THE MEDICAL STAFF ORGANIZATION.pptx hm ppt

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1. THE MEDICAL STAFF ORGANIZATION

2. INTRODUCTION In December 1919, The American College of Surgeons adopted the 5 important criteria, for the medical staff organization which became as the MINIMUM STANDARD: The physicians and the surgeons practicing in a hospital should be organized as a definite group of staff which includes the Regular staff, Visiting staff and Associate staff. The membership upon the staffs must be restricted to physicians and surgeons who are Fully graduated in medicine with legal license Competent in their fields Worthy in character and in matters of professional ethics. 3. With the approval of the governing body the staff must adopt the rules and regulations and the policies of the hospital and should Conduct the staff meetings at least once a month The staff review and analyses of their work in regular intervals The accurate and complete records must be written for all patients and filed in an accessible manner in the hospital. 5. The diagnostic and therapeutic facilities must be competent enough to diagnose the patients at least the hospital must contain A clinical laboratory An X-ray department

3. THE MEDICAL STAFF The DOCTORS are the most dominant decision makers in the hospital, they are responsible for the diagnosis and treatment of the patients. They are responsible for the growth of the hospital and the patient care. Medicine is a science, so it is left to the medical professionals only. Nontechnical staffs must not interfere or influence the medical professional. One of the most important objective of the medical staff organization is SELF-GOVERNING . The senior doctor should involve in setting up the code of practice, medically related policies and procedures, treatment protocols, etc. Beyond the medical professionals serving the human needs, they must SELF-SACRIFICE themselves. This profession is not a 9-5 job or shut downing in weekends doesn’t happen, the medical emergencies cannot be postponed to suit the doctor’s convenience and emergency care must be provided irrespective of the patients ability to pay the fees.

4. In hospital practice the doctor doesn’t work in isolation but as a team member. As different doctors are responsible for the patient care during the course of a hospitalization, CONTINUITY OF CARE must be ensured throughout with proper documentation of the patient details in the medical records. As the doctors are exposed to a patient's innermost secret they should maintain the CONFIDENTIALITY. The Medical Council of India published its CODE OF MEDICAL ETHICS which includes general principles/ responsibilities, duties of physicians to their patients, duties of physicians to the profession, professional services of physicians to each other, duties of physician in consultation, duties of physician to the public.

5. OBJECTIVES OF THE MEDICAL STAFF ORGANIZATION To ensure that all the patients admitted to the hospital are treated in OPD/A & E, and receive the best possible care. To initiate periodically review and implement rules and regulations for governance of the staffs. To provide means for the medico-administrative issues are discussed with the hospital administration and governing board. To establish and maintain high professional and ethical standards by means of review, analysis and evaluation of quality of medical care provided. To provide opportunities for in-service education. To develop community health services.

6. NATURE OF THE ORGANIZATION The medical staff organization may be formal/informal depending upon the nature of the hospital. A rigid, formal medical staff structure occurs in a large, specialist, well-reputed, teaching hospital, having full time salaried clinicians. A relatively informal medical staff structure is seen in small, non-teaching hospital where senior clinicians are mostly part-time or visiting.

7. CLINICAL COMMITTESS The structure, function and relationship of committees play an important role in the medical staff organization. The main body that governs the practice of medicine in the hospital is the MEDICAL COMMITTEE. Various other committees include To regulate and monitor the quality of care : Medical bylaws committee Quality assurance committee Infection control committee Pharmacy and therapeutics committee Utilization review committee Blood utilization committee 2. To review various users of a service Medical records committee Theatre users committee Cardio pulmonary resuscitation committee Tumor board Intensive care committee Diagnostic service committee

8. 3. To undertake specific tasks CME committee Disaster management committee Medical planning committee Ethics and research committee CHIEF OF MEDICAL STAFF Mostly known as MEDICAL DIRECTOR OR MEDICAL SUPERINTENDENT. He is a full-time medical administrator or an administrator-cum-clinician. CLINICAL DIRECTORATES A clinical directorate is generally headed by a clinician, perhaps elected for a 3 year term. Assisted by a manager and a nurse administrator and responsible for Management of all medical, nursing and paramedical staff of that directorate and including their recruitment, performance, discipline. The appropriate working of the concerned specialties and level of care provided by the staff Raising of revenue through provision and expansion of services, including marketing and contracting Control of costs through economical use of the resources Decisions related to procurement of equipment's, drugs, surgical devices and medical consumables.

