Simulation and clinical skills development

It is acknowledged worldwide that simulation training is an useful and  value-added precursor to actual clinical work for healthcare workers.

Simulation is becoming a norm and an essential part of pre-clinical training in several countries and reputed institutes worldwide. Some examples:

1. Skills Development ... - Queensland Health - Queensland Government

(http://www.sdc.qld.edu.au/)

2. EISE ( Ethicon Institute of Surgical Excellence) , India

 http://www.jnjindia.com/EISE_Index.asp

3. Medical Simulation Centre, Rhode Island Hospital

http://www.rhodeislandhospital.org/rih/services/simctr/

The Apollo Group of Hospitals has set up a clinical simulation centre at Hyderabad. In addition, Defence R & R Hospital, Delhi and AFMC, Pune have facilities for clinical simulation.

Presenting a conceptual note on Clinical Simulation Centres:

                     1.CPR (Cardiopulmonary Resuscitation)  Lab :

This would be utilized for BLS, ACLS, NALS and PALS classes. CPR mannequins are used, which provide training in CPR, AED use, and the Heimlich maneuver. Airway, breathing and circulation systems are simulated and the results of interventions can be demonstrated.

A CPR mannequin for practicing cardiopulmonary resuscitation of a human has a simulated human head and neck portion with an air passage extending from a mouth opening to a neck opening in an end of the neck remote from the head. An inflatable simulated human chest portion is secured to the neck and has an upper flexible wall member, a lower wall member and a flexible bag there between and a further air passage connects the air passage in the neck to the flexible bag. The upper flexible wall member simulates a chest which rises and falls with inflation and deflation of the flexible bag.

The types of mannequins required would be-

a)    Adult mannequin for BLS

b)    Adult mannequin for ACLS

c)    Pediatric mannequin for PALS

d)    Neonatal mannequin for NALS

     Other than these, the following would be required-

e) 3 demonstration rooms with Seating Capacity for 20 people each.

f) Audiovisual equipment

                           2. Airway Management Lab

     This would be utilized for teaching of airway management to physicians, nurses and paramedics. It would be provided with a  

      variety of simulators including pediatric and neonatal models.

A mannequin such as the Human Patient Simulator (HIPS) system is used, which contains a self-regulating pulmonary system which regulates the body’s O2 requirements and rate of CO2 production and automatically adjusts the respiratory rate and tidal volume. Breath sounds are auscultated by standard stethoscopes in several locations to detect abnormalities. A number of techniques can be taught using the anatomically correct airway. Bronchoscopy can be performed in the upper airway and trachea. Nasal or oral intubation can be performed. Ventilation can be compromised by tongue or upper airway swelling, bronchospasm, or laryngospasm. If an esophageal intubation is performed, the stomach swells up when ventilated.

During a tension pneumothorax, the adult manikin allows either needle decompression or chest tube placement. The treatments are performed through the computer interface for the pediatric manikin.

                                          i.    Access Management Lab

Access Lab would have realistic models for both peripheral and central venous devices, placement of Intercostal catheters, and Spinal Punctures, Regional Anesthesia etc. The mannequin would simulate vascular access and fluid management. Infusions of whole blood, packed cells, crystalloids and colloids independently (artificial solutions), can be carried out. The patient can lose either whole blood or plasma, to simulate the different effects of blood loss through active bleeding versus volume loss through leakage into extracellular spaces.

                                        ii.    Emergency and Trauma Management Skills Lab

     Trauma management skills are taught using mannequins, audiovisual aids and life support stations.

                                       iii.    General Surgical Skills Lab

It provides simulated hands on surgical skills to a minimum of 15 learners at the same time. Each student is able to see the skills being taught by the teacher, on the monitor and then perform the same at his/her station. All the skills are supervised by a team of dedicated trainers.

                                       iv.    Laparoscopic Surgery Skills Lab

This would contain a Laparoscopic Trainer station that includes an introductory board, several anatomic models, and a camera for training in laparoscopic surgery skills. Trainees begin on the introductory board. Stations demonstrate basic skills which will be incorporated into many real surgical procedures. Once the trainees are comfortable in the laparoscopic environment, the introductory board is removed and various surgical anatomic models are placed in the trainer, each of which will be used to teach operating techniques or full length procedures.

