PRACTICAL TRAINING REPORT ON CANCER HOSPITAL AND RESEARCH INSTITUTE, GWALIOR (M.

P)

Submitted to Centre for Hospital Administration Jiwaji University, Gwalior (M.P.) Towards Partial Fulfillment of Requirement For Masters in Business Administration (Hospital Administration) 1st Semester Submitted By Vikash Kumar Pulaiya MBA (HA) 1st Semester December 2010

CONTENTS
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Certificate. Declaration. Chairmans message. Acknowledgement. History. Vision & Mission. Future Plans. Hospital Profile. Process of Registration and Admission of patients At Reception. Functioning and Various Departments within Hospital. OPD Services. Pharmacy Wards. Personal / H R Dep. & Public Relation. Library in Hospital. Marketing. Laboratory Services (Investigation). Billing and Discharge. Conclusion.

DECLERATION
I declare that the practical training report is my original work. I further declare that to the best of my knowledge and belief, the practical training report does not contain any part of my work, which has been submitted for the award of any degree either in this university or in any other university.

Vikash Kumar Pulaiya MBA (HA) 1 semester Jiwaji University, Gwalior (M.P.)

CHAIRMANS MESSAGE
Dear student,

Dr.B.R.Shrivastav Chairman CHRI Gwalior

ACKNOWLEDGEMENT

In the preparation of this project I have received great help from many of our teachers, friends in number of ways, I take this golden opportunity to thank all of them the normal construction and sentence pattern of this project are introduced gradually, systematically and are well drilled at every stage. I hope that this project report will cater to their need on this subject. Lastly I should be failing in our duty if we do not express our gratitude to our family members who have given us great encouragement to complete this report.

Vikash Kumar Pulaiya MBA (HA) 1 semester Jiwaji University, Gwalior (M.P.)

HISTORY
ABOUT HOSPITAL Cancer Hospital and Research institute, Gwalior has a tragic back ground in its foundation. In March 1971, Shri & Smt. Shitla Sahai had lost their only son Rajiv, who was suffering from bone sarcoma. Hardly any facilities were available then in Gwalior for the treatment of cancer. Undaunted by the grief, this family vowed to start a Cancer Hospital to provide benefit to cancer patients in Gwalior. With this aim in view, a charitable trust Jan Vikas Nays was founded in May 1971. Surmounting difficulties and with untiring efforts of the bereaved family, Cancer Hospital was Started in 1977, which has gradually developed to a modern Cancer Hospital with facilities for diagnosis and management of the diseases. Government of Madhya Pradesh had been generous to allot 266 acres of land for this noble cause on a hill top of Mandrel Ki Mata. The construction of the main hospital building and patients attendants hostel was taken up initially and then the full campus with all amenities developed in phased manner. The institute was recognized as early as in 1980, as one of then 10 regional Cancer Centers for Research and Treatment by the Government of India. The Institute is serving not only to the people of Madhya Pradesh but also from the neighboring districts of Uttar Pradesh and Rajasthan besides some patients coming even from far distant states. With meager resources at hand and with generous though a limited quantity of Grantin -aid from Government of India and some contributions from Government of Madhya Pradesh, the institute, which started from scratch, has developed into a modern hospital with facilities to provide all the three modalities of treatment for cancer viz., Surgery, Radiotherapy, Chemotherapy. The institute also has modern diagnostic facilities in the department of Radio- diagnosis, Pathology, Biochemistry and Microbiology and in addition palliative care to cancer patients. Department of Radio diagnosis has been playing an important role in early diagnosis of Cancer and other non - cancerous diseases. It is equipped with modem CT scanner, MRI, and U.S.G. Colour Doppler, Mammography, Portable Ultra Sonography, 300 MA X- ray unit and

two mobile X-ray units. Addition of latest high resolution multi slice (16 slice) C.T. Scanner, Portable Colour Doppler, Digital X-ray system this year makes Radio diagnosis department in this area modern to provide many imaging techniques like 3D reconstruction (useful for cancerous patients and orthopedic purposes), virtual bronchoscope and colonoscopy, non - invasive whole body angiography and non - invasive coronary angiography under one roof with assured image quality and diagnosis. Portable Ultra Sonography and Doppler is a useful tool for bed - ridden patients and provide bed side services .Department is also engaged in complicated interventional imaging guided procedures VIZ. CT and USG - guided FNAC, fluid and abscess drainage,USG - guided PTBD and nephrostomy..

VISION & MISSION

Our mission, vision and strategy are a reflection of the things that we aspire and that we seek they are our goals, our beliefs and our aspirations. Vision To be the most sought after organization of the 21st century. Mission Imbuing all our operations with the motto of fair business practices, family values and high growth-high profitability. To be sought after by,

Customers for trust and deliverance Our team for creditworthiness Authorities for transparency Environment for conscientiousness Society for socio-economic transformation Stakeholders for value enrichment.

1-Process Of Registration And Admission Of Patients At Reception.

