MEDEX

General Hospital

1- VISION:
a. Way Forward. We will lead our industry in developing and delivering the next generation of consumer-driven health care. b. Superior Quality. We will pursue breakthrough medical advancements and practices to deliver superior clinical outcomes. c. Personalized Experience. Our care will focus on our patients as individuals. We will provide every patient an experience customized to their medical, emotional, social, and spiritual needs.

2- Mission
We provide exemplary physical, emotional and spiritual care for each of our patients and their families.

We balance the continued commitment to the care of the poor and those most in need with the provision of highly specialized services to a broader community. We build a work environment where each person is valued, respected and has an opportunity for personal and professional growth. We advance excellence in health services education. We foster a culture of discovery in all of our activities and supporting exemplary health sciences research. We strengthen our relationships with universities, colleges, other hospitals, agencies and our community. We demonstrate social responsibility through the just use of our resources.

3- Philosophies and Values

Our Values represent the philosophy and beliefs of our organization, guiding all of our decisions and actions. a. Human Dignity We value each person as a unique individual with a right to be respected and accepted. b. Excellence We value quality in care, work life, education and research.

c. Compassion We value a quality of presence and caring that accepts people as they are and fosters healing and wholeness. d. Social Responsibility We value integrity and the promotion of the just use of resources entrusted to us for the enhancement of human life. e. Community of Service We value a work climate of mutual trust and harmony to enable healing, collaboration and the fulfillment of human potential. f. Pride of Achievement We value our colleagues, our work and our accomplishments and take pride in bringing our rich tradition of hope and healing to every person in our care.

4- Function of Program
Health
In Pakistan every ninth child died before his/ her 5th birth day due to Malnutrition (Imbalanced diet), (WHO survey 2009). During past three years growth rate of diseases in children is approximately 60% percent due to lack of hygienic factors & polluted atmosphere. But growth rate in hospital industry is just 15%, the reason is that there is no technological advancement in hospital industry. In private or public sector there is no single hospital is situated in Raiwind, match with our standard & caliber. So, no direct competitor is there but some indirect competitor have established their clinics and doing practices.

5- Work Flow
HOSPITAL WORKFLOW AND MATRIX STRUCTURE

i.

Workforce Doctors Physicians Medical officers (M.O) Anesthetic specialist Pharmacists Neurosurgeon Pathologists Psychiatrists

no of persons

5 10 2 14 2 2 2

Paramedic staff: Nurses Dispenser Operation thither assistant Laboratory assistant 25 15 8 4

Office Administration: Administration Accountant Human Resource Personal Procurement 10 3 3 2

Accounts Office: Accounts Staff 5

ii.

Organizational Structure Organizational Structure refers to levels of management within a hospital. Levels allow efficient management of hospital departments. The structure helps one understand the hospitals chain of command. Organizational structure varies from hospital to hospital. Large hospitals have complex organizational structures. Smaller hospitals tend to have much simpler organizational structures. Grouping of Hospital Departments within the Structure: Hospital departments are grouped in order to promote efficiency of facility. Grouping is generally done according to similarity of duties. Common Categorical Grouping: Administrative Services Informational Services Therapeutic Services Diagnostic Services Support Services Administrative Services Hospital Administrators CEO, Vice President(s), Executive Assistants, Department Heads Business people who run the hospital Oversee budgeting and finance Establish hospital policies and procedures Often perform public relation duties Informational Services Document and process information Includes: Admissions Billing & Collection Medical Records Computer Information Systems Health Education Human Resources Therapeutic Services Provides treatment to patients

Includes following departments:

Physical Therapy treatment to improve large muscle mobility Occupational Therapy treatment goal is to help patient regain fine motor skills Speech/Language Pathology identify, evaluate, treat speech/language disorders Respiratory Therapy treat patients with heart & lung disease 5. Medical Psychology concerned with mental well-being of patients 6. Social Services connect patients with community resources (financial aid, etc.) 7. Pharmacy dispense medications Dietary maintain nutritionally sound Diets for patients Sports Medicine provide rehabilitative services to athletes Nursing provide care for patients Diagnostic Services Determines the cause(s) of illness or injury Includes: Medical Laboratory studies body tissues Medical Imaging radiology, MRI, CT, Ultra Sound Emergency Medicine -provides emergency diagnoses & treatment Support Services Provides support for entire hospital Includes: i. Central Supply orders, receives, stocks & distributes equipment & supplies ii. Biomedical Technology design, build repair, medical equipment iii. Housekeeping & Maintenance maintain safe, clean environment

iii.

