que & ans of hospital

8/8/2019 Que & Ans of Hospital

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1. Give the definition of a hospital. What are the drivers that stimulate the growth of

hospitals? Enumerate and explain the various classifications of

hospitals. (2+4+4)

Definition

The hospital is a complex organization utilizing specialized scientific equipments andfunctioning through a team of trained staff educated to the problems of modern medical

science.

All these are coordinated together for the common purpose of restoration and maintenance

of good health.

It is a place where all the resources viz.

A) Services of healthcare professionals

B) Physical facilities and equipments

C) Funds

Are organized together and utilized to fulfill the healthcare needs of the community.Drivers that stimulate growth of Hospitals

Realization of importance of good health by the public at large

Public awareness regarding preventive healthcare

Advances in medical and related biological sciences

Assurance about the quality of care provided by the hospitals that created faith in the minds

of people

Classification of Hospitals

1. Clinical Services

Specialized

Medicine

a. Tuberculosis

b. Internal Medicine

c. Pediatrics

d. Nervous System Diseases

e. Communicable Diseases

Surgery

a. Orthopedic b. Otolaryngology

c. Gynecology

General

Clinical Care

2. Based on Length of Stay:


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Short Term ( Acute) Average length of stay of patients is less than 30 days

Long Term ( Chronic) Average length of stay of patients is more than 30 days

e.g. Psychiatric Conditions

3. Based on Ownership and Control:

Governmental: this includes those hospitals that are owned and or operated by agency ofcentral, state or other political subdivisions of Government

Non-Governmental:

i. Private a. Profit b. Non profit

ii. Community

Government hospitals

iii. Central Govt

i. All India Institute of Medical Sciences

ii. Central Govt Health Scheme Hospitals

iv. State Govti. Civil Hospitals

ii. Cottage Hospitals

iii. Primary Health Centers

v. Others

i. Military Hospitals

ii. Corporation Hospitals

4. Based on Accreditation: In the United States, Hospitals are also classified on the basis of

accreditation procedure which considers the compliance to specified standards of healthcare Accredited Hospitals

Non Accredited Hospitals

5. Based on the Number of Beds / Bed Capacity

Small Hospitals

Up to 50 beds

50 99 beds

100 199 beds

Large Hospitals 200 299 beds

300 399 beds

400 499 beds

500 and over beds


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2. Draw the organizational chart for a corporate hospital. Enumerate the functions of a

hospital. Enumerate the factors which led to the changing role and functions of

hospitals. (2+4+4)

Organizational chart

Functions of the Governing Body

1. To select competent personnel including medical staff

2. To control the hospital funds

3. To supervise the physical plant

4. The governing body in consultation with the chief administrative officer must establish the

following:

5. The working hours and conditions, salary schedules and proper check on personnel

6. Schedule of room rates and other charges for hospital inpatient and ambulatory care

7. Methods for obtaining grants which will supplement income from paying patients and help

to balance the hospital budget


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8. Method of investing the funds from which the interest is to be used for operating hospitals

9. The needs for additional or replacement construction of the physical plant of the hospital

Factors which led to the changing role and functions of the hospital

Expansion of clientele from the dying, destitute, poor and the needy to all classes of people

Improved economic and social status of the community

Control of communicable disease and increase in chronic degenerative diseases

Progress in the means of communication and transportation

Political obligation of the government to provide comprehensive healthcare

Increasing health awareness

Rising standards of living

Control and promotion of quality care by statutory and professional associations

Increase in specialization where need for a team approach to health and disease is now

required

Rapid advances in medical and science technology

Increase in population requiring more number of hospital beds

Sophisticated instrumentation, equipment and better diagnostic and therapeutic tools

Advances in administrative procedures and management techniques

Awareness of the community


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3. Explain the changing concepts of hospitals, from the trusteeship period to the growth

of the corporate sector. What are the recommendations and the plans of the BhoreCommittee.(5+5)

Changing Concepts of Hospitals

Trusteeship period:

1. Minimal advances in technology

2. The period till 1920

3. Professionals not working for money4. Only humanitarian approach

5. Objective of the hospital remained to provide comfort to the patient

Physician period

1. A physician dominated period

2. Hospitals being utilized for medical practice

3. The period from 1940 to 19504. Political and economic environment started influencing the hospitals

Administrative and team periods:

1. Hospital practice became a team approach2. More rapid advances in technology

3. Use of computers

4. Management of hospitals5. Concept of professionally managing the hospitals

Growth of corporate sector: With liberalization, policy of the government all over the

world leads to globalization. The concept of corporatization of the hospital has changedfrom service approach to the profit making approach.