                                        v.    Endoscopic Skills Lab ( Lower GI / Upper GI endoscopy)

This would contain a endoscopic model, consisting of a endoscope, a box containing the computer components, and a screen to view images. Cases are grouped, to allow trainees to focus on basic principles (introduction module) or to learn biopsy or polypectomy procedures. Within all modules, the simulator gives instructional information beforehand, real time patient feedback during the simulation, and constructive feedback after the simulation has been completed.

The endoscope is shaped like a real colonoscope, including all the directional controls and adjunct buttons. The functionality has been removed from the scope, although the simulator senses what the user is doing and causes the image to change appropriately. During the case, the simulated patient responds in real time to the trainee's actions, both verbally and with vital sign changes. The modules contain a series of videos and text instructions.

                                       vi.    Bronchoscopic Skills Lab

The fiberoptic bronchoscopy simulator consists of an anatomic model of the face, with an opening in one nare for nasal insertion of the fiberoptic bronchoscope. It has an attached motion sensor system and a video system with screen for the images. As the user inserts and manipulates the bronchoscope, the simulator senses the movements and adjusts the screen images in real time. The respiratory tree and the full length of the bronchoscope are visible as it is currently positioned. 

Feedback is given during the procedure (such as an audible patient cough if topical anesthetic is insufficient) as well as after the procedure is complete.  Other output is intended to help the trainee develop a personal technique (such as the order the bronchial segments were visited).

Modules within the bronchoscopy simulation include basic maneuvers, lesion visualization, bronchial lavage, and tumor biopsy. There is also one pediatric difficult airway module.

      3.         Cath Lab, Imaging Lab, Neuroelectrophysiology Lab and other Labs as identified would be required.

In addition, Demonstration Rooms, Lecture halls and Audiovisual Aids would be required for teaching.

New hospital new thinking

 Sharing the story of how NHS Wolverhampton, UK, met patients's expectations:

http://www.ashridge.org.uk/website/IC.nsf/wFARATT/New%20Hospital%20New%20Thinking/$file/hospthink023.pdf

Who said doctors can’t be ethical and successful?

(This article was published in The Hindu on July 24, 2011)

-By Dr. K.R. Antony

http://www.thehindu.com/opinion/open-page/article2288190.ece#comments

When doctors enrolled themselves in the profession, they are bound to observe certain professional ethics and decorum. That is not for sainthood but for the upkeep of a certain code of professional conduct which was practised by our seniors. That gave us the social recognition and dignity we earned collectively.

Now there is value erosion, everybody admits. Breach of medical ethics is seen not as grave, restrained and punished timely, but is being overlooked and condoned easily as an “inevitable evil of the prevailing conditions.”

The strength of the majority is not used to correct the wrongdoing of a minority, but to justify its misdeeds and approval by the whole body as a “survival strategy.” Professional associations are also resorting to strikes to safeguard their business interest and protection from the “public” whom they are supposed to serve. The old fashioned and the not-so-smart ethically practising doctors are becoming a minority. Even a laughing stock! No wonder, the same society that treated us once as “god” is now treating us as “dogs” as lamented by Dr. Manorama Gadde (Open Page, The Hindu, July 17, 2011).

Who is at fault? Rather than taking it to the “media” accused of using “doctors as punching bags,” it is high time for introspection.
What happens, for example, if we refuse to pay 25 per cent of the fees to the local RMPs to get referral cases? My firm belief is that if a doctor is ethical, skilled and very good in his/her profession, people flock to that doctor. Client satisfaction is the best advertisement for a doctor or hospital. People may be unlettered, but their wisdom can differentiate the bad from the good doctor. It is only the mediocre and below average who need advertisement props.
I have seen very poor patients travel from far off tribal areas and districts and across State borders to Ganiari near Bilaspur city to receive the good services of a group of committed specialist doctors who passed out of the AIIMS, Delhi. These doctors do not even put up a decent nameboard.
I started paediatric practice in a 150-bed mission hospital in a rural area where not more than five or six patients came a day. Within a few months, the number grew up to almost 90, and it became unmanageable for me as a specialist to give quality time and attention to my patients. Finally, I was compelled to restrict my outpatient tokens.
Many local practitioners referred patients to me, instead of to the district headquarters hospital, because they knew I did not pass any remark on the missed diagnosis or the not-so-correct case management by the referring doctor. Moreover, would get a return referral slip, in a sealed cover, on what the diagnosis turned out to be upon investigation and the lines of management that I followed.
In India, no qualified doctor willing to practise ethically is going to starve. There is enough revenue generation from consultancy for everybody’s need, but may be not enough to everybody’s greed. The “greed” is often perceived and firmly believed as “need” when you actually embark upon certain ambitions of life for the sake of survival in cut-throat competition. One more building block, one more operation theatre, a CT scan machine and similar sorts, for which banks are ready to advance loans fast but also quick to retract when EMIs are delayed. The stress is passed on to the middle class patients who might not have actually needed it at all. Why join that rat race?

