sexypablo’s blog

Being a back office worker for approximately four years, today I am going to tell you  about the positive and negative effects of this profession.  I am a medical transcriptionist by profession and started my career as a junior medical transcriptionist after receiving a training of 6 months at Infovision Software Private Limited.  This training period lasted for another month and finally I got the job at Infovision and worked for more than 3 years.  I changed my company to Metrics at Shovabazar and thought that my company Infovision was better than this being more systematic and well-managed.  I returned back after working in Metrics for 11 days and worked for another year. 

In Infovision, I used to work in 3 shifts in the beginning, morning (7 a.m. to 5 p.m.), afternoon  (11 a.m. to 9 p.m.) and night (9 p.m. to 7 a.m.). In any back office you go the starting time is fixed but the end time depends on the work load.  There is a target, in case of Infovision, it was line count.  Speed and accuracy are important in this field.  You have to work under pressure.  You have stay in the accommodation provided by the office where there is strike for more than 1 day.  You have to be responsible for your job.  You have to chalk out a plan and your target in the next 1 or 2 or 3 years will be asked in the KRA. Infovision had a system called KRA (Key Result Area).  This is evaluation of the employee every year on the basis of his/her performance.  The salary raise in my case, I should say was not enough compared to the rising price of the things in the market and compared to other MT companies. 

Many friends who used to work with me left the company for a better salary and benefits.  I wanted a single shift job and kept on trying for government jobs.  I gave tests in private firms also.  I wanted a headphone less job but found that the jobs have a low salary.  So I kept on working consistently with the support of my dear father who always motivates me to work with quality.  After working for more than 3 years in a three shift job, I needed a change badly.  I needed a normal job with a single shift.  I got too tired with the company lifting the canteen facilities.  On tea was provided to us and we had to go out in the scorching sun and rain to fill our empty stomach!  In fact, most of the MT companies are doing it just like that except Metrics where I worked for 11 days.  Metrics has a canteen facility where the boss arranged a system in which the employees share a lunch pack. 

 I left Infovision and joined Infoscribe, which is located in Rabindra Sadan.  It is a good company and under Mr. Atulit Bhalotia, the company is well managed.  The employees are getting salary at a fixed date in month and getting promotions in time!  The call center guys and gals speak with the head phone as a crown! J  We need to create reports based on the instructions of the healthcare providers. The work pressure in a single shift job is high where are more files as you need to end your allotted job within the same day.  There is no one who is going to go at the night.  You have to take all the pressure.  When there is less work pressure, you are a happy person, moving out from the office like a free bird! J  I forgot to tell you Infoscribe starts at 8 a.m. in the morning.  I had to stay one night at Infoscribe, which I will tell you in a different blog! J  In this company, as soon as I finish work, I am free to go home.  There is no fixed hours of staying office as I did in Infovision where there was a supervisor who used to order us to stay at least 8 hours.  In this company, the techs are very efficient allotting files and providing us with all support in technical problems of the computer. 

I found that in this profession, quality and speed matters and I would advise you to work in a company where there is provident fund.  You should not worry about night shift. You do not know that a back office with night shift helps reduce your burden in the daytime.  It means that when a job gets downloaded later in the day, you do not have to worry as the workers slotted in the next shift will do it.  But in a single shift job, you have to do the additional work getting downloaded.  These things might be different for different back office jobs and here I am talking only about my profession, i.e. medical transcription. 

And bad audio files?????  Never get worried about those bad files my friend.  In real life, they are like wicked people who are going to screw you, cheat you!!  In medical transcription, you might write some homonymns, wrong words at the wrong place.  This irritates the editor/proofer.  So be careful!  It might lead to a reduction in salary and finally job loss!   

If you do not see success in this profession within one year, it is better for you to change your profession.  This is my first advice.

My second advice is that you have to be strong in the following things to be successful in this field:

1. You should not look at the watch while working.
2. You should be good in English.  If you are not, then read English grammar books for self-improvement.
3. Always obey senior.  If you see the company is not suitable, then look for self-improvement till you achieve the capacity to work for home as no company can provide you a heavenly atmosphere.

Though I work as a medical transcriptionist for more than 2 years, I would love to be an archeologist, anthropologist, historian, explorer, geologist, tourist guide, body builder, writer, market surveyor, disk jockey, administrative job in hospital etc.  I had studied anthropology and loved the subject.  I studied in my higher secondary (class 11 and 12).  I studied this subject in Narasinha Dutt College.  This college is in Howrah, West Bengal.  You don't know how lucky I am, just after passing out Higher Secondary, this higher secondary teaching was stopped.  Now no one can study higher secondary anthropology.  I got interested and proceed with this subject in my graduation.  Only graduation and pass course are now taught in this N.D. College.  This college is memorable for another thing as my father is a lecturer in this college.  I attended his classes when I was in college.  My father teaches English Literature.  He used to teach the History of English to us and he is a good teacher as me, myself attended the classes.

I studied anthropology as Hons in graduation.  Bangabasi College in Sealdah, Kolkata is an old college where anthropology was first started in India.  As per history, then anthropology was talked in Narasinha Dutt College, Habra Sri Chaitanya College and elsewhere.  I studied this subject.  We used to measure the human fossils, and I used to love this studies and we went to Maharashtra, a village 7 km away from Nagpur to study the Kolam tribe.  We studied the Kolam tribe and I felt great while taking photographs of the village. 

