TERM PAPER OF PRODUCTION & OPERATION

MANAGEMENT

TOPIC:- PROBLEMS IN PRODUCTION & OPERATION

MANAGEMENT IN HOSPITALS

SUBMITTED TO:- SUBMITTED BY:-

Mrs RITA KUMARI ASHUTOSH BASOTRA

SECTION:-R1813

ROLL NO:- A “22

 INTRODUCTION:-

Like other organizations and institution hospitals or any healthcare

facility passes through the following stages or in other words they need
the management of below sections for the smooth running of their
organizations, but the hospitals are very complex in its nature.

• Operations (actions)
• Finance (money and resources),
• Personnel(human relations)
• Information(needed information for wise decisions)
• Time (your own and that of others)

Each of these five elements mentioned, must be managed by any

person, who has its own set of principles and guidelines to follow. For
instance, when it comes to managing people, the teachings of Industrial
Psychology become pertinent. For operations, the teachings of
Operations Management as a subject become important. So, in
analyzing these five elements, it also becomes evident that the
teachings of Financial Management, Information Management and
Time Management, are also important for the other three elements. In
a nutshell, for a hospital manager it is compulsory to have the sound
knowledge of Operations Management, Financial Management,
Information Management, Human Resources Management, Time
Management and Communication.
 So as my topic is to understand the problems in production and
operation management in hospitals , I will find these kind of problems:-

PROBLEMS

 Material:

It is clear fact that the good material management can be use to

diminish operating costs for the time it is somehow been neglected in
hospitals and other facilities, so it is most important to take in
consideration the vitality of the material management in order to
achieve the goals and objectives of the hospital. As it is indicated in
previous surveys that 40 to 50 percent of the annual budget of the
hospital are spending on material used.
Hospitals
must adapt the ways and methods to streamline and make more
efficient their procurement, consumption and utilization control,
inventory and records control, storage and dissemination and service
organization.

The following factors have a big role in the effectiveness of

materials.
• The items which are needed urgently should be provided.
• Use the money in such a way that the cost of storage is reduced to a
minimum.
• Handle the items and equipments with the least loss in storage and
management.

 Pathology Services:

In general the pathology services are the cornerstone of the medical

field and it is playing a great role in diagnosis of different pathologies
and diseases. Pathological laboratories have a crucial role in the
diagnosis and detection and eventually in treatment of the patients. The
course of treatment and the cost of the medicine is quietly related to the
out come of the pathological tests, so the management and operation of
this department has a great importance.

 Management of Blood Banks:

Blood is the part of life that is given to those who need it by those who
have the resource to satisfy the need. Emergencies occur every minute.
For each patient requiring blood, it is an emergency and the patients
could have set back if blood is not available. And also the surgeries need
blood, and also the blood is also required in blood disease, such as
leukemia’s, thalassemia, and a blood cancer.
The main tasks of blood banks are as follows:-
1) Collection of Blood
2) Testing of the blood.
3) Storage of Blood.
4) Supply of Blood to the hospitals and other health facilities.
Some Critical issues in blood banks:

Insufficient provision of Blood: The blood bank is facing many

problems, one of the most important one is the lack of donor and
volunteers, so this deficit is due to some misconceptions and lack of
education among the local people, to educate the people and to wash
the brain of the people so the public information campaign is so vital
because the media is the blood of the war, the volunteers and especially
the youth should encourage to donate blood.

NURSE SCHEDULING
Nursing services are very important elements in the smooth running of
a hospital.There are basically three types of nurses in a ward at PWH.
They are the Sisters, the registered nurses, and the student nurses. The
ratio of nurses to patients varies from ward to ward, depending on the
department to which the wards belong. For example, for the Intensive
Care Unit, the ratio may be as high as one to one while the average ratio
for other departments is about one nurse to six patients. Each nurse is
allocated to, a particular ward upon joining the hospital. Rescheduling
of nurses from one ward to another is infrequent (but this does not
apply to student nurses).
The responsibility of scheduling nurses rests on the nursing officers. If
we take example of hospitals,There are three shifts a day for the nurses
at the hospital. They are the a.m. shift, from 7 a.m. to 2 p.m. in the
afternoon; the p.m. shift, from 2 p.m. to 9:30 p.m. in the evening, and
the overnight shift from 9:30 p.m. to 7 a.m. of the next day. Under the
present system, each nurse is required to work no more than three a.m.
shifts and three p.m. shifts per week. If an overnight shift is allocated to
her in a week, the nurse will have one less a.m./p.m. shift. Also, no
nurse can have two consecutive overnight shifts. As a result there is 1
day off per week. For student nurses the system is basically the same,
but they have to work with overnight shifts for 1 week every 6 to 7
weeks. After a week of overnights, they willhave 2 consecutive days off.

OPERATING THEATRE USAGE

The hospital under study has 10 operating-theatres. Operating-theatre
time is divided into units of 1/4 days, called sessions. Surgical patients
come mainly from two sources, the Accident and Emergency
Department, and the Outpatient Department. Each day some operating
theatres will be reserved for emergency cases. The exact demand from
day to day for emergency admissions can never be known and hence
these cases can
never be scheduled. Patients from the outpatient consultation form the
regular waiting list. These planned admissions are scheduled to have
operations that fit into a given operating theatre timetable. For planned
admissions, the operating-theatres are normally used on weekdays. A
department that needs surgical operations will be allocated a given
number
of sessions each week. An Operating-Theatre Users' Group (OTUG)
checks the usage of the operating theatres periodically. If a certain
department were found under-utilizing the operating theatres, its quota
for operation sessions would be reduced to a suitable level and those
sessions would be given to departments which have a greater demand
for operatingtheatres.
This procedure was designed to ensure more efficient allocation of
resources. However, it bears the risk that some departments may not
want to give up the operating sessions that were given to them. It
depends on the power granted to the OTUG and their judgment in
carrying out the duty.

