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CHAPTER-5

SUMMARY OF FINDINGS, CONCLUSION & RECOMMENDATIONS

5.1 SUMMARY OF FINDINGS

Queuing theory application in outpatient department of Owaisi Hospital & Research

Centre and Yashoda Hospital

The first objective is to study the waiting time distribution of patients in the outpatient

department. This objective of studying the waiting time distribution of patients in the

outpatient department is achieved through the application of queuing theory. The waiting

time of patients at OP registration, billing, consultation, laboratory (sample collection),

diagnostics and pharmacy at both the hospitals i.e. Owaisi Hospital & Research Centre and

Yashoda Hospital is analyzed through the application of queuing theory. Queuing theory

application has led to the following findings at both the hospitals:

• It was found that arrival rate and service rate are following exponential distribution in

both the hospitals i.e. Owaisi Hospital & Research Centre and Yashoda Hospital.

• It was observed that for both the hospitals arrival rate ‘λ’ is more than service rate ‘µ’.

• Mean inter-arrival time is more at diagnostics (18.15 minutes) and less at pharmacy

(14.875 minutes) for Owaisi Hospital & Research Centre.

• Mean inter-arrival time is more at consultation (18.46 minutes) , OP registration

(18.26 minutes) and less at OP billing (14.88 minutes) for Yashoda Hospital.

• Mean service time is more at consultation (15.725 minutes) and less at pharmacy

(6.35 minutes) for Owaisi Hospital & Research Centre.

• Mean service time is more at consultation (14.68 minutes) and less at laboratory

sample collection (6.195 minutes) for Yashoda Hospital.

• Arrival rate ‘λ’ is highest at pharmacy with 4.034 patients per hour in Owaisi Hospital

& Research Centre.

• Arrival rate ‘λ’ is highest at OP billing with 4.02 patients per hour in Yashoda

Hospital.

• Arrival rate ‘λ’ is least with 3.306 patients per hour at diagnostics in Owaisi Hospital

& Research Centre.

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• Arrival rate ‘λ’ is least with 3.25 patients per hour at consultation in Yashoda

Hospital.

• Service rate ‘µ’ is highest at pharmacy (9.4489 patients served per hour) and OP

registration (9.248 patients served per hour) in Owaisi Hospital & Research Centre.

• Service rate ‘µ’ is highest at pharmacy (9.907 patients served per hour) and laboratory

(9.687 patients served per hour) in Yashoda Hospital.

• Service rate‘µ’ is least at consultation with 3.8156 patients served per hour in Owaisi

Hospital & Research Centre.

• Service rate‘µ’ is least at diagnostics (4.255 patients served per hour) and consultation

(4.385 patients served per hour) in Yashoda Hospital.

• Utilization rate is highest at consultation (0.923577) and diagnostics (0.7962) in

Owaisi Hospital & Research Centre. It means the server is busy for 92.357 % of the

time at consultation and 79.62 % of the time at diagnostics.

• Utilization rate is highest at diagnostics (0.86) and consultation (0.74) in Yashoda

Hospital. It means the server is busy for 86 % of the time at diagnostics and 74 % of

the time at consultation.

• Idle time is more at registration with 63.88% in Owaisi Hospital & Research Centre.

• At pharmacy (57.307%) and OP billing (53.046%) also, for more than 50% of the

time, the system is idle in Owaisi Hospital & Research Centre.

• Idle time is more at laboratory sample collection (65%) and pharmacy (65%) in

Yashoda Hospital.

• The queue length is more at consultation (11.161 patients) and less at OP registration

(0.2) for Owaisi Hospital & Research Centre.

• The queue length is more at diagnostics (5.18 patients) for Yashoda Hospital.

• The queue length is less at OP registration with 0.204 patients for Owaisi Hospital &

Research Centre.

• The queue length is less at laboratory and pharmacy with 0.19 patients for Yashoda

Hospital.

• Average number of patients in the system is also highest for consultation with 12.085

patients in Owaisi Hospital & Research Centre.

• Average number of patients in the system is highest for diagnostics with 6.04 patients

in Yashoda Hospital.

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• Average waiting time in the queue is highest at consultation with 3.16 hours in Owaisi

Hospital & Research Centre.

• Average waiting time in the queue is highest at diagnostics with 1.42 hours in

Yashoda Hospital.

• Average waiting time in the system is highest at consultation with 3.429 hours in

Owaisi Hospital & Research Centre.

• Average waiting time in the system is highest at diagnostics with 1.65 patients in

Yashoda Hospital.

• There is a 0.63884 probability that no patients are there in the system at registration in

Owaisi Hospital & Research Centre whereas it is 0.59 in Yashoda Hospital.

• There is a 0.99996 probability that less than or equal to 9 patients are in the System at

Owaisi Hospital & Research Centre registration

• It is a certainty (probability of 1) that there are less than or equal to 5 patients at any

given time at the registration in Yashoda Hospital.

• There is a 0.53046 probability that no patients are there in the system at OP billing in

Owaisi Hospital & Research Centre whereas it is 0.5 in Yashoda Hospital.

• There is a 0.99995 probability that there can be a maximum of 12 patients in the

system at OP billing in Owaisi Hospital & Research Centre whereas in Yashoda

Hospital with 1.0 probability there are a maximum of only 6 patients.

• There is a 0.07642 probability that no patients are there in the system at consultancy

in Owaisi Hospital & Research Centre whereas it is 0.26 in Yashoda Hospital.

• There is a 0.91495 probability that there are less than or equal to 30 patients in the

system at consultancy in Owaisi Hospital & Research Centre.

• The probability that there are less than or equal to 15 patients in the system at

consultancy in Yashoda Hospital is 1.

• There is a 0.04815 probability that no patients are there in the system at laboratory

(Sample collection) in Owaisi Hospital & Research Centre.

• There is a 0.65 probability that there are no patients in the system at laboratory

(Sample collection) in Yashoda Hospital.

• The probability that there are less than or equal to 13 patients in the system at

laboratory (sample collection) is 0.99990

• The probability that there are less than or equal to 4 patients in the system at

laboratory (sample collection) in Yashoda Hospital is one.

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• The probability that there are 13 patients in the system at laboratory (sample

collection) in Owaisi Hospital & Research Centre is 0.99990

• There is a 0.20376 probability that no patients are there in the system at diagnostics in

Owaisi Hospital & Research Centre whereas it is 0.14 in Yashoda Hospital.

• The probability that there are less than or equal to 30 patients in the system at

diagnostics in Owaisi Hospital & Research Centre is 0.99914 and it is 1.0 for Yashoda

Hospital.

• There is a 0.57307 probability that there are no patients in the system at pharmacy in

Owaisi Hospital & Research Centre and is 0.65 in Yashoda Hospital.

• The probability that there are less than or equal to 11 patients in the system at

pharmacy in Owaisi Hospital & Research Centre is 0.99996.

• The probability that there are less than or equal to 4 patients in the system at

Pharmacy in Yashoda Hospital is 1.0.

Though queuing theory is applied to study the waiting time of patients in the outpatient

department, further research is required to find the applications in other different areas of the

hospital. The study can be done in not only multispecialty hospitals but also at clinics, single

specialty hospitals, diagnostic centers where there is a random arrival of the patient. Queuing

theory is also helpful in studying the bed occupancy.

