Stared in the year 2002  affiliated to University of Calicut,  Recognized by Kerala Nurses' and Midwives' Council.  Recognized by the Indian Nursing Council, New Delhi.  Has 4 year B. Sc nursing and 2 year M. Sc Nursing  Baby Memorial School Of Nursing  Established in 1995  Recognized by the Kerala Nursing Council & Indian Nursing Council.  3.5 year Diploma course in General Nursing & Midwives  Helpers for Hospital and Nursing Home Course  Course Conducted by JAN SHIKSHAN SANSTHAN.  6 Month course with internship.  Anaesthesia Assistants course  CME programmes

Community Services
The hospital also does community services like free plastic surgery, medical camps, medical checkup, Epilepsy treatment, Cardiac surgery screening camp etc.

Indian Institute of Management Kozhikode

Page 6

Operations Management Project

Organization Structure

Chairman and Managing Director Dr. K. G. Alexander

Medical Director Prof. T.P.Joseph

Exeutive Director Mrs. Anitha Alexander

Medical Superintendent Dr.Shaji Thomas John

Diretor Academic Studies Prof.P.V.Ramana

General Mananger Mr.P.V.Rajendr

Dy.Medical Superintendent Dr.P.K.Inderjit

Indian Institute of Management Kozhikode

Page 7

Operations Management Project

Major Departments
ANAESTHESIOLOGY AND CRITICAL CARE 9
CARDIOLOGY 5 3

CARDIO THORACIC SURGERY

CHILD AND ADOLESCENT GUIDANCE 1 DENTAL 3 DERMATOLOGY 2 ENT & AUDIOLOGY 5 GASTROENTEROLOGY 4 GENERAL,VASCULAR AND LAPAROSCOPIC SURGERY 5 GYNAECOLOGY AND OBSTETRICS 11 INTERNAL MEDICINE 9 MEDICAL ONCOLOGY 1

CMO

NEPHROLOGY 3 NEUROLOGY 5 NEUROSURGERY 3 OPHTHALMOLOGY 2 ORTHOPEDICS 7 PAEDIATRICS AND NEONATOLOGY 5 PAEDIATRICS SURGERY 3 PLASTIC,RECONSTRUCTIVE AND MICRO-VASCULAR SURGERY 5

PHYSICAL MEDICINE AND REHABILITATION 7 RADIO DIAGNOSIS AND IMAGING 2 RESPIRATORY MEDICINE 3 REPRODUCTIVE MEDICINE AND LAPROSCOPIC SURGERY 3 UROLOGY AND TRANSPLANT SURGERY 3

Indian Institute of Management Kozhikode

Page 8

Operations Management Project

Departments and number of available doctors
Paediatrics & Neonatology
Baby Memorial hospital is in fact the first ‘Baby Friendly Hospital’ in Malabar. It is in level III, 15 Bedded Neonatal ICU with incubators, radiant warmers, advanced Neonatal ventilators for managing extreme premature neonates. It also has Facilities for the management of babies with low birth weight, respiratory distress syndrome, hyaline membrane disease, congenital cardiac anomalies, metabolic problems in neonates, single & double surface phototherapy for the management of neonatal jaundice; baby clinic with free immunization services, rehabilitation facilities for children with special needs, special clinic for children with Down’s syndrome, Epilepsy clinic for children & an Adolescent care clinic for older children. The hospital also ensures that the medical staff is available 24x7.

Cardiology
This department has a state-of-the-art 12 bedded Intensive Coronary Care Unit (ICCU) with ultra-modern resuscitative devices, external pacemaker, multi parameter monitors, computerized central monitoring system etc. Temporary & permanent cardiac pacemaker implantations are regularly performed. Colour Doppler Echocardiography having Tissue harmonic imaging, colour kinesis & acoustic quantification, Burdick computerized tread mill stress testing, Holter monitoring recorders & analyzing. It also boasts the first Multi-plane Trans Oesophageal Echo (TOE) facility of its kind in North Kerala.

Neurology
Baby memorial hospital has a dedicated, 10 bedded Neurology ICU with the latest monitoring equipments. Testing facilities include digital EEG with brain mapping,

video EEG, EMG and Nerve Conduction studies. Special clinics for epilepsy, movement

Indian Institute of Management Kozhikode

Page 9

Operations Management Project

disorders & neuromuscular disorders, behavioral neurology are also available. Neuroradiology facilities like spiral CT & 4-vessel Angiogram are one of the best in Kerala.

