Hospital Management

Rapid Assessment Tool

GTZ Health Service Management System ACEH

Gedung Administrasi Lama Lantai II, Rumah Sakit Umum Dr. Zainoel Abidin
Jl. Tgk. Daud Beureueh No. 108 Banda Aceh 23126 ACEH-Indonesia
PO BOX 672 Banda Aceh 23001
www.gtz.de
1. General hospital information
1.1. Date (period) in which the assessment is being conducted:

1.2. Name of the hospital:

1.3. Location (District/City):

1.4.Population in catchment area: (Area from which population comes to seek services. Is there
a predefined catchment area? Does this differ to the actual catchment area, for example:
people from other regions come to make use of this facility?

1.5.Are the clients who actually attend the hospital in correspondence with the population in the
catchment area or the target population defined in the mission statement? If not please
specify where they differ. (For example: number, age, gender, religion)

1.6.Mission. What is the mandate of the health institution? What services is the institution
supposed to offer to what population? Is this statement documented and where?

1.7.Vision. Medium to long term aspirations and plans for the health institution. What institutional
development is intended with owners and political decision makers? Is this statement
documented and where?
1.8.Type of Hospital. Please mark 

Sub District hospital/health center

District hospital/general hospital

Provincial /referral hospital

Specialized hospital

Other (explain) __________________________________

1.9.Hospital basic indicators for given observation period (Preferable one full calendar year.
Use the same observation period for all indicators and departments).

In-patients. Please fill out the following indicators for key in-patient department of the hospital.
Please also state the period of observation to which the data refers. Some key in-patients
departments are surgery, obstetrics and gynecology, internal medicine or pediatrics rather than
ENT, ophthalmology, dermatology...etc.

Observation period__________________________________

Name of in-patient Number of Average Bed #

department beds length of occupancy Admissions
stay (ALOS) rate (BOR) per period
 Out-patients. Please fill out the following indicator for key out-patient departments of the hospital.
Some key out-patient departments are XXX.

Observation period__________________________________

Name outpatient department/ policlinic Number of out-

patients per
period

1.10. Staff. Amount of medical and non medical staff employed in the whole medical facility
at the moment of the study. (Full time, part time, long term, short term or other type of
employment. Not to include any outsource services staff).

# # # # # # Total # Staff
Specialized General Nurses Midwive Administr All other
doctors doctors s ative staff staff
 1.11. Available equipment

Please mark () which equipment is available in the hospital at the moment of the interview. The
interviewer should adapt this list of equipments to the list of required medical equipment as
defined by local / national standards for the same type of facility. The” type of hospital” answer
refers to the possibility that the national health system for the country doesn’t require that type of
facility to have certain equipments.

Will have it,

EQUIPMENTS (to be Have it, but does not
Have it Don’t have it because… acquisition is
adapted according to work because… (short
() () planned for…
local standards) reason)
(date)

Budget

Fixed equipment for Type of hospital

standard X-Ray No request/ no need
Other reason

Budget
Type of hospital
Electro cardiogram
No request/ no need
Other reason
 Will have it,
EQUIPMENTS (to be Have it, but does not
Have it Don’t have it because… acquisition is
adapted according to work because… (short
() () planned for…
local standards) reason)
(date)

Budget

Multi blood Type of hospital

analyzer No request/ no need
Other reason

Budget
Type of hospital
Ventilator/respirator
No request/ no need
Other reason

Budget
Type of hospital
Electric Centrifuge
No request/ no need
Other reason

Budget
Type of hospital
Spectrophotometer
No request/ no need
Other reason

1.12. Amount of services offered in the observation period in relation to specialized

staff. Please fill out the following indicators for the observation period (preferably previous year).
The number of doctors and staff refers to the number of medical staff who is exclusively connected
to the provision of the mentioned service in that observation period. For example: 350 general
surgeries per year with 5 general surgeons available. Use the same observation period for all
services.
SERVICES HOW MANY PER PERIOD
If such intervention is not available mark (-).
# Doctors # Other
specialized
staff
1. Surgery
a. General # interventions
surgery
b. Abdominal # interventions
surgery
c. Neurosurgery # interventions
 d. Traumatology # admissions

e. Special # interventions
surgery
2. Obstetrics / Gynecology
a. Deliveries # of deliveries

b. Cesarean # interventions
section
3. Pediatrics
a. General # admissions
pediatrics
b. Intensive care # admissions

c. Neonatology # admissions
intensive care
4. Internal medicine
a. General # admissions
internal medicine
b. Intensive care # admissions

c. Cardiology # admissions

d. Hemodialysis # procedure

e. Neurology # admissions

f. Oncology # procedure

5. Dental care # patients

6. Dermatology # patients

7. Ophthalmology # patients

SERVICES HOW MANY PER PERIOD

If such intervention is not available mark (-).
# Doctors # Other
specialized
staff
8. Ear-nose- throat # admissions