9. SPECIALITY AND SUB-SPECIALITY DEPARTMENTS Major discipline/specialty e.g.. Medicine, surgery, pediatrics, Obstetrics and Gynecology, Laboratory medicine, Anesthesia and Intensive care etc. – distinct clinical entity or a separate department. The number and size of clinical departments depend on: The hospital size/bed complement The quantum of workload (average IP,OP no of major and minor surgeries, working hours per week, frequency of duty Rota, teaching and research commitments etc.) The number of specialties and super/sub-specialties functioning independently in that hospital The number of clinicians required in each specialty proportionate to the workload Statutory requirements or norms prescribed for teaching hospitals (e.g. Medical Council of India, University). Management plans to develop and give importance to particular services.

10. CLINICAL UNITS Considering the nature and quantum of workload, and for better team cooperation, a clinical department may be sub-divided into two or more units. The staffing complement of each unit consists of : No: of OP Sessions per week, no: of op visits per session Its bed strength, bed occupancy, ip admission, bed-turn over interval Type and number of diagnostic and therapeutic procedures. Manpower required to run the on-call/duty Rota which may be 1 in 3 days. Teaching and other commitments. MEDICAL STAFF HIERARCHY For the effective functioning of the medical staff organization the doctors in each department are organized in the hierarchy of consultant, senior registrar, registrar, senior house officer, intern.

11. CONSULTANT Clinicians with 7-10 years postgraduate experience also called as professor/associate professor in teaching hospital The person must report to the department head, and should have all the information about the clinical and administrative matters. He administers and manages staff of the unit, supervises their performance, ensures that they keep him informed of relevant issues. The consultant bears the final responsibility for the care of all the patients treated by the unit whether it is OP or IP. Beyond the working hours the consultant must be accessible at all times and respond promptly when in emergencies Should consult OP admissions and attend inter-departmental references and examines IP. Should ensure the medical records of the patients under his department. He participates in clinical committee, education and research activities of the hospital and carries out other administrative responsibilities too.

12. SENIOR REGISTRAR Clinician with 5-7 years postgraduate experience also called junior consultant or assistant professor. He reports to the head of the clinical unit , through him, to the head of the department. Works under the supervision of the consultant He supervises registrars, senior house officers and interns In case of absence of the consultant, junior consultant is responsible for the clinical unit. Should consult OP admissions and attend inter-departmental references and examines IP at least once a day. Should keep watching the medical records of the patients under his clinical unit. Should prepare and verify medical reports, death reports and medico-legal reports issued by the unit. Should readily accessible to provide telephonic advice and be immediately summoned to the hospital when needed. Should go on evening rounds on all new admissions and critically ill-patients. He coordinates the clinical audit, teaching and research activities of the department. He carries out all other duties as may be assigned to him by the consultant.

13. REGISTRAR Clinician undergoing postgraduate training or with 1-3 years postgraduate experience also called as specialist, lecturer ,senior resident. Reports to his head of the clinical unit and through him to the head of the department. Works under the supervision of consultant and senior registrar. He supervises senior house officers and interns and subordinates of the unit. Generally senior most doctor after the normal working hours and so takes the spot decisions on behalf of his unit and should inform his seniors immediately. Examines all the IP at least once a day and more often when clinically needed, i.e., after surgery or in critical conditions. Verifies and countersigns discharge certificates prepared by the juniors. Prepares medical reports and certificates which require authentication by the seniors. Participates in teaching and research activities of the unit.

14. SENIOR HOUSE OFFICER Clinician with basic medical degree and also called as resident medical officer. Works and reports under his head of the clinical unit and through him to the head of the department . Works under the supervision of consultant and senior registrar and registrar. Supervises the inters and subordinates of the unit. Checks patients and is responsible for initiating and updating the admission record, progress notes, operation notes, discharge summary, leave and death certificates. Follows up on results of investigations requested Follows up on instructions of his seniors with regard to scheduling and preparing patients for diagnostic and therapeutic procedures Prescribes medications to IP and OP in accordance with departmental protocols and instructions from the seniors. Participates in training and research activities of the unit.

