P. I. C. S. I. Management Lifeline Heart Centre
P. I. C. S. I. It is a structured Quality System for continuous improvement in a healthcare establishment leading to new trends in Quality Efficiency.
P. I. C. S. I. Tool Master Tool Application Operating System Philosophy Way of Existence
P. I. C. S. I. (Contd.) It is a time cycle variation approach to quality, which reduces disruption or variation from set goals and improves efficiency and time value. Time cycle is the period required to complete one cycle of a particular operation.
Necessity for P. I. C. S. I.? Over a period of time, in our pursuit of Quality Culture we had implemented so many tools / apps that we were finding it difficult to keep a track of these. The need was felt to evolve a composite, all encompassing management system in consonance with our hospital s philosophy of Quality Care.
P. I. C. S. I. Management (Our Innovation)
Existing Trend Usually in hospitals and healthcare sectors there is no defined timetable or a structured cycle for daily functions. Everything depends upon whether the department managers are present or not. If they are present then too the outcome depends on how active they are. It means that if there is no manager present for the particular day then the hospital s daily functions are in disarray.
Aim Through the innovation of PICSI management our aim was to develop an effective quality cycle for efficient day to day management of the hospital, which was not dependent upon any manager or department in-charge. Irrespective, whether the manager or responsible person was available or not, the hospital would function like clockwork, with structured quality.
Objectives Develop a Structured Quality Care System. Improve the Efficiency of Care. Improve the Efficiency of Management.
Symbol of our Innovation - PICSI Quality Clock
P: Punctuality Cycle (7:00 AM to 8:00 AM & 1:00 PM to 2:00 PM & 7:00 PM to 8:00 PM) Enter the security entry right time (Punctuality Counter). Code of Silence. Mark the Attendance. Attend the Prayer. Take the Over.
P: Punctuality Cycle (At a Glance)
Punctuality at Lifeline Heart Centre
Punctuality Counter The punctuality counter is established at the main entrance of the hospital where the staff is being monitored by a Punctuality Officer. If any of the staff is found to be late for duties he / she is issued a positive get-in token. The staff who receives this token has to report to the HR Head before he / she is allowed to start the duty. Similarly, the staff is required to leave the duty also on time. Any staff member leaving late is issued a Positive Get-out Token, which they are supposed to submit next day in the Quality Manager s Office.
Code of Silence Ahead of the Punctuality Counter entry, the silence area begins. As the hospital is a serene place where Life and Death situations are an everyday occurrence, the staff is stressed about the need and importance of silence through the Silence Reminder Board. In case if any of the staff member violates the code of silence, then for the next one day their designation changes to that of the Silence Trainer who is supposed to train other staff members about the importance of Silence.
Marking of Attendance Employees generally feel that entering the hospital main gate is the punctuality indicator but actually that is not so at Lifeline Heart Centre. Here, after going through the Punctuality Counter and the Silence Area, they have to sign the Commitment Chart and then mark their attendance. Signing the Commitment Chart amounts to Moral Attendance while punching the machine signifies Physical Attendance.
Attend the Prayer Soon after marking the attendance, the staff enters the next zone called the Prayer Zone. Here, the staff members pray that they be granted the ability to take better care of the patients and also wish their patients a speedy recovery. Through this prayer the staff is inspired to perform well morally and physically.
Take the Over After attending the prayer, the staff initiates the Over System as given below: Protocol Handover. Medication Hand Over. Documentation Hand over. Communication Hand Over. Patient Hand Over.
I: Infection Control Cycle (8:00 AM to 9:00 AM & 2:00 PM to 3:00 PM & 8:00 PM to 9:00 PM) Safety Checklist Completion. Disinfection Hour. Check the Dressing. Check the Catheters. Check the Bedside Trolleys.
Infection Control Cycle (At a Glance)
Infection Control at Lifeline Heart Centre
Safety Check List Completion Each staff member is responsible for the infection control maintenance, area wise & bed wise of the patients under his / her care. During handover of the duty the existing staff hands over the infection control safety circle along with the patient to the staff to whom he / she gives the over. If case the area is not infection free, then pin pointing the responsibility becomes easy. Each shift before leaving their duty has to submit the signed infection control checklist to the Infection Control Nurse.
Disinfection Hour If at any time we ask the staff whether disinfection of regular and daily routine items has been done. The usual reply would be Yes it has been done. Unless there are visible dust particles, we cannot be sure whether it s been done or not. In the new system that we implemented, Disinfection Hour is observed everyday between 9 AM &10 AM, 2 PM & 3 PM and 8 PM & 9 PM. As a result of this the staff at very station has to disinfect the B. P. Apparatus, Thermometer, Stethoscope etc. thrice daily. The designated management staff on each floor monitors the entire disinfection activities. Counter checking of the same becomes easy.