9. Laboratory

a. Lab Elisa

b. Blood
transfusion
c. Blood bank

10. Radiology

a. CT Scan
 b. MRI

c. 24 radiology
procedure
d. echography

11. Other specialized services

Burn center/ stroke center/
HIV-AIDS unit
1.13. Support equipment and services

o Electricity
Do you have 24-hour electricity availability (generator)? YES NO

o Air conditioner/heating
Do you have air conditioner/heater in all operating theaters? YES NO

o Running water
Do you have running water available in the main treatment buildings? YES NO

o Sewage
Do you have sewage water treatment facilities? YES NO

o Waste management
Does the hospital have a professional waste management system? YES NO

If NO: explain why.

If YES: Give details (type of incinerators, equipment used procedures...etc.)

Is the waste management done by an external party? YES NO

If YES by who and how?

2. Human Resources

2.1.Qualifications. Does the Human Resources department or the Staff Training

Department assess the training needs of the hospital staff or the departments?

YES NO

2.2.Method. If YES describe the method for assessing the training needs and with what
frequency they are assessed? Commonly used methods are: Request of the
staff/departments, internal decision of the HR department, based on the trainings given
in previous years.

Please explain the method used

2.3.How did the responsible unit for trainings respond to the training needs identified
in the assessment? Describe (e.g. Systematic preparation and implementation of
trainings according to needs, taking advantage of offers by third parties according to
needs...etc.(Collect a copy of trainings curriculum for observation period)

2.4.Are training courses or further qualifications of staff registered in the staff /

personal records?

YES NO
 If YES how? (Electronic personal records or physical records, describe the process)

2.5.Commonly do training courses or further qualifications of staff automatically

lead to better salary, improvement in position or other sort of remuneration?

YES NO

2.6.Are there mechanisms to monitor in how far trainings and qualifications contents
are implemented / applied / used in the daily work? Please explain.

2.7.Performance. How is staff performance assessed? Explain the method for assessing
the staff performance, the frequency and who is responsible for initiating the
assessments.

Is the individual staff performance/evaluation system correlated to remuneration

or other incentives?

YES NO

2.8. Please state how many persons were hired/fired/suspended during the last year in
the hospital.

How many persons

were...
Hired
 Fired

Suspende
d

Please state the top 5 main dismissal reasons.

 1.
2.
3.
4.
5.
-

3. Finances
3.1. Revenues and expenditures. Please fill out the following information.

Budget amount of the hospital. Estimated amount of money the hospital had at its disposal
for the previous fiscal year : ________________ currency: _________

Source of % of total
Further questions
Budget budget

From the public allocated budget which percentage was actually

spent? ___________ %
Public
(governme
nt)
The budget is made available when in the fiscal year?
____________

From the total amount of insurance which percentage comes

from…

- Capitation
___________ %
Insurance - Fee for service
___________ %
- Package diagnostic related groups (DRG)
___________ %
- Other
___________ %

Private out
of pocket
(direct Is there an electronic system to track these incomes?
payments
by the YES NO
customers)

Others How does the hospital keep track of these other incomes?
(donations) ___________________________________________________
____
 100 %

3.2.Hospital’s annual budget Expenditures. Break down the actual hospital expenditures
in the last fiscal year using the following categories (roughly estimation). If the planning
figures for the same categories at the begging of the same year are available note them
too. )

% %
Budget line of the hospital’s of the hospital’s
budget SPENT on… budget PLANNED to
be spent on…
Staff (salaries)

Drugs (medicines for prescription

and daily operations)
Energy (electricity bill)

Maintenance (equipments and

buildings)
Investment in equipments /
infrastructure (new or replacement)
Other regular expenditure which
represent a considerable amount of
the budget.

3.3.Billing. Please describe the current method of processing patient’s billing.

By hand or electronic spread sheet (excel)

Simple, stand alone electronic billing programme
Billing system as integrated part of HMIS
Other
 If Other please describe.

3.4.Is every payment accompanied by the production of a receipt? (Direct

observation).

