Introduction

Healthcare operations encompass the totality of those healthcare functions

that allow those who practise healthcare delivery to do so. As the healthcare
industry undergoes dramatic reform, so will the jobs of those who manage
healthcare delivery systems. Although healthcare operations managers play
one of the most vital and substantial roles in the new delivery system, the
criteria for their success (or failure) are being defined now. Yet, the new and
vital role of operations manager has been stunted in its development, which
is primarily because of old and outdated antipathy between hospital
administrators and physicians.
Although there is wealth of research on operations management and
strategic planning in hospitals, there has been little if any research on the
integration of these two issues. Hospital administrators are being pressured
to improve the quality of services and to curb costs two primary themes
within the field of operations management. This leads us to wonder to what
extent operations are considered within the strategic planning process and
what impact it may have.

Operations Management & Legal Aspects in Hospitals

1

Task 1: Differentiate between NABH and JCI accreditations.

What is the nature of functioning and role of Quality
Council of India? (Criteria-2.1, 2.2, 2.3)
NABH

National Accreditation Board for Hospitals and Healthcare Providers (NABH) is

a constituent board of Quality Council of India (QCI), set up to establish and
operate accreditation programme for healthcare organizations. The board
while being supported by all stakeholders including industry, consumers,
government have full functional autonomy in its operation. The board is
structured to cater to much desired needs of the consumers and to set
benchmarks for the progress of health industry.
Scope of NABH
1. Accreditation of healthcare facilities
2. Quality promotion
3. Education and training for quality and patient safety
4. Recognition:
Endorsement
of
various
healthcare
courses/workshops

quality

Accreditation
Accreditation is an external review of quality with four principal components.
1. It is based on written and published standards.
2. Reviews are carried by professional peers.
3. The accreditation process is administered by independent body.
4. The aim of accreditation is to encourage organisational development.
NABH Accreditation
1. Establishment of protocols and policies as per National/International
Standards for patient care, medication management, consent process,
patient safety, medical records, infection control and staffing.
2. Commitment to create a culture of quality, patient safety, efficiency
and accountability towards patient care.
3. Patient are treated with respect and dignity at all times.
4. Patients are treated by qualified and trained staff.
5. Transparency in billing and availability of tariff list.
Operations Management & Legal Aspects in Hospitals
2

6. Continuous monitoring of its services for improvement.

The NABH standards for hospitals were released in December 2005. The
NABH standards have 10 chapters, 100 standards and 503 objective
elements. The standards are suitable for the country and are in accordance
with relevant international standards.
Standards
A standard is a statement that defines structures and processes that must be
substantially in place in an organisation to enhance the quality of care.
Standards focus on:
1. Patient safety
2. Staff and employee safety
3. Environment and community safety
4. Information, education and communication.
Objective Element
Objective element is a measurable component of a standard.
Section I:
Patient-Centred Standards
Standards
Objective Elements
Access, Assessment 15
78
and Continuity of
Care (ACC)
Patients Rights and 5
29
Education (PRE)
Care
of
Patients 18
105
(COP)
Management
of 13
61
Medications (MOM)
Hospital
Infection 9
44
Control (HIC)
Section II:
Health Care Organisation Management Standards
Continuous Quality 6
37
Improvement (CQI)
Responsibilities
of 5
20
Management (ROM)
Facility Management 9
41
and Safety (FMS)
Human
Resource 13
47
Management (HRM)
Information
7
41
Management
Operations Management & Legal Aspects in Hospitals
3

Systems (IMS)
TOTAL

100

503

Prepared by the learner

Joint Commission International (JCI)

Joint Commission International (JCI) identifies, measures and shares best

practices in quality and patient safety with the world. They provide
leadership and innovative solutions to help health care organizations across
all settings improve performance and outcomes. Their expert team, works
with hospitals and other health care organizations, health systems,
government ministries, public health agencies, academic institutions and
businesses to achieve peak performance in patient care.
History
Founded in 1994 by The Joint Commission, JCI has touched more than 90
countries. Today, the organization helps patients in five continents and fields,
a well-trained team of international accreditation surveyors and consultants.
JCI enjoys a 20 percent annual growth in the number of accredited
organizations, just one metric of how they help health care leaders to
improve quality, safety and efficiency as a shared goal.
Mission
The mission of JCI is to improve the safety and quality of care in the
international community through the provision of education, publications,
and consultation and evaluation services.
Differentiate between NABH and JCI (Criteria 2.1)
Sl.
NABH
JCI
No
1
NABH is propagated by JCI is the international arm of the
Quality Council of India and is American Joint Commission on
an Indian product.
Accreditation
of
Healthcare
Organizations (JCAHO) standards.
2
NABH and JCI are divided into patient and administrative sections of
healthcare. The majority of the standards for both JCI and NABH are
Operations Management & Legal Aspects in Hospitals
4

the same.
All objective elements are In JCI not all objective elements are
mandatory in NABH, making mandatory.
it tougher to achieve.
The domain areas of the standards for both NABH and JCI are also
same. Thus a comparative analysis shows that NABH standard is at
par with JCI and other international standards.
JCIA, NABH is technically better as there are standards for small
hospitals also released by NABH which can be used by smaller
hospitals. We can do either of the standards or both.
NABH and JCI is not the driving force to attract more patients. It is
the adherence to JCIA and NABH standards, process compliance as a
result, training of doctors, nurses and all staff of the hospital which
leads to the quality process compliance which results in better
patient satisfaction. It is not necessary to have NABH to satisfy
above mentioned quality aspects, but NABH gives a ready-made
guidelines, which is at par with the best in the world.

Prepared by the learner

Quality Council of India

The Quality Council of India (QCI) is a pioneering experiment of the
Government of India in setting up organisations in partnership with the
Indian industry.
Background
Since 1992 a need had been felt for the establishment of an accreditation
body in the country to establish internationally acceptable mechanism for
recognition of conformity assessment results. As regards laboratories, an
accreditation body under the Ministry of Science and Technology was already
functioning. A committee which included various interested ministries and
stakeholders including industries was established to make suitable
recommendations. The work was coordinated by the then Department of
Industries (Department of Industrial Policy and Promotion) and the
recommendations were submitted to the Cabinet in 1996. Key
recommendations included the need for establishing an organisation jointly
by the Government and the industry and the need for the organisation to be
self-sustaining and be away from the government.
Accepting the recommendations, the Cabinet Committee decided to set up
Quality Council of India as a non-profit autonomous society registered under
Societies Registration Act XXI of 1860 to establish an accreditation structure
in the country and to spread quality movement in India by undertaking a
National Quality Campaign.
Main Objectives
Operations Management & Legal Aspects in Hospitals
5

