operation management in baby memorial hospital

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

PROCESS FLOW ANALYSIS AT BABY MEMORIAL HOSPITAL

Guide: Prof. Sanjay Jharkaria

Group 4, Section A


Indian Institute of Management Kozhikode

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



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.



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 includes-

1. Fully automated Biochemistry Analyzer.

2. Blood gas analyzer (ABG).



3. Coagulation Profile Analyzer.

4. Automatic Cell Counter.

5. Electrolyte Analyzer.

6. Elisa reader.

7. Modern Histopathology and Microbiology labs.

8. Blood Bank.

Operation theatre

The operation theatre of BMH is equipped with:

1. Fourteen operating rooms. 2. Stainless steel wall cladding. 3. Zero percent post operative infection. 4. Antistatic flooring. 5. Laminar flow air conditioning system with hepa filters. 6. 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.



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.



Organization Structure

Chairman and Managing Director

Dr. K. G. Alexander

Medical Director

Prof. T.P.Joseph

Medical Superintendent

Dr.Shaji Thomas John

Diretor Academic Studies

Prof.P.V.Ramana

Exeutive Director

Mrs. Anitha Alexander

General Mananger

Mr.P.V.Rajendr

Dy.Medical Superintendent

Dr.P.K.Inderjit



Major Departments

CMO

ANAESTHESIOLOGY AND CRITICAL CARE 9

CARDIOLOGY 5

CARDIO THORACIC SURGERY 3

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

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



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



disorders & neuromuscular disorders, behavioral neurology are also available. Neuro-

radiology 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.



Layout

BMH is a 480-bed hospital with about 10

ICUs and 14 operation theatres set in about 11-

floors. The hospital consists of a number of

different functionalities such as front desk,

Pharmacy, outpatient areas, in-patient areas,

Emergency care, other specialty services,

laboratory and 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



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.



Legend

1. Pharmacy

2. Gynec Dept

3. Lift & Stairs to IP areas

4. Reception/New Registration

5. Cash/ID issue/Old Registration

6. Medical Records Department

7. Accounts Department

8. Laboratory

9. Lift 2

10. Administration area

11. Stairs and Lift to Theatres

12. To Consulting Rooms

13. Emergency Handling Area

14. GM’s Room

15. Ambulance Bay

16. Canteen



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



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

Old Patient Emergency Care

Patient Arrival

New

Registration

Cash payment

and Id Issue

Consulting of

Doctors

Laboratory

Pharmacy

Exit



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.



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



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.



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.

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


Running at 23% of full capacity. This process is seriously underutilized.

No. of Doctors

Doctor hours

Patients arrival

Capacity

Department Junior Senior Total hours Peak

Off peak

AST (min)

Peak hours

Other hours Peak

Off peak

Pediatrics 3 2 32 20 12 14 63 12 86 51

Cardiology 2 3 28 20 8 18 75 15 67 27

Neurology 3 2 32 20 12 16 36 9 75 45

Gynecology 6 5 68 52 16 35 85 20 89 27

Internal Medicine 5 4 56 56 0 10 410 0 336 0

ENT 3 2 32 24 8 20 55 10 72 24



Cardiology



Needs improvement since this department is running at 112% of full capacity.



Running at 55% of full capacity. Therefore no improvement needed.

Neurology



This indicates under utilization (48% of full capacity)



This indicates under utilization (20% of full capacity)

Gynaecology



The demand is close to capacity ( 96% of full capacity). Some improvements needed.



Running at 74% of full capacity. Therefore no improvement needed.



Internal Medicine



Seriously over utilized – running at 122% of full capacity.

ENT No. of patients arriving during peak hours: 55


Running at 76% of full capacity. Therefore no change needed.



Running at 42% of full capacity Therefore no improvement needed.



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.



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

Time entered(sec)

Time left(sec) Time spent in Pharmacy

1 0 173 173

2 34 272 238

3 197 443 246

4 312 508 196

5 345 - -

6 363 546 183

7 452 -

Calculation: Time for 5 customers to finish shopping = 546 sec

Average time for serving one customer = 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.



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.



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.



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.



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



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 e-

commerce 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 SAP-

LAP 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.



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.



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

http://www.babymhospital.org/

http://www.babymhospital.org/specialities.php

http://www.babymhospital.org/center.php

http://findarticles.com/p/articles/mi_qa4012/

http://findarticles.com/p/articles/mi_qa4012/is_200104/

operation management in baby memorial hospital

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