Organizational Chart

CEO

Physician & surgeon

Nutrition Specialist

Psychiatrist

Anesthetic specialist

Neurologist

Medical Officers

Medical Officers

Psychiatrist Assistant

Anesthetic Assistant

Medical Officers

Other Dept. Admn. Accounts

Ward Boys

Nurses

Paramedical staff

iv.

Mechanistic Structures Mechanistic

Individual specialization: Employees work separately and specialize in one task Simple integrating mechanisms: Hierarchy of authority well-defined Centralization: Decision-making kept as high as possible. Most communication is vertical. Standardization: Extensive use made of rules & Standard Operating Procedures Much written communication Informal status in org based on size of empire Organization is a network of positions, corresponding to tasks. Typically each person corresponds to one task

v.

Strategic Plan 1. Goals To provide immediate attention & medical relief to our patients. To provide them a favorable health environment. To accommodate poor and needy free of charge who cannot afford medical facilities and relief. Set 3 fully functional and equipped Operation theaters for major surgeries. Objectives: To maximize inflow and utilize resources prudently. To introduce new technologies to make services better than ever before. To provide incremental value to our patients. To protect and maintain our resources. To respond approximately whenever possible to societal expectations and environmental needs. Maintain a positive and steady growth of 15% each year. Create awareness programs to sustain better health amongst general public. Extend relief programs to people in nearby villages through mobile hospital facility.

2. Operation strategy 1. Finance Initial finance needed 46,193,025 (calculated) 47,000,000 (Required)

There is no such typical financial plan. As, we are making the feasibility report therefore; we have decided to include the prices of different equipments and 1st time salary needed for a hospital.

2. Sources of Funds
1. 2. 3. 4. 5. Student Body and personal connections Govt funding institutions and NGOs External / public awareness through social structure Corporate Involvement Direct Public input through mass media communication

We have requested for a loan of 20 million from the Punjab Medical

Association (PMA) to be paid in 20 years without interest (Approved). This debt will cover medical equipment costs, an ambulance and buildings leased cost.

vi.

Department, equipments and their prices

Building First Month salaries Operation theater equipment Laboratory equipment Office equipment Promotion City Scan Machine Equipment for rooms and wards 40,000,000 585,000 2,305,000 1,650,000 266,525 1,000,000 Credit 121,000 46193025

Total

Salaries
Doctors Physicians Medical officers (M.O) Anesthetic specialist Pharmacists Neurosurgeon Pathologists Psychiatrists Paramedic staff: Nurses Dispenser Operation thither assistant Laboratory assistant Office Administration: Administration Human Resource Personal Procurement 10x10000= 03x5000= 04x10000= 02x5000= 05x8000= 03x6000= 02x5000= 100000 15000 40000 10000 40000 18000 10000 02x30000= 04x15000= 02x15000= 02x12000= 02x40000= 01x30000= 02x20000= 60000 60000 30000 24000 80000 30000 40000

Accounts Office: Accounts Officer Accounts Staff 01x1000 03x6000 10000 18000

Total
a. Operation Theater Equipment:
Operation theater lights Operation table Anesthetic machine B.P monitor Cardiac monitor Diathermy Suction machine Oxygen cylinder Nitrous cylinder Autoclave Set of surgery instruments Total

585000

150,000/300,000/80,000/120,000/500,000/300,000/150,000/25,000/30,000/150,000/500,000/2,305,000/-

b. Equipment for Laboratory:

Colorimeter Analyzer Microscope Centrifuge machine X-ray machine Chemicals Glucose meter Total 200,000/500,000/45,000/15,000/800,000/50,000/50,000/1,650,000

c. Office Equipment:
stethoscope (10) B.P apparatus (5) 15,000/5,000/-

Thermometer (10) Laminator Otoskop Tongue depressor (10) Torch (5) Measuring tap Glucose monitor Stationary Table lamp (5) Office table (5) Office chair (5)+(50)+ (30) Toys for children Weight scale (2) Total

500/500/3,000/500/1,000/25/45,00/1,000/2,500/80,000/103,000/5,000/45,00/266,525/-

After the description of doctors list now we explain some other offices which will be compulsory for further hospital functioning. For this purpose, fist of all we describe finance office

vii.

