Aim: The aim of the study was to assess the impact of never-use list and standardized abbreviatio... more Aim: The aim of the study was to assess the impact of never-use list and standardized abbreviations on error prone abbreviations Background: Abbreviations are commonly used in medical records to save time and space but use in prescriptions, which can lead to communication failures and preventable harm. Prescriptions need to be clear for correct interpretation. Hospitals should implement uniform use of approved abbreviations, such as an approved list or never-use list of abbreviations and symbols. In the hospital under study, there was no system of avoiding error prone abbreviations while prescribing any medication. Hence, an interventional study was performed to quantify and reduce the incidence of error prone abbreviations. Objectives: The main objectives were to determine the incidence of error prone abbreviations, development and implementation of ‘Never-use’ list and standardized abbreviations and finally determine its effectiveness in reducing the error prone abbreviations in t...
International Journal of Environmental Health Engineering, 2022
Aim: This study aimed at the identification of environmental cleaning and managerial best practic... more Aim: This study aimed at the identification of environmental cleaning and managerial best practices for integration in competitive bidding documents for outsourcing of housekeeping services in tertiary care hospitals in India. Materials and Methods: This study design was cross-sectional. The sample comprised of tender documents of eight government super-specialty hospitals/corporations and housekeeping contract agreements of five private ones. Convenience sampling was used-current tenders of most popular government hospitals available online and housekeeping agreements of consenting popular private hospitals were considered. Excel sheet was used for the analysis. Results: Hospitals outsourced housekeeping services on performance or human resource basis, use risk classification (23%) of hospital areas for determining intensity of cleaning, and outlined scope of services (50%). Fifteen percent tenders provide comprehensive lists of material. Scrubber requirements ranged from one per 25–250 beds. In 40% tenders, scope included handling of biomedical waste. Workforce included managerial cadres. There is a focus on occupational health and safety. Quality assurance is inbuilt in the contracts including bid evaluation criteria for selecting competent agencies and penal provisions such as in case of adverse report (INR 10,000) and unsatisfactory survey reporting (1% of monthly payment). Conclusion: Since successful outsourcing must focus on above-mentioned parameters, this study provides necessary guidance for health-care administrators for patient satisfaction, positive image, reducing hospital-acquired infections, and ensuring provision of quality care services.
BACKGROUND : Good housekeeping plays an important role not only for patient satisfaction, its rol... more BACKGROUND : Good housekeeping plays an important role not only for patient satisfaction, its role in prevention of hospital acquired infections has been established beyond doubt. Satisfaction surveys are ways to finding patients’ perception of cleanliness, but for improving cleanliness accountability and monitoring performance play important role. AIM: The objective of this study was to evaluate the impact of random surprise visual inspections/audits on cleanliness in the in-patient wards of a tertiary care hospital in the National Capital Territory, India. METHODS: Surprise inspections/audits were conducted based on key performance indicators to objectively assess the cleanliness at variable intervals of time in the various patient care areas like medical, paediatric, surgical, and critical care units. The areas were sub-classified into staff, patient and common sub-areas each with measurable element like cleaning of toilets, cleaning equipment, patient beds, etc. for which “yes” ...
Background: An outreach (OR) health-care facility providing broad specialty outpatient services w... more Background: An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana. Objectives: This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided. Methods: A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility. Results: Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patien...
Introduction: Benefits of Economic Order Quantity are established worldwide. In India, limited st... more Introduction: Benefits of Economic Order Quantity are established worldwide. In India, limited studies on EOQ have been conducted in hospital setup. This study aimed to calculate benefits of EOQ and its applicability for A-class and AV-category items in hospital.
