OPERATIONS

MANAGEMENT
OF SHIFA
INTERNATION
AL HOSPITAL
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Department of Management Sciences

Final Project Report of Execution & Control of Operations in

Supply Chain Management
Operations Management

of Shifa International Hospital

Submitted to:
Sir Raja Khalid Hafeez
Submitted by:
Fakhir Ansari
Junaid Hassan
Mustehsan Raza
Muneeb Ahmed
Zarmeena Gauhar
Sohaib Hassan Bukhari
Waseem Shahzad Raza
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Acknowledgement
We all are thankful to ALMIGHTY ALLAH (The Most Merciful and Mighty) who gave
us the strength to complete the project and ability to gain tremendous knowledge.
We would like to thank our Instructor Mr. Raja Khalid Hafeez who have been a
great influence on us throughout the course. He taught us and been very helpful. It
was indeed due to his effort we were able to complete this project.
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Table of Content

➢ History a) Hospital Equipment

➢ Introduction Preventive
Services Maintenance Manual
➢ SCM of Shifa Hospital b) Provision for
Shifa Hospital SCM functions Maintenance in
overview Hospital
Shifa Hospital SCM strategy c) Effective Maintenance
➢ Operations Management of Shifa Strategy
Hospital d) Disposal of Equipment
➢ Problem in Operations Management e) Planned Maintenance
of Shifa Hospitals medical equipment
➢ Drugs Shortage ➢ Hospital Wastes
Proposed Solutions Present scenario of waste at
➢ Data Shortage Shifas
Proposed Solutions Proposed Solutions
➢ Poor Workflow Design a) Administration and
Proposed Solutions managerial aspects
➢ Lack of integration ➢ Conclusion
Proposed Solitons
➢ Scheduling & Staffing
Benefits of managing staff
➢ Facility Location & Layout
Proposed Solutions
➢ Facility & Expandability for Hospital
➢ Controlled Circulation
➢ Maintenance
Proposed Solitons
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Operations Management
of Shifa International Hospital
History
The Hospital was incorporated on September 20, 1987 as a Private Limited Company and
converted into Public Limited Company on October 12, 1989. The first Shifa office was established
at the residence of Dr. Zaheer Ahmad in sector F-8/3 of Islamabad. Later it was moved to a rental
place in Blue Area (commercial buildings area in Islamabad), and finally the site office building
was established in January 1988.
The construction activity to prepare the site for laying the foundation of the Hospital was started
in the beginning of 1988. The foundation ceremony took place on October 06, 1989 by the
parents and well-wishers of the sponsors and their dedicated team of colleagues and well-
wishers.
The idea of developing a high-class medical facility in Pakistan was conceived in New York, USA
in the mid of 1985. The initiator Dr. Zaheer Ahmad, who had just finished his Internal Medicine
Residency, called a meeting at his apartment in Brooklyn, New York on the weekend of July 20 &
21. Five professionals gathered there and discussed the idea in detail and approved it. The
participants included Dr. Manzoor H. Qazi from Leesville, Louisiana, Mr. Muhammad Zahid from
Kew Gardens, New York, Mr. Samiullah Sharif from Brooklyn, New York, Dr. Sabir Ali from Palm
Bay, Florida and Dr. Zaheer himself Dr. Zaheer Ahmad was asked to prepare the feasibility report
and the action plan. Subsequently Dr. Zaheer Ahmad moved to Islamabad on December 17, 1985
to start the work on this project.
After extensive discussions and many meetings, the present site in the capital city of Islamabad
was selected for this project. The name SHIFA was approved because of its comprehensiveness,
originating from our culture, belief and values in totality.
After acquiring over 11 acres of land in Islamabad in 1987, CRI, a hospital development company
in Princeton, New Jersey was hired to develop the plan and design of the project. Mr. William
Parker, Chief Architect of CRI headed the team, visited the site in Islamabad besides visiting the
other hospitals across Pakistan. CRI finished its job in 1989.
Shifa International Hospital offers 398 IPD beds with quality care and OPD facility in different
specializations. Nevertheless, it is an unending journey. People at Shifa are continuously striving
hard to bring improvement and novelty with every passing moment.
Now after two decades, Shifa International Hospital proudly stands as a symbol of quality
healthcare with its own brand name SHIFA. The short history of Shifa witnessed rare dedication
and devotion of its consultants, management and staff who worked round the clock to make
Shifa a reality of its own.
It was the vision of the founding Sponsors which took its shape into reality. The task was made
possible only with the help of dedicated team of experts and managers under the quality-
oriented and inspiring leadership.
Today, the hospital’s Block-A, B, C, D, E and F, ICU beds, new ORs etc., sprawled on its site are
efficiently functioning. Allah’s grace made it feasible and viable to carry out such a gigantic and
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enormous venture. Unique in its concept and efforts set up by the expatriate Pakistanis to repay
their homeland with a beautiful gift in the form of a functional institution in the healthcare
industry of Pakistan.

Introduction
It was in the early 90’s, when the pioneers of Shifa International Hospital, made a critical decision
to make available much needed state of the art medical treatment for cancer patients. The first
phase of this commitment led to the opening of the first radiation oncology department in the
private sector at Shifa International Hospital in 1994. This proved to be the focal point for
development of additional cancer treatment facilities over the years, till the inauguration of a
full-fledged Shifa Cancer Center in 2012.