The professions I would like to be engaged if I were not a medical transcriptionist are as follows:

ARCHAEOLOGIST:  I loved this subject while I was studying anthropology.  I used to love prehistory, Harappa and Mohenjo Daro, and in my school life, I stored 99/100 in class V.  I felt very happy!!  It is wonderful to be an archeologist as you go unraveling the past mystery!!

ANTHROPOLOGIST:  Anthropology is a subject I studied in higher secondary and graduation.  I loved the subject but could not work as an anthropologist, as I found less openings, less opportunity and finally my father discouraged me to continue MSC in anthropology.  I got the chance but later joined the training of medical transcription.

HISTORIAN:  History is my favorite subject as you know and I am studying for competitive examination that requires good history passion.  Anyway I were a historian, I would have written books on ancient Indian history, my favorite topic.

EXPLORER:  Exploring is something I like.  Even in my profession, I travel often to places like Botanical garden in Shibpur, Sundarban, Bakkhali, and if I had lots of money, I would have ventured in far off lands.

GEOLOGIST:  Geology is a subject I like and even during my field work, I used to collect stones of unusual color and stone tools of early man.  I could identify them being a study of anthropology and get fascinated by early man's effort to shape their culture with sophisticated stone tools.  I often go to museum and get surprised to see the stones of various colors in the geology department. 

TOURIST GUIDE:  Tourism is a field I would love to join.  I would love to accompany my travelers guiding them in the remote forest, hills, mountain, etc.  Tourist guide has encyclopedic knowledge about the region and he is an expert.  Once I met an expert in Sundarban who was a post graduate in English but joined this profession out of love!  He was a good tourist guide.

BODY BUILDER:  Body building is something I like.  I love to do exercise and I used to go to gym for 5 years and now stopped going there because of this medical transcription profession.  The 3 shift job takes a toll on me and not only me but all the employees of this back office world!!  I do now the following exercises:

1. Skipping:  the maximum I can do is 1800 times!!
2. Yoga.
3. Jogging.
4. Using my machines, push up, sit up, dumbbell curling.
5. I do sit ups with abslimer

In all, I created a mini gym in my home and the hours, as you know, are quite flexible!  I now feel good though I do not go to gym.

I formerly dreamt of having  a big muscular body but now I stress more on fitness of mind and body.'

WRITER:  As you all know, I love to write, I love to write each day of the year.  May be I write not so good but I try to express my thoughts as clearly as possible on any damn topic!!

MARKET SURVEYOR:  Survey is something that I did while doing a household survey in Maharashtra among the tribals.  Its interesting to talk with people!  I did the survey on a clinic at Apollo in Gariahat on Patient Satisfaction, which I did with a smile climbing the 3 floors for 2 to 3 hours. 

DISK JOCKEY:  I aspired to be a disk jockey when I bought a mobile with FM.  I listened to radio.  I loved to listen to western classical, Bollywood music and more.  I loved to listen to songs and music and lot more.  I dream of doing this profession in the near future.

ADMINISTRATIVE JOB IN HOSPITAL:  I did my post graduation diploma in hospital administration from Apollo Gleneagles Hospital and did as distance learning.  I am searching for an administrative job.  In spite of the hype that there are plenty of jobs in healthcare, I found that hardly there is any response when I apply to big hospitals.  Job market seems to boom only in Newspapers and Magazines!!!  It might be good for techies!!!!!!!!!!!!!!!

Being a student of anthropology, I know the meaning of culture better than any other graduates.  I have studied not only the present culture but also the prehistoric ones of different countries in my days of graduation in Bangabasi College.  I have heard the term "Work Culture" first from the mouth of our Chief Minister of West Bengal.  We work to make a livelihood and I don't think that there should be a new culture for work.  Work should be done so that a city progresses, a state progresses and if a state progresses, it will motivate the country to progress.  Do the people of Gujarat talk about work culture?  Do the Europeans talk about work culture? They just do their work quietly!  I will be talking about more of this later but first let me tell you how a strike made things complicated on October 31.

In early morning I woke up to go to my office.  My office is in Gariahat and an arrangement has been made to catch the car arranged by my company which will come at a point close to my house around 5:30 p.m.  My sleep in the night was disturbed.  I was in tension of how to go to office the next day.  The office is a medical transcription company.  It was not a normal day especially October 31.  Trinomul Congress called a bandh or strike for 12 hours started from 6 a.m. and ending around 6 p.m.  So the cars have been arranged to pick up the workers around before six in morning and enter the office around 6.  You know this strike is being made by the TMC in protest of the violence of Nandigram but it disrupted the normal life.  It does not hamper the government employees who enjoy this strike and the salary without work.  But it really affect an employee of private company who has to take the risk and go to the office in a car arranged by the company. 

