Summer Internship Report

Manpower planning planning and optimization optimization (of technicians) technicians) using Erlang’s Erlang’s method

1. INDUSTRYOVERVIEW A hospital is an institution for health care providing treatment by specialized staff and equipm equipmen ent’ t’s, s, and often often but not not alway alwayss provi providin ding g for for longer longer term term pati patient ent stays stays.. Today hospitals are usually funded by the state, health organization (for profit or nonprofit), health insurances or charities, including direct charitable donations. n history, however, they are often founded and funded by religions orders or charitable trust individuals and leaders. !imilarly modern day hospitals are largely staffed by professional physicians surgeons and nurses, where as in history, this wor" was usually done by the founding religious orders or by volunteers. Thee healt Th health h care care indust industry, ry, or medic medical al indus industry try,, is a secto sectorr withi within n theeconomic the economic system that

provides

goods

and

services

to

treat

patients

with

curative, preventive curative, preventive,, rehabilitative rehabilitative,, and and palli palliati ative ve care. care. Th Thee mo moder dern n healt health h care care secto sectorr is divi divide ded d into into many any sub# sub#se sect ctor ors, s, and and depe depend ndss oninte on interdis rdiscipl ciplinar inary y team teamss of trai traine ned d professionals and paraprofessionals and paraprofessionals to to meet health needs of individuals and populations. The health care industry is one of the world$s largest and fastest#growing industries. %onsuming over &' percent of gross domestic product (*) of most developed nations, health care can form an enormous part of a country$s economy. n accord with the original meaning of the word, hospitals were originally +places of hospitality+, and this meaning is still preserved in the names of some institutions such as the oyal -ospital %helsea, established in &/& as a retirement and nursing home for veteran soldiers. !ome patients go to a hospital 0ust for diagnosis, treatment, or therapy and then leave ($outpatients$) ($outpatients$) without staying overnight1 while others are $admitted$ $admitted$ and stay overnight or for several days or wee"s or months ($inpatients$). -ospitals usually are distinguished from other types of medical facilities by their ability to admit and care for inpatients whilst the others often are described as clinics. General

1


The best#"nown best#"nown type of hospital is the general hospital, which which is set up to deal with many "inds of disease and in0ury, and normally has an emergency department to deal with immediate and urgent threats to health.

District

A district district hospital typically is the ma0or health care facility in its region, with large numbers of beds for intensive care and long#term care. Specialized

Type

of

spe specia cialized zed

hospi ospittals als

incl nclude ude traum umaa

centre ntres, s, reh rehabi abilit litati ation

hospitals, children$s hospitals, seniors$ (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories such as cardiac, oncology, or orthopaedic problems, and so forth. A hospital may be a single building or o r a number of buildings on o n a campus. Teaching

A teac teachin hing g hospi hospita tall combin combines es assist assistan ance ce to patie patients nts with with teach teachin ing g to medic medical al students and nurses and often is lin"ed to a medical school, nursing school or university. Clinics

The medical facility smaller smaller than a hospital is generally called a clinic, and often is run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). %linics generally provide only outpatient services.

Departents

-ospitals vary widely in the services they offer and therefore, in the departments (or +wards+) they have. 2ach is usually headed by a %hief *hysician. They may have acute services such as a depart mentor specialist trauma centre, burn unit, surgery, or urgent care. These may then be bac"ed up by more specialist s pecialist units such as3 •

2mergency department

•

%ardiology

•

ntensive care unit 2

Manpower planning planning and optimization optimization (of technicians) technicians) using Erlang’s Erlang’s method •

*ediatric intensive care unit

•

4eonatal intensive care ca re unit

•

%ardiovascular intensive care unit

•

4eurology

•

5ncology

•

5bstetrics and gynecology

!ome hospitals will have outpatient departments and and some will have chronic treatment units such as behavioural behavioural health services, services, dentistry dentistry,, dermatology, dermatology, psychiatric psychiatric ward, rehabilitation rehabilitation services,

and physical

therapy.

%ommon

s u p po r t

units

include

a

dispensary or pharmacy, pathology and radiology, and on the non#medical side, there often are medical records departments, release of information departments.

1.1!"spitals in India

-ealt -ealth h care care is ndia’ ndia’ss mo most st impor importa tant nt servic servicee indus industry try.. Th Thee mo moder dern n syste system m of medicine was introduced in &6th century with the arrival of 2uropean %hristian missionaries in south ndia. 7rom its gradual evolution through the &/th and &8th centuries the hospitals both in western and eastern east ern world has come of age only onl y recently during the past pas t 9' years. The concept of today’s hospital contrasting fundamentally from the old idea of hospitals as no more than a place for treatment of the sic", with the under coverage of every aspect of human welf welfare are viz#p viz#phy hysic sical al menta mentall and social social well wellbei being ng etc. etc. Th Thee healt health h care care servic services es have have undergone steady metamorphosis and the role of hospital, has changed with the emphasis shifting from • • •

A curative to chronic illness A curative to preventive medicine ndividual orientation to community orientation 3

Manpower planning planning and optimization optimization (of technicians) technicians) using Erlang’s Erlang’s method • • • • •

npatient care to outpatient and home care estorative to comprehensive medicine solated function to area wise or regional function Tertiary and secondary to primary healthcare 2pisodic care to total care

!pecialized hospitals are coming up in many places in recent years. f the tas" of hospi hos pital talss is to resto restore re healt health h and hot merel merely y to cure cure diseas diseasee entity entity then the role role and responsibilities of hospital assume to be of great significance.