Background: Quality of healthcare services, patient safety and staff satisfaction the essence of ... more Background: Quality of healthcare services, patient safety and staff satisfaction the essence of accreditation,are indispensable to favourable patient outcomes. This study aimed at identifying opportunities forimprovement based on extent of conformance to existing applicable accreditation standards.Method: A cross-sectional observational study was conducted in an apex public sector ophthalmichospital in India during March and April 2016. Opportunities for improvement identified based on extentof compliance to accreditation standards as per criteria laid in NABH self-assessment toolkit. Reviewsof hospital departments, services and functions were done through document review; visit to differentpatient care areas; staff and patient interviews were conducted. A sample of ten observations was takenfor each objective element from same or different areas based on applicability and scored as full, partial ornon-compliant (0, 5, 10 respectively).Gaps were identified based on score less than ...
Abstract Organisational competitive procurement environment positively impacts prices while suppl... more Abstract Organisational competitive procurement environment positively impacts prices while supply side factors also determine participation in bidding. With strong competition costs come down. Instances of low competition in equipment purchase in the apex tertiary care hospital led to this study aimed at determining procurement practices, competition in procurement and its determinants. Review of tender records for three financial years (2011–2014) was conducted to ascertain procurement practices and resulting competition. Sellers’ perspective on factors determining participation was captured through a questionnaire. Although four bids per tender were received only two qualified technically emphasising need for broad based specifications. Both sellers and peer staff also feel that specifications are not broad based. Regression analysis showed that one unit increase in bid led to six per cent price reduction. Increase in number of equipment led to an increase in the number of bids received but no price decrease. Pre-bid meetings have no effect on the price offered. Quality of tender document and feasible demonstration are modifiable bidding factors. Procuring agencies need to be transparent to reflect an organisationally supported competitive environment. The future research directions are interventional studies on specifications, pre-bid meetings and increasing transparency.
International Journal of Research in Medical Sciences, 2019
Background: Salaries, supplies and machinery account for bulk of public funding necessitating eff... more Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineeri...
International Journal of Environmental Health Engineering (IJEHE), 2022
Aim: This study aimed at the identification of environmental cleaning and managerial best practic... more Aim: This study aimed at the identification of environmental cleaning and managerial best practices for integration in competitive bidding documents for outsourcing of housekeeping services in tertiary care hospitals in India. Materials and Methods: This study design was cross-sectional. The sample comprised of tender documents of eight government super-specialty hospitals/corporations and housekeeping contract agreements of five private ones. Convenience sampling was used-current tenders of most popular government hospitals available online and housekeeping agreements of consenting popular private hospitals were considered. Excel sheet was used for the analysis. Results: Hospitals outsourced housekeeping services on performance or human resource basis, use risk classification (23%) of hospital areas for determining intensity of cleaning, and outlined scope of services (50%). Fifteen percent tenders provide comprehensive lists of material. Scrubber requirements ranged from one per 25–250 beds. In 40% tenders, scope included handling of biomedical waste. Workforce included managerial cadres. There is a focus on occupational health and safety. Quality assurance is inbuilt in the contracts including bid evaluation criteria for selecting competent agencies and penal provisions such as in case of adverse report (INR 10,000) and unsatisfactory survey reporting (1% of monthly payment). Conclusion: Since successful outsourcing must focus on above-mentioned parameters, this study provides necessary guidance for health-care administrators for patient satisfaction, positive image, reducing hospital-acquired infections, and ensuring provision of quality care services.
Background: Cleanliness is one of the main reasons for poor satisfaction among the patients and t... more Background: Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities. Objective: To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India. Methods: The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping. Results: Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc. Conclusion: Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.
In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, ... more In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, New Delhi was expedited at war footing level and converted into a COVID-19 Emergency response Centre (ERC). Engineering works were completed in a speedy manner and various patient care areas were equipped as deemed necessary for providing tertiary care to COVID-19 patients. A highly spirited team comprising of Emergency Medicine Specialists, Anesthesia and Critical Care specialist, Hospital Administrators and Nursing Officers was formed. Effective segregation of patient care areas into clean, contaminated, and intermediate zones was done using physical barriers and air conditioning modifications. The screening area for patients suspected of having COVID-19 was created in addition to a 2-step process i.e., Triage 1 and Triage 2, thereafter, patients requiring admission would be referred to the emergency area. An in-house designed and fabricated sampling booth was created to bring down the...
