THE IMPACT OF TQM IN HEALTHCARE

History

The journey of Jinnah Postgraduate Medical Center (JPMC) began in 1930 in Medicinal
Corps Doctor's facility, implied for restorative guide to military staff only. In 1942 it was re-
named as the British General Healing facility and stayed thusly till 1947; a 100 bedded
hospital with all fundamental essential facilities. After the creation of Pakistan in 1947, the
father of the nation, Quaid-e-Azam Muhammad Ali Jinnah was requested to grant approval to
lend his name to the hospital, which he graciously accorded, with the condition that it be
opened for the public. Thus the Medical Corps Hospital/British General Hospital was named
as Jinnah Central Hospital (JCH). In 1952, Dow Medical college (DMC) was connected with
JCH. In August 1954 the National assembly of Pakistan authorized the basic medical sciences
institute (BMSI) as essential sciences training was regarded urgent to building up a middle
for higher medical education. After its underlying foundation at DMC, Karachi, the
government of Pakistan changed the site for the improvement of BMSI to a building arranged
at the site of JCH .

Introduction

The opening ceremony was a grand affair. The first class of students was inducted on
1st June, 1959. In 1963, the amalgamation of BMSI and all units of JCH led to the creation of
JPMC with the combined administration headed by a Director. JPMC, accordingly settled,
contained a cluster of buildings spread more than 148 acres . The prime reason for this
institution, in addition to treating patients, ended up plainly higher medical education,
training and research. The JPMC is an open healing facility. The healing centre was set up in
1959. First and foremost the doctor's facility worked in a building, which was really an armed
force sleeping shelter built in 1865 and exchanged to the Jinnah Postgraduate medical Center
in 1959. JPMC is ostensibly Pakistan's biggest doctor's facility. It has large number of wards
and the doctors are proficient. Thereafter, with the passage of time, more buildings were
constructed to cater to the growing needs of various evolving specialties. It can now proudly
claim to be the biggest and the best equipped public sector hospital in Pakistan, employing
highly qualified staff in numerous specialties, ready to render quality health care services to
the ailing. Simultaneously, JPMC also imparts high quality to training to medical graduates,
nurses and professionals and embraces important research in clinical and fundamental
medical sciences.
JPMC Mission

Improve education and healthcare in Pakistan by imparting quality education and

care.
Promotion of research and generation of knowledge and skill development.
Provide quality healthcare to all irrespective of ability to pay.
Explore avenues for resource generation.

Aims and Objectives:

The aim of working on this research topic is to:
Get the knowledge of practical application of 5s and learn how this Japanese Concept is
implemented in well known Hospital & Jinnah Hospital with an objective to make
recommendations for further improvements.
Investigate and understand the benefits 5s housekeeping applications.
Deep Knowledge of TOTAL QUALITY MANAGEMENT and its concepts that how
high quality methods can be embed in different systems of the work place.

About 5s Housekeeping Application

PLACE FOR EVERYTHING & EVERYTHING IN ITSPLACE.

Housekeeping does not mean only cleanliness, it means much more than only cleanliness. good housekeeping
implies neatness, cleanliness and Good housekeeping advances Quality, Safety, Productivity and Clean condition.
Good housekeeping guarantees that there is a place for everything which implies that the organization has stock of
each required thing and can dispose of undesirable material, having low unneeded stock at last means lesser cost.
Good housekeeping also helps in ensuring that everything is in its place which results indiscipline and
identification system in the department and ultimately eliminates searching time with improved
productivity and high moral. 5s is a systematic approach towards housekeeping. The concept of good
housekeeping has been with Japanese for a very long time. It was only in 1980s that good
housekeeping turned into an applicable issue in Japanese industries, as organizations understood
its effective commitment to efficiency and quality improvement. The reason for good
housekeeping in Japanese organizations is an idea prominently known as 5s. This stands for five
good housekeeping ideas in Japanese.

Concept of 5S:

1. Sorting/segregating (Sort Out The Item and Discard The Unwanted)

2. Self Arrangement/arranging (Place for Everything)
3. Spic and Span (Neat and Clean)
4. Standardization (Maintain High Standards of Housekeeping at Workplace at
all Times)
5. Self-Discipline (Train People to Follow Good Housekeeping Discipline).

