SUMMER INTERNSHIP REPORT (SIP)

Internship Report on “.PATIENT SAFETY & FALL PREVENTION IN

MANGALORE HOSPITALS”

A summer Internship report submitted

To

SRINIVAS UNIVERSITY

For partial fulfillment of the Requirement for the Award of the Degree

In

MASTER OF BUSINESS ADMINISTRATION

by

MOHAMED RIJAS.K 01SU22HH008

Under the Guidance of

DR.ABHISHEK N

DEPARTMENT OF MBA

INSTITUTE OF ENGINEERING AND TECHNOLOGY

SRINIVAS UNIVERSITY, SRINIVAS NAGAR, MUKKA, MANGALORE- 574146

1
 DECLARATION

I, MOHAMED RIJAS K hereby declare that the thesis entitled “PATIENT SAFETY &
FALL PREVENTION IN MANGALORE HOSPTITALS” submitted to the Institute of
Engineering and Technology, Department of MBA, Mangalore, in partial fulfillment of
the requirements for the award of the Degree of Master of Business Administration of is a
record of the original research work done by me during 2023 under the supervision and
guidance of DR.ABHISHEK N ,Assistant professor Srinivas University and the project
work has not been previously formed the basis for the award of any degree, diploma, or
any other similar title.

MOHAMED
RIJAS.K
01SU22HH008

Date:
20/11/2023

ii
 INSTITUTE OF ENGINEERING &
TECHNOLOGY MUKKA, MANGALORE –
574146

Department of Master of Business Administration

CERTIFICATE

This is to certify that the internship project entitled “PATIENT SAFETY & FALL

PREVENTION IN MANGALORE HOSPITALS” is a Bonafide work carried out by

MOHAMED RIJAS K bearing the USN 01SU22HH008 in the partial fulfillment for

the award of Master of Business Administration in Hospital and healthcare

management of Srinivas University, Department of MBA, Institute of Engineering

and Technology during the year 2022-23. It is to certify that all

corrections/suggestions indicated for internal assessment has been incorporated in

the report deposited in the department library. The internship report has been

approved as it satisfies the academic requirements in respect of internship work

prescribed for the said degree.

Dr. Thomas Pinto

iii
Dr. Abhishek . N (Dean)

COMPANY/ HOSPITAL
INTERNSHIP CERTIFICATE

iv
 Acknowledgements

Place:
Mangalore
Date:20/11/
2023

Through this acknowledgement I express my sincere gratitude towards all those people
who helped me in this project, which has been a learning experience.
This space wouldn’t be enough to extend my warm gratitude towards my project guide for
efforts in coordinating with my work and guiding me in the right direction.
Firstly, I would like to place on record my heartfelt gratitude to my guide Dr.Abishek N,
Assistant professor Srinivas University . Words prove insufficient for his scholarly
insights, inspired discussions, progressive vision, loving encouragement, meticulous care
and friendly concern.
I express my gratitude to Dr. Anil, Registrar, Dr. P.S. Aithal, Honorable Vice-Chancellor,
Srinivas University, for giving me the essential hand in concluding this work. I express
my gratefulness to Dr. Thomas Pinto, Dean, Institute of Engineering and Technology,
Department of MBA, Srinivas University and Claresa operation manager Private Hospital.
It would be injustice to proceed without acknowledging those vital supports I received from
my beloved classmates and friends, without whom I would have been half done.
I also use this space to offer my sincere love to my parents and all others who have been there,
helping me walk through this work.

MOHAMED RIJAS K

v
 EXECUTIVE SUMMARY

This title “PATIENT SAFETY & FALL PREVENTIONS IN HOSPITALS IN

MANGALORE” it provides an introduction to ensure patient safety in health care
organization, practice and policy , presenting an overview of healthcare that emphasizes the
interplay between society & individuals. It aims to develop understanding of how healthcare
organizations are aware of patient safety. This report will also help us to understand the
prevention of patient fall and medication errors in the hospital. This study will help us to
know how hospitals in Mangalore are aware of patient safety.
Patient safety is defined as “the absence of preventable harm to a patient and reduction of risk
of unnecessary harm associated with health care to an acceptable minimum." Within the
broader health system context, it is “a framework of organized activities that creates cultures,
processes, procedures, behaviors , technologies and environments in health care that
consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make
error less likely and reduce impact of harm when it does occur.

There are many categories of the healthcare units that have been set up in Mangalore and the
categories have been made According to the areas that are served by the healthcare units
here I am conducting my study on private Medical College about patient safety, patient
fall ,medication errors, risk assessment, infection control, medical equipment errors, Hygiene
factors, risks associated with the reusing of surgical tools , infrastructure defects & overall
quality improvement.

Patient safety is a paramount concern in any healthcare project, serving as its ethical and
foundational cornerstone. The primary purpose is to mitigate and prevent harm to patients
during the course of their medical care. This involves implementing robust systems and

vi
 protocols to identify, address, and learn from potential risks and errors. Ensuring patient
safety not only upholds the fundamental principle of healthcare - to do no harm - but also
contributes

to building trust between healthcare providers and patients. It fosters a culture of continuous
improvement, where lessons from past incidents drive enhancements in processes and
standards, ultimately safeguarding the well-being of those seeking medical assistance. In
essence, patient safety is not just a project goal; it's a commitment to the highest standard of
care and the preservation of human.
This study will also help to identify various patient fall, unhygienic treatment conditions,
medical errors, infection controlling, & helps to know how infrastructural development are
related with patient safety. This report will shows the comparison of various hospitals in
Mangalore regarding patient safety for that we took a non random survey from people in
Mangalore .
While doing my internship in Private Hospital I had identified various infrastructural
defects,
Lack of technology, lack of modern medical equipments, leackages in wards & floors,
unhygienic environment, reusing of surgical tools. From these problems I will make sure to
find the solution by using various ways. For analyzing patient safety & fall prevention in
Private Hospital i will take some quality tools & survey methods for internship study. Here as
a methods for analyzing & identifying the problems in Private Hospital I will use
observational methods, comparative analysis , feedbacks from professionals etc.

While doing my internship in Private Hospital I had identified various infrastructural

defects,
Lack of technology, lack of modern medical equipments, leackages in wards & floors,
unhygienic environment, reusing of surgical tools. From these problems I will make sure to
find the solution by using various ways. As a study Design I am using non random sampling
method which is according to my convenience , observational study & direct interview
methode for my study, this survey method that I have done Mangalore regarding the
comparison patients safety hospitals in Mangalore. For non random survey I am taking 50
vii
sample sizes.

For measuring & implementing patient safety I am using some quality tools that is

1) DMAIC
2) BENCHMARKING

For measuring the problems , I had gone through various departments in ground floors , first
floor, 2nd floor & 3rd floors . on my 1 month of internship I was assigned to work in various
departments under the quality manager. From that I was assigned to work as a facility
manager for that I had visited in every departments in the srinivas such as orthopeadics ,
casuality, cathlab ,x-ray rooms,
Ultrasounds , cardiology, ENT, Radiology, OBG, Surgeries,peadiatrics ,gynecology etc. from
the above mentioned departments I have identified various problems including defects on
tiles, errors on medical equipments, lack of hygiene etc. I made list of various defects &
errors inside Private Hospital & handover to high authority. I found so many risks which may
harm patients

Based on my analysis & recommendation in Private Hospital for ensuring patient safety , the
hospital has to make some changes in infrastructure to prevent patient fall because I
identified that so many tiles were brocken in departments which may leads to patient fall, if
patient fall happens ultimately which results in hospital reputation & it will goes down. If the
hospital raises amount replacing the cracks & defects on walls, roofs which will prevent
patient fall.
The hospital has to focus on hygiene to prevent infections inside the hospitals, for that the
hospital
Should be steriled & cleaned . Controlling infections in a hospital requires a multifaceted
approach to mitigate risks and ensure patient safety. Fundamental to this effort is the strict
viii
 enforcement of hand hygiene practices among healthcare workers, patients, and visitors.
Proper use of personal protective equipment, isolation precautions for contagious patients,
and diligent environmental cleaning contribute significantly to preventing the spread of
infections. Implementing robust sterilization and disinfection protocols for medical
instruments, along

with effective waste management, is essential. Hospitals should also emphasize antibiotic
stewardship to combat antibiotic resistance and promote responsible medication use.
Education and training programs for healthcare staff play a crucial role in keeping everyone
informed about the latest infection control guidelines. Collaboration with public health
agencies, routine surveillance, and the development of emergency preparedness plans
enhance the hospital's ability to respond effectively to infectious disease challenges.
Together, these measures establish a comprehensive framework to control infections and
maintain a safe healthcare environment.

Minimizing the reuse of single-use medical equipment is essential for infection prevention and
patient safety. Healthcare facilities should adopt strict policies and practices to ensure the
responsible disposal of single-use items after each patient encounter. This includes items
such as syringes, needles, and certain surgical instruments. Implementing clear guidelines on
the appropriate use and disposal of single-use items, as well as providing staff with adequate
training, helps maintain a high standard of hygiene. Additionally, investing in quality single-
use alternatives and promoting awareness among healthcare providers about the potential
risks associated with improper reuse can contribute to a safer healthcare environment.
Regular audits and monitoring of adherence to these practices further reinforce the
commitment to minimizing the reuse of disposable medical equipment.
Staff Training: Provide comprehensive training for healthcare professionals on patient
safety protocols, infection control, and the proper use of medical equipment. Regular updates
and ongoing education help keep staff informed about best practices.
Checklists and Protocols: Implement standardized checklists and protocols for various
procedures to ensure consistency and reduce the risk of errors. This is particularly effective in
critical processes like surgery or medication administration.
Infection Control: Strict adherence to infection control practices, including hand hygiene,
ix
proper use of personal protective equipment, and environmental cleanliness, is crucial to
prevent healthcare-associated infections.
Patient Safety Committees: Establish patient safety committees within healthcare
institutions to regularly review incidents, analyze root causes, and implement corrective
actions. This promotes a culture of continuous improvement .

Ensuring patient safety in healthcare relies significantly on the use of updated medical
equipment. Continuous advancements in technology offer opportunities to enhance
diagnostic accuracy, treatment precision, and overall quality of care. Modern medical
equipment often incorporates features that prioritize patient well-being, such as improved
infection control measures, ergonomic designs, and user-friendly interfaces. Upgrading to
state-of-the-art equipment allows healthcare providers to stay at the forefront of medical
innovation, facilitating more accurate diagnoses and efficient treatments. Regular
maintenance and calibration of these technologies are imperative to ensure their optimal
performance and reliability. Investing in the latest medical equipment not only improves
clinical outcomes but also reflects a commitment to providing the highest standard of care
and safety for patients

x
.
TABLE OF CONTENT

Chapter No. Title Page No.

Declaration 2

Certificate 4

Acknowledgement 5

Executive Summary 6-10

List of Tables 12

List of Charts and Figures 13

CHAPTER I INTRODUCTION 14-32

Healthcare industry
Importance of research
Problem statement
Objectives of research
COMPANY PROFILE 33-51
Background
CHAPTER II
Vision , mission and quality policy
Organisational structure
DESIGN OF STUDY 52-57
Objective
CHAPTER III
Scope
Limitation
REVIEW OF LITERATURE 58-62
CHAPTER IV

INTERNSHIP ENGAGEMENT 63-79

Organisational study
Operations
CHAPTER V
Marketing
Finance
Human Resource Management
80-98
CHAPTER VI LEARNING OUTCOME
99-104
CHAPTER VII CONCLUSION

REFERENCE 100-102

Annexure 103-104

xi
 LIST OF TABLES

Sl. No. Title Page

No.
1.1 HEALTHCARE INDUSTRY 15-21

1.2 IMPORTANCE OF RESEARCH 21-22

1.3 OBJECTIVES OF REASEARCH 31-32

2.1 VISSION &MISSION 37

2.2 DEPARTMENTS 37-43

2.3 SURGICAL FACILITIES 43-47

COMPETITORS IN MARKET 48-51

2.4

3.1 INTERNSHIP OBJECTIVES 53-54

3.2 SCOPE 54-55

3.3 HYPOTHESIS 56

3.4 LIMITATIONS 56-57

4.1 REVIEW OF LITERATURE 58-62

5.1 ORGANISATIONAL STUDY 64-65

5.2 MEDICAL RECORD DEPARTMENT 66-71

5.3 OPERATIONS 71-77

5.4 HOSPITAL MANAGEMENT INFORMATIONAL SYSTEM 77-79

6.1 METHODE OF MY STUDY 82-84

6.2 FINDINGS 84-85

6.3 DATA ANALYSIS OF CONVENIENT SAMPLING 86-97

6.4 INTEPRETATION 97-98

6.5 SUGGESTIONS/SOLUTIONS 98

7.1 CONCLUSION 100

7.2 REFERENCE 100-102

7.3 ANNEXURE 103-104

xii
 LIST OF CHARTS AND FIGURES

Sl. No. Title Page No.

