Introduction of project:

We are going to prepare a project for the subject of “Total Quality Management”. This subject deals with

the study of Zero defects, continual improvement, and elimination of waste in organization to increase its

quality. The major important strategic tool in total quality management is benchmarking. Benchmarking

should be a reference or measurement standard for comparison. It is a tool for performance assessment

and continuous improvement in an organization performance. So the organization that is assigned to us is

“Aziz Bhatti shaheed Hospital Gujrat”. By using benchmarking technique we want to improve hospital

performance, quality, customer satisfaction and providing some suggestions in the areas where it lack.

Importance of health sector and contribution of our work for this sector:

The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of

complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.

That’s why health sector play a major role in maintenance of health or make a healthy environment. In

the development of any country is necessary that their people must use their skills effectively or properly

do their work in better manner and make planning for their better future. This can be achievable if the

people of that country are in good health. For a healthy society need good hospitals those deal with

people and provide proper guidance for improving their health. Our project will help Aziz Bhatti

Shaheed Hospital to improve its services in orthopedic department. If hospital apply best in class

methods then their patient will become more satisfied, generate positive word of mouth. Our project

describes continual improvement, best workers performances, how internal customers are satisfied, and

ways to improve performances as well as the suggestions for organization improvement where they are

in lack.

History:

The DHQ Hospital Gujrat was established

in 1963 and renamed in 1966 as Aziz Bhatti

Shaheed Hospital, Gujrat. The hospital has

400 beds. It is the Government hospital that

full fills the health care needs of local

people as well as people of neighbouring

districts and towns such as Bhimber, Mandi

Bahauddin and Wazirabad. It has been

attached with the Nawaz Sharif Medical College as the teaching hospital. This hospital is also providing

routine care services to the prisoners of District Jail, Gujrat. The Pakistan Medical and Dental Council

have recognised the hospital for house-job training. The hospital has the departments of Emergency,

ENT, Gynaecology, Medicine, Obstetrics, Ophthalmology, Orthopaedics, Surgery, Paediatrics, TB/Chest

Cardiology and Urology.

Introduction of orthopaedic department:

In Aziz Bhatti Shaheed Hospital orthopedic services provide

treatment of the skeletal system, its joints, muscles, and associated

structure. Orthopedic primarily concerned with the handling of all

types of trauma cases and road traffic accident. There are mostly

legal issues involve in the fighting so medical causality officer

deals with these issues and patient are treated in emergency

department for stopping their blood, shock recovery and then

transfer them to the related department. The department of

orthopedic has 32 beds. It provides emergency care for patients of

muscular skeletal trauma. Two doctors are available in this

department: Dr. Tallab and Dr. Wazahat Hussain. They are doing orthopaedic surgery of patient like

joint replacement surgery, entering the plates in body etc. Major activities in this department are

checking of outdoor patient, surgeries and ward visit. This department deals with general operations and

not for specialized operations due to lack of technology.

Major competitor and their introduction:

Gujrat hospital on Bhimber Road Gujrat

City hospital

Bashir Hospital Bukhari Diagnostic Center Ali Children Hospital Doctor Hospital Fauji Foundation Medical Center Wahid Trust Hospital Ishaq Eye Hospital

Critical success factors:

Speed:

Check almost 105 to 110 patients in 5 hours.

Quality:

With in limited resources they provide quality services that increase the satisfaction level of their

patient

24- Hour services:

They provide 24-hours ward service with in three shifts.

Detail of Current process (flow chart):

10:00 to 11:00 am

8:00 to 2:oo pm

Doctors (orthopedic

dept.)

Surgeries

Ward visit

Outdoor patient Monday, Wednesday, Thursday, Saturday

Daily morning

Tuesday, Friday

Flow chart of medical services for outdoor patient:

Patient

Arrive

Patient in yes doctor yes

the system available

No No

Patient leaves

Decision Start/end

Take appointment

Waiting room

Patient with doctor

Check up/ treatment

Take prescription

Process

Assets/resources of the department:

Human resource:

2 doctors

2 ward servant

3 staff members

1 dresser

3 sweepers

1 peon

Physical resources:

Outdoor:

21 visitor chairs

4 benches, 1 stature, 1 X-Ray scanner, 5 chairs, 1 cupboard

in doctor office

Indoor:

2 wards for female and male both include 17 beds for

female and 15 for male

Doctor office for Talib Hussain & Wazahat Hussain Warraich

Identify external and internal customers:

Internal customers:

Internal customers include their employees. Those are

2 doctors

2 ward servant

3 staff members

1 dresser

3 sweepers

1 peon

External customers:

Their external customers mostly include Gujrat area people as well as other districts and towns such as

Bhimber, Mandi Bahauddin and Wazirabad people. Due to lack of modern technology and funds

specialized cases did not deal here and quality of service is little bit low. Mostly average or low income

people are from external customers.