5s on JPMC (Private Wing)

JPMC implements 5s housekeeping by constituting and altering the ideas of 5s. The
housekeeping at JPMC does not straightforwardly take after the means of 5s housekeeping,
but rather their system falls under the umbrella of 5s housekeeping. As the idea is Japanese
and any is somewhat new in Pakistani condition, henceforth idea is similarly hard to apply
with its creativity. Thusly, JPMC has made certain changes as per the local culture and
environment through meeting the accompanying housekeeping application at JPMC has been
highlighted:

1: Sorting/SEIRI
The housekeeping department at JPMC has more than 1000 employees as it's isolated into
different divisions of departments. They are scheduled into three shifts. They are then
arranged, implying that the specialist is designated for cleaning of a specific place, he/she
needs to clean a similar place same time each day. This keeps the specialists from not
finishing their undertaking and abandoning it for others to finish.
There are three sorts of ward at JPMC, the General ward, Semi-private ward, and Isolation
wards

General ward
The Mobs and dusters utilized as a part of general ward are cleaned and reused.
Semi-private ward
Hordes utilized as a part of SEMI PRIVATE WARD are likewise cleaned and resused.ward
Private
All Mobs and dusters utilized as a part of this ward are not re-utilized rather they are burned.
as confinement ward has basic patient So to keep germs from spreading they are burned.

Red bags
JPMC never discards these red sacks in the customary route, so as to maintain a strategic
distance from their re utilize and reusing, these packs are copied out at JPMC encasings.
According to MR.Deedar JPMC as of late outsourced contamination free separator from
France. Both green and blue sacks are additionally stuffed in the containers and given to the contractors to
dispose of. The material being squandered after chemography and radiology are held for up to 3-4 months in
the healing center and afterward a group is being outsourced from abroad to discard this waste. Apart from all
exercises of housekeeping, there is an extraordinary movement at JPMC known as PROJECTWORK. It
is periodical, done each Friday. It incorporates, shampooing, cleaning and cleaning.

2. Spic and Span/SEISO

JPMC is a standout amongst other healing facilities in Pakistan for its neatness and
cleanliness condition.

View of JPMCHospital entrance, which seems to be absolutely spotless and green.

The thought behind influencing the healing centers to clean is to improve the patients
feel as they advance in the clinic. We can state that third step of 5s that is sieso
(Clean) is followed in its actual sense in the JPMCHospital.

JPMC gives most extreme significance to tidiness and cleanliness. As the turnover of
patient day by day is 125-130, hence, at whatever point a patient is released, the bed
sheets, the sleeping cushion and the bed is cleaned. It is then cleanly prepared for the
following patient.

The disinfectants and sanitizers are appropriately tried and after that utilized for
cleaning. JPMC utilizes Sodium Hypo chloride as disinfectant, which is provided by
Sitara Chemicals in Faisalabad. The level of chlorine ought to be 5-7 in this
compound. The Inspection ControlTeam keeps up the record and is in charge of this.
 For cleaning of the floor fig.7 indicated process is utilized. This must be utilized with
extraordinary careas it can ruin dress, materials, however it is the best disinfectant.

4: Standerdization/SEIKETSU
To keep up exclusive expectations of housekeeping at work environment consistently JPMC
has a 7 stage cleaning technique as takes after

1.High cleaning

2.Sanitation

3.Dry Mop

4.Wet Mop

5.Machine utilization

6.Shampooing of floor

7.Self cleaning

Instruct Train Sustain

For supporting the accepted procedures of institutionalization in housekeeping, JPMC has

dispensed time to specialists to finish their undertaking on time. A standard is additionally
kept up with the weakened disinfectant that is it can't be utilized following 24 hours of its
weakening. This is done to accomplish greatest adequacy of the disinfectant. Short out
cameras are utilized to investigate and defeated the issue of burglary.

5: Sustain/SHITSUKE
To keep up and manage great housekeeping administrations, the housekeeping staff at JPMC
at its commencement was prepared by SERVIVE MASTER COMPANY, which is a standout
amongst other Chicago, based Service Company. They were talented with best
administrations of house keeping which has driven JPMC to a standard.
The administration of housekeeping trusts that it is their obligation to first practice the
housekeeping application themselves, which will set the case for whatever is left of the
laborers to take after the same, generally the specialists exploit this.