1. Liberalization

2. Globalization3. Corporatization of hospitals4. Service approach to profit making approach

5. Doctor beginning to focus on management principles

6. Focus on productivity

7. Rapid advancements in the field of information technology

8. Medical tourism

9. Telemedicine


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10. Patients can be treated and monitored by remote devices

11. Focus on easing the burden of financing the healthcare

12. Concept of contracting or public-private-partnership

13. The financing of health services through insurance sector

Bhore Committee

Health survey and Planning Committee

Sir Joseph Bhore, 1943

Survey the existing health care organizations and to advice on the development of health

services in the country

It laid the foundations of the infrastructure for the delivery of medical and health care

system in Independent India

Recommendations

1. Provision of adequate preventive, promotive and curative services to all in form of

comprehensive healthcare

2. Delivery of this comprehensive health care through an infrastructure of hospitals,

dispensaries and by opening primary healthcare centers at taluka level

3. Development of adequate communication in rural areas

4. Demarcation of health services in two groups, personal and impersonal

5. Fitting the above concepts in a short term and a long term plan

Short term plan:

1. Province wise organization for preventive and curative healthcare

2. Establishment of a number of primary, secondary and district health units

3. Village and town planning

4. Housing, water supply

5. Drainage and general sanitation

6. Bed: population = 1.03 per 1000 population by 1956

Long term plan:

1. A PHC for every 40,000 population

2. Min. 30 bedded rural hospitals

3. Raising of hospital accommodation to 2 beds per 1000 population

4. Creation of 12 more medical colleges

5. High priority to health development programs

6. Reduction of sickness and mortality among mothers and children


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7. Emphasis on nutrition, health education, school health services, housing, water supply,

industrial health and legislation for environmental health

4. What are the objectives, constitution and the composition of the Indian Nursing Council

Act?

Objectives

An Act to constitute an Indian Nursing Council

To lay down the educational standards and requirements for the registration of nurses

To constitute an Indian Nursing Council in order to establish a uniform standard of:

(1) Training for nurses

(2) Midwives

(3) Health visitors

It extends to the whole of India except the State of Jammu and Kashmi

Constitution and composition of the Council

One nurse enrolled in a State register elected by each State Council

Two members elected from among themselves by the heads of institutions recognized by

the Council for the purpose of this clause in which training is given

One member elected from among themselves by the heads of institutions in which health

visitors are trained

One member elected by the Medical Council of India

One member elected by the Central Council of the Indian Medical Association

One member elected by the Council of the Trained Nurses Association of India

One midwife or auxiliary nurse-midwife enrolled in a State register, elected by each of the

State Councils in the four groups of States mentioned below, each group of States being

taken in rotation in the following order, namely:

(i) Kerala, Madhya Pradesh, Uttar Pradesh and Haryana

(ii)Andhra Pradesh, Bihar, Maharashtra and Rajasthan,


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(iii)Karnataka, Punjab, Himachal Pradesh and West Bengal,

(iv) Assam, Gujarat, Tamil Nadu and Orissa

Four members nominated by the Central Government, of whom at least two shall be nurses,

midwives or health visitors enrolled in a State register and one shall be an experiencededucationalist

Three members elected by Parliament, two by the House of the People from among its

members and the other by the Council of States from among its members.

What are the objectives of the Transplantation of Human Organs Act and under what

circumstances can the doctors remove the organs from the donors? (5+5)

Objectives of the Transplantation of Human Organs Act

An Act to provide for the regulation of removal, storage and transplantation of humanorgans for therapeutic purposes

For the prevention of commercial dealings in human organs

Authority for removal of Human Organs

Any donor may authorize the removal before his death for therapeutic purposes

If any donor had, in writing and in the presence of two or more witnesses (at least one of

whom is a near relative of such person), authorized at any time before his death for

therapeutic purposes

An application was made by any person before his death and also no objection was also

expressed by such person to any of his human organs being used after his death for

therapeutic purposes

Provided such a removal is made by a registered medical practitioner only

5. Define medical records. Enumerate the purpose and the uses of medical records. What are

the contents of medical records? (2+6+2)

Definition:

Medical record is a clinical, scientific administrative and legal document relating to patient care

in which is recorded sufficient data, written in sequence of events to justify the diagnosis and

warrant the treatment and end results

- Dr. J. R. Gibony


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Importance of Medical Records

The quality of medical records is a direct reflection of the quality of medical practice. To

achieve and maintain a high standard of medical practice, proper medical documentation

is essential

all doctors have a responsibility to maintain clear, accurate, adequate and

contemporaneous medical records of their patients. Systematic record keeping helps in

ensuring patients problems are followed and properly looked after

- Section 1.1.2 of the Medical Council Code of Conduct

Purpose and Uses of Medical Records

In addition, the medical record may serve as a document to educate medical

students/resident physicians.

to provide data for internal hospital auditing and quality assurance, and to provide data for

medical research.