#ac$gr"%nd

7or purposes of finance and management, the health care industry is typically divided into sever veral are areas. As a basic sic fram ramewor" or" for for def definin ning the secto ctor, the :nit nited 4ations nternati nternational onal !tandar !tandard d ndustrial %lassification(! %lassification (!%) %) categori categorizes zes the health health care industry as generally consisting of3 &. -ospital activities1 ;.
ndu n dust stry ry

%las %l assi sifi fica cati tion on

!ta tand ndar ard d an d

the nd ndus ustry try

%las %l assif sific icati ation on

>enchmar" further >enchmar" further distinguish the industry as two main groups3 &. -ealt -ealth h care care equi equipm pment ent and and servi service cess ;. *harmaceuticals *harmaceuticals,, biotechnology biotechnology and and related life sciences. sciences. -ealt -ealth h care care equip equipme ment nt and servi services ces compri comprise se compa companie niess and entit entitie iess that that provi provide de medical equipment, medical supplies, and health care services, such as hospitals, home health 4


care providers, and nursing homes. homes. The second industry group comprises sectors companies that produce biotechnology, pharmaceuticals, and miscellaneous scientific services. 5ther approaches to defining the scope of the health care industry tend to adopt a broader definition, also including other "ey actions related to health, such as education and training of health health professi professional onals, s, regulati regulation on and managem management ent of health health service servicess delivery delivery,, provisio provision n of traditional and complementary medicines, and administration of health of health insurance. insurance. 1.& 'r"(iders and 'r")essi"nals

A health care provider is is an institution (such as a hospital or clinic) or person (such as a phy physici sician, an, nurse, nurse, alli allied ed heal health th prof professi essional onal or or comm community unity heal health th wor wor"er "er ) that that provid provides es preventive, curative, promotional promotional,, rehabilitative or palliative care services in a systematic way to individuals, families or communities.

The ?o ?orld rld -ealth 5rgani 5rganization zation estim estimate atess there there are are 8.; 8.; mill million ion phy physic sician ians, s, &8.@ &8.@ million nurses and midwives, &.8 million dentists and other dentistry personnel, ;. million pharmacists and other pharmaceutical personnel, and over &.= million community health wor"ers worldwide ma"ing the health care industry one of the largest segments of the wor"force. The medical industry is also supported by many professions that do not directly provide health care itself, but are part of the management and support of the health care system.. system

The

incomes

of

mana ma nage gers rs

and an d

admi ad mini nist stra rato tors rs,, underwriters underwriters and and medical

malpractice attorneys, malpractice attorneys, mar"eters, investors and shareholders of for#profit services, all are attributable to health care costs. n

;''=,health

care

co s ts

paid

homes,, diagnostic homes diagnostic laboratories, laboratories, pharmacies pharmacies,, med edic ical al

to

hospitals,

physicians, nursing

devi de vice ce manufa nufact ctu urers ers

and

other her

components of the health care system, consumed &9.= percent of the * of the :nited !tates, the largest of any country in the world. 7or :nited !tates, the health share of gross domestic product (*) is epected to hold steady in ;'' before resuming its historical upward trend, reaching &8. percent of * by ;'&. n ;''&, for the 52% 52% countries countries the average was /.@ percent with the :nited !tates (&=.8B),!witzerland (&=.8B),!witzerland (&'.8B (&'.8B), ), and ermany (&'.6 (&'.6B) B) being being the the top three three.. :! healt health h care care epend ependitu iture ress total totaled ed :!C;. :!C;.; ; trill trillion ion in ;''. According to -ealth Affairs, :!C6,@8/ be spent on every woman, man and child in the

5

Manpower planning and optimization (of technicians) using Erlang’s method

:nited !tates in ;''6, ;' percent of all spending. %osts are pro0ected to increase to C&;,6/; by ;'&. 1.* Deli(er+ ") Ser(ices

The delivery of health care services D from primary care to secondary and tertiary levels of care D is the most visible part of any health care system, both to users and the general public. There are many ways of providing health care in the modern world. The place of delivery may be in the home, the community, the wor"place, or in health facilities. The most common way is face#to#face delivery, where care provider and patient see each other $in the flesh$. This is what occurs in general medicine in most countries. -owever, with modern telecommunications technology, in absentia health care is becoming more common. This could be when practitioner and patient communicate over the phone, video conferencing, the internet, email, tet messages, or any other form of non#face#to#face communication.

mproving access, coverage and quality of health services depends on the ways services are organized and managed, and on the incentives influencing providers and users. n mar"et# based health care systems, for eample such as that in the :nited !tates, such services are usually paid for by the patient or through the patient$s health insurance company. 5ther mechanisms include government#financed systems (such as the 4ational -ealth !ervice in the :nited Eingdom). n many poorer countries, development aids as well as funding through charities or volunteers helps support the delivery and financing of health care services among large segments of the population. The structure of health care charges can also vary dramatically among countries. 7or instance, %hinese hospital charges tend toward 9'B for drugs, another ma0or percentage for equipment, and a small percentage for health care professional fees. %hina has implemented a long#term transformation of its health care industry, beginning in the &8/'s. 5ver the first twenty#five years of this transformation, government contributions to health care ependitures have dropped from =B to &9B, with the burden of managing this decrease falling largely on patients. Also over this period, a small proportion of state#owned hospitals have been privatized. As an incentive to privatization, foreign investment in hospitals D up to 6'B ownership D has been encouraged.

1.,-edical T"%ris 6


include

elective procedures as well

as comple

specialized surgeries such as 0oint replacement ("neeFhip), cardiac surgery, dental surgery, and cosmetic surgeries. -owever, virtually every type of health care, including psychiatry, alternative treatments, convalescent care and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication# connection#contract, and in such cases this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed. 5ver 9' countries have identified medical tourism as a national industry. -owever, accreditation and other measures of quality vary widely across the globe, and there are ris"s and ethical issues that ma"e this method of accessing medical care controversial.

Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

7


8


&. CO-'NY 'RO/I0E

oard for -ospitals and -ealth %are *roviders (4A>-). <
9


&.1 Visi"n

+?e shall strive to establish a medical institute of international standard for providing comprehensive healthcare to the people as a %aring
*rovide %omprehensive, %aring and %ost effective
•

nvolve in
•

4urture rapport among the
•

2nsure ethical practice of
•

7ulfill the social responsibility to the underprivileged by providing free or subsidized medical treatment.

