Report on Information & Service Procedures Square Hospitals Limited

1.01 About Square Hospital

 Square Hospitals Limited, a concern of Square Group is a 320-bed tertiary care hospital. The hospital is an affiliate partner of Methodist Healthcare, Memphis, Tennessee, USA, SingHealth, Singapore, Bangkok Hospital Medical Centre, Thailand and ChristianMedicalCollege, Vellore, India.

 A lot of physicians have joined from CMC-Vellore, India. Bangladeshi Physicians with impeccable reputation are also part of the medical team. Huge emphasis has been made on quality nursing services, as we have trained over a hundred nurses for over a year. We have nurse educators from Australia, UK, India and the Philippines. Nurses and technicians have already received training from CMC-Vellore which continues to be an on- going process.

 SquareHospital is located in the heart of Dhaka and aims to serve greater portion of the capital city. At present it comprises of two buildings on either side of Panthapath connected by an over-bridge. The main hospital building is 18 stories and is approximately 450,000 sq.ft. The second building (ASTRAS) is located across the street and is 16 stories with 136,000 sq.ft. The second building is expected to be operational by 2011. Both facilities are constructed in accordance with US Fire and Building safety standards

 The outpatient department of this hospital can serve up to 1200 patients daily, through 60 examination rooms. To ensure optimum healthcare-hospitality, the patients are closely monitored in their waiting times in outpatient clinics, emergency and admissions.

 1.02 ORGANIZATION OF THE MAIN BUILDING:

Basement 3 and 2
Car park (can accommodate 80 cars)

Basement 1
Emergency room (ER) with 6 beds for non critical cases, two procedure rooms, two trauma rooms; ER registration and ER pharmacy; linear accelerator for radiation therapy; morgue

Ground floor
ER with 4 beds for critical cases, ER triage; lobby; cafeteria; flower and gift shop

First & second floor
OPD clinics with 60 consultation rooms; Physiotherapy center

Third floor
Radiology and Imaging; dialysis unit; chemotherapy center; outpatient Fine needle aspiration cytology(FNAC) clinic; outpatient Bone Marrow procedure room

Fourth floor
Intensive care unit (ICU) with 21 beds of which two are isolation units; Coronary care unit (CCU) with 11 beds; endoscopy and bronchoscopy suite with complete facilities for ERCP (equipped with C arm) as well as lithotripsy

Fifth floor
OR complex with 8 ORs, including two dedicated for Cardiac surgery; Cardiac surgical intensive care unit (CSICU) with 7 beds;Surgical intensive care unit (SICU) with 13 beds; two cath labs and post
cath recovery room with 7 beds

Sixth floor
Twenty four foundation beds; Pathology; Hospital pharmacy; CSSD

Seventh floor
Labour and delivery (L&D) with 4 L&D rooms and two dedicated ORs for Caeserian section,Neonatal Intensive care unit (NICU) and Paediatric intensive care unit (PICU) with 21 beds of which two are isolation units; Invitro fertilization (IVF) center; Obstetrics and Gynaecology (OBGYN) OPD clinic

Eighth floor
Mother and child floor: 19 rooms with 28 beds

Ninth floor
Pediatrics floor: 19 rooms with 26 beds

Tenth to fourteenth floor
Each floor has 22 rooms with 31 beds. The Tenth floor is equipped with Telemetry service

Fifteenth floor
Library and training rooms

Roof top
Helipad

THE ASTRAS BUILDING IS ORGANIZED AS:

Basement to third floor Car park (can accommodate 100 cars)

The remaining 9 floors will provide service for the hospital.

1.03 Vision

Our vision is that SquareHospital will become the location of choice for Bangladeshis and people of South and Southeast Asia for quality healthcare and an integrated centre for clinical services, medical and nursing education and research.