Personal health records combine many of the above features with portability, thus allowing

a patient to share medical records across providers and health care systems.

The primary purpose is to be readily available at all times for the care and treatment of the

patient.

Provide the means of communication between the physician and other health care

professional contributing to patient care.

Serve as a basis for planning individual patient care.

Furnish documentary evidence of the course of the patient illness and treatment during each

hospital admission and treatment visit.

Serve as a basis for analysis, study and evaluation of the quality of care rendered to the

patient.

Assist in protecting the legal interest of the patient, hospital and physician.

Provide clinical data for the use of research and education.


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Provide information to third party payer.

To the provider hospital

Evaluating the competencies of medical, nursing and ancillary staff (quality assurance).

Justifying the result of treatment

Medico legal purpose

Defense in malpractice suit

Basis for preparing operating budget

Administrative control over functional activities

Statistical data to assist in controlling bed allocation

Infection, mortality and length of stay

Planning for additional facilities, staff and equipment as well as improving medical

education and patient care

National health agencies

(ICMR, MOH)

Allocate budget, staff and equipment

Plan and construct hospital and health center in required location

Determine the types of health services required

Monitor all hospital and health care institution

Exchange expertise from other nations

Collaborate with international service organization

Develop medical and allied health education

International health agencies

(WHO, Red Cross, Medicine Sans Frontiers)

Responsible for assisting and guiding nations

Control infectious disease and epidemics


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Provide assistance to needy nation and accepting assistance from countries have surpluses

Exchange experts and specialist

Send medical supplies and other items to needy nation

Need reliable information from all countries to achieve global healthier living

To the third party payers

To reimburse the claim made, mainly used in case of

Insurance cases

Works man compensation

Will cases

Income tax

To the accreditation agencies

To evaluate the quality of care, services rendered to the patient.

To found out the result of care given

CONTENTS OF MEDICAL RECORD

Consultation report

Progress notes

ECG report

EEG report

Radiology report

Anesthesia report and record

Operation report

Nurse records

Admission and Discharge record

Discharge summary


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Lab reports

Short stay records

Doctors order

Graphic (TPR chart)

6. Define medical negligence. What are the constituents of negligence? What is medical

negligence under the criminal law? What is medical negligence under the civil law?

(2+2+3+3)

Negligence

Negligence may be defined as breach of duty caused by the omission to do somethingwhich a reasonable man, guided by those considerations which ordinarily regulate the

conduct of human affairs would do.

Or doing something which a prudent reasonable man would not do, actionable negligence

consists in the neglect of the use of ordinary care or observing ordinary care and skill

toward a person to whom the defendant owes a duty of observing ordinary care and skill.

Constituents of Negligence

1. A legal duty to exercise due care on the part of the party complained of towards the party

complaining the formers conduct within the scope of duty2. Breach of the same duty

3. Consequential damages

Medical Negligence under Criminal Law

Culpable homicide if a patient dies from the effects of:

Anesthesia

An operation

Any kind of treatment

If it may be proved but the death was the result of gross negligence

A person cannot be accused of an offence if she/ he performs an act in good faith for the

others benefit

Does not intend to cause harm even if there is a risk

The patient has explicitly or implicitly given consent

Doctors must not in any way suffer their negligence


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The patient of medical negligence are still suffering and they need additional protection

Especially the patients of government hospitals

Consumer laws may be a great help provided the consumers must be aware of their rights

Investigation is another area where the interest of the patient is sacrificed to the greed of

the care giver Headache is one such common symptom

Medical Negligence under Civil Law

An action for damages in the civil court

Complainant has suffered an injury in consequence of negligence or unskilled treatment

Liability of medical attendant not decreased by the fact that he treated the patient

graciously in a charitable hospital The amount of damage inflicted is a measure of the extent of liability.

The suit for negligence must be filed in a civil court within three years from the date of

alleged negligence

Persons who enters the medical profession undertakes to use reasonable degree of skill,

care, knowledge and prudence in the treatment of his patient to the best of his judgment

He is not liable for error of judgment or of diagnosis

Implied undertaking on the part of the medical professional

Every doctor has a duty to act with a reasonable degree of care and skill.

- State of Haryana vs. Smt Santra

7. What are the rights of a mentally ill person? What do you mean by primary health care

services? (5+5)

Rights of a Mentally Ill Person

The necessity of providing help to mentally retarded persons in order to enable them to

develop their abilities and promoting their integration in the normal life - Declaration on

the Rights of a Mentally Retarded Person, 1971

The Declaration provides a framework within which national and international actions

should be initiated for the advancement of rights set forth in the Declaration

Maximum degree of feasibility

Right to proper medical care and physical therapy and to such education, training,

rehabilitation and guidance


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Right to develop his ability to maximum potential

Right to economic security and to a decent standard of living

Right to participate in different forms of community life

Right to a qualified guardian

Right to protect his personal well being and interests Disabled persons are entitled to have their special need taken into consideration at all stage

of economic and social planning

Right to participate in all social, creative or recreational activities

Right against all exploitation, and treatment of a discriminatory, abusive or degrading

nature

Right to avail themselves of qualified legal aid when such aid proves indispensable for the

protection of their person and property

Right to better and more accessible care

Right to good recovery and

Right to increased hopes of reintegration into society

Primary care servicesshould include at least the following:

General practitioner/family physician services for personal health care.