&.* -a"r ccreditati"ns 2 3ard

4A>- (4ational Accreditation >oard for -ospitals and -ealthcare *roviders) <oard) <
10


<oard of 2aminations,
?elfare epartment, ovt. of ndia to conduct training for 4> students in 24T, eneral asic Gife !upport, Advanced %ardiac Gife !upport, Trauma Gife support and *aediatrics %ardiac Gife !upport. &.4 Uni5%e )eat%re ") -I-S •

5ver a hundred medical professionals as full time doctors

•

7irst multi#specialty hospital in the country to gain 4A>- accreditation

•

Gevel H Trauma care facility

•

5ne of the best ntensive care facilities in the country

•

!tate of the art Gaboratory with highest level of quality control

•

>lood >an" with component separation facility

•

The first %ochlear mplant %linic in the !tate

•

Advanced nterventional adiology

•

!tate of the art 4uclear
11

Manpower planning and optimization (of technicians) using Erlang’s method •

ound the cloc" availability of nterventional %ardiologists for *rimary angioplasty

&.6 7%alit+ '"lic+

all phases of activity will be achieved by periodical review and repeated training processes. The motto of the hospital is +%aring mission with a lobal Hision+ and attainment of highest quality in our wor" will be essential part of our policy. &.8 -I-S Charita9le Tr%st

As a part of %orporate !ocial esponsibility <elow *overty Gine. :nder its charitable wing, <

health chec"#up, ay %are ?ards etc. t is relevant that in today’s world, speedy and suitable health management has increased two folds. The modern society now is afflicted with ailments, lin"ed to the current stressful and competitive life styles in this harsh and unforgiving world that did not eist in olden days. The ever increasing cost of medical treatment deters people living in poverty to gain an access to premium health care. ?e witness an apathetic state of affairs where many children and adults afflicted with all sorts of diseases and ailments are left to die a slow and agonizing death, not for lac" of epert medical treatment but for want of financial support. Enowing that they will not be able to

afford timely medical treatment with prohibitive costs, their vitality and spirit for living ebbs away and they slowly sin" into despair, waiting for death to ta"e over. <

poor people have benefited from their charity. Halsan from Tellicherry, a recipient of aid from <
!pecial ac"nowledgement is given to the staff for their ecellent hospitality during hi and his family$s stay in <
Gife is a gift of od. ood healthcare should never be the prerogative of the privileged few. The main focus of <oard of Trustees is comprised of eminent doctors, dedicated and distinguished *hilanthropists.
%hief of medical service

r.-amsa

2ecutive irector irector

asheer r. Ali 7aisal

irector 14


r. Abdul ahman *rof3 r. E Earthi"eya Harma
irector # Academy, esearch J Iuality %hief 7inancial 5fficer %ompany !ecretary

C"re c"ittee e9ers


r.-amsa

2ecutive irector irector M Academy, esearch J Iuality %hief 7inancial 5fficer

asheer r. E Earthi"eya Harma
%onsultant M Gaboratory eneral
r. eorge E.A
#"ard ") Direct"rs

%hairman

r. Azad
Hice %hairman

r. <. Ali


r. -amsa

2ecutive irector

asheer

•

2ngr. !alahuddin <

•

•

2ngr. Abdurahman E *

•

r. -amza * <

15


•

•

r. smail E.<.

•

2ngr.
•

•

•

r.(*rof). Earthi"eya Harma

•

•

•

r. Abdul ahiman E

•

•

•

r. *a""ar Eoya

•

r. Ali 7aizal

•

•

2ngr. Ahamed
•

•

2ngr. Ahamed
•

r. !alim A.

•

&.1> C"rp"rate -anageent ") the C"pan+

<
The day to day affairs of the %ompany is loo"ed after byasheer : (2ecutive irector) and r.-amsa (%hief of medical service) assisted by a team of professional managers which includes ichu(Asst.

'r""ters ") the C"pan+ •

r. Azad
•

2ngr. A. ahman

•

•

•

•

•

r. Abdulla %heraya""at

•

•

•

r. Ali <

•

r. Ali 7aizal

•

•

•

•

•

r. smail E.<.

•

•

•

•

r.
•

•

•

•

•

•

•

•

•

•

•

r. *a""ar Eoya

•

•

•

17


•

•

r. !alim A..

•

r. !ayed
•

•

•

•

&.11 -I-S cade+

<oard of 2aminations, training. < in &' specialties, overnment approved iploma, *ost >asic iploma, egree and *ostgraduate 4ursing courses, harat !eva" !ama0 Approved %ourses, and various <asic Gife !upport, Advanced %ardiac Gife !upport, Trauma Gife support and *ediatrics %ardiac Gife !upport. &.1& Certi)icati"ns

oard (*%>) for ta"ing the best pollution control measures in the health sector and for initiating social !ervice in the sector. <
18


As part of its mission to provide -ealth care of nternational !tandards, <
%onsumed in releasing the patients from our -ospital and also saved the precious time of the doctors, which can be utilized in caring the other patients.

2.14 DEPARTMENTS Clinical Departents •

Anesthesiology

•

%ardiac Anesthesia

•

%ardiology

•

%ardiothoracic and Hascular !urgery

•

%ritical %are
•

ental And
•

ermatology

•

2mergency
•

2ndocrinology

•

24T

•

astroenterology

19


astrointestinal !urgery

•

eneral
•

eneral !urgery

•

•

4eonatology

•

4ephrology

•

4eurology

•

4eurosurgery

•

4uclear medicine

•

5bstetrics and ynecology

•

5phthalmology

•

5rthopedics

•

*athology

•

*ediatric %ardiac !urgery

•

*ediatric %ardiology

•

*ediatric !urgery

•

*ediatrics

•

*hysical

*lastic and econstructive !urgery

•

*reventive -ealthcare

•

*sychiatric
•

*ulmonary
•

adiology and maging !ciences

•

heumatology

•

:rology

Ser(ice Departents •

>lood >an"

•

%!!