I came out of my house around 5:10 a.m. in the morning.  It was dark as winter was closing it and days getting shorter!  So I could not get a rickshaw as most of the rickshaw pullers are sleeping.  I walked all the way to B.T. Road where the car is scheduled to come.  The road was empty.  There are hardly any people.  One could hear the barking sounds of dogs who see a stranger with a big bag.  Sometimes I wonder why these dogs should at these strangers!!! Do they think that these people with bag will take them away?  It is still a mystery!  Do you have any answer?  Anyway as I walking through the road lit by yellow neon lights.  There was hardly any breeze blowing.  The leaves of the trees are still.  I thought that it would rain today.  The skies are cloudy.  But I do not have the plastic slippers nor the umbrella.  But later this day it rained heavily.  Though I was lucky when I came out of office around 5:30 p.m.  It was dry and the road was partly dry as the rain stopped a few hours ago.  In my childhood, we used to say, "Rain, rain go away, come again another day "  but now life has got so mechanical that we lost touch with nature.  The life cycle goes on like this:  Sleep, breakfast, office, home, sleep ., .this cycle goes on and on till you become tired. 

In this festive season, my parents went for a trip of 6 days in Darjeeling in West Bengal.  I couldn't go as I was busy with my office in the puja.  Among the four days of Puja, I got off in Saptami and Astami.  The puja held in October is Durga Puja and it is greatly celebrated by the Bengalis.  Lights and pandals and lot of merry making is connected with this puja.  Beautiful idols and pandals and beautiful themes of pandals in different clubs in Kolkata make the Durga Puja an unforgettable event in October.  The best pujas are rewarded by different companies like Berger, Asian Paints, etc.  

The time moves so fast as fast as the light which takes only 8 seconds to reach earth from the Sun.  Our company spent  so much time in preparation for the cars and the canteen facilities on this strike day.  It all passed away . ..and there was another day!  Life moves fast these days as you remain engaged in work.  I never felt the pain to work from 6 a.m. instead of 7 a.m.  So the work culture that our Chief Minister Budhdhadeb Bhattacharya talks about is only confined to words.  It has hardly been converted to action.  All words and no work has become a part of a government job.  People hardly take the initiative to work.  With the number of holidays they get, they hardly work in the working days which is often a declared holiday as in strike and heavy rains.  I think most of these government workers are like school boys!!  They feel happy when their no work and frown when they have to work more!  Sometimes they need to be bribed for doing their "so-called duty."

Though some government offices are computerized, you will still see government offices full of stacked papers in shelves and tables.  It looks so dirty when it is flashed in televisions.  The news channels show that in the days of strike, the offices are empty.  So the strike is supported.  Though the strike as claimed by all party excludes IT sector, which is the sector I am working for more than 2 years, I feel that no special initiative has been made.  The drivers who drive us to our office are afraid to drive.  They feel that their life will be taken by the supporters of the Trinomul Congress.  In spite of assuring them that nothing will happen, they are not going to listen.  For this, the car that lifted me should have taken 11 people but we were 3 when we reached office!  Sometimes I am worried what to do with these timid and stupid drivers!  He was saying, "I am not going to give my life for Rs. 100."  So I came to know that this poor man was given Rs. 100 for covering the places of pick up and he also is not doing his duty and he is trying to avoid the places of pickup stating that Dumdum Road is a lane and he will not enter.  In reality, it is a big road!    

Back office is an office where job from U.S.A is done at a low cost.  In a back office, we jobs of American hospitals in case of medical transcription and in case of call center, we serve customers live by talking with them.  My job is medical transcription.  So let me tell you the companies these days are abandoning their canteen facility to make more profit.  These companies are asking their employees to take food from outside.

In my company, the canteen has been stopped and we are asked to take food from outside.  Think of the rainy season, a person will have to get wet in the rain for his hunger.

The employees think that the money given for food can be saved if they take food from outside but think of the difficulty, an employee has to go outside and take the food.  In the scorching heat, he has to go out as he is hungry. 

Canteen facility is good and in a company, if a person wants food again from the canteen, a canteen owner will not charge for that but in outside canteens, they charge always. 

Life is becoming so hard these days.  We have little choice.  Most of the companies are adopting this as they think it will reduce their cost.

Contact program Day 1

Dr. P.S. Reddy

We spent 3 trillion dollars on healthcare around the world

In US, 1.3 trillion dollars spent on healthcare.

In terms of expenditure, US ranks 37^th, 36^th Puerto Rico, Slovenia 38^th.

Functions of management:

1. Leadership
2. Delegation
3. How to get along with people.

Concept:  Transaction Analysis.

Management was there in the building of the Pyramids of Egypt.

Transaction Analysis was proposed by Eric Berne.

Eric Berne was a Swedish Psychologist.

He wrote a book called: "Games People Play."

Penfield did research on temporal lobe epilepsy

He stated that human mind is like a small tape recorders.

Human being has multifaceted personality.

Transaction is the basic unit of human interaction.

Ego

Superego —- Controlling/restricting.

Id—— Intuitive/instinct behavior

He found that out of 100, words share 7%, body language 55%, and paralingual the rest.  It shows that human body language has a major role to play in the human communication.  We get to know more about body language:  http://en.wikipedia.org/wiki/Body_language

There are 3 types of ego:  http://en.wikipedia.org/wiki/Ego

Parent Ego

Adult Ego

Child Ego

Ego?behavior thoughts and feelings

Parent ego—– nurturing parent

                ———critical parent

Child ego— can be divided into happy child and destructive child.

Destructive child can be divided into Rebellious child and compliant child.

Parent ego ' Taught concept of life.