Employees (total no of employees in department, their positions, salaries, timings,

duties, shifts, who is immediate boss? Who assigns duties and responsibilities

There are 12 total employees in this department.

Positions:

There are two doctors, three staff members, one dresser, two ward servants, three sweepers and one

peon.

Salaries:

The salary of the peon, ranges 9000 to 12000 depend on their service period. The salary of the

assistant of the doctors is 15000.

The salary of nurses is 25000 and above.

The salary of seniors’ members is around 55000 to 65000.

The salary of the doctor is 1 lac and above according to their service time/ experience.

Timings:

The timing hours of doctor are 8 a.m. to 2 p.m.

There are two shifts of peon timing hours of one peon is 8 a.m. to 2 p.m. And second peont is 3

p.m. to 9 p.m.

Nurses and sweeper have three shifts of there duties: morning, evening and night and every

employee work 8 hours.

The duty of doctor is checking outdoor patient and surgery. Nurse’s duty is to provide medicine

to patient that is admitted in hospital. Peon has the duty of security and checks every one that is

entered in the hospital. Assistant of the doctor record the entries of patients. Sweepers have the

duty to clean hospital. Ward servant handle the work that is take place in the ward like doze

timing etc.

Dr. Wazahat Hussain is the immediate boss of the department. He is also assigns the

responsibilities and duties of all employees.

Volunteers, students, internees’ role in department:

This hospital does not provide the proper facility of intern ship so there is no internee in the hospital at

that time. There was only one internee in this hospital last year and the duration of his internship was

four to six month but there is no internee in this department. The internee helped seniors for their routine

work, reduce the burden of employees and treat every one equally.

How quality of product/service is ensured?

Dr. Wazahat Hussain Warraich assigns duties to their employee according to their capabilities. Also

there is proper check and balance on these duties those assigned by their supervisor (Dr. Wazahat

Hussain Warraich).

They also increase their quality by daily visiting the ward & ask the patient about their problems. So in

this way they provide better solution about their problem that increases their quality services.

How problems are being resolved?

Lack of staff

lack of beds

lack of equipment

lack of specialist

lack of medicines

lack of financial resources

Solution:

Government should offer new vacancies for staff and specialist as well. Government should provide

budget for this department on continuously basis and MS should not miss manage these resources. There

must be medicine facility at one spot that should fulfill requirement of all departments in this hospital.

There must be proper utilization of department space.

Problems face by employees (process owners) in current process:

The biggest problem of process owners is lack of financial resources. Government do not provide

sufficient funds and MS (Medical Superintendent) miss use all the resources. So in this department

doctors do not have innovative machines for surgeries, blades, plates, threats, medicine, nuts and proper

medicine for surgery. Doctors do pre operating activities about 2 to 3 days before surgery and tell their

patient for proper nuts size, blades, plates etc. These things are mostly brought from Lahore so more time

required. There is lack of specialist in this department for operations, poor quality medicine, poor quality

of X-Rays so doctors can not identified proper area and cause for treatment.

Outlook of the facilities, employees’ look (uniform, card etc):

There is proper uniform that is assign to all employees but employees do not wear it. Doctors mostly

wear dress pent, sweeper and assistant mostly wear shalwarqamiz and nurses wear white shalwarqamiz

with white upper and dophata. We do not see any card that is wear to any employees.

External customer:

Average no of customers per month and per day:

Average no of customers per day are 105 to 110.

Average no of customers per month 1800 to 2000.

Employee customer ratio:

Employee customer ratio shows one employee handles how much patient

Employee customer ratio= Patients/employee

=110/12

=9.167 or 10

Facilities available for customers:

For the purpose of guidance the employee outside the doctor room provides help to patient

regarding ward location, doctor office etc.