Checking the Dressing The major source of Infection is wounds. The staff is well aware that every day between 9 AM &10 AM, 2 PM & 3 PM and 8 PM & 9 PM the staff have to give special attention to Wound Care part of the patient care. They have to countercheck the dressings of the patients under their care. Giving special attention to the dressings has helped us to bring down the infection rate.
Checking the Catheters The staff is well aware that every day between 9 AM & 10 AM, 2 PM & 3 PM and 8 PM & 9 PM the staff have to give special attention to the Catheter care part of the patient and have to countercheck the catheter of the patient. Giving special attention to the catheters helped us to bring down the infection rate.
Checking the Bedside Trolleys Care of Bedside Trolleys is very important as far as infection control is concerned. The staff is supposed to check and ensure the order of items in bedside trolleys as per the standard protocol of the hospital regarding Maintenance of Bedside Trolleys. As a result of this, bedside trolleys are always in order and infection free.
C: Care Cycle (9:00 AM to 10:00 AM & 3:00 PM to 4:00 PM & 9:00 PM to 10:00 PM) E-PEEP for Nurses. ISBAR for Medical Officers. Note the Queries about the care. Completion of all checklists. High Care Charter for Consultants.
Care Cycle (At a Glance)
Care at Lifeline Heart Centre
E-PEEP for Nurses All patients who come to the hospital have the right to know the kind of care that they are to be afforded. In accordance with the international system of E-PEEP checklist, every two hours our staff educates and explains to the patient as to what has been done in the last two hours and what will be done during the next two hours. This briefing includes information on injections, medications, food, doctors rounds and counselling. The patients are thus made fully aware about the care that they are being afforded.
ISBAR for Medical Officers Just like E-PEEP method for nurses, there is an offered care explanation for the medical officers called ISBAR. Through the ISBAR method every medical officer of the hospital is required to sit with the patient and educate the patient regarding the clinical care they are offering that particular patient. Also, what kind of progress they observed during monitoring. Through this method the patient is made aware about the Clinical progress of his / her health.
Note the Queries about the Care Usually in the healthcare sector, patients have lots of questions and medical consultants have very less time to attend to all their queries, which leads to a high level of dissatisfaction. As a solution for this issue we developed a system called Queries about my Care in which the staff notes down all the queries of the patient in a prescribed form and submits the same to the particular medical consultant at his / her OPD.
Completion of all Checklists During this hour, the staff has to complete all the checklists concerned with patient care and ensure that these have are attached with the patient file. Through completing these checklists, the staff ensures that their part in patient care is perfect. It also makes a way for medical consultants to counter check.
High Care Charter for Consultants (Care + Education = High Care) Lifeline Heart Centre believes that the care is not complete without educating, answering the patient s queries and counselling. As has been seen earlier, staff submits Queries about my Care to the Medical Consultant. Hence, the Medical Consultant is well prepared and ready to answer the patient s queries as he has already been apprised about the same. On entering the patient s room the consultant can address the issues that the patient has put forward without the patient having to ask for the same.
S: Satisfaction Cycle (10:00 AM to 11:00 AM & 3:00 PM to 5:00 PM & 10:00 PM to 11:00 PM) Management Round. All open daily satisfaction charter for patients. Dissatisfaction Tracking Register. Video Education by the In-charge. Patient Satisfaction Notification System-Area wise.
Satisfaction Cycle (At a Glance)
Satisfaction at Lifeline Heart Centre
Management Round A mature and dedicated management is essential for the success of any organisation. As managers are the leaders of the Institution they have to know practically everything that is happening in the hospital. Once the managers are well aware about the practical problems of the various functioning areas of the hospital, they can give solutions to the particular problems then and there itself. Keeping this principle in mind, during this hour there is an effective management round in which they meet all the staff on duty and all the IPD patients to interact with them personally and to countercheck all activities of the hospital.
All open daily satisfaction charter for patients Generally patients fill up feed-back forms at hospitals at the time of discharge. Their input could not address their problems. We introduced a new system called All open patient feedback charter, which is displayed in the patient s room at the time of their admission. The patients can write their feed back, good or bad, at any time they feel like. If anything negative is found written by the management team during their round, corrective action is immediately taken. The endeavour is to provide solutions to any problem within two hours so that the patients get fully satisfied. If it s a positive feedback then it s a great motivation for the staff.
Dissatisfaction Tracking Register Once we find that a patient is dissatisfied in our hospital, we take a detailed interview of the patient and the same is recorded in a designated register mentioning the name and address of the patient, Nature of Dissatisfaction, Root Cause of the Dissatisfaction, Caused by Whom & Corrective action taken. This register is circulated to all departments for awareness and is kept as a record forever. As a result all staff members become aware of the same.
Video Education by the Patient In-charge Each day the Department In-charge of the particular department meets the patient with a small tab and educates the patient about one topic through a small video presentation. This makes the patients more aware about their health and preventive aspects.