First level referral hospital care and basic specialty services (general medicine, general

surgery, obstetrics and gynecology, pediatrics and orthopedic), including dental and

ophthalmic services.

Immunization services against all vaccine preventable diseases.

Maternity and reproductive health services for safe pregnancy, safe abortion, delivery and

postnatal care and safe contraception.

Pharmaceutical services - supply of only rational and essential drugs as per accepted

standards.


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Epidemiological services including laboratory services, surveillance and control of major

diseases with the aid of continuous surveys, information management and public health

measures.

8. What is informed consent? What are the components of informed consent? What are

implied and written consents? Explain the right to refuse treatment.

(2+3+2+3)

What is Informed Consent

Definition - Doctors will give information about a particular treatment or test in order for

the patient to decide whether or not they wish to undergo such treatment or test. This

process of understanding the risks and benefits of treatment is known as informed consent.

Based on moral and legal premises of patient autonomy The patients have the right to make decisions about their health and medical conditions.

A patient must give your voluntary, informed consent for treatment and for most medical

tests and procedures.

Components of Informed Consent

The patient must have the capacity (or ability) to make the decision.

The medical provider must disclose information on the treatment, test, or procedure in

question, including the expected benefits and risks, and the likelihood (or probability) that

the benefits and risks will occur.

The patient must comprehend the relevant information.

The patient must voluntarily grant consent, without coercion or duress.


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Written Consent

Contains:

An explanation of the medical condition that warrants the test, procedure, or

treatment

An explanation of the purpose and benefits of the proposed test, procedure, or

treatment

An explanation or description of the proposed test, procedure, or treatment,

including possible complications or adverse events

A description of alternative treatments, procedures, or tests, if any, and their relative

benefits and risks

A discussion of the consequences of not accepting the test, procedure, or treatment

The consent form should be signed and dated both by the doctor and the patient.

The patient may ask for a copy of the signed consent form.

Right to Refuse Treatment

Legal and moral right

True even in case of a bad decision

Against Medical Advice form

The next best treatment should always be offered to anyone who refuses the recommended

care

Following categories of patients cannot refuse treatment:

1. Intoxication

2. Injury

3. Illness

4. Emotional stress

5. Other reason

9. What is therapeutic privilege? Explain its nature and limitations. Describe the six

instances where disclosure is restricted.

(2+4+4)

A Possible exception to the law of Informed Consent

One possible exception to the notion that disclosure is necessary for capable patients is

termed the therapeutic privilege.

Therapeutic Previlage provides a way around the requirement that capable patients ought

to have full disclosure in order to be able to fully and voluntarily consent to treatment.


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At times, information regarding a procedure or regarding the patients condition is in fact

considered to be a potential danger to the patients well being.

With this exception to the disclosure requirement it is thought that doctors can avoid

conflict with the most fundamental portion of the Hippocratic Oath: do no harm.

In order to protect the patient, some clinicians think it best to withhold or generalize certain

disturbing information thought to pose an actual threat to the patient.

The Therapeutic Privilege: Its Nature and Its Limitations

The therapeutic privilege is an exception to the general requirement of informed consent.

If a physician feels that disclosure of certain information will lead to the harm or suffering

of the patient, she or he is said to be free to withhold this information.

Information can be withheld if it is counter therapeutic, dysfunctional, or distorting for theparticular patient in question.

This doctrine is traced back to the American case ofCanterbury v. Spence, where it is

declaredthat if information is menacing to a patient, it need not be disclosed.

The exception is raised where a direct conflictarises between the doctors medico-

ethical duty to health and his legal-ethical duty to inform.

This is based on the assumption that the physician cares not only for the patients

physiological health but for his psychological and moral well-being as well.

It may be the case that a particular patient may, because of emotional factors, be unable to

cope with facts relevant to recommend surgery or treatment and the doctor may, in such a

case, be justified in withholding or generalizing information as to which he would

otherwise be required to be more specific.

(1) A custodian may refuse to disclose health information to an applicant:

if the disclosure could reasonably be expected, to result in immediate and grave harm to the

applicants mental or physical health or safety.

It is not clear how severe the imagined effect on the patient must be in order to withhold

information.

