SERVICE IMPROVEMENT

AND
DEVElOPMENT OF DISTRICT
HOSPITAL SAATHIPUR
GROUP 2
Aman, Shiny, Prerna, Len, Shikha,
Preksha, Mahima, Kartavya

CASE STUDY
This case is that of a 200
bedded District Hospital in
Saathipur.
A
major
Multilateral
Donor
has
recently
selected
this
Hospital
for
Service
Improvement
and

PRIMARY Stakeholder:
Community people

TERTIARY Stakeholder:

Financial institution
Maoist leader
SECONDARY Stakeholder:
Media
Local authority
Civil societies
District administration
State
authorities
Businessman and supplier National authorities
NGOs program officer
Leaders
Private hospital
(ruling and opposition)
Nursing home
INTERNAL Stakeholder:
District health society
UNICEF
Hospital staf
Multilateral
donors

High Importance
Low Support

High Importance
High Support

MANAGE

INVOLVE

Low Importance
Low Support

Low Importance
High Support

MONITOR

ACKNOWLEDGE

High Importance Low Support

MANAGE

Local people /tribal population

Local authority/ district administration
Shabhadipatis
Doctor (MOs, MS, Dy. MS, radiologist,
microbiologist, other specialist )
other hospital staf and grade d stafs
District health society
Leaders (ruling)
Media

High Importance High Support

INVOLVE
CMOH , Program officers
Community
Multi lateral donors
UNICEF
State and national authorities

Low Importance Low Support

MONITOR
Criminal tribe/ Maoists
Private hospital
nursing homes
NGOs (SEVA)

Low Importance High Support

ACKNOWLEDGE
Opposition leaders
Civil societies
Business Suppliers

STRENGTH
1. 1 large 200 bedded hospital

2. Functional diagnostic laboratory

3.
4.
5.
6.

10
9
9
8

Operation Theatre is well equipped

Multispecialty hospital
Core group is highly motivated
CMOH of district is honest and
respectful person
7. Sufficient MOs and nursing staf
8. District secretary is member of IMA

9
9

WEAKNESS
1. Remote and backward district
located in rural area
2. Infrastructure is not good and
hospital born infections are
prevalent
3. Resources are less
4. Inappropriate Auto-analyser
5. Poor functional blood unit
6. Poor functioning generators
7. Poor power situation
8. USG machine never been used

8
7

7
6
8
8
8
7

WEAKNESS
9. Radiology department partially
functional
10 CMOH is a weak administrator and
.
unable to take decision
11 Computers are non functional
.
12 Hospital doesnt have any waste
.
management system
13 Microbiologist have interest in local
.
private laboratory
14 The ward master and group D staf
.
strongly resisted the

8
7
7
9
7
6

WEAKNESS
15
.
16
.
17
.
18
.
19
.

Dilapidated staf quarters and

nursing quarters
Microbiologist have interest in local
in local private laboratory
2 deputy superintendent less
motivated and confused
Mos of district hospital operate at
SEVA and nursing home
Utilization and client perception

8
7
6
9
9

OPPORTUNITIES
1. Nursing college attached to hospital 7
2. UNICEF identified district for pilot
project and NICU

3. Set up of First Referral Units (FRUs)

in 6 blocks

4. Availability of blood bank

5. Doctors of high esteem

8
7

THREATS
1. Criminal tribe, Maoist movement
and violence

2. The private hospital SEVA is well

equipped with modern diagnostic
facilities

3. Private hospital employ marketing

strategies

4. Lack of precedence
5. Less political support
6. Not good collaboration of DC and
sabhapati

8
7
9

OPPORTUNITIES
100

50

15
2
250

200
150

WEAKNES
S

37

25

150
200

100

50

10

2
6

25
50

71

100

THREATS

50

100

STRENGTH
S

10
0
75

Extern
al

50

S-W = 71-152 = -81

O-T = 37-26 = 11

25

11
-100
50

75

-75
100

-50

-25

-25

-81

-50

-75

25

Intern
al

Logical framework

Goal/impact
To become an institution of
excellence
by
providing
quality health care
at
Saathipur district hospital by
2020

Narrative
statement

OVI

MOV

RISK
ASSUMPTIONS

GOAL
To become an
NABH/NABL
Comparison
Becoming
accreditation
with other
excellence in
institution of
existing
healthcare is
excellence by
hospitals
important for
providing
service
quality health
improvement
care at
and
Sathipur district
development

hospital by
2020
OVI-Objectively Verifiable Indicators
MOV-Means Of Verification

S.NO
.