(The writer is a former Health & Nutrition Specialist for UNICEF and former Director, State Health Resource Centre, Chhattisgarh. His email id is krantony53@gmail.com)

Health Insurance – A Perspective

 

Dr L Rathika MBBS DFH

With escalating costs, healthcare has become a high priced commodity. In the changing economic scenario, health insurance is no longer a luxury, but indeed a necessity.  More and more households are opting for health insurance cover to tide over the unexpected hospitalization expenses. Nowadays, it is a common practice for employers to provide group health insurance coverage to their employees.

Indian Scenario

Indian Healthcare Industry contributes significantly to the country’s gross domestic product (GDP). In recent years, the concept of health insurance is receiving increasing prominence in India.  According to current research, health insurance market constitutes the second largest non-life insurance sector in India and has registered phenomenal growth in 2008-09 and 2009-10. Health insurance industry is one the fastest growing businesses and the premium mark is expected to cross a compound annual growth rate (CAGR) of 25% by 2013-14.

                                            

Health Insurance

Health insurance is a product that protects the insured person against the risk of incurring medical expenses and provides with specified sums to cover the treatment costs. In India, most health insurance policies cover only hospitalization expenditure.

Need for Health Insurance Cover

Most of the Indians receive healthcare through state owned primary care centers, as well as secondary and tertiary hospitals.  Nevertheless, only 6% of GDP is spent on healthcare. Poor state of government-owned healthcare facilities and the fewer number of hospitals per 1000 population as compared to global average have led to the exponential growth of private secondary and tertiary care hospitals, which constitutes nearly 80% of the country’s health infrastructure. This, among others has contributed to the escalation of healthcare costs. In addition, massive population growth is straining the already over stretched health infrastructure. Socio-economic changes such as ongoing migration of people from rural to urban areas in search of livelihood, sedentary life style, globalization and stress have contributed to the increased incidence of life style diseases such as diabetes and hypertension. Given this background, the need for health insurance is more prominent than ever, considering that merely 10% of Indian population has health insurance coverage.

Advantages and Disadvantages of Health Insurance Policy

Health insurance policy covers the risk of unexpected expenditure resulting from medical treatment. Most insurance providers offer cashless facility of claim settlement when the insured person gets admitted in the hospitals belonging to their preferred provider network, the details of which are made available while purchasing a health insurance policy. There are various health insurance products in the market, offering consumers with a wide range of choice to suit their specific requirement.  Some insurance providers offer discount on the premium amount for the succeeding year, if no claim has been made in the previous year on the policy.

More often than not, health insurance policies cover only hospitalization expenditure, and the cost of outpatient treatment is not generally covered. Moreover, most policies exclude the pre-existing diseases for varying periods of time when the policy is in force, and this makes it wiser to purchase the insurance cover at an early age. One of the exceptions is Star Health – Senior Citizen Red Carpet Policy, which offers coverage of all pre-existing diseases from the first year of policy. In addition, hospitals tend to charge health insurance policy holders at rates higher than the reasonable treatment cost, requiring the insured person to spend additional sums from his pocket.

Public and Community Health Insurance Schemes

The Government of India has increased the plan allocation for the healthcare expenditure from US$ 4.97 billion in 2010-11 to US$ 5.96 billion in 2011-12. Furthermore, the Ministry of Health & Family Welfare has proposed to increase the domestic healthcare funding by at least 2 per cent of the GDP in the 12th Plan period. Taking into cognizance the need for greater population health risk coverage, the central and state governments in India have launched innovative health insurance schemes to help the poor. Rashtriya Swasthya Bima Yojana (RSBY) was introduced by the Government of India for BPL (below poverty line) population in the unorganized sector in April 2007. Recently the government has approved extension of RSBY to cover registered domestic workers, which is likely to cover 47.50 lakh workers. Some of the popular insurance schemes run by the state governments include Aarogyashri in Andra Pradesh, Chief Minister’s Health Insurance Scheme in Tamil Nadu and Yashaswini Insurance scheme in Karnataka.

