Indian Journal of Public Health Research & Development

Deepu Rani ¹, D. Shalini ², S. Arun Mavaji ³

Affiliations
1 Department of Hospital Administration, M.S. Ramaiah University of Applied Sciences, IN
2 M.S. Ramaiah University of Applied Sciences, IN
3 Ramaiah Memorial Hospital, Karnataka, IN

Abstract

A quality improvement initiative is incomplete if the improvement is not sustained. The concept of sustainability is not limited to achieving the change and adhering to it, but further commitment is required from the staff for continuous improvements in the organization. The application of Six Sigma for process efficiency and achieving break through results are quite obvious, but evidence on its sustainability is limited. So, the current study was designed to re-explore the applicability of Six Sigma to re-engineer the discharge process with emphasis on determinants of sustainability factors. The methodology chosen was DMADV approach of Six Sigma. Define phase involved scrutinizing the finer details of process and resources utilized. The mean Turn-Around Time was measured for credit (269 mins) and cash (241 mins) patients using a time motion study. The NHS sustainability model was utilized for assessing the existing sustainability score of process. Minitab and Minitab Companion software was used for analysis of process capability and value stream metrics analysis. The process was re-engineered by streamlining the activities based on the standards given by NABH 4^th Edition, JCI 6^th Edition and best practices followed in different healthcare settings. Specific roles and responsibilities of staff were re-defined for the improved process. Failure Mode and Effect Analysis and control and impact matrix was conducted and provided to process stakeholders for ease of implementation. Validation of process improvement was done by value stream metrics analysis and discussion with the hospital administrator. The outcomes of the study were simplified process and discharge pro-forma which can be further utilized for application of Six Sigma in similar healthcare settings.

Keywords

Quality Improvement, Discharge Process, Six Sigma method, Sustainability, Re-Engineering.

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Sneha Ashwani Sharma ¹, D. Shalini ¹, S. Arun Mavaji ²

Affiliations
1 Department of Hospital Administration, Ramaiah University of Applied Sciences, Gnanagangothri Campus, IN
2 Ramaiah Memorial Hospital, New BEL Road, MSR Nagar, Bangalore, IN

Abstract

Health care witness new technologies frequently as there is always need to improve patient care. One of such technology emerging rapidly in surgical field is robot assisted surgery. This technology has proven its efficacy all around the world and now gaining popularity in India. Study of robotic system technology will provide benefits in health care sector. This study will focus on feasibility of robotic surgery from hospital perspective. An elaborate discussion will be done on operational and financial parameters to assess the feasibility of robotic surgery in a tertiary care hospital in Indian set up. An explorative study design based on retrospective data is used to forecast the possibility of success of robotic program in future. The associated parameters will be assessed with the use of checklist, survey and financial aspects in form of return on investment and break-even analysis. The study suggests that number of da Vinci system installed and robotic procedures done are increasing every year world-wide as well as in India. Result of this study is 100% surgeon’s readiness to adopt, get trained and perform the robotic surgery. Hospital infrastructure supports robotic program with requirement of small modifications in form of dedicated uninterrupted power supply for the equipment, internet facility and plasma sterilizer. Hospital can attain positive return on investment by 7^th year if 25% surgeries out of the potential cases performed through da Vinci X^® every year. 731 surgeries to be performed by da Vinci X to attain breakeven point.

Keywords

Robotic Surgery, Da Vinci Robotic System, Surgical Indications, Feasibility, Robotic Setup.

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