Human Resources Management

Human Resources Management in hospitals is a complex structure, it houses professionals from varied disciplines like Doctors, Nurses, Technicians, Therapists, Cooks, Stewards, Cleaning staff, Administrative staff etc.
The central theme conspicuous in a hospital is that it gives prominence to the people who deliver services to the wider constituents of a hospital. A human asset in modern times is considered to be a treasure rather than a mere resource in progressive business organisations. This is because it is the people who shape the destiny of the business, rather than the structures, systems and processes effectively formulated in the organisations. Many a time, managers comment, 'I wish I had a highly competent, motivated and committed staff working for me', while setting aside the structure and processes of their organisations. Hospitals are becoming large and complex, with the increase in modern health facilities, increased health awareness among people, and the advent of new technologies in medicine. Government intervention in recognizing the hospital as a industry, and regulating their purpose and performance, has also increased in India.

Hospital Committees

1. Medical Executive Committee: 

Medical Executive Committee is Composed of  Elected officer of medical staff Past president of medical staff Chairperson of various department President of hospital Physician Matron.

Duties: Accounting to BOD for patient care, Coordinating the activities of medical staff, Making recommendation on medical issues, Recommending appointment and corrective action of medical staff.

2. Ethics Committee: 

Ethics Committee an advisory committee appointed by hospital medical executive board, Review on request ethical or moral question that may come up during patient’s care. 

Members: doctor ,nurses ,social worker , attorney etc.

Duties: To act as patient advocate on bio ethical issue Develop and recommend hospital about other clinical policies and guidelines that define ethical principles for conduct within hospital. Educate hospital and clinical personnel.

3. Pharmacy & Therapeutic Committee: 

An important medial staff advisory group, All matter related to use of medication including pharmacy programme must be reviewed and approved through this committee. Medical formulation data is reviewed through committee and recommendation are offered to medical staff.

4. Infection Control Committee: 

Members: Physician, Nursing staff Infection control practitioner, Quality assurance personnel, Risk management personnel, Microbiologist, Members from Operating room, Central Sterile Supply Department etc.

5. Medical Record Committee: 

Duties: Reviewing MR for timely completion Clinical relevance Whole course of treatment Adequacy of file for use in quality review activity.

6. Safety Committee:

Duties: Assess and Review Hospital setup with a safety point of view of patients and their relatives, Staff and visitors.

ADVANTAGES: 

Exchange of views and information. Solution of problem in hospital. Recommend action. Generate new ideas. To make decision collectively. To bring collective judgment, group deliberation on subject.

DISADVANTAGES: 

Waste of time. Interference of external member. Dominance of overbearing and aggressive member. Members can use their position to further their self interest.

Facility Management in a Hospital

Facility Management Services in a hospital is in itself a different management setup as it comprises of varied facets.

1. Cleaning Services.
2. Security Services.
3. Support Services.
4. Electro-Mechanical Services. etc

Cleaning Services: Housekeeping services in a hospital has a different view as compared to other industries as hospital is a center for patient care and control of infection is a primary objective of cleaning services of a hospital.

As hospital industry is furthering its standards as per "Hospitality industry" for affording class of clients as the desires of patients have grown for comfort.

Cleaning in a hospital must be assured with a Cleaning schedule in place for entire hospital with the periodicity of cleaning, check lists are required to be maintained for washrooms and other areas to ensure the cleanliness.

Security Services: Security services has a vital role to play in the hospital as there is high probability for violence breaking out due to uneven death of the patient, Issues with billing etc.

Visitors control, vigilance, preparedness for disaster management etc are some of the roles a security team has to play.

Support Services: Support services include Linen Management, Transport services etc.

Support service team should always ensure smooth flow of the essential linen and transport services.

Electro-mechanical Services: Maintenance team of the hospital should be manned 24/7 to attend any kind of uneven breakdowns.

The team must maintain equipment logs, Preventive Maintenance checklists, Downtime monitoring, ensure water availability etc.

Nursing Services

Nursing is an integral part of healthcare it is a profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.

Today the profession has evolved and is serving the needs of individuals in different areas like Emergency, Intensive Care Units, Operating Rooms, Wards, Schools, Industries etc.

Management of Nursing Services in a hospital.

Managing nursing services in a hospital setup is a complex structure where individual performances have to be measured giving patient care as fundamental importance.

Nurse Patient Ratio: As per INC The norms are based on Hospital Beds. 
Chief Nursing Officer 1 per 500 beds.
Nursing Superintendent 1 per 400 beds or above.
Dy Nursing Superintendent 1 per 300 beds and 1 additional for every 200 beds. 
Asst N.S 1 for 100-150 beds or 3-4 wards Ward Sister 1 for 25-30 beds or one ward.

Staff Nurses 1 for 3 beds in Teaching Hospital in general ward & 1 for 5 beds in Non-teaching Hospital +30% Leave reserve Extra Nursing staff to be provided for departmental research function. 

For OPD and Emergency 1 staff nurse for 100 patients (1 : 100 ) + 30% leave reserve.