Narrative summary

OVI

MOV

RISK
ASSUMPTIO
N

OUTCOME
1

To improve
utilization

service

OUTPUT
1.1

To increase OPD & Increased Hospital Service

IPD
service %
of register, availability
utilization
utilization periodic , Quality of
of service quality
control is
of SDH & care
maintaine
evaluatio report
d
n
done
by
3rd
party
evaluator

S.NO Narrative summary

.

ovi

mov

Risk
assumption

ACTIVITIES
1.1.
1

Protecting the
rights of the
patients and
treating them with
respect , dignity
and courtesy
1.1. Increase number of
2
patient treated at
SDH for various
health problem

Regular
Feedbac Service
evaluatio k forms availability,
Quality
of
n of the
control is
patients
maintained
forms
%
Increase
no. of pt.
treated at
SDH for
various
health
problem

Same
IPD
and
above
OPD
slips
Hospit
al
Record
Register

as

S.NO Narrative summary

.

ovi

mov

Risk
assumption

1.1.
3

Increase
transportation

Increase
transport
usage

Proper
maintenan
ce
&
availability
of
resource

1.1.
4

Provision of
minimal cost
(afordable)
service

Decrease
out of
pocket
expenditur
e
100 %
medical
staf
attendanc

Monitorin
g number
of vehicle
available
&
transport
register
Hospital
Bill
Receipt

Same
above

as

Attendan
ce
register,
duty

Same
above

as

1.1. Medical staf

5
should be
present

S.NO Narrative summary

.

ovi

mov

Risk
assumption

1.1.
6

Ensure
availability of
drug

100%
essential
drug
available
in
pharmacy

Inventory
register &
register
of drug
distributi
on

Proper
maintenan
ce
&
availability
of
resource

1.1.
7

Increase bed
occupancy rate

Bed
IPD
occupancy Register
rate up to
>90%

Proper
Maintenan
ce

S.NO Narrative summary

.

ovi

mov

1.2

Increase referral
rate/active case
finding or
suspect rate

IPD &
OPD
Registrati
on

1.2.
1

Employ
multispecialty
doctor, trained

% increase
of
successful
surgeries
or cure
rate in
patient
coming to
hospital &
positive
feedback
from
patient
Positive
Feedback
from

Risk
assumption

Proper
maintenan
ce
&
availability
of
Feedback resource
on
Doctors
and other
staf

Feedback Same
above
on
Doctors &

as

S.NO Narrative summary

.

1.3

ovi

Increase lab and 100 %

diagnostic test,
patient
radiology service avail lab ,
diagnostic
and
radiology
service

1.3. Increase test

1
and funding

mov

Risk
assumption

Register
of
patient,
register
for
radiology
and
diagnosis

Proper
maintenan
ce
of
register

Same as
above

Same as Same
above
above

as

1.3. Fully functional

Same as
2
diagnostic setup above

Same as Same
above
above

as

S.NO Narrative summary

.

1.4

ovi

Proper utilization 90% fund

of allocated fund utilization

1.4. Proper
1
monitoring

mov

Risk
assumption

Utilization
of
certificat
e
statemen
t
of
expenditu
re audit
report

No
resistance
from
group D
Availability
of
investmen
t
No
resistance
from
group D
Availability
of

S.NO Narrative
.
summary

ovi

mov

Risk
assumption

100% people
visiting SDH
have access
to
quality
care
,decrease
mortality &
morbidity of
people
visiting SDH
by
calculating
death
rate
and
cure

Populatio
n
level
survey in
commun
ity
,feedbac
k
form
from
people

Improveme
nt
in
quality
of
care
provided
which
is
important
to Improve
the health
status and
well being
of people

OUTCOME
2

To ensure
quality of
OPD , IPD
clinical service

S.NO Narrative summary

.

ovi

OUTPUT
2.1 Proper diagnosis
of disease and to
be a
multispecialty
hospital
ACTIVITIES
2.1. Course for training Number of
1
and motivation
training
and
its
applicatio
n

mov

Feedback
form and
continuo
us
monitori
ng of
Positive
training
feed back received

Risk
assumption

Number
of trained
staf
available

S.NO Narrative summary

.