Gynaecology & Obstetrics
Baby Memorial hospital conducts maximum number of deliveries in the private sector in North Kerala. They have treatment for all gynecological disorders and specialists in dealing with high Risk Pregnancy. They have facilities for treatment for both male & female

infertility as well as laparoscopic hysterectomy and ovarian surgeries. The department is headed by a retired Medical college professor and has 10 specialists.

Internal Medicine
Baby Memorial Hospital is a regional centre of excellence for the treatment of all medical disorders. A fully fledged Intensive Care Unit & Respiratory Care Unit is available, and is equipped with sophisticated Ventilators and Multi parameter Monitors. A large number of critically ill patients are successfully managed by a team of dedicated doctors.

ENT & Audiology
Outpatient procedures like otoendoscopy, diagnostic nasal endoscopy, vertigo management with practical repositioning manoeuvre, removal of foreign bodies of ear and nose are often of top quality. Aetiological Services done includes pure tone eudiometry, BERA, Speech and voice evaluation and voice therapy. Operative procedures performed include micro ear surgeries, nasal surgeries, surgeries of pharynx, video endoscopic and micro laryngeal procedures, partial and total larynxgectomies as well as Head & Neck Surgeries.

Indian Institute of Management Kozhikode

Page 10

Operations Management Project

Layout
BMH is a 480-bed hospital with about 10 ICUs and 14 operation theatres set in about 11floors. The hospital consists of a number of different functionalities such as front desk, Pharmacy, outpatient areas, in-patient areas, Emergency laboratory care, and other specialty services,

diagnostic

equipments,

Administration, Staff areas, Food and other services etc. An efficient layout should b e aimed at providing following features:  Provide optimal functional adjacencies. These adjacencies should be based on a detailed functional program  which describes the hospital's intended operations from the

standpoint of patients, staff, and supplies. Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi- purpose spaces.    Provide a well organized and efficient logistics system including elevators. Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces. Increase the comfort of patients by placing mostly accessed functionalities in easily reachable locations.

At BMH the OP area and emergency care unit is located at the ground floor itself, which provides sudden action in case of emergencies and contain majority of crowd coming to OP areas to the ground floor itself. A detailed layout of ground floor is provided in the next page. From the layout we can see most of the essential functionalities such pharmacy, labs, canteen services etc are provided at the ground floor itself and are

Indian Institute of Management Kozhikode

Page 11

Operations Management Project

placed at optimum locations. Analysis of location various functionalities are as following. 

Out-patient: The functionalities required by out-patients such as Registration counter, cash-payment, majority of consulting rooms, Laboratory, waiting areas etc are optimally located around a central activity centre. This minimizes the distance to be travelled between various functionalities.

Registration desk: Enquiry cum new registration and cash-payment cum ID issue desks are separately located yet nearer in order to prevent over-crowding in front of a single desk. Also the medical records and accounts departments are optimally placed just behind the cash-payment cum ID issue desk to decrease transfer times.

Pharmacy: It is separated from the general crowd area and is located towards the exit so that the patients can buy the prescribed medicines before they leave the hospital hassle free.

Emergency Care: It is located separated from the general areas. It has a separate entrance and is attached with an ambulance bay. Hence emergency situations can be handled effectively with high priority

Consulting Rooms: Majority of the consulting rooms are provided in the ground floor itself with the exception of few departments. An improvement can be done in this regard. The waiting areas are provided commonly to different departments which provide efficient use of the limited available space.

 

Canteen: It is also provided in the ground floor at the back to separate the crowd. It can be entered both from inside and out-side. Administration: Administrative wing is again located at the ground floor. Though it is placed optimally behind the accounts department, using up the limited space in the ground floor for admin, which doesn’t directly come in contact with the patient, is not properly justified.