There are 21 seats for patient outside doctor’s room and within doctors room there are 5 seats,

bench and one stature for patients.

Doctors visit the wards daily from 10 a.m to 11 a.m. And the patient relatives visit the ward since

morning to night 10 p.m.

There are electric cooler of water for patient and only one people is allowed to stay with patient.

Major problems faced by customers and their reasons:

Major problems include waiting for surgery, limited medicine for surgery, bought surgery nuts, threats,

and slabs by patients themselves, lack of bed facility. The hospital do not has specialized equipment for

surgery so patients cannot avail these services in this hospital. Patient must go to Lahore or Islamabad

for these services.

Reason for these problem lack of financial resources, lack of specialized doctors, mismanage of funds

and improper utilization of space.

How much time customer waits for different services?

Patients wait for beds until the earlier patient discharged.

Only 10 to 15 minutes comes for in one patient so next patient in the room wait for this time.

For surgery there are 3 day require for doctors for pre operating activities so patient must wait

three days.

Benchmarking Organization:

Shifa International Hospitals Ltd Islamabad

Business sector:

The Hospital was incorporated on September 20, 1987 as a Private Limited Company and converted

into Public Limited Company on October 12, 1989.

Reason of selection benchmark:

We select Shifa International Hospital as a benchmark because it provides best quality services to their

patients in a cost effective way. Now after more than one and a half decade Shifa International Hospital

proudly stands as a symbol of quality healthcare with its own brand name "SHIFA". Hospital has

medical expertise, clinical excellence, state of the art technology that effectively and efficiently provides

best customer services. Factors that contribute hospital quality and performance include caring people,

preventive medicine and health care management. Hospital’s orthopedic department is filled with best

trained, qualified and experience staff. This department handles general as well as specialized cases like

arthroscopy, joint replacement etc. Its major focus is on customer satisfaction, improve quality of its

services, competitive position and continuously improve process and system. Hospital’s upper

management is fully committed and working hard to apply effective change. So Aziz Bhatti Hospital can

increase their service quality, customer satisfaction and competitive position if it will consider the

policies and method of Shafa international hospital Islamabad in its orthopedic department as well as in

whole organization.

Data source (sources-internal, published, external or original research):

We used internal source as well as published material for getting data about the organization. Internally

we get data Mr. Waqar and Sajjad Hassan. We also used hospital website to get data that help us to

conclude our result.

Contact person:

Waqar M. Jan / ORTHOPEDICS

Sajjad Hassan Orakzai / ORTHOPEDICS

Check list of topic:

What is hospital service delivery speed?

How hospital provides Quality of service to its customers?

What type of resources Shifa International hospital has in its orthopedic department?

How many customers have in its orthopedic department?

What is the timing of customers visit?

What specific dress its employees wear?

What type of facilities available to customers in orthopedic department?

Past history positives:

The Shifa International hospital’s orthopedic department provides general as well as specialized

operation facility to its customers. It provides treatments of musculoskeletal conditions such as bone and

joint injuries, degenerative joint diseases etc. The department provides a 24 hour trauma service for the

hospital, managing all orthopedic trauma and injuries such as fractures and dislocations. It also

coordinates the management and rehabilitation of patients after injury.

The department is being managed by 3 consultants and a full fledge team of well-trained staff to cater to

patients. Cost effective quality medical care are available to all patients. They also ensure ethical practice

of medicine in their department. The history of Shifa showed that its consultants, management and staff

are fully devoted and provides best customers services to its patients to become more competitive.

Flow chart of Shifa International Hospital Ltd:

Patient

Arrive

Patient in doctor yes

the system available

No

(Patient in the critical situation)

Shift in the ward

Patient

Leave

Patient leave

Decision Start/end

Critical performance measures of benchmarking partner:

Take appointment

Waiting room

Patient with doctor

Check up/ treatment

Take prescription

Process

Recover

Shifa International Hospital has strong image in customers mind. It has better performance due to highly

qualified & experienced doctors, latest technology and enough resources that meet the patient

requirements. Hospital orthopedic department has three consultant and provides 24 hours services. It

provides different general as well as specialized service like Management of fractures, Joint replacement,

Management of upper/lower limb injuries, Arthroscopy, Muscle biopsy, Management / correction of

limb deformities. It has ward as well as separate rooms for patient. Average no. of patient is 2500 in one

month that show their customer satisfaction. Their timing for consultant with doctor is from 8 am to 11

a.m. Shafa international has more staff than Aziz Bhatti Hospital that is specialized in their work.