Services
1. Board certified Oncologists, Radiologists, Surgeons, qualified nurses and technicians
2. 24/7 support for Chemotherapy & Bone Marrow Transplant
3. Multidisciplinary Tumor Board
4. A state-of-the-art Linear Accelerator and CT Simulator (Wide Bore) used for accurate
visualization of tumors and normal tissues in each individual patient so that accurate
targeting of tumors and protection of normal tissues can be done.
5. Treating Medical Oncology/ Solid tumors and hematological malignancies
6. Radiation Oncology
7. Day Care Unit facility for patients suffering from various benign and malignant disorders

Shifa International Hospital provides a series of major and minor surgeries under its head
department of General Surgery. The department is housed by seasoned professionals who have
an extensive hands-on experience of performing simple to complex surgeries with intensive care
and dedication.

At Shifa International, we try to update our patients with the procedures they are going through
so that they get to know about the precautions they have to take during or after a surgery. This
skillful education leads our patients to a quick recovery and peace of mind.

The expertise of our qualified surgeons is not confined to the heart or brain, as they are capable
of treating any condition that may be affecting a specific body area of the patient.
The General Surgery department brings the widest range of specialties to the capital city of
Pakistan so that people across the city can take benefit of the facility.
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Supply Chain Management of Shifa Hospital

A hospital like Shifa, or any business for that matter, cannot operate in isolation. Right from the
procurement of raw material to providing the service and finally to the concluding transaction
where service/ goods delivery is completed and exchange of money takes place, it is a chain of
interconnected businesses and business processes. Every time a requirement is communicated,
order is placed and inventory is stocked, there is a potential opportunity of value addition, waste
reduction and process standardization. Supply Chain Management (SCM) is the process of
planning, implementing and controlling the operations of the supply chain with the purpose of
satisfying the customer requirements as efficiently as possible with a continuous eye on
operating cost reduction. SCM encompasses the planning and management of all activities
involved in sourcing and procurement, conversion and all logistics management activities.
Shifa’s supply chain has two main objectives.
1. The first is making sure the product is always available when it is needed.
2. The second is to ensure the first objective is fulfilled in the most cost-effective way.
Shifa Hospital provide a unique problem in establishing and maintaining a supply chain process.
Not only, in most cases, individual departments in a hospital act as individual buying centers but
also there exist a mind-boggling number of intermediaries. The challenge lies in efficiently
integrating suppliers, logistics, different hospital departments (outpatient, emergency ward,
radiology, pathology, supplies, stores and purchase) to ensure optimum utilization of resources.
The ultimate aim is to transform a sick patient to a healthy person at a reasonable cost, in the
shortest possible time and with superior patient satisfaction. Consolidation of demands from all
the departments and proper flow of information between the departments and suppliers can
remove a lot of bottlenecks and resultant reduced cost of all the parties involved.
Most of the times, orders are placed to the suppliers on an “As and When required basis”. The
problem of this approach is twofold:
1. There is a higher chance of stock-outs from the supplier’s end.
2. The transport and ordering cost incurred is also more, considering the fragmented
nature of the orders placed.
This approach also prevents the hospitals from entering into any long-term contracts with drug
distributors. Hence, they are denied of optimal bulk order discounts from the drug distributor/
manufacturers. From a criticality point of view, this has an even larger dimension attached: the
hospitals lose out the preferential/priority supplies commitments in case there is a shortage of
some lifesaving drugs. So, in all, there is incurring of greater cost and still running a chance of
lower customer service being offered. From materials management point of view, having a
centralized database and standardized inventory control systems in place is of immense
importance. As observed in the financial reports of one of the India’s greatest hospital chains,
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the expense towards materials and supplies amount to more than 45% of the total revenue
generated.
According to a research published in a leading medicine journal, high volume drugs like antibiotics
and anti-ulcer drugs constitute more than 70% of the total drug consumption in a typical hospital.
Expensive, restricted drugs account for a mere5% of general usage. This suggests that a proper
inventory control mechanism and order placing procedure can be brought in place for these high-
volume drugs. Systematic measurement of drug utilization patterns is the key element of drug
cost control strategies. Continuing the above point further, research also proves that majority of
the cost is borne by specialized departments like Oncology, Cardiology etc. It is unlikely that these
specialized departments will have a high degree of variation in their prescribing practice. In
contrast, routine drugs like Claforan / Cefotaxime are used by a large number of hospital’s
internal departments and practitioners including specialists, surgeons, gynecologists and
surgeons for different clinical conditions. In such a case where the use spans different
departments and wards, subject to individual practice and policy, the usage experiences greater
variation of demand. The volume of usage and variability in demand are mutually exclusive. Some
medicines like ampicillin, tetracycline etc., are not only prescribed by many departments but also
their volume of usage is much higher. This presents a good case where ABC method of inventory
classification can be done and suitable re-order point policies can be brought in. The article later
deliberates on a probable inventory control system and application of some contemporary supply
chain management technique for the improvement of the overall operations in hospitals.