BackgroundAbbreviations are commonly used in medical records to save time and space but use in pr... more BackgroundAbbreviations are commonly used in medical records to save time and space but use in prescriptions can be a reason for communication failures and preventable harm during healthcare delivery. Nearly 5% of medication errors can be attributable to abbreviation use. Prescriptions need to be clear so that nurses and pharmacists can correctly interpret intentions of doctors. For patient safety, hospitals should implement a process for uniform use of approved abbreviations, such as through use of an approved list or never-use list of abbreviations and symbols.Local ProblemIn the hospital under study, there was no system of avoiding error prone abbreviations while prescribing to prevent medical errors. Hence, an interventional study was done to quantify and reduce incidence of error prone abbreviations.MethodsThe study design was pre-post interventional / quasi-experimental design to assess the impact of never use list and standardized abbreviations. The study was conducted after ...
Aim: The aim of the study was to assess the impact of never-use list and standardized abbreviatio... more Aim: The aim of the study was to assess the impact of never-use list and standardized abbreviations on error prone abbreviations Background: Abbreviations are commonly used in medical records to save time and space but use in prescriptions, which can lead to communication failures and preventable harm. Prescriptions need to be clear for correct interpretation. Hospitals should implement uniform use of approved abbreviations, such as an approved list or never-use list of abbreviations and symbols. In the hospital under study, there was no system of avoiding error prone abbreviations while prescribing any medication. Hence, an interventional study was performed to quantify and reduce the incidence of error prone abbreviations. Objectives: The main objectives were to determine the incidence of error prone abbreviations, development and implementation of ‘Never-use’ list and standardized abbreviations and finally determine its effectiveness in reducing the error prone abbreviations in t...
International Journal of Environmental Health Engineering, 2022
Aim: This study aimed at the identification of environmental cleaning and managerial best practic... more Aim: This study aimed at the identification of environmental cleaning and managerial best practices for integration in competitive bidding documents for outsourcing of housekeeping services in tertiary care hospitals in India. Materials and Methods: This study design was cross-sectional. The sample comprised of tender documents of eight government super-specialty hospitals/corporations and housekeeping contract agreements of five private ones. Convenience sampling was used-current tenders of most popular government hospitals available online and housekeeping agreements of consenting popular private hospitals were considered. Excel sheet was used for the analysis. Results: Hospitals outsourced housekeeping services on performance or human resource basis, use risk classification (23%) of hospital areas for determining intensity of cleaning, and outlined scope of services (50%). Fifteen percent tenders provide comprehensive lists of material. Scrubber requirements ranged from one per 25–250 beds. In 40% tenders, scope included handling of biomedical waste. Workforce included managerial cadres. There is a focus on occupational health and safety. Quality assurance is inbuilt in the contracts including bid evaluation criteria for selecting competent agencies and penal provisions such as in case of adverse report (INR 10,000) and unsatisfactory survey reporting (1% of monthly payment). Conclusion: Since successful outsourcing must focus on above-mentioned parameters, this study provides necessary guidance for health-care administrators for patient satisfaction, positive image, reducing hospital-acquired infections, and ensuring provision of quality care services.
BACKGROUND : Good housekeeping plays an important role not only for patient satisfaction, its rol... more BACKGROUND : Good housekeeping plays an important role not only for patient satisfaction, its role in prevention of hospital acquired infections has been established beyond doubt. Satisfaction surveys are ways to finding patients’ perception of cleanliness, but for improving cleanliness accountability and monitoring performance play important role. AIM: The objective of this study was to evaluate the impact of random surprise visual inspections/audits on cleanliness in the in-patient wards of a tertiary care hospital in the National Capital Territory, India. METHODS: Surprise inspections/audits were conducted based on key performance indicators to objectively assess the cleanliness at variable intervals of time in the various patient care areas like medical, paediatric, surgical, and critical care units. The areas were sub-classified into staff, patient and common sub-areas each with measurable element like cleaning of toilets, cleaning equipment, patient beds, etc. for which “yes” ...