1. To lead nationwide quality movement in the country through National

Quality Campaign aimed at creating awareness amongst citizens,
empowering them to demand quality in all spheres of activities, and
promoting and protecting their well-being by encouraging
manufactures and suppliers of goods and service providers for
adoption of and adherence to quality standards and tools.
2. To develop apropos capacities at the level of governments, institutions
and enterprises for implementing and institutionalizing continuous
quality improvement.
3. To develop, establish and operate national accreditation programmes
in accordance with the relevant international standards and guides for
the conformity assessment bodies certifying products, personnel,
management systems, carrying out inspection and for the laboratories
undertaking testing and calibration and such other areas of organized
activities that have significant bearing in improving the quality of life
and well-being of the citizens of India.
4. To develop, establish and operate National Accreditation Programmes
for various service sectors such as education, healthcare, environment
protection, governance, social sectors, infrastructure sector, vocational
training etc., to site a few, as may require, based on
national/international standards and guidelines and where such
standards are not available, to develop accreditation standards to
support accreditation programs.
5. To build capacities in the areas of regulation, conformity assessment
and accreditation to overcome TBT/SPS constraints.
6. To encourage development and application of third party assessment
model for use in government, regulators, organizations and society.
7. To promote quality competitiveness of Indias enterprises especially
MSMEs through adoption of and adherence to quality management
standards and quality tools.
8. To facilitate effective functioning of a National Information and Enquiry
Services on standards and quality.
9. To develop and operate an appeal mechanism to deal with unresolved
complaints.
10.
Promoting the establishment of quality improvement and
benchmarking centre, as a repository of best international/national
practices and their dissemination among the industry in all the sectors.
i. To encourage industrial/applied research and development in the
field of quality and dissemination of its result in relevant
publication including trade journals.
ii.
To build capacities including development of appropriate quality
accreditation mechanism for other emerging areas that have
significant bearing in improving the quality of life and well-being
of the citizens of India such as food sector, oil and gas, forestry,
agriculture/animal husbandry, warehouse, pharmacy etc. or as
the need may arise from time to time.
Operations Management & Legal Aspects in Hospitals
6

Structure of QCI
The society is governing by a Council comprising of 38 members, and has an
equal representation of Government, Industry and other stakeholders. The
Council is the apex level body responsible for formulating the strategy,
general policy, constitution and monitoring of various components of QCI
including the accreditation boards with objective to ensure transparent and
credible accreditation system.
The Council through a Governing Body monitors the progress of activities
and appeal mechanisms set by the respective boards. QCI functions through
the executive bodies (boards/committees) that implement the strategy,
policy and operational guidance set by the Quality Council of India with a
view to achieve international acceptance and recognition of various
programs offered by the Boards. Each board has a Chairman nominated by
the Chairman, QCI and comprises of representatives volunteer group of
stakeholders who guide and monitor the activities and progress of the
respective boards.

Operations Management & Legal Aspects in Hospitals

7

Council

Governing Body

Secretariat

Accreditation
Boards
National
Accreditation
Board for
Certification
Bodies(NABCB)

National
Accreditation
Board for
Education and
Training(NABET)

National
Accreditation
Board for
Hospitals and
Healthcare
Providers

National
Accreditation
Board for Testing
and Calibration
Laboratories

Quality Promotion

National Board for

Quality Promotion
(NBQP)

Prepared by the learner

Operations Management & Legal Aspects in Hospitals

8

Quality
Information and
Enquiry Service

Task 2: Describe the Operations Management of a multispecialty

hospital,
hi-lighting
both
clinical
and
administrative departments. Explain the concepts of Third
Party Insurance in Hospitals. List the various Health
Insurance Companies in India. Explain the schemes such
as ECHS, CGHS and ESI. (Criteria 1.1, 1.2)
Third Party Insurance in Hospitals
The health infrastructure in India is facing daunting challenge of meeting the
health goals and complexities emerging from the changing disease pattern.
The proliferation of various healthcare technologies and increase in cost of
care has necessitated the exploration of health financing options to manage
problems arising out of increasing healthcare costs.
An insurance policy purchased for protection against the actions of another
party. Third party insurance is purchased by the insured (first party) from an
insurance company (second party) for the protection against another partys
claims (third party). The evolution of a new body for cash-less claim
processing in the form of Third Party Administrators (TPAs) marks a new
chapter towards addressing some of the problems of health insurance
industry.
Third Party Administrator (TPA) was introduced through the notification on
TPA-Health Services Regulations, 2001 by the IRDA. The basic role is to
function as an intermediary between the insurer and the insured and
facilitate the cash-less service of insurance. For this service they are paid a
fixed per cent of insurance premium as commission. This commission is
currently fixed at 5.6 per cent of premium amount.
Time taken to settle claims of providers of healthcare services
TPAs were introduced as intermediaries to facilitate claim settlement
between the insurer and the insured. The agreement between TPAs and
healthcare facilities provides for monitoring and collection of necessary
information, documents and bills pertaining to the treatment. Documents are
examined and after processing sent to the insurance company for
reimbursement. TPAs have the responsibility of managing claims, getting
reimbursements from the insurance company and paying to the healthcare
provider. It is expected that with the introduction of TPA services, the claim
settlement process would be simplified. IRDA has suggested that all claims
should be settled in seven days. Outsourcing claim-processing services may
help in reducing the claim period, but settling claims in seven days look very
ambitious target in current scenario.
Impact of TPAs on hospital administration and cost
Operations Management & Legal Aspects in Hospitals
9

The introduction of TPAs as claim settlement intermediaries in health

insurance gives rise to certain concerns. For example, many hospital
administrators feel that TPAs put additional burden on their administration.
Hospitals have raised concerns about the cost of providing required data/
TPAs also influence their payment rates. There are also concerns of selective
contracting by insurers with significant market penetration (Matthies and
Cahill 2004).

Health Insurance
Health insurance in India is popularly known as mediclaim .PSU health
insurance companies have named basic health insurance companies also
provide health insurance products .There are few health insurance
companies in India whom IRDA has issued license for providing only health
insurance products .There are total 24 companies providing health insurance
in India.
Non-life Insurance Companies in India (Mediclaim
Companies in India)
1. Bajaj Allianz General Insurance Co. Ltd
2. Bharti AXA General Insurance Co. Ltd
3. Cholamandalam MS General Insurance Co. Ltd
4. Future General India Insurance Co. Ltd
5. HDFC ERGO General Insurance Co. Ltd
6. ICICI Lombard General Insurance Co. Ltd
7. IFFCO Tokio General Insurance Co. Ltd
8. L & T General Insurance Co. Ltd
9. Liberty Videocon General Insurance
10.
National Insurance Co. Ltd
11.
Raheja QBE General Insurance Co. Ltd
12.
Reliance General Insurance Co. Ltd
13.
Royal Sundaram Alliance Insurance Co. Ltd
14.
SBI General Insurance Co. Ltd
15.
Shriram General Insurance Co. Ltd
16.
Tata AIG General Insurance Co. Ltd
17.
The New India Assurance Co. Ltd
18.
The Oriental Insurance Co. Ltd
19.
United India Insurance Co. Ltd
20.
Universal Sompo General Insurance Co. Ltd

