1. The purpose of an organization structure 2. The meaning of "organizing" and "organization."

1. LEARNING OBJECTIVES 1. The purpose of an organization structure 2. The meaning of "organizing" and "organization." 3. The distinction between formal and informal organization. 4. How organization structures and their levels are due to the limitations of the span of management. 5. The exact number of people a manager can effectively supervise depends on a number of underlying variables and situations. 6. The nature of entrepreneuring and intrapreneuring. 7. The key aspects and limitations of reengineering. 8. The logic of organizing and its relationship to other managerial functions. 9. That organizing requires taking situations into account.

2. OrganizingA basic process of combining / integrating Human / Physical / Financial resources in productive interrelationship for the achievement of enterprise objectives

3. Definition of Organization Organization implies a formalized intentional structure of roles or positions Effort Pooling towards designated objectives through definition / division of activities / responsibilities / authority

4. identification and classification of required activities Organizing involves Departmentation Manageable units Maximum possible specialization grouping of activities necessary to attain objectives Delegation Aptitude / Attitude Job Requirement / Capabilities Assigning responsibility with necessary authority To a manager for each grouping Synchronization Interrelationship between different positions must be clearly defined From whom ? To whom ? Coordination in organizational Structure Vertically, Horizontally

5. Organizational Structure Design Who Give what Is to do Results What Fitting various activities Smoothly Efficiently Effectively

6. intentional structure of roles in a formally organized enterprise Well defined jobs Should not be flexible Formal organization Definite authority / responsibility Channeled individual and group efforts

7. Any joint personal activity without conscious joint effort even through contributing towards Joint Results Loosely organized Structure (membership), communication networks (“grapevine”), and relationships behaviors and norms) do not necessarily follow those of the formal organization. Informal organization A network of personal / social relationships, not established, required by FORMAL organization but arising spontaneously flexible ill defined Spontaneous

8. What is a Department? The department designates a distinct area, division, or branch of an organization over which a manager has Authority for the performance of specified activities

9. Organization Level and Span of Management

10. Levels = 4 Span of Control = 3 Total Employees = 40 Organization with Narrow Span Variety of non-recurrent problems, involving non-programmed strategic decisions • Disadvantages • Too much involvement in subordinate’s work • Many levels / higher cost • Excessive distance between top and lowest level • Advantages • Close supervision • Close control • Fast communication between levels

11. Levels = 3 Span of Control = 7 Total Employees = 57 Organization with wide span For Recurrent, repetitive and routine problems • Disadvantages • Overloaded superior / decisional bottleneck • Superior’s loss of control • Requires exceptional quality managers • Advantages • Superiors are forced to delegate • Clear policies are required • Subordinates must be carefully selected

12. Principle of the Span of Management The principle of the span of management states that there is a limit to the number of subordinates a manager can effectively supervise, but the exact number will depend on the impact of underlying factors

13. Operational-management position: a situational approach Classical theory: No. of subordinates:3-8 Operational management theory: No. depends of many underlying factors: • What to supervise: complexity and variety of the subordinate’s work • Which tools are used • Quality of manager and subordinate • Degree of interaction

14. Difference Between an Intrapreneur and an Entrepreneur • An intrapreneur is a person who focuses on innovation and creativity and who transforms a dream or an idea into a profitable venture by operating within the organizational environment • The entrepreneur is a person who does similar things as the intrapreneur, but outside the organizational setting

15. Definition of Reengineering • "...the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical contemporary measures of performance, such as cost, quality, service, and speed.“

16. Key Aspects of Reengineering Fundamental rethinking of what the organization is doing and why. Radical redesign of the business processes Reengineering calls for dramatic results The need for carefully analyzing and questioning business processes

17. Nurses form a very important group - the largest single technical group - of personnel engaged in patient care in hospitals next to doctors, consuming approximately one-third of hospital costs. because….

18. Nursing care is required for the prevention of disease and for promotion of health. • The nursing care of sick patients - a. in the interest of his or her mental and physical comfort. b. by reason of the disease from which he or she is suffering.

19. Functions of nursing services are: • Clinical • Technical • Caring relationship • Administrative • Educational

20. It is observed that 50% or more of her time will be spent on non-nursing functions like • Clerical • Answering telephones • Supervise indent of drugs • House keeping, etc

21. staffing The number of nurses required to man the nursing services in a hospital depends on many factors, • Number of beds in a hospital • The type of hospital and the prevailing medical practice, including kinds of treatment and medications given and tests and services required for the patients. • Pattern of assignment of nurses - based on functional method, case method or teach method. • The type and the number of emergency cases coming into the hospital. • Available labour - saving devices, automation, mechanization, centralization • Level of competence based on - qualification, experience, efficiency and sincerity.