Shifa Hospital SCM Function Overview

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Shifa Hospital Supply Chain Strategy

Shifa hospital internal supply chain links the logistics processes and patient care services within
the hospital. Today's hospital supply chains face several issues, including fragmented supplier
base, supply chain inefficiencies, excessive administrative expenses, poor management,
inappropriate care, waste, etc. Hence, an effective supply chain management can positively
impact the hospital's bottom line. With supply chain operations taking up to 40% of the hospital's
budget, implementing a successful hospital supply chain strategy is important. Hospitals that take
a holistic view of their supply chain and focus on strategic issues may realize significant benefits,
such as improved employee satisfaction, patient safety and outcomes. The key steps to strategic
healthcare SCM include improved collaboration with vendors, align with physicians, focus on
integration, automate the supply chain, adopt more and better standards and use process
improvement methodologies.

SCM provide guidelines for planning an effective supply chain strategy by taking into account
customer needs, internal assessment of supply chain capabilities (benchmarking), industry
trends, evolving technologies, risks and competition. Hospitals can gain competitive advantage
by effectively managing their supply chain and hence, achieve supply chain excellence. Finally,
the right supply chain key performance indicators (KPIs) should be defined to track performance
and evaluate the implementation of the supply chain strategy.
Unlike other industries, where SCM techniques are already successfully applied, the healthcare
sector is lagging behind in adopting the logistics concepts due to several factors, including
regulatory issues, outdated information technology (IT) systems, poor inventory and distribution
management, lack of executive involvement, no process improvement culture, etc. The
healthcare sector when assessing the internal hospital supply chain capabilities. They can learn a
lot by looking at best-in-class practices from manufacturing or retail industry as a way to maintain
a high level of efficiency (control costs) and effectiveness (i.e. high quality of patient care). Shifa
is adopting Collaborative Planning, Forecasting and Replenishment (CPFR) and information is
shared through World Resource Planning (WRP). Such concepts are key to get an integrated
supply chain. However, the unique characteristics in the healthcare setting, a diverse group of
stakeholders, complex technologies and a dynamic internal and external environment make it
difficult to transfer logistics concepts from the healthcare sector.

Operations Management of Shifa Hospital

Shifa Hospital is large and complex organization, yet they function largely without sophistication
and technology inherent in other large businesses. In a time when well over half of hospital report
negative operating margins, driving down costs by achieving operational excellence is one of the
most important yet overlooked areas. Shifa operations management is the emerging discipline
that integrates quantitative and qualitative aspects of management to determine the most
efficient and optimal methods of supporting patient care delivery. Operations management
helps Shifa hospital and health systems understand and improve labor productivity, reduce
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waiting lines, shorten cycle times, and generally improve the patient’s overall experience all of
which helps to improve the organization’s financial health. Shifa operations management covers
fairly large range of functions in a hospital as compared to well-known boundaries of operations
management function in business. Harnessing full potential of hospital operations management
is desirable in order for the hospital to stay cost-competitive, profitable and of immense service
to the society at large. In any systems improvement exercise, it is important for a hospital to map
out its own flows and interrelationships as only then some specific initiatives for efficiency
enhancement, productivity improvement, quality control, etc. can be initiated, which all come
within the realm of Shifa operations management. Shifa operations management is concerned
with applying traditional managerial functions (planning, organizing, directing and control) to
Shifa daily services, namely, outpatient services, inpatient services, emergency services and
diagnostic services, and management of other activities such as hospital pharmacy, vendor
managed and co-managed inventory control, supply chain management, warehouse
management, pharmacy management, etc. Hospital operation management includes all day-to-
day activities that it is busy all throughout the day but functions particularly marketing,
accounting and finance, and HR, but no less important are usually kept out of its scope. This is
because unlike outpatient or inpatient services; marketing, finance and accounting, and HR are
not daily routine activities. However, at the same time addressing all major activities within the
realm of hospital operations management is more important than narrowly limiting its scope on
academic angle as real objective of hospital operations management is rendering more effective,
efficient and productive services of world class quality than excluding some really vital activities
from its fold on academic reasoning. Hospital management can be defined as entire hospital
operations management plus HR, marketing and finance, and a few other hospital clinical and
administrative functions. A patient visit to a hospital creates flurry of activities in the warehouse,
pharmacy and dispensing counters, which keeps associated hospital vendor-managed or co-
managed inventory systems including the supply chain in active mode throughout the day.
Hospital warehouse, pharmacy, vendor-managed or co-managed inventory control, and supply
chain management are thus viewed as daily activities on the ground that no patient normally
leaves hospital without taking some medicine along with him or her.

Problems in the Operations Management of Shifa Hospital

➢ Hidden Costs
Top challenge that Shifa face is the hidden costs of every service & product. Most providers have
historically just looked at the product cost and the shipping cost. But there are additional
expenses, such as inventory holding, waste and emergency cost. Actually, is not using the most
advance technology to manage the operations which are needed in this era for every hospital,
Due to these hidden costs Shifa in improving in revenue but its annual profit margin is declining
due to occurring to much hidden cost.
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Proposed Solutions

1. They need to plan their budget around total landed supply costs.
2. They need to be aware of the losses they will incur from the unavoidable aspect of expired
products and excess supplies.
3. They need to look at product standards and purchase price variance.
4. Shifa hospital can start taking a more holistic approach to pricing their products, including
the costs associated with moving and managing supplies. This means product utilization,
special deliveries, internal distribution, and much more.

