February 2014

An Overview of the Hospitals Infrastructure – A Call to Action!

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Today hospitals are not just about being simply nice or fancy than traditional hospitals. Rather, the focus is to create hospitals that actually help patients recover and be safe, and help staff do their jobs better. Japneet Kaur, ENN, giving an overall perspective on Indian Healthcare infrastructures.
Healthcare services are in a dire need of a paradigm shift in terms of providing care more efficiently. Healthcare today harms too frequently and routinely fails to deliver its potential benefits. The delivery of health and social care is undergoing profound change and being redesigned to improve capacity and performance through the provision of high quality, patient-centric services.
Hospital design can impact clinical outcomes. Construction program should be provided with an opportunity to rethink hospital design. The impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, less noise, improved lighting, better ventilation, supportive workplaces and improved layout can help reduce errors, stress, improve sleep, pain and drugs, increase effectiveness in delivering care, improve patient safety, and overall healthcare quality.
In addition to a deteriorating physical infrastructure, India faces a huge shortage of trained medical personnel. The size of the health workforce (both health professionals and other health workers) has declined in absolute numbers, and this directly threatens patient safety.

Nurses, physicians, and other healthcare employees work under extremely stressful physical conditions. The design of hospitals often increases staff stress and reduce their effectiveness in delivering care. While much research in the hospital setting has been aimed at patients, there is a growing and convincing body of evidence suggesting that improved designs can make the jobs of staff much easier. Workplace design that reflects a closer alignment of work patterns and the physical setting can improve work flow and increase patient satisfaction with the service.
The chronic shortages of equipment and supplies (including vaccines, antibiotics, and other essentials) compounds poor quality of services. Irregular supply of essential drugs at all levels of the health delivery system leads to unnecessary delays in treatments.
clinicMost of health workers highlight a lack of capacity to satisfactorily complete diagnostic examinations at dispensaries and hospitals. These workers often go months without supervision. Inadequate communication between health service providers at the various levels means that provided skills and facilities are not maximised.
There is an immediate need for medical education and training, which could provide additional opportunities for private sector providers or public-private-partnerships (PPP). Technology should be applied in innovative ways to enhance operational efficiency, enabling care coordination and improving patient outcomes. Technology that enables telemedicine could also be used to deliver training courses.
These medical professionals cite many concerns common in lowerlevel facilities: low salaries, frequent unavailability of necessary equipment and consumables, inadequate performance evaluation and feedback, poor communication channels between workers and management, lack of participation in decision-making processes, and a general lack of concern for workers welfare by the hospital management.

Priority areas for further action

*Design of healthcare environments

*Provide single-bed rooms. Single rooms have been shown to lower hospital-induced nosocomial infections, reduce room transfers and associated medical errors, greatly lessen noise, improve patient confidentiality and privacy, facilitate social support by families, improve staff communication to patients, and increase patients’ overall satisfaction with health care

*Installation of high-performance sound-absorbing ceilings, and eliminating noise sources (for example, using noiseless paging)

*Improve ventilation through the use of improved filters

*Improve lighting, especially access to natural lighting and fullspectrum lighting

*Design ward layouts and nurses stations to reduce staff walking and fatigue, increase patient care time, and support staff activities such as medication supply, communication, charting, and respite from stress Immediate availability of complete medical record (compiled from all sources) to any point-ofcare

*Enable use of tools and equipments such as electrical sub-stations, generators, AC plant, kitchen equipment, laundry equipment etc. to facilitate delivery of care

*Manpower requirement

*Increasing the operational efficiency of healthcare space

*Reduce length of stay of patients in hospitals by providing them timely services

Invariably, it is at this crucial stage that the aspect of maintenance has got neglected without the realisation that this very aspect that determines the efficient delivery of healthcare, results in patient satisfaction. Over time, senior management staff, healthcare providers and clinicians at various hospitals have realised this oversight and have instituted corrective measures. They are incorporating the costs of maintenance of medical equipment in the procedure of procurement. This makes maintenance the onus of the supplier and ensures that timely checks and actions are taken by the supplier to make sure that delivery of healthcare is uninterrupted and efficient.
Taken together, population growth, too few health workers and their poor morale, lack of equipment and medical supplies, and increasing health burdens from chronic and emerging diseases have overwhelmed the capacity of the health system. The overall performance of health service delivery is unsatisfactory at all levels, especially in the public sector. Commitment by the government and other stakeholders of adequate financial and human resources, together with their efficient and effective utilization, will go a long way to improve the health of its population.

 

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