In addition, several community-based health insurance schemes are run successfully by NGOs across the country and a few of them are listed below.

·         Self Employed Women's Association, Ahmedabad, Gujarat (1992)

·         Goalpara, Shantiniketan, Rural West Bengal (1984)

·         Voluntary Health Services (VHS), Medical Aid Plan, Chennai, Tamil Nadu(1963)

·         Social Work and Research Centre (SWRC), Ajmer, Rajasthan ( 1972)

·         Sewagram Kasturba Hospital, Wardha, Maharashtra (1972)

Leading Health Insurance Providers in India

Though successful, existing health insurance schemes do not cover all sections of the society, thus leaving the field open to private players. Currently we have public sector general insurance companies and private insurance companies offering health insurance products. Of these Star Health Insurance is the only stand alone health insurance company. Leading health insurance providers in India include,

·         National Insurance company

·         New India Assurance Company Limited

·         United India Insurance Company Ltd

·         Star Health & Allied Insurance Company Limited

·         ICICI Lombard Insurance

·         TATA AIG Insurance

·         Royal Sundaram General Insurance

·         Bajaj Allianz Insurance

·         Oriental Insurance Company Ltd

·         Max Bupa Health Insurance

·         Apollo Munich Health Insurance

Popular Health Insurance Products

Some of the most innovative and popular health insurance products are,

·         STAR Health – Medi  Classic, Family Health Optima, Senior Citizen Red Carpet

·         National Insurance – Varishta Mediclaim

·         New India Assurance – Mediclaim policy

·         United India – Family Medicare

·         Oriental – Individual Mediclaim Policy

·         Max Bupa – Heart Beat Gold, Silver and Platinum

·         Bajaj Alliance – Health Guard

·         Apollo  Munich – Easy Health Individual -Standard Plan

Future of health insurance in India

Indian health insurance industry is on the verge of an exponential growth. Key factors driving this industry include escalating healthcare costs with resultant need to purchase private health cover to supplement public schemes;   sub-optimal quality of public health services;  booming population growth; increasing incidence of lifestyle related diseases; greater awareness and affordability among the educated middle class;  and deficiencies in pension schemes.

In conclusion, from the consumer stand point, it would be only prudent to purchase health insurance cover for the individual as well as the family — earlier the better!

AIA guidelines for hospital planning.

AIA guidelines for hospital planning:

http://www.scribd.com/doc/61018483

Staff who resist quality improvement efforts

-by Donald Tex Bryant


Perhaps you are just beginning a quality improvement program or project.  Perhaps you have several project improvement projects successfully completed at your healthcare site.
No matter what your level of experience, you have encountered staff who are roadblocks to your efforts.  What are you to do?  Ignoring them or doing nothing will imperil your quality efforts eventually.  Let me share some ideas on what to do based upon my own experience and on advice from experts.

Before I share some strategies I will share an example based upon my own experiences.  A primary care group with six physicians specializing in family practice and internal medicine has been focusing on process improvement and patient-centered care for six months.  They have retained a Lean healthcare consultant to help them with timely advice and occasional training.  The consultant keeps them focused on standard procedures, value adding processes and waste elimination and on continuous improvement, all of which are focused on the patient outcomes.  They decide to explore whether they should have their patients who come in for physicals have their blood work done a week before their scheduled appointment.  The office manager asks some of the physicians, nurses and office staff to come together for a few one-hour meetings before the practice opens for patients in the morning.  The goal of this team of volunteers is to assess the pros and cons of having the blood work done before the physical and if so, to develop a standard operating procedure (SOP) for having it done.  Some of the pros and cons are:

• Physicians will be able to discuss with the patients indicators such as triglyceride levels outside of normal ranges so lifestyle changes can be suggested
• Patients who are focusing on improving their health can discuss the results with their physician
• Some patients may find going to a lab before the visit an inconvenience, especially if the lab is in the same building or near the group practice site