Insurance

Stand Alone Health Insurance Companies in India

1. Star Health and Allied Insurance Co. Ltd
Star health is a joint venture among some insurance veterans in India,
ETA Ascon Group and Oman Health Insurance Company. It is also the
Operations Management & Legal Aspects in Hospitals
10

first ever stand-alone health insurance provider operating in India to

provide consumers with individual and family floater health plans.
The company gained popularity for offering many an innovative policy
like Diabetes Safe meant for diabetic patients and Star Netplus to cater
to the needs of people suffering from HIV positive. Unlike other health
insurance establishments Star Health boasts an in-house TPA. Their
customers are also provided with the unique facility to consult with
general physician for free in some of their health insurance plans.
2. Apollo Munich Health Insurance Co. Ltd
Apollo Munich came into existence back in 2007 after the collaboration
between Munich Health and Apollo Hospitals Group. Apollo Munich
bagged the prestigious award of Health Insurance Company of the
Year in 2014 for its excellence in offering beneficial health policies to
make medical expenses affordable. Apollo Munich, under its Optima
Restore policy offers cashless treatment option in over 4000 hospitals
all over India. Aside from Optima Restore, other popular health covers
on offer at Apollo Munich are Optima Cash, Optima Super and Energy
and Easy Health.
Most of the health plans on offer at Apollo Munich boast some unique
traits in the likes of portability of existing policies along with all due
benefits and lifetime renewal option. Its health plan also offer
maternity cover, after a certain waiting period.
3. Max Bupa Health Insurance Co. Ltd
Max Bupa Health Insurance Company Limited is the outcome of a joint
venture that took place in 2010 between Max India Limited and Bupa
which is a renowned UK based Healthcare Group. Based out of New
Delhi, Max Bupa offers bespoke services and offers cashless treatment
in more than 3500 hospitals in India.
Some of the standout features of a Max Bupa health insurance policy
include cashless facility and medical costs for pre and post
hospitalization. The company has already bagged the IT Leadership
Award. Max Bupa is widely regarded as one of the best health
insurance companies in India for its individual and family floater plans.
4. Religare Health Insurance Co. Ltd
Religare Health Insurance Company came into appearance in 2012
when Religare Enterprises Limited, Union Bank of India and Corporation
Bank tied up with one another. It is an Indian stand-alone health
insurance company. The network of Religare Health Insurance
Company for cashless hospitalization is massive as it encompasses
over 4000 hospitals across India.
Operations Management & Legal Aspects in Hospitals
11

5. Cigna TTK Health Insurance Co. Ltd

Cigna Corporation and TTK Group merged with a view to put together
an insurance house solely focusing on offering good health insurance
products. The Company was licensed by IRDA in 2013 and began to
operate from the February of 2014. Cigna TTK is one of the few standalone medical insurance firms in India. Cigna TTK is highly acclaimed
for its affordable insurance covers and robust customer service. The
establishment even aims to boost personal health management to tis
policyholders through its health plans.
Cigna TTK introduced Cigna Global Health Policy, an exclusive group
health insurance product that covers Indian employees globally while
travelling around the world. Cigna TTK is the partner of two prominent
Marathons namely Standard Chartered Mumbai Marathon and Airtel
Delhi Half Marathon.
List

of health insurance plans available at Cigna TTK

ProHealth Protect Plan
ProHealth Preferred Plan
ProHealth Plus Plan
ProHealth Premier Plan
Lifestyle Protection Accident Care Plan
Lifestyle Protection Critical Care Plan

Ex-Serviceman Contributory Health Scheme (ESCHS)

Retired Armed Forces personnel till 2002 could avail medical facilities only for
specific high cost surgery/treatment for a limited number of diseases covered
under the (AGI (MBS)) Army Group Insurance (Medical Branch Scheme) and
(AFGIS (MIS)) Armed Forces Group Insurance Scheme (Management
Information Scheme) schemes. These medicare schemes could provide some
relief to the ESM, but it was not a comprehensive scheme as compared to
and available for other Central Government Employees. Therefore, the
requirement was felt of establishing a medicare system which could provide
quality medicare to the retirees of the Armed Forces.
Based on this noble aim, and after detailed deliberations, a comprehensive
scheme has taken shape as ECHS, authorized vide Government of India,
Ministry of Defence letter No. 22 (i) 01/US/D (Res) dated 30 Dec 2002. The
ECHS was launched with effect from 01 April 2003, with the advent of this
scheme. Ex-servicemen pensioners and their dependants who were only
entitled for treatment in service hospital are now authorized treatment, not
only in service hospitals, but also in those civil/private hospitals which are
specifically empanelled with the ECHS. The Scheme is financed by
Government of India.

Operations Management & Legal Aspects in Hospitals

12

Organization of ECHS
The ECHS Central Organization is located at Delhi and functions under the
Chief of Staff Committee (COSC) through AG and DGDC & W in Army HQ. The
Central Organization is headed by Managing Director, ECHS, a serving Major
General. There are 28 regional centres and 426 ECHS Polyclinics. There are
five types of ECHS polyclinics i.e., Type A, B, C, D and E. Authorization
of contractual staff in each type of ECHS polyclinic is based on the load
capacity of ECHS polyclinic.
The existing Command and Control Structure of the Army, Navy and Air Force
have been given the Administrative and financial powers to run this
scheme .Station commanders will exercise direct control over the ECHS
polyclinics Regional Centre ECHS and ECHS Cell, Station Headquarters will be
able to clarify and doubts that you may have on ECHS. Regional centres
ECHS are under command HQ/ Area HQ .Central Org ECHS functions as part
of AGs Branch, Army HQ.
ADVANTAGES OF BECOMING ECHS MEMBER

1. NO age or medical condition bar for becoming a member.

2. Life time contribution ranges from Rs 1500/- to Rs 60000 (depending upon
Grade Pay)
3. Provision for re-imbursement at CGHS rates, in case of treatment under
Emergency in a non-empanelled facility.
4. No monetary ceiling on treatment.
5. Indoor / outdoor treatment, tests and medicines.
6. Familiar environment and sense of belongingness.
7. Covers spouse and all eligible dependents.

CGHS (CENTRAL GOVERNMENT HEALTH SCHEME)

OBJECTIVES
1. To provide comprehensive medical care facilities to the Central
Government employees/ pensioners and member of their families.
2. To avoid cumbersome system of reimbursement of medical expenses
to the employees/ pensioners.
ELIGIBILITY
The scheme as it stands today, covers:
1. Central Government employees residing in CGHS covered cities.
2. Judges of Supreme Court of India and Judges of High Court of Delhi,
including employees residing in CGHS areas.
3. Retired Judges of Supreme Court of India and retired Judges of all High
Courts of India residing in CGHS areas.
4. Freedom fighters [O.M. No. S-11011/C/94-CGHS (P) dated 16.8.94]
5. Members and ex-members of Parliament
6. Central Government pensioners, who were members of CGHS just
before retirement.
7. Accredited journalists (up to Dispensary level only)
8. Ex-Governors and Ex-Vice Presidents of India.
Operations Management & Legal Aspects in Hospitals
13