Application of PERT in emergency department, patient discharge process & operation

theatre of Owaisi Hospital & Research Centre and Yashoda Hospital

The second objective is focused to study the process flow of the emergency department,

patient discharge process & operation theatre and developing network diagrams. The network

diagrams were made for emergency process, discharge process and OT for both the hospitals

i.e. Owaisi Hospital & Research Centre and Yashoda Hospital. PERT is applied at both the

hospitals to find the total duration of the process, critical path, slack times and accordingly

network diagrams are developed.

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PERT application in the emergency process of Owaisi Hospital & Research Centre and

Yashoda Hospital revealed the following findings:

• The total duration of the activities of the emergency process or the expected time for

completion of the project in Owaisi Hospital & Research Centre is 84.89 minutes or

1.415 hours (figure - 4.37) & 146.41 minutes or 2.44 hours (figure - 4.38) in Yashoda

Hospital.

• The variance of the project for emergency process in Owaisi Hospital & Research

Centre is 253.1 minutes or 4.22 hours (figure - 4.37) & 35.54 minutes or 0.59 hours

(figure - 4.38) in Yashoda Hospital.

• The critical path for emergency process in Owaisi Hospital & Research Centre is

(figure - 4.37):

A B E F H I K

• The critical path for emergency process in Yashoda Hospital is (figure - 4.38):

A B D F G H I J K N O Q R T

• The activities on the critical path are critical activities. The critical activities for

emergency process in Owaisi Hospital & Research Centre as per figure 4.37 are - A

(time taken to shift the patient from ambulance or private vehicle to emergency

department), B (time taken by the registered medical officer to attend the patient), E

(time taken to call the technician), F (time taken by the technician to attend the

patient), H (time taken for performing lab tests, CT scan, ECG, X-RAY and other

investigations and minor procedures), I (time taken for the report arrival of laboratory

& diagnostic tests) & K (time between getting report and exit of the patient). As

critical activities do not permit any flexibility in scheduling, any delay in any of the

critical activities A, B, E, F, H, I & K at Owaisi Hospital & Research Centre, will

delay the duration of emergency process.

• The critical activities for emergency process in Yashoda Hospital as per figure 4.38

are - A (time taken for patient’s call), B (time taken to confirm the patient about

ambulance), D (time taken to inform emergency medicine technician), F (time taken

for emergency medicine technician to reach ambulance), G (time taken by ambulance

driver to reach patient’s location), H (time taken at patient’s house to shift patient into

ambulance), I (time taken by ambulance driver to reach hospital from patient’s

location), J (time taken to shift the patient from ambulance or private vehicle to

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emergency department), K (time taken by the registered medical officer to attend the

patient), N (Time taken to call the technician),O (time taken by the technician to

attend the patient), Q (time taken for performing laboratory tests, CT scan, ECG, X-

RAY and other investigations and minor procedures), R (time taken for the report

arrival of lab & diagnostic tests), T (time between getting report and exit of the

patient).As critical activities do not permit any flexibility in scheduling, any delay in

any of the critical activities A, B, D, F,G, H, I,J, K,N,O,Q,R and T at Yashoda

Hospital will delay the duration of emergency process.

• Activities C (time taken by the nurse to attend the patient), D (time taken to inform

the specialist), G (time taken by the specialist to attend the patient) & J (time taken for

registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency

process have total float value of 1.14, 49.2, 29.2 & 49.2 minutes respectively as

shown in table 4.91. It means that there is flexibility with regard to time available in

informing specialist, also in registration, billing and pharmacy. If the 2 activities D

and J are delayed for 49.2 minutes, they will not delay the emergency process

duration. Similarly there is flexibility of 1.14 minutes for nurse to attend the patient

and 29.2 minutes flexibility for specialist to attend the patient.

• Activities B (time taken to confirm the patient about ambulance), D (time taken to

inform emergency medicine technician), K (time taken by the RMO to attend the

patient), L (time taken by the nurse to attend the patient), O (time taken by the

technician to attend the patient), R (time taken for the report arrival of laboratory &

diagnostic tests) of Yashoda Hospital emergency process have total float value of

1.06,1.06, 1.92, 80.99, 81 & 38.5 minutes respectively as shown in table 4.94. If the 2

activities B and D are delayed for 1.06 minutes, they will not delay the emergency

process duration. Similarly if registered medical officer takes more 1.92 minutes to

attend the patient, there will not be any delay in emergency process duration. There is

flexibility of 80.99 minutes, 81 minutes and 38.5 minutes for activities L, O and R.

• Activities D (time taken to inform the specialist) and G (time taken by the Specialist

to attend the patient) of Owaisi Hospital & Research Centre emergency process have

interfering float value of 49.22 and 29.22 minutes respectively as shown in table 4.91.

This float causes a reduction in the float of the successor activities i.e. for activity D

activity G is the successor and for activity G activity J is the successor. Thus any

delay in the time taken to inform the specialist (activity D) will decrease the float time

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taken by the specialist to attend the patient (activity G). Similarly delay of specialist

attending the patient (activity G) will decrease the float time of activity J i.e. time

taken for registration, billing and pharmacy.

• Activities B (time taken to confirm the patient about ambulance), L (time taken by the

nurse to attend the patient), O (time taken by the technician to attend the patient) of

Yashoda Hospital emergency process have interfering float values of 1.05, 80.99,

80.99 minutes respectively as shown in table 4.94. This float causes a reduction in the

float of the successor activities i.e. for activity B, activities C & D are successors.

Thus any delay in time taken to confirm the patient about ambulance will reduce the

float time taken to inform ambulance driver & emergency medicine technician. For

activity L, activity O is the successor and for activity O, activity Q is the successor.

Thus any delay in the time taken by the nurse to attend the patient (activity L) will

decrease the float time taken by the technician to attend the patient (activity O).

Similarly delay by the technician to attend the patient (activity O) will decrease the

float time of activity Q i.e. time taken for performing lab tests, CT scan, ECG, X-

RAY , other investigations and minor procedures.

• Activities C (time taken by the nurse to attend the patient) and J (time taken for

registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency

process have free float value of 1.14 and 49.22 minutes as shown in table 4.91. This is

that part of the total float which can be used without affecting the float of the

succeeding activities. Thus delay by the nurse to attend the patient (activity C) by 1.14

minutes will not effect on the flexibility of scheduling its successor activity F (time

taken by the technician to attend the patient). Similarly delay in the time taken for

registration, billing and pharmacy (activity J) by 49.22 minutes will not affect the

float of its successor activity K (time between getting report and exit of the patient).