                —–Child ego— felt concept of life.

Sigmund Freud  was an Austrian Neurologist and Psychiatrist (http://en.wikipedia.org/wiki/Sigmund_Freud)

It is always advised to use soft words in hard arguments.  In a hard argument, when the manager talks in a soft tone.  He gets the situation under control otherwise it would be a total chaos. 

Building Adult Ego:

—-Recognize your child

—–Recognize your parent

—–Recognize others child

—-Be sensitive to child in others

—–Count ten.

—–When in doubt, leave it out.

Thomas Harris—-Life Positions

I am ok. You are ok. —-natural child

Strokes —- gives recognition

A stroke can make you feel good or bad.

People work hard for strokes.

Argument is worst sort of conservation.

Contact Program Day 2

31/7/2007

Dr. P.S. Reddy

Hospital Administration

Beautifying the Mind —- Edward De Bono

Functions of Management:

PODSCROB (acronym denoting planning, organizing, directing, etc.)

Intensive care therapy is very expensive.

Hospital Laws and Medical Ethics

It is very important as on the basis of this a number of litigations are made for improper service in healthcare.

Legislative body makes the law.

National Laws:  Indian Penal Code, Welfare Code, and Administrative Code.

Implied consent:  A consent that is not told but is implied, say when a patient visits a doctor, the implied consent is the patient wants treatment, so tests are done by injecting syringes and blood taken, etc.

IPC sec. 90 —- Consent

IPC sec 88 —– Medicine

IPC sec 80 —- Accident in doing a lawful act

IPC sec 92 —–Act done in good faith for benefit without consent

IPC sec 320 —- grievous hurt

IPC sec 336 —– rash and negligent act endangering life

IPC sec 304 A —–Causing death by negligence

IPC sec 269 and 270 ——Negligent act likely to spread infection of disease.

Indian Medical council  act 20 —– confidentiality

Break the bad news — it is difficult for a doctor to tell the bad news of the disease to the patient, say if he suffers from blood cancer or any thing like that.

The method is called SPIKE:

S—-Setting up

P —- Perception.

I — Information.

K —– Knowledge

E—- Empathy

Terry Schiavo Case

——She was a model who wanted to be slim.  She wanted to be slim so she vomited food after eating called bulimia (a form of eating disorder).

—–Teenager with bulimia

——Potassium (K+) deficiency —it lead to cardiac arrest.

——Anorexic brain damage in 1990

——Removal of feeding tube.

——She died on March 31, 2005 due to dehydration.

Mary and Jodie

—-they are conjoined twins

——Mary uses Jodie as life support machine

——Separation might kill Mary as Jodie uses some organs of Mary to survive.

——continuation will kiss both.

Euthanasia is Mercy Killing.

IVF mix up.

It happens accidentally say a white couple has a black child.  They claim this is a mix up with some other donor's sample. 

Men ought not to play God before learning to be men.

Human cloning

Physician assisted suicide

–Case of Dr. Timothy E. Quill

Ethics—law, good/bad, moral, principles.

"Ethics has to do with my feeling tell me is right or wrong."

"Being ethical is doing what the law requires."

"Ethics has to do with my religious beliefs."

Why ethics???????

Doctors use technical skill and expertise which the patient does not have, possessing this skill gives doctor greater power, in caring for patients, doctors, make a series of judgments, decisions .

What is ethics????

—-Standard of right and wrong that prescribe what humans ought to do .

Surrogate mother — There is no law which states that surrogate mothers not allowed during child birth in India.

Law is silent (a legal term meaning nothing to say).

Law:  Set of rules of conduct enforced by threat of punishment.

Ethics is more than law e.g. Harmless negligence.

8 slice CT scan, then 64, 128, and finally we have 256 CT scan.  1 CT scan is 400 chest x-rays (according to radiation).

Importance of Medical Ethics:

1. Increase in use of technology.
2. Better informed society.
3. Public scrutiny.
4. Trial by media.

According to Medical Council of India, a doctor is not supposed to advertise on any healthcare product.  We often see doctors in advertisements.

Theories:

—Consequentialism or Teleology (what is the consequence of the action)

—-Deontologism (proposed by Emanuel Kant; end never justifies the means.  The means must be correct.  If the process is good, the output will be acceptable.)

—-Utilitarianism (Proposed by Jeremy Bentham  — positive and negative).

Principles ———-

1.  BENEFICENCE:  Goal of medicine, always do good, benefit to the patient, and paternalistic.

2.  NON-MALEFEASANCE:  Do no harm, fundamental commitment, constant duty to minimize or avoid harm.

3.  AUTONOMY:  DNR (do not resuscitate) New York, 1988.  DPAH (Durable Power of Attorney for Healthcare) —Proxy directives.

Deliberate self rule, living will, obligation to consult and obtain agreement.

"Medical Jewelry"— a wrist band is tied to wrist of the patient.

5. JUSTICE: 

1. Distributive justice.
2. Right based justice.

Ethical models in medicine:

1. Ethical Model —-Disease, not person.
2. Priestly Model —- Benevolence, moral dominance.
3. Collegial Model —- Patient as a colleague or partner.
4. Contractual Model —- Negotiated sale of services.

Issues:

—-Abortion versus right to life.