Office Equipment:
Equipment Computer Draw Safe Table Total Cost 70,000/8,000/35,000/8,000/121,000/-

viii.

Equipment for general ward and other rooms:

Incubator Nebulizers Weight machine ECG machine Stabilizer Sucker machine Oxygen equipment Pulse oxinator Wheelchairs(3) Stature(3) Total 500,000/10,000/5,000/200,000/4,000/50,000/15,000/30,000/24,000/12,500/850,500/-

a. Fund Raising We segment our market on Income bases: Amount of finance needed to start. According to our assumptions and the rates of different things required like machinery, equipment and building for the hospital we need 50 million approximately. Amount of investments. All of the partners will provide 30 million to start the new venture. We have requested for a loan of 20 million from the Punjab Medical Association (PMA) to be paid in 20 years without interest. This debt will cover medical equipment costs, an ambulance and buildings leased cost. Statement of confidentiality of report This report is confidential and is the property of all the four partners. It is intended only for use by the persons to whom it is transmitted with the consent of all the partners. Any reproduction or divulgence of any of its contents without the prior written consent of the company is prohibited. Violation of which may lead to certain legal action. b. Budgeting and Allocation The initial finance required amounting rupees 46, 193, 025 will be allocated as per detail given below

c. Development and maintenances of account Department, equipments and their prices Building First Month salaries Operation theater equipment Laboratory equipment Office equipment Promotion City Scan Machine Equipment for rooms and wards Total 40,000,000 585,000 2,305,000 1,650,000 266,525 1,000,000 Credit 121,000 46,193,025

Hospital Equipment When any business is going to be practically implement office equipment is essential for routine work established discipline and identifications of specific designations. Similarly, in our hospital three medical departments require some particular office equipments, which will be helpful in checking of the patients while check by the doctors. The most interesting thing is that our office equipment is quite different from other manufacturing organizations. These three departments have three offices and each office should contain following equipments. All above listed materials should in every office for checking the patients because without equipment doctor is like the soldier without the weapon in war. Another thing, which we have in our mind that all the equipment should be, modernized enough in handily. After the description of doctors list now we explain some other offices, which will be compulsory for further hospital functioning. For this purpose, fist of all we describe finance office and the equipment needed for this is: Operation Theater Equipment Equipment for Laboratory Equipment for general ward and other rooms Other equipment includes Suppliers

6- Marketing
Environmental Scanning a. Situational Analysis Our city environment is very much supportive for the hospital industry. Through environmental analysis we came to know there is no direct competitor here.

i. Strengths New idea which will be highly acceptable in the market. We are the trend setters. Our relationships with suppliers are strong enough that offer credit arrangements, flexibility & response to special product requirements. Employee competency and professionalism, which are the asset of our company. Our commitment is quality to customers. We not only satisfy the customers but also build relationship with them in order to get their loyalty and better future of the company. Our unique strength is giving all medication services under one roof. Competitive advantage of first to enter in the market.

ii. Weaknesses Access to capital. Cash flow continues to be unpredictable. Lack of awareness to people. They dont have the exact concept of interior designing. People living in rural areas difficult to target All the weaknesses of a company are not the weaknesses; actually they are the opportunities for improvement in the companys functions. So by properly arability the opportunities, they would become you strengths.

iii. Opportunities Growing market with a significant percentage of our target market doesnt know about nutrition and psychiatrist services. Increase in opportunities beyond the target area of R.Y.K. By providing ambulance services to rural areas we can capture that market also. We can expand business by targeting Sukhar to Hyderabab city.

iv. Threats New Entrance of competitor High Import duty on machines can increase the cost and make direct effect on our services charging from people. Our first strategy is about the awareness of our hospital to the patients Informing those not yet aware of what Smile Child Hospital offers. We will increase the awareness among the customers through proper advertising. b. IDENTIFICATION OF STAKE HOLDERS: STAKEHOLDERS INCLUDE GENERAL PUBLIC, STAFF, STUDENT BODY, GOVERNMENT, DOCTORS, PHARMASUTICAL COMPANIES, ETC EVERYBODY CONCERNED OR BENEFIT WITH THE HOSPITAL.

