HUMAN RESOURCE

Competence, awareness and training various personnel both direct and in direct are assessed annually through performance evaluation system.

Ensuring that required training is provided in line with needs identified.

Evaluating the effectiveness of training based on training evaluation to meet the necessary competence.

Creating awareness amongst employees on the relevance and performance of their and induction program employees role and contribution to achievement of quality objective is reviewed and discussed in management review meeting.

M.R (management representative)/H.R maintain performance records of staff, executives and all other employees

.

These records indicate the education background, skills and experience(past & present), training undergone of individuals.

CUSTOMER SATISFACTION

Customer satisfaction levels are assessed by collecting feedbacks from OP/IP departments based on periodic feedbacks, direct interactions, and compliance. In addition once in 6 months customer satisfaction feedbacks collected are consolidated to get a first-hand feedback on overall performance and identifying areas of improvement.

INTERNAL AUDIT

Conforms to requirements of international standard.

Is effectively implemented and maintained.

Status and importance of activities/areas of audit.

Results of previous audits.

PREVENTIVE ACTION

Identifying potential non conformities and their causes

Evaluating the need for initiating suitable actions

Finalizing and implementation of needed preventive actions.

Recording the results of action taken.

Reviewing the effectiveness of preventive actions taken.

MAINTENANCE

Activities:

Day to day maintenance

Preventive maintenance

Breakdown maintenance

Handling of outsourcing maintenance activities

Calibration of IMTE

Input

Day to day maintenance register

Preventive maintenance register

Breakdown history register

Outsourcing equipment maintenance register

List of IMTE

Out put

Day to day performance report

Preventive maintenance schedule

Outsourcing equipment maintenance register

Calibration report/verification report.

PHARMACY

Activities

Inward medicines

Issue of medicines

Maintain adequate stock level

Request for purchase

Identification of materials

IN PATIENT

Activities:

Handling of in patient

Surgical

Non-surgical

Dispensing of medicines

Dressing

Control of outside visiting consultant

Handling of biomedical waste disposal activities

Disposal of biomedical waste

Yellow colour indicates Human excreta, human parts, micro biological waste, pathological waste, cotton, bandage, surgical mask, plaster of Paris, disposal sheet.

Red bag indicates plastic syringes, IV set, plastic tubes, uro bags, catheter, dialysis, kit gloves, glucose bottle, Ryle’s tube, oxygen mask, and drainage tubes.

Blue bag indicates sharp glass test tubes, glass bottles and glass slides.

Interface

Store keeper

In requirement of materials and performance appraisal of supplier.

Supplier

Procurement of materials

Doctor

Supplier performance appraisal - ONCE IN A YEAR

Purchase Order - ONCE IN A MONTH

OUT PATIENT

Process owner- Doctor/OP IN charge

Activities

OP registration

Consultation

Treatments

Follow up

Once in a month the number of new patients visited compared to previous year of the same month and the increase and decrease is reported to the top management.

OP Feedback – Once in a month

SURGERY

Process owner – Theatre in charge

Activities

Equipment maintenance

Maintenance of medicine

Monitoring of culture test

Preoperative inspection

Sterilization of equipment’s

Once in a year – theatre premises is tested for culture test by outside agencies.

Sterilization report – once in a month.