5.2 MEDICAL RECORD DEPARTMENT 66,68,71

5.4 OPERATIONS 73,74

6.1 METHODE OF STUDY 83,84

6.3 DATA ANALYSIS OF CONVENIENT SAMPLING 86-97

xiii
 CHAPTER-1
INTRODUCTION

14
1. INTRODUCTION TO THE STUDY

This report provides an introduction to ensure patient safety in health care organization,
practice and policy , presenting an overview of healthcare that emphasizes the interplay
between society & individuals. It aims to develop understanding of how healthcare
organizations are aware of patient safety. This report will also help us to understand the
prevention of patient fall and medication errors in the hospital. This study will help us to
know how hospitals in Mangalore are aware of patient safety.
Patient safety is defined as “the absence of preventable harm to a patient and reduction of
risk of unnecessary harm associated with health care to an acceptable minimum." Within
the broader health system context, it is “a framework of organized activities that creates
cultures, processes, procedures, behaviors , technologies and environments in health care
that consistently and sustainably lower risks, reduce the occurrence of avoidable harm,
make error less likely and reduce impact of harm when it does occur.
There are many categories of the healthcare units that have been set up in Mangalore and
the categories have been made According to the areas that are served by the healthcare
units here I am conducting my study on Private Hospital about patient safety, patient fall
,medication errors, risk assessment, infection control, medical equipment errors, Hygiene
factors, risks associated with the reusing of surgical tools , infrastructure defects &
overall quality improvement.

1.1 HEALTHCARE INDUSTRY

The Healthcare Industry is comprised of companies that offer clinical services, manufacture drugs
and medical equipment, and provide healthcare-related support services like medical insurance. Its
also referred to as the medical industry. These companies play a key role in the diagnosis,
treatment, nursing, and management of illness, disease, and injury.

15
The healthcare industry also provides preventive, remedial and therapeutic services to patients. To
offer these services, there needs to be collaboration amongst healthcare providers including

doctors, nurses, medical administrators, government agencies, pharmaceuticals, medical

equipment manufacturers, and medical insurance companies.

The Healthcare Industry is one of the largest and is expected to continue growing well into the
future guided by several drivers. Key among them will be; technological innovation, integration of
medicine and healthcare, smart healthcare data management, and a patient-centered restructuring.

This growth will be inevitable if and when technology is be embraced in every sector of the
healthcare industry. This will call for massive investments in terms of cognitive computing,
electronic patient records, interoperability, big data, etc. A digitized healthcare system will
provide for better diagnostics, improve the quality of care, and also reduce operational costs.

At the center of this digital transformation is the need for innovative and cost-effective ways to
deliver patient-centered, technology-enabled health care. Innovation will play a key role in the
design and manufacture of medical products, equipment, and services.

Technological innovation can, for instance, stimulate operational efficiency by helping connect
and coordinate operations of all healthcare providers in their different areas of expertise.
Integration of medicine and health care will also provide a holistic approach to healthcare through
creation of a collaborative framework that will promote integration of skills and competencies
across pharmaceuticals, medical equipment manufacturers, and healthcare providers.

Healthcare data management will mainly revolve around smart systems that can provide
permission control, anonymity, and confidentiality when it comes to health data.

For healthcare providers, data analysis will help to determine which patients need prompt or
specialized care, which can go a long way in efficiently managing available resources. It will also
assist them in deploying innovative care delivery and wellness models based on metrics derived
from data. With technology, it will be possible to monitor and ascertain the effectiveness of certain
medications on individuals or entire patient populations.The future healthcare industry will be
patient-centered; placing emphasis on the creation of value for patients rather than the volume of
services delivered. Based on that, how effective a healthcare system is will be determined by

16
clinical outcomes and patient experience. A value-based healthcare system can be developed and
supported by an array of reform policies and programs within the healthcare industry.

FUTURE OF HEALTHCARE INDUSTRY

The future of the healthcare industry is poised for significant transformation on multiple fronts,
driven by technological advancements, evolving patient expectations, and the need for improved
healthcare delivery. One of the most prominent trends in the industry is the increasing integration
of digital health solutions. Telemedicine, remote patient monitoring, and wearable health tech are
becoming more widespread, offering convenient and cost-effective ways for patients to access
care and manage their health. Artificial intelligence and machine learning are also being harnessed
for tasks like diagnostics, treatment planning, and predictive analytics, enhancing the efficiency
and accuracy of healthcare services.

Personalized medicine is another key aspect of the future of healthcare. Advances in genomics and
precision medicine enable tailored treatment plans, reducing the one-size-fits-all approach and
improving patient outcomes. Moreover, the healthcare ecosystem is shifting towards a more
patient-centric model, with a focus on enhancing the overall patient experience. This includes
greater transparency in healthcare pricing and outcomes, empowering patients to make informed
decisions about their care.

The importance of data security and privacy in healthcare cannot be overstated, given the growing
digitization of health records and the increasing amount of sensitive patient data. Regulatory
bodies are likely to play a critical role in shaping the industry's future by implementing and
enforcing strict data protection and cybersecurity measures.

Additionally, the healthcare industry is expected to experience increased collaboration between

various stakeholders, such as healthcare providers, pharmaceutical companies, and technology

17
firms. These partnerships will drive innovation and the development of new therapies, as well as
streamline healthcare delivery.

In terms of the workforce, the future of healthcare will see a shift in roles and responsibilities, with
a growing demand for healthcare professionals skilled in data analysis, telemedicine, and AI
technologies. It is also likely that healthcare delivery will become more decentralized, with a
greater emphasis on home-based care and community health services.

In conclusion, the future of the healthcare industry is marked by an exciting and dynamic
landscape. Technology will continue to play a central role in improving healthcare access, quality,

and personalization. Patient empowerment, data security, and collaboration will be essential
elements of this transformation, ensuring that the healthcare industry evolves to meet the changing
needs of individuals and society as a whole

HEALTHCARE INDUSTRY IN INDIAN ECONOMY

The healthcare industry in India plays a vital role in the country's economy, contributing
significantly to both its GDP and employment. India's healthcare sector is multifaceted,
encompassing various components such as hospitals, pharmaceuticals, medical devices, health
insurance, and telemedicine. This industry is characterized by its rapid growth and increasing
investments in recent years, driven by factors such as a growing population, rising healthcare
awareness, and government initiatives.

One of the primary drivers of India's healthcare economy is medical tourism. The country has
become a popular destination for patients seeking high-quality medical treatments at a fraction of
the cost compared to Western countries. This influx of medical tourists bolsters revenue for
hospitals and related services.

Pharmaceuticals are another key pillar of the Indian healthcare sector. India is one of the world's
largest producers of generic drugs, supplying affordable medicines globally. This not only caters
to the healthcare needs of its own population but also helps in curbing healthcare expenses for
countries worldwide.
18
Additionally, the Indian government has introduced various health insurance schemes, aiming to
provide affordable healthcare to the masses. These initiatives further stimulate the growth of the
healthcare industry and contribute to economic development.

The emergence of telemedicine and digital health services in India has also been noteworthy.
Especially in light of the COVID-19 pandemic, the adoption of telehealth services has surged,
making healthcare more accessible and convenient for the population.

While the healthcare industry in India has witnessed significant growth, challenges such as
unequal healthcare access, infrastructure disparities, and regulatory issues persist. However, as the
country continues to invest in healthcare infrastructure and improve healthcare delivery, the
industry is poised to remain a significant contributor to India's economy and well-being.

1.Healthcare Providers

 Hospitals and other medical centers: They conduct diagnosis and treatment of diseases,
teaching, research, and training. Hospitals are equipped with medical equipment and
facilities of all kind including operating theatres where medical professionals conduct
major surgical procedures.

 Nursing homes and rehabilitative centers: They offer both short- and long-term care
services. Short-term care may include rehabilitative care after undergoing a surgery, illness
or injury. This may include physical therapy, occupational therapy or speech-language
therapy. Long-term care is offered to the sick, elderly and disabled.

 Ambulatory service providers: These are physicians and other health professionals who
provide outpatient medical services or non-hospital-based care. For outpatient-based care,
a patient visiting a hospital or an outpatient clinic gets diagnosed, treated, and released on
the same day.

2. Healthcare Financiers

 These are government agencies and private companies that provide health insurance
policies and fund healthcare services. They are tasked with pooling of medical funds
collected through employer contributions or individual insurance policies, and oversee
payment for services rendered. Healthcare financiers outline how people access health
care, the kind of healthcare to be covered, and the allocation of healthcare services.

19
 3. Life Sciences

 This segment includes; pharmaceutical firms which make drugs and other chemical
products needed for the provision of health care; manufacturers who make high-tech
medical equipment; and biotechnology firms that conduct research and development to
create new drugs, equipment, and treatment methods. Others who also fall in this segment
are all those who provide other miscellaneous scientific services for the diagnosis,
treatment, and monitoring of patients.

CHALLENGES IN HEALTHCARE

The healthcare industry faces a myriad of challenges, both in India and globally. These challenges
have far-reaching implications for patient care, cost management, and overall healthcare system
effectiveness. One major challenge is the rising cost of healthcare. As medical technology
advances and the demand for healthcare services grows, the cost of treatments, medications, and
procedures escalates. This makes healthcare less accessible to many, leading to financial burdens
for individuals and governments alike.

Another significant challenge is the issue of healthcare inequality. Disparities in healthcare access
and quality exist within and between countries. In India, for instance, rural areas often lack
adequate healthcare infrastructure and services, resulting in unequal access to care. This inequality
is further compounded by socioeconomic factors, leaving vulnerable populations with limited
access to essential healthcare services.

Healthcare industry professionals also face challenges related to regulatory and compliance issues.
Stringent regulations, evolving healthcare laws, and the need to adopt electronic health records can
be burdensome for healthcare providers. These regulatory complexities can divert resources and
attention away from patient care.

Technological challenges are also prevalent, particularly with the integration of electronic health
records and cybersecurity concerns. The digitization of patient information introduces issues
related to data privacy and security, which, if not addressed effectively, can compromise patient
confidentiality and trust in the healthcare system.
20
The shortage of healthcare professionals is a global challenge, impacting the quality and
availability of care. India, like many countries, faces a shortage of doctors, nurses, and other
healthcare workers. This can lead to overburdened healthcare facilities and longer wait times for
patients seeking care.
Lastly, the global health challenges brought about by pandemics, such as COVID-19, highlight the
need for improved healthcare infrastructure and preparedness. The healthcare industry must
remain adaptable and resilient in the face of unforeseen health crises.

Addressing these challenges requires a multi-faceted approach that involves government

intervention, healthcare providers, technological advancements, and public awareness. By tackling
these issues, the healthcare industry can work towards a more equitable, cost-effective, and
accessible healthcare system that meets the needs of diverse populations

1.2 IMPORTANCE OF RESEARCH

In this project I will explain the objectives of patient safety in a hospital, Methodologies,
hypothesis testing on while patient safety is directly related
To the overall quality & Growth of the hospital, sources of survey &interpretation of surveys,
what all strategies can enhance the patient safety.

The significance of patient safety in a hospital cannot be overstated, directly impacts the
well-being of patients, the reputation of healthcare institutions, and the overall quality of
healthcare delivery. In my project report, I can elaborate on the importance of patient safety.
Patient safety is of paramount importance in hospital settings as it directly impacts the well-being
and lives of individuals seeking medical care. Ensuring patient safety is a fundamental ethical and
professional responsibility of healthcare providers. It involves a multifaceted approach that

21
includes preventing medical errors, minimizing risks, and promoting a culture of open
communication and continuous improvement. Patient safety not only safeguards patients from
harm but also has significant financial implications for hospitals, as medical errors can result in
costly legal actions and decreased trust in healthcare institutions. Moreover, it is closely tied to the
overall quality of care, influencing patient satisfaction and outcomes. As a critical component of
healthcare, patient safety underscores the need for comprehensive training, robust protocols, and
vigilant oversight, all contributing to the delivery of effective and compassionate healthcare
services. Therefore, prioritizing patient safety is vital for hospitals to fulfill their mission of
providing high-quality, safe, and reliable care to patient.

The occurrence of adverse events due to unsafe healthcare is likely one of the ten leading causes
of death and disability around the world.
1) These adverse events may be related to medication errors, healthcare-associated infections, un
safe surgical care procedures, unsafe injection practices, diagnostic errors, unsafe transfusion
practices, radiation errors,
sepsis, venous thromboembolism, etc.
2 )Yearly, around134 million adverse events occur in hospitals in low- and
middle-income countries due to unsafe medical care resulting in a humongous 2.6 million deaths.