Advertising through 1) Local news papers 2) Using cable network 3) www.facebook.com c. Identification of target community Our target market is from Raiwind to Kasur, because within this rang there is no standard hospital giving medication services under one roof. d. Promotion Strategy: Marketing Mix i. Product Input Process Output Sick Patient Treatment of dieses Healthy Patient

ii.

Place We believe that place is not just about distribution it is about convenience too. If the services are not available where and when people need, it will create a lot of problems for customers. The physical place which we have chosen of our Hospital is Raiwind Road because it is a most famous and well known place for all the people. Another reason for that place so most of people, although, which are not our direct competitors, are operating in that area and awareness will be created frequently.

iii.

Price Doctors Fee Consultant physician Physician Physiotherapist Ward and room charges per day Ward charges Single non AC room Singe AC room Double non AC Double AC ICU (intensive care unit) charges ITR (intensive treatment room) charges City Scan

500/500/800/200/300/500/500/900/600/800/4000/-

iv.

Promotion We will promote our Services through different types of promotions like Advertising Public relations We need one million (1,000,000) R.s for promotion.

v.

Advertising Medias: We have decided to use almost all types of advertising media because we are the new entrants in the market. So, we have to aware and educate people to come to our hospital with their children to get a better treatment with advanced technology. Circulate Hand outs Advertise through Newspapers Through Cable TV because it has made a major source of advertisement Billboards and banners

Project awareness Through: Marketing strategies. Internet search engines Face book. Circulate Hand outs Advertise through Newspapers Through Cable TV because it has made a major source of advertisement Billboards and banners

7- Administration
a. Setting employee performance slandered Performance Goals and Objectives: Statements of results and how to get there. Describes the condition that will exist when the desired outcome has been achieved. Examples include: Complete the employee orientation booklet by March 31, incorporating input from all area supervisors and preparing a content list by February 15 for review by the HR advisory committee. Learn desktop publishing techniques to produce the departmental newsletter. Complete training sessions within the next two months and produce a draft of the spring newsletter by March 1. Increase number of tests performed daily from 5 to 7. Investigate new instrumentation to improve the accuracy of testing and make recommendations to task force to purchase new instrumentation. By July 1, a new file system for survey responses will be developed and all office staff will be trained to use and understand the system. Meet with clients monthly, responding to their needs, addressing their concerns, explaining policies and assisting them with problem solving. b. Identify measurement criteria Communicate Responsibilities, Goals and Objectives By communicating performance standards, you will be able to obtain desired results/outcomes, improve an employee's performance, and develop new skills. When you do meet to discuss these expectations, standards, and goals, meet in a quiet place without interruptions and have the job description and objectives in hand. Be sure to discuss the expectations with the employee and confirm that the employee understands the tasks and responsibilities of the position. i. Meet in a quiet place without interruptions ii. Have the employee's position description as well as unit's business plan and/or objectives at the meeting iii. Talk with employee about expectations, iv. Confirm that employee understands the tasks, responsibilities of the position v. Ask the employee for comments, suggestions on performance standards vi. Finalize performance standards with employee, confirm the employee's understanding vii. Define performance standards at each level of performance, e.g., meets expectations, exceeds expectations. c. Device controlling tools (feedback)

d. Reviewing performance
During the annual review phase the staff member and supervisor should meet to discuss how well the staff member has met their work plan objectives. This is also an opportunity to consider work priorities, objectives and development plans for the next work plan. If regular progress reviews take place throughout the year, the annual review should contain no surprises for either the staff member or supervisor. The focus of the annual review meeting should be to: recognize achievements confirm what has already been discussed to date discuss what will be documented in the Performance and Development Review sections of the work plan (see below) discuss any outstanding problems review development activities undertaken Consider the work plan and development priorities for the next year.