•

epartment of 4ursing

•

Gaboratory
•

Units

<
<
21


The - Accredited hospital in ndia) and
earned a very good recognition as a leader in providing world class health care services with international standards to the common man at an affordable cost. The hospital is continuously in tune with the latest technology that promotes the health care and wellbeing of passion.

&.16 -I-S ?"tta$$al

The <
<
The -uman esource epartment of <
The aim of - epartment is to ma"e sure that a fruit full relationship is maintained within the organization. -a"r r"le

22


•

!taffing Training Appraisals 2mployee welfare

•

%omply with statutory governmental bodies

• • •

Sta))ing

The - epartment ma"es sure that they recruit the right candidate for the right 0ob. They see to it that proper manpower planning and recruitment procedures are followed.

Training

The - epartment engages the new employee in a structured nduction process that consist of <
*erformance appraisals are carried out yearly for rating the performance of the employees, to understand the training requirements, confirmation, promotion, salary revisions, transfer etc. Epl"+ee 3el)are

The - epartment ta"e care of employees welfare through schemes li"e 2*7, 2!, 7ree family insurance etc. ;' employees are included in 2! welfare fund. Stat%t"r+ C"pliance

The - epartment sees to it there is liaise with statutory government bodies li"e 2*7 egional office, istrict lab our office, 2! corporation etc. every month with proper reports. Apart from this the - epartment conducts 2it interviews for every employee who leaves the organization. &.1< E@cl%si(e 7W0 eas%res ad"pted in -I-S • • • •

7ree treatment for the employees and their family Oob enlargement Oob rotation epartment wise pleasure trips (one day trip paid by the management) 23


etirement benefit (contributory pension scheme)

•

<
•

ewards (K>est employee’ award is given to employees of different departments

•

annually, on the basis of attendance and performance) %omplete health chec"#up for new employees at half the original cost ecreational facilities (ndoor games li"e table tennis, carom, chess etc.

•

24


&.&> ORGNIATION0 STRUCTURE

25


*. !OS'IT0 OVERVIEW The study is conducted in

2amining the organizational ob0ectives and policies. Assessing manpower demand. 7orecasting supply of manpower. ap analysis. esigning manpower programs.
t is the first step towards manpower management. t refers to the process of using available assets for the implementation of the business



plan. t also involves the process of coordinating and controlling various activities in the





organizations. 2fficient utilization of s"illed labours. ncrease productivity.



t helps to face the shortage of certain categories of employees andF or variety of s"ills



despite the problem of unemployment. Needs ") -anp"3er 'lanning 

All the recruitment and selection programs are based on manpower planning.

26

Manpower planning and optimization (of technicians) using Erlang’s method 

educe labour cost as ecess staff can be identified and thereby overstaffing can be



avoided. t helps to identify the available talents in a concern an according training programs



can be given to develop those talents. Through manpower planning human resource can readily available and they can be



utilized in this manner. rowth and diversification of business. t helps to realize the importance of manpower management which ultimately helps in



the stability of a concern. !hortage and surplus can be identified so that quic" action can be ta"en whenever



required. d(antages • • • • • • • • • • • •

*.& ER0NG STUDY .?. Erlang

2rlang is named after a anish telephone engineer named A.E 2rlang (Agner Erarup 2rlang). -e was born on &st Oanuary &/6/ and although he trained as a mathematician, he was the first person to investigate traffic and queuing theory in telephone circuits.After receiving his <) and it was through this organization that 2rlang met the

27


%hief 2ngineer of the %openhagen Telephone %ompany (%T%) and as a result, he went to wor" for them from &8'/ for almost ;' years. ?hile he was at %T%, 2rlang studied the loading on telephone circuits, loo"ing at how many lines were required to provide an acceptable service without installing too much over#capacity that would cost the company money. There was a trade#off between cost and service level. 2rlang developed his theories over a number of years, and published several papers. -e epressed his findings in mathematical forms so that they could be used to calculate the required level of capacity, and today the same basic equations are in widespread use. n view of his ground#brea"ing wor", the nternational %onsultative %ommittee on Telephones and Telegraphs (%%TT) honored him in &8@ by adopting the name N 2rlangP + for the basic unit of telephone traffic. 2rlang died on =rd 7ebruary &8;8 after an unsuccessful abdominal operation. Erlang

An 2rlang is a unit of telecommunications traffic measurement. !trictly spea"ing, an 2rlang represents the continuous use of one voice path. n practice, it is used to describe the total traffic volume of one hour. 2rlang traffic measurements are made in order to help telecommunications networ" designers understand traffic patterns within their voice networ"s. This is essential if they are to successfully design their networ" topology and establish the necessary trun" group sizes.

2rlang traffic measurements or estimates can be used to wor" out how many lines are required between a telephone system and a central office (*!T4 echange lines), or between multiple networ" locations. !everal traffic models eist which share their name with the 2rlang unit of traffic. They are formulae which can be used to estimate the number of lines required in a networ", or to a central office (*!T4 echange lines). A formula also eists to model queuing situations, and lends itself well to estimating the agent staffing requirements of call centers. The ain Erlang tra))ic "del is listed 9el"3=

28


Erlang tra))ic "del •

2rlang> This is the most commonly used traffic model, and is used to wor" out how many lines are required if the traffic figure (in 2rlang’s) during the busiest hour is "nown. The model assumes that all bloc"ed calls are immediately cleared.

•

2tended2rlang> This model is similar to 2rlang >, but ta"es into account that a percentage of calls are immediately represented to the system if they encounter bloc"ing (a busy signal). The retry percentage can be specified.

2rlang% This model assumes that all bloc"ed calls stay in the system until they can be handled. This model can be applied to the design of call center staffing arrangements where, if calls cannot be immediately answered

pplicati"n ") Erlang st%d+ in !%an Res"%rce 'lanning

>ased on the basic principle of 2rlang used in Telecommunication ndustry, by conducting a process study initially and brea"ing the daily wor" load of each employee into individual smaller tas"s, we can calculate the number of employees that would be required in performing the tas" efficiently with optimum use of human resources.

