1.

INTRODUCTION
A. REASON: Mayo Hospital, Lahore is a service sector because it gives intangible health services. Reason to select this hospital is that we could gather factual & actual data about Mayo Hospital because we have reference in this hospital. B. HOSPITAL HISTORY: Mayo Hospital is the oldest and largest hospital of the country, serving the humanity since 1871. It was named after the Earl of Mayo, the then Viceroy and the Governor General of India. The father of the nation, Quaid-e-Azam Muhammad Ali Jinnah also paid tribute to services rendered by this hospital on his visit to Mayo Hospital dated 19.03.1940. Mayo Hospital was completed in 1870 and it started patient care in 1871. Earlier, after its construction in 1871, the Mayo Hospital was affiliated as a teaching hospital with the King Edward Medical College which came into being in 1860. The hospital was used to be managed by the Medical Superintendent under the administrative control of Government till 1999. In 2002, the Board of Governors took over the charge of the institution & posts of Dean and Deputy Dean were created. In year 2003, the Board of Governors was replaced with the Board of Management under which Principal KEMC was declared Head of Institution consisting of KEMC & Mayo Hospital. In year 2005, the King Edward Medical University (KEMU) came into existence to which Mayo Hospital is to be declared as attached hospital for teaching purposes. The hospital so attached, however, has been placed under the administrative control of Govt. of the Punjab. C. SERVICES HISTORY: Mayo hospital provides different health services to their patients. It comprises of different departments that are engaged in serving the patients. i. 1) 2) 3) 4) 5) 6) 7) 8) Medicine and Allied Departments Cardiology Chest Medicine Dermatology Medicine Neurology Pediatric Medicine Psychiatry and Behavioral Sciences Social and Preventive Pediatric

ii.

Surgery and Allied Departments

1) Anesthesiology 2) Cardiac Surgery 3) Neurosurgery 4) Obstetric and Gynecology 5) Ophthalmology 6) Oral and Maxillofacial Surgery 7) Orthopedics 8) Otorhinolaryngology 9) Pediatric Surgery 10) Plastic Surgery 11) Radiology 12) Surgery 13) Thoracic Surgery D. DECISION FRAMEWORK: i. PROCESS:

There is the availability of all facilities to cope up any disaster or mass catastrophe. Mayo Hospital is located in the heart of Lahore City and is surrounded by busy commercial and thickly populated residential areas with famous Anarkali Bazaar, Nila Gumbad, Gawalmandi and the Walled City of Old Lahore around it. The equipments used are up to date, new & technologically improved. Some new equipment was also purchased like 10 New Ventilators for Neurosurgery. Latest Operating Microscope has been purchased for Plastic/Neurosurgery Theater and an Endoscopy Unit has been made at Medical Floor with installation of latest Video Endoscopy machines. Hospital also provide incentive, rewards and compensation program for Emergency staff, recruitment/selection of new energetic and dedicated staff for Departments and arrange training program for doctors/nurses & paramedics about quality health care, interpersonal communication & evidence based medicine learning program. Job design used in the hospital work effectively and efficiently that fulfill the requirements of the patients ii. QUALITY:

Certain standards for the quality have been set. The standards include measures to maintain service quality & to ensure the quality of patients served. It is based on the effective implementation of Government commitment i.e. Health for All, scalar Principle of Management, and command on communication, decentralization of Authority (Finance and Administration). Mayo hospital provides the patients with the services of the well trained staff (doctors, nurses, technicians, and attendants). All are well qualified and able to deliver quality services. Services that are provided are according to the patients requirements and

specifications. Medicines and equipment used for operations and therapy are of good quality. The equipment that used is of high quality and sterilized that dont harm the patient health. Each department of the hospital has interaction with one another for ensuring the quality in the services. iii. CAPACITY:

The Mayo Hospital is:

1) 2) 3) 4) 5)

Built over 54.6 acres of land Number of beds 1799 (But the number of patients is almost 2200) Professorial Units 32 Non-teaching Units 11 Total 43 Departments

The following data shows the number of patients & the services performed in the year 2010 Total attendance Total admissions Operations performed Major Minor Lab. Tests performed X-Ray performed ECGs Ultrasound C.T.Scan 14,36,162 93,070 89,516 32,767 56,749 26,66,236 2,20,165 86,424 51,692 12,760

Professional and ancillary staff is available for achieving goals of the Hospital. Following is the table that describe number of human resource available for the service of humanity in the hospital along with total budget for the year 2010-11 Gazatted Staff 1355 Nursing Staff 1149 NonGazatted Staff 2554 Total staff 4970 Total Land Annual Recurring Budget 171,77,80,000

54.6 Acres

After construction / renovation the outlook has become attractive and the capacity of holding more patients has remarkably increased iv. INVENTORY:

Doctors are made available for 24 hours a day & stock of every kind for medicines are also made available inculcating sense of social security through the availability of 100%

commodities for 100% patients on 100 % occasions. Hospital has separate pharmacies both in the Emergency Ward and Operation Theatre and are providing all pre-operative medicines / surgical items. Fully functional pharmacy is also available at medical floor. All the necessary well stocked and quality standard medicines and surgical tools are available round the clock at the "Hospital Pharmacy" for the convenience of the patient at 5% less than the market price. A round the clock ambulance service fully equipped with first aid, "CPR" kit and other transport service is provided by the hospital administration to prevent any delay in life saving measures and other supportive purposes.

