Manpower Planning for a

New Hospital
HospiArch 2012, Bangalore
Usha Manjunath, Ph.D.
Dean-Academics & Student Affairs, IHMR, Bangalore
 Hospital Planning……….

Aesthetically beautiful building

Latest Equipment & Instruments

Latest Technology
Hospital Planning………….

Smart People…………
Greedy HR!!!!!!!!!!

Wisdom of Experience At the pay

Drive of a
a 50 year of a 40 scale of a
30 year old
old year old 20 year old
Manpower: Costly affair……

Medical professionals 20-25%

Salary & wages 18-20%

Medicine & consumables-20-25%

Hospital running expenses 7-8%

Administrative expenses 3-4%

Depreciation 6-7%

In general, Manpower accounts for around 30% of operational cost for

any hospital
Core Team: Starting Point…..

• Commissioning Team
– Hospital consultant
– Administrator
– Chief of Clinical Services
– Senior Nurse/s
– Supplies Officer
– Others
Critical Steps in Manpower
Planning
Step 1: Changing business
paradigms
Sl. Paradigm Earlier Now
No
.
1. Customer Clinical effectiveness & Patient/Customer
Key Drivers Cost efficiency Perception of Quality and
Value
2. Culture & Provider driven Focused on both Clinical
Service & Customer Service
Delivery
3. Staff Focus on clinical skills Focus on both Clinical &
Training Customer Skills

4. Service Technical Efficiency & Seamless integration for

System Clinical Effectiveness high quality Customer
Design Service across all
functions
Step 2: Manpower Availability
Parameter India China USA UK
Physicians per 0.6 1.06 2.56 2.03
1,000 population
Nurses per 1,000 0.8 1.05 9.37 12.12
Population
Midwives per 0.47 0.03 - 0.63
1,000 Population
Dentists per 0.06 0.11 1.63 1.01
1,000 Population
Pharmacists per 0.56 0.28 0.88 0.51
1,000 Population
Lab Technicians 0.02 0.16 2.15 0.34
per 1,000
Population

Source: WHO “World Health Report” 2006

Projected HR Requirements for Medical
Personnel in India (in ‘000s)

2008 2012 2018 2022 Incremental

Doctors 725 1,208 1,947 2,705 1,980

Nurses 1,600 2,416 5,192 10,822 9,222

Technicians, 27 232 530 812 785

Paramedics &
others

Dentists 80 121 389 676 596

Pharmacists 681 724 779 811 130

Based on the projected population growth.

Source: IMaCs Analysis
News: TOI May 15th 2012

Ø 2 lakh doctors out of 7.5 lakh have stopped working

Ø 6 lakh nurses out of 10.7 nurses registered do not exist

Regional Disparities in Manpower
Availability
South India -45% of medical
colleges with 47% of MBBS
seats
West India- 21% of medical
colleges with 22% of MBBS
seats
Central India- 5% of medical
colleges with 5% of MBBS
seats
East India- 10% of Medical
colleges with 9% of MBBS
seats
North India- 17% of medical
colleges with 16% of MBBS
seats
Quality: difficult to determine……

• Education

• Experience

• Employability

• Talent, Knowledge, Skills and Attitudes

Step 3: Promoter Vision

• Secondary, Tertiary, Quaternary

• Multi or Super specialty
• Type of clientele (niche market?,
Boutique hospital???)
• Service mix of the hospital
• Funding pattern
• Plans for accreditation
• Commercial orientation
Step 4: Hospital Set Up Analysis

• Space Planning:
– Helps in understanding work flows, patient flow, staff flow
etc which in turn helps in manpower allocation
• Bed Break Up:
– Number of beds i.e. bed per floor, suite, single rooms,
double rooms, ICU, casualty beds etc…
• Number of OPDs
• Number of Operating Rooms
• Type of ICUs
• Diagnostic Facilities/Labs
• Business areas/Facilities
Departmental Assessment