15. MEDICAL INTERN Medical student who has completed the final year examination and is undergoing mandatory one year preceptorship. Works for 2-3 months in various departments in accordance with his internship programmer. Since he is under training, he is not allowed to practice independently. He is not authorized to prescribe medicines, issue medical certificates or certify death. He examines and checks IP and OP, writes admission, progress and procedure notes, discharge summaries. He draws blood sample for investigation He follows up on results of investigations requested by the unit. He assists his superiors at diagnostic and therapeutic procedures. Participates in training and research activities of the unit.

16. EMPLOYMENT CATEGORIES OF MEDICAL STAFF Senior house officers, registrars, senior registrars generally are full-time salaried employees of the hospital. The consultants can be Full-time, salaried without private practice and this is common in teaching centers of excellence, some governmental and mission hospitals and industrial hospitals. The consultants can be full time, salaried, with geographically limited private practice at the hospital(in the evening), home or clinics outside the normal working hours of the hospital. The consultants can be full time, part-salaried, partly allowed a percentage cut from the amounts collected from patients in private wards. The consultants can be part-timed, part-salaried, allowed unrestricted private practice. In addition to the nominal salary paid by the hospital, the consultants maybe given a percentage cut on consultations, daily visits and procedures carried out on private patients. Honoraries ( service done without payment ) are now progressively discontinued but also persists in some hospitals in the voluntary sector. Fee for service. The consultant is only on the hospital panel to be called in whenever needed in hospital. Whole or portion of amount is collected from the patient towards consultation and procedures are passed on to the consultant.

17. BYLAWS, RULES, REGULATIONS APPLICABLE TO MEDICAL STAFF The major elements of these bylaws include: APPOINTMENT OF CLINICAL STAFF There must be a procedure to fix and annually review the medical staff positions. The manner of filling the procedure should be specified by: Internal promotion Review of applications on file Special invitations Visiting staff 2. CLINICAL PRIVILEGES To guarantee a high level of patient care there must be periodical examination of the credentials of all the staff members from the senior most to the junior most in each specialty. These privileges only decide whether the doctor can practice independently or under supervision. The clinical privileges cover: OP consultation, inter-departmental references, IP admission, list of common and higher level diagnostic and therapeutic procedures, list of surgeries and other invasive procedures, prescription of select antibiotics and drugs.

18. 3. PERFORMANCE REVIEW Appraisal is generally done by the clinical head of unit and is subjected to review by the head of the department. The quality assurance department may additionally be able to draw up the performance profile according to the workload, utilization indicators, operative results, length of stay, risk management, prescribing practices, revenue generation. 4. SERVICE RULES The rules must detail out the general conditions of employment, retirement age, working hours, holidays, arrangements for on-call, on site availability on duty days, code of behavior, emergency management, disciplinary process, participation in departmental meetings etc..

19. MEDICO-ADMINISTRATIVE POLICIES AND PROCEDURES OP system for booking appointments, referral and back referral, OP procedures. Daycare unit policies and procedures IP admission policies and procedures Emergency treatment irrespective of patients ability to pay Medico – legal formalities ICU and CCU admission and operational policies Policies for cardio-pulmonary resuscitation, certification of brain death, discontinuation of ventilator support Policies relating to trauma resuscitation, multi-organ trauma Inter-departmental referrals for consultation Patient billing policies Patient consent, patient rights Medical records documentation, medical reports, and discharge summaries, retention policy Reporting of critical incidents and risk management issues Reporting of notifiable diseases Equipment and drug trials conducted in hospital

20. CLINICAL PROTOCOLS Hospitals a re centers on team approach and thus there must be continuity of patient care must be reassured irrespective of the physician. In order to ensure such a unified approach each department should write up protocols for: Routine work-up of patients Common diagnostic and operative procedures carried out Management of ailments where treatment regimens are fairly standardized ( eg , asthma, TB, AIDS, HIV, snake bite etc.) Flow charts with specific milestones are developed to ensure compliance, monitor progress and detect divergence. In this manner the treatment goals can be achieved without delaying the length of stay and increasing costs.