3) Patient safety is the reduction and mitigation of unsafe

acts within the healthcare system through the implementation
of best practices to ensure an optimal patient outcome.
4) It aims to prevent and reduce risks, errors, and harm to patients
during healthcare delivery. A reduction in patient harm leads
to a better patient outcome (both physical and psycho-
logical), as well as, a lesser economic burden.
5) Recognizing that patient safety is a global health priority,
the World Health Assembly adopted a resolution on patient
safety . Patient safety is still in its infant stages in India, despite the
emphasis by the World Health Organization.
6) Patients form the cornerstone of patient safety.

Hence ,it is imperative to understand the awareness of patients, i.e. the healthcare consumers,

22
about patient safety. There is a dearth ofstudies from India evaluatingpatients’ perspectives on
patientsafety. Hence this study was performed to gain an insight into the awareness of Indian
patients about patient safety .

PROBLEM STATEMENT

The problem of patient safety in healthcare is a critical and pervasive issue. Despite significant
advancements in medical practices and technology, preventable medical errors, adverse events,
and hospital-acquired infections continue to pose a threat to patient well-being. These safety
lapses can result from various factors, including miscommunication among healthcare
professionals, medication errors, understaffing, lack of standardized protocols, and issues related
to patient handoffs. Patients are sometimes exposed to unnecessary risks during hospital stays or
medical procedures, which can lead to avoidable harm, extended hospitalizations, and increased
healthcare costs. Ensuring patient safety requires a comprehensive approach that includes
improved communication, enhanced training for healthcare professionals, the implementation of
quality improvement programs, and the use of technology to minimize errors and improve care
coordination. Addressing patient safety concerns is vital to achieving high-quality healthcare and
preventing avoidable harm to patients.

Common sources of patient harm

Medication errors. Medication-related harm affects 1 out of every 30 patients in health care, with
more than a quarter of this harm regarded as severe or life threatening. Half of the avoidable harm
in health care is related to medications .

Surgical errors. Over 300 million surgical procedures are performed each year worldwide .
Despite awareness of adverse effects, surgical errors continue to occur at a high rate; 10% of
preventable patient harm in health care was reported in surgical settings , with most of the
resultant adverse events occurring pre- and post-surgery .

Health care-associated infections. With a global rate of 0.14% (increasing by 0.06% each year),
health care-associated infections result in extended duration of hospital stays, long-standing
disability, increased antimicrobial resistance, additional financial burden on patients, families and
health systems, and avoidable deaths .

23
Sepsis. Sepsis is a serious condition that happens when the body’s immune system has an extreme
response to an infection. The body’s reaction causes damage to its own tissues and organs. Of all
sepsis cases managed in hospitals, 23.6% were found to be health care associated, and
approximately 24.4% of affected patients lost their lives as a result .

Diagnostic errors. These occur in 5–20% of physician–patient encounters . According to doctor

reviews, harmful diagnostic errors were found in a minimum of 0.7% of adult admissions . Most
people will suffer a diagnostic error in their lifetime .

Patient falls. Patient falls are the most frequent adverse events in hospitals . Their rate of
occurrence ranges from 3 to 5 per 1000 bed-days, and more than one third of these incidents result
in injury , thereby reducing clinical outcomes and increasing the financial burden on systems .

Venous thromboembolism. More simply known as blood clots, venous thromboembolism is a

highly burdensome and preventable cause of patient harm, which contributes to one third of the
complications attributed to hospitalization .

Pressure ulcers. Pressure ulcers are injuries to the skin or soft tissue. They develop from pressure
to particular parts of the body over an extended period. If not promptly managed, they can have
fatal complications. Pressure ulcers affect more than 1 in 10 adult patients admitted to
hospitals and, despite being highly preventable, they have a significant impact on the mental and
physical health of individuals, and their quality of life.

Unsafe transfusion practices. Unnecessary transfusions and unsafe transfusion practices expose
patients to the risk of serious adverse transfusion reactions and transfusion-transmissible
infections. data

on adverse transfusion reactions from a group of 62 countries show an average incidence of 12.2
serious reactions per 100 000 distributed blood components.

Patient misidentification. Failure to correctly identify patients can be a root cause of many
problems and has serious effects on health care provision. It can lead to catastrophic adverse
effects, such as wrong-site surgery. A report of the Joint Commission published in 2018 identified
409 sentinel events of patient identification out of 3326 incidents (12.3%) between 2014 and 2017.

24
Unsafe injection practices. Each year, 16 billion injections are administered worldwide, and
unsafe injection practices place patients and health and care workers at risk of infectious and non-
infectious adverse events. Using mathematical modelling, a study estimated that, in a period of 10
years (2000–2010), 1.67 million hepatitis B virus infections, between 157 592 and 315 120
hepatitis C virus infections, and between 16 939 and 33 877 HIV infections were associated with
unsafe injections .

Factors leading to patient harm

Patient harm in health care due to safety breaks is pervasive, problematic and can occur in all
settings and at all levels of health care provision. There are multiple and interrelated factors that
can lead to patient harm, and more than one factor is usually involved in any single patient safety
incident:

 system and organizational factors: the complexity of medical interventions, inadequate

processes and procedures, disruptions in workflow and care coordination, resource
constraints, inadequate staffing and competency development;
 technological factors: issues related to health information systems, such as problems with
electronic health records or medication administration systems, and misuse of technology;
 human factors and behaviour: communication breakdown among health care workers,
within health care teams, and with patients and their families, ineffective teamwork,
fatigue, burnout, and cognitive bias;
 patient-related factors: limited health literacy, lack of engagement and non-adherence to
treatment

 external factors: absence of policies, inconsistent regulations, economic and financial

pressures, and challenges related to natural environment.

System approach to patient safety

25
Most of the mistakes that lead to harm do not occur as a result of the practices of one or a group of
health and care workers but are rather due to system or process failures that lead these health and
care workers to make mistakes.

Understanding the underlying causes of errors in medical care thus requires shifting from the
traditional blaming approach to a more system-based thinking. In this, errors are attributed to
poorly designed system structures and processes, and the human nature of all those working in
health care facilities under a considerable amount of stress in complex and quickly changing
environments is recognized. This is done without overlooking negligence or missbehaviour from
those providing care that leads to substandard medical management.

A safe health system is one that adopts all necessary measures to avoid and reduce harm through
organized activities, including:

 ensuring leadership commitment to safety and creation of a culture whereby safety is

prioritized;
 ensuring a safe working environment and the safety of procedures and clinical processes;
 building competencies of health and care workers and improving teamwork and
communication;
 engaging patients and families in policy development, research and shared decision-
making; and
 establishing systems for patient safety incident reporting for learning and continuous
improvement.

patient harm, improves system efficiency, and helps in reassuring communities and restoring their
trust in health care systems .

UNDERSTANDING THE GUIDELINE TO ENHANCE PATIENT SAFETY

Actions to improve patient safety have shown widely varying degrees of effectiveness. Usually
hospitals are focused on the occurrence of adverse events and the level of adversity to the patient
in the contexts of insurance premiums and the costs of malpractice. Furthermore, even risk
management units within hospitals focus on these factors, when comparing the performance of
departments or wards. However, for the improvement of patient safety in clinical practice, a

26
different approach is required, in which the prevention of patient harm and effectiveness of
clinical actions is standardized and assessed on the basis of scientific evidence.

Recommendations that have been translated into guidelines are the best possible evidence-based
solutions to clinical practice issues. However, it appears that there are very few clinical guidelines
focused on patient safety, particularly in the risk management sector. Furthermore, when using
clinical guidelines for quality and safety improvement, practices often seem to diverge. Higher
quality and safer clinical practice are consequently difficult to achieve, share, and promote.

Existing knowledge of patient safety essentially covers the nosography of threats and causes of
patient harm, as opposed to possible evidence-based solutions that can (a) prevent risks, (b)
address healthcare incidents, and (c) which can be compared. This means that etiology,
pathogenesis, and observations of safety issues in clinical departments, and, more broadly in
healthcare organizations, are often investigated while proven solutions to patient safety issues are
rarely discussed. To give an appropriate analogy, it is like saying that there are many papers that
have examined perioperative complications, type of surgeries, and patient characteristics.
However, no research is available on how the occurrence of these complications have been
managed in different settings according to organizational and human factors.

It is essential that healthcare professionals acquire proficiency in producing evidence that can be
used for making improvements to patient’s safety and managing the risks of adverse events. To
successfully achieve this goal, the first step is for them to have a clear idea of what guidelines and
practices are. Definitions of these terms will be the content of the first section of this chapter.
Once these concepts have been introduced, the second section will show the current picture
regarding patient safety and why a greater number of valuable clinical guidelines are needed. The
third section will then consider possible solutions, lessons to apply in practice, and will explain
how to prepare and update a guideline. The challenges we are facing along with the limits of the

current guidelines will be considered at the end, which will assist in managing patient safety in
future.

27
The World Health Organization (WHO) regards guidelines as tools to help people to make
decisions and particularly emphasize the concept of choosing from a range of interventions or
measures. A WHO guideline is any document developed by the World Health Organization
containing recommendations for clinical practice or public health policy. A recommendation tells
the intended end-user of the guideline what he or she can or should do in specific situations to
achieve the best health outcomes possible, individually or collectively. It offers a choice of
different interventions or measures that are intended to have a positive impact on health and
explains their implications for the use of resources. Recommendations help the user of the
guideline make informed decisions on whether to undertake specific interventions or clinical tests,
or if they should implement wider public health measures, as well as where and when to do so.
Recommendations also help the user to select and prioritize across a range of potential
interventions .

With a greater emphasis on clinical practice, the U.S. Institute of Medicine (IOM) defines
guidelines as “statements that include recommendations, intended to optimize patient care, that are
informed by a systematic review of evidence and an assessment of the benefits and harms of
alternative care options” . This definition emphasizes that the foundation of a guideline is a
systematic review of the scientific evidence bearing on a clinical issue. The strength of the
evidence leads the clinical decision-making process through a set of recommendations. These
concern the benefits and harms of alternative care options and address how patients should be
managed, everything else being equal.

The U.S. National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and
Quality (AHRQ) also uses the definition of clinical practice guidelines developed by the IOM,
stating that “clinical practice guidelines are statements that include recommendations intended to
optimize patient care that are informed by a systematic review of evidence and an assessment of
the benefits and harms of alternative care options” .

28
The British National Institute for Health and Care Excellence (NICE) stresses scientific evidence
as the basis of guidelines. It states: “NICE guidelines make evidence-based recommendations on a
wide range of topics, from preventing and managing specific conditions, improving health, and
managing medicines in different settings, to providing social care and support to adults and
children, safe staffing, and planning broader services and interventions to improve the health of
communities” .

The Italian National Center for Clinical Excellence (CNEC) that is responsible for the National
Guidelines System (SNLG) uses essentially the same definition as NICE, stressing the importance
of evidence-based medicine as the foundation of recommendations in guidelines

The recent report on healthcare quality improvement published by the European Observatory on
Health Systems and Policies reiterates that clinical guidelines focus on how to approach patients
with defined healthcare problems, either throughout the entire care process or in specific clinical
situations. As such, they can be considered as a tool to inform healthcare delivery, with a specific
focus on the clinical components, in the context of medical practice as an applied science. Clinical
guidelines have the potential to reduce unwarranted practice variation and enhance translation of
research into practice; a well-developed guideline which is also well implemented will help
improve patient outcomes by optimizing the process of care .

From the perspective of international accreditation societies such as Joint Commission

International (JCI), guidelines that help healthcare organizations to improve performance and
outcomes are part of the foundation of processes aimed at reaching the goal of safe and high-
quality care . JCI maintains that clinical practice guidelines are truly major and effective tools in
the practice of delivering evidence-based medicine to achieve more effective patient outcomes and
safer care. These guidelines, which must be used in all JCI accreditation programs, can achieve
their maximum potential when they are both well developed and effectively introduced into
clinical practice.

All of the definitions mentioned are consistent. Guidelines are not presented as a substitute for the
advice of a physician or other knowledgeable healthcare professionals or providers. They are tools

29
describing recommended courses of intervention whose key elements are the best available
scientific evidence and actions according to this evidence. The goal is the promotion of health and
consequently, the quality and safety of care. However, it is also desirable for professionals to share
within the scientific community the results from using clinical practice guidelines in the context of
valuable, real-world experience to inform safety interventions. Professionals are expected to share
their current practice to help them apply guidelines to real-life situations and also to improve
guidelines in the light of that experience.

Ensuring the quality of healthcare services and making improvements to patient safety require that
evidence-based recommendations from guidelines, and their application in the form of practical
interventions (best practices), always function as synergetic tools. Nevertheless, there is no
consensus on what constitutes practice-based evidence (which is what emerges from routine
hospital activities) and what metrics can be used to ensure the quality of this evidence. Healthcare
interventions that have been shown to produce desirable outcomes and that are suitable for
adaptation to other settings can be called “best practices.” A best practice is “an intervention that
has shown evidence of effectiveness in a particular setting and is likely to be replicable to other
situations” [9]. Moreover, a best practice is not a synonym of a good practice or, simply, of a
practice: it is an already existing and selected intervention whose effectiveness has already been
established. This concept is widely applicable in health care, from patient safety to public health,
including the quality of care. In fact, a best practice is based on evidence from up-to-date research
and it has the added value of incorporating experience acquired in real-life settings.