Indian Institute of Management Kozhikode

Page 12

Operations Management Project

Legend
1. 2. 3. 4. 5. 6. 7. 8. Pharmacy Gynec Dept Lift & Stairs to IP areas Reception/New Registration Cash/ID issue/Old Registration Medical Records Department Accounts Department Laboratory 9. 10. 11. 12. 13. 14. 15. 16. Lift 2 Administration area Stairs and Lift to Theatres To Consulting Rooms Emergency Handling Area GM’s Room Ambulance Bay Canteen

Indian Institute of Management Kozhikode

Page 13

Operations Management Project

Treatment Process
1. New Registration: Done at enquiry cum new Registration counter. There are two people at this counter. They give Details regarding the required department number and availability of the doctors. 2. Cash Payment: Done at cash counters opposite to new registration counter. There are four counters at this desk. There will be a registration fee for new patients and consulting fee for all patients. 3. ID issue: After Payment, the patient is issued an ID card from the same counter. ID card has the following details. i. Patients Name ii. Patient ID no. iii. Date iv. Department Name/Number v. Doctors name 4. Old Patients: Old patients can directly go the cash counters and after registering their ID no. and payment if required, they can go to their previously allotted departments. 5. Consulting: A file containing detail of each department is forwarded to the concerned dept, where he is to be treated. Average waiting before consulting time is about 20-30 minutes, which at present can go upto 1 hour during peak hours. Patients are generally handled by junior doctors. Only major cases are handled by senior doctors. 6. Post-Consultation: After consultation, a. Some cases maybe recommended for In-patient. There will be another registration process at the previously mentioned counter and patient will be allotted respective room after payment of cash deposit. b. Some patients will have to take tests from laboratory and meet the doctor again the same day with the results. No registration is required again in this case. c. Some patients will have to meet the doctor again at a later time. The patient can book an appointment in advance in this case. 7. Pharmacy: Patients can buy the prescribed medicines at the pharmacy. Process at pharmacy is explained separately.

Emergency Handling
A separate area is available for emergency handling. An ambulance bay is attached to it and it has got a separate entrance. Process here is slightly different. The registration process is relaxed and quick here. Patients will be directly carried to required departments with high
Indian Institute of Management Kozhikode Page 14

Operations Management Project

priority and there will be no waiting time. A detailed and proper registration process similar to ordinary patients will be done at a later stage.

Process Flow Chart
Patient Arrival
Old Patient Emergency Care

New Registration

Cash payment and Id Issue

Consulting of Doctors

Laboratory

Pharmacy

Exit
Indian Institute of Management Kozhikode Page 15

Operations Management Project

Process Flow Analysis and Capacity Calculation
Operational analysis of various departments is done to calculate the capacity and to find any bottlenecks if any. Then by the analysis of the present and future demand, we can optimize the process flow and thereby the capacity of the department.

Front desk and Reception
Time taken to meet the receptionist = 75 seconds New patients coming per day peak hours = 1200 to 1400 I.e. approx 1300

Peak Hours
Assuming 80 % of them come during peak hours Total number of patients during peak hour =0.80 X 1300 =1040 patients. No: of receptionist = 2 Peak hour shift = 10 hours (8:30 am – 6:30 pm) No of man hours =20 Maximum patients serviced = 20 X 3600/ 75 =960 patients. Clearly, there is over utilization during peak hours (108.33 % of full capacity).

Off peak hours
Of the remaining i.e. during non-peak hours No: of patients = Total no: of patients’ coming- no of patients coming during peak hours = 1300 – 1040 =240 patients.
Indian Institute of Management Kozhikode Page 16

Operations Management Project

No of receptionist = 1 Non peak hour shift = 14 hours No: of Man hours = 14 Maximum no: of patients that can be serviced = 14 X 3600/75 = 672 patients. I.e. it works at 35.71% of full capacity at this shift. No need for improvement or change during this time.

Cash Counter
This section has 5 persons. They collect the slip; which is forwarded from the receptionist via, the patients themselves. Depending upon the availability of doctors / choice of the patients; they issue an Id which contains details of the patient as well as the name of the doctor. A moving staff (usually an assistant periodically takes the file and forward to the concerned department). Since and existing customer already have an Id card; servicing them takes less time Time taken to service a new patient = 3 minute Time taken to service an old patient = 1 minute

During Peak Hours:
No of Receptionist = 5 Peak hour shift = 10 hours Total man hours = 50 hours No of new patients coming = 1040 (refer previous page) Assuming the number of old patients are about 30% of new patients; No of old patients = 0.30 X 1020 =306 = approx. 300 old patients. Time taken to service new patients =1020 X 3 minutes =3060 minutes =51 hours

Indian Institute of Management Kozhikode

Page 17

Operations Management Project

Time taken to service new patients = 300 X 1 minute =5 hours Total service time = 56 hours.

Working at 112% of full capacity.