The Canterbury decision indicates that the impact of the information must be that it would

impede rational decision-making.


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4. Criterion based audit involves agreeing explicit and measurable criteria of good practice

for selecting cases and for comparing what is done against them. Thus, it is possible to

compare health care performance between different units.

Clinical Audits

Recognizing the review activities which professionals already undertake and make them

more systematic

Ensuring that proposals for improvements are derived from these reviews

Ensuring that improvements are implemented and evaluated

Benefits

Clinical Audits:

1. Internal retrospective audit is not commonly used

2. Does not require implementation

3. Is compulsory in all hospitals

4. Does not require additional time for clinicians

5. Results in savings for the organization

11. What is inquest? Explain the scope and object of the inquest proceeding under criminal

procedure code. Explain any two types of inquests. (2+4+4)

DEFINITION

The term Inquest means (quasistus i.e., referred as to seek); legal or judicial inquiry to

ascertain a matter of fact.

In broad terms, it can be understood as inquest that implies to inquiry about the cause of

death, which is apparently not due to natural causes.

Such an inquiry and investigation of sudden, suspicious, or unnatural death is obviously

necessary to apprehend and punish the offender.

Inquest under Code of Criminal Procedure

An inquest report or panchnama, is a report in which the available history of the case

and circumstances under which the body was found or recovered are recorded.

This recorded opinion of the witnesses and the police officers, regarding the injuries,

manner of their causation, the cause of death, and indication of suspected foul play, if any.


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Scope and object of Inquest proceedings under India Criminal Procedure Code

(i)Whether a person has died under unnatural circumstances or an unnatural death and if

so, what the cause of death?

(ii), where the questions regarding the details as to how the deceased was assaulted?

(iii) Who assaulted him?

(iv)What circumstances he was assaulted is foreign to the ambit of scope of the proceedings

under sec. 174 of the Code?

Three Types of Inquests

Coroners Inquest

Police Inquest

Magistrate Inquest

CORONERS INQUEST

Coroners INQUEST and the reforms under Indian Legal System

The term coroner was originated from Common Legal System, its also known as crown,

or (corona curia regis or custodes placitorum coronae) i.e., a forensic examiner who is

responsible for examining any suspicious or unnatural death.

He is the person appointed by the State Govt. to inquire into causes of all unnatural or

suspicious deaths.

Coroners inquest in India and their Functions:

(1) He is empowered to inquire into causes of all unnatural or suspicious deaths and also deaths

occurring in jails within his jurisdiction. He can commit any suspected person or accused to stand a

trial before a magistrate.

(2) He can view a dead body to decide whether or not an autopsy is required and, if necessary, holdan inquiry on it with the help of a jury.

(3) He can order the exhumation of a body for identification or for medico legal examination.

(4) He is authorised to order any registered medical practitioner (usually the Police Surgeon) to

hold a postmortem examination and summon him as well as other persons as expert witnesses to

give evidence in his court.


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(5) He can appoint a deputy coroner during his sickness or absence due to unavoidable

circumstances.

POLICE INQUEST

Brief Concept To Police Inquest

The inquest is held by a Police Officer (called Investigating Officer) not below the rank of

Senior Head Constable is known as police inquest.

When Inquest Report shall be prepared?

Police are empowered in the following causes:

1. A person has committed suicide

2. A person has been killed by another person

3. A person has been killed by an animal

4. A person has been killed by machinery

5. A person has been killed in an accident

6. A person has died in suspicious circumstances

MAGISTRATE INQUEST

Magistrates inquest means an inquiry conducted by a magistrate to ascertain matters of

fact.

It is commonly held in the following cases:

1. Admission of a mentally ill person in a psychiatric hospital or a psychiatric nursing home

under certain provisions of the Mental Health Act, 1987

2. Death of a convict in jail

3. Death of a person in police custody or during police interrogation

4. Death as a result of police shooting killing

5. Exhumation cases and Dowry deaths under section Sec 176 Criminal Procedure Code,

1973.

Magistrates Court are generally a court of trial were accused are present during trial, the court can

impose fine and/or punishment or can punish those guilty of contempt of his court when the

offence is committed in or outside his courts premises.


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Purpose behind Magistrate Inquest

(1) No person is unjustly deprived of his liberty and his rights as a citizen

(2) No person who is deprived of his liberty can die as a result of neglect or brutality by the people

in whose charge he is

(3) In case of a person who is already buried, if there is any doubt as regards identity, cause of

death, or manner of death, it will be settled by a judicial inquest and not a police inquest.

(4) Due to peculiar circumstances associated with dowry death, it should be investigated by a

magistrate.

12. What are industrial disputes? What are the causes of industrial disputes? What are the

dispute resolution machineries in India? (2+4+4)

What are Industrial Disputes?