The outcomes of the Annual Performance and Development Review discussion are recorded in the appropriate sections of the work plan and should include: comments about how the agreed objectives were met comments about development and support activities undertaken an overall comment and rating on performance in relation to the agreed objectives set out in the work plan Certifications and space for supervisors to make recommendations about incremental progression or performance pay where applicable.

e. Time frame: (Example) In this we have to review that the work in progress is being done according to the specific time frame already specified in the standard operating procedure. For and example we would check interval the pace of work and targets being achieved within time. f. Responsible person In this Order responsible person means a) in relation to a workplace, the employer, if the workplace is to any extent under his control; b) in relation to any premises not falling within paragraph (a)-i. the person who has control of the premises (as occupier or otherwise) in connection with the carrying on by him of a trade, business or other undertaking (for profit or not); or

ii.

the owner, where the person in control of the premises does not have control in connection with the carrying on by that person of a trade, business or other undertaking

g. Reinforcements (Rewards and Award) Reinforcement means praise, rewards, certification or other official recognition of learning, and other positive feedback. For example giving students feedback on whether they have learned effectively is reinforcement. This is sometimes called knowledge of results. So a reasonable mark in a quiz or test is reinforcement, so is ticking off a task or competence. We have awarded our best team leaders and team members many cash rewards for best performance and honorarium per annum and Additional increments and Bonuses etc. h. Resources Required

Administrative personal Logistics Mobilization resource Etc add more

i. Schedule of activities
2011 SCHEDULE OF ACTIVITIES

MONTH JANUARY

DATE 23 (Sat) Valdes Hall, VMM

FEBRUARY

18 (Thurs) Rm 1 SMX 19 (Fri) SMX 20 (Sat) SMX 23 (Tue) 25 (Thurs) Saturdays 26 (Fri) 26 (Fri) Perpetual Succour Hospital 27 (Sat) UST

MARCH

ACTIVITY 1 scientific meeting Radiation Protection and Physics Freshmen Orientation Night RTC Annual Meeting, Fellowship Night Induction of Subspecialty & Chapter Officers PCR Business Meeting Battle of the Brains / Research Contest Induction Night PCR-RSNA Workshop in Cebu PCR-RSNA Workshop in Fontana BLS / ACLS workshops Deadline of scientific papers for those taking PBR exams Residents Case Discussion: Visayas Northern Mindanao Chapter PROS scientific meeting
st

28 (Sun) APRIL 9 to 11 (Fri to Sun) 9 to 11 (Fri to Sun) Amorita Resort, Bohol 17 (Sat) 24 to 25 (Sat to Sun) 30 (Fri) Cebu Doctors University Hospital 30 to May 2 MAY 3 (Mon) 18 to 24 22 (Sat) SLMC 28 (Fri) 30 (Sun) 21 (Mon) UP-PGH 25 (Fri) 25 (Fri) Perpetual Succour Hospital 26 (Sat) No date yet 24 (Sat) JRMMC 25 (Sun) 30 (Fri) Chong Hua Hospital No date yet 14 (Sat) 27 (Fri) No date yet 13 (Mon) UP-PGH 13 (Mon)

1st in service exam (PARP & Pediatric Radiology) BISP Meeting: Essentials of Breast Imaging PROS Midyear Convention: Quality Assurance in Radiation Oncology 2nd scientific meeting Cardio & Pulmo & Pediatric Radio Trainors Training Workshop Scientific Meeting PIMS, Islamabad Chapter CT-MRI Teaching Seminar Summer Workshop Deadline for submitting requirements for RTC clearance for PBR 1 PMA Annual Convention PROS scientific meeting Consultants Lecture & 2ndQuarterly Meeting of MEDEX Officers 2nd in-service examination (CVS & Pulmo) CT-MRI 1st scientific meeting Deadline for scientific papers of FPCR applicants Residents Journal Report MEDEX Chapter 3rd Scientific meeting (GUT & Womens Imaging & Pediatric Radiology) Research Workshop 1 PROS scientific meeting 3rd in-service examination (GUT & Womens Imaging) Residents Case Presentation MEDEX Chapter Research Workshop 2 4th scientific meeting (GIT & MSK & Pediatric Radiology) Consultants Lecture & 3rd Quarterly Meeting of MEDEX Officers Research Workshop 3 CT-MRI 2nd scientific meeting Deadline for submitting requirements for RTC clearance for PBR II & III