2. SERVICE DESIGN
A. THE SERVICE PROCESS BUNDLE: i. Physical Goods 1) Medicines 2) Blood ii. 1) 2) 3) 4) 5) Sensual Services: Prescription services X-ray / radiology services Central ICU with central and suction system Standard CCU facilities Angiography, angioplasty, cardiac bypass, heart valves replacement and all sorts of cardiac operations and procedures Psychological services:

iii.

1) Patient care: 100% free medicines to all patients attending in accident & emergency department. Separate pharmacy in emergency operation theatre. 2) Better communication system: Mike has been installed at the reception for announcement and better communication with the attendants of the patients. Computerized collection of data

B. CYCLE OF SERVICE

leaves hospital purchase medicine

takes appointment on telephone

arrives at hospital

go to hospital pharmacy

goes to reception

get health services

tell about appointment & get no.

patiet enters doctors' room peon calls no. wait for his/her turn

makes payment

3. PROCESS SELECTION
A. BATCH FLOW: On the basis of product flow classification hospitals adopt the batch flow process for the production and delivery of services. Because in hospitals each doctor with specialization in particular area of health deals with patients in batches having similar type of problems and relate diseases. Each department is made for handling the patients having diseases related to specific part of the body. B. MAKE TO ORDER: On the basis of type of customer order classification process that is selected in the hospital is make to order. Services provided to each patient are according to his/her disease or problem. Customer makes contact with the relevant doctor and then gets services according to the demand.

4. MANAGEMENT SKILLS
As we have many departments working for the betterment of humanity. Good management skills are required for that. In our hospital all departments are coordinating in the best possible way to serve patients and to provide them best treatment and facilities. All the gazatted, nongazatted and nursing staff are properly managed, they are well trained and knows their duties very well. They all are lead by Medical Superintendent having assistants and deputies to control activities of different departments. All the staff is qualified and their inspection is done on regularly basis so that quality of work is not affected. The missions, objectives, strengths and weaknesses of each department is analyzed to determine their roles in achieving the mission. A plan of action is devised for each department. Policies and strategies are reviewed regularly.

5. TOTAL QUALITY MANAGEMENT

Improving health care quality and patient safety is a top priority for health care institutions everywhere. The Mayo Clinic Conference on Quality, Safety and Service is an annual conference designed to promote improved patient care quality at Mayo Clinic. Health care quality leaders physicians, administrators and allied health staff from all disciplines are looking for ways to integrate human factors, quality improvement, teamwork, professionalism and patient-centered care into clinical practice. A significant need has arisen for education, collaboration and application of systems engineering techniques such as: 1) Lean 2) Six Sigma 3) Human factors tools (systems, process, workflow and equipment design) 4) Patient- and family- centered care practices Each of these techniques has best practices that can effectively impact quality improvement in health care. Traditionally, health care providers have not been trained to use the concepts mentioned above in their practice. The Mayo Clinic Conference on Quality, Safety and Service provides a forum for learners to better understand the core elements of quality improvement initiatives to continually improve the delivery of effective patient care. For ensuring the total quality management proper analysis of available resources, planning, documentation, implementation, management, monitoring, control and evaluation through feedback is made essential the hospital. There is Clinical / Surgical Audit on the feedback of all the cases admitted or entertained in Mayo Hospital to ensure that no patient is left unattended or at the mercy of indifferent, unprofessional or casual attitude. Compulsory and Surprise Inspection by the Medical Superintendent, Zonal Heads (Addl. Medical Superintendents, Deputy Medical Superintendents, Chief Pharmacist, Deputy Chief Nursing Superintendent and Nursing Superintendents) has been made mandatory. Periodic meetings with Senior Registrars, Registrars, Nursing staff, Administrative staff in addition to Technical, Tender and different Hospital committees, have been scheduled on regular basis. Through these meetings, concerned officials and staff are inspired and motivated. They are focused on ethical and moral

values and the noble cause of their profession. Their refined attitude ensures quick and quality health services towards humanity-in-distress. This course is targeted to health care quality professionals and teams working to improve quality and safety in patient care. All members of the care team will benefit, including physicians, allied health staff and administrative professionals.

6. VALUE ANALYSIS
The main objective of hospital is to provide services & to achieve or support this objective hospital makes different secondary functions. The purpose of value analysis is basically to find out the ways through which some more values or comfort can be added at the same cost or provide the same value at lower cost. The following are the ways through which value or comfort is being added: 1) Providing facility of taking appointments by doctor on telephone. In old times patients used to come to the hospital, stand in line, take time from doctor & then have checkup. But now patients can take time at phone. This has increased the value or comfort for the patients in a way that now it is easier to handle patients, elimination of mismanagement as the rush of patients is managed & the patients are more satisfied. This lowers down the cost by reducing average waiting time (Admission & Preoperative) and average length of stay in the hospital. It helps in increasing the number of patients that can be served and improve patients satisfaction. 2) Contact with the medical raps. Mayo hospital has contact with the medical rap of such a company that provides quality medicines that ultimately bring comfort for the patients. 3) Provide ambulance service on time. Through this a patient in emergency is brought to hospital more quickly & then has necessary treatment. This reduces the hospital death rate and improves the level of comfort for the patients and their attendants in the hospital. 4) Hospital website is launched. Mayo hospital provides information on the internet by creating its website that ultimately leads to awareness in the patients or in people in a way that they come to know about the hospital, doctors, staff, departments, facilities completely & easily. And they can also have contact numbers from the site. 5) Computerization & networking of all the hospital records is introduced. It reduces the cost of handling data and errors and problems that arise because of manual working. 6) Hospital shift blood Bank from 1st floor to Ground floor. It gets easier for patients to approach it.