—–Assisted reproduction

—–Death and dying

—–Transplantation.

—–Research injury.

—— Confidentiality.

Euthanasia

1. Active
2. Passive
3. Involuntary
4. Voluntary

Indian Journal of Medical Ethics

Privileged Information —Whom should you tell in what manner and when.

CPA — 1986 —- speedy redressal of repetition—- replaced MRTP Act etc. —-amended in 1991 and 1993.

CPA is compensatory —-Simple speedy and inexpensive redressal.

Consumer is any person who hires for a consideration which is either paid or to be paid.

Deficiency —- Fault, imperfection, shortcoming, inadequacy, nature and manner of performance.

District forum —State Forum (20 lakhs to 1 crore) —– National Forum (above 1 crore)—–Supreme Court.

Unclean hands—- bribes, corruption.

Vicarious responsibility —- select the right person.

Consumer is the patient who hires the service for consideration.

In government hospital, private ward is charged and general hospital is not charged.

User charges are not applicable.

We cannot collect indemnity from the hospital as well as consumer forum.

Consumer forum does not give money for the claims for the following reasons —-

1. The money charged is inflated.
2. The patient suppressing facts.
3. The negligence is not gross.
4. The losses are imaginary.
5. The complaint is not precise.

How do we determine the compensation?

1.      Severity of negligence or loss.

2.      Functional loss.

3.      Age of patient.

4.      Number of dependents.

5.      Loss of future earnings.

6.      Effect on career.

7.      Future expenditure.

8.      Anxiety, agony and distress.

9.      Expenditure on travel, stay, and loss of reputation.

Duration of medical record maintenance—

Medicolegal record —10 years.

Medical council —- 3 years.

Support groups are insurance companies.

Technical defence —- Treatment without charge, concurrent jurisdiction, complicated issue like cerebral hemorrhage.

Factual defence.

BUILDING A HOSPITAL:

1.      Beds.

2.      Speciality.

3.      Budget.

4.      Area and land.

5.      Speciality.

6.      Need assessment.

7.      Planning.

8.      Structure and design.

9.      Staff.

10.  Licence

11.  Market.

Bed is the universal indicator of a hospital.

Funds for hospitals come from share and bank loan.

Funds for hospitals come from your own investment, partners (who gets a share of profit), investors (interest on investment), shares, loans, hire purchase.

If a company wants to release IPO (initial public offer), track record should be proved.

Gestation period is the amount of time to build to the time to get the profit.

Waste Management

Biomedical Waste

Law and regulation in biomedical waste management and handling.

Biomedical waste is the waste that is generated during the diagnosis, treatment and immunization of human being or animals or in research activities, pertaining thereto, or in the production or testing of biological.

What is the first step in Waste Management?

—–Creating systems for segregation of waste in the first step.

—–Segregation of waste into infected or contaminated waste and noninfected waste is mandatory and is a prerequisite for safe and hygienic waste management.

1. No biomedical shall be mixed with other waste.
2. Biomedical waste be segregated into containers/bags at the point of segregation.
3. Color coding signifying the different kind of wastes.
4. Segregation is mandatory prior to storage, transportation, treatment and disposal.

Government rules:  Biomedical Waste Regulations of the Ministry of Environment and Forests, Government of India.

Human Anatomical Waste —Yellow.

Animal waste — Yellow.

Microbiology and Biotechnology Waste —Yellow.

Waste Sharps —Sharp Container.

Discarded medicines and cytotoxic drugs —-Black.

Soiled waste contaminated with blood —-Yellow.

Soiled waste generated from disposable items other than sharps —Blue.

Sharp container should be puncture proof.

If a substance is kept in sodium hypochlorite solution, no infection occurs.

Safety at work àHand Gloves and Face Mask.

Don't mix the infectious waste with noninfectious waste.

Don't recap the needle or break the needles by hand.

Don't fill the container more than ¾ capacity.

Don't allow unauthorized person access to waste collection.

Don't use open buckets for infectious waste or sharps.

Bins are placed in nurse's counter in all wards.

The packed bags are stored in the garbage bin.

The trolleys are green in color and are placed in the service lift area.

Handling of infected linen — Yellow garbage bag.

The infected linen is sent to laundry for chemical treatment and washing.

It is advised to inform your head of the department or supervisor if you have any needle stick injury. 

Quality in Healthcare

Dr. V. R. Ramanan

Quality means conformance to the standards both stated and implied, at a given time, over a period of time, and at a price, the customer can afford to pay, or is willing to pay.

Quality management is the scientific search for the most effective way to deliver the best care to the patients.

Quality is the lifeblood of any organization.  Our aim is to do the right thing, the right way, first time and every time.

How would it help us?

—Improved patient care.

—-Safe environment.

—-Continuous improvement.

—–Self-development.

—–Strengthen patient confidence.

—–Achieve international recognition.

—–Expand customer base.

From where it started—-

In December 1919, American College of Surgeons adopted 5 criteria, known as minimum standards, by 1950, it became a national norm.

Formation of US joint commission on Accreditation of Hospitals in December 1951.

In August 1966, JCI undertook a complete revision of standards to reflect an 'Optimal Achievable' rather than a 'minimal essential' level of care.

JCI accreditation manual has 152 pages.