Hospital have sufficient finds that they are utilize in proper place and in proper way that increase their

efficiency in process and service quality but charges in Shifa international hospital little higher that Aziz

Bhatti hospital.

Gap analysis:

This step involves analyzing the data collected, discovering to what degree present performance lags

behind the best in each area and combining the best features from the best practices into an ideal process.

The correct implementation of this step will result in a clear picture of your processes in comparison with

others in your business or industry.

For outdoor checkup Aziz Bhatti Hospital has two consultant, Dr. Tallab and Dr. Wazahat

Hussain while Shafa International has three consultant that check their patients properly . They

give more attention and accurate advise due to division of work.

Aziz Bhatti Hospital has less staff like sweeper, ward servant and peon etc while Shafa

International Hospitals has one peon, 2 sweepers and necessary ward servant better than Aziz

Bhatti Hospital. So more staff for necessary work better contribute to provide services to its

patients.

In Aziz Bhatti Hospital customer visit time is 8 a.m to 2 p.m. While in Shafa International

Hospital customer visit time is 8 a.m to 11 a.m because more trained and experience consultant

are available here.

In Aziz Bhatti Hospital physical resources like chairs, X-ray scanner, benches, stature etc. are

less than Shafa International Hospital. Aziz Bhatti Hospital has two wards for male and female

but in Shafa International Hospital has wards as well as separate rooms that are available for

customer demands. So patients do not wait for services until bed is empty.

Aziz Bhatti Hospital 's orthopaedic department provides only general operation facility to its

patients and for specialized operations patients go other hospitals while Shafa International

Hospital provides general as well as specialized operations facilities. These specialized operation

facilities at one place increase customer satisfaction and well trained doctors increase service

quality.

In Aziz Bhatti hospital there is pre operation activities for operations because operation screws,

blades, plates, threats, nuts and proper medicine for surgery is not available in Gujrat so these

things bring to other big cities while in case of Shafa International Hospital mostly all necessary

equipment is available.

In Aziz Bhatti Hospital there is lack of new technology like X- ray facility, X-ray scanner and

operation machines while in Shafa International Hospital there is modern technology in

operations machines, best X-ray and X-ray scanner facility so doctor easily understand the

problem for treatment.

In Aziz Bhatti Hospital, Ms does not utilize the funds of government in better way but in Shafa

International Hospital government funds utilize efficiently so customer spend a little on operation

equipments and medicine etc.

Aziz Bhatti Hospital does not utilize their department place effectively so there are less beds for

patients while Shafa International Hospital utilizes there space and also develop separate room

facilities for patients to provides best services.

So best features include increase consultant, increase staff members, increase technology, proper

utilization of space, proper utilization of government funds, best technology, better equipment and

medicine, sufficient physical resources and general as well as specialized operation facilities. These all

features make a best process and provide quality services to its customers.

Gaps (positive or negative):

There is a negative gap because

Best in class (Shafa International Hospital) performance Aziz Bhatti Hospital Gujrat

Shafa International Hospital almost leads in all area to Aziz Bhatti Hospital in its orthopaedic

department.

Gap is widening or narrowing along with reasons:

The gap between performances of Aziz Bhatti Hospital and Shafa International Hospital’s orthopaedic

department is widening.

Reasons:

The gap is widening because Shafa International Hospital is best in almost all services that it

provide in its orthopaedic department than Aziz Bhatti Hospital.

Shafa International has more consultant than Aziz Bhatti Hospital.

It has better technology in process like X-ray facility-ray scanner than Aziz Bhatti Hospital.

Shafa International Hospital has proper utilization of government funds.

It has separate rooms for patients as well as wards but Aziz Bhatti Hospital has only two wards

for patients.

Shafa International has best qualified, trained and experienced staff with sufficient human

resource than Aziz Bhatti Hospital.