RECEPTION ADMISSION COUNTER REGISTRATION DEPARTMENT RECEPTION Reception is the FACE OF THE HOSPITAL creating the first impression of the services which is the entrance to the clinical area. First impression are powerful and long-lasting, they said the tone for all the interaction that follow. They shape the individual perception about the facilities, services in the hospital. In the front office, the receptionist guide the patients, there relatives and reassures them. Receptionist must do other duties like registration, renewal, consultation. WHEN PERSON COMES TO THE HOSPITAL, FIRSTLY GO TO THE REPTION COUNTER FOR FURTHER ENQUIRES. SUCH AS. o o o o o o o ABOUT THE HOSPITAL PATIENT ENQUIRY DOCTORS AVAILABILITY VISITING DOCTORS MEDICAL FACILITY EMERGENCY FACILITY INVESTIGATION FACILITY, ETC

Location of the department.. Front office is located near the main entrance in such a way that it becomes that first sight of the hospital. Front office is located with a best impression near the billing counter. General waiting area and OPD are also located near the front office. REGISTRATION DEPARTMENT Registration is the process of recording patients full details. And medical history in the registration form and in computer system. Admission Department At the admitting department, the patients will require to provide personal informational sign consent forms before being taken to the hospital unit or ward. If the individual is critically ill, then, this information is usually obtained from a family member. Process of registration The registration is also a very important part of the hospital organization. It gives registration to New OPD Follow-up IPD

Steps. 1) File making of new admit patients and entry 2) Entry of OPD patients(old, new) 3) Entry of follow-up (old admitted patients) Collection and deposition of files of the patients Store files of all the patients after the complete treatment.. Files are color coded in the registration room. The purpose of color coding of the file is for patients benefit as well as registration department for keeping and storing. When consultant ask about the previous history of the disease of the patient then patient cant explain so color coding are to be used by the hospital at the bottom of the files. The different Color coding are used in various diseases. Such as..

2-FUNCTIONING OF VARIOUS DEPARTMENTS WITHIN HOSPITAL

A hospital is an integral part of a social and medical organization, the function of which is to provide for the population complete health care, both curative and preventive, and whos out patients services reach out to family and its home environment; the hospital is also a center for the training of health workers and biosocial research. The various departments of the hospital are as. 1. CLINICAL SERVICES Out Patients Departments Emergency service departments In patients departments Operation theatre Intensive care unit PMR services 2-DIAGNOSTIC &THERAPEUTIC DEPARTMENT

Laboratory service Radiology departments Pharmacy departments Transfusion departments

Medical record department(MRD) Central sterile supply department(CSSD) Linen and laundry department Dietary department. Hospital housekeeping department. Hospital engineering department.

3-SUPPORT AND UTILITY DEPARTMENT

 Hospital transportation system. Hospital equipment management. Mortuary services of hospital

4-RISK MANAGEMENT Hospital waste management. Nosocomial infections. Disaster management. Hospital security services. 5-ADMINISTRATIVE DEPARTMENT Account department Purchasing department Marketing department Public relation department. Material management The functions of various departments within hospital are as CLINICAL SERVICESOutpatient department To provide specialist diagnostic, medical opinion to outpatient. To treat patient on ambulatory basis. Screen patient for hospitalization. Follow up treatment of discharged patients. Provide primary health care ,by means of Health education Immunization clinics Well baby clinics Voluntary counseling and testing centre [VCTC] for HIV/AIDS. Inpatient department Admitting the patients and maintain admission register. Transferring the patient among the wards and specialty. Generating appropriate patient record. Therapeutic and medical care to the patient.

 Helping for discharging patient. Operation theatre To provide high degree of asepsis. To provide complete environment control.

Intensive care unit Close observation and treatment of critically ill patient. With centralized highly skilled manpower and equipments to provide specialized treatment. Care for post surgical patient. To provide life support to critically ill patient. PMR servicesThe PMR means physical medicine and rehabilitation is the need of the hour. it is the combined and coordinated use of medical,social,educational,and retraining of individuals to the highest possible level of functional ability. it includes physiotherapy, occupational therpy,education,social work, vocational guidance and placement services. DIAGNOSTIC AND THERAPEUTIC DEPARTMENTLaboratory departmentLaboratory examinations help the physicians for better and more precise diagnosis. The hospital laboratory dedicates itself in providing comprehensive, high quality laboratory services to the communities, physician and patients. Radiology departmentRadiology is the medical specialty directing medical imaging technology to diagnose and something treat diseases. Originally it was the aspect of medical science dealing with medical use of electromagnetic energy by emitted by xray machine or other such radiation devices for the purpose of obtaining visual information as part of medical imaging .radiology that involves use of X-ray is called roentgen logy. Today extensive training, radiologists, direct an array of technologies [such as ultrasound, computerized tomography, and magnetic resonance imaging] to diagnose or treat diseases. Interventional radiology is

the performance of medical procedure with the guidance of imaging technologies. As a medical specialty, radiology can be classified broadly into Diagnostic radiology it is the interpretation of image of the human body to help in diagnosis and prognosis of diseases. Therapeutic radiology it utilizes radiation for treatment of diseases such as cancer. There is now separate sub specialty as radiation oncology. Pharmacy department Provide specification for the purchase of drugs, chemicals biological etc Proper storing of drug. Maintaining liaison between medical staff, nursing staff and patients. Discarding the expired drug and container with worm and missing labels. Patient counseling service while supplying drugs especially for outpatient department. Filling and labeling of all drug containers from which medicines are to be administered. Dispensing of drugs as per the prescription of the medical staff of the hospital. Dispensing and sterilizing parental preparations which are manufacture in the hospital.

