STRUCTURE OF SOP

As per NABH 5th edition

SOP (Standard Operating Procedures)
• These documents define the steps that will be carried out to complete
tasks or parts of tasks.
• Also known as Operations Documentation or Operations Manual.

• The term standard refers to its current relevance rather than its
permanent nature.
• Hence it is essential that these documents are kept relevant to the
requirements of alteration to processes that are necessary from time
to time due to improvements, change in technology, and changes to
statutory norms, etc.
• The standard operating procedures of one area may or may not apply
to other fields.
• Hence there are multiple manuals specific to departments/group of
related tasks and will have documentation for the processes and
procedures related to concerned department, section or activity.
• The Standard Operating procedure (SOP) are developed for the
healthcare facilities based on the Health Care Standards involved in
the health service providers and experts.
Importance of SOP
• Consistency – Each staff is consistent in the way they carry out a
particular task., reducing the risks of quality concerns.

• Fewer mistakes – As long as each individual within your team consistently

performs the written procedure in the SOP, the risks of errors remain low.

• Communication – SOPs require improvements and updates from time to

time. Updating these standard procedures give employees a chance to
communicate their concerns and suggestions in processing changes.
SOP Content
• Scope
• Purpose
• Roles and Responsibilities
• Procedures
• Definition of Terms
• References
• Appendices
• Evaluation Criteria
• Document History
• Name and signature of the author, reviewers, and the authorized person to approve
the SOP.
Sample SOP - PATIENT ENROLLMENT
Purpose
To provide maximum comfort and support to patients and their
attendants during the registration process.
Scope
• Requiring the front desk team to fully understand the whole patient
enrollment process, including the dos and don’ts.
• Providing accurate and smooth patient enrollment experience.
• Increasing the staff’s productivity
• Giving patients adequate comfort upon entering the hospital or clinic.
Procedure
As the first step before receiving medical treatment, the enrollment process is
mandatory to keep track of records and count the exact number of incoming
patients.
The whole procedure generally includes the following:
• Getting patient’s basic information (name, age, gender, occupation, marital
status, religion, contact details, address in case of the minor patient, and
emergency case relationship of the attendant).
• Generating a unique patient identification number.
• Keeping and maintaining patient files for documentation.
• Proper collection of necessary fees for visitation and treatment.
• Informing the patient and attendant about the next step after enrollment