Facilities provided to Members

The following facilities are being provided to the beneficiaries through the
dispensaries and polyclinics, Government and recognised hospitals:
1. Out-patient care facilities in all systems.
2. Emergency services in Allopathic system.
3. Free supply of necessary drugs.
4. Lab and Radiological investigations.
5. Family Welfare Services
6. Treatment in specialised hospitals, both in Government and private
recognised hospitals.
7. Specialist consultation both at the dispensary and hospital level.
Facilities for pensioners
1. The same type of medical facilities are provided to the Central
Government pensioners residing in CGHS covered areas as are being
provided to the serving Central Government employees.
2. Extension of CGHS to All India Service Pensioners.
Employees State Insurance (ESI) Act, 1948
The ESI scheme, introduced by an Act of Parliament in 1948, is a unique
piece of Social Legislation in India. It aims at bringing about social justice to
the poor Labour class of the land.
The promulgation of Employees State Insurance Act, 1948 envisaged an
integrated need based social insurance scheme that would protect the
interest of workers in contingencies such as sickness, maternity, temporary
or permanent physical disablement resulting in loss of wages or earning
capacity and death due to employment injury. The Act also guarantees
reasonably good medical care to workers and their immediate dependents.
Benefits of ESI
1. Medical benefit
Full medical care is provided to an insured person and his family
members from the day he enters insurable employment. There is no
ceiling on expenditure on the treatment of an insured person or his
family member. Medical care is also provided to retired and
permanently disabled insured persons and their spouses on payment
of a token annual premium of Rs.120/-.
System of treatment
Scale of medical benefit
Benefits to retired IPs
Administration of medical benefit in a state
Domiciliary treatment
Specialist consultation
Operations Management & Legal Aspects in Hospitals
14

2.

3.

4.

5.

6.

In-Patient treatment
Imaging services
Artificial limbs and aids
Special provisions
Reimbursement
Sickness benefit (SB)
Sickness benefit in the form of cash compensation at the rate of 70 per
cent of wages is payable to insured workers during the periods of
certified sickness for a maximum of 91 days in a year. In order to
qualify for sickness benefit the insured worker is required to contribute
for 78 days in a contribution period of 6 months.
Extended sickness benefit (ESB)
SB extendable upto two years in the case of malignant and longterm diseases at an enhanced rate of 80 per cent of wages.
Enhanced sickness benefit
Enhanced sickness benefit equal to full wage is payable to
insured persons undergoing sterilization for 7 days/14 days for
males and female workers respectively.
Maternity benefit (MB)
maternity benefit for confinement/pregnancy is payable for three
months, which is extendable by further one month on medical advice
at the rate of full wage subject to contribution for 70 days in the
preceding year.
Disablement benefit
Temporary disablement benefit (TDB)
From day one of entering insurable employment and irrespective
of having paid any contribution in case of employment injury.
Temporary disablement benefit at the rate of 90% of wage is
payable so long as disability continues.
Permanent disablement benefit (PDB)
The benefit is paid at the rate of 90% of wage in the form of
monthly payment depending upon the extent of loss of earning
capacity as certified by a Medical Board.
Dependants benefit (DB)
DB paid at the rate of 90% of wage in the form of monthly payment to
the dependants of a deceased insured person in cases where death
occurs due to employment injury or occupational hazards.
Other benefits
Funeral expenses
An amount of Rs.10,000/- is payable to the dependants or to the
person who performs last rite from day one of entering insurable
employment.
Confinement expenses

Operations Management & Legal Aspects in Hospitals

15

An insured women or an IP in respect of his wife in case

confinement occurs at a place where necessary medical facilities
under ESI scheme are not available.
1
2
3
4

ESI Scheme-A Total Social Security for Workmen

Medical Care
Primary, secondary and tertiary medical care
with no cap on individual expenditure
Sickness Benefit
91 days
Extended
Sickness 730 days (upto 2 years) for specified 34
Benefit
diseases
Maternity Benefit
84 days + 1 month (due to complications
arising out of pregnancy, confinement,
premature birth of child etc.)
Permanent
Based on loss of earning capacity/ as long as
Disablement
Benefit/ the disability lasts.
Temporary Disablement
Benefit
Dependants Benefit
On the death of IP of the wife till she is
alive/remarried and to family members as per
conditions w.r.t. age/marriage.
Rajiv Gandhi Shramik 50% of daily average wages upto 12 months
Kalyan
Yojna unemployment on account of closure of
(Unemployment
factories,
retrenchment
or
permanent
Allowance)
invalidity of not less than 40% arising out of
non-employment injury.
Incentive Scheme to The employers share of contribution is paid by
employers
for government for 3 years for providing
employing persons with employment to persons with disabilities
disabilities
drawing monthly wages upto Rs.25,000/Medical Care to Retired Medical facility available within ESIC on
IPs
payment of Rs.120/- per annum.

Prepared by the learner

Operations Management & Legal Aspects in Hospitals

16

Task 3: Explain the importance of waste management in

hospitals and various statutory implications in connection
with PCB, STP, Incinerator and IMAGE. (Criteria-3.1)
According to Biomedical Waste (Management and Handling) Rules, 1998 of
India, Any waste which is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining
thereto in the production or testing of biological.
The Government of India (notification, 1998) specifies that Hospital Waste
Management is a part of hospital hygiene and maintenance activities. This
involves management of range of activities, which are mainly engineering
functions, such as collection, transportation, operation or treatment of
processing systems and disposal of wastes. One of Indias major
achievement has been to change the attitudes of the operators of healthcare
facilities to incorporate good healthcare waste management practices in
their daily operations and to purchase on-site waste management services
from private sector (Bekir Onursal, 2003).
World Health Organization states that 85% of hospital wastes are actually
non-hazardous, whereas 10% are infectious and 5% are non-infectious, but
they are included in hazardous wastes. About 15% to 35% of hospital waste
is regulated as infectious waste. This range is dependent on the total amount
of waste generated (Glenn and Garwal, 1999).
Classification of
Waste category
Infectious
waste

Healthcare Waste
Description and examples
Waste suspected to contain pathogens. Eg. Laboratory
cultures; waste from isolation wards; tissues (swabs),
materials, or equipments that have been in contact with
infected patients; excreta.
Pathological
Human tissues or fluids, Eg. Body parts; blood and
waste
other body fluids; fetuses.
Sharps
Sharp waste. Eg. Needles; infusion sets; scalpels;
knives; blades; broken glass
Pharmaceutical Waste containing pharmaceuticals Eg. Pharmaceuticals
waste
that are expired or no longer needed; items
contaminated by or containing pharmaceuticals
(bottles, boxes)
Genotoxic
Waste containing substances with Genotoxic properties.
waste
Eg. Waste containing cytostatic drugs (often used in
cancer therapy); Genotoxic chemicals
Chemical waste Waste containing chemical substances. Eg. Laboratory
reagents; film developer; disinfectants that are expired
Operations Management & Legal Aspects in Hospitals
17

or no longer needed; solvents.

