QUESTIONNAIRE

Information flow and Patient flow in the Hospitals and Clinics

General Organization:

What type of Health Care Service is this? (Governmental, NGO, private, etc)
# Of in-patient beds
- Fixed
- Movable
Where do you get the money to run the facility?
What % of your money comes from each of the about sources?
What type of services/departments do you have available?
Do you have an organizational set-up (chart)?
Who does the director of this clinic report to?
Do you have separate locations for processing patients for each department?
(Does this require patients to fill out separate forms and give additional information?)
Do you have a separate accounting/financial office?

General Staffing:

Do you feel that your facilities are Overcrowded/ Underutilized?
In what way do you feel that they are?
What services do you think most overused?
What services do you think most underused?
Does the number of patients admitted ever exceed total capacity?
How do you insure that the physicians and nurses are properly certified and trained?

Information collecting systems:

What type of “information” collecting system do you have?
What type of “data” do you collect?
Do you use any computers in the facility?
What type of computers?
What is being done with the computers?
Do you think that if you were able to have more computers and had the people trained to use them, it would make the hospital more efficient?
What jobs do you think that computers can do that could improve the efficiency and management of the clinic?
What Information do your “directors” require?
Do your sources require you to develop a budget?
- For drugs?
- For supplies?
- For supplies?
- Maintenance?
- Salary and benefits?
Do your sources review how your money was spent at the end of the budget period?
- Informally?
- Weekly?
- Monthly?
- Yearly?
What happens if you are over-budget?
What happens to the money when you are under-budget?
What types of financial audits do you have?
Do you have internal audits ?
What types of internal audits do you have?
What information do you report to the government?
Is this information difficult for you to gather?
How do you collect this information to report to the government?
Do you have written procedure manuals?
How do you insure that all people know the procedures and are trained?
Where do you hired the “computer people/accounting people”
Do you use the World Bank ICD-9 codes for diagnosis for diseases?
How do “you” classify your diseases? (What “types” of diseases) do you keep?
Do you report them as separate items on any reports?
Do you keep medical records on each patient?
What information do you keep on each patient?
Do you assign “patient numbers” to each patient
How do you keep this information?
If the patient returns to he clinic, do you pull his records out to see why he has been in the clinic before?
Do you have standards for treatments of different type of diagnoses?
How were these standards developed?
How/Where are these standards available for use?
How do you monitor the physicians to make sure that they are using the standards?
Is there a medical audit of the patients records?
How do you control the physician, nurses, and other personal to be sure that they are working and not being paid for work when they are not working.
Do you have a way to measure your quality of care compared to the other clinics
How do you measure this quality of care?

Information and control of supplies and equipment

What information do you keep on employees? (absenteeism, overtime, job performance reviews,etc)
How do you collect this information on employees?
It there written job descriptions for each employee?
How do you control your inventory of drugs and supplies?
Do you ever have a shortage of drugs?
Do you ever have a shortage of supplies?
Do you feel that theft of drugs and supplies are a problem?
Do you have an equipment maintenance schedule?
Do you have frequent equipment failures?

Out-Patient Clinic Patient Flow (information):

What are the Out Patient Clinic Hours?
Is there a difference between the female and male clinic?
What types of difference are there between the female and male clinic?
How many Physicians Attending?
How many Nurses Attending ?
How many Paramedical Attending?
Number of Patients usually seen in a day (by age, gender, "Problem")
How would you classify the severity of your patients on the average on a scale of 0-10 with 10 being the most severe?
Is the number of patients seen different by month?
Your slowest months?
Your busy months?
Do you bring in more workers during busy months?
Where do you get these workers?
How many persons do you have at “Check In”?
Do you bring in more persons to help at the Check-in when it gets busy
What information do you collect at Check-In ?
Who gets this information you collect at “Check-In”?
If you wanted to make your “Check-In” system better, how would you do it?
Are certain patients not admitted?
Are patients classified?
How are patients classified?
Are some patients seen faster than others (are patients prioritized)?
For what reasons are some patients seen before others?
Can a patient make an appointment with a certain physician and be seen at a specific time?
Do you schedule diagnostic and therapeutic care in advance?
Does a physician see all patients?
Who makes the clinical diagnosis? (Physician, Nurse, Paramedical)?
If not seen by a Physician, Who sees the patient?
What are the patients most common complaints?
Do you provide Education when the patients are here in the clinic?
- Hygiene
- Family Planning

Do you include “discharge” teaching ?
What type of treatments are most commonly provided in the outpatient clinic?
Do you calculate the cost of the medical services for different types of out-patient services?
How do you calculate the cost of patient care?
How long do patients wait in the waiting room before they are seen?

Emergency Room Procedures

In-Patient Admission Procedures and Information:

Is there a separate location for admitting patients in “out vs in” patients
How do you determine who is admitted to the hospital?
How do you transfer a patient from one department to another in the clinic?
What information is collected at admission?
Who decides on the Admission Requirements?
What type of Inpatient Services can you offer?
How Many Departments in in-patient services Departments:
Number of Physicians Attending the In-Patient
Number of Patients admitted in a day
- Average age
- Ratio of males/females
What are the Common Health Conditions/Illnesses of Patients for which you admit patients?
Are there any reasons for you not to admit patients?
Are there any reasons for you to admit patients?

Special Studies

Fees:

How much do you charge and how is the fee schedule structured?
What Type of payment do you receive?
For what services:
For how long: (per diem, per visit)
Are the physicians collecting “private fees”?
How are these “private fees” being collected?
How much?
By all Physician or just some?
How did you let the people know the fee structure?
Do you think that certain individuals should be exempt from paying the fees?
Who is responsible for allowing the exemptions?
What is your criterion for exemptions?
How do you think the poor can be taught that there will be an exemption for them?
How do you provide training of personal for administration of fee collecting system?
What is your method for adjustment of fee increases?
How do you controls for theft, fraud, and uneven enforcement of exemption rules?
What special equipment and supplies do you use in the collection of fees?
Do you think that it cost extra money to collect these fees?
What extra expenses do you incur to collect these fees?
Do you have to hire help to collect the fees?
Does it take more time to process a patient to get him/her into the clinic if you have a fee?
What do you do when it gets very busy at “check in.”? Do you ask for additional personal to come from other departments?
Do physicians stay longer when the number of patients is higher than normal?
Do physicians reduce the time spent with a patient to deal with many patients?
What do physicians do when it is slow and there are not many patients?
Were the patients coming into the hospital sicker after the charging fees then before the charging of fees?
Did this change the flow pattern of the patients into the clinic?
How will these fees be used?
Will they be maintained here at the clinic?
Do you think that better quality of medical care can be provided if uses are charged fees?
How will this improvement come about?
Do you think that the government donors will continue to provide you the same amount of funds if you start to raise your own funds through user fees?
How do you think the fees where received by each of the following group:
Consumer acceptability
Acceptability to professional organizations
Politically acceptable
What would the fund providers do if the number of patients go down.

Referral

Is there any system for referral of patients to other hospitals in your area?
Do you use this system?
What is the policy for transfer of patients to other hospitals?
What reasons for which you transfer patients to other hospitals?
What types of follow up system do you have for people who are referred
to another facility?

MISC

Do you have a disaster plan in case of floods, cyclones, etc,
Do you have a system for in-house infection control?
Is there a record kept of the “cases” of hospital infections?
Do you schedule diagnostic and therapeutic care in advance
If you wanted to make your “Check-In” system better, how would you do it?

OBSERVATIONS:

Time to process patients
Entry system
Flow Chart "Check In"
Admission Area

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