1.04 Mission

Mission

Deliver QUALITY health care within 5 CORE standards

• Adhering to high ethical and moral standards at all times
• Making service quality top priority in all we do
• Training staff to work within a quality care environment
• Providing quality health care service in all processes

Delivering customer satisfaction through quality service

Outpatient Services

2.01 OPD Services

The outpatient department of the hospital can serve 1200 patients per day through 60 examination rooms. To ensure optimum  healthcare-hospitality, the patients are closely monitored in their waiting times in outpatient clinics, emergency and admissions.

2.02 Outpatient Facilities

• 60 fully-equipped medical consultation & exam rooms
• 100+ foreign-trained medical & nursing specialists
• Open daily – convenient early morning / afternoon / late evening hours

2.03Medical Specialties :

• Internal Medicine
• Cardiology
• Pulmonary Medicine
• Gastroenterology
• Pediatrics & Neonatology
• Neurology
• Hepatology
• Nephrology
• Endocrinology
• Hematology
• Dermatology
• Rheumatology
• Physical & Rehabilitation Medicine
• Infectious Diseases
• Geriatric medicine
• Diagnostic & Interventional Radiology
• Clinical Pathology
• Medical Oncology
• General Surgery
• Cardiovascular & Thoracic Surgery
• Neonatal & Pediatric Surgery
• Obstetrics & Gynecology
• Otolaryngology(Ear/Nose/Throat)
• General & Cardiac Anesthesiology
• Minimal Invasive Surgery (MIS)
• Neurosurgery
• Orthopedic & Joint Surgery
• Hepato Biliary Surgery
• Colorectal Surgery
• Urology
• Surgical Oncology
• Dental & Maxillofacial Surgery
• Ophthalmology
• Plastic Surgery
• Emergency Medicine & Trauma Surgery

All hospital services are carreid out with the support of the hospital information system , especially tailored to meet the requirement of our staff and patients.

3.03 Inpatient Facilities 

• 300 beds
• Large, comfortable, full-furnished suites and deluxe patient care rooms
• Large, clean, modern private & semi-private rooms
• Cable TV & telephone services
• Specialized hospital beds with all state-of-the-art medical outfits
• Central gas system (piped oxygen in all units)
• 24-hour nurse call & monitoring system
• Dietitian supported meals

3.02 ICU, CCU, NICU, PICU, CSICU, SICU

Labor and Delivery Unit

• State-of-the-art Operating Theaters
• State-of-the-art Cardiac Catheterization Lab.

3.03 Critical Care

SHL is well-aware of the inadequate critical care services in Bangladesh. The ER, ICU and CCU are exceptionally well designed to rectify this. All ambulances will be staffed with trained paramedics. Two rooms in ER are dedicated as trauma rooms. Emergency Services

• 24-hour Emergency & Trauma Services with Express TRIAGE & Resuscitation area
• Emergency Cardiac Care Specialists
• Trauma Surgery Specialists
• 24-hour Ambulance Service
• Regional Helicopter Transport Service

When a patient arrives at the ER, s/he will be seen at the ER triage area. Critical patients will immediately be sent to the area next to the triage area which is composed of 4 beds with intensive care facilities. Non-critical patients will travel to basement 1 via the lift located at the ER triage area. The lift connects the ER area to floors above where the patient can be transferred to ICU, CCU, OR and obstetric floor. This lift will not be used for any other purpose.

 3.04 Coronary Care Unit (CCU)

A coronary care unit (CCU) is a hospital ward specialized in the care of patients with heart attacks, unstable angina, heart failure and various other cardiac problems that require continuous monitoring and treatment.

3.05 Intensive Care Unit (ICU)

Intensive care unit is one in which patients requiring close monitoring and intensive care are housed for as long as needed. Our ICU contains highly technical and sophisticated monitoring devices and equipment, and the staff in this unit are educated to give critical care as needed by the patients. The ICU and CCU are designed in a way where the nurses and physicians are situated in a central position with rooms around them. Patient vitals can be monitored with a central monitor.

All hospital services are carreid out with the support of the hospital information system , especially tailored to meet the requirement of our staff and patients.