This study, although not completely a replication of the actual 2rlang !tudy, still manages to serve the purpose as it wor"s on a principle that can be applicable universally.The process study helps in classifying tas"s into those which are high impact, those which are low impact and those which are trivial. >ased on the process study, the high impact sub tas"s can be studied in detail, as to what are the factors that would facilitate better output.

The hiring policies of the -uman esource epartment can be modified according to the findings in the study which can elaborate on the "nowledge and s"ill requirement in a particular tas".

*.* SWOT N0YSIS STRENGT!

29

Manpower planning and optimization (of technicians) using Erlang’s method 

<-



accreditation. <
WE?NESS 

-igh attrition rate among the nurses wor" force as many of them move to western countries for 0obs

O''ORTUNITIES 

T!RETS  

:pcoming -ospitals coming with new facilities and services can be ma0or threat %ompetitors, eisting hospitals can be a threat for <
,. REVIEW O/ 0ITERTURE According to G"rden -ac#eath,Apr ;@, ;'&= # (&88;)
30


According to -"nd+ et (&88) -uman esource *lanning is a systematic analysis of - needs in order to ensure that correct number of employees with the necessary s"ills are available when they are required. Stainer (&86&)define manpower planning as N!trategy for the acquisition, utilization,

improvement, and preservation of an enterprise’s human resources. t relates to establishing 0ob specifications or the quantitative requirements of 0obs determining the number of personnel required and developing sources of manpower. pplicati"n ") 5%e%ing the"r+ in health care 3This paper reviews the contributions and

applications of queuing theory in the field of health care management problems. This review proposes a system of classification of health care areas which are eamined with the assistance of queuing models. The categories described in the literature are epanded and a detailed taonomy for subgroups is formulated. The goal is to provide sufficient information to analysts who are interested in using queuing theory to model a health care process and who want to locate the details of relevant models. 0a$shi CB Si(a ?%ar ppa +er "n1, -arch &>1*. 'atient )l"3 and res"%rce %tilizati"n in an "%tpatient clinic 3 This paper describes the

results of a study ta"en at an outpatient clinic to describe and quantify issues related to patient flow and resource utilization for an individual physician during the delivery of primary health care. A discrete#event simulation model is constructed of the physician’s practice to eamine the relationship between eamining room capacity and patient flow across four clinic#based performance measures. A simulation eperiment is presented with results identifying several important and generalizable aspects of outpatient clinic operations. n particular, increased

resource utilization does not necessarily imply longer waiting lines or longer patient flow times. -%rra+  Ct,B %g%st 1<<< Fplease ta$e care ") the )"rat ") citati"n. -"deling healthcare s+stes 3ith phaset+pe distri9%ti"ns= *hase#type distributions

constitute a very versatile class of distributions. They have been used in a wide range of

31


stochastic modeling applications in areas as diverse as telecommunications, finance, biostatistics, queuing theory, drug "inetics, and survival analysis. Their use in modeling systems in the healthcare industry, however, has so far been limited. n this paper we introduce phase#type distributions, give a survey of where they have been used in the healthcare industry, and propose some ideas on how they could be further utilized. -ar$ /ac$rell,>8 %n &>>:. 'atient )l"3 and res"%rce %tilizati"n in an "%tpatient clinic= *hase#type distributions

constitute a very versatile class of distributions. They have been used in a wide range of stochastic modeling applications in areas as diverse as telecommunications, finance, biostatistics, queuing theory, drug "inetics, and survival analysis. Their use in modeling systems in the healthcare industry, however, has so far been limited. n this paper we introduce phase#type distributions, give a survey of where they have been used in the healthcare industry, and propose some ideas on how they could be further utilized. -%rra+  C"teB , %g%st 1<<< 'atient )l"3 "deling and per)"rance anal+sis ") healthcare deli(er+ pr"cesses in h"spitals=  re(ie3 and re)lecti"ns= Analysis of hospital processes is essential for

development of improved methods, policies and decision tools for overall performance improvement of the hospital system. Amidst the current scenario of continuously increasing healthcare costs and scarcity of resources, optimal utilization of resources without hampering the quality of care has gained importance in any country.
pertaining to modeling of patient flows in hospital systems have been classified and critically appraised focusing on the recent advancements in order to identify future research avenues. A generic framewor" for patient flow modeling and performance analysis of hospital systems that may serve as a guide for the practitioners dealing with similar "inds of problems to

32


improve healthcare delivery has also been provided. 'api+a #hattachareeB B'radip ?%ar Ra+B < -a+ &>1, The N%rsing !%an Res"%rce 'lanning #est 'ractice T""l$it= Creating a #est 'ractice Res"%rce )"r N%rsing -anagers 3 2vidence of acute nursing shortages in urban hospitals has

been surfacing since ;'''. 7urther, new graduate nurses account for more than 9'B of total nurse turnover in some hospitals and between =9B and 'B of new graduates change wor"place during the first year. %ritical to organizational success, first line nurse managers must have the "nowledge and s"ills to ensure the accurate pro0ection of nursing resource requirements and to develop proactive recruitment and retention programs that are effective, promote positive nursing socialization, and provide early eposure to the clinical setting. The 4ursing -uman esource *lanning >est *ractice Tool"it pro0ect supported the creation of a networ" of teaching and community hospitals to develop a best practice tool"it in nursing human resource planning targeted at first line nursing managers. The tool"it includes the development of a framewor" including the conceptual building bloc"s of planning tools, manager interventions, retention and recruitment and professional practice models. The development of the tool"it involved conducting a review of the literature for best practices in nursing human resource planning, using a mied method approach to data collection including a survey and etensive interviews of managers and completing a comprehensive scan of human resource practices in the participating organizations. This paper will provide an overview of the process used to develop the tool"it, a description of the tool"it contents and a reflection on the outcomes of the pro0ect. QThis article was originally published in 4ursing Geadership, ;=(!pecial ssue) ;'&'R 0eslie Vincent and -ar+ gnes #ed%z. -edical -anp"3er 'lanning= !ince &8/', numerous articles have discussed impact

analysis1 in addition, the 5ntario -ospital Association and the 5ntario
medical manpower plan is at the core of a successful hospital strategic plan. This article presents a population#service#based model of a medical manpower plan and reviews its use at *eel 1,.