Industrial Dispute means any dispute or differences between employers and employers or

between employers and workmen or between workmen and workmen which is connected

with the employment or non-employment or the terms of employment or with the

conditions of labor of any person.

These are :

Wages, including the period and mode of payment

Compensatory and other allowances

Hours of work and rest intervals

Leave with wages and holidays

Bonus, profit sharing, provident fund and gratuity;

Shift working otherwise than in accordance with standing orders

Classification by grades

Rules of discipline


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Rationalization

Retrenchment of workmen and closure of establishment

Any other matter that may be prescribed.

Who can raise an Industrial Dispute?

Any person who is a workman employed in an industry can raise an industrial dispute.

A workman includes any person (including an apprentice) employed in an industry to do

manual, unskilled, skilled, technical, operational, clerical or supervisory work for hire or

reward.

It excludes those employed in managerial or administrative capacity.

Industry means any business, trade, undertaking, manufacture and includes any service,

employment, handicraft, or industrial occupation or avocation of workmen.

Causes for ID.

The causes of industrial disputes can be broadly classified into two categories:

Economic causes: The economic causes will include issues relating to compensation like

wages, bonus, allowances, and conditions for work, working hours, leave and holidays

without pay, unjust layoffs and retrenchments.

Non-economic causes: The non economic factors will include victimization of workers, ill

treatment by staff members, sympathetic strikes, political factors, indiscipline etc.

Dispute resolution machinery in India

1. works committee

2. conciliation officer

3. board of conciliation

4. court of enquiry

5. Labor court

6. Industrial tribunal

7. National tribunal


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13. Differentiate strikes and lock outs. Differentiate lay-off and retrenchment.

(5+5)

Does the workman have the Right to go on strike with proper notice in Public Utility Services?

No person employed in a Public Utility Service can go on strike without giving to theemployer notice of strike;

Within 6 weeks before striking.

Within 14 days of giving such notice.

Before the expiry of the date of strike specified in such notice.

During the pendency of any conciliation proceedings before a Conciliation Officer and 7

days after the conclusion of such proceedings.

Does the Employer have the right to lock out any Public Utility Service?

No employer carrying on any Public Utility service can lockout any of his workman :

Without giving to them notice of lockout provided within 6 weeks before locking out.

Within 14 days of giving such notice.

Before expiry of the date of lockout specified in any such notice.

During the pendency of any conciliation proceedings before a Conciliation Officer and 7

days after the conclusion of such proceedings.

Lay off (Chpt. VA & VB)

Section 2 (KK) of the Act defines lay off as the failure, refusal or inability of an

employer on account of shortage of coal & power or raw material or the accumulation of

stocks or the breakdown of machinery or for any other reason to give employment to a

workmen whose name is borne on the muster roll of his industrial establishment & who has

not been retrenched.

In Industrial undertaking where lay off provisions apply, only those workmen will beentitled to lay off compensation.

A workman is entitled for compensation for all days of lay off unless there is an

agreement to the contrary between him & the employer to the limit of 45 days in a year.


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Retrenchment (Chpt. VA & VB)

Sec. 2 (oo) defines Retrenchment as the termination by the employer of the service of the

workman for any reason whatsoever, otherwise than a punishment inflicted by way ofdisciplinary action.

Retrenchment does not include voluntary retirement superannuation, termination of

employment on grounds of ill health; do not amount to retrenchment.

No workmen who has been employed for 1 year can be retrenched until:

1 month notice in written & reason for retrenchment.

15 days average pay for every completed year of service.

Notice served to the appropriate government.

I. Compensation shall be equivalent to 15 days average pay for every completed years of

continuous service or any part thereof in excess of 6 months

II. Notice shall be given to appropriate government or such authority & the permission of such

government or authority is obtained.

III. Government or authority after making inquiry may grant or refuse the permission to the

employer within 3 mths. Of the date of service of the notice.

I. if it does not communicate within 3 mths. Of such notice then the retrenchment

legal.

II. if it does refuse the permission then the retrenchment is illegal.

14. Explain the Hospital Organizing and control activities, with relevant examples. Explain

any five. (10, 2marks each)

The organization implies formalized intentional structure of roles and position.

The function of the manager in designing and maintaining the systems of roles is called

organizing.