Transfusion department Screening the blood donor. Maintenance of donors records. Ensuring the safety of the donor. Protecting the patient receiving the transfusion. Ensuring the safety of laboratory and clinical staff. SUPPORT AND UTILITY DEPARTMENTMedical record department Reporting Retainable of record. Storage and retention of records Analysis and statistics.

 Indexing. Coding Completion of incomplete record. Assembling of medical record. Quantitive analysis of records Deficiency check. Numbering and filling. Central sterile supply department After use, the used and soiled material are received and transported in a proper way to the CSSD. Determining whether the item should be reused or discarded. Carrying out the cleaning process in the dirty area prior to sterilizing. Packing of all material for sterilizing. Linen and laundry services To provide comfortable and pleasing environment to the patient and visitors of the hospitals of the hospital by supplying clean linen. To control hospital infection. Improve efficiency and productivity. Improve image of the hospital. Dietary services Selection, procurement and storage of food ingredients like cereals, pulses, vegetables etc. Inventory control of the food items. Menu planning of different kinds of food. Distribution of food and serving of food. Planned preventive maintenance program for the equipment. Hospital housekeeping services Clean rooms ,clean corridors, clean wards, clean floors Roofs, fixtures, curtain, windows and toilets. Hospital waste disposal. Sanitation and hygiene. Odor control ward. Prevention of fire. Hospital transportation systemThe function of HTS is generally internal transportation

And external transportation. Mortuary services of hospitalTo shift the dead body immediately to mortuary, till other formalities for handling over the dead body to the claimant are completed and also to keep the dead bodies in the mortuary till they are handed over to the authorized persons. RISK MANAGEMENT-S Hospital waste managementControl the waste material of the hospital such as general waste, sharps, infected waste, chemical waste, radio active waste, cytotoxic drugs etc. Nosocomial infectionNosocomial infections are a major public health problem in hospitals throughout the world. The impact of infection upon the patient, hospital personnel, family and community are such that nosocomial infections are an important challenge to those committed to health of the people. Prevention of nosocomial infection is becoming more challenging as a result of the ever expanding use of new invasive and immune compromising diagnostic and therapeutic techniques, and the increasing prevalence of the chronic diseases that dispose to infection. Disaster management To prepare a hospital disaster plan. To prepare departmental plan in support of hospital plan. Establishment of criteria for the emergency care. Supervise the mockdrialls.

Hospital security services Provide security services to all the staff of the hospital. Protection of the hospital property Analyses the security threats Surveillance program.

ADMINISTRATIVE DEPARTMENTAccount department Audit analyses. Staff salary Billing Turnover Budgeting etc. Material management Material planning and budgeting. Purchasing. Receiving and inspection. Stocking and distribution. Inventory control. Cost reduction Value analyses Disposal. Public relation department Service provided by the hospital- if hospital enjoys a good reputation in respect of the services provided by the hospital to the public e.g. The quality of medical care. Hospital administration must attempt to find out the need and demand of the public, what is there need?, what is demand which kind of services?, what are the requirement of the people?. The management should feel social responsibility and should be responsive to the societys needs. The public must have easy access to the information of the hospital; many a times people feel that the hospital does not provide the information in the desired manner. The information must be user friendly. The publicity should be relevant, accurate and no exaggeration.

3-OPD SERVICES
The out patient services provide the main linkage of the hospital with the community. The outpatient department interacts with the neighborhood. Efficient outpatients produce favorable public image .out patient is the person who is given general or emergency diagnostic, therapeutic or preventive health services provided through the hospitals facility or health program and who, at the time is not registered as an inpatient in the hospital. The outpatient is four types they are:un referred cases

discharge case from hospital (fallowup)

O.P.D
referred cases from private practitioners dispensaries and peripherals hospital

emergency &

accidents

1) General patient(Un Referred or new patient) general out patient is a person who is given diagnostic or therapeutic services and care, who has not been directly referred for such services by his attending physician and who is not coming for emergency situation. 2) Referred patient a person referred directly to the opd by his attending medical practitioner for specific diagnostic or treatment procedure ,for

other than emergency condition ,and who will return to the practitioner for further care and disposition is called referred out patient. 3) Emergency out patient-emergency out patient is a person who is given emergency or accident care for condition determined clinically or by allied services. 4) Follow-up patients- when patient discharge from the hospital after cure, after sometimes patient come back for routine examination. So this types of patient called as follow-up patients.