Shafa International Hospital provides all kind of operation facilities in its orthopaedic department

with less time than Aziz Bhatti Hospital.

Root causes:

Root causes involve:

Lack of trained and experienced staff

lack of modern technology like efficient X- ray facility, X-ray scanner and operation ma-

chines

lack of beds facilities

lack of operation equipment like crews, blades, plates, threats, nuts etc

lack of specialist

lack of financial resources

Suggestions for improvements:

Government should offer new vacancies for staff and specialist In Aziz Bhatti Hospital to meet its

Human resource need. Government should provide budget for this department on continuously basis and

MS should not miss manage these resources. There must be medicine facility at one spot that should

fulfill requirement of all departments in this hospital. There must be proper utilization of department

space and build more wards as well as separate rooms for patients. Orthopaedic department of Aziz

Bhatti Hospital must invest funds in new technology to better identification of diseases and their

solutions. Aziz Bhatti Hospital should focus on orthopaedic specialist for conducting specialized

operations. All staff members should pay reasonably. Proper training should be given to employees on

continuously basis for improvement in service quality.

Effect of positives or negatives of these suggested changes, in terms of cost, customer satisfaction

level, employee performance, employee satisfaction level, process owner’s resistance or

convenience and management of the organization:

Due to increase in staff and specialist, new technology in process and increase in salaries the cost of the

service will increase automatically.

Customer satisfaction level will increase because they will get better quality services due to new

technology, trained and experienced staff and specialists, specialized operation facility, getting all

necessary medicine and operation equipment in one place and lees waiting time for service availability.

When Aziz Bhatti Hospital’s orthopaedic department hire trained and sufficient staff that meet our HR

needs then performance of employees will increase. Through continuous training, employee’s

performance will also increase.

When employees get good salaries and department has sufficient employees for work then employees

burden decrease and they will become satisfied.

If Process owner receives necessary equipment and high quality machinery then they perform their duties

on time and in more effective way. Proper training of process owners will also increase service quality.

Action plan

According to our research on both organizations and after comparing them there are some deficiencies

which need to be removed immediately. For abolishing these deficiencies they are required to make

some changes in the different areas of their department. To implement these changes and to get required

results our planning will be for 3 to 5 years. And the employees of department will be responsible and

committed to complete their tasks and assignments in time.

First of all they need to increase their staff members although they have general staff but not specialists.

To fulfill the patient’s need they will have to create some new vacancies for specialists. The other change

which is needed to bring of new technological equipments to satisfy their patients and to decrease the

dependability. And the last but most important need to bring some more financial resources in

department so they can fulfill the requirement of more beds for patients and the need of a medical store

in the boundary of hospital.

To measure the performance of employees their appraisal system is not fully established that’s why

employees are not fully committed with their duties and because absence of this commitment they get so

much complaints from their patients.

they handle almost 100 patients per day due to so much patients they can’t pay attention each and every

patient completely so, they need to increase vacancies of specialists, in this way they will easily handle

all patients with full attention.

On the basis of these changes our redefined goals will be:

Continuously improve customer satisfaction. Continuously improve the quality of services and systems. Continuously improve the Hospital’s financial performance and sustain long-term viability. Continuously improve the Hospital’s competitive position. Continuously improve the Hospital’s organization and work environment.

Now paths are so clear after redefining the goals. by achieving these goals:

Their efficiency will improve.

Employee’s commitment will increase.

And most importantly patients will be satisfied.

Redefining the positions and creating new vacancies:

Will divide the authority among them.

Burden of work will decrease.

Their performance will increase.

Department’s efficiency will increase.

Patients will be satisfied from doctor’s response.

The revision of goals:

Increase the good will.

The cases that are referred to other hospitals will reduce.

The good image will enhance the promotion efforts.

To achieve goals it is necessary to:

Establish a management committee.

Clinical audit should be regular.

Increase the commitment with goals.

Management must understand the proposed goals and fully support them.

management must communicate the goals to all affected employees in such a way as to obtain

their full commitment

President

Basically organization must establish the performance management system and also implemented it.

Clinical audit must be regularly checking the employee’s performance. They should priorities their needs

like their financial needs and job vacancies should be on first priority.

Vice President

Staff/ nurses Assistant Receptionist

Sweeper Ward servant

Dresser