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Give the presentation on Plant Maintenance and also explain the given case study.

Case Study on Memorial Hospital A 265-bed regional health care facility is located in the mountains in Dehradun. The mission of the hospital is to provide quality health care to the people. To accomplish this mission, three objectives have been outlined by the CEO of the hospital; 1. Maximize customer service to increase customer satisfaction. 2. Minimize costs to remain competitive, and 3. Minimize fluctuations in workforce levels to help stabilize area employment. The hospital’s operations are segmented into eight major wards for the purposes of planning and scheduling the nursing staff. These wards are listed below in Table – 1, along with the number of beds, targeted patient-to-nurse ratios, and average patient census for each ward. The overall demand for hospital services has remained relatively constant over the past few years even though the population of the seven counties served has increased. This stable demand can be attributed to increased competition from other hospitals in the area and the rise in alternative health care delivery systems, such as health maintenance organizations (HMOs). However, demand for Memorial Hospital’s services does vary considerably by type of ward and time of year. Table – 2 provides an historical monthly breakdown of the average daily patient census per ward. The Director of nursing for the Memorial Hospital confronts one of the most challenging aspects of her job: planning the nurse-staffing levels for the next calendar year. Although the average demand for nurses has remained relatively stable over the past couple of years, the staffing plan usually changes because of changing work policies, changing pay structures, and temporary nurse availability and cost. The Director has begun to collect information to plan next year’s staffing levels. The nurses at the hospital work a regular schedule of four 10-hour days per week. The average regular time pay across all nursing grades is Rs.80/- per hour. Overtime may be scheduled when necessary. However, because of the intensity of the demands placed on nurses, only a limited amount of overtime is permitted per week. Nurses may be scheduled for as many as 12 hours per day, for a maximum of five days per week. Overtime is compensated at a rate of Rs.100/- per hour. In periods of extremely high demand, temporary part-time nurses may be hired for a limited period of time. Temporary nurses are paid Rs.90/- per hour. The hospital has a policy that limits the proportion of temporary nurses to 15% of the total nursing staff.

Table – 1 Ward Capacity Data Ward Intensive Care Cardiac Maternity Pediatric Surgery Post-Op Emergency General

Number of Beds 20 25 30 40 5 15 10 120

Patient Census* 10 15 10 22 † 8( T – F daily equivalent)‡ 5 (daily equivalent) ‡ 98

Patient /Nurse 2 4 4 4 † 5 3 8

* Yearly average per day. † The hospital employs 20 surgical nurses. Routine surgery is scheduled on Tuesdays and Fridays: Five surgeries can be scheduled per day per operating room (bed) on these days. Emergency surgery is scheduled as needed.

† Daily equivalents are used to schedule nurses because patients flow through these wards in relatively short periods of time. A daily equivalent of 5 indicates that throughout a typical day, an average of five patients are treated in the ward.

Table – 2 Average Daily Patient Census Per Month Ward Intensive Care Cardiac Maternity Pediatric Surgery* Post-Op† Emergency† General

M 8 15 12 24 18

A 7 13 13 24 17

M 7 14 10 25 16

Month J J 6 11 12 13 8 13 21 22 16 22

10 8 7 6 4 4 110 108 100

7 7 98

6 8 95

6 5 90

J 13 18 8 22 20

F 10 16 8 23 18

10 5 88

A 13 12 13 20 21

S 9 13 14 18 17

O 10 15 10 20 18

N 12 18 8 21 20

D 14 20 7 19 22

10 4 92

7 4 98

8 9 3 4 102 107

10 6 94

* Average surgeries per day. † Daily equivalents. Finding, hiring, and retaining qualified nurses is a problem that hospitals have been facing for years. One reason is that various forms of private practice are luring many nurses away from hospitals with higher pay and greater flexibility. This situation has caused Hospital to guarantee its full-time staff nurses pay for a minimum of 30 hours per week, regardless of the demand placed on nursing services. In addition, each nurse receives a four-week paid vacation each year. However, vacation scheduling may be somewhat restricted by the projected demand for nurses during particular times of the year.

At present, the hospital employs 130 nurses, including 20 surgical nurses. The other 110 nurses are assigned to the remaining seven areas of the hospital. The personnel department has limited average cost to the hospital for hiring a new full-time nurse to $400 and for laying off or firing a nurse is $150. Questions for discussion: 1. Explain the alternatives available to the Director while developing a nurse-staffing plan for Memorial Hospital. How does each meet the objectives stated by the CEO? 2. Based on the data presented develop a nurse staffing plan for Memorial Hospital. Explain your rationale for the plan.