33


The ipact ") h%an res"%rce anageent "n healthcare 5%alit+= The management of

human resources in healthcare institution is essential to enable the delivery of efficient and effective medical services and to achieve patient satisfaction. This study aims to investigate the impact of practicing human resources management on the quality of healthcare service and achieving patients’ satisfaction. The descriptive methodology was applied to demonstrate and analyze the previous literatures. The study shows that effective human resources management has a strong impact on healthcare quality and improving the performance of hospital’s staff. The !tudy suggests the need to measure the performance of the managers of human resources department in the hospital before starting performance development process as well as continuous development and training of staff performance. !assan -"haed Elara9iB /%adah "hari /ac%lt+ ") Ec"n"ics and -%aalatB Uni(ersiti SainsIsla -ala+sia FUSI-HB Negeri Se9ilanB -alas+a.

,.1 NEST!ESI DE'RT-ENT ND ITS /UNCTIONS

34


Anesthesia is a way to control pain during a surgery or procedure by using medicine called anesthetics. t can help control your breathing, blood pressure, blood flow, and heart rate and rhythm. nesthesia a+ 9e %sed t"= •

ela you. (Avoid NyouPSuse Nthe patientP instead)

•

>loc" pain.

•

•

5ther medicines may be used along with anesthesia, such as ones to help you rela or to reverse the effects of anesthesia. T+pes ") nesthesia 

0"cal naesthesia3 # numbs a small part of the body for minor procedures.

7or eample, you may get a shot of medicine directly into the surgical area to bloc" pain. ou may stay awa"e during the procedure. 

Regi"nal naesthesia3 # bloc"s pain to a larger part of your body. ou may

also get medicine to help you rela or sleep. Types of regional anaesthesia include3 •

'eripheral ner(e 9l"c$s This is a shot of anaesthetic to bloc" pain around a specific

nerve or group of nerves. >loc"s are often used for procedures on the hands, arms, feet, •

legs, or face. Epid%ral and spinal anaesthesia This is a shot of anaesthetic near the spinal cord and the nerves that connect to it. t bloc"s pain from an entire region of the body, such as the belly, hips, or legs.



General naesthesia 3 # affects your brain and the rest of your body. ou may get some

anaesthetics through a vein (intravenously, or H), and you may breathe in some

35


Anaesthetics. ?ith general anaesthesia, you$re unconscious and you don$t feel pain during the surgery.

,.1.1Vari"%s acti(ities per)"red 9+nesthesia technicians *repare and planning of case (arranging the medicines, machines)

36


Ta"ing patient from pre#operative area. >ringing to 5T nsertion of iv cannula. iving anaesthesia (intubation) of the patient. According to the type of anaesthesia giving position (A, Gocal etc.).

After anaesthesia documentation (anaesthesia chart) is done.

rape (cover) the patient with sterile sheet.

Arranging the medicine for the patient which is used in between the case (antibiotics).

After surgery giving reversal (etubation) to the patient.

!hifting the patient to the bed.

Ta"ing patient to the post#operative area.

Arranging the medicines and machines for the net surgery

,.& DI0YSIS DE'RT-ENT

ialysisis a process for removing waste and ecess water from the blood, and is used primarily as an artificial replacement for lost "idney function in people with "idney failure.

37


ialysis may be used for those with an acute disturbance in "idney function (acute "idney in0ury, previously acute renal failure), or progressive but chronically worsening "idney functionDa state "nown as chronic "idney disease stage 9 (previously chronic renal failure or end#stage renal disease). The latter form may develop over months or years, but in contrast to acute "idney in0ury is not usually reversible, and dialysis is regarded as a +holding measure+ until a "idney transplant can be performed, or sometimes as the only supportive measure in those for whom a transplant would be inappropriate. The "idneys have important roles in maintaining health. ?hen healthy, the "idneys maintain the body$s internal equilibrium of water and minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium, and sulphate). The acidic metabolism end#products that the body cannot get rid of via respiration are also ecreted through the "idneys. The "idneys also function as a part of the endocrine system, producing erythropoietin and calcitriol. 2rythropoietin is involved in the production of red blood cells and calcitriol plays a role in bone formation.ialysis is an imperfect treatment to replace "idney function because it does not correct the compromised endocrine functions of the "idney. ialysis treatments replace some of these functions through diffusion (waste removal) and ultra#filtration (fluid removal). !ae"dial+sis

-aemodialysis, the patient pumped through the blood compartment of a dialyzer, eposing it to a partially permeable membrane. The dialyzer is composed of thousands of tiny hollow synthetic fibres. The fibre wall acts as the semi permeable membrane. >lood flows through the fibres, dialysis solution flows around the outside of the fibres, and water and wastes move between these two solutions. The cleansed blood is then returned via the circuit bac" to the body. :ltra filtration occurs by increasing the hydrostatic pressure across the dialyzer membrane. This usually is done by applying a negative pressure to the dialysate compartment of the dialyzer. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of ecess fluid during a typical @#hour treatment. n the :nited !tates, hemo#dialysis treatments are typically given in a dialysis centre three times per wee" (due in the :nited !tates to
however, as of ;''9 over ;,9'' people in the :nited !tates are dialyzing at home more frequently for various treatment lengths. !tudies have demonstrated the clinical benefits of dialyzing 9 to 6 times a wee", for  to / hours. This type of hemo#dialysis is usually called 38


+nocturnal daily haemodialysis+, which a study has shown a significant improvement in both small and large molecular weight clearance and decrease the requirement of ta"ing phosphate binders. These frequent long treatments are often done at home while sleeping, but home dialysis is a fleible modality and schedules can be changed day to day, wee" to wee". n general, studies have shown that both increased treatment length and frequency are clinically beneficial.-aemodialysis was one of the most common procedures performed in :.!. hospitals in ;'&&, occurring in 8'8,''' stays (a rate of ;8 stays per &',''' populations).