➢ Drugs Shortages
Because of the unpredictability situation of Pakistan that comes part and parcel in the healthcare
industry of Pakistan, drug shortages seem inescapable. This can create a mess in the healthcare
supply chain. It forces providers to either purchase alternatives that are much more expensive or
maintain a comprehensive backup inventory of products that are at risk of being in short supply,
which then leads to the added cost of inventory management and product expiration.

Proposed Solutions

The best option for dealing with this is the use of technology that assists with early notification
and response, especially in the case of certain surgical agents, cardiovascular agents, and the
fluids. This technology enables providers to more effectively manage and monitor the long-
standing shortages of hundreds of drugs and to be prepared for unforeseen shortages in other
drugs

➢ Data Shortage
Data is helping to improve efficiency and effectiveness in every sector. It allows organizations to
see what they have been missing, to gain a bird’s-eye view of their operations, and to optimize
their processes. And this is exactly what it can do for healthcare supply chains.

A lack of actionable data is something that is endemic among providers. Executives in Shifa
hospital recognize that their decisions are not sufficiently informed because they do not have
access to advanced modeling systems and real-time reports. One of the reasons for this lack of
data is that supply chain data is very siloed due to the inherent vertical internal structures of
providers. However, this is a problem that must be addressed, as over two-thirds of healthcare
IT professionals believe that the supply chain is where the most actionable data lies especially
the data that goes beyond purchasing activity and into consumption activity.
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Proposed Solutions

Shifa can use several software solutions that can help hospitals optimize their supply chain. While
their BUDGET software allows healthcare practices to streamline their equipment request
process and enhances all routine replacements. This software is specifically designed to help with
new construction projects. Their cloud-based point of entry empowers hospitals to plan out all
capital equipment needed for a specific renovation or construction project and enables enhanced
collaboration among stakeholders.

➢ Poor Workflow Design

Throughout the Shifa’s supply chain, many processes are unnecessarily duplicated. The reason
for this is that the systems and entities that make up the supply chain are disconnected. Many of
the tasks could be automated and integrated in a way that would allow all participants to share
information more freely.

Proposed Solutions

The healthcare supply chain is complex and delicate. So, while these challenges can and should
be addressed, it will take the right technology and solutions. Shifa need to identify their problems
in the service providing and should adopt all the possible modern resources to manage the
process.

➢ Lack of Integration
Healthcare practices, facilities, and hospitals are becoming more consolidated. Health systems
are growing, merging, and acquiring. As this happens, supply chains within these siloed yet
merged organizations remain separate. Shifa need to address this because inconsistency
between these supply chains will negatively impact the bottom line.

Proposed Solutions

1. These supply chains need to be integrated.

2. Purchasing channels need to be centralized. Facilities need to share contracts so that they
can gain access to higher tier pricing.

Without these adjustments, the supply chain will not be cost-effective and the processes that it
contains will remain inefficient
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➢ Scheduling & Staffing

Shifa is lacking in highly technical environment and management of human element. Shifa’s
employs a large number of people of different categories with widely varying educational and
technical background. Some of them are highly skilled professionals while some others are of
moderate education and without possession of any specific skill. This calls for a very efficient
degree of personnel management. Personnel management in essence involves the following
elements of function by the Shifa’s administration.
The relationship between patients and health care providers is the foundation of care and
requires communication across cultures, geography and life experiences. The very nature of
medical staff scheduling demands the utmost efficiency when it comes to managing scheduling
for staff and physicians at medical offices, hospitals, home health services, medical centers and
other medical care facilities. While some medical facilities focus exclusively on certain types of
medical care.
Some medical practices and institutions engage in community awareness and prevention
programs to help educate the public on various medical concerns, and all of these activities have
their own scheduling demands. With so many positions and skill requirements to meet, there is
no room for anything less than total staff organization, especially when the staff count reaches
into the dozens, hundreds and even thousands, operating 24/7 and covering hundreds of shifts.
Shift Planning’s custom installation and set-up allows every medical staffing demand to be met.
Whether there are two or three shifts to cover in each 24-hour cycle, and taking into account the
individual needs and preferences of each staff member, Shift Planning provides the powerful
scheduling tools you need to cover a multitude of shifts, needs and expectations every day,
efficiently and easily. Shift Planning’s medical and hospital staff scheduling program puts real
time data at the scheduler’s fingertips. Managers always know the availability of qualified
personnel, staff preferences for particular days, shifts and units, and union and regulatory
requirements. Shift Planning provides the tools necessary to keep track of staffing reports,
regulated ratios and all of the demands that medical services must meet.
✓ Benefits of managing Staff
Following are the benefits of managing staff:
1. Helps to accommodate safety and response time by keeping adequate staff on call
hand at all times.
2. Complies with union and governmental regulations automatically.
3. Allows staff and workers consideration in their individual shift preferences.
4. Provides the ability to reach any staff member within moments electronically,
even if they are off-shift.
5. Shift Planning allows you to manage the medical facility’s labor force and field
services simultaneously, crucial to maximizing the standards of operation.
6. Shift Planning will provide powerful scheduling tools to prepare for everyday
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➢ Facility Location and Layout

Shifa’s continues to consolidate, decisions are made daily to close, merge, acquire, and sell. Shifa
having a complex structure and layout throughout the whole organizations. Shifa hospital is
comprised of a wide range of services and functional units. These include diagnostic and
treatment functions, such as clinical laboratories, imaging, emergency rooms, and surgery;
hospitality functions, such as food service and housekeeping; and the fundamental inpatient care
or bed-related function.
This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that
govern hospital construction and operations. Each of the wide-ranging and constantly evolving
functions of a hospital, including highly complicated mechanical, electrical, and
telecommunications systems, requires specialized knowledge and expertise. No one person can
reasonably have complete knowledge, which is why specialized consultants play an important
role in hospital planning and design. The functional units within the hospital can have competing
needs and priorities. Idealized scenarios and strongly-held individual preferences must be
balanced against mandatory requirements, actual functional needs (internal traffic and
relationship to other departments), and the financial status of the organization.