LOCATION OF THE OUT PATIENT DEPARTMENT The OPD of hospital nearer to the main road and close to main hospital entrance. Free from noise and dust pollution. They separate from IPD wards and other departments but connected with them, can function more efficiently in terms of scheduling and communications, easier for patients to find their way around, less patient and attendant traffic through hospital, kept closed when not in use, and easier to expand, should a need arise.

INFRASTRUCTURE

REGISTRATION
OPD TELIMEDICINE

MATERNITY

PAEDIATRIC

SURGERY

MEDICINE

E.N.T.

RADIOLOGY

The importance of OPD 1) The OPD contributes towards reducing the mortality and morbidity, therefore, provides a stepping stone to health promotion and disease prevention. 2) It reduces the number of admission to a hospital to raise the threshold of admission. 3) It ensures that only those patients are admitted who really inpatients need care. Demand Demand of the OPD services is based upon the following factors.. 1) No. of out patients visit per person per year from population living in the formal catchments area of the hospital. 2) Reattendance rate per new outpatients registered. The average number of outpatients visits per population per year is the most commonly used and simplest parameter of outpatient department. Function of OPD 1) To provide specialist diagnostic, medical opinion to outpatients. 2) To treat patients on ambulatory basis. 3) Screen patients for hospitalization. 4) Follow-up treatment of discharge patients. 5) Provide primary health care, by means of. a. Health education b. Immunization clinics c. Voluntary counseling and testing centre d. (VCTC) for HIV/AIDS. e. Training and education and of medical, paramedical and nursing staff. f. Collection, analysis of medical records. Physical facilities-

The physical facilities of the OPD can be categorized in to the following areas1) Patients areas 2) Clinical areas 3) Administrative area 4) Circulation area Patients areaa. Entrance b. Reception c. Registration d. Record room e. Waiting area Clinical areas a. Consultation room b. Consultation room c. Special examination room d. Dressing room e. Minor OT f. Pharmacy g. Laboratory h. Radiology i. Blood bank Administrative area a. Administrative office b. Business office c. Housekeeping d. Store rooms forGeneral store Drug store Linen store

Circulation area The circulation area includes: a. Stairs b. Corridors c. Lifts d. Conveyor belts Equipments : Following types of equipments are usually made available in the OPD: I. Wheel chairs II. Stretchers III. Work tables IV. Physicians desk V. X-ray view box VI. Revolving stool VII. Chairs VIII. Examination couch IX. Wash basin X. Instruments trolley XI. ECG machine XII. Ultrasonography machine XIII. EEG machine.

4. PHARMACY
The Pharmacy Module deal with the Retail Sale of medicines to OPD patients and Issue of medicines to the In-patients in the hospital. Its function includes clinical trial of drugs (chemotherapeutic drugs), inventory management and billing of drugs, consumables and sutures. This module is closely linked to the Billing Module and In-patient Module. All the drugs required by the patient can be indented from the various sub stores. HOSPITAL PHARMACY may be defined as that department of the hospital which deals with procurement, storage, compounding, dispensing, testing, and packaging, of drugs. it also concerned with education and research in pharmaceutical services. A hospital pharmacy is controlled by a professionally competent and a qualified pharmacist. It deals with Supply of drugs, medicine, and ailed products to the nursing units and other such services. Filling of special prescriptions for out patients and dispensing as per the intention of a physician. Storage and dispensing of narcotic and biological products. Supply and storage of ancillary products and article required in the hospital

EQUIPMENT Drug stock cabinets Sectional drawer cabinets with cupboard bases. Work tables and counter for routine dispensing Cabinet to store mortars and pestle. Cabinet for glass utensils, flasks, funnel, etc . Refrigerator. FUNCTION OF HOSPITAL PHARMACY Proper storage of drug. Dispensing and sterilizing parenteral preparations which are manufactured in the hospital. Dispensing of drugs as per the prescriptions of the medical staff of the hospital Filling and labeling of all drug containers from which medicines are to be administered. Establishment and maintenance of drug information centre which will provide information regarding medications to the physician, nurses or any other competent person who deals in drugs. Maintaining liaison between medical staff, nursing staff and patients. HOSPITAL FORMULARY The hospital formulary is a list of pharmaceutical preparation including important information which is required for medical staff.

OBJECTIVE Information of drug products approved by PTC and provides basic therapeutic information.