JUNE

JULY

AUGUST

SEPTEMBER

24 (Fri) 25 (Sat) CSMC 26 (Sun) No date yet 21 to 23 (Thurs to Sat) 23 (Sat) 29 (Fri) 29 (Fri) Cebu Doctors University Hospital No date yet NOVEMBER 21 (Sun) 26 (Fri) 27 (Sat) MMC No date yet 4 (Sat) 18 (Sat)

OCTOBER

Residents Research Presentation MEDEX Chapter PROS scientific meeting 4th in service examination (GIT & MSK Radiology) Research Workshop 4 CT-MRI-USP Convention 5th scientific meeting (ENT & Neuro & Pediatric Radiology) Deadline for submission of all requirements for FPCR status Residents Journal Report MEDEX Chapter Research Workshop 5 5th in service examination (Neuro & H&N Radiology) Consultants Lecture & Last Quarterly Meeting of MEDEX officers PROS scientific meeting Research Workshop 6 Eliminations for Battle of the Brains & RTC Eid ul Fittar Party Eid ul Fittar Party of MEDEX Chapter

DECEMBER

j. Develop policies and procedures

POLICY Johns Hopkins Health System Corporation (JHHSC) and The Johns Hopkins Hospital (JHH) are committed to establishing standards of conduct in the workplace. This policy sets guidelines and procedures for maintaining these standards of conduct, congenial working conditions and employee safety. It is the policy of MEDEX that such standards are enforced in a consistent and equitable manner to promote operating efficiency and optimum patient care. MEDEX expects every employee to observe basic rules of good conduct. It is important that employees understand these standards of conduct and the consequences. Disciplinary action taken under this Policy is to: 1. Inform employees of behavior or conduct that is considered inappropriate and/or does not meet departmental standards or expectations. 2. Allow employees to correct such behavior and bring performance to an acceptable level. This policy is a tool for use in managing the behavior of all employees. Standardization and consistency are necessary, but good judgment and common sense are also vital to

the success of the program. While the techniques and tools should be consistent, the treatment of people must continue on an individual basis. PROGRESSIVE DISCIPLINE STEPS Pre-disciplinary Counseling: Pre-disciplinary counseling is a corrective discussion between the employee and the supervisor regarding the employees failure to meet performance standards, service standards, and expectations. During this discussion an attempt is made to identify the cause of the problem and prevent recurrence of the undesirable behavior. Documentation of counseling permanently becomes part of the employees file. Written Reprimand: A written reprimand is a written notice to an employee regarding the employees failure to meet performance standards, service standards and expectations. It will include a discussion of the behavior or performance at issue, expectations for improvement, and a timetable for making corrections. A follow-up date to review the situation will also be included. An employees failure to comply with the terms of a written reprimand will result in progressive disciplinary action. A written reprimand remains active for one (1) year and becomes a permanent part of the employees file. Written Warning with Decision-Making Leave: A written warning is notice with one-day suspension. Upon return to duty, management will meet with the employee to discuss and/or clarify the work plan. A work plan is a written document (or verbal discussion which is documented) that outlines action steps an employee will take to address the unacceptable behaviors identified by management. Management has the responsibility to specify outcomes should the Work Plan not be followed. A written warning with decision making leave remains active for one (1) year and becomes a permanent part of the employees file. Suspension Pending Discharge: The time period for management to investigate an apparent violation. The outcome of the investigation will be termination or return to work. If the determination is that no disciplinary action is required, the employees pay will be restored. Managers should prepare and review complete documentation with an HR Consultant. NOTE: An exempt employee will be paid during suspension pending discharge pursuant to Fair Labor Standards Act. Discharge (Involuntary Termination) Discharge is the most serious disciplinary action imposed. It is used for violation of Critical rules which are considered Critical violations or because of cumulative/progressive discipline. CORRECTIVE ACTION RULES FOR MINOR, MAJOR, AND CRITICAL RULES 1. Minor Violations