• Activities B (time taken to confirm the patient about ambulance), D (time taken to

inform emergency medicine technician), K (time taken by the RMO to attend the

patient), O (time taken by the technician to attend the patient) and R (time taken for

the report arrival of laboratory & diagnostic tests) of Yashoda Hospital emergency

process have free float values of 0.01, 1.06, 1.92, 0.01 and 38.5 minutes as shown in

table 4.94. This is that part of the total float which can be used without affecting the

float of the succeeding activities. Thus delay of activity B for 0.01 minutes will not

affect the float time of activities C (time taken to inform ambulance driver) & D (time

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taken to inform emergency medicine technician). Delay in activity D by 1.06 minutes

will not have effect on the flexibility of scheduling its successor activity F (time taken

for emergency medicine technician to reach ambulance). Similarly delay by registered

medical officer to attend the patient (activity K) by 1.92 minutes will not affect the

float of its successor activities M (time taken to inform the specialist) & N (time taken

to call the technician). Delay of activity O (time taken by the technician to attend the

patient) by 0.01 minutes will not affect the float of its successor activity Q (time taken

for performing lab tests, CT scan, ECG, X-RAY and other investigations and minor

procedures). Delay in activity R (time taken for the report arrival of laboratory &

diagnostic tests) by 38.5 minutes will not affect the float of its successor activity T

(time between getting report and exit of the patient).

• Activities G (time taken by the specialist to attend the patient) and J (time taken for

registration, billing and pharmacy) of Owaisi Hospital & Research Centre emergency

process have independent float value of 49.22 and 29.22 minutes as shown in table

4.91. It is the amount of float time which can be used without affecting either the head

or tail events.

• Activities B (time taken to confirm the patient about ambulance), D (Time taken to

inform emergency medicine technician) & K (time taken by the registered medical

officer to attend the patient) of Yashoda Hospital emergency process have

independent float values of 0.01, 0.01 and 1.92 minutes respectively as shown in table

4.94.

• The slack of an activity measures the excess time and resources available in achieving

that particular activity. Positive slack indicates ahead of the schedule, negative slack

indicates behind the schedule, and zero slack indicates on the schedule. It is clear

from tables 4.91 & 4.94 that the activities on the critical path of the emergency

process are having zero float value in both the hospitals indicating that they are on the

scheduled time. No activities are with negative float time.

Application of PERT in the discharge process of Owaisi Hospital & Research Centre

and Yashoda Hospital revealed the following findings:

• The total duration of the activities of the discharge process or the expected time for

completion of the project for discharge process in Owaisi Hospital & Research Centre

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is 108.47 minutes or 1.807 hours (figure – 4.39) and it is 158.88 minutes or 2.468

hours (figure – 4.40) in Yashoda Hospital.

• The critical path for Owaisi Hospital & Research Centre discharge process is (figure-

4.39):

A C D E F G H I J K

• The critical path for Yashoda Hospital discharge process is (figure- 4.40):

A B D J K N O P

• The variance of the project for discharge process is 80.79 minutes or 1.3465 hours

(figure- 4.39) in Owaisi Hospital & Research Centre and is 333.87 minutes or 5.56

hours (figure – 4.40) in Yashoda Hospital.

• The critical activities for Owaisi Hospital & Research Centre discharge process as per

figure 4.39 are - A (consultant checking the patient’s condition, informing nurse

about the discharge of patient and issuing prescription), C (nurse in-charge informing

the resident doctor about the discharge & forwarding the case sheet and discharge

summary to the doctor), D (resident doctor preparing discharge summary), E

(consultant checking and signing the discharge summary), F (resident doctor

forwarding discharge summary to nursing station), G (nurse in-charge at nursing

station forwarding the case sheet to billing department.), H (final bill preparation by

the billing department), I (payment of the bill by patient attendee at the billing

department), J (billing department returning case sheet to nursing department with

patient discharge slip) & K (patient to vacate the room). Delay in any of the critical

activities A, C, D, E, F, G, H, I, J, K will delay the duration of discharge process in

Owaisi Hospital & Research Centre.

• The critical activities for Yashoda Hospital discharge process as per figure 4.40 are –

A (consultant checking the patient’s status), B (consultant informing ward in-charge

about discharge of patient), D (ward in-charge informing personal relations executive

about discharge), J (forwarding case sheet to billing Department), K (final bill

preparation by the billing department), N (payment of bill by patient attendee at

billing department), O (billing department issuing discharge intimation slip to ward

in-charge) and P (discharge of patient at ward and patient vacating the room). Delay

in any of the critical activities A, B, D, J, K, N, O, and P will delay the duration of

discharge process in Yashoda Hospital.

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• In Owaisi Hospital & Research Centre, activity B (nurse entering the discharge date &

time in register and returning excess medicine to the pharmacy) of discharge process

has got the same float time of 39.81 minutes for total, interfering and independent

floats (table - 4.97 ). It means that there is flexibility with regard to time available for

nurse to enter the discharge date & time in register and return excess medicine to the

pharmacy. Delay of activity B for 39.81 minutes will not delay the discharge process

duration. As free float can be used without affecting the float of the succeeding

activities , delay in activity B (nurse entering the discharge date & time in register and

returning excess medicine to the pharmacy) will not cause any affect on the flexibility

of scheduling its successor activity G (nurse in-charge at nursing station forwarding

the case sheet to billing department.) . Thus delay in the time taken by activity B for

39.81 minutes will not affect the float of its successor activity G. As activity B of

Owaisi Hospital & Research Centre discharge process has independent float value of

39.81 minutes (table 4.97), it is the amount of float time which can be used without

affecting either the head or tail events.

• Activities C (consultant issuing prescription and instructing patient about medication),

E (ward in- charge informing duty medical doctor about discharge), F (preparation of

discharge notes by duty medical doctor), G (returning excess medicine to pharmacy),

H (medicine brought to pharmacy by the ward attender), I (time taken by ward

attender to return medicine at pharmacy), L (checking of discharge summary for

corrections) and M (final preparation of discharge summary and attestation by

consultant) of Yashoda Hospital discharge process have total float value of 63.05,

45.84, 45.83, 63.05, 63.05, 63.05, 45.83 & 45.83 minutes respectively as shown in

table 4.100. If the activities C, G, H and I are delayed for 63.05 minutes, they will not

delay the discharge process duration. Similarly delay of activities E, F, L, and M by

45.83 minutes will not delay the discharge process duration.

• Activities C (consultant issuing prescription and instructing patient about medication),

E (ward in- charge informing duty medical doctor about discharge), F (preparation of

discharge notes by duty medical doctor), G (returning excess medicine to pharmacy),

H (medicine brought to pharmacy by the ward attender) and L (checking of discharge

summary for corrections) of Yashoda Hospital discharge process have interfering

float values of 63.05, 45.84, 45.83, 63.05, 63.05 and 45.83 minutes respectively as

shown in table 4.100. This float causes a reduction in the float of the successor

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activities i.e. for activity C, G is the successor. Similarly for activities C, F, G, H & L,

successor activities are F, L, H, I & M. Thus any delay in activities C (consultant

issuing prescription and instructing patient about medication), G (returning excess

medicine to pharmacy) and H (medicine brought to pharmacy by the ward attender)

by 63.05 minutes will reduce the float of their successors G (returning excess

medicine to pharmacy), H (medicine brought to pharmacy by the ward attender) and I

(time taken by ward attender to return medicine at pharmacy). Similarly delay in

activities E (ward in- charge informing duty medical doctor about discharge), F

(preparation of discharge notes by duty medical doctor) and L (checking of discharge

summary for corrections) by 45.83 minutes will reduce the float of their successors F

(preparation of discharge notes by duty medical doctor), L (checking of discharge

summary for corrections) and M (final preparation of discharge summary and

attestation by consultant).