Quality is virtually important in the hospital sector for it determines what, when and how much will be the same effort of care.

Quality in service establishments has to be ensured by emphasis on the processes rather than on the final output or income.

ATTRIBUTES OF QUALITY IN HEALTHCARE:

—Effectiveness.

—-Effeciency.

—-Optimality.

—–Acceptability.

—-Legitimacy.

—-Equity.

Evolution of the Concept of Quality Management:

Statistics and audit –à Quality Assurance -à Total Quality Management à Continuous quality improvement à Quality Circle.

How to measure quality?

—-Credential and clinical privilege.

—-Risk management  —-incident review.

—-Committee.

—-Patient satisfaction survey.

—–Audit.

—–Quality indicators.

Root Cause Analysis —- is a process for identifying the basic or causal factor that underlies the variation in performance, including the occurrence or possible occurrence of a sentinel event.

Product of root cause analysis is Action Plan.

Evidence based Medicine à  It is clinical practice based on sound evidence.

Six sigma —It is a methodology to manage process variations that cause defects defined as unacceptable deviation from the mean or target; and to systematically look towards managing variation to eliminate those defects.

Objective of six sigma:  To deliver high performance.

                                         Reliability.

                                       Value to the end customer.

Six Sigma was pioneered by Bill Smith at Motorola in 1986.

Three main areas:

—-Improving customer satisfaction.

—-Reduce cycle time.

—-Reduce delays.

DMAIC:

D—-Define.

M—-Measure.

A—-Analyse

I—-Improve.

C—-Control.

QUALITY POLICY OF APOLLO HOSPITAL:  "Our mission is to bring healthcare of international standards within the reach of every individual.  We are committed to the achievement and maintenance of excellence in education, research and healthcare for the benefit of humanity."

My First Blood Donation

I am doing a course at Apollo Gleneagles Hospital in Kolkata under Medvarsity Online Ltd. through distance learning.  I am presently doing a contact program from 30 th July to 12 August in this hospital at Eastern Metropolitan bypass.  It is my fourth day in the contact program.  Today we did our class on Human Resource Management from 11:30 a.m. to 1 p.m.  We were asked to do a department visit on the same day.  We are a batch of 30 students.  We come from various backgrounds of doctor, hospital employee, housewives who are qualified doctors, nurses, paramedical staff.  Students living far away from Kolkata like Durgapur, Tripura have come to this contact program on the above-mentioned dates. 

I never gave blood anywhere before in my life.  I thought primarily due to unhygienic condition and the chance of getting infected with disease was my primary fear.  I loved the atmosphere of Apollo Gleneagles Hospital.  The hygienic surrounding of Apollo Gleneagles Hospital will motivate you to give blood.  Giving blood is a social work.  It is a duty to the society.  It is for the patients who need blood and it is the only thing which we cannot get in a shopping mall.  It is produced by man for another human being.  Blood has a limited life span.  Blood is basically composed of red blood cells, white blood cells and platelets.  A person giving blood will be able to get blood from the hospital when he or his relative is admitted to the same hospital.

I gave blood along with four students of Medvarsity Online Ltd.  They are my close friends.  Two of them are males and two are female donors.  I am a donor with A+ blood.  The hospital has a systematic approach of blood testing with sophisticated equipment imported from foreign countries.  The costs of the equipment for blood testing goes around Rs. 50,000 to Rs. 75,000.  The Blood Bank has equipments to store blood for a long period of time. 

Procedure for Blood Donation:

The procedure for blood donation are as follows:

1. I was asked to take to fill up the card at the reception where a technician filled up the card putting my surname first and then my first name.  Then he wrote my age, sex and I was asked whether I had any blood donations before.  I said, "No, this is my first time!" 
2. I was then taken to another room where a nurse was seated in the chair.  She told me to take the weight and then she told me to wait a while my friends data are collected and blood sample taken to determine the type of blood.  Then the same was done for me.
3. The blood sample was taken.  Only one drop was blood was taken in a slide and the blood was thrown in copper sulfate solution to see whether the blood has the right percentage of hemoglobin.  If the hemoglobin is lower than the specific gravity of the solution, it will float.  So it was found that I have the right percentage of hemoglobin.
4. My blood pressure was tested by the doctor who is in charge of the Blood Bank.  He was curious to know about Medvarsity.  I clarified his doubts.
5. I was taken to the blood testing area. 
6. I was asked to relaxed.  The staffs talked with me with smile and told me that there is nothing to be tense about as it is only a small pouch of blood they will take.  I asked them, "How much blood will u take?"  The nurse said, "350 ml."
7. The blood collection had already begun in my 3 friends.
8. I am the fourth donor. 
9. I was asked to lie down in a chair which is quite comfortable.  It is an adjustable chair.  It is a chair whose height and the angle of inclination can be adjusted.  It is a well-cushioned chair which will make you sleep after lying down!!
10. I laid myself in the chair.  I was made to lie and my upper arm was tied. 
11. I was told to fold my full sleeve shirt. 
12. I was given a small wooden piece to hold it tight and then relax. 
13.  I was then told to relax the arm and a thick needle with a tube connected to the pouch was placed.
14.  The pouch had the capacity of holding 350 mL blood. 
15.   The blood was gradually going down and I never felt any pain.
16.   Only when the needle  was inserted, I felt a pain there but after that no pain.
17.   I was told to relax and the tube was removed. 
18.   A cotton was placed at the junction of my fore arm and upper arm. 
19.   I was told to keep the arms folded for 15 minutes.
20.   After this donation, I was told to sit there for some time and given  fruit juice.
21.   At the end of this session, we came out of the blood donation center.