Minor Violations normally warrant pre-disciplinary counseling on the first offense. Listed below are examples (not all inclusive) of minor violations. Accepting money from patients or family members, or engaging in the unauthorized sale of services, merchandise, raffle tickets, lotteries, etc Unauthorized use of nourishments or food intended for patient use Unauthorized absence from an assigned work area, less than one (1) hour Failure to complete required time records, or sign in or out of work area where required Unauthorized or inappropriate use of the telephone, computer, E-mail, voice mail, fax or other office/business equipment Negligent use of property resulting in damage or loss Failure to follow MEDEX department, division, unit standards, and infectious control policies covering personal hygiene, grooming standards, and standards regarding the wearing of uniforms and/or scrubs. Unsatisfactory job performance, or otherwise not performing to standards Returning to or remaining on the premises during non-working time, except to conduct business or seek medical care Unauthorized solicitation or distribution of material on the premises during work time, or in patient care areas during non-working time Presence in an unauthorized area Failure to call in an absence or tardiness according to departmental procedures Unwelcome, intimidating or harassing comments, remarks, conduct or gestures creating an unfavorable hostile working environment Engaging in rude or discourteous behavior Failure to produce professional license renewal in a timely mane

2. Major Violations Major Violations normally warrant written/decision-making leave on the first offense Listed below are examples (not all inclusive) of major violations: Soliciting gifts or money from patients or family members. Failure or refusal to perform assigned duties or carry out instructions or engaging on any activity detrimental to the operations of JHHSC/JHH. Violation of posted safety, security, health, or fire prevention rule, or otherwise causing a safety hazard or failure to report an unsafe condition existing on the premises. Engaging in disruptive, unprofessional or inappropriate behavior while on the premises, including but not limited to using profane and abusive language, gambling, horseplay, practical joking, name-calling, yelling, arguing loudly in a public area, etc. Harassment/Discrimination including advances verbal and/or physical conduct, with regard to all applicable laws covering JHHSC/JHHs EEO/AA Policies, when submission or rejection of such harassment is used as a basis for employment decisions, or where such harassment has the purpose or effect of interfering with an employees work performance or creating an intimidating, hostile or offensive work environment.

 Reporting to work while under the influence of any intoxicant, hallucinogenic, or narcotic or where the presence of any such agent can be established by a for cause drug test under the Substance Abuse Policy. Unauthorized absence from an assigned work area more than one (1) hour Unauthorized use of property 3. Critical Violations Critical Violations normally warrant immediate discharge or suspension pending discharge on the first offense. Listed below are examples (not all inclusive) of critical violations. Deliberate inattention to patient care, or engaging in any conduct detrimental to patient care, or the safety and security of patients, employees, or visitors. Unauthorized possession of a deadly weapon on the premises Smoking in non-designated areas Theft of property, or willfully causing damage to, waste of, or loss of property Falsification of records, alterations of documents, and any fraudulent activities relating to MEDEX business Fighting, issuing threats or verbal abuse, or other disorderly conduct on the premises, or while otherwise engaged in MEDEX business Failure to submit to a required fitness for duty examination, including testing for drugs or alcohol. Job abandonmentNo longer covered by this policy. Please refer to HR608 Separation. Violation of Security Access - Patient Information Policy or deliberately releasing confidential information covering Hopkins business, patient information, employee information, etc. Unauthorized possession or use of an intoxicant, hallucinogenic, or narcotic while on the premises A criminal complaint, arrest, indictment, or conviction of an employee for alleged unlawful activity may result in a suspension pending an investigation or discharge, depending upon, for example, the alleged seriousness of the act, or the jobrelatedness, and the evidence supporting the allegation(s). Failure to notify management regarding criminal complaint, arrest, or convictions that Occur during the course of employment. Important to Note: HR Consultants will have the responsibility to assist management in the evaluation of allegations of a criminal complaint, arrest, indictment or conviction as described above, in partnership with Corporate Security Department, to recommend, on a case-by-case basis, whether suspension and/or disciplinary action, up to and including discharge, should occur. 4. Disruptive Conduct Conduct by an employee that intimidates others to the extent that quality and safety could be compromised cannot be accepted or tolerated. Such conduct may be verbal or nonverbal, may involve the use of rude language, may be threatening, or may involve