Overall, the team decides that they will pilot this approach with two of the physicians.  A SOP is developed involving staff who schedule appointments, nurses aides and physicians.  Indicators of the outcomes in terms of patient health and  physician and staff  attitudes are developed and tracked.
The results of this pilot are positive and the office manager decides to implement the changes for the whole office.  She discusses the procedures with the rest of the staff and physicians and sets up a chart for her use and her staffs’ observation of the rate of compliance with the new procedure.  After a couple of months she finds that there is a lack of progress in improved compliance with the procedure.  Upon further investigation she finds that one of the schedulers and a nurse’s aide are consistently not following through with their procedures.  She talks to them about this and after a couple of months they are still not following their procedures.  What should she do?
According to a recent newsletter of Lifewings, a quality improvement group for healthcare, CEO Steve Harden stated that about 8% of staff of groups who are beginning quality improvement projects at their site will not participate or will actively block projects.  In the newsletter he advises that management have a plan in place to deal with these 8%.  Lifewings trainers get a verbal commitment from management that they will actively engage those who are blocking projects by having a conversation with them and trying to get them to commit to join in the improvement efforts.  Some will agree to but will still not change.  Some will not even agree.  Mr. Harden suggests that managers then ask these staff to find another place to work.  Further, he says to celebrate the achievements of those who have helped improve patient health outcomes through process improvement projects.
Jim Zawacki, co-author of It’s Not Magic, the Rebirth of a Small Manufacturing Company, suggests another approach.  In his book which describes the Lean quality improvement efforts at his company, GR Spring and Stamping, he describes how a team of managers and front line employees came to grips with those who would not join others as they started the cultural transformation necessary to ensure the success of a Lean Process Improvement program.  After the Lean program had been well established the team decided that management would have to ask those who were unwilling to change to leave the company.  Mr. Zawacki as CEO made sure that happened.
If you are just beginning quality improvement efforts at your site, you must come to grips with dealing those who will not join it.  Eventually, they will sabotage much of your efforts and will negatively influence those staff members who are involved.  Management should have a plan on how to consistently deal with the recalcitrant staff, including asking them to find other employment.  Do not let a rotten apple spoil the barrel.

Donald Tex Bryant is a consultant who helps healthcare providers meet their challenges. He can be reached at Bryant’s Healthcare Solutions.

Role of Facility in healthcare delivery and Patient Safety

-Dr.Abhimanyu Bishnu, Head of Quality and Senior Manager- Medical Operations and Quality, Aditya Birla Memorial Hospital, Pune;Email- abhimanyu.bishnu@gmail.com
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“Five babies die due to fire in phototherapy unit at a hospital in Punjab” (Jan 2009)

“Patient critically injured after fall from 3^rd floor of hospital in Maharashtra” (Oct 2009)

“30 injured in Hyderabad hospital fire” (Feb 2010)

 “New born abducted from maternity ward of Ahmedabad hospital” (Mar 2011)

These are some of the alarming headlines in recent times. In a healthcare environment that is constantly volatile and increasingly competitive, this is an adverse publicity that these hospitals could probably do without. Which brings us to the fundamental premise that hospitals have to be designed and operated as safe, comxfortable and efficient buildings.

To quote Winston Churchill, “We shape our buildings and afterwards our buildings shape us”. According to Louise Sullivan, “Form follows function.” Today, evidence links patient safety outcomes to hospital design, but it is only in recent times, due to the awareness of accreditation requirements, that hospitals are laying emphasis on facility-related patient safety aspects.

Casualty Room after an emergency

The linkage of hospital structure to the healing process has a historical angle. The very first hospitals, in ancient Greece, Rome, India and Egypt, were part of temples and had a spiritual and medical function. In medieval Europe, too, hospitals had a religious association, and patient wards were designed so as to allow avn unobstructed view of the alter of the presiding diety. Spirituality was considered an important part of the healing process. Later, the pioneering work of Florence Nightingale in sanitation, hygiene and hospital ward outlay during the Crimean War (1854- 1856) led to alterations of hospital facility design, leading firstly to changes in hospital ward design and air flow and later to the multiple bed “Nightingle Ward” as we know it today, which combines utility, grid pattern design, adequate ventilation and optimal use of facilities. Today, as times have changed and patient comfort and infection control have become paramount, we see the popularity of smaller patient bays (4-6 beds) and single rooms.

The important aspects to be considered in hospital design are: 1) Promotion of a healing environment, 2) Enhancement of safety, 3) Promotion of utility and convenience, 4) Infection prevention, 5) Facilitation of an IT-enabled environment, 6) Removal of human and biomedical waste.

A basic framework of hospital facility safety laid down by accreditation agencies such as the Joint Commission International (JCI) includes-

1) General Safety & Security

Guarding of key entry and exit points, visitor identification, close circuit camera monitoring and access control devices are deployed to provide a safe and secure environment, protected from intrusions and unauthorized access. Patient assist devices are used to prevent patient falls in bathrooms, and the floor design element includes the use of anti-skid flooring.