During non peak hours:
No: of cashiers =2 Non peak hour shift = 14 hours Total man hours = 28

No of new patients = 240 No: of old patients =0.30 X 240= 72 Time to serve new patients = 240 X 3/60 hours = 12 hours. Time to serve old patients = 72 X 1/ 60 hours =1.2 hours Total service time = 13.2 hours

I.e. it works at about 47.14% of full capacity.

Indian Institute of Management Kozhikode

Page 18

Operations Management Project

Departments
The patients after registering go to their respective departments where they consult their respective doctors. The servicing time per patient differs from departments to departments and also among patients. However, for analysis purpose, we take the average time to service a patient in a particular department called Average Servicing Time (AST). The number of doctors, both senior and junior, varies according to the demand for that particular department. The shift time for senior doctors are 4 hours, while it is 8 hours for junior doctors. Sometimes, junior doctors assist senior doctors also. The distribution of patients and the capacity of that particular department are calculated below.

No. of Doctors Department Pediatrics Cardiology Neurology Gynecology Internal Medicine ENT Junior 3 2 3 6 5 3 Senior 2 3 2 5 4 2 Total hours 32 28 32 68 56 32

Doctor Patients hours arrival Capacity Off AST Peak Other Off Peak peak (min) hours hours Peak peak 20 12 14 63 12 86 51 20 8 18 75 15 67 27 20 12 16 36 9 75 45 52 16 35 85 20 89 27 56 24 0 8 10 20 410 55 0 10 336 72 0 24

Analysis
Paediatrics
No. of patients arriving during peak hours: 63 Max. Service capacity: 86 Running at 73% of full capacity. Therefore no change needed No. of patients arriving during Off peak hours: 12 Max. Service capacity: 51 Running at 23% of full capacity. This process is seriously underutilized.
Indian Institute of Management Kozhikode Page 19

Operations Management Project

Cardiology
No. of patients arriving during peak hours: 75 Max. Service capacity: 67 Needs improvement since this department is running at 112% of full capacity. No. of patients arriving during Off peak hours: 15 Max. Service capacity: 27 Running at 55% of full capacity. Therefore no improvement needed.

Neurology
No. of patients arriving during peak hours: 36 Max. Service capacity: 75 This indicates under utilization (48% of full capacity) No. of patients arriving during Off peak hours: 9 Max. Service capacity: 45 This indicates under utilization (20% of full capacity)

Gynaecology
No. of patients arriving during peak hours: 85 Max. Service capacity: 89 The demand is close to capacity ( 96% of full capacity). Some improvements needed. No. of patients arriving during Off peak hours: 20 Max. Service capacity: 27 Running at 74% of full capacity. Therefore no improvement needed.

Indian Institute of Management Kozhikode

Page 20

Operations Management Project

Internal Medicine
No. of patients arriving during peak hours: 410 Max. Service capacity: 336 Seriously over utilized – running at 122% of full capacity.

ENT
No. of patients arriving during peak hours: 55 Max. Service capacity: 72 Running at 76% of full capacity. Therefore no change needed. No. of patients arriving during Off peak hours: 10 Max. Service capacity: 24 Running at 42% of full capacity Therefore no improvement needed.

Indian Institute of Management Kozhikode

Page 21

Operations Management Project

Pharmacy
The pharmacy is located at the ground floor near the main entrance/ exit. So it’s convenient for people coming from outside to get medicines easily. There is only one entrance; which is located perpendicular to the main entrance. Also it is adjacent to the Gynaecology &obstetrics department as well as operation theatre. This makes it easy for the pregnant ladies to get medicines without much difficulty. Besides medicines, injections and anaesthesia needed for surgeries are obtained without any delay. It has 5 pharmacists and one of them also acts as cashier. The layout is as shown:

Key:
C: Cashier cum pharmacist S1-S4: Other pharmacists.
Indian Institute of Management Kozhikode Page 22

Operations Management Project

The Time taken for each customer to enter and exit the pharmacy were noted and tabulated as shown below. (Time was noted only till the 5 customers had completed the shopping) Customer no 1 2 3 4 5 6 7 Time entered(sec) 0 34 197 312 345 363 452 Time left(sec) 173 272 443 508 546 Time spent in Pharmacy 173 238 246 196 183

Calculation:
Time for 5 customers to finish shopping Average time for serving one customer = 546 sec = 546/5 = 108 sec.

