DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195502

Resource optimization through process re-engineering of inhalational therapy unit at a tertiary care public hospital

Abdul Hakim Choudhary, Manisha K. Palaskar, Mohammad Kausar, Mahesh R., D. K. Sharma

Abstract


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-engineering were deliberated upon: “Why do we do what we do?” “And why do we do it the way we do?” Fundamental rethinking for new process was organized around the outcome.

Results: Average utilization coefficient was 6.2% (3.3% to 12.1%). Ventilators utilized per day were 1.43. Expenditure on salaries was INR 315000 per month and INR 10500 per day. Low utilization offered low value for expenses incurred. All activities in ITU focused on “provision of ventilators” (outcome) and the old rule was, “If one needed a ventilator one must contact ITU”. Since nurses were using the “outcome” and performed activities of arranging, they were handed-over the ventilators (based on utilisation patterns). ITU was disbanded, human resource and space were re-allocated to various hospital areas (costs tied were done away with) with no adverse effect on hospital functioning.

Conclusions: Process re-engineering led to improved healthcare delivery, curtailed delays in hospital processes, optimised costs involved in human resources and medical equipment.


Keywords


Equipment and supplies utilization, Hospital costs, Hospital personnel, Process re-engineering

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References


World Health Organization. (‎2011)‎. Core medical equipment. World Health Organization. Available at: http://www.who.int/iris/handle/10665/95788 Accessed 8 May 2019.

World Health Organisation. WHO | Priority medical devices. WHO. World Health Organization; 2019. Available at: https://www.who.int/medical_devices/priority/en/. Accessed 8 May 2019

World Bank. Electronics in South Asia. 2016. Available at: http://documents.worldbank.org/curated/en/776591475756781967/pdf/108827-WP-P146865-PUBLIC-electronics.pdf. Accessed 8 May 2019.

World Health Organization. Medical equipment maintenance programme overview. 2011; Available at: https://www.who.int/medical_devices/publications/medical-equipment-maintenance/en/. Accessed 16 May 2019.

Burns, L.R. India's Healthcare Industry: A System Perspective. In Burns, L.R. ed, India's Healthcare Industry: Innovation in Delivery, Financing, and Manufacturing. Cambridge University Press. 2014;3-37.

Hammer M, Champy J. Reengineering the Company-A Manifesto for Business Revolution. Harper business, New York USA. 2001;19(3):271.

Hammer M. Reengineering Work: Don’t Automate, Obliterate. Harvard Business Review. 1990; Available at: https://hbr.org/1990/07/reengineering-work-dont-automate-obliterate. Accessed 16 May 2019.

AbdEllatif M, Farhan MS, Shehata NS. Overcoming business process reengineering obstacles using ontology-based knowledge map methodology. Futur Comput Inform J. 2017;3(1):7-28.

Hassan MMD. An Application of Business Process Management to Health Care Facilities. Health Care Manag (Frederick). 2017;36(2):147–63. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28358788. 16 May 2019.

Sungau JJ, Ndunguru PC, Kimeme J. Business Process Re-Engineering: the Technique To Improve Delivering Speed of Service Industry in Tanzania. Indep J Manag Prod. 2014;4(1):208-27.

Yarmohammadian MH, Ebrahimipour H, Doosty F. Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress. J Educ Health Promot. 2014;3:111.

Álvarez JA, Flores RF, Grau JÁ, Matarranz J. Process reengineering and patient-centered approach strengthen efficiency in specialized care. Am J Manag Care. 2019;25(2):e50-7.

Jabour AM, Dixon BE, Jones JF, Haggstrom DA. Toward Timely Data for Cancer Research: Assessment and Reengineering of the Cancer Reporting Process. JMIR Cancer. 2018;4(1):e4.

Walsh AL. Managing your practice’s first impression: the process of front-desk reengineering. J Med Pract Manage. 2004;19(5):264-71.

Bragg R, Losi B, Dugan J, Wegryn J, Pitsikoulis J. Straight talk. New approaches in healthcare. Enterprise-wide collaboration is key to successful reengineering. Mod Health. 2004;34(23):37-40.

Buchanan EC. Computer simulation as a basis for pharmacy reengineering. Nurs Adm Q. 2019;27(1):33-40.

Lilly CM, McLaughlin JM, Zhao H, Baker SP, Cody S, Irwin RS, et al. A Multicenter Study of ICU Telemedicine Reengineering of Adult Critical Care. Chest. 2014;145(3):500-7.

Dayuta JCD, Ong LT, Pang NL, Chia SN, Tan HKK, Gomez JM, et al. Process reengineering of preoperative verification, site marking and time-out for patient safety. World Hosp Health Serv. 2013;49(2):4-9.

Joy MS, Candiani C, Vaillancourt BA, Chin H, Hogan SL, Falk RJ. Reengineering Clinical Operations in a Medical Practice to Optimize the Management of Anemia of Chronic Kidney Disease. Pharmacotherapy. 2007;27(5):734-44.

Chu K-Y, Huang C. Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital. BMC Health Serv Res. 2013;13(1):215.

Chou YC, Chen BY, Tang YY, Qiu ZJ, Wu MF, Wang SC, et al. Prescription-Filling Process Reengineering of an Outpatient Pharmacy. J Med Syst. 2012;36(2):893-902.

Ramani KV. Managing hospital supplies: process reengineering at Gujarat Cancer Research Institute, India. J Health Organ Manag. 2006;20(3):218-26.

Wei Y, Yu H, Geng J, Wu B, Guo Z, He L, et al. Hospital efficiency and utilization of high-technology medical equipment: A panel data analysis. Heal Policy Technol. 2018;7(1):65-72.

Gupta V, Gupta N, Sarode GS, Sarode SC, Patil S. Assessment of equipment utilization and maintenance schedule at a dental institution in Bengaluru, India. World J Dent. 2017;8(2).

Chaudhary P, Kaul P. Factors affecting utilization of medical diagnostic equipment: A study at a tertiary healthcare setup of Chandigarh. Chrismed J Heal Res. 2016;2(4):316.