22. Work allocation Patterns of assignment: the tasks of the nursing unit are carried out by 3 accepted patterns of assignment, depending on the training, experience and the rules of a particular institution. • Functional method: The tasks are divided among the staff. • Case method: Each nurse is assigned one or more cases. • Team method : Under this system the nursing staff is divided into teams each of which is guided by an experienced nurse. The team leader is responsible to the ward sister and she organizes the nursing care for her group of patients. • Group Assignment method: one nurse is assigned to a group of patient to provide total nursing care. • Primary nursing method: the primary nurse assumes 24-hour accountability for the care, planning and evaluation. When on duty on a shift, the primary nurse herself assumes responsibility for providing total care. Other functions of primary nurse is the coordination of nursing activities with physician and other health professionals.

23. Physical dependency of patients This is an important factor in assessing the workload. The patients can be classified under the following headings: • Totally ambulant • Partially bedfast • Bedfast but not helpless • Partially helpless • Totally helpless

24. Indices of hospital nurses The nursing time provided per patient per day is the most useful and realistic index, since it takes into account Occupancy rates, working hours, and days absent from work.

25. To find out the average number of working days per year by a nurse: Earned leave 30 days Sick leave 10 days Casual leave 14 days Weekly off 85 days Non-working days 139 days Total working days in year 365 days Therefore total working days is 226 days

26. To find out the average number of hours worked per year by a nurse Average number of working days per year X Average number of working hours 226 x 8 = 1808 nursing hours

27. To find out the total number of nursing hours per day The hours worked per year by a nurse X total number of nurses For example Total bed capacity of hospital = 500 Required number of nurses = 217 nurses (as per INC norms 1808 x 217 = 361736

28. To find out the number of nursing hours per day Total number of nursing hours per year 365 361736 365 991.21 nursing hours per day To find out the number of nursing hours per Patient 991  500 = 1.98 nursing hours per patient per day approximately

29. Duties of different categories of nursing staff Director of nursing The nursing director has very little or no technical duty to perform. The work is mainly administrative and conceptual. • Supervision - working pattern • Maintaining discipline • Planning diff. services • Preparing policies to upgrade the routines. • Participating in recruitment of staff • Organizing for academic purposes. • Arrange (in-service) training programmes.

30. Sister-in-charge Sister-in-charge is the administrative head of the ward/section. Therefore the duties are based on responsible attitude and supervision. • Maintaining cleanliness and orderliness in the ward. • Supervising housekeeping activities. • Supervise staff nurse, nurse-aides, labour staff, patients. • Maintaining inventory. • Accompany senior clinician during their rounds/ discussion and actively participate in taking and implementing the decisions.

31. Staff Nurse This category is the most active. The duties they are expected to carry out are General and routine care of patients as per clinicians instructions. She is an active bridge between treating clinician and patients. To assist clinician. Assist or independently perform certain procedure like a. collecting blood, b. catheterization of bladder, c. giving IV fluids, d. first aid. Assist actively at ante natal clinic, post natal clinic, diabetes, asthma, etc. Educational activity like health talk, counseling, etc. Attend outdoor activities. Admit and discharge patients.

32. Problems faced: • Shortage of nurses due to a. improper ratio of nurse : patient b. recruitment policy c. non availability d. migration to other hospitals e. increase in requirement. • Dissatisfaction • Absenteeism : particularly for night duty. • Unionization • Deterioration in standard of performance

33. Professional Hazards: • Risk of infection • Stress and burn out • Backache due to prolonged standing and walking on hard surface. • Fatigue due to shift duties. • Improper behavior of some patients, relatives, labour staff and even doctors. • Frustration.

34. Functions of CSSD • Receiving and sorting the soiled material used in the hospital • Determining whether the items should be reused or discarded. • Carrying out the process of decontamination or disinfection prior to sterilizing. • Carrying out specialized cleaning of equipment and supplies. • Inspecting and testing instruments, equipment and linen. • Assembling treatment trays, instrument sets, linen packs, etc. • Packaging all materials for sterilizing. • Sterilizing. • Labelling and dating materials. • Storing and controlling inventory. • Issuing and distributing.