'erit"neal dial+sis n peritoneal dialysis, a sterile solution containing glucose (called dialysate) is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a partially permeable membrane. The peritoneal membrane or peritoneum is a layer of tissue containing blood vessels that lines and surrounds the peritoneal, or abdominal, cavity and the internal abdominal organs (stomach, spleen, liver, and intestines) iffusion and osmosis drive waste products and ecess fluid through the peritoneum into the dialysate until the dialysate approaches equilibrium with the body$s fluids. Then the dialysate is drained, discarded, and replaced with fresh dialysate. This echange is repeated @#9 times per day1 automatic systems can run more frequent echange cycles overnight. *eritoneal dialysis is less efficient than -aemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to -aemodialysis. *eritoneal dialysis is carried out at home by the patient, often without help. This frees patients from the routine of having to go to a dialysis clinic on a fied schedule multiple times per wee". *eritoneal dialysis can be performed with little to no specialized equipment (other than bags of fresh dialysate)

,.&.1 Vari"%s acti(ities per)"red 9+ Dial+sis technicians

39

Manpower planning and optimization (of technicians) using Erlang’s method Confrm the boo!n" #hether !m$%t!ent& o't$%t!ent.

(ee$ the )!%*+,!, m%-h!ne #!** %** ne-e,,%r+ ,et, re%)+ or the $ro-e)'re,.

Re-e!/e $%t!ent %n) -he- #e!"ht.

M%e h!m&her -omort%b*e on be).

A--e,, /!t%* ,! n,

Che- )o-tor or)er or $ro-e)'re, )'r%t!on '*tr%f*tr%t!on et-.

St%rt $ro-e)'re ,t%rt D

Cont!n'o', mon!tor!n o %t!ent

Term!n%t!on o $ro-e)'re %ter re-ommen)e) t!me.

Che- /!t%* ,!"n, %n) #e!"ht $o,t D.

Sent the $%t!ent #!th %** the )o-'ment, to the re,$e-t!/e #%r) or home

Com$*ete the re-or), Re$ro-e,, the )%!*+ ee %n) b*oo) t'b!n" %n) ee$ re%)+ or the net ',e. C*e%n the be) %n) m%-h!ne, %n) "et the m%-h!ne re%)+ or the net -%,e.

4.'RO#0E- STTE-ENTB O#ECTIVES ND SCO'E O/ T!E STUDY Research pr"9le= 40


To find out if a change is needed in the eisting manpower planning with respect to various designations in various departments. O9ecti(es=

&. ;. =. @.

To find out actual requirements. To forecast staffing level needs. To optimize the utilization of eisting personnel. To efficiently utilise wor"force to maintain productivity.

Sc"pe ") the st%d+

*roper planning and utilization of wor" force can help the hospital save money and thus plan for the companies’ future. The manpower planning using 2rlang’s method provides a framewor" by which the hospital can prepare for and monitor future growth. This study is to forecast staffing level needs and wor" with the manager to ma"e sure that each department is properly staffed.

6.RESERC! -ET!ODO0OGY 5bservational study and secondary data analysis was done. 6.1Research T""ls= •

5bservation 41

Manpower planning and optimization (of technicians) using Erlang’s method • •

6.& 'riar+ Data= •

*rimary data was gathered through interaction with permanent senior technicians of

•

anesthesia and dialysis department. 5bservational study was also conducted to "now the actual time ta"en by the technicians for a particular procedure conducted in respective departments.

6.* Sec"ndar+ Data= • • •

eview of similar studies nformation from -< nternet

6., Saple Techni5%e

!ample size3 &;' Anesthesia epartment
8.DT N0YSIS ND INTER'RETTIONS 8.1 NEST!ESI TEC!NICIN ; ER0NG C0CU0TION T"tal n%9er ") s%rgeries O9ser(ed  6> nesthesia TechnicianJs tas$s

&. Time spent preparing and planning the patient prior to the operation 42


;. =. @. 9.

Time spent in transferring the patient from pre M op to 5T Time spent in the 5T when the surgery is performed Time spent in transferring the patient from 5T to post M op
>ased on the 5bservational studies done in the 5T, the Average time ta"en for each of the above mentioned tas"s was calculated to arrive at the average total time spent by one anesthesia technician per surgery. The calculation is as follows1 8.1.& Tie ta$en )"r s%rger+ Tie Tas$

ta$en

; Tie

ta$en

-a"r S%rger+

-in"r S%rger+

F-in%tesH

F-in%tesH

&'.'/

&'.;

@.//

@.6

&'9.&@

;=.9

&.''

&.''

&;&.&

=8.@

8.& DT /RO- DE'RT-ENT O/ !E0T! IN/OR-TION -NGE-ENT

5ne year data of all the surgeries performed in the 5T comple since April ;'&@ was analyzed to arrive at the average number of surgeries performed in a day, including ma0or and minor. 7rom the data received, following are the calculations, 8.&.1 T"tal s%rgeries 'RI0 &>1, t" -RC! &>14

NU-#ERS

&&&9=

&=' 43

;


/r" the data recei(edB )"ll"3ing are the calc%lati"ns

Total number of wor"ing days in a calendar year U =&; (2cluding !undays) -ence, Average number of
Total
-ence, 7or
U =  &;&.& U @=98. minutes U 6;. hours

7or
U @  ='.8 U &;=. minutes U ;.' hours

-ence Total
44


U 69 hours n addition to the above mentioned tas"s, &. Two anaesthesia technicians are posted mandatorily for night shift which begins from 9 pm to / am, which accounts for a wor"ing hour of &9 hours per technician.-ence, =' man hours are used every day, irrespective of surgery posted. ;.
TI-E T?EN F!"%rsH

elated to surgeries

69

4ight duty (two deployed everyday)

='

Time spend in other department

;@

Total
&;8

Erlang Calc%lati"n=

&. Total number of wor"ing hours permitted per employee is / hours, according to - policy. ;. According to - policy, a ='B Geave vacancy is recruited to account for employees ta"ing leave. %alculation3 Total number of staff required

U Total man hours utilized per day F / U &;8 F / U &.'8 U & (ounded off)

Addition of ='B Geave Hacancy

U ='B of & U @./ U 9 (ounded off)

-ence, Total number of Anesthesia Technicians’ required U & V 9 U ;&

45


8.&.* E@isting n%9er ") nesthesia Sta))

Anesthesia Technician

&

Trainee

/

!tudent trainee

/

7rom this analysis we find that there is a deficit of 9 Anesthesia Technicians.