Wastes
with Batteries; broken thermometers; blood pressure gauges
high content of etc.
heavy metals
Pressurized
Gas cylinders; gas cartridges; aerosol cans.
containers
Radioactive
Waste containing radioactive substances. Eg. Unused
waste
liquids from radiotherapy or laboratory research;
contaminated glassware, packages or absorbent paper;
urine and excreta from patients treated or tested with
unsealed radionucleides; sealed sources.
Prepared by the learner

Problems relating to Bio-Medical Waste

A major issue related to current Bio-Medical Waste management in many
hospitals is that the implementation of Bio-Waste regulation is unsatisfactory
as some hospitals are disposing of waste in a haphazard, improper and
indiscriminate manner. Lack of segregation practices, results in mixing of
hospital wastes with general waste making the whole waste stream
hazardous. Inappropriate segregation ultimately results in incorrect method
of waste disposal.
Inadequate Bio-Medical Waste management thus will cause environmental
pollution, unpleasant smell, growth and multiplication of vectors like insects,
rodents and worms and may lead to the transmission of diseases like
typhoid, cholera, hepatitis and AIDS through injuries from syringes and
needles contaminated with human.
The problem of bio-medical waste disposal in the hospitals and other
healthcare establishments has become an issue of increasing concern,
prompting hospital administration to seek new ways of scientific, safe and
cost effective management of the waste, and keeping their personnel
informed about the advances in this area. The need of proper hospital waste
management system is of prime importance and is an essential component
of quality assurance in hospitals.
Need of bio-medical waste management in hospitals
The reasons due to which there is great need of management of hospitals
waste such as:
1. Injuries from sharps leading to infection to all categories of hospital
personnel and waste handler.
2. Nosocomial infections in patients from poor infection control practices
and poor waste management.
3. Risk of infection outside hospital for waste handlers and scavengers
and at time general public living in the vicinity of hospitals.
Operations Management & Legal Aspects in Hospitals
18

4. Risk associated with hazardous chemicals, drugs to persons handling

wastes at all levels.
5. Disposable being repacked and sold by unscrupulous elements
without even being washed.
6. Drugs which have been disposed of, being repacked and sold off to
unsuspecting buyers.
7. Risk of air, water and soil pollution directly due to waste, or due to
defective incineration emissions and ash.
Bio-medical Waste Management Process
There is a big network of Healthcare Institutions in India. The hospital waste
like body parts, organs, tissues, blood and body fluids along with soiled linen,
cotton, bandage and plaster casts from infected and contaminated areas are
very essential to be properly collected, segregated, stored, transported,
treated and disposed of in safe manner to prevent nosocomial or hospital
acquired infection.
Waste

collection

Segregation

T
ransportation
storage

and

T
reatment and
disposal
T
ransport to final
disposal site

Final

disposal

Prepared by the learner

Treatment and disposal technologies for healthcare waste

Incineration
Incineration is a high temperature dry oxidation process that reduces organic
and combustible waste to inorganic incombustible matter and results in a
very significant reduction of waste-volume and weight. The process is usually
selected to treat wastes that cannot be recycled, reused or disposed off in a
land fill site. Incineration requires no pre-treatment, provided that certain
Operations Management & Legal Aspects in Hospitals
19

waste types are not included in the matter to be incinerated. Characteristics

of the waste suitable for incineration are:
1. Low heating volume above 2,000 kcal/kg for single- chamber
incinerators, and above 3,500 kcal/kg for pryolytic double-chamber
incinerators
2. Content of combustible matter above 60 per cent
3. Content of non-combustible solids below 5 per cent
4. Content of non-combustible fines below 20 per cent
5. Moisture content below 30 per cent.
Waste types not to be incinerated:
1. Pressurized gas containers
2. Large amount of reactive chemical wastes
3. Silver salts and photographic or radiographic wastes
4. Halogenated plastics such PVC
5. Waste with high mercury or cadmium content, such as broken
thermometers, used batteries, and lead-lined wooden panels
6. Sealed ampules or ampules containing heavy metals
Types of incinerators
Incinerators can range from very basic combustion unit that operates at
much lower temperature to extremely sophisticated, high temperature
operating plants.it should be carefully chosen on the basis of the available
resources, the local situation, and the risk-benefit consideration. Three basic
kinds of incineration technology are of interest for treating healthcare waste:
1. Double-chamber pyrolytic incinerators which may be especially
designed to burn infectious healthcare waste
2. Single-chamber furnaces with static grate, which should be used only
if pyrolytic incinerators are not affordable
3. Rotary kilns operating at high temperatures, capable of causing
decomposition of Genotoxic substances and heat-resistant chemicals.
PCB (Pollution Control Board)
The Central Pollution Control Board (CPCB), statutory organization, was
constituted in September 1974 under the Water (Prevention and Control of
Pollution) Act, 1974. Further, CPCB was entrusted with the powers and
functions under the Air (Prevention and Control of Pollution) Act, 1981. It
serves as a field formation and also provides technical services to the
Ministry of Environment and Forests of the provisions of the Environment
(Protection) Act, 1986. Principal functions of the CPCB, as spelt out in the
Water (Prevention and Control of Pollution) Act, 1974 and the Air (Prevention
and Control of Pollution) Act, 1981:
1. To promote cleanliness of streams and wells in different areas of the
States by prevention, control and abatement of water pollution.
2. To improve the quality of air and to prevent, control or abate air
pollution in the country.
Operations Management & Legal Aspects in Hospitals
20

Functions of the Central Board at the National Level

1. Advise the Central Government on any matter concerning prevention
and control of water and air pollution and improvement of the quality
of air.
2. Plan and cause to be executed a nation-wide programme for the
prevention, control or abatement of water and air pollution.
3. Provide technical assistance and guidance to the State Boards, carry
out and sponsor investigation and research relating to problems of
water and air pollution, and for their prevention, control or abatement.
4. Co-ordinate the activities of the State Board and resolve disputes
among them.
5. Organise through mass media, a comprehensive mass awareness
programme on the prevention, control or abatement of water and air
pollution.
6. Plan and organize training of persons engaged in programme on the
prevention, control or abatement of water and air pollution.
7. Prepare manuals, codes and guidelines relating to treatment and
disposal of sewage and trade effluents as well as for stack gas cleaning
devices, stacks and ducts.
8. Collect, compile and publish technical and statistical data relating to
water and air pollution and the measures devised for their effective
prevention, control or abatement.
9. Disseminate information in respect of matters relating to water and air
pollution and their prevention and control.
10.
Lay down, modify or annul, in consultation with the State
Governments concerned, the standards for stream or well, and lay
down standards for the quality of air and perform such other function
as may be prescribed by the Government of India.
Sewage Treatment Plant
Sewage is a mixture of domestic and industrial wastes. It is more than 99%
water, but the remainder contains some ions, suspended solids and harmful
bacterial that must be removed before the water is released into the sea.
The treatment of waste water is divided into three phases: pre-treatment,
primary treatment and secondary treatment.
1. Pre-treatment
Large solids (i.ie, those with a diameter of more than 2cm) and grit
(heavy solids) are removed by screening. These are disposed of in
landfills.
2. Primary treatment
The water is left to stand so that solids can sink to the bottom and oil
and grease can rise to the surface. The solids are scraped off the
bottom and the scum is washed off with water jets. These two
substances are combined to form sludge.
3. Secondary treatment
Operations Management & Legal Aspects in Hospitals
21