We are students of Medvarsity and we came here for increasing our knowledge in blood testing.  We had the opportunity to know it as closely as possible being the only four candidates who had the patience to wait for quite some time to know about blood testing from the person who is in charge of the Blood Bank of Apollo Gleneagles Hospital in Kolkata.  After the class, we felt quite fortunate being a part of Apollo and being a blood donor in one of the leading hospitals in India.

The knowledge we gathered are as valuable as platinum for being a future administrator in a hospital. 

History of Blood Testing:

1. In blood testing, the venereal diseases was tested at the initial stages.
2. In the 70s and early 80s, hepatitis B was tested.
3. In 1985-86, HIV (human immunodeficiency virus) was tested.
4. In 1989, government made laws for compulsory testing of blood and the following things were tested:

1. Hepatitis B.
2. HIV.
3. Venereal Disease.
4. Malarial Test.

5. Licensed blood bank was started after that under the government laws.
6. Drug control was made and the laws were made stringent.

In blood preservation, CPDA1 , an anticoagulation is used so that the bloods do not coagulate or clump after the donation. 

As the blood comes out and anticoagulant added to it, it becomes a medicine under Drug and Cosmetics Rules, 1945.

7. According to the order of  Supreme Court in 1998, blood cannot be collected from Professional Donor.  It is important to state that a professional donor is a person who gives blood for money.  In the past, it has been found that these professional people have low blood cell count and due to frequent giving blood, the required blood components are not found and they are often found to have narcotics in their bloods which is not all desirable.  Their lifestyle is different from the voluntary blood donors in the sense that their blood often contains something which is not desirable for transfusion to another recipient of his blood.  So it had to be banned under court order and so nowadays a person giving blood is not given money but an opportunity for his family to take blood if the patient or his family gets admitted to the hospital.  But on discharge, some blood should be given as per the specific hospital rules.
8. From June 1, 2000, Hepatitis C testing was also made after blood donation.

It is to be noted that the medical laws we follow is from U.K.  The Indian Medicine follows 3 pharmacopeia:  USA, UK and Indian.  Among these three, British is given more emphasis. 

A blood bank is run on "no profit —- no loss" basis as per the order of the Central Government.

A stand-alone blood bank is made with the blood supply mainly from the relative of the patient and blood donation camps done regularly in a year.

  Blood becomes a pharmacy product under the name "solvent detergent treated plasma." 

  Red cell is given to Anemia and Thalassaemia patients.  Red cell is called "packed cell" in medical terms.  A red cell is 230 ml in a 1 liter blood of man.  Packed cells are stored at 2 to 6 degree Centigrade.

  Platelets are stored at 22 degrees in a shaker.  The shaker is run for 5 days continuously so that the platelets can thrive. 

Plasma is yellow in color.  It is 150 mL in 1 liter of blood.  It is given to liver disease patient.  Plasma is stored at -18 degree Centigrade.

Platelet is 30 mL per 1 liter blood.  It is given to blood cancer (leukemia) patients.  Platelets are stored at 22 degree Centigrade.

It is to be noted that in a 350 mL of blood of the donor, 49 mL is anticoagulant.

Every year the machines for storage of blood of the donors are calibrated by an organization run by Central Government called Eastern Regional Testing and Calibration Laboratory.  Calibration is a method in which the temperature of the machines storing the blood of the donors are checked.  It is a special technique done by an organization whose duty is to see the machines are okay for future use.

VDRL is Venereal Disease Research Laboratory.

At the time of admission, a patient asks for blood to the blood bank.  If he has given blood to that particular hospital before, he gets blood and during his discharge, his relatives are asked to give blood.  The relatives may argue but it is duty of the person in charge of the blood bank to counsel him.

Before my blood donation, the nurse asked me whether I had a disease like jaundice, any allergies, recent medicine uptake etc.  If I take an aspirin before my blood donation, I was told by the supervisor of this blood bank that my blood platelets loses functional ability in the last 72 hours.  So it is always advised to give blood after 2 hours of heavy meals. 

We were eager to know how a pathologist comes to know whether the donor is a professional donor or not.  It can be known by the low hemoglobin count and the number of punctures in the arms. 

After my blood donation and the knowledge we gained from the person in charge of the blood bank in Apollo, we felt that a bottle of blood can save life in crucial moments.  It is something as priceless as gold.  It is something a person whether a rich or poor has to take without any discrimination in race, sex, class, etc.  It is something which will be produced for oneself and for others in his community.  A blood is a priceless gift a man can give to another human being.

Motivation

Three key factors:

1. Direction.
2. Intensity.
3. Persistence.

Motivation is the willingness to exert high degree of effort by overcoming any obstacle to reach every goal.

Abraham Maslow —-Hierarchy of Needs à

Physiological à Safety à Social à Esteem à Self-Actualization.

Frederick Herzberg:

Motivators and Demotivators.

Satisfaction — no satisfaction (absence of good salary).