At the point when new employyes are named, they are prepared and afterward assigned
determined work. The specialists are trained and it is apparent from the way that 35 laborers
play out their assignment during the evening without boss.

Analysis of Application of 5s at Jinnah Hospital (Government Wing)

Jinnah Hospital Karachi needs utilization of 5s housekeeping. Notwithstanding the
way that it is a standout amongst the most settled and government asserted specialist's
office, still it has no proper housekeeping application system, affecting it to depict a
lamentable vibe
Jinnah Hospital depend intensely on the conventional housekeeping practices of
cleaning the healing facility day by day, now and then once in a while, that is at
whatever point there is assessment from any administration official the clinic is made
spic and traverse, and may even sparkle. Be that as it may, this affability of neatness
isn't kept up by the housekeeping office at Jinnah.

There is no arranging of the laborers and their task, no planning, which gives the
specialist high ground to influence their own wills of doing to or not doing work.

The emergency department, patient wards, patient beds, floors, walls, corners etc. all
are unclean either with dust, or other littering material. This makes the hospital an
unhygienic and unhealthy place, or one might say the hospital deviates from its
purpose of providing health facilities at their best.
It has been well said that benchmarks go before from upper management, the house keeping
management at Jinnah Hospital needs enthusiasm for keeping up a legitimate framework and
guaranteeing that it is being done at all levels, accordingly making the clinic wasteful in
giving quality administrations to its clients.
EFFECTIVENESS OF 5S IN JINNAH HOSPITAL KARACHI

5s has effectively contributed towards hospitals management in their smooth running. It has made the work of
doctors much easier, rather made their work mistake proof like Aga khan has made wonderful
contribution towards implementation of 5s in its hospital and trying to improve as much as it
can. The extent to which they are implementing is reflected as we visit the hospital, totally green, clean
and clear, everything looks to be in its place. Whereas the case seems to be totally different, when you
visit Jinnah hospital in which most of peoples access is easy because of it low cost. Any crisis
instance of this metropolitan city is dealt with by Jinnah hospital, where everything ought to
be of guidelines of well being control, however it isn't so. There you will discover polluted
condition, no indication of neatness and everything messy. We have gathered distinctive
pictures from various sources to safeguard above said reality.
A Glance at Jinnah Hospital
As it is said prevention is more than cure, but here at Jinnah hospital it seems to be untrue. Patients
are welcomed by different diseases borne from this water. This stagnant water is the best place for the
mosquitos growth as well as different diseases also arises from here.
This shows the care for the patient in the Jinnah Hospital. It is one of the rooms beside the ward that is
full of sewerage water allowing the germs to grow .and the state of building of Jinnah hospital where
patients stay. The building infrastructure is too weak and hazardous for the patients to stay over there.
Jinnah hospital Condition where there is no dustbin and everywhere rappers are lying a if
there is no swapper. A window at Jinnah Hospital from where fresh air comes in. and Jinnah hospital
Karachi showing dis-composed perspective of operation. Nature of Jinnah Hospital
unmistakably there is no understanding of 5s in this clinic. The environment is absolutely
dangerous for the wellbeing of patients that is the reason Jinnah Hospital has lost its character
in giving quality support of its patients..

Conclusion
Jinnah hospital Karachi alot of improvement is needed and that is not possible without
government intervention being a cheaper hospital, mostly lower-class patients are admitted to
this hospital, they are treated very rudely by the staff and no standardized procedures are
followed for proper cleaning unlike Aga khan their staff of is very co-operative and very
well educated which add one more attribute to their excellence. The implementation of 5s at
Jinnah hospital is an awesome test for the legislature of Pakistan

St

RECOMMENDATIONS:
We suggest following recommendations for Jinnah Hospital to improve and overcome their
problems

Jinnah hospital needs to implement the housekeeping concept, since the people
working at the hospital do not even know the basic activities that are carried out by
housekeeping staff, so proper training must be provided to the staff. Even though
outsourcing is an option available for housekeeping.
Jinnah hospital does not even have a hygienic waiting area, all the patients (including
even those who were infected with chronicle diseases) sit in the same waiting area,
where the probability of disease catching is very high. So proper tidiness of holding
up zone and separate sitting tight territory for patients with account ailments is
required.
The administration must take measures for general tidiness, guaranteeing support
of the building and its framework, linen administration, waste management , pest
control, disease control, wellbeing and security of the patients in this doctor's facility.