4.01 Ancillary Services

SQUARE Hospital aims to provide unparallel service to the people of Bangladesh by delivering the highest possible level of care. For this, huge investment has been made on equipment and technology. We have successfully recruited consultants from USA, UK and quality hospitals in the Middle East. About half a dozen physicians are coming from CMC, Vellore. Bangladeshi physicians with impeccable reputation are also part of the medical team. Huge emphasis has been made on quality nursing services, for which we have trained over a hundred nurses for more than a year. We have nurses’ educators from Australia, UK, India and The Philippines. Nurses and technicians have already received training from CMC Vellore and it continues to be and on-going process. Medical services will be provided as both outpatient and inpatient services as well as an Ambulance service. Dental services are also incorporated within the medical services.

4.02 Pathology:

The most up-to-date diagnostic laboratory in the country is located at SH. The laboratory is equipped with excellent analyzers. To support tumor diagnosis Flow cytometry and immunohistochemistry is being set up. Modern techniques not typically available in Bangladesh in areas such as Blood Bank and Surgical Pathology are being implemented. Examples include automated tissue processor, automated strainers, gel cards for blood bank, component preparation. Frozen section facilities will be available round the clock.

4.03 Radiology and Imaging:

In addition to all standard modern radiology equipments, SH offers two CT scanners (54-slice and 16-slice). We are thus capable of performing quality CT Angiograms. A 1.5 Tesla MRI machine is in place. Radiology also offers Bone densitometric scan, portable X-rays, ECHO and USG to meet patient requirement whenever and wherever necessary. Level 7 of the main building is dedicated to women services. This area is equipped with its own ultrasonography and mammogram. To facilitate patient diagnosis and treatment, PACS (Picture Archiving and Communication System) is in place. This enables us to store and recreate 3-dimensional images. Images can be sent anywhere in the world for second opinion. Patients may obtain images in CDs.

4.04 Diagnostic Facilities include:

• 1.5-Tesla Supercon. MRI
• 64-slice CT Scan
• 16-slice CT Scan
• Digital X-ray, BMD
• ECG, ECHO, ETT, EEG, EMG, NCV
• 24-hour Holter Monitor
• 24-hour Ambulatory BP
• Mammography
• 4D Ultrasound
• Pulmonary Function Test
• Endoscopy, Bronchoscopy, ERCP
• State-of-the-art clinical laboratory
• Home & office service

All hospital services are carried out with the support of the Hospital Information system, especially tailored to meet the requirements of our staff and patients.

5.01 Service Support Facilities

• Professional USA-standard housekeeping & cleaning services
• 24-hours pharmacy services
• Convenient & secured car parking garage
• Full-service cafeteria & snacks cafe
• Cyber corner – computer info access
• Flowers, fruits, books & gifts shop
• USA-standard safety & security system
• Prayer rooms

All hospital services are carried out with the support of the Hospital Information system, especially tailored to meet the requirements of our staff and patients.

6.01 Accommodations

6.02 Charges Include:

·      Food (As per the direction of the treating consultant. Out side food is strictly prohibited for the patient and attendants.)

·     Duty Doctors Services (RMO) and Nursing Care

·    Utility & Hospitality Services

·       House Keeping & Laundry Services

 6.03 Charges Exclude:

 Investigations, Medications, Consultations, Major hospital supplies, Procedures, Blood screening and cross matching, Daily news paper, Telephone & Others.

 Allocated Bed/Room: When patient is shifted to OT/ICU/CCU/CT-ICU/NICU/PICU/LDR, allocated bed/room of the patient will be treated as vacant and will not be available for the patient attendant.

 For any surgery package, charges of C-ARM and Harmonic Scraple are excluded. Charges will be applicable if it is used for the patient during operation.

7.01 Pathology & Lab Centre

SQUARE Hospital pathology and laboratory centre is located on the sixth floor of the main building. However outpatients sample collection rooms (phlebotomy centres) are located on the first and second floor.

We use vacuum tubes to collect blood from our outpatients and inpatients. These tubes are labeled with our customized labels which are bar coded. This ensures that patient samples are not mixed up. Samples are transported to the laboratory where all the tests are done.