VARIOUS MEASURES TO ENSURE PATIENT SAFETY :

Ensuring patient safety in a hospital is of paramount importance, as it directly impacts the well-
being and outcomes of patients. Several measures and protocols are in place to minimize risks and
enhance safety within healthcare facilities. One fundamental measure is hand hygiene, which
involves regular and thorough handwashing by healthcare providers. Proper hand hygiene helps
prevent the spread of infections, which is a common risk in hospitals. Strict adherence to hand
hygiene guidelines significantly reduces the likelihood of hospital-acquired infections.

Medication safety is another critical aspect of patient safety. Hospitals implement processes like
barcode scanning of medications and electronic medication administration records to reduce

30
medication errors. These technologies help ensure that patients receive the right medication at the
right dose and at the right time.

Patient identification and verification procedures are also essential. Healthcare providers must
accurately confirm the identity of patients before any procedures, tests, or medication
administration. This involves checking the patient's name, date of birth, and sometimes medical
record number or unique identifiers.

Infection control protocols, such as the proper sterilization of medical equipment and the use of
personal protective equipment (PPE), are crucial for preventing the transmission of infections
within the hospital. Isolation rooms and units are designated for patients with contagious diseases
to limit their contact with other patients and healthcare workers.

Regular training and education of hospital staff on safety protocols are integral to maintaining a
culture of safety. This includes ongoing education on infection control, patient safety goals, and
the reporting of incidents or near-misses. Open communication and a culture that encourages staff
to speak up about safety concerns are essential.

Additionally, hospitals often conduct root cause analysis (RCA) to investigate adverse events and
near-misses. RCA helps identify the underlying causes of incidents and allows for the
development of strategies to prevent their recurrence.

Electronic health records (EHRs) play a significant role in patient safety by providing a
comprehensive and accessible patient history. EHRs enable healthcare providers to access critical
patient information, including allergies, current medications, and past medical history, reducing
the likelihood of errors due to incomplete or missing data.

Patient safety in hospitals also involves clear and effective communication among healthcare
teams. Care coordination and accurate information transfer during shift changes and handovers are
vital to prevent misunderstandings and mistakes.In conclusion, patient safety in hospitals relies on
a multi-faceted approach that combines strict adherence to protocols, the use of technology,
continuous education, and a culture of safety. By implementing these measures and maintaining a
strong focus on patient safety, hospitals can significantly reduce the risks associated with
healthcare delivery and enhance the quality of care provided to patients.

31
1.3 OBJECTIVES OF RESEARCH

1. Preventing Harm: Patient safety aims to minimize harm to patients by reducing medical
errors, adverse events, and preventable complications.

2. Prevent patient fall in the hospital

3. Identifying Risks: It involves identifying and understanding the various risks and vulnerabilities
within healthcare systems that may compromise patient well-being.

4. Overall quality improvement & business improvement in hospital.

32
 CHAPTER -2

COMPANY PROFILE

33
HOSPITAL NAME : Private Hospital College & Hospital
TYPE OF BUSINESS ENTITY: PRIVATE
INDUSTRY TYPE : SERVICE INDUSTRY
INDUSTRY : HEALTHCARE
FOUNDED : 1988
LOCATION: MANGALORE (KARNATAKA)
PIN CODE: 575001
EMAIL: info@srinivasgroup.com
WEBSITE : www.srinivasgroup.com

34
 Figure 2.1

Srinivas institute of medical science is a Hospital that was situated in Mangalore Near surathkal
mukka. The Private Hospital is one of the largest healthcare group in the region. Private Hospital
was commissioned in 1988 and today it is 715 bed multi-specialty renowned for its medical
expertise, nursing care and quality of diagnosis. Being attached to the medical college, the
hospital has earned a very good recognition as a leader in providing world class health care
services to the common man at an affordable cost. The hospital is continuously in tune with the
latest technology that promotes most modern health care and wellbeing of the patient. Private
Hospital is a forerunner towards social service. It has been promoting a proactive approach to
35
diseases. Conducting health check-up’s, camps and CMEs has been a regular feature to spread
awareness among the medical fraternity and the general masses. Being attached to the medical
college, the hospital healthcare services to the common man at an affordable cost. The hospital is
continuously in tune with the latest technology that promotes the most modern healthcare and
well-being of the patient. Private Hospital is also, a forerunner towards social service and has been
actively promoting a proactive approach to diseases by conducting free health check- up and out-
reach camps as a part of the corporate social responsibility. Srinivas Laboratories Services has
been accredited by National Accreditation Board for Testing and Calibration by NABH for Blood

Bank since testing centre for HIV by the Director-General of Health Services, New Delhi and the
Karnataka State Aids Prevention Society. Private Hospital Mangalore has been striving
ceaselessly to achieve its goals without compromising on its mission of providing affordable
healthcare. It has been a trendsetter in terms of social service as part of its corporate social
responsibility. It has also been organising medical camps from time to time in order to fulfil its
mission and goals. Private Hospital Mangalore has been moving in the visionary path set by its
founders in its efforts to provide international standard of healthcare in Mangalore. It will
continue in its efforts to live up to the expectations of the people and excel in its chosen field.
Private Hospital has an objective to provide affordable medical services to the community with the
skill, knowledge and resources to prevent, diagnose and treat diseases. The land chosen is on the
Udupi Mangalore Highway, and is ideally located to serve people from Mangalore and
surrounding suburban districts. The location is easily accessible by public transport. The hospital
is equipped with up-to-date medical technology and facilities to provide modern state of the art
medical treatment to the poor and needy. The institute is affiliated to Rajiv Gandhi University of
Health Sciences, Bangalore, and Approved by Medical Council Of India, New Delhi.

Attached with hospital Private Hospital runs medical college which provides quality education for
MBBS& MD programmes. They also have other colleges called The Srinivas group of colleges,
the dream of an ideal teacher A.Shama Rao, was made a reality by his noble son CA. A.
Raghavendra Rao. The foundation named after the great luminary A.Shama Rao was established
by his son in the year 1988.Education is not just providing the powerful tool of knowledge to the
young, but also nurturing an ethical conscience in them to apply it constructively. About 12,000
students in the 18 colleges of the Srinivas group spread in three campuses in Pandeshwar, Valachil
and Mukka are being prepared for life by well qualified teaching and support staff.

36
2.1 VISION & MISSION

VISION

Transforming Society through Education by setting up academic institutions in dynamic

equilibrium with its social, ecological and economic environment striving continuously for
excellence in education, research and technological service to the nation.

MISSION

To create and sustain a community of learning in which students acquire knowledge and learn to
apply it professionally with due consideration for ethical, ecological, and economic issues and to
pursue research and disseminate research findings. To provide knowledge-based technological
services to satisfy the needs of society and the industry. To help in building national capabilities in
science, technology, humanities, management, education and research.

2.2 DEPARTMENTS / FACILITIES

Ground floor :

37
. OT

.MICU

.PICU

.ICU

.RADIOLOGY

.DIAGNOSTIC

.CATH LAB

.ULTRA SOUND

.CASUALTY

.DIALYSIS UNIT

.ECHO

.MRD

.EMD

1ST Floor

.Pharmacy

.OP & Pharmacy billing counter

.HR Department

38
.Quality Department

.OP Registeration

.ENT

.General medicine

.Psychiatry

.Orthopaedics

.Obstetrics & Gynaecology

.General surgery

.Paediatric

.Lab

.Blood bank

2ND Floor

.Ophthalmology

.Corporate Word

.Dermatology [skin]

.Physiotherapy department

.Medical Oncology
39
.General surgery wards

.Orthopeadics wards

.General medicine wards

3rd Floor

.General Medicine ward

.ENT ward

.Peadiatric Ward

.Obstetrics Ward

.General Ward

Services Available at Srinivas Hospital , Mangalore

.Emergency Services

.Out Patient Services

.IN Patient Services

40
. Intensive Care Services

.MICU, SICU/CCU, PICU, NICU, HDU

.Executive Health Check UP

.Operation Theatre Service

.Dialysis

.ECG, ECHO &TMT

.Laparoscopy & Endoscopy

.Electroconvulsive Therapy (ECT)

.Cardiac Catheterisation Lab

.Physiotherapy

.Clinical Psychology & counseling

.Audiology

.Dietetics

.Cardiology

.Neurosurgery

.Urology

.Plastic Surgery
.Paediatric Surgery

41
.Gastroenterology

.Radiotherapy (Consultation Only)

Support Services Of Srinivas Hospital

.Front Office & Billing

.TPA Claims

.Bio-medical Waste Management

.Bio-medical Engineering

.CSSD

.Food & Beverage

.HIMS

.Laundry Services

.House Keeping Services (outsourced)

.HR & Finance

.Mortuary &embalming of body

.Ambulance

.Pharmacy

42
.Blood Bank

.Clinical Laboratory

. Radiology-X-ray, Mammography

.USG, CT, MRI

OTHER FACILITIES

.Parking

.Internet

.Laundry Services

.Telecommunication Services

.Interpretation Services

.Cafeteria

.Rest Room

.ATM

2.3 SURGICAL FACILITIES

43
OBSTETRICS & GYNECOLOGY SURGERY:

.Caesarean section

.MTP procedures

.Cervical encirclage

.Tubal sterilization ( laparoscopy / open)

.Hysterectomy ( abdominal / vaginal / laparoscopy)

.Dilatation and curettage

.Cervical biopsy ( including colposcopy guided)

.Diagnostic laparoscopy for infertility

.Operative procedures for benign ovarian cysts and malignant ovarian tumors

.Tubal surgeries – for ectopic pregnancy, tuboplasty

.Myomectomy

.Uterine prolapse surgeries

.Hysteroscopy
PAEDIATRIC SURGERY:

. Paediatrics hydronephrosis-pelviureteric junction obstructions and vesicoureteric reflux.

.Paediatric Oncosurgery- Wilms’s tumour , neuroblastoma ,soft tissue sarcoma.

.Complex urological birth defects -exstrophy

44
.Therapeutic and diagnostic bronchoscopy

.Congenital hydrocephalus and neural tube defects.

.Hypospadias

.Cleft lip and palate corrections.

.Paediatric thoracic cysts and esophageal replacement .

laparoscopy

.Paediatric thoracoscopy and advanced laparoscopy.

.Surgery for (intersex) disorder of sexual differentiation.

GENERAL SURGERIES :

.Appendicetomy (laproscopy/open)

.Hernia (laproscopy /open)

.Cholecystectomy(laproscopy /open)

.Thyroid surgeries (benign /malignant)

.Breast surgeries (benign /malignant)

.Perianal surgeries (hemorrhoids /fissure /fistula in ano)

.Emergency /elective abdominal surgeries

45
.Curative / palliative surgeries for abdominal malignancies

.Vascular surgeries (varicose vein/PVD/aneurysms

ENT SURGERY:

.Tympanoplasty ( repair of ear drum)

.Mastoidectomies( removal of disease from ear)

.Ear cyst and sinus excisions ( for swellings and discharge around the ear)

.Myringotomy and Grommet insertion ( for drainage of fluid behind ear drum)

NOSE :

.Septoplasty ( correction of nasal septum)

.FESS( endoscopy assisted sinus surgery)

THROAT :

.Tonsillectomy ( removal of tonsil)

.Adenoidectomy ( removal of adenoids)

.Excisions of swellings in and around oral cavity

46
.Rigid scopies( direct laryngoscopy, esophagoscopy, microlaryngoscopy)

.Micro laryngeal surgeries( Microscopic surgeries of voice box)

NECK :

.Thyroidectomy (removal of thyroid)

.Adenoidectomy ( removal of adenoids)

EYE:

.Ophthalmology surgery

.Cataract surgery, lacrimal sac surgeries, pterygium surgery, lid tear repair, corneal tear repair, glaucoma
surgeries.

SRINIVAS HOSPITAL COMMITTEE

CENTRAL RESEARCH COMMITTEE:

47
Chairperson : Dean , SIMS & RC

Vicechairperson: Dr. sukesh ,professor & HOD, Dept . of pathology

Secretary : Dr. shreelaxmi Hegde ,Assoc .prof, Dept of Biochemistry

BOARD MANAGEMENT

Shri. CA. A Ragavendra Rao

Shri. CA A. Raghavendra Rao established the A.Shama Rao Foundation to achieve his stated aim
of transforming society through quality education which will be in harmony with the social,
economical and ecological environment. This firm belief was the driving force which created the
Srinivas Group of Colleges under the umbrella of A.Shama Rao Foundation. Shri. CA A.
Raghavendra Rao has a unique and focused approach towards life. He dons different hats in his
service to the cause of ‘Nation Building”. He is successful Chartered Accountant with offices in
Seven cities across India, he is an hotelier par excellence who has created one of the first and
finest 3 –Star hotel with a vegetarian restaurant as its hallmark. His most notable contribution has
been in moulding the careers of thousand’s of students through the chain of colleges imparting
professional education in such varied fields as Engineering, Medicine, Physiotherapy, Hotel
Management, Business Management, Computer application , Nursing and Pharmacy. His
dedication and excellence in his field makes him completely a reliable person and hence he has set
an example to his clients, staff, students and admirers.

