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D.S. Shepard, D. Hodgkin and Y.E. Anthony
Analysis of Hospital Costs: A Manual for Managers
A practical guide to the principles and methods of cost analysis as a managerial tool for improving the efficiency of hospitals. Addressed to managers and administrators, the manual aims to equip its readers with the knowledge and skills needed to calculate the costs of different activities or departments, analyse their significance, and use this information to manage resources wisely. Throughout, recommendations and advice are specific to the different purposes of cost analysis and the different types of decisions commonly facing managers.
The manual, which is intended for use as a training tool, was finalized following extensive field testing in workshops in Bangladesh, Egypt, and Zimbabwe. Methods of cost-finding and cost analysis are thoroughly explained and illustrated with practical examples and model step-by-step procedures for performing calculations. Since hospital accounting systems in developing countries may have gaps or inaccuracies, the manual gives particular attention to reliable methods for estimating costs when existing data are problematic.
The manual opens with an explanation of the many advantages of using cost-finding and cost analysis as managerial tools. These include the provision of data needed for informed decisions on operations and infrastructure investment, the planning of future budgets, the establishment of charges for patient services, and the development of mechanisms for ensuring that costs do not exceed available revenues and subsidies. Against this background, the core of the manual is presented in three chapters. The first and most extensive chapter explains how to allocate costs to cost centres and how to compute unit costs. Information and examples are presented according to seven steps. Each is discussed in terms of the types of data needed, how component cost items should be treated, and how costs can be computed in particular situations or cases. Practical examples are used to illustrate the types of questions addressed in cost analysis and the value of this information in guiding decisions.
Chapter two explains how cost data can be used to improve the management of an individual hospital. Information is intended to guide decisions at both the cost centre, or department, level and the hospital level. Managerial tasks covered include budgeting, profitability, efficiency improvements, contracting outside services or producing in-house, and assessing fiscal solvency. Chapter three considers the use of cost data in managing national and regional hospital systems. Specific applications include improvements in the referral system, the appropriate use of different providers of services, and the comparison of similar hospitals to identify inefficiencies or sources of waste. The manual concludes with a series of practical exercises, followed by explanations of their answers.
Guidelines for Development
WHO Regional Publications, Western Pacific Series, No.
1996, x + 189 pages [E]
ISBN 92 9061 117 0
Sw.fr. 61.-/US $54.90
In developing countries: Sw.fr. 43.-
Order no. 1512004
Presents detailed, richly illustrated guidelines for the planning and design of district hospitals, including extensive information on the selection and maintenance of medical and laboratory equipment. The aim is to help administrators and the hospital planning team to make the right decisions when matching needs with resources, choosing construction materials or equipment, anticipating recurrent costs, planning for future expansion, and looking for ways to assure that services are both attractive to patients and affordable.
The book has two main parts. The first, devoted to hospital planning and design, presents an overview of the complex planning and design process. Conscious of the need to use scarce resources wisely, the book stresses the crucial importance of careful advance planning by a multidisciplinary team. Solutions proposed are intended to facilitate the efficient utilization of space, the easy movement of people, equipment, and supplies, and the most cost-effective expansion of facilities at a future date. Readers are also given advice on how to make the best use of economical construction methods and local manpower, while at the same time benefiting from the latest technological developments.
The second part provides guidelines for selecting the equipment normally required in district hospitals, and for assuring regular maintenance. The book also advises technical personnel on the things to look for and procedures to follow during routine preventive maintenance.
The Hospital in Rural and Urban Districts
Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level
WHO Technical Report Series, No. 819
1992, vii + 74 pages [E, F, R, S]
ISBN 92 4 120819 8
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1100819
Elaborates a number of guiding principles concerning the organization of first referral hospitals, their integration into a system based on primary health care, and their technological requirements. The book aims to help governments and hospital administrators understand the many factors - whether concerning financial allocations or the local pattern of disease - that must be considered when defining the hospital's functions and organizing its services.
The report has two parts. Chapters in the first part focus on the hospital's functions within its district setting. The integration of the first referral hospital into the district health care system, overseen by a district health council, is presented as the best way of strengthening primary health care. The second and most extensive part provides a practical guide to the internal activities of a hospital. Guidance is given on admission policies, clinical services, hospital and community nursing and midwifery, quality assurance, and training. Other chapters examine the requirements for clinical support functions, including laboratory, diagnostic imaging, pharmacy, sterilization and dietary services. Readers are also reminded of the need to plan for the efficient operation of utilities, maintenance and repair, hospital hygiene, transportation, catering, laundry, storage, and communications.
Maintenance and Repair of Laboratory, Diagnostic Imaging, and Hospital Equipment
1994, vi + 158 pages [C*, E, F*, R, S]
ISBN 92 4 154463 5
Sw.fr. 39.-/US $35.10; in developing countries: Sw.fr. 27.30
Order no. 1150423
A practical guide to the maintenance and repair of essential laboratory and hospital equipment. Intended for use in institutions that do not have specially trained technicians or engineers, the book responds to the situation, frequently seen in developing countries, where much of the equipment is imported and adequate information on maintenance and repair is rarely provided by suppliers. With these special needs in mind, the manual aims to help staff using specific types of equipment to understand basic principles of construction and operation, adopt good working practices, avoid common errors, perform routine maintenance, and spot the early signs of defects or deterioration. Advice on equipment repair concentrates on common causes of problems that can be solved without expertise in engineering.