Organizing involves:

1. Identification of the activities

2. Grouping of similar activities

3. Assignment of authority and responsibility to each group

4. Provision for coordination


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5. Types of organizations

6. Centralization and decentralization

7. Authority and power

8. Organizational development

Identification of the activities

Activities to be performed in a hospital:

1. The admission procedure

2. The consultation procedure

3. The treatment procedure

The activities identified may be:

1. Registration of patients

2. Consultation with the consultants

3. Clinical examination of the cases4. Investigations

5. Minor surgical procedures

6. Dispensing of drugs etc

Grouping of similar activities

To group similar activities into one group

In hospitals, there are several activities, and some of them even though appear different

nature, have some kind of similarity and these can be grouped into one category for

convenience. OPDs

IPDs

ICUs

OTs

CSSDs

Assignment of authority or responsibility to each group

Unless the requisite authority is vested with the heads of the departments, the departments

will not be able to plan and control the activities within the groups

This is also essential to demarcate clear line of authority and reporting relationship in thegroup

Provision for Co-ordination

Vertical where there is clear reporting relationship

Horizontal to coordinate with the different units or the departments at the same level and

in the same organization


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The organizational structure is designed to clarify:

1. Who is to do what task

2. Who is responsible for what results

3. Remove uncertainty in the organization

Types of Organizations1. Formal Organizations:

It is an intentional structure of roles in formally organized institution like hospitals.

The relationship of the people in the organization is intentionally created for the

achievement of the organizations objectives.

2. Informal Organizations:

Any joint personal activity without personal conscious joint purpose even though

contributing to the joint results.

Eg. People joining tea clubs in the organization

Span of control How many subordinates a superior can manage:

Rule of thumb: six at the top and twenty at the bottom

The factors responsible for determining an effective span of control are:

1. Subordinates training

2. Clarity of delegation of authority

3. Use of objectives standards

4. Clarity of plans

5. Rate of change

6. Communication techniques7. Amount of personal contact

8. Training of the manager

Centralization and Decentralization

Centralization tends to concentrate decision making at the top level of management

Decentralization disperses decision making and authority throughout and further down the

organizational hierarchy

The size of the organization is also a key factor in determining the extent of centralization

and decentralization

As the scope and amount of work for managers increases, the trend is towardsdecentralization.

Authority and Power

Power can be defined as the ability of the individuals or groups to induce or influence the

beliefs or actions of other person or group

The authority is the right in a position to exercise discretion in making the decisions

affecting others


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The bases of powers are:

1. Legitimate power

2. Expert power

3. Referent power

4. Coercive powerLine and staff authority

Line functions are those that have direct impact on the accomplishment of the objectives of

the organizations

The doctors are the line managers or line functions of the hospitals

The doctors are responsible for the accomplishment of the objectives of rendering medical

care to the patients

The staff functions are those functions of the organization that helps the line managers or

line persons work most effectively in the organizations

The finance department people in the hospital are the staff functions or staff people in thehospitals

15. What is tort? Explain the difference and the resemblance between crime and tort.

(2+4+4)

TORT

The term tort is the French equivalent of the English word wrong and of the Roman law

term delict.

The word tort is derived from the Latin word tortum which means twisted or crooked or

wrong and is in contrast to the word rectum which means straight.

Everyone is expected to behave in a straightforward manner and when one deviates from

this straight path into crooked ways he has committed a tort.

Hence tort is a conduct which is twisted or crooked and not straight.

As a technical term of English law, tort has acquired a special meaning as a species of civilinjury or wrong.

Tort now means a breach of some duty independent of contract giving rise to a civil cause

of action and for which compensation is recoverable.

In spite of various attempts an entirely satisfactory definition of tort still awaits its master.

In general terms, a tort may be defined as a civil wrong independent of contract for which

the appropriate remedy is an action for unliquidated damages.


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Difference between crime and tort

Tort is an infringement or privation of private or civil rights belonging to individuals,

whereas crime is a breach of public rights and duties which affect the whole community.

# in tort the wrong doer has to compensate the injured party whereas in crime, he is punished by

the state in the interest of the society.

# in tort the action is brought about by the injured party whereas in crime the proceedings are

conducted in the name of the state.

# in tort damages are paid for compensating the injured and in crime it is paid out of the fine which

is paid as a part of punishment. Thus the primary purpose of awarding compensation in a criminal

prosecution is punitive rather than compensatory.

# the damages in tort are unliquidated and in crime they are liquidated.

Resemblance between crime and tort

There is however a similarity between tort and crime at a primary level.

In criminal law the primary duty, not to commit an offence, for example murder, like any

primary duty in tort is imposed by law.

The same set of circumstances will in fact, from one point of view, constitute a crime and,

from another point of view, a tort.

For example every man has the right that his bodily safety shall be respected.

Hence in an assault, the sufferer is entitled to get damages. Also, the act of assault is a

menace to the society and hence will be punished by the state.

However where the same wrong is both a crime and a tort its two aspects are not identical.

Firstly, its definition as a crime and a tort may differ and secondly, the defenses available

for both crime and tort may differ.

16. Explain any five management techniques implemented in hospitals in brief: Operations

research, EOQ, ABC Analysis, MBO, Decision Tree, and Current Realty Tree. (2 M each)

17.Define trade unions. Explain the objectives and types of trade unions. Explain whyworkers join trade unions?