Proposed Solutions
In addition to the wide range of services that must be accommodated, Shifa must serve and
support many different users and stakeholders. Ideally, the design process incorporates direct
input from the owner and from key hospital staff early on in the process. The designer also has
to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not
generally have direct input into the design.
Good hospital design integrates functional requirements with the human needs of its varied
users. The basic form of a hospital is, ideally, based on its functions:
1. Bed-related inpatient functions
2. Outpatient-related functions
3. Diagnostic and treatment functions
4. Administrative functions
5. Service functions (food, supply)
6. Research and teaching functions
Physical relationships between these functions determine the configuration of the hospital.
Certain relationships between the various functions are required—as in the following flow
diagrams
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These flow diagrams show the movement and communication of people, materials, and waste.
Thus, the physical configuration of a hospital and its transportation and logistics systems are
inextricably intertwined. The transportation systems are influenced by the building
configuration, and the configuration is heavily dependent on the transportation systems. The
hospital configuration is also influenced by site restraints and opportunities, climate, surrounding
facilities, budget, and available technology. New alternatives are generated by new medical
needs and new technology. In a large hospital, the form of the typical nursing unit, since it may
be repeated many times, is a principal element of the overall configuration. Nursing units today
tend to be more compact shapes than the elongated rectangles of the past. Compact rectangles,
modified triangles, or even circles have been used in an attempt to shorten the distance between
the nurse station and the patient’s bed. The chosen solution is heavily dependent on program
issues such as organization of the nursing program, number of beds to a nursing.
Hospital Building Attributes
Regardless of their location, size, or budget, Shifa should have certain common attributes. An
efficient hospital layout should follow the points given below:
1. Promote staff efficiency by minimizing distance of necessary travel between frequently
used spaces
2. Allow easy visual supervision of patients by limited staff
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3. Include all needed spaces, but no redundant ones. This requires careful pre-design
programming.
4. Provide an efficient logistics system, which might include elevators, pneumatic tubes, box
conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient
handling of food and clean supplies and the removal of waste, recyclables, and soiled
material.
5. Make efficient use of space by locating support spaces so that they may be shared by
adjacent functional areas, and by making prudent use of multi-purpose space
6. Consolidate outpatient functions for more efficient operation—on first floor, if possible—
for direct access by outpatients
7. Group or combine functional areas with similar system requirements
8. Provide optimal functional adjacencies, such as locating the surgical intensive care unit
adjacent to the operating suite. These adjacencies should be based on a detailed
functional program which describes the hospital’s intended operations from the
standpoint of patients, staff, and supplies

✓ Flexibility & Expandability for Hospital

Since medical needs and modes of treatment will continue to change, hospitals should: Follow
modular concepts of space planning and layout
1. Use generic room sizes and plans as much as possible, rather than highly specific ones.
2. Be served by modular, easily accessed, and easily modified mechanical and electrical
systems.
3. This system also uses walk-through interstitial space between occupied floors for
mechanical, electrical, and plumbing distribution. For large projects, this provides
continuing adaptability to changing programs and needs, with no first-cost premium, if
properly planned, designed, and bid.
4. Be open-ended, with well-planned directions for future expansion; for instance,
positioning “soft spaces” such as administrative departments, adjacent to “hard spaces”
such as clinical laboratories

✓ Controlled Circulation
Shifa is a complex system of interrelated functions requiring constant movement of people and
goods. Much of this circulation should be controlled.
1. Outpatients visiting diagnostic and treatment areas should not travel through inpatient
functional areas nor encounter severely ill inpatients.
2. Typical outpatient routes should be simple and clearly defined.
3. Visitors should have a simple and direct route to each patient nursing unit without
penetrating other functional areas.
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4. Separate patients and visitors from industrial/logistical areas or floors.

5. Outflow of trash, recyclables, and soiled materials should be separated from movement
of food and clean supplies, and both should be separated from routes of patients and
visitors.
6. Transfer of cadavers to and from the morgue should be out of the sight of patients and
visitors.
7. Dedicated service elevators for deliveries, food and building maintenance services.
Hospitals are among the most regulated of all building types. Like other buildings, they must
follow the local and/ or state general building codes. However, federal facilities on federal
property generally need not comply with state and local codes, but follow federal regulations. To
be licensed by the state, design must comply with the individual state licensing regulations.
Following are the emerging issues are conducting with Shifa Hospital layout:
1. The decreasing numbers of general practitioners along with the increased use of emergency
facilities for primary care.
2. The increasing introduction of highly sophisticated diagnostic and treatment technology.
3. State laws requiring earthquake resistance, both in designing new buildings and retrofitting
existing structures.
4. Preventative care versus sickness care; designing hospitals as all-inclusive “wellness centers”.
5. Use of hand-held computers and portable diagnostic equipment to allow more mobile,
decentralized patient care, and a general shift to computerized patient information of all kinds.
This might require computer alcoves and data ports in corridors outside patient bedrooms.
6. Need to balance increasing attention to building security with openness to patients and visitors.
7. Emergence of palliative care as a specialty in many major medical centers
8. A growing interest in more holistic, patient-centered treatment and environments such as
promoted by plane tree. This might include providing mini-medical libraries and computer
terminals so patients can research their conditions and treatments, and locating kitchens and
dining areas on inpatient units so family members can prepare food for patients and families to
eat together