The sludge is further treated in sludge digesters: large heated tanks

in which its chemical decomposition is catalysed by microorganisms.
The sludge is largely converted to biogases, a mixture of CH 4 and CO2
which is used to generate electricity for the plant.
The liquid is treated by bacteria which break down the organic matter
remaining in solution. It is then sent to oxidation ponds where
heterotrophic bacteria continue the breakdown of the organics and
solar UV light destroys the harmful bacteria.
Statutory implications in connection with PCB, STP and Incinerator
Sl.
Name of the Rule/Act
Year
No.
1
The Air (Prevention and Control of Pollution) Rules
1982
2
Air (Prevention and Control of Pollution) Act
1981/19
87
3
Environment Protection Act
1986
4
Environment Protection Rule
1986
5
Noise Pollution Control Rules
2000
6
Indian Boilers Act
1923
7
Gas Cylinder Rules
2004
8
Radiation Protection Rules
1971
9
Water (Prevention and Control of Pollution) Act
1974
10
Biomedical Waste Management Handling Rules
1998/20
00
11
The Water (Prevention and Control of Pollution) Cess 2003
(Amendment) Act
12
The Water (Prevention and Control of Pollution) Act
1974/19
88
13
Explosive Act (for diesel storage)
1884
14
Petroleum Act + Storage Rules
2002
Prepared by the learner

Indian Medical Association Goes Eco-Friendly (IMAGE)

Indian Medical Association, Kerala State Branch, established IMAGE, a stateof-the art Common Biomedical Waste Treatment and Disposal Facility at
Palakkad and it was commissioned on the 14 th December 2003. IMAGE was
conceived and launched to support healthcare providers to overcome the
challenges posed by the responsibilities laid down in the Biomedical Waste
(Management and Handling) Rules 1998.
IMAGE (Indian Medical Association Goes Eco-Friendly), the biomedical waste
treatment and disposal project of the Indian Medical Association has been
wrought with challenges. IMAGE is unique in conception and execution. The
project is a testimony of the grit, determination and social commitment of
the Indian Medical Association. I.M.A by its persistence has achieved
Operations Management & Legal Aspects in Hospitals
22

resounding success by overcoming the difficulties in dealing with a ravaging

issue as waste. The story of IMAGE is a reflection of public trust and the
unshakable faith in IMAs credentials. IMAGE is an institution of excellence
and is now renowned as The Kerala Model having catapulted Gods own
country ahead of other states in the field of Biomedical Waste Management.
IMAGE is guided by a team of professional doctors, elected from among the
members of I.M.A Kerala State Branch, dedicating their knowledge in the
field of medicine and the hazards posed by biomedical waste.
Services Offered
IMAGE affiliates healthcare institutions based on their bed strength. The
nominal non-refundable Affiliation Fee is being charged. The operating
expense is being met by charging a nominal fee as operational cost. The
plant has been working effectively from January 2004 and has been
rendering meritorious service to the State since its inception. IMAGE provides
the following services for the participating healthcare institutions:
1. Imparting segregation training to appropriate staff of the institutions
for scientific segregation of biomedical waste. Training is provided to
the staff using state of the art tools like laptops, projectors etc. three
modes of training are provided. They are:
Imparting training on handling of biomedical waste to the staffs
of institution and safe handling of biomedical waste.
Hands on training to each nursing staff
Retraining to new staff as and when required.
2. Facilitation for requirement of appropriate color coded liner bags and
containers for segregated collection of biomedical waste.
3. Daily collection of segregated biomedical waste from the institutions
from the final collection point.
4. Transportation of the collected waste in closed vehicles authorized by
the Pollution Control Board.
5. Treatment and disposal of the biomedical waste in scientific manner at
the IMAGE plant, strictly adhering to the Biomedical Waste
(Management and Handling) Rules, 1998.
6. Maintain records on the quantity of biomedical waste collected,
transported, treated and disposed.
7. Provide necessary information to the healthcare institution and the
Pollution Control Board as and when on biomedical waste generated,
collected and disposed from the institutions.
8. Create awareness among the public about the need for proper
biomedical waste management.
9. Organize medical related camps as part of Corporate Social
Responsibility to the society.
Services to Private Healthcare Institutions
Operations Management & Legal Aspects in Hospitals
23

IMAGE provides comprehensive service to all private healthcare institutions

by executing the complete cycle of biomedical waste disposal, right from
regular collection of biomedical waste from affiliate healthcare institutions in
color coded bags, transportation in specially designed vehicles, treatment
and safe disposal of the biomedical waste, brought into the Common
Biomedical Waste Treatment and Disposal Facility at Palakkad.
IMAGE thereby ensures scientific disposal of infectious waste generated from
healthcare institutions across Kerala, within 48 hours, in accordance with the
stipulations laid down in the Biomedical Waste (Management and Handling)
Rules 1998 by the Ministry of Environment and Forests, Government of India.
Benefits
Apart from availing the benefits of daily removal of the highly infectious
biomedical waste from their premises, all healthcare facilities can draw upon
the various value added services offered by the IMAGE, including
Complimentary Training of hospital staff in scientific segregation of
biomedical waste, providing advice and assistance in procuring materials for
installing a fool proof, in house, waste management system which includes
provision to make available color coded bags and containers with emblem.
Adding to the above benefits, the healthcare facilities are furnished with
Annual Reports and Certificates regarding the quantity of biomedical waste
collected and disposed, on behalf of the institutions, enabling them to file
mandatory returns to the Kerala State Pollution Control Board.
Affiliation to IMAGE facilitates smooth procurement of valid license for the
health care facility from the local self-government Moreover, all government
health care facilities are beneficiaries of the special scheme by which they
are exempted from paying affiliation fees and are entitled for the service
from IMAGE at a subsidized rate.
Growth Graph
After a decade of service, IMAGE has grown to be the largest Biomedical
Waste Management project in the country. It houses all the modern
equipment required for Biomedical waste treatment and disposal in a
common facility and a fleet of 34 specially designed vehicles which collect
and transport biomedical waste from all the affiliated health care facilities in
Kerala, crisscrossing the length and breadth of the state every day,
confirming to all the legal regulations and statutes of the land. The treatment
facility now boasts of exponential growth, adding to its repertoire, three more
incinerators, three more autoclaves, two plastic shredders, and a cluster of
sharp pits, vast facility for storage of incineration ash, a most modern waste
water treatment plant and an immediate expansion plan which is on the
anvil.

Operations Management & Legal Aspects in Hospitals

24

As of today, IMAGE covers the nook and corner of the state ensuring prompt
collection of biomedical waste through a highly efficient logistics network
which when combined with the assemblage of most modern treatment and
disposal mechanisms ensure scientific transportation, treatment and
disposal. About 4500 health care establishments are affiliated to IMAGE. This
amounts to a total bed strength of about 100,000. Presently IMAGE handles
more than 75% of the biomedical waste generated in Kerala.