For Intensive Care unit: (I.C.U.)- 1:1 or (1:3 for each shift ) +30% leave reserve. 

It is suggested that for 250 bedded hospital there should be One Infection Control Nurse (ICN).

National Accreditation Board for Hospitals & Healthcare Providers (NABH)

National Accreditation Board for Hospitals & Healthcare Providers (NABH) is a constituent board of Quality Council of India, set up to establish and operate accreditation programme for healthcare organisations. the board is structured to cater to much desired needs of the consumers and to set benchmarks for progress of health industry. The board while being supported by all stakeholders including industry, consumers, government, have full functional autonomy in its operation.

It consists of 10 chapters, out of which 5 are Patient centered standards and 5 are Management centered Standards.

Patient-Centered Standards

Chapter 1: Access, Assessment and Continuity of Care (AAC)

Chapter 2: Care of Patients (COP)

Chapter 3: Management of Medications (MOM)

Chapter 4: Patients Rights and Education (PRE)

Chapter 5: Hospital Infection Control (HIC)

Management-Centered Standards

Chapter 6: Continuous Quality Improvement (CQI)

Chapter 7: Responsibilities of Management (ROM)

Chapter 8: Facility Management & Safety (FMS)

Chapter 9: Human Resource Management (HRM)

Chapter 10: Information Management Systems (IMS)

Medical Records Management

In-patient as well as out-patient medical records generated in the hospital, in its own interest as well as for the patient are required to be stored for stipulated time depending on the relevance of the record.

Good practices required in managing medical records.

Why are medical records so important?

Medical records constitute a range of medical care documents, which include patient’s history, diagnostic investigations, consent documents, operative notes, nurses’ daily notes, intake / output sheet, treatment sheets, etc. Managing these records systematically is really important, as these records are the only way for the doctor to prove that the treatment was carried out properly. These records become the sole and critical evidence for the treating doctors to defend themselves from false claims.

How Are Medical Records Stored?

Today at most hospitals, medical records are paper based and are stored manually in designated areas in the hospitals – some have a dedicated medical records room and officers looking after them. However, with increasing volumes of patients over the years, the physical records occupy more space and its more time consuming and difficult to retrieve the patient record. The paper based records are also prone to damage by weather, rodents, dust, etc.

Classification of Medical Records

There are two ways in which medical records can be relevantly classified: the extent to which they can be shared and the contents of the records.

The Extent to Which Records Can be Shared:

Must be given to the patient- certain records, viz. discharge summary, referral notes, etc., have to be shared with all patients including those who are discharged against medical advice irrespective if the bill payment has been made.

Can be given to the patient after a formal application- records such as, indoor papers, operative notes, investigations, etc., requires a formal application from the patient. The copies of these records given to the patient are generally attested as true copies by the hospital.

Given only with direction of the court - some OPD and IPD records, especially those of medico-legal cases cannot be given to the patient without the direction of the Court.

On the other hand, medical records can be distinguished as per the constituent documents and each of them have its own significance, for example – discharge notes, are considered as a critical proof with respect to the in-hospital treatment provided to the patient, irrespective of the fact that the patient has been discharged with / against the advice of the doctor.

Preservation Period, Legal Aspect

There has been ambiguity with respect to clear regulations on how long a medical record must be preserved. Most hospitals follow their own set of policies in retaining records as per the relevance. The limitation period for filing a case paper is up to three years under the Limitation Act 1963 (two years under the Consumer Protection Act 1986). Nonetheless, the limitation period starts only after the patient becomes aware of the effect of the alleged negligence by the doctor.

The Maharashtra Government has issued a resolution (ref GR No. JJH-29 66/ 49733) which says that OPD paper should be kept for three years, indoor case papers for a period of five years and in case of a medico-legal case, 30 years. Usually medical records are summoned in a court of law in:

• Medico legal cases: where often the medical records are referred to establish medical history / treatment given, especially important in road traffic accidents, medical negligence, etc.
• Insurance cases: where the insurance company wants to review the medical records verify the claim
• Workmen’s compensation cases: In cases where an injury occurs to a workman out of and in the course of employment.
• Criminal cases – to prove the nature, timing and gravity of injuries.

MCI Guidelines

The Medical Council of India, has issued the (Professional Conduct, Etiquette and Ethics) Regulations, 2002, which mentions the following on Maintenance of Medical Records (Section 1.3)

• Every physician shall maintain the medical records pertaining to his / her indoor patients for a period of three years from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of India (Section 1.3.1 and Appendix 3).
• If any request is made for medical records either by the patients / authorised attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours (Section 1.3.2)
• A registered medical practitioner shall maintain a Register of Medical Certificates giving full details of certificates issued. When issuing a medical certificate he / she shall always enter the identification marks of the patient and keep a copy of the certificate. He / She shall not omit to record the signature and/or thumb mark, address and at least one identification mark of the patient on the medical certificates or report. The medical certificate shall be prepared as in Appendix 2. (Section 1.3.3 and Appendix 2).
• Efforts shall be made to computerise medical records for quick retrieval. (Section 1.3.4)