physical contact. Any behavior that interferes with the ability of others to carry out their duties or that undermine a patients confidence in the organization may be considered disruptive. Discipline appropriate to the actual conduct or actions will be applied in accordance with this policy. Cumulative Violations Subsequent violations generally will move to the next step in the discipline process (e.g., Written Reprimand will be followed by a Written Warning with Decision Making Leave which will be followed by Discharge if violations continue). Examples of cumulative actions are as follows: MINOR VIOLATION Failure to Follow Dept Rule Presence in Unauthorized Area Failure to Follow Dept Rule Unsatisfactory Performance Unsatisfactory Performance Presence in Unauthorized Area ACTION ISSUED Pre-disciplinary counseling Counseling Written Reprimand Counseling Written Warning with Decision Making Leave Suspension Pending Discharge DATE 12.01.2011 15.01.2011 18.02.2011 07.03.2011 02.04.2011 30.04.2011

Multiple Violations of Minor, Major or Critical Levels PREVIOUS ACTION Written Reprimand for a Minor Rule Violation + + NEXT VIOLATION Written Reprimand for a Minor Rule Violation (for which counseling has been issued) Written Reprimand for a Minor Rule Violation + Critical Rule Violation (Suspension pending discharge, if warranted Decision Making Leave for a Major Rule Violation = = OUTCOME Written Warning with Decision Making Leave Discharge

Decision Making Leave for a Major Rule Violation Written Reprimand for a Minor Rule Violation Decision Making Leave for a Major Rule Violation

Discharge

Discharge

For any combination of violations disciplinary action will be taken in the following manner (all actions for minor violations are to be preceded with counseling): RESPONSIBILITIES Supervisor: The supervisor is responsible for the ongoing communications with employees under their supervision regarding standards of conduct and enforcing MEDEX rules and

regulations and for the handling of any disciplinary action that may be required. The supervisor has the responsibility to accurately document and issue discipline in a timely manner on the proper forms. HR Consultants should be contacted for assistance. Copies of all disciplinary action that is issued must be sent to the Office of HR Consultants and Labor Relations and the HR Service Center immediately (within 24 hours of the issuing of the action).

Employee The employee is responsible for understanding and following all rules of conduct of MEDEX which are outlined in this policy. (Also see the Employee Handbook) PROCEDURES Please note that completed copies of paperwork should be distributed as follows: Original - HR Service Center 2nd copy - to the Office of HR Consultants and Labor Relations 3rd copy - Department Head 4th copy Employee

Pre-disciplinary counseling Before taking formal disciplinary action for violation of a Minor rule, the employee should be afford corrective and/or developmental counseling. It is recommended that employees be provided with a written copy of corrective developmental recommendations. The counseling should be documented on the Disciplinary Action Tracking Form (See Attachment 1) for departmental uses only. The Disciplinary Action Report (See Attachment 2) should also be filled out. Employees signature is not required for counseling. NOTE: There must be a documented counseling for the initial violation of each Minor Rule. Written Reprimand A written reprimand will remain active for one (1) year; however, the documentation will not be removed from the employees file. Written Warning with Decision Making Leave A Written Warning with Decision Making Leave will remain active for one (1) year; however, documentation will not be removed from the employees file. If sufficient improvement has not occurred at the time of the follow-up meeting, the supervisor can put the employee in the next step of discipline.

Suspension Pending Discharge Before any suspension pending discharge, Office of HR Consulting and Labor Relations is to review the proposed action. NOTE: An exempt employee will be paid during suspension pending discharge, pursuant to the Fair. Labor Standard Act. Discharge Before any discharge, the proposed action must have the approval of the Office of Employee/Labor Relations before it becomes final. REVIEW CYCLE 3 Years