Throughout the manual, line drawings illustrate features of construction and design, while numerous checklists offer advice on periodic inspection and cleaning, good working practices, and the essential do's, don'ts, must's, and never's of routine operation and maintenance. Information ranges from the steps to follow when recharging batteries, through advice on how to protect microscopes in hot climates, to instructions for changing a blown fuse in an ultrasound scanner. Basic safety procedures, for protecting staff as well as patients, are also described.
The most extensive chapter covers the maintenance and repair of basic laboratory equipment, moving from autoclaves and incubators, to cell counters and systems for water purification. The remaining chapters describe the correct use, maintenance, and repair of diagnostic equipment, anaesthetic and resuscitation equipment, operating room equipment, and ultrasound and X-ray diagnostic equipment.
edited by A. Prüss, E. Giroult and P. Rushbrook
1999, xiv + 230 pages + 4 colour plates (available in English; French and Spanish in preparation)
ISBN 92 4 154525 9
Sw.fr. 72./US $64.80; in developing countries: Sw.fr. 50.40
Order no. 1150453
| Full text online |The companion volume: Teacher's Guide | online photographs to support training |
This handbook provides the first comprehensive guide to the safe and efficient handling, treatment, and disposal of all categories of hazardous waste generated by health-care activities. Although the major emphasis is on waste generated by hospitals, guidelines and advice are also relevant to wastes produced in health centres, research facilities, and laboratories, or associated with home care or treatment in doctors' and dentists' practices.
In publishing this handbook, WHO aims not only to promote a sound managerial approach and the use of appropriate technologies, but also to inform countries about the health risks that result from inadequate management of health-care waste. With these goals in mind, the book provides both an alert to documented public health and environmental hazards and a catalogue of the technical, managerial, and legislative options available for reducing these risks. All components of a waste management policy whether at national or institutional level are considered in detail.
Although recommended policies and procedures have universal relevance, the handbook gives particular attention to conditions in developing countries, where methods for the safe treatment and disposal of hazardous waste may be limited. With these conditions in mind, the handbook includes approaches for gradual improvements together with a catalogue of options for waste management that include both simple and highly sophisticated technologies. Throughout, photographs, lines drawings, checklists, tables, and step-by-step procedures are used to enhance the practical value of the wealth of guidance provided.
The book opens with a definition and characterization of hazardous health-care wastes categorized as infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste with high content of heavy metals, pressurized containers, and radioactive waste. The health consequences of exposure to each category of waste are described in the next chapter, which considers the nature and severity of associated health hazards, factors influencing the likelihood of exposure, persons at risk, and significance for public health. Concentrated cultures of pathogens and contaminated sharps are identified as the waste items that represent the most acute potential hazards to health. Other chapters consider legislative, regulatory, and policy issues, and offer a step-by-step guide to the planning of waste management, including use of a detailed model survey questionnaire for gathering data on waste generation and management practices in hospitals.
Against this background, five chapters offer guidance in a range of specific practices and procedures for safe waste management. Chapters cover strategies for waste minimization, recycling, and reuse; good practices in the handling, segregation, packaging, storage, and transportation of wastes; a wide range of treatment and disposal technologies; treatment and disposal technologies appropriate for specific categories of waste; and the collection and safe disposal of hazardous wastewater. The remaining chapters discuss costs, health and safety practices for health-care personnel and waste workers, the management of spillage and other emergencies, basic principles of hospital hygiene and infection control, and training needs. The final chapter sets out a minimum programme of essential waste management practices considered suitable for smaller rural health care establishments and field hospitals in refugee camps and other temporary situations.
Teacher's Guide: Management of Wastes from Health-Care Activities
A. Prüss and W.K. Townend
1998, v + 227 pages (English)
Sw.fr. 35./US $31.50; in developing countries: Sw.fr. 24.50
Order no. 1930134
| online edition | online photographs to support training |
A spiral-bound collection of resource materials for use in a three-day training course focused on the safe management of health-care wastes. Course materials are aimed at an audience of managers of hospitals and other health-care establishments, policy-makers, and professionals involved in waste management. Noting that health-care waste has a higher potential of infection and injury than any other type of waste, training materials aim to both heighten awareness of specific hazards and illustrate the strategies whether involving national legislation or safe practices at the institutional level that can minimize these risks. The teacher's guide is a companion to the WHO handbook, Safe Management of Wastes from Health-Care Activities.
Training materials include ready-to-copy texts for overhead transparencies or slides, lecture notes, handouts, exercises, worksheets, and evaluation forms. Apart from drawing attention to the public health and environmental hazards of health-care wastes, material for the course includes abundant technical information on various safe options for waste segregation, storage, collection, labelling, transport, treatment, and disposal.
Specific training materials range from overheads listing the components of national programmes for waste management and outlining an action plan, through a handout illustrating technical options for waste treatment, to a worksheet for calculating the costs for construction and operation of an incineration plant. Advice on how to organize and conduct the course is provided together with suggestions for using problem-based approaches and supplementing the materials with locally-relevant examples and exercises.