• Activities I (time taken by ward attender to return medicine at pharmacy) and M

(final preparation of discharge summary and attestation by consultant) of Yashoda

Hospital discharge process have free float values of 63.05 and 45.83 minutes

respectively as shown in table 4.100. This is that part of the total float which can be

used without affecting the float of the succeeding activities. Thus delay of activity I

for 63.05 minutes will not affect the float time of activity N (payment of bill by

patient attendee at billing department). Similarly delay in activity M by 45.83 minutes

will not cause any affect on the flexibility of scheduling its successor activity P

(discharge of patient at ward and patient vacating the room).

• It is clear from tables – 4.97 & 4.100, that the critical activities of Owaisi Hospital &

Research Centre and Yashoda Hospital discharge process are having zero float value

indicating that they are on the scheduled time. No activities of discharge process are

with negative float time.

• The total duration of the activities of the operation theatre process or the expected

time for completion of the project for Owaisi Hospital & Research Centre operation

theatre process is 168.23 minutes or 2.80 hours (figure – 4.41) and is 517.08 minutes

or 8.618 hours for Yashoda Hospital (figure 4.42).

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PERT application in operation theater of Owaisi Hospital & Research Centre and

Yashoda Hospital revealed the following findings:

• The critical path for Owaisi Hospital & Research Centre operation theatre process is

(figure – 4.41):

• A B D F I J L M N O P Q R S.

• The critical path for Yashoda Hospital operation theatre process is (figure – 4.42):

• A B D G H I J L M N O P Q R S T.

• The variance of the project for operation theatre process in Owaisi Hospital &

Research Centre is 261.1 minutes or 4.35 hours (figure – 4.41) and is 3758.81 minutes

or 62.647 hours in Yashoda Hospital (figure 4.42).

• The critical activities for operation theatre process in Owaisi Hospital & Research

Centre are A (operation theatre manager calling the respective ward to inform the

nurse to shift the patient & taking confirmation), B (shifting of the patient from

respective ward to the operation theatre), D (junior anesthetist performing pre-

anesthesia check-up), F (Head of the department of anesthesia permitting the

concerned anesthetist for giving anesthesia to the patient), I (shifting of the patient

into the theatre by ward boy or aya), J (transferring the patient to the operation table),

L (team of doctors verifying patient’s name , consent and pre-anesthesia check-up

before starting the surgery), M (team of anesthetists giving anesthesia), N (doctor

marking the site of surgery on patient), O (surgeons performing the surgery), P

(shifting of the patient to the recovery room by ward boy / aya), Q (monitoring and

documenting the patient’s physiological status & post-anesthesia status), R (informing

the ward boy/ aya to shift the patient to post- operative ward), S (shifting of the

patient from recovery room to post- operative ward by ward boy / aya). As critical

activities do not permit any flexibility in scheduling, any delay in any of the critical

activities A, B, D, F, I, J, L, M, N, O, P, Q, R & S will delay the duration of operation

theatre process at Owaisi Hospital & Research Centre .

• The critical activities for operation theatre process in Yashoda Hospital are A

(operation theatre manager calling the respective ward to inform the nurse to shift the

patient & taking confirmation) , B (shifting of the patient from respective ward to the

operation theatre) , D (the junior anesthetist performing pre-anesthesia check-up) , G

(informing the ward boy or aya to change the dress of the patient) , H (ward boy or

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aya changing the dress of the patient) , I (shifting of the patient into the theatre by

ward boy or aya) , J (transferring the patient to the operation table), L (the team of

doctors verifying patient’s name , consent , pre-anesthesia check-up and other

parameters like blood pressure, pulse rate etc. before starting the surgery) , M (the

team of anesthetists giving anesthesia), N (doctor marking the site of surgery on

patient), O (surgeons performing the surgery), P (informing the ward boy or aya to

shift the patient to recovery room), Q (shifting of the patient to the recovery room by

ward boy / aya) , R (monitoring and documenting the patient’s physiological status &

post-anesthesia status) ,S (informing the ward boy/ aya to shift the patient to post-

operative ward) and T (shifting of the patient from recovery room to post- operative

ward by ward boy/aya). As critical activities do not permit any flexibility in

scheduling, any delay in any of the critical activities A, B, D, G, H, I, J, L, M, N, O,

P, Q, R, S and T will delay the duration of operation theatre process at Yashoda

Hospital.

• Activities C (operation theatre manager writing the consent in the case sheet), E

(doctor explaining the complications of operation to the patient & the attendee), G

(informing the ward boy or ‘aya’ to change the dress of the patient), H (ward boy or

‘aya’ changing the dress of the patient) & K (nurses arranging the instruments set for

surgery) of the operation theatre process at Owaisi Hospital & Research Centre have

total float value of 10.01, 10.01, 0.67, 0.67 & 33.31 respectively as shown in table-

4.103. It means that there is flexibility in regard to time available for activities C, E,

G, H & K. Delaying activities C and E by 10.01 minutes will not delay the project

duration. Similarly delay of the activities G, H & K by 0.67, 0.67 & 33.31

respectively will not affect the total duration of the operation theatre process.

• Activities C (operation theatre manager / concerned doctor writing the consent in the

case sheet), E (doctor explaining the complications of operation to the patient & the

attendee), F (the head of the department of anesthesia permitting the concerned

anesthetist for giving anesthesia to the patient) and K (team of nurses arranging

instruments for surgery) of the operation theatre process at Yashoda Hospital have

total float value of 6.74, 6.74, 4.15 & 42.39 respectively as shown in table- 4.106. It

means that there is flexibility with respect to time available for activities C, E, F & K.

Delaying activities C and E by 6.74 minutes will not delay the project duration.

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Similarly delay of the activities F, K by 4.15 & 42.39 will not affect the total duration

of the operation theatre process.

• Activities C (operation theatre manager writing the consent in the case sheet) and G

(informing the ward boy or aya to change the dress of the patient) of Owaisi Hospital

& Research Centre operation theatre process have interfering float value of 10.01 and

0.67 as shown in table – 4.103. This float causes a reduction in the float of the

successor activities i.e. for activity C activity E is the successor and for activity G

activity H is the successor. Thus any delay in operation theatre manager writing the

consent in the case sheet (activity C) will decrease the float time taken by the doctor

explaining the complications of operation to the patient & the attendee (activity E).

Similarly informing the ward boy or aya to change the dress of the patient (activity G)

will decrease the float time of activity H (ward boy or aya changing the dress of the

patient).

• Activity C (operation theatre manager / concerned doctor writing the consent in the

case sheet) of Yashoda Hospital operation theatre process has interfering float value

of 6.74 minutes as shown in table – 4.106. As this float causes a reduction in the float

of the successor activity, delay in activity C by 6.74 minutes will decrease the float

time taken by activity E (doctor explaining the complications of operation to the

patient & the attendee).