Average time spent by a customer in pharmacy = (173+238+246+196+183)/5 =207.2 sec So a patient spends half of the time waiting to be serviced. So there is a need for improvement.

Indian Institute of Management Kozhikode

Page 23

Operations Management Project

Recommendations
BMH Layout
Here the administration wing is not an essential part in the ground floor, while providing all out patient consulting rooms in the ground floor itself will greatly ease the effort for patients. So we suggest re-locating the admin Area to a higher floor and Bring down the consulting rooms in the higher floors to the area previously used up by the administration wing.

Front desk and reception
So we conclude that the reception is working in full force during peak hours. There may be a bottle neck; but the employees try to work hard; so as to eliminate the bottle neck. However there are chances that this may affect their performance & may cause error in forwarding the type of department needed. Still by experience the receptionists of Baby memorial Hospital are never heard of misdirecting patients. Even then, hiring another employee will eliminate the bottleneck.

Cash Counter
At peak hour shift cashiers work is worth 56 hours; even though they themselves have only 50 hours to spend; and during non peak hours they work only at 47.14% of full capacity. One way of tackling this issue would be appointing an additional cashier. Another way would be using online registration. This would reduce the rush at reception & cash counter; by approx 5- 10 % (as seen in some hospitals which have implemented it). Mobile registration too could be effective; as more people have mobile phones than internet in this part of world. At non peak time cashiers and receptionists work very less than their full capacity. This could be avoided by reducing the no: of receptionist to 1. But that may increase the load on him. Another suggestion is to scrap the reception system at non-peak and appoint 2 cashiers; who do both the job of cashier and receptionist.
Indian Institute of Management Kozhikode Page 24

Operations Management Project

Feasibility calculation of such a system:
Total man hours available at cash counter during non- peak time = 28 hours (from previous calculations) Time required for doing cashier’s part of job during non peak hours = 13.2 hours

Time required for doing receptionist’s part of job during non- peak hours = no: of patients X mean service time = 240 X 75/ 3600 =5 hours Total time to do both operations = 18.2 hours

Hence this set up will work at 65.2% of full load capacity & eliminate the need of a person at the reception.

Departments
Cardiology
Currently there is over utilization during peak hours since the patients are around 75 and the capacity is only 67. We can see that the servicing time of one customer is about 18 minutes or 3.33 customers per hour. So additional hours to be added = 8/3.33 = 2.4 hours. If 3 hours are added, Current capacity will become 77 current demand is 75. So demand can be satisfied for the time being. Since there are 3 senior doctors, increasing their shift by 1 hour will increase the servicing capacity by the required three hours. Again this solution is only temporary and in the long run, they may have to hire at least one junior doctor which will increase the servicing capacity by 3.33* 8 = 26.6 patients/shift

Neurology
Neurology is seriously underutilized with most of the capacity wasted. During peak hours the difference in capacity is about 39 patients and during off peak hours it is about 36 patients. Average servicing time = 16 minutes.
Indian Institute of Management Kozhikode Page 25

Operations Management Project

Therefore during peak hours 39*16/60 = 10.4 hours are wasted and during off peak hours, 36*16/60= 9.6 hours are wasted. This wastage can be reduced by reducing the shift time of senior doctors, who are generally more expensive. In the meantime, the hospital should take steps to increase its patient inflow and when the capacity increases, they can increase the shift time back to normal.

Gynaecology
Currently, the gynaecology department is on the verge of full capacity with an average of 85 customers during peak hours and full capacity of 89 customers. By the current trend, the number of patients is expected to increase and soon they will have to have additional doctor hours. Since there are 11 doctors in this department, this additional demand can be satisfied by giving over time work to doctors on a shift basis so that every doctor will have to do overtime of 4 hours a week, extra. Therefore increase of doctor hours in one week= 44 Increase of doctor hours in 1 day = 44/7 = 6.3 hours/day Increase in servicing capacity per day = 6.3 *60/35 = 10.8 Then the current capacity will become 100 during peak hours which will be enough for the time being.

Internal Medicine
This department faces the most serious over utilization with 410 patients visiting and capacity of only about 336. The difference in capacity = 410 – 336 = 74 patients per day Average servicing time = 10 min Therefore extra hours needed = 74*10/60 = 12.33 hours. These 12.33 hours can be gained by hiring 2 junior doctors by whom the department can gain additional 3.66 hours for future increase which will increase the total capacity to 94 patients during peak hours.