Background: An outreach (OR) health-care facility providing broad specialty outpatient services w... more Background: An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana. Objectives: This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided. Methods: A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility. Results: Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patien...
Introduction: Benefits of Economic Order Quantity are established worldwide. In India, limited st... more Introduction: Benefits of Economic Order Quantity are established worldwide. In India, limited studies on EOQ have been conducted in hospital setup. This study aimed to calculate benefits of EOQ and its applicability for A-class and AV-category items in hospital.
Background: Quality of healthcare services, patient safety and staff satisfaction the essence of ... more Background: Quality of healthcare services, patient safety and staff satisfaction the essence of accreditation,are indispensable to favourable patient outcomes. This study aimed at identifying opportunities forimprovement based on extent of conformance to existing applicable accreditation standards.Method: A cross-sectional observational study was conducted in an apex public sector ophthalmichospital in India during March and April 2016. Opportunities for improvement identified based on extentof compliance to accreditation standards as per criteria laid in NABH self-assessment toolkit. Reviewsof hospital departments, services and functions were done through document review; visit to differentpatient care areas; staff and patient interviews were conducted. A sample of ten observations was takenfor each objective element from same or different areas based on applicability and scored as full, partial ornon-compliant (0, 5, 10 respectively).Gaps were identified based on score less than ...
Abstract Organisational competitive procurement environment positively impacts prices while suppl... more Abstract Organisational competitive procurement environment positively impacts prices while supply side factors also determine participation in bidding. With strong competition costs come down. Instances of low competition in equipment purchase in the apex tertiary care hospital led to this study aimed at determining procurement practices, competition in procurement and its determinants. Review of tender records for three financial years (2011–2014) was conducted to ascertain procurement practices and resulting competition. Sellers’ perspective on factors determining participation was captured through a questionnaire. Although four bids per tender were received only two qualified technically emphasising need for broad based specifications. Both sellers and peer staff also feel that specifications are not broad based. Regression analysis showed that one unit increase in bid led to six per cent price reduction. Increase in number of equipment led to an increase in the number of bids received but no price decrease. Pre-bid meetings have no effect on the price offered. Quality of tender document and feasible demonstration are modifiable bidding factors. Procuring agencies need to be transparent to reflect an organisationally supported competitive environment. The future research directions are interventional studies on specifications, pre-bid meetings and increasing transparency.
International Journal of Research in Medical Sciences, 2019
Background: Salaries, supplies and machinery account for bulk of public funding necessitating eff... more Background: Salaries, supplies and machinery account for bulk of public funding necessitating efficient utilisation. Studies suggest that process re-engineering helps improve cost, quality, service, and speed. Disbanded once and re-commissioned, a centralized Inhalational Therapy Unit (ITU) banked and provided portable mechanical ventilators to the inpatient wards. A demand for new ventilators from ITU led to the present study involving its critical review and cost analysis.Methods: An interventional study was conducted at a large tertiary care public hospital in India from April 2015 to June 2015. Critical review of process of providing portable ventilators and cost analysis were conducted. Review of records of and interview with ITU personnel and nursing staff were carried out. Fundamental rethinking and radical redesign of the process was done with attention to human resource, costs, space and actual medical equipment utilization. Two fundamental questions of process re-engineeri...