• Activities E (doctor explaining the complications of operation to the patient & the

attendee), H (ward boy or aya changing the dress of the patient) and K (nurses

arranging the instruments set for surgery) of Owaisi Hospital & Research Centre

operation theatre process have free float value of 10.01, 0.67 & 33.31 as shown in

table – 4.103. As this float doesn’t affect the float of the succeeding activities, delay

of activity E & H by 10.01, 0.67 minutes respectively will not cause any effect on the

flexibility of scheduling their successor activity I (shifting of the patient into the

theatre by ward boy or aya). Similarly delay in the time taken by activity K by 33.31

minutes will not affect the float of its successor activity M (the team of anesthetists

giving anesthesia).

• Activities E (doctor explaining the complications of operation to the patient & the

attendee), F (the head of the department of anesthesia permitting the anesthetist

concerned for giving anesthesia to the patient) and K (team of nurses arranging

instruments for surgery) of Yashoda Hospital operation theatre process have free float

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value of 6.74, 4.15 and 42.39 minutes respectively as shown in table – 4.106. As this

float doesn’t affect the float of the succeeding activities, delay of activity E, F by

6.74&4.15 minutes will not cause any effect on the flexibility of scheduling their

successor activity I (shifting of the patient into the theatre by ward boy or aya).

Similarly delay in the time taken by activity K by 42.39 minutes will not affect the

float of its successor activity M (the team of anesthetists giving anesthesia).

• Activities H (ward boy or aya changing the dress of the patient) and K(nurses

arranging the instruments set for surgery) of Owaisi Hospital & Research Centre

operation theatre process have independent float values of 1.34 and 33.31 minutes

respectively as shown in table – 4.103. It is the amount of float time which can be

used without affecting either the head or tail events.

• Activities F (the head of the department of anesthesia permitting the anesthetist

concerned for giving anesthesia to the patient) and K (team of nurses arranging

instruments for surgery) of Yashoda Hospital operation theatre process have

independent float values of 4.15 and 42.39 minutes respectively as shown in table –

4.106. It is the amount of float time which can be used without affecting either the

head or tail events.

• As per tables 4.103 and 4.106, the critical activities of operation theatre process at

Owaisi Hospital & Research Centre (A, B, D, F, I, J, L, M, N, O, P, Q, R & S) and

Yashoda Hospital (A, B, D, G, H, I, J, L, M, N, O, P, Q, R, S and T) are having zero

float value indicating that they are on the scheduled time. No activities are with

negative float time.

Network analysis finds its applications in many areas of the hospital right from hospital

planning to management of operations. Reviews also show that not much application of

PERT is done in hospitals. Though the study is focused on understanding the critical path and

slack times at emergency, discharge and OT, there is further scope to extend the application

to other areas like hospital billing, hospital bed expansion, Arogyasree cases, health camps,

process flow analysis of a central sterile supply department etc.

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Application of MUSIC – 3D in pharmaceutical inventory of Owaisi Hospital &

Research Centre and Yashoda Hospital

The third objective is to study MUSIC -3D process of inventory management by classifying

the pharmaceutical inventory into ABC, VED & SDE. The third objective concentrates on

applying MUSIC -3D in the pharmaceutical inventory of Owaisi Hospital & Research Centre

and Yashoda Hospital, by classifying the pharmaceutical inventory into ABC, VED & SDE.

An insight into the application of MUSIC-3D in the pharmaceutical inventory resulted in the

findings as discussed below.

ABC analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and

Yashoda Hospital

ABC analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre from table

4.107 revealed the following findings:

There are 55 ‘A' items accounting to 19.5035 % of total items & 70.07791 % of total

consumption.

There are 86 ‘B’ items accounting to 30.4964 % of total items & 20.05315 % of total

consumption.

There are 141 ‘C’ items accounting to 50% of total items & 9.868 % of total

consumption.

ABC analysis of pharmaceutical inventory at Yashoda Hospital from table 4.112 revealed the

following findings:

There are 123 ‘A’ items accounting to 33.79 % of total items & 70.19 % of total

consumption.

There are 102 ‘B’ items accounting to 28.03 % of total items & 19.85 % of total

consumption.

There are 139 ‘C’ items accounting to 38.18 % of total items & 9.96 % of total

consumption.

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VED analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and

Yashoda Hospital

The following are the findings of VED analysis of pharmaceutical inventory at Owaisi

Hospital & Research Centre (table- 4.108):

There are 27 'V' items accounting to 9.57447 % of total items that are vital for patient

care.

There are 165 'E' items accounting to 58.5106 % of total items that are essential for

patient care.

There are 90 'D' items accounting to 31.9149 % of total items that are desirable for

patient care.

The following are the findings of VED analysis of pharmaceutical inventory at Yashoda

Hospital (table- 4.113):

There are 65 'V' items accounting to 17.8 % of total items that are vital for patient

care.

There are 236 'E' items accounting to 64.8 % of total items that are essential for

patient care.

There are 63 'D' items accounting to 17.4 % of total items that are desirable for patient

care.

In both the hospitals ‘E’ items (165 in Owaisi Hospital & Research Centre and 236 in

Yashoda Hospital) which are essential for patient care are more when compared to ‘V’ or ‘D’

items. Though requirement of ‘V’ items in both the hospitals is less in comparison to ‘E’

items, ‘V’ items are vital for patient care and it should be seen that they are always available.

SDE analysis of pharmaceutical inventory at Owaisi Hospital & Research Centre and

Yashoda Hospital

The following are the findings of SDE analysis of pharmaceutical inventory at Owaisi

Hospital & Research Centre (table -4.109):

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There are 6 'S items accounting to 2.12766 % of total items that are scarcely available,

have short supply & are especially imported.

There are 33 'D' items accounting to 11.7021 % of total items that are difficultly

available in indigenous market

There are 243 'E' items accounting to 86.1702 % of total items that are easily

available.

The following are the findings of SDE analysis of pharmaceutical inventory at Yashoda

Hospital (table -4.114):

There are 10 'S items accounting to 2.7 % of total items that are scarcely available,

have short supply & are especially imported.

There are 72 'D' items accounting to 19.8 % of total items that are difficultly available

in indigenous market

There are 282 'E' items accounting to 77.5 % of total items that are easily available.

SDE analysis shows that maximum pharmaceutical items are easily and locally available

(86.17 % in Owaisi Hospital & Research Centre and 77.5 % in Yashoda Hospital). But

hospitals should concentrate on obtaining scarce items, as they need long lead time.

MUSIC – 3D analysis of pharmaceutical inventory at Owaisi Hospital & Research

Centre and Yashoda Hospital

The following are the findings of MUSIC-3D analysis of pharmaceutical inventory at Owaisi

Hospital & Research Centre (table – 4.110):

No items are there under HLC (high consumption value , long lead time, critical)

category

0.7 % of the items are under HSC (high consumption value, short lead time, critical)

category.

1.06 % of the items are under HLN (high consumption value, long lead time, non-

critical) category.

18.08 % of the items are under HSN (high consumption value, short lead time, non-

critical) category.

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7.09 % of the items are under LLC (low consumption value, long lead time, critical)

category.

5.3 % of the items are under LSC (low consumption value, short lead time, critical)

category.

4.25 % of the items are under LLN (low consumption value, long lead time, non-

critical) category.

63.4 % of the items are under LSN (low consumption value, short lead time, non-

critical) category.