Scheduling of Operations:- It is also one more problem in

hospitals which means that schedule of operations must be pre
determined that can leads to inefficient working of hospitals.
With the help of computer and
statistical techniques, a periodic forecast of demand can be easily
carried out. With such information, effective control, coordination, and
preparation can be materialized. Material Requirement Planning
(MRP) for patients already
in the ward and planned admissions can be done by the computer. 9
However, for emergency admissions we must use probability
estimation of the number of patients admitted everyday to estimate
material requirements. Based on such information as predictions about
the length of stay and resources needed, an efficient schedule can be
constructed.

Blood Bank and Drug Inventory Control

This is one more problem which mainly happen in hospitals.
Furthermore, blood has only a 21- to 35-day shelf life and is subject to
scarce supply; therefore, proper management of blood inventory is of
prime importance.
Once the inventory of any drug falls below a reorder level,
the computer will detect this and automatically advise the management
to order accordingly. Information about costs, suppliers, time needed
for delivery, etc. can also be stored in a drug inventory database so that
it becomes easier and more efficient to place orders on time. Besides,
it becomes possible to keep full records, prepare periodic reports, and
check
whether physicians' prescriptions are correct for the patients involved.

LIVE EXAMPLE OF LI KA SHING

SPECIALIST CLINIC

THE QUEUEING PROBLEM AT THE LI KA SHING

SPECIALIST CLINIC
The Li Ka Shing Specialist Clinic is a unit providing follow-up services
for the outpatients of the Prince of Wales Hospital. The queueing
problem in this clinic has long been criticized by the public. Before we
discuss the problem, it would be appropriate to investigate the
operations of the clinic first. Patients of the clinic fall into two main
categories. The first one is those outpatients who require follow-up
services after they have left the hospital, whereas the other is those who
are referred by other medical organizations and outside private doctors.
Both of them have to make arrangements with the corresponding
division in advance. The nurses
tell the patients which day they should come back and whether in the
morning or afternoon session. (The morning session is from 9:00 a.m.
to 1:00 p.m., while the afternoon session is from 2:00 p.m. to 5:00
p.m.)
Everyday there are around 800 patients, approximately 400 in the
morning session and another 400 in the afternoon session, who have
made appointments and come to the clinic for services. Before
consulting the doctors or receiving any treatment, the patients have to
pay a medical fee of $12 at the counter on the Ground Floor. There is
only one counter and its functions include identifying and recording the
information of the patients,
collecting the fees, and issuing tickets for certification. This process
takes about 20 to 40 sec, depending on the cooperation of the patient,
such as whether he or she tenders the exact fees. As so many patients
have to be served each day, the workload of the counter is rather heavy.
 To make the situation worse,
the arrival of patients is not in a random manner. It seems that patients
like to arrive in the period between 8:30 a.m. and 9:30 a.m. during the
morning session and between 1:30 p.m. and 2:30 p.m. during the
afternoon session.
In fact, during this 1-hr period for each session, over 200 patients
arrive. These clustered arrivals have made the queue-length for these
periods over 100 persons. Obviously, this causes a lot of complaints
about the system among the patients. After investigating and analyzing
certain aspects of the system, we propose here three alternatives to
solve the queueing problem previously mentioned:

Alternative1) Increase the number of servers to two.

This is perhaps the simplest and the most obvious way to solve the
problem. The additional server can either act as an assistant to the
original one or be responsible for another counter. Either way the
efficiency of the system can improve considerably, especially during the
busiest hours. The main disadvantages of this alternative are that the
costs involved are high and that more idle time would result during the
off-peak periods.

Alternative2). Employ a block appointment system.

This method divides the service period into certain time intervals
(blocks), say 1 hour long (e.g., 9:00 a.m.-10:00 a.m., 11:00 a.m.-12:00
a.m.). When an outpatient makes an appointment, the nurse should
arrange the schedule so that she can tell the outpatient, in addition to
the date, at which block the patient should arrive. As the outpatient
knows more precisely, when he will be served, he will arrive at a more
appropriate time. The
method can hopefully smooth out the cluster arrival pattern into a more
dispersed one. If this method can be operated successfully, there is no
need to employ an additional person and the efficiency can be greatly
improved. Of course, this would increase the workload of the
registration nurse but this is unlikely to cause any serious problem.

Alternative3) Payment immediately after the booking.

Under this method, after making an appointment, a patient has to go to
the counter to pay the medical fees immediately and receive a ticket.
Afterwards, the outpatientreturns the ticket to the corresponding
department to confirm his/her appointment. The major advantage of
this method is that the arrival pattern of payment approaches a
completely
random manner and hopefully it will maximize the servicing efficiency.
This method, however, may cause some complications in the
accounting system of the hospital. Each alternative proposed has its
own advantages and disadvantages. Deciding which alternative is more
appropriate is a matter of trade-off among costs, efficiency, and other
factors.
CONCLUSION:-
Most people thought that the reputed hospitals like AIMS are running
smoothly in terms of operations but the real picture is different
because the hospital have to face a lot of operations management
problems However, we still find that there are some areas where
further improvement can be
enhanced. In this paper we have highlighted those aspects that we are
especially interested in. As we have discussed earlier, computerization
can upgrade the services provided by the hospital and make the whole
system run more efficiently. We therefore feel that once enough capital
is available, investment in a computerized information systemwill bring
about very fruitful results for the hospital operations.

REFERENCES:-
www.scribd.com
www.google.com
articles for live example by www.times of india.com