2) Hazardous materials Safety

Exposure to hazardous materials such as formalin, ethylene dioxide, mercury (from broken thermometers/ BP apparatus) represents a serious occupational and health hazard. To counter this, the organization draws up a list of hazardous materials used, along with precautions to be taken while handling, and management of exposure. The materials are classified into inflammables, corrosives and irritants, with due precautions taken for each. The hospital also forms a team, comprising of members from the Security, Engineering and Housekeeping services, which deals with the management of hazardous material spills.

3) Emergency management

Patient collapse, verbal/ physical disputes, abduction of infants etc represent emergencies which have to be dealt with efficiently and swiftly. Specific systems (called Codes , such as Code Blue, Code Purple etc) are set up, with designated personnel, to deal with these emergencies.

4) Fire safety

Healthcare facilities are prone to fire accidents due to factors such as the usage of pure oxygen, anaesthetic gases, multiple electrical equipment, kitchen facilities etc. Hospitals in India need to adhere to the National Building Code, which prescribes– a) Fire detection systems such as manual electric fire alarms, automatic detection and alarm systems and b) Fire suppression systems such as automatic sprinklers, fire extinguishers, hose reels, fire hydrants . Hospitals also constitute a fire safety team, headed by a Fire Safety Officer, managed by Fire Marshals and consisting of hospital security, engineering and other staff, to deal with fire situations.

5) Medical equipment safety

Medical equipments make up the armoury of the modern-day hospital, and regular checking and timely preventive maintenance and calibration of these equipments is a must for ensuring that equipment work well at all times.

6) Utility management safety

Electricity and water are the lifelines of a hospital, and  it is important to ensure that in addition to the primary source, standby systems for electricity such as Diesel Generator ( DG) sets, Uninterrupted Power Supply( UPS) sets and that for water such as borewell or river water supply be kept ready at all times. It is important to provide clean, uncontaminated water, which is vital for processes such as dialysis, endoscopy, invasive procedures. Regular checking and maintenance of biomedical gas supply is also an important part of utility management.

The Institute of Medicine (IOM), in its iconic report,” Crossing the Quality Chasm: A New Health System for the 21^st Century”, has identified the following critical design elements for Patient Safety- Patient centredness, Safety, Effectiveness, Efficiency, Timeliness and Equity. The features deployed by hospitals, mentioned above, would help to achieve these objectives.

The hospital of the future is likely to be a safer and more welcoming place, instead of the intimidating structures of yesteryear. Globally, the transformation is already happening at places like the new Rikshopitalet University Hospital in Oslo, Norway, where architects designed a large facility on a human scale, inspired by the comforting layout of a bright, glass-roofed “street” that gently curves to suggest a village road, with the treatment areas and labs clustered around central courtyards on one side of the street and patient wards on the other side. The hospital provides ample views of nature, incorporates daylight and has used soothing tones for bed areas and energizing shades for physiotherapy, believing that the right environment promotes patient health and well-being.

Interiors are receiving considerable attention in new hospitals in India, and the concept of the Atrium/ Courtyard or public place within the building catching on.

At the under- construction Cleveland Clinic Abu Dhabi (to be opened in 2012), giant cranes move blocks of concrete and place them neatly, piling more layers upon what will be a huge, yet intricately designed landmark construction- a 360 bed (expandable to 490), 24- storied hospital with advanced facilities, positioned to be one of the leading hospitals in the Middle East. The hospital is using a village concept, providing gathering places, indoor water elements, skillfully employed wayfinding elements, sleek glass walls and color-coding. It will deploy displacement ventilation to provide energy saving and infection control, and use alternative and recyclable sources of energy. Inputs for facility safety have been provided by the Quality and Patient Safety Institute at Cleveland Clinic, Ohio.

Nearer home, the Tata Memorial Centre, Kolkata, a newly-designed comprehensive cancer hospital, has employed JCI as a project consultant , and  has received their certification on conformance to Quality and Patient Safety requirements. Many other hospitals in India and abroad are planning to follow suit. Facility Safety is becoming an integral part of hospital planning in India.

From temples of god to abodes of safety and comfort, hospitals have come a long way. This is an era of facility safety and patient comfort that Florence Nightangle, arguably the world’s first Patient Safety Officer, would have been justifiably proud of.