The following are the findings of MUSIC-3D analysis of pharmaceutical inventory at

Yashoda Hospital (table – 4.115):

5.76 % items are there under HLC (high consumption value , long lead time, critical)

category

3.29 % of the items are under HSC (high consumption value, short lead time, critical)

category.

2.47 % of the items are under HLN (high consumption value, long lead time, non-

critical) category.

22.25 % of the items are under HSN (high consumption value, short lead time, non-

critical) category.

4.39 % of the items are under LLC (low consumption value, long lead time, critical)

category.

4.94 % of the items are under LSC (low consumption value, short lead time, critical)

category.

9.89 % of the items are under LLN (low consumption value, long lead time, non-

critical) category.

46.97 % of the items are under LSN (low consumption value, short lead time, non-

critical) category.

Although MUSIC-3D shows maximum percentage of items under LSN (low consumption

value, short lead time, non-critical) category for both the hospitals i.e. Owaisi Hospital &

Research Centre (63.4%) and Yashoda Hospital (46.97%), all the other categories of items

under MUSIC -3D also play an important role in providing timely patient care. Strategies

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have to be developed accordingly to procure these pharmaceutical items based on the

category obtained by MUSIC-3D analysis.

MUSIC-3D is a very good inventory management tool as it considers inventory management

from a three dimensional view. In the present study pharmaceutical inventory is analysed

keeping in mind the consumption value, criticality and lead time. Further research can be

done to apply MUSIC-3D at pharmacy outlets, surgical items, linen and any other

consumables of the hospital.

Replacement analysis of medical equipment revealed the following findings:

The fourth objective of the study is the application of replacement model in understanding the

optimal replacement period of major medical equipment. Replacement model is applied to

study the optimum replacement period for the medical equipment of Yashoda hospital

It is found that the average cost of MRI equipment for replacement is a minimum of

Rs 48,25,000 in the 12th year, and increases from thereon. This clearly shows that

MRI equipment should be replaced at the end of the 12th year from the date of

purchase.

For CT scan equipment the average cost for replacement is found to be a minimum of

Rs 33,50,000 in the 10th year, and increases from thereon. CT-Scan equipment should

be replaced at the end of the 10th year from the date of purchase.

The average cost for X-ray machine for replacement is found to be a minimum of Rs

10,87,500 in the 8th year, and increases from thereon. So the X-ray machine should be

replaced at the end of the 8th year from the date of purchase.

For Ultrasound monitor, the average cost for replacement is a minimum of Rs

2,81,363.636 in the 11th year, and increases from thereon. This means the Ultrasound

monitor should be replaced at the end of the 11th year from the date of purchase.

It is observed that the average cost for replacement is a minimum of Rs 2,85,000 in

the 9th year for 2D-ECHO equipment, and increases from thereon. Thus 2D-ECHO

equipment should be replaced at the end of the 9th year from the date of purchase.

For C-ARM equipment, the average cost for replacement is a minimum of Rs

1,54,375 in the 8th year and increases from thereon. So the C-ARM equipment should

be replaced at the end of the 8th year from the date of purchase.

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The average cost of replacement for ENMG machine is a minimum of Rs 1,71,500 in

the 10th year and increases from thereon. So the ENMG machine should be replaced at

the end of the 10th year from the date of purchase.

Ventilator equipment has a minimum average cost of replacement of Rs 1,10,000 in

the 9th year and increase from thereon. Hence optimum replacement policy for

Ventilator is to replace it at the end of the 9th year from the date of purchase.

The average cost for replacement of Dialysis machine is found to be a minimum of Rs

96,888.889 in the 9th year and increases from thereon. Accordingly the Dialysis

machine should be replaced at the end of the 9th year from the date of purchase.

For ECG Monitor, the average cost of replacement is found to be a minimum of Rs

24,222.222 in the 9th year and increases from thereon. Thus the optimum policy for

Monitor (ECG) is to replace it at the end of the 9th year from the date of purchase.

In the present study, replacement analysis is performed for the major medical equipment

of the hospital. Further research is required to understand how replacement models find

use in framing replacement policies for ambulances and replacement of old equipment

with the new one. Optimal replacement period for minor equipment can also be found.

Similar application of replacement analysis can be carried out for the equipment of the

diagnostic centers.

Application of LPP for diet problem revealed the following findings:

The fifth objective of the study is the application of LPP in formulating an optimal cost

balanced diet problem for a healthy life style. Two solutions have been provided for the

balanced diet problem:

• First one is an optimal or minimum cost solution to the balanced-diet problem.

Minimum cost solution entails a total cost of Rs. 2,842.991 per month per person.

But, it resulted in an unpalatable diet. Out of 89 food items, the solution resulted in

use of only 12 items (table 4.148).

• Second one is a sub-optimal cost solution to the balanced-diet problem which is

formulated keeping the cultural and culinary background of local people. The sub-

optimal cost diet is not only nutritious but also palatable. The quantity of all the 89

food items that can be consumed in a month is found keeping in mind the constraints

that have to be satisfied (table 4.149).

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• The sub-optimal solution provides a balanced diet with total cost of Rs. 4,121.103 per

month per person and includes a wide variety of food items.

Though LPP is used in formulating a nutritious balanced diet, several other applications

can be done in hospitals. One can explore on how it can be applied, as LPP has several

applications right from man power scheduling, transportation, finance, media selection to

product mix problems. In hospitals, LPP can be effectively applied to study the

scheduling of operation theater, nurses, doctors and other manpower. Transportation of

sterile items from central sterile supply department to other departments and receiving

back the used items from various departments to central sterile supply department can

also be effectively planned through LPP. Assigning nurses to different wards,

transportation of patients using ambulances etc. are some other areas where research has

to be focused.

5.2 CONCLUSION

The basic objective of the study is the application of OR techniques to optimize hospital

services. Several OR techniques like queuing theory, PERT, MUSIC-3D analysis,

replacement analysis and LPP have been applied during the research. Queuing theory is

applied to study the waiting time of patients in both the hospitals i.e. Owaisi Hospital &

Research Centre and Yashoda Hospital. PERT is used in developing network diagrams for

the processes of emergency, discharge and OT in both the hospitals. MUSIC-3D is performed

for the pharmaceutical inventory of both the hospitals. Replacement analysis is used to find

the optimum replacement period of the medical equipment of Yashoda Hospital. LPP is

formulated for finding an optimal cost diet which satisfies the nutritional requirements.

Conclusion based on queuing theory application in Owaisi Hospital & Research Centre

and Yashoda Hospital

In Owaisi Hospital & Research Centre, waiting time of patients in the queue is more at

consultation (3.16 hours) and diagnostics (0.941 hours). Waiting time of patients in the

system is also more at consultation (3.429 hours) and diagnostics (1.182 hours). Long waiting

may result in more rush at consultancy and diagnostics. The waiting time in the queue (1.42

hours) and system (1.65 hours) is more at diagnostics in Yashoda Hospital when compared to

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other stations. It is observed that for both the hospitals waiting time is more at diagnostics

when compared to other stations.

Waiting time and length of the queue are more at consultation when compared to other

stations. As Owaisi Hospital & Research Centre is a teaching hospital, waiting time and

queue length might be more at consultancy. This is because of senior doctors teaching the

medical students. Many times junior doctors or intern students with little experience attend

the cases. Only complicated cases are seen by the senior consultants. This also causes longer

queues and more waiting for the patients in Owaisi Hospital & Research Centre.