Our philosophy is that we do tests which all other laboratories in the country do but we follow the best possible methodology and guidelines (i.e. we do it better) and we do some tests which is not available elsewhere.

All our reagents are stored under appropriate conditions. Expired regents are not used. All our automated analyzers are state of the art machines. Calibrations and controls are run as per international guidelines. We participate in internal and external quality assurance programmes.

We publish our results as stat, urgent or routine. Stat results are reported within half an hour and urgent results are published in two hours. Routine results whenever possible are published in four hours.

Our laboratory is operational 24 hours a day, 365 days a year. You may wish to use our services at any time of day. We also have home collection service for a small nominal fee.

7.02 BLOOD BANK

 SQUARE Hospitals aims to provide our patients with the safest possible blood, comparable to any international standard. The patient may receive blood from our blood bank stores or may receive blood obtained from donors (which are typically family or friends).

Our objective is to protect both the donor as well as the recipient of the blood.

When a donor arrives at blood bank, the individual goes through a strict screening guideline. The screening process consists of a confidential medical history, physical examination which includes checking the donor’s body weight, pulse, blood pressure and temperature. A small sample of blood is also taken from the donor to check his or her hemoglobin level. All information regarding the donor evaluation is kept strictly confidential.

We then take a sample of blood from the donor and check for certain infectious diseases. This includes screening for malaria, test for syphilis, hepatitis B (surface antigen and antibody to core antigen), hepatitis C and HIV (both antigen & antibody). We also check the donor blood group.

If the donor is of the same blood group as the potential recipient and all tests are negative the donor is asked to donate blood. This he or she does in a reclining chair in blood bank. The donor is observed for at least thirty minutes and is provided with refreshments.

SQUARE Hospitals provides whole blood as well blood components. This includes packed red cells, plasma, platelets, platelet rich plasma and cryoprecipitate.

An adult if he or she requires platelets needs four to six donors. These donors will donate whole blood from which the platelets are separated and the amount platelets obtained form four to six donors comprises of one dose of platelets for adults. This entire cumbersome process may be avoided by obtaining platelets by aphaeresis technology from a single donor. SQUARE Hospitals is equipped with appropriate platelet aphaeresis machines.

Blood donation is safe. New, sterile, disposable equipments are used at SQUARE Hospitals blood bank. If you are a healthy adult you can usually donate one bag (450 ml) of blood without endangering your health. Within 24 hours of blood donation your body replaces the lost fluid enough within several weeks; your body replaces the lost red blood cells.

8.0 SWOT Analysis of Square Hospitals Ltd

SWOT analysis is the details study of an organization’s exposure and potential in perspective of its Strength, Weakness, Opportunities and Threats. This methods uses the organization to make their existing line of performance and also focus by SWOT analysis and organization can also study their current position. For this reason, an assessment of every service  organization is required to judge the performance from aspects of its strength, Weakness, Opportunities and Threats (SOWT)

 Strengths

 Unique and defined Surgical procedure (could not be varied)
Facility that encourages movement
Up to date equipment
Less time taken (time for operation as well as for recovery is lower than industry average)
Educated and experienced and efficient surgeons (perform 600 or more operations in a yr while industry average is 25-50 ops/yr)
Lower nurse-to-patient ratio required which reduces costs
Efficient, good quality and mostly uniform service
Huge demands
Pay scale of staff higher than union scale of comparable jobs in the area
Unique training in administration which allows switching work amongst secretaries
Reasonable rates
It has a well reputation in the market

Not engaged in unfair business practice

Officers are highly Educated

All employees are friendly

Executives are highly qualified and Experienced

Working environment is very good

All time duty Doctors service (RMO) and Nursing care

Utility & Hospitality Service

As per the direction of the treating consultant  out food strictly prohibited for the patient and attendants

Patient attendant pass this pass will allow the holder to remain with the patient unless the patient is in the OT/ICU/CCU/PICU/NICU and Ward (SFU)

Children below 7 years are not allowed inside the hospital as a visiting hours.