➢ Maintenance
Maintenance has become a principal phase in the life cycle of built assets. The high performance
of hospital buildings requires that maintenance considerations be taken into account at early
stages of design. Maintenance management issues play a major role in the performance of
constructed facilities Outsourcing of one or more maintenance services may entail various
difficulties, such as various employee related issues, loss of skills, lack of internal expertise to
manage outsourcing contracts, potential loss of control, etc. On the other hand, outsourcing may
result in cost savings, improved quality, the transfer of knowledge from outside specialists to
internal personnel, etc. Shifa’s 34 subcategories. The majority of the maintenance budget in
hospitals was spent on interior finishing and interior construction (32%), and on heating,
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ventilation and air-conditioning (HVAC) (29%). The rest of the budget (39%) was spent on
electricity (13%), exterior envelope (13%), water and plumbing (10%), and other electricity
systems, such as communications and low-voltage systems (3%).
One method used to assess the efficiency of maintenance proposes seven key performance
indicators (KPIs) that provide benchmarks for the asset management (AM) of medical facilities.
Most of these indicators deal with business and financial performance, and thus are applicable
mainly to private-sector medical facilities. These indicators neglect factors such as building
performance, intensity of use, sources of personnel, etc. This is the reason this emphasized the
functionality (performance) and cost effectiveness in the KPIs, compared with customer
satisfaction, revenue/ profit and business growth in the business KPIs. While developing the
Property Standard Index (PSI). Hospital Maintenance is responsible for the operation:
1. Operation and maintenance of lighting
2. Plumbing, electrical distribution
3. Air conditioning/heating systems
4. Finishes of all hospital buildings
5. Preventive maintenance program

Proposed Solutions
✓ Hospital Equipment Preventive Maintenance Manual
It provides hospital engineers and other health care professionals involved with the operation
and maintenance of hospital physical plant equipment comprehensive, technical maintenance
information. This material is useful for both the user and the hospital administration because it
is prepared in a simple way. This generic approach in hospital equipment preventive maintenance
is unique to preventive maintenance in medical facilities with this approach it is possible to assess
different manufacturers’ systems and products, while emphasizing general procedures for
preventive maintenance. Of necessity, the material is technical in many categories for technically
oriented hospital engineers, equipment users and maintenance personnel who must evaluate
the performance capabilities of different systems and equipment against basic technical data and
applications indigenous to the generic category. It allows users to compare systems and
equipment against specifications.
✓ Provision for Maintenance in Hospital
The equipment management cycle: Maintenance of healthcare equipment is not just a question
of repairing broken things. It is an integral part of managing the whole lifecycle of equipment: It
can be seen that maintenance and repair is just one element. To make the whole cycle work
properly, a number of different inputs are required. All groups of staff will have a role at some
point: Management Policy makers Procurement Stores Pottering Finance Clinical Technical
Maintenance Administration Patients Suppliers The equipment user should be involved or
consulted in each and every one of these stages. Medical Equipment Maintenance Manual First
 18

line maintenance for end users recommended resources. The user should not be left on their
own. Once a piece of equipment is installed, commissioned and accepted and once the user has
been fully trained in operation, they will need these resources to carry out the use and
maintenance of the equipment well: Maintenance schedule of regular visits by qualified
maintenance personnel will be needed. This might be managed by the maintenance department
or senior hospital management. Whether the maintenance is in-house or outsourced, a system
of reminders to prompt the work will be needed.
It is a well-known fact that a good Hospital management System must result into cost cutting and
efficient management and has to be very precise too. Moreover, it should provide relevant
information across the hospital to support effective decision making for patient care, hospital
administration and critical financial accounting, in a seamless flow. Furthermore, while going for
a Hospital Management System, the technology used should be secure, interoperable,
manageable, scalable and reliable. Therefore, it is very necessary to keep a balanced solution in
mind.