Dr A. Srinivas Rao
Vice President of Srinivas Group

Dr. A. Srinivas Rao Vice President of A. Shama Rao Foundation and Srinivas Group of

48
colleges, Mangalore, has received Doctorate Degree in “Education Management” for his
Thesis on “Quality in Higher Education – A case study of Srinivas Institute of Management
Studies” from Ashley University, an international University based on California, USA,
established in the year 1981. The university has also recognized his contribution in Managing
higher education institutions effectively during past 25 years and presently srinivas group has
18 higher education institutions in three campuses, 75 U.G. and P.G. courses, 2,800 employees
and about 13,000 students .

2.4 COMPETITORS IN THE MARKET

INDIANA HOSPITAL & HEART INSTITUTE ,MANGALORE

Indiana Hospital & Heart Institute is a state-of-the-art, 300-bed multi-speciality hospital. Located
at an important junction on National Highway-66 in Mangalore where the Bengaluru Highway,
the Kerala Highway and the Mumbai Highway meet, the hospital follows process-driven quality
systems that adhere to international standards of clinical care in a safe, infection-free environment
that respects patients’ rights and privacy.With the tagline, Indian at heart, Global in healthcare, it
boasts the best of clinical talents in the region, and has full-time consultants available 24×7. Little
wonder then that the hospital is accredited with NABH (National Accreditation Board of Hospitals
&Healthcare), NNF Accreditation (National Neonatology Forum) and NABH Nursing Excellence
Certification.

KANACHUR HOSPITAL

Kanachur Institute of Medical Sciences(KIMS) stands strikingly as an architectural beauty, with

its massive structure and aesthetic view which leaves every one spell bound. Strategically located
away from the hustle bustle of the city traffic, the ambient atmosphere provides an ideal learning
environment for students coming across the globe. Its state-of-the-art infrastructure backed by the
well-qualified faculty and highly sophisticated equipment bears a testimony to its uniqueness.

Kanachur Institute of Medical Sciences(KIMS) one of the leading medical institutes of this region
providing high quality Medical education and health care services of truly global standards. A
comprehensive range of general and advanced medical services are provided here including super-
49
specialty services.
The institute focuses on delivering high quality, holistic medical education encouraging innovative
thoughts towards Research & Development. We provide the conducive learning atmosphere and
training facilities to our students. When it comes to learning and research under the able guidance
of experienced and dedicated faculty, outstanding clinical facilities, and a world-class environment
to impart Medical education. We offer different courses apart from Medicine such as Nursing and
management science under the banner of our trust. The elegant college building with its beautiful
architectural design attracts the attention of all visitors.
We run a 300 bedded multi-specialty teaching hospital which provides 24-hours, seven-day-a-
week services. Departments like Emergency , Critical Care unit, Blood Bank, Pharmacy, Central
Diagnostic Lab and Ambulance Services works round the clock to attend promptly according to
the requirements of the patients situation.
We would like to accomplish our mission of serving the society with our widespread
infrastructure, state-of-the-art equipment, backed by the dedicated and empathetic professionals of
national and global standards.

AJ HOSPITAL

A.J Hospital and Research Centre is one of the foremost tertiary hospitals in India. This leading
institution provides state of the art health care treatment and facilities across 30 major medical
disciplines. The Visionary initiative of Dr. A.J. Shetty, a reputed entrepreneur, educationist and
well known philanthropist, was realised, when the hospital began in 2001 and today it stands as a
unique center of medical excellence.A.J Hospital and Research Centre is a unit of the Laxmi
Memorial Educational Trust ® a premier institution which manages a string of professionals
colleges that include medical, dental and engineering.

YENEPOYA HOSPITAL

Established in 1995, Yenepoya Speciality Hospital, a 234 bedded multi-specialty hospital is a

leading name in the medical fraternity in India. Located at an easily accessible area in the heart of
Mangalore City, Karnataka, South of India, this hospital is attending to more than 300 cases of
health care needy people in and around Karnataka State and beyond on daily basis. In addition

, since the time of its inception, we have been catering to the health needs of our patients within

50
and outside India.
With the latest technology infrastructure, multitude of specialty care units and a highly proficient
medical care team, we boast ourselves as one among the best in the industry. Our highly qualified
medical professionals team and health care management team are available round the clock.

UNITY HOSPITAL

Unity Hospitals in Mangalore was established in 1978 as a platform to provide doctors with a
conductive environment to practice medicine and to provide patients with a safe, economical and
comfortable environment to avail healthcare services. Since its inception, we have been
consistently providing high quality and up-to-date preventive and curative health services to a
population spread across the western coast of Karnataka and northern Kerala. We have constantly
renovated, upgraded, and modernized our facilities to be in tune with the changing times. Today,
our organization offers some of the most modern medical technology complemented by an
enduring tradition of compassion and respect.

TEJASVINI HOSPITAL

Tejasvini Hospital and Shantharam Shetty Institute of Orthopaedics and Traumatology(SSIOT) is

a state-of-the-art speciality hospital providing a depth of expertise in Orthopaedics and Trauma
with other specialities like Neurosurgery, Vascular and Plastic Surgery, Gen. Medicine and
Paediatrics, Neurology with a comprehensive mix of inpatient and outpatient services to all
patients irrespective of their economic status. The 200 bedded hospital was set up in May 2004
and is located in Kadri, an ancient historic spot in the heart of Mangalore City. The hospital is
recognized for treatment by all major health insurance companies and reputed private and public
sector companies, gives high quality medical treatment along with free concessional treatment to
deserving patients.
SSIOT a recognized institute in Orthopaedic training, where care is taken to impart orthopaedic
training to PG students from different parts of India and offers a foreign fellowship to registrars
from the UK & inland fellowships to D.Ortho and MS(Ortho) candidates. We have a fully
equipped library for our DNB postgraduates with internet and telemedicine facilities. The
Tejasvini Hospital and SSIOT is recognized by the National Board of Examinations, New Delhi
for Orthopaedic Surgery since 2004 with our intake of 6 candidates per year. The hospital has

51
FATHER MULLER’S HOSPITAL

Father Muller Medical College is a unit of Father Muller Charitable Institutions, a Registered Society
sponsored by the Catholic Diocese of Mangalore; a Religious Minority Educational Institution established
primarily for the benefit of the members of the Christian Community.

CHAPTER -3
STUDY DESIGN

52
A study design in the context of patient safety refers to the systematic approach taken to
investigate and evaluate factors that impact the safety of patients within healthcare settings.
Designing such studies involves careful planning and methodology to gather relevant data and
draw meaningful conclusions. Here's a detailed explanation of study design in patient safety:

Research Question and Objectives: The first step is to define a clear research question or objective.
For patient safety, this could be to assess the impact of a specific intervention, the prevalence of adverse
events, or the effectiveness of safety protocols.

Literature Review: Researchers should conduct a comprehensive review of existing literature to

understand what is already known about the topic, identify gaps in knowledge, and inform the
study's design

STUDY METHODES:

 SAMPLING METHODE
 OBSERVATIONAL METHODE
 INTERVIEW METHODE

3.1 INTERNSHIP OBJECTIVE

The Hospital and Healthcare management internship is a course done in fulfillment of the
requirements of Master of Business Administration in Hospital and Healthcare. This was a 4-week

53
programme done at Srinivas Hospital Mukka. This Internship reports aims to describe the
internship activities, objectives and observations which I did at Srinivas hospital. It will illustrate
evidence of my understanding of facility management , internal audit assessment , Hospital
policies, activities, customer relationship and feedback. How various departments and procedures
followed by the Hospital.
As a part of my internship I was assigned to worked as an facility management within that my
duty were to find out infrastructural errors in the every floors of the department for that I had gone
through each & every department , I inspected “NEAR MISS” inside the hospital.
“NEAR MISS” as “an error that has the potential to cause an adverse event (patient harm) but fails
to do so because of chance or because it is intercepted” . According to the Institute of Medicine, a

near miss is “an act of commission or omission that could have harmed the patient but did not
cause harm as a result of chance, prevention, or mitigation” . “An error caught before reaching the
patient.
Here I have identified the near miss inside the hospital including, infrastructural defects, medical
equipments which are at the risk for harming patients, etc & I made a report for that to my higher
authority. The hospital s objective is To ensure the patient safety & overall quality inside the
Hospital . Here the hospital has identified their problem regarding patient safety based on that they
are going to improve it by measuring. I started the internship on the 25 th OCTOBER 20223 .
During the internship, I observed, recorded and analysed daily routines, various departmental
procedures and help desk functionality. The internship contributed to an understanding of how
hospital works to promote patient-centred healthcare Centre.
For me that was a great opportunity to learn & study the hospital structure. For identifying the
problem & implementing the results the hospital administrators plays an crucial role in that.

OBJECTIVES OF MY STUDY

1. Preventing Harm: Patient safety aims to minimize harm to patients by reducing medical
errors, adverse events, and preventable complications.

2. Prevent patient fall in the hospital

3. Identifying Risks: It involves identifying and understanding the various risks and vulnerabilities
within healthcare systems that may compromise patient well-being.

54
4. Overall quality improvement & business improvement in hospital.

3.2 SCOPE

Patient safety is a critical and multifaceted aspect of healthcare, encompassing a wide scope that
extends across the entire healthcare system. It revolves around the prevention of medical errors,
injuries, and harm to patients during the provision of healthcare services. The scope of patient
safety is extensive, covering various dimensions.

First and foremost, it involves the identification and mitigation of risks in clinical settings. This

includes preventing medication errors, surgical complications, infections, and other adverse events
that can jeopardize patient well-being. Healthcare providers, from doctors and nurses to
pharmacists and technicians, play a crucial role in ensuring these risks are minimized.

Moreover, patient safety extends beyond clinical care to encompass the safety of healthcare
environments. Hospitals and clinics need to maintain safe physical spaces for patients, with proper
sanitation, well-maintained equipment, and measures to prevent falls and other accidents.

Another vital aspect of patient safety is effective communication. Clear and open communication
among healthcare professionals, patients, and their families is essential for preventing
misunderstandings, misdiagnoses, and treatment errors. This also involves informed consent
procedures, where patients are fully aware of the risks and benefits of treatments and procedures.

Furthermore, patient safety incorporates the use of technology and data to improve care.
Electronic health records, data analysis, and healthcare information systems are integral in
identifying trends and patterns related to patient safety issues.

Healthcare policies and regulations are also within the scope of patient safety. Regulatory bodies
and healthcare organizations must establish and enforce standards that promote patient safety,
ensuring that healthcare providers adhere to best practices and quality standards.

In conclusion, the scope of patient safety in hospitals and healthcare settings is extensive,

55
involving risk management, facility safety, communication, technology, data analysis, and
regulatory compliance. The ultimate goal is to provide the highest quality of care while
minimizing the risk of harm to patients, making patient safety a fundamental and ongoing priority
in the healthcare industry.

3.3 HYPOTHESIS

Hospitals that implement comprehensive patient safety protocols and training programs will
experience a reduction in adverse events, including medication errors, hospital-acquired
infections, and patient falls, leading to improved patient outcomes, decreased healthcare costs, and

higher levels of patient satisfaction."

In my hypothesis I am expecting that there is a relationship between the implementation of patient

safety measures and various positive outcomes, including fewer medical errors, improved patient
well-being.

3.4 LIMITATIONS

In the course of my internship at Srinivas Hospital, I have been assigned the task of facility
management & conducting an asset inventory assessment within various departments, including
the physiotherapy ward, ENT ward, and the closed wards. This report summarizes the findings
and challenges encountered during this 4-week period.

Challenges faced :

Crowded Wards: Conducting a quality checking in crowded wards can be challenging, as it may
disrupt the daily operations and patient care. This can make it difficult to access and inspect the

56
resources in the hospital.

Dusty and Closed Wards: while inspecting in the ward as a part observational method in
hospital I found Closed wards , which tend to accumulate dust and debris over time, which can
hinder the assessment process and potentially pose health risks to personnel. Cleaning and
organizing such spaces can be a time-consuming task.

Asset Disorganization: In some cases, assets & hospital equipment may not be properly
organized or labeled, making it challenging to identify and document them accurately. This can
lead to inaccuracies in the facility management.

Staff Cooperation: Coordinating with the hospital staff to gain access to the assets and gather
necessary information can be challenging. Ensuring their cooperation is vital for a successful asset
assessment. But while inspecting every departments in hospital some of staffs are cooperative with
us that make bit difficulty to inspect the resources.