Expectancy theory —Victor Broom.

Individual Effort à Individual Performance à Organizational Reward à Personal Goals

The individual effort to individual performance is called Expectancy.

The individual performance to organizational reward is Instrumentality.

The organizational reward to personal goals is Valence.

MBO 'Management by objective.

Management is doing things right and leadership is doing the right things.

Important books on Management:

Emotional Quotient —Daniel Goldman.

Seven Habits of Highly Effective People — Steven Covey.

Leaders

'Autocratic Leaders 'High degree of dependency on the leaders.

Democratic Leaders — bottom up approach.

Change leadership style.

Consolidation.

Change Management:

1. Immobilization.
2. Minimization.
3. Depression.
4. Depression.
5. Acceptance.
6. Search for meaning.
7. Internalization. (Change is understood and adopting it within the length and breadth of the company).

Theories of leadership —

1. Trait Theory:  Leaders are born.
2. Behavioral Theory:  Leader can be trained.
3. Contigency Theory:  Leaders need different styles of functioning with different groups.

According to Jack Welch, Teaching Organization is better than learning organization.

Leaders are actually developed by honing skills.  Leaders are not always born.

 Gaming Policy à Abstract environment, solution out of it.

XYZ theory.

Steven Robins: Organizational Behavior.

Theory Z is the personality X and Y.

The Japanese have a lifelong employment.  The Americans have a hire and fire policy. 

Marketing of Services in 21^st Century — Joshua Kahn.

Leadership Engine 'Eli Cohen.

Human Resource Management

In 1940s 'industry in West Bengal was mines following Mines Act.  Labor laws were followed.  Consumer protection Act is not a cabinet act, so it cannot order imprisonment.  The fines are made in terms of money. 

The labor laws are:

Maternity Benefit Act.

Minimum Wages Act.

Provident fund Act.

Gratuity Act.

Recruitment and Selection:

Recruitment:  Advertise, short list, etc.

Selection:  Written test, group discussion, interviews.

Framing advertisement.

Word-of-mouth (cheapest method of recruitment).

Job sites (for high quality worker).

Campus interview.

Internal advertisement.

Orientations:  history, profit, goal, mission, vision.

A goal does not have a statement.  A goal is set for the customers.  For the HR, it is the employee; for the doctor, it is the patient.

A vision is a generalized statement.

A mission is for the community.  It gives better profit to the stakeholder.  There is no motivation. 

Companies of different types:  public ltd., trust, society.

Pvt. Ltd.:  For 2 persons.

Public Ltd.:  Minimum 8 persons and maximum infinity.

Departmental orientation.

Self-appraisal is made for an employee.

360 degree appraisal is made for the CEO of a company.

Abraham Maslow:  Hierarchy of needs.

Training:  Periodic training can be in-house.  It can be external as well as internal. 

Big bowl of soup.  The bowl is 10 feet in diameter.  There are chairs around.  An 8 feet long spoon is given.  Only through team work the soup can be drunk.

Spiritual Quotient. 

Emotional Quotient (emotionally how you feel at that moment; emotional quotient is very important in modern management).

Being an employee of an organization for nearly 2 years, I have not enjoyed the benefits of the employee state insurance card, commonly known as ESI card.  It is the card with the help of which one employee and its family members will get the benefits.  A photograph of the employee with his family members is attached with the card.  With the help of this card, the employee can take the doctor's consultation free of cost.  It is a card which helps us for hospitalization of the employee's family.  The government system has redtapism.  The processing of the card is so slow that I had to write at the ministry level, i.e. labor ministry to get the card.  I had to write under the Right to Information Act, 2005, which states the person has the right to information about the decisions taken on a particular case.

I had to run pillar to post to get the card ready for use.  This card can be used for leave in the office and it is a great opportunity for the employee.  The right to enjoy the benefits of the card is important and often the employee neglect their rights.  In a back office, an employee only works and he does not pay attention to the benefits he is getting.  But a conscious employee is he who also asserts his rights at the proper place and the proper time. 

I visited the office of Employee State Insurance after getting the address from our manager.  I learnt from him that it is the redtapism of the government for which my card is being delayed.  So I went straight to the office at Dhakuria in Kolkata.  The office is an old building under repair.  In front of such a health insurance office, there is a garbage dump.  I was surprised to find the stench and dirt in front of a government office.  The environment of the office is so clumsy.  The officer gave me the card and I filled up the card the next day and went to submit to my nearest doctor's chamber.  The doctor's assistant refused as there was again some fault.  Then I had to approach the manager and stamped it as the date was wrong. 

Finally  on production of the card in the right format, I got the final card with the family photo pasted.  This card can be used for free medical checkup for me and my family.  I also had the opportunity for hospitalization at some ESI hospitals nearby!  This medical facility is available upto an income level.  Then as you move up to a higher income level, this opportunity will not be there. 

Then there are schemes like Mediclaims where you will deposit a yearly subscription for sudden hospitalization.  The subscription increases as per the need of the customer.

Redtapism can be seen everywhere in government jobs.  In private company, the productivity is important.  In government office, the environment is very relaxed, people gossip as there is no such targets to be met per day.  Still there are some good government offices where work is done and for this reason I got my  final card.  I am quite happy as I will get the benefit in the future.