TYPES OF MATERIALS STOKED Capsules, tablets liquid dosage form and injection etc. Biological, antibiotics are stored properly in refrigerator. Narcotics and psycho tropic substances are stored under lock and key. POISON is stored in separate closed rack labeled as POISON Large bulk items on bottom. Vaccines and other thermo labile drugs are required to be stored at cold stores 2c-10c.antibiotics, vitamins, liver preparation etc.should be stored at cool temperature (15c-20c) STORAGE CONDITIONS Cold storage-2c-8c Cool tem.-8c-25c Room tem. Warm-30c-40c Excessive heat-above 40c

5-WARDS
For most of the people hospital means the ward .it is in reality also .basically people go to hospital for two purpose; either to seek out door consultation in the OPD of the hospital or for admission to hospital and treatment as inpatient .the consultation can be done in the consulting chamber outside the normal OPD of a hospital also. For hospitalization we necessarily require an inpatient department. The IPD of hospital consists of the following component. Nursing station The beds Necessary services, storage work Public area. WARDS AND ROOM-there are three types of wards in the hospital General ward. Specific ward. Private ward. General ward- in the hospital

Specific ward-in specific type two types of ward are included chemotherapeutic ward and radio therapeutic ward. Private ward/deluxe ward this is just like a five star room in which every type of facility are available like air condition, T.V., refrigerator, furniture etc. this is specially for vip. NURSING SERVICES-the quality of ip care is highly dependent on the services provided by the nurses and doctors .the nursing must have the following facilities. It must be centered between the wards to make maximum observation of patients. It should have direct access from the corridor. It should be provided with toilet facilities for the nurse. It must be provided with tables and chair and the electrical panel to indicate calls from rooms.

Treatment and dressing room should also be provided. DIETARY SERVICES-diets are important part of inpatient medical care. A centralized dietary service is a must in all hospitals. A qualified and experienced dietician should be the in charge of the dietary department. She/he interacts with the consultants and advices them regarding the dietary requirement of individual patients.

6-PERSONEL/H R DEPARTMENTS WITHIN HOSPITAL

What is HRM??? H = human R = resources M= management Multidisciplinary factors effecting HR

selection

development

recruitment

discipllne

employment legislation

Human resources management Objectives Effective utilization of human resources Organizational structure of relationship Development of human resources

 Rewards Compatibility of individual goals with those of an organization Maintain high moral

Role of human resource management system: Activities Sub-systems BASIC OVERVIEWS OF HUMAN RESOURCE MANAGEMENT

Human Resource Management is the organizational function that deals with issues related to people such as compensation, hiring, performance management, organization development, safety, wellness, benefits, employee motivation, communication, administration, and training.

GETTING THE BEST EMPLOYEES RECRUITING:- (General information , Advertising for job candidate , online recruiting ) SCREENING JOB APPLICANTS Interview Conducting background checks Testing job candidates Selecting PAYING EMPLOYEES Minimum wage Equal pay Holiday pay Student loans

SAFE WORK ENVIRONMENT Clean work spot Maintenance of equipment Add safety feature Work with concentration

TRAINING EMPLOYEES The right employee training, development and education, at the right time, provides big payoffs for the employer in increased productivity, knowledge, loyalty, and contribution. Learn the approaches that will guarantee your training brings a return on your investment

HIGH PERFORMING EMPLOYEES Employee evaluations are an important part of maintaining a motivated and skilled workforce. Employee should be following qualities. work processes and results communication skills decision making skills leadership skills planning skills Program/project management

7-LIBRARY IN HOSPITAL

A depository built to contain book and other materials for reading and study.

RULES OF LIBRARY Entry Working hours Membership General Information Computer use policy Terms and Conditions DIFFERENT SECTION OF LIBRARY REFERENCE SECTION READING ROOM SECTION JOURNAL PERIODICAL SECTION BOUND JOURNAL SECTION TECHNICAL SECTION CIRCULATION SECTION STAKE ROOM

 REPROGRAPHY SECTION TYPE OF REGISTER USER WRITTEN REGISTER ISSUE WRITTEN REGISTER JOURNAL REGISTER BOOK DEMANDS REGISTER ACCESSION REGISTER LIBARARY SERVICE REFERENT SERVICE. CURRENT AWARNESS SERVICE. SDI (SELECTED DESIMINATION INFORMATION). OPAC (ONLIINE PUBLIC ASK COLLECTION). DOAJ (DIRECTORY OF ACCESS JOURNAL).

ARRENGEMENT OF BOOK CLASSIFICATION WISE. SUBJECT WISE. MEDICAL RELATED BOOK Pathology Surgery Gynecology Radiotherapy and Chemotherapy Oncology cancer Paramedical Physiotherapy Anatomy

X-ray diagnosis/ultrasound Immunology Enzymes and enzyujm mology Microbiology Bacteriology and virology Biochemistry Cell biology

8-MAARKETTING
Definition & meaning of marketing The key word in this marketing definition is "process"; marketing involves researching, promoting, selling, and distributing your products or services. Marketing is a process of planning and executing the conception, pricing, promotion and distribution of ideas, goods and services to create exchanges that satisfy individual or organizational goals. Some common points emerge from these definitions. These are---Marketing is management process. Marketing offers and exchanges ideas, goods, or services. Marketing is identifying and anticipating customers requirements. Marketing is giving customers what they want. Marketing involves pricing, promotion, and distribution of ideas, goods or services. Marketing Channels Press releases Education and training In-house journals Health exhibition Special events Medical camps Sponsorship Internet