 While doing internship I cannot ask or take reviews from the patients regarding the
patient safety of the hospital so I choose non random sampling method according to my
convenience & my sample size were 50, I selected some people from mangalore & done
my study.

57
 CHAPTER - 4
REVIEW OF LITERATURE

58
 4.1 REVIEW OF LITERATURE

A literature review is an overview of the previously published works on a topic. The term can
refer to a full scholarly paper or a section of a scholarly work such as a book, or an article. Either
way, a literature review is supposed to provide the researcher/author and the audiences with a
general image of the existing knowledge on the topic under question. A good literature review can
ensure that a proper research question has been asked and a proper theoretical framework and/or
research methodology have been chosen. To be precise, a literature review serves to situate the
current study within the body of the relevant literature and to provide context for the reader. In
such case, the review usually precedes the methodology and results sections of the work.

Producing a literature review is often a part of graduate and post-graduate student work, including
in the preparation of a thesis, dissertation, or a journal article. Literature reviews are also common
in a research proposal or prospectus (the document that is approved before a student formally
begins a dissertation or thesis).

A literature review can be a type of review article. In this sense, a literature review is a scholarly
paper that presents the current knowledge including substantive findings as well as theoretical and
methodological contributions to a particular topic. Literature reviews are secondary sources and do
not report new or original experimental work. Most often associated with academic-oriented
literature, such reviews are found in academic journals and are not to be confused with book
reviews, which may also appear in the same publication. Literature reviews are a basis for research
in nearly every academic field.

59
a brief overview of some key literature related to patient safety, along with the authors and
publication dates. However, it's important to note that the field of patient safety is vast, and this is
not an exhaustive list. Here are a few influential works:

1. To Err is Human: Building a Safer Health System by the Institute of Medicine (IOM) -
Published in 1999.
- This landmark report emphasized the high prevalence of medical errors and the need for a safer
healthcare system. It brought the issue of patient safety to the forefront and called for significant
changes in healthcare.

2. Crossing the Quality Chasm: A New Health System for the 21st Century by the Institute
of Medicine (IOM) - Published in 2001.
- Building on "To Err is Human," this report outlined the need for a redesigned healthcare system
that prioritizes patient safety, quality, and efficiency.

3. Patient Safety and Quality: An Evidence-Based Handbook for Nurses edited by Ronda G.
Hughes - Published in 2008.
- This comprehensive handbook provides evidence-based strategies and practices to enhance
patient safety, focusing on the role of nurses in improving healthcare quality.

4. The Joint Commission's Sentinel Event Policy and RCA: 2020 Update by The Joint
Commission - Published in 2020.
- This document discusses The Joint Commission's approach to investigating and learning from
sentinel events, which are serious adverse events in healthcare. It highlights the importance of root
cause analysis (RCA) in improving patient safety.

5. The Safety of Care Transitions in Patients Who are Ill by Leora Horwitz et al. - Published
in 2019.

- This research article explores the safety of care transitions for patients who are acutely ill,

60
shedding light on the risks associated with handoffs and the importance of effective transitions.

6. Patient Safety: What You Don't Know Can Hurt You by Kohn, L. T., Corrigan, J. M., &
Donaldson, M. S. – 1999
- This publication from the IOM further explores the issue of medical errors and offers
recommendations for enhancing patient safety.

7. The Human Factor: The Critical Importance of Effective Teamwork and Communication
in Providing Safe Care by Leonard, M., Graham, S., & Bonacum, D. – 2004
- This study delves into the significance of teamwork and communication in preventing medical
errors.

8. Communication in the Operating Room by Greenberg, C. C., Regenbogen, S. E.,

Studdert, D. M., & Lipsitz, S. R. – 2007

- This research examines the role of communication in the operating room and its impact on
patient safety.

9. A Comprehensive Review of Patient Safety Research: 2005-2015 by Landrigan, C. P.,

Parry, G. J., Bones, C. B., Hackbarth, A. D., & Goldmann, D. A. – 2010
- This review provides a comprehensive overview of patient safety research during the specified
period.

10. The WHO Surgical Safety Checklist by Haynes, A. B., Weiser, T. G., Berry, W. R.,
Lipsitz, S. R., Breizat, A. H. S., et al. – 2009

- This article introduces the World Health Organization's Surgical Safety Checklist, a tool to
enhance surgical safety.

11. The Swiss Cheese Model of Safety Incidents: Are There Unrecognized Latent Failures?
by Reason, J. – 1995
- James Reason's Swiss Cheese Model is a classic concept that illustrates how multiple factors
can align to result in patient safety incidents.

12. Patient Safety: A New Standard for Care by Walton, M., Woodward, H., Van
Staalduinen, S., Lemer, C., Greaves, F., & Noble, D. – 2006
61
 - This research examines the concept of patient safety and the role of healthcare organizations in
achieving it.

13. The Role of Simulation in Continuing Medical Education for Acute Care Physicians by
Okuda, Y., Bryson, E. O., DeMaria, S., Jr, Jacobson, L., Quinones, J., et al. – 2008
- This article explores how simulation-based training can improve the skills and performance of
healthcare professionals, contributing to patient safety.

14. Medication Errors: Prevention Using Information Technology Systems by Koppel, R.,
Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., et al. – 2005
- This study investigates how information technology systems can help prevent medication
errors, a significant aspect of patient safety.

15. ABOUT PATIENT SAFETY CULTURE by CE Sammer in 2010

A comprehensive review of the culture of safety literature within the U.S. hospital setting. The
review was a qualitative meta‐analysis from which we generated a conceptual culture of safety
framework and developed a typology of the safety culture literature. Safety culture is a complex
phenomenon that is not clearly understood by hospital leaders, thus making it difficult to
operationalize. We found senior leadership accountability key to an organization ‐wide culture of
safety.

62
 CHAPTER – 5
INTERNSHIP ENGAGEMENT

63
5.1 ORGANIZATIONAL STUDY

An organizational study of a hospital involves a comprehensive examination of the hospital's

structure, functions, and operations. It encompasses various aspects, including its administrative
setup, clinical departments, support services, and the overall management structure. This study
aims to gain a deep understanding of how the hospital functions and how it provides healthcare
services to the community it serves.
 One key aspect of the organizational study is the hospital's administrative hierarchy, which
includes the governing board, executive leadership, and department heads. This helps in
understanding the decision-making processes, leadership dynamics, and overall
governance of the hospital.

 The clinical departments within the hospital, such as cardiology, surgery, pediatrics, and
others, are analyzed to assess their organization, staffing, equipment, and service delivery.
This provides insights into the quality and scope of healthcare services offered.

 Support services like human resources, finance, and facilities management are integral to a
hospital's efficient operation. The organizational study explores how these departments
support clinical functions, manage resources, and ensure regulatory compliance.

64
Moreover, the study may include an examination of the hospital's policies and procedures, patient
management, and electronic health records systems to evaluate efficiency and patient care quality.
It can also assess the hospital's community outreach programs and partnerships.Overall, an
organizational study on a hospital is a comprehensive analysis that helps identify areas for
improvement, streamline operations, and enhance the quality of healthcare services provided to
patients. It is a valuable tool for hospital management to optimize their operations and meet the
evolving healthcare needs of their community.

As a part of my internship in facility management within a hospital setting is a valuable

opportunity for me looking to gain practical experience in the field. Facility management in a
hospital involves overseeing the maintenance and operation of the hospital's physical
infrastructure to ensure a safe and efficient environment for patients and staff. During this
internship, participants typically work closely with experienced facility managers and maintenance
teams to understand the intricacies of healthcare facility operations. They may be involved in tasks
such as managing equipment and utility systems, planning and executing preventive maintenance

schedules, ensuring compliance with safety regulations, and optimizing energy efficiency. Interns
also play a crucial role in responding to emergency maintenance requests and problem-solving to
minimize disruptions to patient care. This immersive experience provides a comprehensive
understanding of the challenges and responsibilities of managing a healthcare facility, making it
an excellent opportunity for individuals seeking a career in facility management in the healthcare
sector

Srinivas Hospital has the following departments:

 MEDICAL RECORDS DEPARTMENT

 QUALITY DEPARTNMENT

 HUMAN RESOURCES DEPARTNMENT

 FINANCE DEPARTNMENT

 MARKETING DEPARTMENT/HEALTH SERVICE DEPARTMENT

65
5.2 MEDICAL RECORDS DEPARTMENT

66
 Figure 5.1

The Medical Records Department, often referred to as Health Information Management (HIM) or
Medical Records Management, is a fundamental component of any healthcare institution, be it a
hospital, clinic, or healthcare system. This department is primarily responsible for the systematic
management and maintenance of patient medical records and health information.

A central function of the Medical Records Department is record compilation, wherein it collects,
assembles, and organizes various forms of health information into comprehensive patient records.

This includes medical histories, diagnosis reports, test results, treatment plans, progress notes, and
any other documentation relevant to a patient's healthcare journey. The accuracy and completeness
of these records are crucial for providing high-quality patient care and for legal and billing
purposes.

67
Data entry and coding are another pivotal aspect of the department's responsibilities. Health
information technicians within the department input patient data into electronic health record
(EHR) systems and apply specific codes for diagnoses, procedures, and services, often utilizing
coding systems like ICD-10 and CPT. Accurate coding is essential for billing, insurance claims,
and statistical analysis.

Ensuring the confidentiality and security of patient records is a paramount responsibility of the
Medical Records Department. In compliance with regulations such as the Health Insurance
Portability and Accountability Act (HIPAA), the department maintains strict policies and
protocols to safeguard patient information from unauthorized access or breaches. They ensure that
only authorized individuals, including healthcare providers, insurance companies, and patients
themselves, have access to this sensitive data.

Moreover, the department is responsible for the long-term preservation of patient records. This
includes physical records, which may need digitization for electronic storage, and electronic health
records (EHRs). Records must be stored securely and be easily accessible when needed.

The Medical Records Department also plays a critical role in the release of patient information.
They manage and process requests from authorized individuals or entities, ensuring that patient
information is released only to those with the legal right to access it.

Quality control is a routine practice to maintain the accuracy and completeness of patient records.
Regular quality checks are performed to identify and rectify discrepancies or errors, ensuring the
integrity of the data.

The department's contributions extend to research and statistics within the healthcare institution.
Patient records serve as valuable sources of data for research, statistical analysis, and reporting.
This data is vital for improving patient care, assessing outcomes, and contributing to medical
advancements.

In addition to these functions, the Medical Records Department supports billing and coding
operations. Accurate documentation and coding are essential for proper billing and insurance

claims, and the department ensures that all services rendered to patients are correctly documented
and coded.

68
To meet regulatory requirements and internal standards, the department conducts regular audits,
verifying the completeness and compliance of all records. This ensures that the institution follows
legal and ethical standards in managing patient health information.

Finally, the department assists patients with inquiries about their health records, providing copies
or explanations as needed, enhancing the overall patient experience.

In conclusion, the Medical Records Department plays a pivotal role in ensuring the accuracy,
security, and accessibility of patient health information within a healthcare institution. Their
efforts are essential for providing quality patient care, facilitating billing and insurance processes,
conducting medical research, and complying with legal and ethical standards in the healthcare
industry. This department is the custodian of an invaluable resource that supports every aspect of
patient healthcare.

Figure 5.2

FUNCTIONS OF MRD

 The Medical Records Department, often referred to as Health Information Management

(HIM) or Medical Records Management, serves as the backbone of a healthcare
institution, playing a multitude of critical functions. Its primary role is to systematically

69
 manage and maintain patient medical records and health information, ensuring
accuracy, security, and accessibility.

 One of its core functions is record compilation, where it collects, organizes, and
assembles various forms of health information into comprehensive patient records,
encompassing medical histories, diagnosis reports, test results, treatment plans,
progress notes, and more. These records are essential for delivering high-quality patient
care and are the foundation for legal, billing, and administrative processes.

 The department is responsible for data entry and coding, involving the accurate input
of patient data into electronic health record (EHR) systems and the application of
specific codes for diagnoses, procedures, and services. This coding is crucial for
billing, insurance claims, and statistical analysis, making it a vital financial and data
management function.

 Confidentiality and security of patient records are paramount, with the Medical
Records Department maintaining stringent policies and protocols in compliance with
regulations such as HIPAA. They ensure that patient information is shielded from
unauthorized access, protecting patient privacy and data integrity.

 The long-term preservation of patient records is another key duty. This includes the
secure storage of physical records and electronic health records (EHRs). These records
must be easily accessible for authorized individuals, allowing for effective continuity
of care and seamless information sharing.

 In managing the release of patient information, the department ensures that requests
from authorized individuals or entities are processed correctly and in compliance with
legal and ethical standards, safeguarding patient data from wrongful dissemination.

 Quality control is a regular practice to maintain the accuracy and completeness of

patient records. Ongoing quality checks identify and rectify discrepancies or errors,
preserving data integrity and reliability.