OTS provides end to end Hospital Management software Solutions for single and multispecialty
hospitals, to cover a wide range of hospital administration and management processes. HMS
solutions are designed and developed keeping in mind today’s complex processing requirements
and stipulations. We first understand your Healthcare Organization’s process and legacy systems
to suggest an ideal solution to our clients. We take special care while devising an HMS so that our
clients get a reliable, scalable and the best throughput from the solution. Most importantly, our
cost-effective solution facilitates early return on investment (ROI), through integrating your
different process, thus reducing processing time and manpower required for completing any
task. This of course, makes our health care software solutions suitable for s organizations like
Shifa and corporate hospitals. The user will need to be able to call on a repair team when things
 19

break. Smaller items of equipment will be serviceable by the hospital team, whereas large
scanners etc. will require specialist outside services. Contract Management The purchase
contract should have details of what warranty services are available and contact details to call in
these services. Either stores or administration should monitor performance against these
contracts and plan for cover on expiry of any agreement. Consumables supply the needs for
consumables should have been specified during the procurement process, so that necessary
supplies are available from the start of equipment use. A schedule of restocking will need to be
developed, so that there is never a gap in services.
✓ Effective Maintenance Strategy
It is essential that we plan the resources required for maintenance. Planning will need to be made for both
repair work and also for planned preventive maintenance. The following will also promote effective
maintenance. Types and approaches to Maintenance of Medical Equipment: There are two types of
maintenance: Corrective Maintenance (or Repair): This is done to take corrective action in the event of a
breakdown of the equipment. The equipment is returned repaired and calibrated. Preventive
Maintenance: This work is done in a planned way before repair is required and the scheduled time for the
work circulated well in advance. It involves cleaning, regular function, safety tests and makes sure that
any problems are picked up while they are still small. The choice of approach for preventive and corrective
maintenance depends on the complexity of equipment. Maintenance by in-house trained technicians the
majority of the problems are relatively simple and can be corrected by a trained technician. Vendors
should provide training to in-house technicians at the time of installation and commissioning.
Maintenance by manufacturer or third party for specialized and advanced equipment, the vendor should
provide maintenance services through a combination of on-call services and a maintenance contract
negotiated at the time of the purchase. It will rarely be economical to provide this level of service in-
house.

✓ Planned Maintenance of Medical Equipment

Planned preventive maintenance is regular, repetitive work done at scheduled intervals to keep
equipment in good working condition. The activities under preventive maintenance involve routine
cleaning, calibrating and adjusting, checking for wear and tear and lubricating to optimize working
efficiency and to avoid breakdown. Also, consumables replacement like the fitting of new of filters, etc.,
is done as part of this work. Effective planning for preventive maintenance involves proper selection of
the equipment to be included in the plan. Decisions must be made on what to include in order reducing
costs. Inexpensive units can be replaced or repaired if they break down, so need not always be included.
The overriding consideration is cost effectiveness.

✓ Disposal of Equipment
Healthcare institutions must ensure that there are proper procedures in place for condemnation and
disposal of equipment that is unserviceable or that is no longer required. This will take old and potentially
unsafe equipment out of service, make sure hazardous materials are properly treated and makes storage
space available. Procedure for condemnation and disposal of medical and allied equipment is given below:
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1. Equipment may be declared surplus, obsolete or unserviceable if it is: Surplus to requirement

where a surplus piece of equipment remains serviceable, management should be informed. It
may be decided to store the equipment, auction it or use it elsewhere.
2. Unserviceable or unreliable if equipment cannot be repaired (either no parts available or not
economical to repair) or it cannot be maintained properly it should be scrapped and replaced.
3. Obsolete when equipment is not usable because parts are out of date or the clinical technique is
no longer recommended it should be scrapped.

➢ Hospital Wastes
Everything is made for a defined purpose “anything which is not intended for further use is
termed as waste”. In the scientific and industrial era combined with increasing population and
their demand, the turnover of products has gone very high resulting into increase in quantum of
urban solid waste. With increasing need of Health Care in fast changing society the role of
hospitals/nursing homes comes to the forefront. “Hospital is a residential establishment which
provides short term and long-term medical care consisting of observational, diagnostic,
therapeutic and rehabilitative services for a person suffering or suspected to be suffering from
disease or injury and for parturient. It may or may not also provide services for ambulatory
patients on an outpatient basis”. Hospital Waste or Health care waste should include any type of
material generated in Health Care Establishments including aqueous and other liquid waste.
Hospital waste means “Any solid, fluid or liquid waste material including its container and any
other intermediate product which is generated during short term and long term care consisting
observational, diagnostic, therapeutic and rehabilitative services for a person suffering or
suspected to be suffering from disease or injury and for parturient or during research pertaining
to production and testing of biological during immunization of human beings. Hospital waste
includes garbage, refuse, rubbish and Bio Medical Waste”

Present Scenario of waste at Shifa

Waste management is one of the important public health measures. If we go into the historical
background, before discovery of bacteria as cause of disease, the principle focus of preventive
medicine and public health has been on sanitation. The provision of potable water, disposal of
odors from sewage and refuse were considered the important factors in Prevention of epidemics.
Coming back to modern age, on the eve of 21st century with increased use of disposable material
and the presence of dreaded disease like Hepatitis – B and AIDS, it is utmost important to take
care of the infected and hazardous waste to save the mankind from disaster. The Health care
institutions or hospitals which are responsible for care of morbid population are emitting
voluminous quantity of rubbish, garbage and Bio Medical Waste matter each day from wards,
operation theatre and outpatient areas. Proper management of hospital waste is essential to
maintain hygienic, aesthetics, cleanliness and control of environmental pollution. The hospital
waste like body parts, organs, tissues, blood and body fluids along with soiled linen, cotton,
 21