Operations Management & Legal Aspects in Hospitals

25

Task 4: What is COPRA? Explain various laws applicable to

Hospitals. (Criteria 3.2)
COPRA
It is the duty of the government to provide the fundamental right to life and
personal liberty guaranteed by Article 21 of the Constitution. Therefore, it is
the duty of the state to provide to all citizens adequate and proper medical
services. The COPRA, 1986 was enacted to provide for better protection of
the interests of the consumers- the consumers of goods and services as
defined under the Act. The Act has been marginally amended in 1991 and
substantially in 1993 and 2001, with a view to making it more effective in
bringing justice to the door steps of consumers.
Consumer protection tries to help consumer to participate actively in the
market processes, not only when he goes to buy goods but also when he
goes to a medical practitioner for treatment. It is quite clear that no person
intends to go to a doctor or a court unless necessary but no matter how
much a person is rich or poor he has to go to court to a doctor for the
treatment of his ailment.
Consumer of Medical Services as under COPRA, 1986
Earlier, the patients aggrieved by medical negligence did not have any
effective adjudicative body for getting their grievances redressed. The Indian
Medical Council Act, 1956 as amended in 1964, provides that regulation
made by the Council may specify conducts, whose violations shall constitute
misconduct. Secondly, the Council was available only at the state
headquarters, thereby making it hardly accessible to the majority of parties.
Further, the Council has no power to award compensation to the patients for
the injury sustained.
The National Consumer Disputes Redressal Commission (NCDRC) upheld a
decision of the Kerala State Commission which said that a patient is a
consumer and the medical assistance was service and therefore in the event
of any deficiency in the performance of medical service, consumer courts
can have jurisdiction. It was further observed that the medical officers
service was not a personal service so as to constitute an exception to the
application of the COPRA.
A patient can seek redressal from a consumer court for medical services
under the following circumstances:
1. The services should have been hired or availed of or agreed to be hired
or availed of by the patient.
2. The services should have been rendered or agreed to be rendered by
the doctor to the patient.

Operations Management & Legal Aspects in Hospitals

26

3. The services of the doctor should have been or availed of or agreed to

have been hired or availed of for consideration.
4. The services of the doctor so hired or availed of or agreed to be hired
or availed of suffer from deficiency in any respect.
5. The services have not been rendered free of charge or under a contract
of personal service
Laws applicable to Hospitals
Laws Governing the Commissioning of Hospital
These are the laws to ensure that the hospital facilities are created after due
process of registration, the facilities created are safe for the public using
them, have at least the minimum essential infrastructure for the type and
volume of workload anticipated, and are subjected to periodic inspections to
ensure compliance.
Sl.
Name of the Act
Year
No
1
Atomic Energy Act
1962
2
Delhi Lift Rules
1942
3
Bombay Lift Act
1939
4
Draft Delhi Lifts and Escalators Bill
2007
5
Companies Act
1956
6
Indian Electricity Rules
1956
7
Delhi Electricity Regulatory Commission (Grant of consent for 2002
captive power plants) Regulations
8
Delhi Fire Prevention and Fire Safety Act
1986
9
Fire Safety Rule
1987
10
Delhi Nursing Home Registration Act
1953
11
Electricity Act
1998
12
Electricity Rules
1956
13
Indian Telegraph Act
1885
14
National Building Act
2005
15
Radiation Protection Certificate from BARC
16
Society Registration Act
17
Urban Land Act
1976
18
Indian Boilers Act
1923
19
The Clinical Establishment (Registration and Regulation) Bill
2007
20
Karnataka Medical Registration (Amendment) Act
2003
21
Red Cross Society (Allocation of Property) Act
1936
22
St. John Ambulance Association (India) Transfer of Funds Act
1956
Prepared by the learner

Laws Governing to the Qualification/Practice and Conduct of

Professionals
These are the regulations to ensure that the staff employed in the hospital
for delivery of healthcare are qualified and authorized to perform certain
technical jobs within specified limits of competence and in accordance with
Operations Management & Legal Aspects in Hospitals
27

standard codes of conduct and ethics, their credential are verifiable from the
registering councils and in case of any professional misconduct the council
can take appropriate action against them.
Sl.
Name of the Act
Year
No
1
The Indian Medical Council Act
1956
2
Indian Medical Council (Professional Conduct, Etiquette, and 2002
Ethics Regulations)
3
Indian Medical Degree Act
1916
4
Indian Nursing Council Act
1947
5
Delhi Nursing Council Act
1997
6
The Dentists Act
1948
7
The Dentists Code of Ethics Regulation
1976
8
Dental Council of India Regulation
2006
9
AICTE Rules for Technicians
1987
10
The Paramedical and Physiotherapy Central Councils Bill
2007
11
The Pharmacy Act
1948
12
The Apprenticeship Act
1961
13
Kerala Anatomy Act
1957
14
Karnataka Anatomy Act
1957
Prepared by the learner

Laws Governing to Sale, Storage of Drugs and Safe Medication

These are laws to control the usage of drugs, chemicals, blood, blood
products, prevent misuse of dangerous drugs, regulate the sale of drugs
through licenses, prevent adulteration of drugs and provide for punitive
action against the offenders.
Sl.
Name of the Act
Year
No
1
Blood Bank Regulation Under Drugs and Cosmetics(2 nd 1999
Amendment) Rules
2
Drugs and Cosmetics Act
1940
3
Drugs and Cosmetics Amendment Act
1982
4
Excise permit to store the spirit, Central Excise Act
1944
5
Narcotics and Psychotropic Substances Act
6
Pharmacy Act
1948
7
Sales of Good Act
1930
8
The Drug and Cosmetics Rule
1945
9
The Drugs Control Act
1950
10
VAT Act/ Central Sales Tax Act
1956
Prepared by the learner

Laws Governing Management of Patients

These are the laws for setting standards and norms for conduct of medical
professional practice, regulating/prohibiting performance of certain
Operations Management & Legal Aspects in Hospitals
28

procedure, prevention of unfair practices and control of public

problems/epidemic disease.
Sl. No
Name of the Act
1
Birth and Deaths and Marriage Registration Act
2
Drugs and Magic Remedies (Objectionable) Advertisement
Act
3
Guardians and Wards Act
4
Indian Lunacy Act
5
Law of Contract Section 13 (for consent)
6
Lepers Act
7
PNDT Act
8
Preconception and Prenatal Diagnostic Tech (Prohibition of
Sex Selection) Rules
9
The Epidemic Disease Act
10
Transplantation of Human Organ Act
11
Transplantation of Human Organ Rules
12
The Medical Termination of Pregnancy Rules
13
The Mental Health Act

health
Year
1886
1954
1890
1912
1994
1996
1897
1994
1995
2003
1987

Prepared by the learner

Laws Governing Environmental Safety

These are the laws aimed at protection of environment through prevention of
air, water, surface, noise pollution and punishment of offenders.
Sl.
Name of the Act
Year
No
1
Air (Prevention and Control of Pollution) Act
1981
2
Biomedical Waste Management Handling Rules (Amended 1998
on 2000)
3
Environment Protection Act and Rule
1986
and
1996
4
NOC from Pollution Control Board
5
Noise Pollution Control Rule
2000
6
Public Health By-Law
1959
7
Water (Prevention and Control of Pollution) Act
1974
8
Delhi Municipal Corporation (malaria and other mosquito 1975
borne disease) By-Law
9
The Cigarettes and Other Tobacco Products (Prohibition of 2003
Advertisement and Regulation of Trade and Commerce,
Production, Supply and Distribution) Bill
10
Prohibition of Smoking in Public Places Rule
2008
11
IPC Section 278 (making atmosphere noxious to health),
Sec 269 (negligent act likely to spread infection or disease
dangerous to life, unlawfully or negligently)
Operations Management & Legal Aspects in Hospitals
29

