ABSTRACT
Aim Healthcare infrastructure projects are a requirement for the progress of the country. The aim of this study was to identify major completed healthcare infrastructure projects in a tertiary teaching hospital in Northern India and to find out the various factors that influenced the success or failures and the cost and time overrun during the project implementation. Materials and methods Periodical review meetings were conducted, right from the planning to the execution and commissioning of these projects. All these had been documented as minutes of the meetings, and the records of the same had been maintained. The study comprised of studying all these documents in detail and finding an answer to the research questions. Results Four major completed projects of a tertiary medical institute of India, All India Institute of Medical Sciences (AIIMS), New Delhi, India, were studied. These were the new Outpatient Department (OPD) Block, Burns and Plastic Surgery Block (BPS), Maternal and Child Health Block (MCH), and National Cancer Institute (NCI). Our study revealed that there was no dearth of funds, and hence, there was no cost overrun in any of the projects. Whenever the funds had to be reworked, the funds that were asked for were released. However, there was a considerable time overrun in all the projects ranging from about one to four years. The various reasons that could be attributed to this are the delay in obtaining statutory clearances, political interference, communication hurdles, improper planning, introducing a project officer late into the project, safety concerns, and the COVID-19 pandemic. Conclusions This study focuses mainly on the very important hurdles that were faced during the implementation of the projects and tries to suggest an average time frame for various activities for project implementation in a healthcare project in the Indian scenario. This can be taken as blueprints while planning newer healthcare projects of this magnitude.
ABSTRACT
Objective: Patients' appraisal of health care delivery system and services during COVID-19 could be an important yardstick for hospital administration and policy makers. The study attempted to develop and test the psychometric properties of a new patient satisfaction scale for COVID-19 patients. Methods: A total of 446 COVID-19-hospitalized COVID-19 patients in a tertiary care designated COVID-19 care hospital constituted the sample. Factor structure of scale was obtained using exploratory factor analysis (EFA). Internal consistency, split-half reliability, and validity (e.g., content, convergent, and divergent) were also evaluated. Results: Item reduction resulted in a 21-item scale consisting of three factors, namely COVID-19-focused treatment facility, COVID-19-appropriate hospital facility, and COVID-19-specific daily needs service facility. It demonstrated excellent internal consistency and reliability (Cronbach's alpha [α]: 0.93; Split-half reliability: 0.90), excellent content validity, and adequate convergent and divergent validity. The scale had no floor effects. Inter-index correlations were significant. To our knowledge: this scale is the first such psychometrically robust self-rated scale for patients' perception about hospital services during COVID-19. Available in both Hindi and English languages, the scale provides a quick measure of patient experience regarding CCOVID-19-specific hospital services.
ABSTRACT
INTRODUCTION: Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources. AIM: To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility. METHODS: Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian's structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan-do-study-act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines. RESULTS: Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts. DISCUSSION: Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility. CONCLUSION: Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.