bandage and plaster casts from infected and contaminated areas along with used needles,
syringes and other sharps are very essential to be properly collected, segregated, stored,
transported, treated and disposed of in safe manner to prevent nosocomial or hospital acquired
infection. Various communicable diseases, which spread through water, sweat, blood, body fluids
and contaminated organs, are important to be prevented. The Bio Medical Waste scattered in
and around the hospitals invites flies, insects, rodents, cats and dogs that are responsible for the
spread of communication disease like plague and rabies. Rag pickers in the hospital, sorting out
the garbage are at a risk of getting tetanus and HIV infections. The recycling of disposable
syringes, needles, IV sets and other article like glass bottles without proper sterilization may be
responsible for Hepatitis, HIV, and other viral diseases. It becomes primary responsibility of
Health administrators to manage hospital waste in most safe and eco-friendly manner. With the
proliferation of blood borne diseases, more attention being focus on the issue of infectious
medical waste and its disposal, Health care institutions must be aware of the potential risk in
handling infectious waste, and adhere to the highest standards of disposal and transport.
Education of the staff, patients and community about the management of the infectious waste
is crucial in today’s health care arena.
The biomedical waste is the waste that is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining thereto, or in the
production or testing of biological components. The different location or points of generation of
waste in a health care establishment are:
1. Operation theatres/wards/labor rooms
2. Dressing rooms
3. Injection rooms
4. Intensive care units
5. Dialysis room
6. Laboratory
7. Corridor
8. Compound of hospital or nursing home

Proposed Solutions
1. Set up requisite biomedical waste treatment facilities like incinerators, autoclave and microwave
systems for treatment of the wastes, or ensure requisite treatment of the waste at a common
waste treatment facility
2. Make an application to the concerned authorities for grant of authorization. A fee as prescribed
shall accompany each application for grant of authorization.
3. Submit a report to the prescribed authority by 31 January every year. The report should include
information about the categories and quantities of bio-medical wastes handled during the
preceding year.
4. Maintain records about the generation, collection, reception, storage, transportation,
treatment, disposal and / or any form of handling of bio-medical waste.
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Report of any accident to the prescribed authority

✓ Administration and Managerial Aspects

The management of the health care establishment should make an action plan to implement
the recommendations of the rules framed by the Government of India (Ministry of Environment
of Forests). This would include the following:
1. Formation of a Waste Management Committee as outlined above.
2. Clear indication of the role of each member of the committee.
3. Action Plan for proper waste management in the particular health care establishment
and its documentation. This plan should be reviewed once a year.
4. Development of a format for reporting accidents and incidents relating to bio-medical
waste management and its meticulous following.
5. Assessment of all the survey results and their utilization– once in every 6 months.

Conclusion
The domain of supply chain management in healthcare, and more specifically at the internal
hospital supply chain in the operating room environment. The internal supply chain is unique and
differs from other industries. Interaction between clinical, material and information flows are
essential for improving operational performance of the logistics processes and to obtain an
integrated supply chain. Although patient care is the primary concern in hospitals, operations
related activities are critical in ensuring safety, availability and affordability of supplies and
processes. The right supplies should be delivered in the right condition to the right patients at
the right time. The operational functioning of the internal supply chain and the integration and
coordination of the processes are vital to support patient care processes. Hospital materials
management impacts clinical, financial and operational outcomes. With the supply costs
accounting for as much as 40% of the average hospital operating budget, a well-defined supply
chain strategy is needed to align the internal logistics processes and to efficiently control supply
costs. In recent years, the costs associated with logistics activities, such as handling, storing and
moving materials have increased and hidden stocks are held by clinical staff to avoid stock-outs.
Hospitals are forced to become operationally efficient in their operations. “Operational
excellence is achieved through the use of best inventory management and distribution systems,
combined with continuous supply chain process improvements and better integration with the
patient care process”. Integration and streamlining the supply chain is required to increase
efficiency while guaranteeing high quality patient care. However, a lack of visibility of end-to-end
performances of logistics processes, low product traceability, internal distribution problems, low
ability to manage product utilization and a lack of data standardization make it challenging for
logistics managers to achieve supply chain excellence. Furthermore, a lack of coordination
between several unit departments and little expertise in the operations research field complicate
the efficient operation of healthcare logistics processes. Coordination and integration between
processes will positively contribute to the performance of the supply chain. Information
technology and technological advances are essential tools to achieve an integrated supply chain.
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This overview focuses on the elements that are determining an efficient and effective logistics
flow within a hospital. It addresses the performance indicators (e.g. costs, time, inventory
parameters, service level, criticality of items, etc.) identified from literature that impact the
internal logistics flow in a hospital. Performance measurement is important to address
inefficiencies in the logistics activities and it serves as a good input for decision makers in the
healthcare supply chain. In hospitals, however, many parameters for inventory management are
not up-to-date, which causes decreased performance of the internal supply chain. Several
performance indicators are of interest to the different stakeholders when optimizing the
inventory management and distribution activities. Therefore, MCDM techniques are useful to
evaluate and combine these indicators while taking into account the stakeholders’ preferences.

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References

1-www.shifa.com.pk
2-Shifa International Hospital Annual Report 2018
3-Information Collect from Lady Doctor Tahira Zubair
 25

Team Evaluation
Total marks = 10

Name Marks Obtain from 10

FaKhir Ansari 8.0
Junaid Hassan 9.5
Muneed Ahmad 8.0
Mustehsan Raza 9.5
Zarmeena Gauhar 8.5
Sohaib Hassan Bukhari 9.0
Waseem Shahzad Raza 9.5