The probability that the server is idle at laboratory services is 0.558 in Owaisi Hospital &

Research Centre. More than 50% of the time the server is idle at laboratory. So, measures

may be taken to optimize the laboratory services at Owaisi Hospital & Research Centre. As

idle time is more at Owaisi Hospital & Research Centre registration & billing with 63.88% &

53.04% respectively, the staff may be trained for carrying out other tasks apart from their

routine duties. In Yashoda Hospital, laboratory and pharmacy are idle for 65% of time

followed by OP registration for 59% of time. Measures may be taken to improve the

utilization rate at these stations.

Pharmacy in Owaisi Hospital & Research Centre has more utilization rate of 42.69 % when

compared to 35% in Yashoda Hospital. The queue length of the patients at pharmacy is only

0.318 in Owaisi Hospital & Research Centre and 0.19 in Yashoda Hospital.

At Owaisi Hospital & Research Centre OP registration, there is a probability of 0.95289 that

the number of patients in the system is less than or equal to 2 and the probability that the

patients is greater than or equal to 3 is 0.01701. This clearly shows that the patient flow can

be improved. Similarly, there are probabilities of 0.95139, 0.92776 & 0.96678 at OP billing,

laboratory & pharmacy respectively for patients to be less than are equal to 3. The

management should plan for optimizing the services at these departments. At Yashoda

Hospital OP registration there is a 0.97 probability that the number of patients is less than or

equal to 3.

The probability of number of patients is less than or equal to k (number of patients in the

queuing system) at OP registration is less at Yashoda (5 patients with probability 1) when

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compared to Owaisi Hospital & Research Centre (9 patients with probability 0.99996).

Probability that there are more than 6 patients in Yashoda Hospital OP registration is zero. It

means that the patients in the queuing system at OP registration cannot be more than 6. When

compared to Owaisi Hospital & Research Centre registration & OP billing, number of

patients in the queuing system at Yashoda Hospital is less. There is a 100 % probability that

there are only 6 patients in the queuing system at OP billing in Yashoda Hospital. The

probability of number of patients in the queuing system <= K (number of patients in the

queuing system) at consultation is almost double in Owaisi Hospital & Research Centre when

compared to Yashoda Hospital.

Conclusion based on PERT applications in emergency, discharge and OT process flows

of Owaisi Hospital & Research Centre and Yashoda Hospital

Emergency process duration time is more in Yashoda Hospital (2.44 hours) when compared

to Owaisi Hospital & Research Centre (1.415 hours). This is because in Owaisi Hospital &

Research Centre, ambulance service is not that effective. So, process flow is starting from the

time patient is brought to the hospital. Variance for emergency process flow is less in

Yashoda Hospital (0.59 hours) when compared to Owaisi Hospital & Research Centre (4.22

hours). Though activities are more in Yashoda Hospital emergency process (as it includes

ambulance services), variance in emergency process duration is less. This shows how

effectively the emergency services are managed in Yashoda Hospital.

Activities D (time taken to inform the specialist), G (time taken by the specialist to attend the

patient) & J (time taken for registration, billing and pharmacy) of Owaisi Hospital &

Research Centre emergency process have larger total float values of 49.2, 29.2 & 49.2

minutes respectively. Activities D (time taken to inform the specialist) & G (time taken by

the specialist to attend the patient) of Owaisi Hospital & Research Centre emergency process

have larger interfering float values of 49.22 and 29.22 minutes respectively. Activity J (time

taken for registration, billing and pharmacy) of Owaisi Hospital & Research Centre

emergency process has large free float value of 49.22 minutes. Activity G (time taken by the

Specialist to attend the patient) of Owaisi Hospital & Research Centre emergency process has

larger independent float value of 49.2 minutes. Activities L (time taken by the nurse to attend

the patient), O (time taken by the technician to attend the patient) & R (Time taken for the

report arrival of lab & diagnostic tests) of Yashoda Hospital emergency process have larger

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total float values of 80.99, 81 & 38.5 minutes respectively. Activities L (time taken by the

nurse to attend the patient) & O (time taken by the technician to attend the patient) of

Yashoda Hospital emergency process have larger interfering float value of 80.99 minutes.

Activity R (time taken for the report arrival of lab & diagnostic tests) of Yashoda Hospital

emergency process has large free float value of 38.5 minutes.

Discharge process duration is more in Yashoda Hospital (2.468 hours) when compared to

Owaisi Hospital & Research Centre (1.807 hours). Variance is very large for Yashoda

Hospital discharge process (5.56 hours) when compared to Owaisi Hospital & Research

Centre (1.3465 hours). It is observed that the expected time for OT process is more at

Yashoda Hospital (8.618 hours) when compared to Owaisi Hospital & Research Centre (2.80

hours). This might be due to the complicated operations performed in Yashoda Hospital than

in Owaisi Hospital & Research Centre.

Variance of OT process is more in Yashoda Hospital (62.647 hours) than in Owaisi Hospital

& Research Centre (4.35 hours). This might be due to the range of surgeries that are

performed in Yashoda Hospital when compared to Owaisi Hospital & Research Centre.

Activity K (nurses arranging the instruments set for surgery) of OT process in Owaisi

Hospital & Research Centre has flexibility with slack time of 33.31 minutes for total, free and

independent floats. Activity K (nurses arranging the instruments set for surgery) of OT

process in Yashoda Hospital has also flexibility with slack time of 42.39 minutes for total,

free and independent floats.

Conclusion based on application of MUSIC-3D analysis, replacement analysis and LPP

in Owaisi Hospital & Research Centre and Yashoda Hospital

The conventional ABC analysis is not an effective selective control mechanism, as there are

other influencing mechanisms like criticality and availability, which influence a great deal on

controlling the materials. Thus, the three-dimensional approach MUSIC -3D is helpful to

classify all materials into eight categories and to control the materials effectively on all

aspects and achieve ‘cost reduction', in order to facilitate the materials department as a profit

center.

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The initial efforts required to implement MUSIC-3D inventory policy may be requiring some

effort, but once implemented, only a marginal action is needed to maintain and improve it.

The benefits are immense. The importance of inventory control is now realized by the

hospital administrators. Its basic objectives are to reduce investment in inventories and

simultaneously avoid stock-outs situation. An effective inventory control balances the two

objectives to optimum advantage. Computerization, automation and use of technique like

MUSIC-3D will aid in achieving these objectives.

It is imperative that all measures for the prevention of stock out situations should be

implemented. Availability of pharmaceutical products is essential for timely patient

treatment. It is also an essential requisite for provision of life saving, effective and efficient

healthcare. Frequency of stock outs is an indicator to assess the effectiveness of the stores

department and the materials management.

Replacement analysis of medical equipment helps to frame an optimum replacement policy.

Except MRI equipment (replacement period of 12th year), all the other equipment are found

to have an optimum replacement period between 8- 10years.