35. Functions of CSSD • To maintain an uninterrupted supply of bacteriologically safe supplies at all times. • To undertake studies for improvement of sterilization practices and • Processing methods to provide supplies economically. • To impart training to hospital personnel in safe hospital practices. • To participate in hospital infection control programme.

36. Receipt Accounting, Sorting Cracked/ broken Unserviceable Torn/punctured Washing, Cleaning, Drying Gloves Instruments Needles & Syringes Packing Syringes & Needles Gloves Gauze & Dressings Instruments Packs Awaiting sterilization Sterility Not ok Sterilization Autoclaves Dry ovens Shelf-life expired Check for Sterility Sterile storage Issue

37. The sequence of events is as follows: • Materials are received into the department from various users. • All used materials are cleaned - prelimary cleaning before sending the articles to CSSD. • Clean materials are inspected, assembled and packed, ready for sterilization. • After sterilization, they are either stored in a sterile storage area or distributed directly as required.

38. Location • The location of CSSD should be convenient to its principal consumers. • Preferably sited close to OT & wards. • Doors should have the following strong colours to signify the different zones to which they give access. Red - denotes contaminated zone Yellow - denotes clean zone Green - denotes sterile zone

39. Space A minimum of 7 sq ft on a per bed basis ( with 100 sq ft for the smallest hospital) is considered essential for planning a CSSD with scope for future expansion and growth. Up to 100 beds 10 sq ft per bed Up to 200 beds 9 - 10 sq ft per bed Up to 300 beds 8 - 9 sq ft per bed 300 and above 7 - 8 sq ft per bed

40. In planning a CSSD, following concept may be kept in mind

41. Staffing One qualified superintendent - In-charge of the dept. CSSD supervisor - senior nurse (traditionally). In-service trained CSSD attendants CSSD assistants - Semiskilled workers CSSD technicians Sweeper. A 500-bedded teaching hospital has the following staff. Technologists 5 Technical assistants 4 Nursing aides 4 CSSD attendants 4

42. Equipments • Autoclaves • Dry oven • Gauze cutter • Ultrasound washer • Needle flushing device • Ethylene oxide sterilizer • Soaking sinks • High pressure water jets.

43. Autoclaves • Saturated steam under pressure is the safest and dependable method of sterilization. • Minimum time for sterilization by autoclaving process is 121°C in 15 min. • sterilization checks for quality control. • Sterility indicators • Mechanical indicators • Chemical indicators • Biological indicators • Shelf life

44. Chemical sterilization Ethylene oxide (EO) - used for heat-sensitive and moisture-sensitive materials like rubber, plastics and fibre glass. Effective sterilization by EO depends upon the Following: Concentration of gas: 450mg/litre or higher Temperature exposure:49 to 63°C and 30 to 37.8°C Packing: The type of wrapping used should be penetrable by ethylene oxide and water vapour. Polyethylene is commonly used for wrapping. Period of exposure: The time ranges from 110 to 260 min. up to 12 hours may be required.

45. Sterilization process After the sterilizer chamber is sealed and the controls set, sterilization process goes through the following phases: • Warming the chamber • Evacuating residual air to partial vacuum. • Introduction of moisture to ensure that it penetrates wrappings and material. • Introduction of EO. • Raising the temperature(if required) • Exposure for the required time. • Release of chamber pressure.

46. Ultra sonic cleaner • Ultrasonic cleaner cleans by bombarding the item with sound waves. • These tiny shock waves will knock debris off nooks and corners of instruments that are not easy to reach.

47. The list of items and special trays commonly processed in the CSSD are: Instruments Dressings Sponges OT linen Special packs Gauze and cotton materials Gloves Bowls and trays

48. Standardization of surgical packs The aim is to have a standard surgical pack containing all the items required for that procedure by the operating surgeon. Some of the Special trays and sets to be processed by CSSD are as follows: • Lumbar puncture set • Sternal puncture set • Catheterization set • Bladder wash set • Liver biopsy set • Fine-needle aspiration cytology set • Suturing set • Thoracic aspiration set • Incision and drainage set • Tracheostomy set.

50. Laundry Services • It is a centralized function coming under the housekeeping department taking care of all activities from purchase to linen management to laundry to condemnation • Linen Management will vary based on the climate, culture, systems and procedure of the individual organization