A number of factors contribute to the quality of care. The extent to which a hospital tries to achieve better standard with regard to these factors will reflect upon quality of hospital services. The factors are as follows.
1. The Hospital Staff:
Care in hospital involves four types of hospital personnel, viz. (i) the medical staff, (ii) the nursing staff, (iii) the paramedical staff, and (iv) general unskilled labour.
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Obviously, an adequate number of each of these categories of personnel should be available on the basis of certain established standards, such as one doctor or one nurse for so many patients, a technician for so many tests, and a radiographer for so many radiographs to be taken, a ward orderly for so many beds, and so on.
Thereafter, the availability as well as effective utilisation of this staff has to be ensured by making rational assignment of duties, authority and responsibility. The points that should be noted are as follows.
Number authorised and available: Is additional manpower in any of these categories based on workload.
Qualification and experience of the staff: Is it adequate?
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Availability of specialist or consultant staff: Are they available when needed or when their services are called for? Can honorary staff this requirement? Proportion of honorary staff to full-time salaried staff
Absentee rate: Apart from the sudden absence from work due to common cause such leave of absence; is there any large scale absenteeism? Disciplinary cases: Undue proportion of cases initiated against staff shows serious lacunae in personnel policies.
Avenues of promotion, pay structure, housing and health benefits and other perks: These have a bearing on job satisfaction.
Continuing education and in-service training of all categories of hospital staff in their respective spheres is necessary to keep up the standard of services. Regular organised programme should be designed and made available for in-service training of personnel.
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Besides, suitable incentives should also be provided by the hospital for enhancing one’s qualifications.
2. Physical Facilities and Equipment:
The location of various departments within the hospital, design of the wards and relationships of nursing stations to the patient beds should be such as to promote smooth flow of patient care activities.
Adequate space, good design, functional layout, clean and pleasant environment all contribute to better services. Availability of necessary equipment, both technical and commonplace, in good working condition at the right place also affects patient care.
3. Clinical and Service Facilities:
Adequate and appropriate clinical facilities are the most fundamental requirements for good patient care which is the reason for the hospital’s existence is the clinical units should also be complemented adequately by diagnostic and supporting departments, viz. pathology, radiology, blood bank, linen service, diet service and so on.
These departments should be organised around the clinical services routine so that they provide effective service to the clinical areas.
Coordination and synchronization of work in these two areas will increase the work output as well as effectiveness.
4. Load of Work:
Load of work on a particular hospital (or department within a hospital) affects the quality of care and serves as an index for augmentation of resources and inputs, or otherwise. The workload can be accessed from routine hospital statistics.
Comparison of figures of one period with that of the previous period or corresponding period of previous year can give an idea of the trend of workload and utilisation of hospital facilities.
5. Effective Use of Beds:
A hospital bed is the basic unit of hospital service. Utilisation of hospital beds is a factor contributing to, as well as a measure of, quality of care. Effective use of beds means:
1. Only patients requiring admission are hospitalised.
2. A patient should remain in the hospital for the minimum number of days so that more number of patients can be treated on one bed in the year. But this will have to be balanced keeping in view the patients’ condition. Too drastic a reduction may increase the frequency of readmissions.
3. Assessment of the patients admitted in a ward should be carried out frequently both by the senior medical staff and hospital administrator to find out unnecessary admissions or unduly prolonged stay.
4. The outpatients’ services should be efficiently conducted to minimise demand on inpatient beds.
6. Hospital Administration:
Management has become a science and management of a hospital both a science and an art. Hospital administration is more than institutional management; it is general administration, business administration, health and medical administration all combined together.
Proper administration of a hospital by a trained and experienced hospital administrator would add to the efficiency and effectiveness of a hospital.
Within the above framework, the organisation in terms of physical facilities equipment and human resources, the service provided in terms of quality, quantity and cost, and the extent of utilisation of the available facilities form the mainstay of a general evaluation of a hospital.
To this must also be added the element of consumer satisfaction. The points to be covered under each of above are given below. In addition to this general framework, each individual functional area must also be looked into. Brief highlights are also subsequently given in respect to each of these areas.