International Journal of Environmental Health Engineering (IJEHE), 2022
Aim: This study aimed at the identification of environmental cleaning and managerial best practic... more Aim: This study aimed at the identification of environmental cleaning and managerial best practices for integration in competitive bidding documents for outsourcing of housekeeping services in tertiary care hospitals in India. Materials and Methods: This study design was cross-sectional. The sample comprised of tender documents of eight government super-specialty hospitals/corporations and housekeeping contract agreements of five private ones. Convenience sampling was used-current tenders of most popular government hospitals available online and housekeeping agreements of consenting popular private hospitals were considered. Excel sheet was used for the analysis. Results: Hospitals outsourced housekeeping services on performance or human resource basis, use risk classification (23%) of hospital areas for determining intensity of cleaning, and outlined scope of services (50%). Fifteen percent tenders provide comprehensive lists of material. Scrubber requirements ranged from one per 25–250 beds. In 40% tenders, scope included handling of biomedical waste. Workforce included managerial cadres. There is a focus on occupational health and safety. Quality assurance is inbuilt in the contracts including bid evaluation criteria for selecting competent agencies and penal provisions such as in case of adverse report (INR 10,000) and unsatisfactory survey reporting (1% of monthly payment). Conclusion: Since successful outsourcing must focus on above-mentioned parameters, this study provides necessary guidance for health-care administrators for patient satisfaction, positive image, reducing hospital-acquired infections, and ensuring provision of quality care services.
Background: Cleanliness is one of the main reasons for poor satisfaction among the patients and t... more Background: Cleanliness is one of the main reasons for poor satisfaction among the patients and their attendants visiting healthcare facilities. Objective: To elevate and transform the sanitation in public sector facilities, a committee was constituted by Ministry of Health and Family Welfare, Government of India to study the existing system of Housekeeping in Central Government Hospitals and draft the Guidelines for house-keeping services, since no such literature is available in context of the healthcare facilities in India. Methods: The committee ascertained the housekeeping services in three tertiary care hospitals of Central Government and simultaneously conducted the literature review of the best practices in hospital sanitation and housekeeping. Results: Formulated national guidelines focus on various aspects of sanitation services in health facilities, i.e., hospital infrastructure; organization of sanitation services; human resource requirements; qualification, experience and training needs of sanitation staff; roles and responsibilities of different personnel; risk categorization of hospital areas; mechanized cleaning; cleaning agents; cleaning standards and standard operating procedures; effective supervision and monitoring; procurement of these services, etc. Conclusion: Formulated guidelines can be adopted by developing countries aiming for standardizing cleaning practices in public health facilities.
In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, ... more In view of the COVID-19 surge, the construction of the Burns and Plastic Surgery Block at AIIMS, New Delhi was expedited at war footing level and converted into a COVID-19 Emergency response Centre (ERC). Engineering works were completed in a speedy manner and various patient care areas were equipped as deemed necessary for providing tertiary care to COVID-19 patients. A highly spirited team comprising of Emergency Medicine Specialists, Anesthesia and Critical Care specialist, Hospital Administrators and Nursing Officers was formed. Effective segregation of patient care areas into clean, contaminated, and intermediate zones was done using physical barriers and air conditioning modifications. The screening area for patients suspected of having COVID-19 was created in addition to a 2-step process i.e., Triage 1 and Triage 2, thereafter, patients requiring admission would be referred to the emergency area. An in-house designed and fabricated sampling booth was created to bring down the...
BackgroundAbbreviations are commonly used in medical records to save time and space but use in pr... more BackgroundAbbreviations are commonly used in medical records to save time and space but use in prescriptions can be a reason for communication failures and preventable harm during healthcare delivery. Nearly 5% of medication errors can be attributable to abbreviation use. Prescriptions need to be clear so that nurses and pharmacists can correctly interpret intentions of doctors. For patient safety, hospitals should implement a process for uniform use of approved abbreviations, such as through use of an approved list or never-use list of abbreviations and symbols.Local ProblemIn the hospital under study, there was no system of avoiding error prone abbreviations while prescribing to prevent medical errors. Hence, an interventional study was done to quantify and reduce incidence of error prone abbreviations.MethodsThe study design was pre-post interventional / quasi-experimental design to assess the impact of never use list and standardized abbreviations. The study was conducted after ...
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Papers by Mohammad Kausar