8.*DI0YSIS TEC!NICIN ; ER0NG C0CU0TION DI0YSIS TEC!NICIN ; ER0NG C0CU0TION

Total number of ialysis 5bserved U ' >ased on the 5bservational studies done in the ialysis department, the Average time ta"en for each of the below mentioned dialysis was calculated to arrive at the conclusion that the total manpower required in the dialysis department. The calculation is as follows 8.*.1The tie ta$en )"r!ae"dial+sis and perit"neal dial+sisd"ne in a "nth=

ialysis

Time ta"en (in hours)

-aemodialysis

@''.9

*eritoneal dialysis

/

The time spends by techniciansfor various other procedures in a month3 &) enal >iopsy

U @9  &@ (hours) U =' (hours) 46


;) *erm%ath =) *erm%ath removal The time ta"en for reprocessing

U &@  &.9' (hours)U ;& (hours) U @9   (hours) U;6'(hours) U @9 minutes that is W hour

U W  =' U ;;.9 hours Total hours in one month

U @''.9 V / V =' V ;& V ;6' V ;;.9

U @89/ (hours) Total wor"ing hours per day U @89/F =' U &9.;6

Erlang Calc%lati"n=

&. Total number of wor"ing hours permitted per employee is / hours, according to - policy. ;. According to - policy, a ='B Geave vacancy is recruited to account for employees ta"ing leave. Geave vacancy

U Total wor"ing hours per day  =' F &'' U &9.;6  =' F &''

U @8.9/ Total time wor" per day

U Total wor"ing hours per day V leave vacancy

U &9.;6 V @8.9/ U ;&@./@6 2rlang

U Total time F / (hours)

U;&@./@6F/

47


 ;./99/====

-ence, the total manpower required

U ;6 (ounded off)

2isting manpower

U ;8

The study was conducted for dialysis technicians1 since the wor" is done by both the dialysis technicians and the nurses together it is difficult to ta"e the time separately. !o the total man power required is calculated for this department including nurses and dialysis technicians. 8.*.&E@isting n%9er nesthesia Sta))s

4urses

;;

ialysis technicians

6

!tudents

&

7rom this study we found that, the required manpower in dialysis department is ;6. >ut at preset they have a surplus of ; people in dialysis department.

48


8.,C""n a"r s%rgeries in nesthesia departent=

-OR SURGERIES 0SCS T!K#SO 0ap ppendect"+ V!K'/R 0ap ch"le E@cisi"n 0ap !ernia Repair 0ap #L0 Tep Crani"t"+ and e@cisi"n ") lesi"n End"sc"pic TNTS dec"pressi"n

TOT0 TI-EFin in%tesH ,> <& 6> :> 1>> &>> 1&> 114 *>> 1:>

49


Interpretati"n and anal+sis 3

7rom the above analysis we can find that %raniotomy and ecision of lesion is ta"ing more time. And the least time is ta"e for G!%!.

8.4C""n in"r s%rgeries in Dial+sis departent=

-INOR SURGERIES

TOT0 TI-EFin in%tesH

D2C@ #i"ps+

&&

W"%nd e@pl"rati"n

4>

D2C cer(ical #i"ps+

*>

E@cisi"n #reast 0%p Rt. side

6>

D Stent Re"(al

1*

50


Interpretati"n and anal+sis=

7rom the above analysis we can find that2cision >reast Gump t side is ta"ing more time. And the least time is ta"e for O !tent emoval. This analysis is done to understand which surgery is ta"ing more time in anesthesia department and which dialysis is ta"ing more time in dialysis department so that this will be helpful for both the departments for any further study.

:./INDINGSB RECO--ENDTIONS ND 0I-ITTIONS O/ T!E STUDY nestesia departent After conducting 2rlang’s study it was found that there was a deficit of five technicians in the anesthesia department and a surplus of two employees in dialysis department. 7rom the observational study it was understood that - department is not willing to hire more technicians to the anaesthesia department because they need to be paid more.

replaced by student or a trainee.After conducting the observational study i found that there islac" of brea" time and free hours for the technicians. Dial+sis departent

ialysis department is highly satisfied with their present manpower since they have a surplus of two employees. The ecess manpower in the dialysis department can be transferred to other departments as required. The number of per day dialysis can be increased by accommodating more patients (currently the departments have only &' beds).

0iitati"ns ") the st%d+

a) :navailability of technicians to answer the queries because of their busy wor". b) 4ot permitted to observe certain complicated surgeries. c) 7ind difficulty in observing aesthesia technicians during surgery because of constant entry and eit of multiple technicians. d) 7ew technicians had a biased reply when as"ed about convenience of duties.

<. SUGGESTIONS !ince the anesthesia department lac" adequate number of technicians - department should hire five more employees.
52


1>. CONC0USION <

the proper time, performing 0obs which meet the needs of the enterprise.it is essential for the achievement of its goals and ob0ectives. After conducting 2rlang study for Anesthesia and dialysis department, it is found that there is an ecess of manpower in the dialysis department so the - department can transfer people to other departments from dialysis department and there is a deficit in the anesthesia department so - department can hire more people to Anesthesia department.

RE/ERENCE

http3FFwww.managementstudyguide.comFmanpower#planning.htm www.erlang.com . (n.d.). etrieved from erlang. www.mimsindia.com . (n.d.). etrieved from mims www.whatishumanresourse. humanresource planning. (n.d.). retrieved from

54

Summer Internship Report

Recommend Documents