YES NO

3.5.Does the hospital have a cost accounting system?

YES NO

3.6.Is the accounting system Accrual Cash based Other

3.7.Financial reporting. Please state what kind of reports does the accounting department
produces and in what frequency.

YES/N
Type of financial reports Frequency
O
Balance sheet
Once a year

more frequent how often________

Cash flow
Once a year

more frequent how often________

Income statement
Once a year

more frequent how often________

Other ________________
Once a year

more frequent how often________

3.8.Are these reports electronically produced? In this case this doesn’t refer to the
reports being produced using excel spreadsheets but more to integrated accounting
 systems.

YES NO

3.9.Please describe shortcomings and perceived problems in the financial management

and accounting process in the hospital? This also refers to budget related problems and
to the procedures to manage/generate financial information.

3.10. Financial accountability. Does the hospital have regular internal audits (organized/conducted
by the health institution itself)?

YES NO

If YES, how regular are they performed? ___________

When was the last one performed (date) ___________

3.11. Does the hospital have regular external audits? Conducted by an external party?

YES NO

If YES, how regular are they performed? ___________

When was the last one performed (date) ___________

4. Quality
4.1.Is there a quality management (Quality assurance) system established?

YES NO
 If YES please explain. Which system is being used? In which units?

4.2. Are key administrative, medical and support procedures defined by SOP?

YES NO

If YES please state some of those key procedures defined by SOPs.

•
•
•
•
•
•

4.3. Commonly who develops these SOPs for the hospital?

The hospital

The Ministry of Health

Other authorities

Others

If others please describe.

4.4. Which services offered by the hospital are accredited and until when? Please
write down the name of the services; in the column next to the name write down until
which date this accreditation is valid.

Services accredited Until when

4.5.Does the hospital have regular evaluations to assess the quality of services?

YES NO

IF YES which ones:

Client satisfaction
Quality assessment
Post surgical infections
Bed sore
Net death rate
Laboratory quality check
Other
5. Maintenance

5.1.Please fill out the following information. The equipment list can be adapted to local
standards. The first group of equipments is considered basic and should be checked for
“All Hospitals”. Provincial hospitals should be checked for the equipment listed in “All
Hospitals” but also for the equipment under “Provincial hospital and specialized
hospital” and so on.

Does the If it doesn’t Does the hospital

Today is it
hospital work, how long have maintenance
functioning?
have? has been contracts for high
Equipment ( )
YES/NO
broken? tech equipments?
All hospitals
X-rays
Echography
ECG
Blood analyzer
Electric centrifuge
Spectrophotometer
Air Conditioned /Heater
24 hours electricity (gen
set)
Provincial hospital and
specialized hospital
CT Scan
Mammography
Echocardiography
Electromyography
EEG
Electroencephalograpy
Elisa
Western blot
Blood bank
Special hospital
Radiotherapy
Extra corporal blood
circulation system
Hyper baric chamber
6. Pharmacy
6.1.Availability. Which are the main problems regarding the availability of drugs?

1.1.1 Fall short on certain drugs

The drugs are expired
Unacceptable delay between request and delivery
Cost of the drugs for certain categories of patients
Patient has to purchase the drugs outside the hospital
Other ____________________________

6.2.Please write down the number of prescriptions served in the hospital’s Pharmacy
according to the payment method used by the patient for a given period. Please
use the same period for all data ( e.g. prescriptions per month / per year).

Type of patient # prescriptions served

Self paying patients

Patient with private insurance

Patient with public insurance

Other payment method

Total

7. IT/Information Systems
7.1. General information from the IT Department

Des the hospital have an IT department?

YE
S

NO
 Which % from the annual hospital budget is destined for
the IT department:

Computer hardware
& software
Networking
Capacity (Quantity of staffs) for:
Programmer

Database query

YE
S
Are there regular maintenance contracts for IT
equipments?
NO

7.2. In general can the hospital information system be described as...

An integrated information system

Parallel stand alone information modules
Other _____________________________

7.3.Does the information generated by the information system allow key personnel to make
conclusions on the performance and quality of management and medical services?

YES NO

7.4. Does the current information system facilitate the production of required regular
reports?

YES NO

7.5.Has some department or the whole hospital ever performed a time efficiency assessment?

YES NO

7.6.Please list the most important reports required by each department of the
hospital. Name 1 or 2 reports that are required from each department

Department Name of the report How often / per

month, or year