What is Services..?? Service has been defined as any activity or benefit that one party can offer to another that is essentially intangible and doesnt result in ownership of anything. Its production may or may be tied to a physical product Market segmentation:Market segmentation Is the concept of dividing the market in to similar, identifiable segments. Market segmentation occupies a key role in marketing. Strategy of successful organization. Segmentation techniques are integral to an organizational entire marketing process from initial marketing research through marketing communication. The process of market segmentation is in of dividing a total market in to a series of sub market. The market segmentation approach is concern with Considering in interactive basis for segmentation. Choosing the specific segments or a single segments within the base. Determining appropriate service levels for these segments. Traditionally, 7 broad elements are used in considering market segmentation1) Geographical segmentation 2) Demographic and socioeconomic segmentation 3) Psycholographic segmentation 4) Benefit segmentation 5) Usages segmentation 6) Loyalty segmentation 7) Occasion segmentation

The marketing mix for services Product Place Price Promotion Physical Evidence process People 9-Laboratory Services (Investigation) DEFINITION OF laboratory: Diagnosis of disease through examination of organs, tissues, bodily fluids, and whole bodies (autopsies) of the patients. Or A room equipped for making scientific experiments, test and clinical studies of the materials obtained from the patient. Or Laboratory section provides information about lab tests your doctor may use to screen for certain diseases or conditions.

What are lab tests? Laboratory tests are medical procedures that involve testing samples of blood, urine, or other tissues or substances in the body of the patients.

Why does your doctor use lab tests ? Your doctor uses laboratory tests to help: identify changes in your health condition before any Symptoms occur diagnose a disease or condition before you have Symptoms plan your treatment for a disease or condition, evaluate your response to a treatment, or Monitor the course of a disease over time. How are lab tests analyzed? After your doctor or lab technician collects a sample from your body, it is sent to a laboratory. Laboratories perform tests on the sample to see if it reacts to different substances. Depending on the test, a reaction may mean you do have a particular condition or it may mean that you do not have the particular condition. Sometimes laboratories compare your results to results obtained from previous tests, to see if there has been a change in your condition. Objectives of laboratory services Early detection of disease Level/grade of infection Diagnosis confirmation Doubt clearance

COLLECTION DEPARTMENT BLOOD COLLECTION URINE COLLECTION RAPID CARD TEST

E.g. (HIV, HCG. Etc) LABORATORY EQUIPMENTS Calorimeter Water bath Hot air oven Microscope Autoclave Incubator Refrigerator Auto analyzer PH meter ELISA reader ELISA washer Wax melting box Hot plates Centrifuging machine

Hematology BLOOD. Hemoglobin Total Leucocytes Counts Differential Leucocytes Counts Erythrocyte Sedimentation Rate ( ESR) Platelet Count Packed Cell Volume (PCV) MCV/MCHC/MCH Reticulocyte Coun Bone Marrow Examination Blood Group/Rh Type Malaria Parasite

URINE. Routine & Microscopic Bence Jones Proteins Ketene Bodies Bile Salts STOOL. Routine/Microscopic Occult Blood BIOCHEMISTRY: Blood Sugar- Fasting/P.P./Random Urine Sugar-Fasting/P.P. S. Cholesterol S. Creatine S. Calcium S. Urea/Uric Acid S. Inorganic Phosphate S. Albumin Sodium/Potassium Protein SGOT/PT Bilirubin-Total/Direct Lipid Profile Alkaline Phosphates'-Total/Prostatic Fraction

What makes the Clinical Pathology Management module valuable to a pathology laboratory? Provides instant access to clinical pathology test results Shows only those results that are relevant to the current case Optimizes workflow Reduces turnaround time Produces a more complete and accurate pathology report BASIC DIFFERENCE B/W PATHOLOGY & LABORATORY PATHOLOGY IS THAT BRANCH OF MEDICAL SCIENCE IN WHICH NATURE, CAUSES OF DESEASE, FUNCTIONAL & STRUCTURAL CHANGES OF THE BODY, CAN USE BY STUDY. LABORATORY IS A ROOM EQUIPPED FOR MAKING SCIENTIFIC EXPERIMENTS, TESTS OR CLINICAL STUDIESOF THE MATERIALS SUCH AS BLOOD, SPUTAM, URINE, STOOL, ETC. OBTAINED FROM THE PATIENT.

Radio therapy department What is radiotherapy? Radiotherapy is the treatment of cancer and other disease with ionizing radiation. Ionizing radiation destroying the DNA inside cancer cells, inhibiting their ability to grow. Although radiation damages both cancer cells and normal cells, the latter are able to repair them and function properly. Type of Radio therapy External beam radiotherapy Internal radio therapy

External beam therapy

Theratron 780 c (cobalt 60)

Location Department divided into three partWaiting room Physician room Therapy room Infra structure Thickness of wall, floor, and ceiling should be such as to prevent escape of radiation. Therapy room 13.5 thick and 6thick RCC roofs are adequate and paint with lead paint. Inter lock system. Precaution Prevent expose to radiation. Protect patient normal tissue TLD apply all staff Radiation attempt by experience staff and specialist

 Never inter therapy room when red bulb indicated. What is the risk? These are the unwanted, but mostly temporary effects of successful treatment. The side effects are very dependent on what part of the body has been treated. MAGNETIC RESONANCE IMAGING (MRI)

DIFINITION OF M R I Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases MRI gives different information about structures in the body than can be seen. MRI also may show problems that cannot be seen with other imaging methods.