70
 The department's contributions extend to research and statistics, providing valuable
data sources for improving patient care, conducting research, assessing healthcare
outcomes, and contributing to medical advancements.

 Furthermore, the Medical Records Department supports billing and coding operations
by ensuring that all services provided to patients are correctly documented and coded.
This accuracy is essential for financial and reimbursement processes.

 To meet regulatory requirements and internal standards, the department conducts

regular audits, verifying the completeness and compliance of all records, assuring that
the institution follows legal and ethical standards in managing patient health
information.

 Lastly, the department assists patients by responding to their inquiries about their
health records, providing copies or explanations as needed, enhancing the overall
patient experience and facilitating patient engagement.

 In sum, the Medical Records Department serves as a vital guardian of patient health
information, fulfilling essential functions that span patient care, data management,
billing, research, and legal compliance within a healthcare institution. It is
indispensable to the healthcare ecosystem, ensuring the seamless flow of information,
security, and data accuracy.

71
 Figure 5.3

5.3 OPERATIONS / QUALITY MANAGEMENT

Operations and quality management are integral components of hospital administration, essential
for the efficient delivery of healthcare services and the assurance of patient safety and satisfaction.

Operations management in a hospital encompasses a wide range of functions aimed at optimizing

the utilization of resources and processes. It involves the efficient scheduling of patient
appointments, management of hospital staff and their workloads, supply chain management for
medical equipment and pharmaceuticals, and the coordination of various clinical and non-clinical
departments. Effective operations management ensures that patients receive timely and
72
appropriate care, minimizes wait times, and maximizes the use of available resources. It also plays
a crucial role in cost control, as it helps in reducing inefficiencies and redundancies in hospital
operations.

Quality management, on the other hand, is focused on maintaining and improving the quality of
healthcare services. This encompasses a commitment to patient safety, clinical effectiveness, and
the overall patient experience. One of the core aspects of quality management is the adherence to
clinical guidelines and best practices to ensure that patients receive evidence-based care. Quality
management also involves monitoring and assessing patient outcomes, tracking adverse events,
and continuously evaluating and improving clinical processes.

One of the key tools in quality management is the implementation of quality assurance programs,
which aim to prevent errors and mistakes in patient care. This includes measures such as medical
error reporting systems, safety protocols, and regular training and education for healthcare staff.
Quality management also involves gathering patient feedback and using it to make improvements
in service delivery.

In addition, quality management is closely tied to regulatory compliance. Hospitals must adhere to
a range of healthcare regulations and standards set by government agencies and accreditation
bodies. Ensuring compliance is not only a legal requirement but also an essential component of
providing safe and effective patient care.

Continuous quality improvement (CQI) is a fundamental aspect of quality management. It

involves the systematic review of processes and outcomes, identifying areas for improvement, and
implementing changes to enhance the quality of care. CQI is an ongoing process that requires the
active involvement of hospital staff at all levels.

In summary, operations and quality management in a hospital are vital for ensuring the efficient
and safe delivery of healthcare services. Operations management optimizes resource utilization
and processes, while quality management focuses on patient safety, clinical effectiveness, and the
overall patient experience. These two functions are interrelated, and their effective implementation
is essential for a hospital to provide high-quality healthcare services while maintaining operational
efficiency and regulatory compliance.

73
 Figure 5.4

IMPORTANCE OF QUALITY MANAGEMENT

Quality management holds paramount importance in hospitals, as it plays a pivotal role in

ensuring the delivery of safe, effective, and patient-centered healthcare. This process is integral to
the healthcare ecosystem for several reasons. Firstly, it safeguards patient safety by implementing
stringent protocols and guidelines that minimize the risk of medical errors, infections, and adverse
events. It also promotes clinical effectiveness by adhering to evidence-based practices, ensuring
that patients receive the most appropriate and efficient care. Quality management is instrumental
in improving the patient experience, as it focuses on factors like communication, empathy, and
responsiveness, enhancing overall patient satisfaction.

Furthermore, quality management is closely tied to regulatory compliance, helping hospitals meet
the standards set by government agencies and accreditation bodies, which are essential for
maintaining licensure and credibility. It contributes to cost reduction by minimizing inefficiencies
and redundancies in healthcare processes and preventing costly errors. Quality management also
fosters a culture of continuous improvement, with hospitals regularly reviewing and enhancing
74
their clinical processes and outcomes. It actively engages healthcare staff at all levels, encouraging
them to be proactive in identifying and addressing issues to maintain and enhance the quality of
care.

In the era of value-based healthcare, where reimbursement is increasingly tied to the quality of
care provided, hospitals that prioritize quality management are better positioned to thrive. Patients

and their families also benefit from improved outcomes, enhanced safety, and a more satisfying
healthcare experience. Therefore, quality management is an indispensable component of hospital
operations, ensuring that healthcare institutions uphold the highest standards of patient care,
safety, and satisfaction.

Figure 4.5

ESTABILISHING QUALITY STANDEREDS IN HOSPITAL

75
 Figure 4.6

Establishing quality standards in a hospital is paramount for ensuring the delivery of safe,
effective, and patient-centered healthcare services. These standards serve as a benchmark for
healthcare providers to maintain and improve the quality of care they provide. In this , we will
explore the essential components of establishing quality standards in a hospital, the importance of
these standards, and the processes involved in their development and implementation.

Quality standards in a hospital encompass a wide range of elements, including clinical care,
patient safety, administrative practices, and overall patient experience. These standards are
developed to align with the hospital's mission and values while adhering to industry best practices
and regulatory requirements. The process of establishing quality standards can be broken down
into several key steps.

76
The first step in setting up quality standards is the formation of a multidisciplinary team. This
team includes healthcare professionals, administrators, quality improvement experts, and patient
representatives. Their diverse perspectives are crucial in creating comprehensive and balanced
standards. The team reviews existing standards and regulations, both at the national and
international levels, to ensure alignment with current healthcare practices.

The next step involves a comprehensive assessment of the hospital's current state, often referred to
as a baseline assessment. This includes a thorough evaluation of the hospital's infrastructure,
resources, clinical outcomes, patient satisfaction scores, and safety records. The information
gathered during this assessment serves as the foundation for the development of new quality
standards.

Quality standards in a hospital typically focus on various aspects of healthcare delivery. Clinical
care standards define evidence-based guidelines for diagnosis, treatment, and patient monitoring.
These standards ensure that healthcare providers follow best practices in their respective fields,
reducing the risk of medical errors and improving patient outcomes.

Patient safety standards are another critical component. They address infection control, medication
management, surgical safety, and the prevention of adverse events. The goal is to create a safe
environment where patients can receive care without unnecessary risks.

Administrative standards encompass the hospital's operational and managerial aspects. These
standards cover staffing levels, staff training, record-keeping, financial management, and other
administrative processes. Ensuring the hospital's administrative practices are in line with
established standards helps improve overall efficiency and resource allocation.

Patient experience standards aim to enhance the quality of care from the patient's perspective. This
includes aspects such as communication, respect for patient preferences, and the provision of
information. Hospitals strive to create a compassionate and patient-centered environment, where
patients and their families feel heard and supported throughout their healthcare journey.

Once the multidisciplinary team has developed these standards, they undergo a rigorous review
process. This involves seeking feedback from various stakeholders, including clinical staff,
patients, and regulatory bodies. The standards should be practical, measurable, and achievable,
ensuring they can be effectively implemented within the hospital's specific context.

77
Implementation of quality standards is a complex process that requires careful planning and
ongoing monitoring. Hospitals must provide training and education to their staff to ensure they are
aware of and capable of adhering to the standards. Quality improvement initiatives and
performance measurement systems are put in place to track progress and make necessary
adjustments.

Continuous monitoring and evaluation are fundamental to the success of quality standards.
Hospitals regularly collect and analyze data related to clinical outcomes, patient safety, and patient
experience. This data-driven approach allows for the identification of areas that require
improvement and the development of strategies to address these issues.

In conclusion, the establishment of quality standards in a hospital is a multifaceted process aimed

at enhancing the quality of healthcare services. These standards cover clinical care, patient safety,
administrative practices, and patient experience. They are developed by a multidisciplinary team,
undergo thorough assessment and review, and are continuously monitored and improved. Quality
standards in a hospital are essential for ensuring that patients receive safe, effective, and patient-
centered care, ultimately improving the overall healthcare experience and outcomes.

5.4 HOSPITAL INFORMATION SYSTEM

A Hospital Information System (HIS) is a comprehensive and integrated software solution that
serves as the backbone of healthcare facilities, including hospitals, clinics, and medical centers. It
encompasses a wide range of functions to streamline the management of patient data, medical
records, administrative tasks, and clinical processes. HIS includes modules for patient registration,
appointment scheduling, electronic health records (EHR), billing and financial management,
laboratory and radiology information, pharmacy management, and more. HIS not only digitizes
and centralizes patient information but also facilitates the exchange of data among healthcare
professionals, ensuring accurate, timely, and secure access to patient records. This system
enhances patient care, reduces administrative burdens, and supports decision-making by providing
real-time clinical data. It is a crucial tool for improving healthcare efficiency, reducing errors, and
ultimately enhancing patient outcomes while adhering to the highest standards of data security and
patient confidentiality.
78
BILLING

Inpatient Billing
Outpatient Billing (consultation)
Outpatient Billing (X-rays, tests)

Inpatient Billing

At the time of Discharge the patient activity chart is sent to Inpatient pharmacy, food and dietary
departments to note the medicine and food expenses. There are two ways of paying the bill that is,
in the form of cash or credit. If the patient doesn’t have health Insurance, then, the bill is paid on
cash basis. If the patient has health insurance, the bill is faxed or sent to the Insurance Company
for the necessary approval. Approval of medical expenses incurred by the patient and the same is
collected with the credit period of 30 days.

Outpatient Billing (Consultation )

Any outpatient has to pay the fixed amount of consultation charges every time they consult
doctors. The billing is done for the same.

Outpatient Billing (X-ray, tests, etc)

79
This section of billing prepares a final bill based on different tests such as x rays, scanning, etc. the
patient has undergone and the amount is collected in cash for the same.
Expenses under Purchase Accounts include Consumables of various departments, this expense
includes
Ambulance charges
Bio-medical waste and Corporation tax
Food and Beverages
Lab test charges, etc.

80
 CHAPTER 6
LEARNING OUTCOMES

I had the privilege to do my internship in various departments below as part of Facility

management , internal audit assessment.

81
.Quality Department

.OP Registeration

.ENT

.General medicine

.Psychiatry

.Orthopaedics

.Obstetrics & Gynaecology

.General surgery

.Paediatric

.casuality

.Radiology

My 1 month of internship in hospital facility management provides invaluable learning outcomes

for aspiring professionals in this field. Throughout this experience, interns gain a deep
understanding of the critical role that efficient facility management plays in the healthcare sector.
They learn how to ensure that hospital facilities are well-maintained, safe, and compliant with
regulatory standards. Interns become proficient in managing resources effectively, optimizing
space utilization, and controlling costs, which are essential skills in healthcare settings where
every dollar counts. Moreover, they acquire the ability to coordinate with various hospital
departments, fostering effective communication and teamwork. This internship also exposes them
to emergency preparedness, as hospitals must be ready to respond swiftly to crises. Overall, the
experience equips interns with a comprehensive skill set, including facility maintenance,
regulatory compliance, resource management, and teamwork, all of which are vital for a
successful career in hospital facility management.
82
While doing my internship in Private Hospital I had identified various infrastructural defects,
Lack of technology, lack of modern medical equipments, leackages in wards & floors, unhygienic
environment, reusing of surgical tools. From these problems I will make sure to find the solution
by using various ways. As a study Design I am using non random sampling method which is
according to my convenience , observational study & direct interview methode for my study, this
survey method that I have done Mangalore regarding the comparison patients safety hospitals in
Mangalore. For non random survey I am taking 50 sample sizes.

6.1 METHODES OF MY STUDY

 OBSERVATIONAL METHODE

 SURVEY METHODE(CONVINIENT SURVEY)

 DIRECT INTERVIEW METHODE

OBSERVATIONAL STUDY:

An observational study in the field of hospital facility management involves gathering data
through direct observation of various aspects of hospital facilities, operations, and maintenance.
This type of study can provide valuable insights into the efficiency and effectiveness of facility
management practices without directly manipulating variables. Here I have selected cohort study.
A cohort study in the context of hospital facility management involves tracking a group of
individuals, patients, over a period of time to assess the impact of various facility management
practices on healthcare outcomes and operational efficiency. Researchers collect data on factors
like maintenance protocols, environmental conditions, and resource allocation. This type of study
helps hospitals make informed decisions to optimize their facility management strategies and
ultimately enhance the quality of care provided while managing costs.