(2+4+4)

Any combination, whether temporary or permanent, formed primarily for the purpose of

regulating the relations between workers and employers, or for imposing restrictive condition on the

conduct of any trade or business

- (Under the trade union act 1926)

Objectives Of Trade Unions

Wages & Salaries

Working Conditions


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Discipline

Fight against malpractices in personnel policies

Welfare of workers

Employee-employer relations

Negotiating Machineries

Types Of Union Structure

Craft Union- Horizontal in character.

- Members from single group. Skilled workers- Strong bargaining power.

Industrial Union

- Vertical in character.

-Members from same Ind. Or Comp. but different jobs. Mix of skilled &unskilled workers

- Strong Bargaining power.

General Union

- Vertical in character.

- Members from different Ind. & crafts. Mix of skilled & unskilled workers.

- Weak bargaining power.

Federations

- National body to which craft union, industrial union & general unions are affiliated

Why Do Workers Join Trade Unions

Self - fulfilment and Development:

Train and develop members. Provide literacy skills to members.

Political Reasons: Put pressure on repressive governments.

Influence labour legislation. Influence government policy on wealth distribution and poverty alleviation.

18. What is collective bargaining? What are the features, and types of collective

bargaining?(2+4+4)


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Collective Bargaining Intro.

Collective bargaining is a procedure by which the terms and conditions of workers are

regulated by agreements between their bargaining agents and employers.

Collective Bargaining Features

Collective

Strength

Flexible

Voluntary

Continuous

Dynamic

Power relationship

Representation

Bipartite process

Objectives Of Collective Bargaining

To settle conflicts/disputes for wages and working conditions

To protect interests of workers.

To resolve differences between workers and management.

To avoid third party intervention in matters relating to employment.

Types Of Collective Bargaining

Conjunctive bargaining

Cooperative bargaining

Productivity bargaining

Composite bargaining

Process Of Collective Bargaining

Identification of the problem.

Collection of data.

Selections of negotiators.

Climate of negotiations.

Bargaining strategy and tactics

Formalizing the agreement.


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Enforcing the agreement.

20. Enumerate the responsibilities of a Hospital Administrator. (10)

Business Aspects

Hospitals are now run like small- or medium-sized businesses and involve all conventional

business operations, practices and procedures.

A hospital administrator has to manage the business side of the hospital to ensure smooth

running of the hospital on all fronts.

The business aspects encompass management of human resources and personnel,establishing policies and procedures, maintaining of computer systems and databases,

allocation of budgets, tracking accounts and finance, and other organizational systems.

He or she coordinates with professionals, staff members and other employees and assignstheir duties and tasks.

Address Doctors' NeedsA hospital administrator has to interact, engage and coordinate with doctors, physicians,surgeons, nurses, health care technicians, other medical staff members and health care

professionals involved with the primary care, treatment and rehabilitation of patients.

A hospital administrator has to draw up schedules for resident doctors and allied medical

staff, address their specific needs and ensure that they are able to perform their primaryduties of looking after patients, professionally and ethically.

A hospital administrator also coordinates with external specialists and consultants in case

of emergencies and specialized operations.

Patients' Medical Care and Well-Being

The care and treatment of patients in the hospital is a major responsibility of the hospital

administrator. He or she has to ensure the availability and deliverability of quality facilities

and amenities for all patients.

The administrator has to motivate the medical teams and allied staff members to perform

their roles, tasks and functions to the best of their abilities to make the patients feel

comfortable at all times.

He or she takes rounds of all rooms and centers where patients are housed or recuperatingand, if necessary, makes quick, informed decisions to alleviate or improve patient care.

Liaise with External Vendors

A hospital administrator has to liaise with vendors, contractors, insurance firms, suppliers

and other partners on a regular basis.


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Keeping the hospital stocked with drugs, medicines, food items, hospital equipment,

systems, allied hospital gadgets and machinery is a priority item.

This is a critical responsibility so as to ensure that the primary and tertiary care of patientsand the specialized needs of doctors and surgeons are not compromised.

The administrator has to have sound negotiation skills to draw up the right contracts,

follow-up on orders and maximize purchasing power with vendors and suppliers.

Other Responsibilities

A hospital administrator interacts with a governing board or trustees or other owner-

management professionals of the hospital to undertake review of policies and frameworks.

Experienced administrators also train trainee doctors, newly inducted nurses and assistant

staff and other assistant administrators.

Depending on budget allocation and resources, the hospital administrator establishesprograms for medical research, preventive medicine and community welfare.

He or she is also involved in various public awareness health care campaigns and socialadvocacy activities.

The administrator attends fundraising events, local health council meetings and

professional industry conferences.

que & ans of hospital

Documents