ABOUT MRI MACHINE For an MRI test, the area of the body being studied is placed inside a special machine that contains a strong magnet. Pictures from an MRI scan are digital images that can be saved and stored on a computer for more study. The images also can be reviewed remotely, such as in a clinic or an operating room. In some cases, CONTRAST MATERIAL May be used during the MRI scan to show certain Structures more clearly USE OF MRI IT IS USED TO FIND PROBLEM SUCH AS: TUMOR BLEEDING INJURY B.V.D. INFECTION ETC. AN MRI SCAN CAN BE DONE FOR THE: HEAD CHEST BLOOD VESSELS ABDOMEN&PELVIS BONES &JOINTS SPINE SOME INFORMATION ABOUT MRI IF CONTRAST NEEDED THE TECHNOLOGIST WILL PUT IN IT I.V. DURING TEST MAY BE ALONE BUT TECHNOLOGIST WILL WATCH YOU THROUGH A WINDOW

 YOU WILL NEED TO TAKE OFF ALL OR MOST OF CLOTHES (GOWN TO USE DURING TEST) TIMING:- USUALLY TAKES 30 TO 60 MIN. BUTCAN TAKES AS LONG AS 2 HOURS. YOU CAN NOT MOVE DURING TEST IF FEEL NERVOUS CAN BE GIVE MEDICINE (SEDATIVE) PRECAUTION OF MRI YOU MAY NOT BE ABLE TO HAVE THE TEST FOLLOWING CONDITION: IN PREGNANCY MEDICAL DEVICE (ELECTRINIC) SUCH AS PACEMAKER & MEDICINE INFUSION PUMP MEDICAL DEVICE (METAL) :- IUD INABILITY TO REMAIN STILL DURING TEST OBESITY REMOVE ATM .MOBILE. ETC. COMPUTED TOMOGRAPHY SCAN (C T SCAN)

DIFINITION OF C T SCAN A CT scan stands for Computed Tomography Scan. It is also known as a CAT (Computer Axial Tomography) Scan. It is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). USES OF C T SCAN (A.) IT IS USED TO FIND PROBLEM SUCH AS: CACER CVD INFECTIOUS DISEASE APPENDISITIS TRAUMA MUSCULOSKELETAL DISORDER

B. C TSCAN CAN BE DONE FOR THE:INTERNAL ORGAN BONE SOFT TISSUES BLOOD VESSELS ABOUT C T SCAN The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the centre. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the

imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination. ADVANTAGE Of CT SCAN ITS ABILITY TO IMAGE BONES SOFTS TISSUES & BLOOD VESSELS IT IS FAST & SIMPLE(SAFE LIFE) IT IS LESS SENSITIVE TO PT. THEN MRI(CAN MOVEMENT) IT CAN BE PERFORMED IF YOU HAVE ANY MEDICAL DEVICE UNLIKE MRI

Blood Bank:A well organized blood transfusion service provided by hospital. It is a vital component of any health care delivery system. Blood Bank and transfusion and collect, process, store, and provide human Blood intended for transfusion, perform pre transfusion testing and finally in fusion in to a patients. Function of blood transfusion services Screening the blood donor. Maintenance of donors record. Insuring the safety of the donor. Testing the to make sure the blood or Blood product is safe for use. Components of blood RBC (H B.) WBC & Platelets Plasma Infrasture and Facilities. Registration and medical examination room with adequate furniture and facilities for registration and selection of donor. Blood collection rooms are available. Rooms for laboratory for blood group serology are available. Room for laboratory for transmissible disease like hepatitis, syphilis, malaria, HIV anti bodies are available. Sterilization and washing room. Refreshment room. Store and record room.

Equipments Equipment such as for blood collection room the following would be needed. Donors beds or tables Bedside table Sphygmomanometer and stethoscope. Recovery beds for donors. Refrigerator for maintaining temperature. Alarm device. Weighing machine.

BLOOD CONTAINER Disposable plastic packs Blood collection bottle. AnticoagulantsDisposable sterile bleeding sets. Blood transfusion sets.

Personnel-a medical officer trained in blood banking for six month a registered nurse and to trained technicians. For AIDS test, the hospital can have its own testing facilities are available.