Patient Satisfaction Notification System - Area wise We believe that once the staff becomes aware about their capability to satisfy the patients, they can perform well. Our hospital has designed a yearly charter in every department, where the patient satisfaction officer marks the month wise satisfaction percentage of every department. As a result, staff of every department becomes aware whether the satisfaction level of the patients is improving or decreasing.
I: Inventory Cycle (11:00 AM to 12:00 Noon & 5:00 PM to 6:00 PM & 11:00 PM to Midnight) Inventory Tracker-Area wise. Check The Inventory. Check all the registers. Set the moving nursing station. Countercheck the cylinders.
Inventory Cycle (At a Glance)
Inventory at Lifeline Heart Centre
Inventory Tracker - Area wise Usually, at any given time there will be a large number of items lying on any counter in a hospital. During an emergency situation it will be very difficult to find out where any particular item is kept. The staff keeps changing the position of the items as per their whims and fancies. In a hospital, we cannot say when an emergency is going to occur. Also, we cannot visualize at which particular time which staff would be available. So we made a Chart at every station, which displays each items name, number, location and box number. That means during an emergency any staff can go through the chart and can find the required items within seconds.
Check The Inventory During this hour the staff have to check the existing inventory and prepare a list of things required to complete the inventory, so that the next shift fills the required inventory and necessary articles. When, the inventory part is checked thrice daily, the hospital is always ready to manage all kinds of emergencies and the staff are fully prepared for the same.
Check all the Registers Registers are not merely for making entries. At the same time the registers keep track of the things that have been done in a health care setting. Keeping registers updated ensures that things are done at the proper time in a proper manner. During this hour, the staff counterchecks all the registers and ensures everything is updated as per orders.
Set the Moving Nursing Station Why should the patients run here and there in search of a nurse? Why should the nurse run back to the Nursing station to get various articles? In a health care setting, losing a single minute can have an adverse outcome. We found a solution to this by creating a Nursing Station on Wheels. The nurse takes the moving Nursing Station to each and every patient s room and administers the necessary medication. Keeping the moving nursing station always stocked and ready makes meeting an emergency real easy.
Countercheck the Oxygen Cylinders Checking the Emergency Oxygen cylinders is very important in a health care settings. Usually what happens in healthcare settings is that once the set-up has a centralised oxygen supply system these emergency cylinders are ignored. Ultimately what happens is that when there is an emergency situation, the availability of these cylinders becomes doubtful. Checking Oxygen cylinders at least three times a day, ensures the availability of emergency oxygen round the clock.
Impacts of our Innovation
Employee Motivation Rate Employee motivation is the level of energy, commitment, and creativity that a company's workers bring to their jobs. Whether the economy is growing or shrinking, finding ways to motivate employees is always a management concern. Competing theories stress either incentives or employee involvement (empowerment). Calculated By: Score achieved X 100 / Maximum possible score Achieved during the period Jan to Jun 2016: Highly Motivated: 97% Motivated: 2% Unmotivated: 1%
Impact on Employee Motivation (January to June 2016)
Employee Satisfaction Rate Employee Satisfaction is defined in terms of the degree to which the employee s expectations are fulfilled. It is an expression of the gap between the expected and perceived characteristics of a service. Calculated By: Score achieved X 100 / Maximum possible score Achieved during the period January to June 2016: Very Satisfied: 95% Satisfied: 4% Dissatisfied: 1%
Impact on Employee Satisfaction
Hospital Acquired Infection Rate A hospital-acquired infection is usually one that first appears three days after a patient is admitted to a hospital. Infections acquired in a hospital are also called Nosocomial Infections. Calculated By: Total No of Infections after 48 hrs x 100 / Total no of Admissions Infection rate during the period January to June 2016: January: 1.5% February: 0.72% March: 0.57% April: 0.33% May: 0.58% Jun: 0.29%
Impact on Hospital Acquired Infection Hospital Acquired Infection 1.5% 0.72% 0.57% 0.33% 0.58% 0.29%
Impact on Patients Admitted
Employee Turnover Rate Employee turnover is the rate at which an employer gains and loses employees. Simple ways to describe it are how long employees tend to stay or the rate of traffic through the revolving door Calculated By: Number of employees who left during the year X 100 / Number of employees at the beginning + employees at the end of the year. Turnaround rate during the period Jan to Jun 2016: January: 1.7% February: 1% Mar: 1.37% April: 0.68% May: 0.64% Jun: 0.32%
Impact on Employee Turnover Rate Decrease in Employee Turnover 1.0%
Impact on Purchase Ratio
Impact on Reputation
Impact on Fresh Recruitment Aspirants
Conclusion In the realm of Quality Innovation, the Quality Gurus and Management Pundits have fixated on keeping the quality movement within reach of every establishment. They have been focussing on how staff is spending their duty time instead of asking for more staff for quality assurance. If genuine improvement in Quality Care is envisaged, P. I. C. S. I. is the Answer. Punctualit y Cycle Satisfactio n Cycle CARE Inventory Cycle Infection Control Cycle