Indian Institute of Management Kozhikode

Page 26

Operations Management Project

Pharmacy
In pharmacy, most of the time is spent by patients waiting to be serviced. So, we feel that since at most of the time there are 3 or 4 customers in the pharmacy (even during peak times the maximum we noted was 7), there is no need of 5 pharmacists. 3 pharmacists are needed at non peak hours and 5 pharmacists are needed at peak hours. Also we noted that there is a bottle neck at the cash counter. This also blocks the easy entry of customers into the pharmacy, as the cashier is seated near the entrance. We propose a new layout. The layout is similar; except some minor changes. We plan to convert one more pharmacist into cashier cum servicing during peak hours, thus having 2 cashiers during peak hours. During non peak hours we may have only one cashier cum pharmacist and 2 other pharmacists. Another point to be noted is the position of the main cashier who works during peak hour as well as non peak hour. He is to be seated away from the entrance. Since most of the patients buy medicines while leaving the hospital; we propose a new exit at the right most corner of the shop. This will also be helpful for the customers as they can exit directly from the pharmacy.

Key: C- cashier/ pharmacist, S - Other Salesman (P)- working only during peak hours
Indian Institute of Management Kozhikode Page 27

Operations Management Project

SAP analysis and LAP synthesis
The development of new ideas and the development in Information Technology in recent years have large impacts on organizations. The success or failure of many business ventures is determined by the implementation of these new ideas in the form of ecommerce and e-business. Also in health services there is an increase in integration of Information Technology and there is a need to make this shift across all levels of health care services. Hospitals have begun to rely on e-commerce based operations to procure medicines and equipments and also for providing advance reservations for patients. As SAP LAP Analysis is used in Organizations to adapt new technologies, we have used the SAPLAP framework for the implementation of web based advance reservation for existing patients.

Situation
     Baby Memorial Hospital is one of the leading multi specialty hospitals in Kerala, located in the heart of Kozhikode. BNH has won several awards and is an ISO 9001:2000 accredited organization. BMH is a 480 bedded multi specialty hospital with more than 100 doctors in various departments. More than 1000 outdoor patients are serviced in a day. Around 29 departments with well equipped facilities.

Actors
    Top Management who takes decisions in various functions. Over 100 well experienced doctors who services the patients Over 300 supporting staffs including nurses, pharmacists and attenders Administration staff responsible for the smooth functioning of the hospital and takes care of various operational strategies and various transactions,

Process
   A registration portal is to be incorporated into the current BMH website. Existing users are given a user id and password so that they can log on to the portal. Through the portal they can reserve for consulting a particular doctor, view schedules of doctors and get updates on reservation status and changes in the schedules.
Page 28

Indian Institute of Management Kozhikode

Operations Management Project

In the long term, the hospital can implement an e-payment facility by which new patients can pay the registration charges and register and also existing patients to pay their medical fees.

Learning
   Implementation of website registration can possibly result in cost reduction. Ease of use for patients since they don’t have to go in person to register and directly go to their department for consulting. Less crowding in front desk means there is no over utilization in the registration counter which can considerably reduce the servicing time.

Action
     Top management should take necessary actions to implement the online registration portal Take stringent quality checks in the new software for registration allocation. Conduct periodic maintenance and trouble shooting on the portal Make patients aware of the new facility which will surely go well with young customers. Commitment in part of administration and front desk operators.

Performance
   The online registration portal improves the utilization of front desk and reception. Less cost is incurred in maintaining the website than the front desk. Less bottleneck in the reception means that the reserve capacity of the registration process increases, which can further increase the patient inflow possibly without any problems. Reservation known in advance means that the hospital reservation can plan their schedule in advance and add shifts if needed. Can learn the trends in patient distribution in various departments and allocate resources accordingly.

 

Indian Institute of Management Kozhikode

Page 29

Operations Management Project

References
 Information from the patients, administrative and medical staffs collected during our field survey.  BMH website - http://www.babymhospital.org/  http://www.babymhospital.org/specialities.php  http://www.babymhospital.org/center.php  Operations Management for competitive Change- Richard B Chase, F Robert Jacobs, Nicholas J
Aquilano, Nitin K Agarwal

 Prof. Sanjay Jharkaria Class Lecture notes  SAP-LAP Models, Global Journal of Flexible Systems Management, Apr-Jun 2001

Indian Institute of Management Kozhikode

Page 30

Sign up to vote on this title
UsefulNot useful