10-BILLING AND DISCHARGE

Bill is an itemized statements of charges for goods supplied or service rendered. Billing services is a process of recording the transaction in a systematic way. In another way a willing service is a entity that assist a provider bills for services performed. Types of billing in hospital In patients billing Out patients billing ICU billing Laboratory billing Radiology billing Pharmacy billing CT scan/MRI billing Bill serves as Record Proof Claims Insurance Item charged

CASH COUNTER ROOM NO 6

Charges of OPD, Reg. and Admission OPD Charges. Registration charges (file making) Admission charge -- Rs.100/--Rs.5/--Rs.100/-

Follow up charges (after one month) General OPD Cancer Pt. -- Rs.5/--Rs.75/-

OPD BILLING

For billing of any OPD service like Pathology Tests, or any imaging investigation, the patient moves to cash (billing) counter. Here the services are charged as per the rates already defined for various categories/ penal/ time etc to the patient with his Patient ID. The Payment is collected for the service provided and a receipt is generated. All services will be automatically entered into the respective modules wherever required like lab & Imaging reporting.

INDOOR BILLING
Indoor billing has a supervisory role. The entries for billing are automatically transferred to the patient bill by the respective departments, which provide The service. The services are charged as per the category(WARD/ICU Etc.)Applicable. Bill is compiled and the payment collected from time to Time. Provisional and Final bills are generated which provides complete information about the Services availed, its Charges, Advance collected, appropriate Receipts, Refunds, Credit notes, Concession allowed, etc

CHARGES.. SPECIAL ROOM CHARGES A/C ROOM A/C DELUXE ROOM -11 HEATER ISUSED IN ROOM NEBULIZATION CHARGES BED SIDE E.C.G. C.T CHARGES ONE DAY C.T CHARGES MORE THAN ONE DAY ASCITES & PLEURAL TAPPING DRESSING IN O.T DRESSING IN ROOM BLOOD TRANSFUSION Rs. 700/Rs.900/Rs.1200/Rs.100/Rs.70/Rs.200/Rs.350/Rs.500/Rs.300+300 CYTELOGY Rs200/Rs.100/Rs.300/-

I.C.U CHARGES I.C.U CHARGES BLOOD TRANSFUSION DRESSING SMALL DRESSING BIG CHEMOTHERAPY MORE THAN ONE DAY NEBULIZATION PLEURAL/ASCITES PLEURAL/ASCITES CYTOLOGY CENTER LINE BED SIDE E.C,G Rs.300/Rs.150/Rs.50/Rs.100/Rs.350+700/Rs.500+700/Rs.70/Rs.300/Rs.300/Rs.500/Rs.200/-

Process of discharge

CONCLUSITIONFront office is the face of the hospital. The prime objective is to guide the patient and attainders. It should be located near the main entrance .receptionist is a person who is handling the front office department. He/she must possess some basic qualities and full knowledge about the hospital layout and facilities. The main process of the front office department is registration. The outpatients are becoming more and more important .ambulatory care reduces dislocation of work, is cheaper and at the same time gives access to the various investigative and diagnostic facilities of the hospital .there is three types of outpatient: general outpatient, referred outpatients and emergency outpatient. Outpatient department is the linkage to other department in the hospital; it should be located near the main entrance area. It must have basic facilities for waiting area, treatment room, recovery room, etc. IPD is the heart of the hospital. it provide the quality of service through nursing services, wards and rooms with sufficient space, dietary services and sanitary facility. The emergency/casualty services provide immediate, emergency diagnostic and therapeutic care to the patients. Proper recording in this department is essencial.In emergency department, various record are maintained. Physical facility in administrative area and clinical area should be maintained. Proper instruction must be given to medical officer who is in charge of emergency department. The importance of laboratory department cannot be under or overestimated because the practice of medicine today requires laboratory examinations. A hospital laboratory service can be a high income generating service and economic asset to the hospital.lab service is one of the most important services in health sector. Special attention should be given for its policies and procedures. Clear idea must be obtained regarding area of lab services.

To main function of radiology services is to assist clinician in the diagnosis and treatment of diseases through the use of the radiography procedures. Rehabilitative medicine encompasses field like physical therapy, occupational therapy, recreational therapy, speech and hearing therapy, bracing, prosthetics and pulmonary medicine, therapy is indicated as a result of surgery, trauma and other functional impairment. The four functional areas of physical therapy department are a hydrotherapy area, a gymnasium area, a treatment cubicle area, space and facility of support and other non-treatment purpose. The location, facility and requirements of different fields are highlighted. Bill is a statement of changes for goods supplied or service is a process of recording in a bill. Different types of billing are done in the hospital. Computer plays an important role in billing services.

FEEDBACK
1-Maximum facility is availableIn the hospital, facility are available such as blood bank, radiodignostic centre, bank, telemedicine, availability of special radiotherapy (thereto 780c cobalt 60,brachy therapy micros electron HDR, inclinator. but some type of facility are not available like ATM and well established pharmacy. 2-The infrastructure of whole hospital are well situated such as waiting room, patients room, physicians room, therapy room. 3-Quality services good transportation services are provided for staff and patient by hospital. Provide proper health care. 4-Cooperative staff the staff of the hospital are very cooperative and they helps to patient as well as students regarding their queries.

SUGGESTION Computerization facility must be available in each and every department. Code blue system must be available in ICU.