Prepared by the learner

Laws Governing Employment and Management of Manpower

This group deals with the laws regulating the employment of manpower,
their salaries and benefits, service rules and system of redressal of
grievances and disputes.
Sl.
Name of the Act
Year
No
1
Bombay Labour Welfare Fund Act
1953
2
Citizenship Act
1955
3
Employee Provident Fund and Miscellaneous Provision Act 1952
4
Equal Remuneration Act
1976
5
ESI Act
1948
6
ESI Rules
1950
7
Industrial Dispute Act
1947
8
Maternity Benefits Act
1961
9
Payment of Bonus Act
1956
10
Payment of Gratuity Act
1972
11
The Essential Service Maintenance Act
1981
Prepared by the learner

Laws Governing to Medico legal Aspects

These are the laws governing the doctor-patient relationship, legal
consequences of breach of contract and medico legal aspects of negligence
of duty.
Sl.
Name of the Act
Year
No
1
Consumer Protection Act
1986
2
Indian Evidence Act
3
Law
of
Privileged
Communication
4
Law of Torts
Prepared by the learner

Laws Governing the Safety of Patients, Public and Staff within the
Hospital Premises
These laws deal with safety of facilities and services against any accidental
hazards that may endanger the lives and the liability of management for any
violation.
Sl.
Name of the Act
Year
No
1
The Radiation Surveillance Procedures for the Medical 1989
Application of Radiation
2
Radiation Protection Rules
1971
3
AERB Safety Code no. AERB/SC/Med-2(rev-1)
2001
Operations Management & Legal Aspects in Hospitals
30

4
5
6
7
8
9
10
11
12

Arms Act
Boilers Act
Explosive Act (for diesel storage)
Gas Cylinder Rules
NOC from Chief Fire Office
Periodic Fitness Certificate for Operation of Lifts
Prevention of Food Adulteration Act
The Indian Fatal Accidents Act
The Tamil Nadu Medicare Service Persons and Medicare
Service Institutions (prevention of violence and damage or
loss to property) Act

1950
1923
1884
2004
1954
1955
2008

Prepared by the learner

Laws Governing Professional Training and Research

These are the laws meant to regulate the standards of professional education
and training of doctors, nurses, technician and controlling research activities.
Sl.
Name of the Act
Year
No
1
MCI Rules for MBBS, PG and Internship Training
2
National Board of Examination Rules for DNB Training
3
ICMR Rules Governing Medical Research
4
NCI Rules for Nursing Training
5
Ethical Guidelines for Biomedical Research on Human 2000
Subjects
Prepared by the learner

Laws
Some
Sl.
No
1
2
3
4
5
6
7

Governing the Business Aspects

rules are applicable to hospital in relation to its business aspects.
Name of the Act
Year
Cable Television Network Act
Charitable and Religious Trusts Act
Contracts Act
Copyright Act
Custom Act
Income Tax Act
Insurance Act

1995
1920
1982
1982
1962
1961
1938

Prepared by the learner

Operations Management & Legal Aspects in Hospitals

31

Conclusion
Everyone should be covered by some form of health insurance. People are
always vulnerable to injury and illnesses from their everyday activities.
Whether it is an individual plan or employer or government-sponsored
coverage, having health insurance is better than not having it at all.
Indian Health Insurance or medical insurance sector has been growing, since
the countrys economic reforms. The reason why mediclaim insurance, has
grown is that it ensures good medical care from reliable healthcare
institutions. With numerous companies offering health insurance and with a
variety of health insurance plans on the offer its hard to decide which plan
you should go for.
Medical wastes should be classified according to their source, typology and
risk factors associated with their handling, storage and ultimate disposal.
The segregation of waste at source is the key step and reduction, reuse and
recycling should be considered in proper perspectives. We need to consider
innovative and radical measures to clean up the distressing picture of lack of
civic concern on the part of hospitals and slackness in government
implementation of bare minimum of rules, as waste generation particularly
biomedical waste imposes increasing direct and indirect costs on society. The
challenge before us, therefore, is to scientifically manage growing quantities
of biomedical waste that go beyond past practices. If we want to protect our
environment and health of community, we must sensitize ourselves to this
important issue not only in the interest of health managers but also in the
interest of community.

Operations Management & Legal Aspects in Hospitals

32

References
Books
1. Hamdy. A. Taha, A.M. Natarajan, P. Subramanie, A. Tamilarasi, Operations
Research, 2009, ISBN: 978-81-17-1104-4, Dorling Kindersley (India) Pvt Ltd.
Licenses of Pearson Education in South Asia
2. S. N. Chary, Production and Operations Management, third edition, 2008,
ISBN: 978-0-00583550-9, Tata McGraw Hill Publishing Company Ltd, West
Patel Nagar, New Delhi
3. G. V. Shenoy, U. K. Srivastava, S. C. Sharma, Operations Research for
Management, second edition, 2006, ISBN: 0-85226-917-X, Dharyaganj, New
Delhi- 110051
4. K. Park, Preventive and Social Medicine, 2013, ISBN: 978-93-82219-02-6, M/s
Banarsidas Bhanot Publishers ISBN 978-93-82219-02-6

Websites
1. http://www.cwejournal.org/vol7no1/need-of-biomedical-wastemanagement-system-in-hospitals-an-emerging-issue-a-review/
2. http://nabh.co/faq.aspx
3. https://books.google.co.in/books?
id=txP6AwAAQBAJ&pg=PA58&lpg=PA58&dq=nabh+standards+have+
10+chapters+with+100+standards+and+503+objectives&source=bl
&ots=rMEWV5Ee2&sig=TDc1oXgG1PfEgU1BEfcLIzXJKnQ&hl=en&sa=X&ved=0ahUKEwj
XhISVjqbKAhVQWI4KHY87CJ0Q6AEIJzAC#v=onepage&q=nabh
%20standards%20have%2010%20chapters%20with
%20100%20standards%20and%20503%20objectives&f=false
4. http://nabh.co/standard.aspx
5. http://www.jointcommissioninternational.org/
6. www.religarehealthinsurance.com
7. www.apollomunichinsurance.com
8. www.starhealth.in
9. www.maxbupa.com
10.
http://cpcb.nic.in/

Operations Management & Legal Aspects in Hospitals

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Operations Management & Legal Aspects in Hospitals

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