 Weaknesses

 High backlogs of scheduled operations
Limited beds
Services are not patented

Opportunities

Can increases more branches is more attractive place

Privet hospitals becomes more reliable to public
Diversification at other locations

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get better grades

into other specialties with similar opportunities
Establish another hospital in/outside Canada
Add to capacity

  Threats

Lots of new banks are coming in the scenario with new service.

Local competitors can capture huge market share by offering similar services

In today’s economy, Depression of global economy always adversely attacked to our economy. Political unrest and terrorism has adversely effected in our economy

9.1 Conclusion

Aiming to provide global standard healthcare services locally at an affordable cost, a Tk350 crore Square Hospitals is set to go into formal operation next month.
The Square Group in affiliation with three renowned international hospitals is implementing the 300-bed tertiary-care hospital located at Panthapath in Dhaka.
These international partners are Methodist Healthcare, Memphis, Tennessee, US, Christian Medical College (CMCH),Vellore, India and Care IVE (Invitro Fertility Centre) Centre, Singapore.
“We hope we will formally launch the operation of the hospital on December 16, 2006 for the customers,” said Tapan Chowdhury, managing director of the Square Hospitals, while talking journalists on the hospital premises yesterday.

He said had the leading local investors come forward, medical services could be one of the major sectors in Bangladesh. But it did not happen because the feedback of any investment in this sector comes late.
‘Good initiative returns good recognition’–keeping this slogan in mind, the Square Group has come forward with tremendous confidence and invested Tk350 crore in construction of the hospital,” he said, adding that this is not a commercial venture of Square Group and its objective is not to merely make money.
He further said in this context that the income of the hospital would be reinvested in its development.
“I can assure you that we will provide quality medical services with an affordable cost, which will be more competitive than any internationally recognised hospital operating in Bangladesh,” the Square Hospitals MD said.
Informing that Bangladeshi people spend about Tk4000crore by taking medical services from abroad, he said,”We hope the Square Hospitals would be able to save this huge amount of money through providing services.” He, however, said Square will not compromise with quality.

The Outpatient Department (OPD) of the hospital is capable of serving 1200 patients a day through 60 fully equipped medical consultation and examination rooms. The patients will get the outdoor facilities from early morning to late evening.
The fully equipped Inpatients Department (IPD) of the Square Hospitals is also ready to provide medical services to the patients.
Coronary Care Unit (CCU), Neonatal Intensive Care Unit (NICU), Pediatric Intensive Care Unit (PICU), Cardiothoracic Intensive Care Unit (CTICU) and all other branches of IPD, usually available in an internationally recognised hospital, have also been set up at the Square Hospitals.
To ensure an international medical service from a local hospital, Square Hospitals is encouraging reputed non-resident Bangladeshi (NRB) doctors working abroad. Out of the 100 doctors, a total of 25 non-resident Bangladeshi (NRB) specialist doctors have been appointed so far in the hospital and many more are waiting to join the hospital, according to the hospital officials.
Besides, approximately 200 doctors and 380 nurses will be appointed in the Square Hospitals.

It has already appointed 150 nurses from home and abroad. For further advancement of the medical sector in Bangladesh, it has hired some nurses from the Philippines, Australia and India. Local nurses, who are already appointed, will be trained up from CMCH, Vellore, India.

The hospital comprising two buildings on either side of Panthapath is connected by an over bridge. With US fire and safety standards, the 18-storey main building has already been equipped with international standard machineries. And the 16-storey second building, which is now under construction, is expected to be operational by late 2010.

9.2 Recommendation

Based on my three months observation in the hospitals, I achieved lot of practical knowledge. During the internship period I faced some problems and based on that I state the following recommendation to the hospitals.

• They should update their hospitals software and system that ultimately result in fully automated hospitals activities to attain customer satisfaction.
• Number of employees of square hospitals should be increase.
• The billing department needs more experience staff for smooth working.
• Officials whom are involved in Customer Services should be trained properly . Because some time they cannot give proper suggestions to the customer queries. Though they try to give their best.