From my observational study I had identified various infrastructural defects, Lack of technology,
lack of modern medical equipments, leackages in wards & floors, unhygienic environment,
reusing of surgical tools. From these problems I will make sure to find the solution by using
various ways. Here I am presenting few of my observational study findings below :

83
Figure 6.1

Figure 6.2

84
 Figure 6.3
6.2 FINDINGS

PROS:

. The Hospital will give All the Pregnancy for free of costs.

. It provides emergency facilities and services to the patients 24×7.

. All the employees in the hospital work as a team to the upliftment of the organization

. The organization offers tremendous opportunity for growth spanning multiple functions, business
and also international exposure.

. Employees in the organization are recognized as heart and essence of the organization. They are
regarded as central resource of the organization.

CONS:

.The infrastructure of the hospital is not good there were somany cracks on the walls & tiles ,
which may leads to patient fall or which might harm patients.

85
. Improper infrastructural facilities

. Lack of modern medical equipments in some of the departments.

. Not maintaining hygiene on some specific wards & floors.

. Lack of op patients.

SURVEY METHODE :

The survey method for comparing hospital patient safety involves collecting data through
structured questionnaires or interviews from patients, healthcare providers, and hospital staff.
These surveys aim to assess aspects such as the prevalence of medical errors, adherence to safety
protocols, communication effectiveness, and overall safety culture within hospitals. By comparing
the survey results across different hospitals, researchers and healthcare administrators can identify
strengths and weaknesses in patient safety practices, ultimately improving healthcare quality and
reducing adverse events.
Here I am doing my study on 50 individuals from Mangalore regarding the comparison of
hospitals in mangalore about patient safety. I done my study according to my convenience that is
non random sampling.

Convenient sampling is a non-probability sampling method where researchers select participants

or data points based on their accessibility and ease of inclusion. It's a quick and cost-effective
approach that often involves choosing subjects who are readily available or convenient to the
researcher, such as surveying people passing by on the street. While it's efficient, convenient
sampling may not provide a representative sample and can introduce bias, limiting the
generalizability of findings to the broader population.

86
6.3 DATA ANALYSIS OF COVINIENT SAMPLING

The data analysis of a convenience survey involves examining the collected information from a
non-random sample of participants who were easily accessible or readily available. This type of
survey may lack the randomization necessary for robust statistical inference, but it can still
provide valuable insights. During analysis, researchers typically employ descriptive statistics to
summarize key features of the data, such as calculating means, frequencies, and percentages.
Interpretation involves drawing conclusions based on these summary statistics and identifying
trends or patterns within the convenience sample. However, caution is needed when generalizing
findings to broader populations, as the non-random nature of the sample may introduce biases.
While convenient surveys are a quick way to gather information, their results should be interpreted
with a recognition of their limitations in terms of representativeness and generalizability.

For my I study I choose 50 sample size according my convenience. I took study of people from
Mangalore regarding the comparison of my hospitals in Mangalore.
For my study I used 10 questions regarding patient safety based on their age.
All my study results & pie charts will added below :

87
1) YOUR AGE GROUP

Figure 6.4

88
Chart 6.1

89
2) Which hospital would you prefer for patient safety?

Figure 6.5

Chart 6.2

90
3) How would you rate AJ hospital for patient Safety?

Figure 6.6

Chart 6.3

91
4) How would you rate PADMAVATHI hospital for patient Safety?

Figure 6.7

Chart 6.4

92
5) How would you rate SRINIVAS hospital for patient safety?

Figure 6.8

93
6) How would you rate YENEPOYA hospital for patient safety ?

Figure 6.9

Chart 6.5
94
7. Did you notice or experience any patient fall from any of these hospitals?

Figure 6.10

Chart 6.6

95
8. Do you consider recommendations from friends, family, or healthcare professionals when
choosing a hospital?

Figure 6.11

Chart 6.7

96
9. Is the overall patient experience, including a comfortable and supportive environment, a
priority for you?

Figure 6.12

10. From what basis did you choose your preferred hospital ?

97
 figure 6.13

Chart 6.8

6.4 INTEPRETATION

For my I study I choose 50 sample size according to my convenience. I took study of people
98
from Mangalore regarding the comparison of hospitals in Mangalore.
For my study I used 10 questions. From my survey I have identified few outcomes regarding
patient safety & people preference while choosing a hospital. In my sample size 68% of people are
between the age of 18-30 , 20% of people are the age above 30 & 12 % of people are between the
age 10-18.
When it comes preference of hospital regarding patient safety in 4 hospitals 40% of people are
choosing YENEPOYA hospital , 34% of people are choosing AJ hospital, 14% of people are
choosing PADMAVATI hospital & 12% of people are choosing SRINIVAS hospital.so in my
study only few % of people are choosing srinivas hospital for patient safety.

.when it comes to rating of each hospitals regarding patient safety, AJ got 44% excellent , 42%
good , 10% of average & 4% of response.

.when it comes to rating of each hospitals regarding patient safety, PADMAVATI got 42%
excellent , 34% good , 16 % of average & 8 % of response.

.when it comes to rating of each hospitals regarding patient safety, SRINIVAS got 10 %
excellent , 14% good , 28 % of average & 48 % of response.

.When it comes to the ratings of hospitals, YENEPOYA got 42 % of excellent, 28% of good , 18
% of average & 12 % of poor.

.Based public priority while choosing a hospital 38 % of people are preferring infrastructure &
hygiene , 28 % of people are preferring Qualified professionals , 18 % of people are preferring
modern medical equipment, 16 % of people are preferring affordability.

Here I found that the public are aware of patient safety but their response is not good on srinivas
hospital. Majority people are rated as poor that the I ssue identified from srinivas hospital.

4.5 SUGGESTIONS / SOLUTIONS

99
 Regular Infrastructure Audits: Conduct regular safety audits of hospital infrastructure to
identify and address potential hazards, ensuring a safe environment for both patients and
staff.
 Simulation Training: Conduct regular simulation training for healthcare staff to simulate
emergency scenarios, improving their response times and decision-making skills in critical
situations.
 Infrastructure and Technology: Invest in modern technologies and infrastructure to support
patient safety initiatives, such as electronic health records and smart monitoring devices.
 Patient Safety Committees: Form interdisciplinary committees to focus on patient safety
initiatives, review incidents, and implement improvements.
 Patient Feedback: Encourage and act upon patient feedback to identify areas for
improvement and enhance the patient experience
 Hand Hygiene Programs: Enforce strict hand hygiene protocols to reduce the spread of
infections within the healthcare environment

100
 CHAPTER – 7
CONCLUSION

7.1 CONCLUSION

On my internship periode it’s a great opportunity for me to learn new things inside the hospital , I
was assigned to work in various departments in the hospital such as facility management , audit
assesments etc. from that I learned various operational activities inside the hospital & that was a
great exposure for me to learn & I choose patient safety & fall prevention in hospitals as my
project topic because I found some issues inside hospital .One of the persistent challenges in
patient safety is the occurrence of medical errors,patient fall , ranging from misdiagnoses to
medication mistakes. Communication breakdowns among healthcare providers, inadequate
training, and systemic issues within healthcare infrastructure contribute to these errors.
Additionally, issues like patient misidentification, lack of standardized protocols, and the potential
for adverse events during transitions of care pose significant threats to patient safety.
In conclusion, safeguarding patient safety requires a multifaceted approach involving ongoing
education, robust communication systems, and a commitment to continuous improvement. By
investing in technology, training, and a culture of transparency and accountability, healthcare
providers can mitigate the risks associated with medical errors and enhance the overall safety of
patient care. It is imperative that the healthcare industry collaborates on implementing best
practices, embraces innovation, and prioritizes the well-being of patients to build a safer and more
101
resilient healthcare system.

7.2 REFERENCE

1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns
Hopkins University (JHU). https://coronavirus.jhu.edu/map. html. Accessed 16 May 2020.

2. WHO global infuenza preparedness plan. The role of WHO and recommendations for national
measures before and during pandemics. https://www.who.int/
csr/resources/publications/influenza/WHO_CDS_ CSR_GIP_2005_5.pdf. Accessed 16 May 2020.

3. World Health Organization. Non-pharmaceutical public health measures for mitigating the risk
and impact of epidemic and pandemic infuenza: annex: report of systematic literature reviews.
Contract No.: WHO/WHE/IHM/GIP/2019.1. Geneva: World Health Organization; 2019.

4. Cheng MP, Lee TC, Tan DHS, Murthy S. Generating randomized trial evidence to optimize
treatment in the COVID-19 pandemic. CMAJ. 2020;192(15):E405–7.

5. Cheng MP, Papenburg J, Desjardins M, Kanjilal S, Quach C, Libman M, et al. Diagnostic

testing for severe acute respiratory syndrome-related coronavirus-2: a narrative review. Ann Intern
Med. 2020;172(11):726–34.

6)Access Economics (2008). The burden of venous thromboembolism in Australia.

https://www.deloitteaccesseconomics.com.au/uploads/File/The%20burden%20of%20VTE%20i n
%20Australia.pdf (accessed 3.2.2017).

7) ACSQHC (2012), Open Disclosure Standard Review Report. Australian Commission on Safety
and Quality in Health Care, Sydney.

8) https://www.safetyandquality.gov.au/publications/opendisclosure-standard-review-report/
AHRQ (2015), National Healthcare Quality and Disparities Report and 5th Anniversary Update
on the National Quality Strategy. Agency for Healthcare Research and Quality.
9) AHRQ Pub. No. 16-00 15. AHRQ (2015b), Saving Lives and Saving Money: Hospital-
Acquired Conditions Update,
102
www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html (accessed
04/12/2016). AHRQ (2016),
10) National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data
From National Efforts to Make Health Care Safer. Agency for Healthcare Research and Quality

11).www.ahrq.gov/sites/default/files/wysiwyg/professionals/qualitypatientsafety/pfp/2015-natl-
scorecard-hac-rates.pdf (accessed 26.01.2017) Andel, C. et al (2012).

12) The economics of health care quality and medical errors. J Health Care Finance;39(1):39-50.
Aranaz Andrés J. M. et al (2011). Prevalence of adverse events in the hospitals of five Latin
American countries: results of the ‘Iberoamerican study of adverse events (IBEAS).

13) BMJ Quality&Safety. doi:10.1136/bmjqs.2011.051284. Arefian, H. et al (2016). Hospital-

related cost of sepsis: A systematic review. British Infection Association.

14 ) http://dx.doi.org/10.1016/j.jinf.2016.11.006 Baldor D and Kravietz A (2016). Response to

Medical error—the third leading cause of death in the US.

15) BMJ 2016; 353. Bayoumi, A. et al (2008). The cost-effectiveness of prevention strategies for
pressure ulcers in longterm care homes in Ontario: projections of the Ontario pressure ulcer
model.

16) NHS. Economic Evaluation Database. Beckman et al (2016). Strategies and partnerships
toward prevention of Healthcare-Associated Venous Thromboembolism. Hospital Medicine; 11,
Supplement S2:S5–S7.

17 ) Berwick D (2016). Era 3 for medicine and health care. JAMA. 2016;315(13):1329-1330.
Birkmeyer JD et al (2001). Leapfrog patient safety standards: The potential benefits of universal
adoption. Washington, DC: The Leapfrog Group Bhasale AL et al (1998), Analysing potential
harm in Australian general practice. Medical journal of Australia, 169(2):73-6

18) Berenholtz SM et al. (2011) Collaborative cohort study of an intervention to reduce

ventilatorassociated pneumonia in the intensive care unit. Infection Control and Hospital
Epidemiology;32:305–314.

19) Borchard A, Schwappach DL, Barbir A, Bezzola P (2012). A systematic review of the
103
effectiveness, compliance, and critical factors for implementation of safety checklists in surgery.
Ann Surg ;256:925-933.

20) Braithwaite et al (2015). Resilient health care: turning patient safety on its head. International
Journal for Quality in Health Care doi: 10.1093/intqhc/mzv063.

7.3 ANNEXURE

1) Age :
A) 0-10
B) 10-18
C) 18-30
D) Above 30

2) Which hospital would you prefer for patient safety?

A) Aj
B) Srinivas
C)Padmavati
D) Unity hospital

3) How would you rate Aj hospital for patient safety

104
A) Excellent
B) Very good
C) Average
D) Poor

4) How would you rate Padmavati hospital for patient safety?

A) Excellent
B) Very good
C) Average
D) Poor

5) How would you rate Srinivas hospital for patient safety

A) Excellent
B) Very good
C) Average
D) Poor

6) How would you rate Yenepoya hospital for patient safety

A) Excellent
B) Very good
C) Average
D) Poor

7) Did you experience any Patient fall from any of these hospitals?
Yes)
No)

8)Do you consider recommendations from friends, family , or healthcare professionals when
choosing a hospital?
Yes)
No)

9)Is the overall patient experience , including a comfortable & supportive enivironment, a priority
for you?
Yes)
No)
105
10)From what basis did you choose your preffered hospital ?
A)Modern infrastructure & hygiene
B)Quality professional
C)Modern Medical equipment
D)Afforadability.

106