OUTPUT
2.2 Increase ANC, folic
acid and tetanus
injection,
reduction in
Malaria & Leprosy
ACTIVITIES
2.2. Increase RMNCH
1
+ A activities in
hospital
2.2. Delivering service
2
by credential staf
2.2. Fully functional
3
diagnostic setup

ovi

mov

Risk
assumption

Improved
maternal
and child
health
care

Studying
the case
history of
patient
admitted

Number
of trained
staf
available

Same as
above
Well trained
staf
in
emergency

well
equipped
lab facility

Hospital
Records

Regular and
continuous
flow
of

S.NO Narrative summary

.

ovi

mov

2.2. Increase testing

4
for malaria cases

Decrease
mortality
and
morbidity
of patient

Decrease
infection

2.2. Active
5
surveillance for
leprosy suspect
case
2.2. Training of staf to
6
use computer

Same
above

Same as
above

Examinin
g
discharg
e
summary
and
calculati
ng death
rate in
hospital
as Same as
above

Trained
staf
to

Risk
assumption

Staf
be

will

S.NO Narrative summary

.

2.3

OUTPUT
Increase
immunization,
increase NICU

ovi

mov

Risk
assumption

%
decrease
in
mortality
and
morbidity
of child for
routine
and
emergenc
y
condition

By
examining
discharge
summary
and
calculatin
g death
rate, cure
rate of
children
admitted
in hospital

Decrease
infection,
well
trained
staf in
emergenc
y

ACTIVITIES
2.3. Setting up of NICU Same

as Same as

Same

as

S.NO Narrative
.
summary

OUTPUT
2.4 Decrease
hospital
acquired
infection
ACTIVITIES
2.4. Sterilization
1
and
disinfection

ovi

mov

Sterilization
and disinfection
technique

2.4. Hospital waste Waste

2
management management

Proper
segregation
area constructed, of bio-waste,

Risk
assumpti
on

Sterilizati
on and
disinfecti
on
techniqu
e being
used
Discharg
e patient
is not

S.NO Narrative
.
summary

2.4. Proper supply

3
of water and
electricity
OUTPUT
2.5 To
enhance
the
relationship
with
all
stakeholders
thereby
ensure
accountability

ovi

mov

Monthly
report
shared with
district
administrati
on

Meetin
g
minute
s

Risk assumption

socio-political
situation is
dealt with
- potential
conflict of
Monthl interest is
y
removed Like
reports Maoists
shared movements
Backward
tribal area
(hilly terrain)

Inputs
Technical:
1. Power supply(generator)
2. Set up of cold chain (ILR)
3. Setting up Isolation ward

financial:
1. Set up Accounts and finance Department

Managerial:
1. Provision of blood storage unit , regular supply of lab
reagent
2. Number of ambulance and vehicle for field visit
3. Residential campus to accommodate staf of hospital
4. Create waste management unit / department
5. Storage and supply of essential drug and other
medicine equipment
6. Provision of supply of water and sanitation

GANTT CHART FOR THE FIRST YEAR 2016-2017

1-Nov-16

Sound Infrastructure

Waste Management System

Purchase of Ambulance, Generators

Basic ammenities (Water, Electricity)

Setup of Laboratory

Recruitment of staf

Availability of Medicines

Motivation Activities for Staf

9-Feb-17

20-May-17

28-Aug-17

GANTT CHART FOR THE SECOND YEAR 2018-19

1-Jan-18

Blood Bank

Collaboration with International Organizations

Emergency Services

Setup of NICU along with UNICEF

20-Jul-18

5-Feb-19

24-Aug-19