Minimum cost diet resulted in selection of 12 food items: rice, red gram, cabbage, yam,

cucumber, peanut, banana, watermelon, egg, milk, cooking oil and sugar. Though 12 items

are satisfying all the 62 constraints of nutritional requirement, it is difficult for a person to

have variety of tasty foods with only on 12 items in a month. For that reason a diet covering

wide variety of food items is planned which resulted in a palatable diet consisting 89 food

items providing the entire nutritional requirement.

The optimal or minimum cost diet is Rs. 2,842.991 per month per person whereas total cost

of Sub-optimal diet is Rs. 4,121.103 per month per person. Though there is a difference of

Rs. 1,278.904 per month per person for optimal and sub-optimal solution, it is preferable to

go for solution based on suboptimal approach as it would be not only nourishing but also

meet aesthetic tastes and culinary preferences of most of the Indian people.

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5.3 RECOMMENDATIONS

Based on the application of different OR techniques like queuing theory, PERT, MUSIC-3D,

replacement analysis and LPP, areas for improvement have been identified in both the

hospitals i.e. Owaisi Hospital & Research Centre and Yashoda Hospital. Accordingly, a few

recommendations have been given for optimizing the services at outpatient department,

laboratory, diagnostics, emergency, OT and for medical equipment replacement. An optimal

diet plan is also proposed for meeting the nutritional requirements of average individual in

general and convalescing patients in particular. The following are the recommendations of

the study, based on the application of different OR techniques like queuing theory, PERT,

MUSIC-3D, replacement analysis and LPP:

• Waiting time of patients in both the hospitals Owaisi Hospital & Research Centre and

Yashoda hospital can be reduced at consultancy by having proper appointment

scheduling. Appointment scheduling has to be done on the same day or before.

• Though the hospital is offering consultation at minimal rate (Rs. 30 per visit) in

Owaisi Hospital & Research Centre, patients may not be interested to wait for longer

duration. Some patients may even like to visit only senior consultants and not like to

be seen by junior doctors or interns. So the hospital should see that the patients who

are interested in visiting senior consultants should be seen by them only. This of

course could be achieved by having high consultation fees (say Rs. 100) for the senior

consultants. This also helps in increasing the hospital revenue.

• For both the hospitals Owaisi Hospital & Research Centre and Yashoda hospital,

measures have to be taken to reduce the waiting time at diagnostics. Though the

waiting time cannot be reduced to zero, it should be seen that patient should not have

to wait for long at diagnostics. This can be achieved by giving prior appointment to

non-emergency patients who have to undergo scans (ultrasound, MRI) for a longer

period.

• As idle time is more than 50% at Owaisi Hospital & Research Centre laboratory and

65% at Yashoda Hospital, services can be optimized by extending the laboratory

facilities to nearby small hospitals and clinics that lack laboratory services, thus

increasing the revenue of the hospital.

• It is observed that most of the medicines prescribed by the doctors are not available in

the pharmacy of Owaisi Hospital & Research Centre, except some commonly

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prescribed drugs. So patients are not showing interest to buy medicines at hospital

pharmacy in Owaisi Hospital & Research Centre. Pharmacy services can be improved

by providing range of drugs. Pharmacy should at least store the drugs prescribed by

in-house doctors. Only then patients will show interest to buy drugs in the hospital

pharmacy.

• Pharmacy in Yashoda Hospital is idle for 65% of time. This might be because the

hospital pharmacy is utilized by only Yashoda Hospital patients. It is better to re-

locate the pharmacy adjacent to hospital main entrance, so that other patients can also

have easy access to hospital pharmacy.

• The server is busy only for 36.12% of the time at Owaisi Hospital & Research Centre

OP registration. So the staff at OP registration counter should be trained to provide

more quality service to patients. This can be done by providing additional information

to patients regarding doctor’s availability, location of the service areas, other facilities

offered at hospital etc. which will improve the quality of care provided by hospital to

patients.

• The server is busy only for 53.04% of the time at Owaisi Hospital & Research Centre

OP billing. In fact management can remove separate enquiry counter at reception. A

notice should be kept at reception that all enquiries are handled at registration and

billing counters. This will optimize the man power at reception.

• Study on the probabilities at Owaisi Hospital & Research Centre OP registration

showed that the patient flow is very less. The hospital should concentrate on medical

camps and healthcare packages to attract more patients. Designing healthcare

packages for overall body check-up, cardiac packages, fitness packages etc. will

attract more patients.

• Even in Yashoda Hospital the probabilities for patients to be more than seven is zero

at OP registration, OP billing, laboratory and pharmacy. The hospital should

concentrate on cost leadership and differentiation. The cost of the services is found to

be more in Yashoda Hospital than in Owaisi Hospital & Research Centre. Yashoda

Hospital should concentrate on providing quality services at affordable costs to face

the competition.

• As Owaisi Hospital & Research Centre is well equipped and has good infrastructure,

it should concentrate on optimizing the services at laboratory and diagnostics. This

can be done by having tie-up with nearby clinics and doctors to send patients for

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diagnostic, lab & specialty services. This will in turn increase the revenue of hospital

as well optimize the manpower utilization at the respective departments.

• Owaisi Hospital & Research Centre should improve the emergency services.

Ambulance services play very important role for any hospital. Owaisi Hospital &

Research Centre should concentrate on improving the ambulance services as the

hospital is in a prime location.

• Total time for discharge process is too long in Yashoda Hospital (estimated time

2.468 hours and variance 5.56 hours). Measures have to be taken to reduce the

discharge process time in Yashoda Hospital.

• Owaisi Hospital & Research Centre has very good infrastructure and facilities in OT.

The hospital should have tie up with good surgeons to perform complicated surgeries.

Only then the quality of the services will improve and optimum utilization of the

operation theatre facilities will happen.

• Application of PERT in hospitals helps to understand the critical and slack times for

various activities. So the hospitals should take enough care in seeing that the critical

activities are not delayed. Any flexibility in timing can be there only for non - critical

activities.

• Indent for materials from different departments in the hospital should be

computerized to reduce errors. Stock of critical items which has high consumption

should be monitored very critically.

• Decentralization of pharmacy store is required at cardiology department, operation

theater, intensive care unit etc. for easy accessibility of drugs for patients.

• Supply of materials from central stores should have separate passage for delivery to

the respective departments.

• Periodic assessment of pharmaceutical items for their expiry dates should be

incorporated.

• Implementation of MUSIC-3D to the inventory stock will enhance the performance at

pharmacy.

• The safety stock level of vital items should be fixed in such way that operation of the

pharmacy does not suffer for want of these items.

• Implementation of computer integrated system with all the critical departments

(operation theatre, intensive care units, etc.) of the hospital to ensure coordinated

planning and smooth flow of drugs.

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• Heavy investment is incurred by the hospitals for procuring medical equipment.

Optimum replacement policy is a must to see that the equipment is replaced on time.

Failure to do so will not only result in higher maintenance costs and poor

productivity, but also diminishes the quality of output.

• The LPP problem is applied to find out a nutritious balanced diet for a healthy life

style. It is recommended to follow the sub-optimal diet which includes 89 food items

and costing Rs.4,121.103 per month per person. Sub-optimal diet is recommended in

comparison with optimal diet, as it is giving a palatable diet.

As long as increasing the productivity of healthcare organizations remains important,

analysis should be done to apply relevant models to improve the performance of healthcare

processes.

299

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