• Subsections of the department. For e.g. various

types of labs-biochemistry, histopathology,
microbiology..
• Equipment in department
• Working days/hours of the department
• Expected work load for each department
• Types of personnel for various jobs/duties
• Standards and norms for the department
Hospital set up

Servic Person Equip Funcat Project Mornin Evenin Night Total

e area nel ment ional ed g g
Catego Quanti Hrs/Da worklo
ry ty ys ad

Work out the numbers for Dialysis Services

 Service Area: Dialysis

Servic Person Equip Funca Projected Morni Evenin Night Total

e area nel ment tional workload ng g
catego Quantit Hrs/D
ry y ays
Dialysis Technic 8 12*6 11 2 1 - 3
ian
Staff 1 - - 1
Nurse
Head 1 - - 1
Ward 1 1 - 2
boys
HK 1 1 - 2
Step 5: Impact of other policy
issues on Manpower
Phases of Commissioning

• Phases of commissioning beds

• The percent of beds to be
commissioned at different stages
– Stage 1- During soft commissioning-50%
– Stage 2- At 6 months=65%
– Stage 3- At 12 months=85%
– Stage 4- At 24 months=100%
• Work load: Target for Bed Occupancy
at various stages of commissioning
Leave Policy

• Leave policy leading to leave relief

• 365 days full working
– 52 sundays
– 7 PH
– 21 EL, 7 SL, 7 CL (Total=35 days)
• 271 actual/12=22.5 p.m. working days in a 30 day month
• Therefore:
– 3 personnel for 30 days = 90 days
– But actually 3X23 days = 69 days
– Deficit=90-69=21 days (approx-1 extra person
– Every 3rd person, 1 extra person required i.e. 30% more
Direct and In-direct Staff
Manpower Planning Simplified…
Sl. No. Category Ratio-Bed:
Manpower
1. Consultants 1: 0.30
2. Resident Doctors 1: 0.30
3. Nurses 1: 1.50
4. Technicians & Para Medicals 1: 0.45
5. Management & Administration Staff 1: 0.20
6. Clerk, Receptionist, Admin & 1: 0.40
Secretaries
7. FSD, House Keeping, Laundry, 1: 1.20
Security
8. Engineering, Maintenance, 1: 0.10
Biomedical
TOTAL INDIRECT STAFF 1: 1.30
TOTAL STAFF 1: 4.45
Work Out Manpower Plan
For a 200 Bed Hospital
Assumption: Phase 4
Commissioning 50% Beds with
Expected Occupancy at 60%
Plan for a 200 Bed Hospital
Sl. Category Ratio Phase 4
No. Bed: Manpower Commissioning-50%
Beds/Exp
Occupancy 60%
1. Consultants 1: 0.30 18
2. Resident Doctors 1: 0.30 18
3. Nurses 1: 1.50 90
4. Technicians & Para Medicals 1: 0.45 27
5. Management & Administration 1: 0.20 12
Staff
6. Clerk, Receptionist, Admin & 1: 0.40 24
Secretaries
TOTAL DIRECT STAFF 1: 3.15 189
7. FSD, House Keeping, Laundry, 1: 1.20 72
Security
8. Engineering, Maintenance, 1: 0.10 06
Biomedical
TOTAL INDIRECT STAFF 1: 1.30 78
TOTAL STAFF 1: 4.45 267
Cost Implications

• Due to demand supply situation, it is

important to note that the salaries are
on the rise.
• Since 18-20% of the cash inflow is
spent on salaries, Surplus can effect a
start up hospital badly and can lead to
huge financial distress
• However, poor staffing levels can
impact quality of services delivered.
Factors Affecting Wage Mix
Total Compensation &
Pay Structure
 HUMAN RESOURCE INFORMATION SYSTEMS
(HRIS)

PERSONAL DATA
Age, Gender, Dependents, Marital status, etc
EDUCATION & SKILLS
Degrees earned, Licenses, Certifications
Languages spoken, Specialty skills
Ability/knowledge to operate specific machines/equipment/software
JOB HISTORY
Job Titles held, Location in Company, Time in each position, etc.
Performance appraisals, Promotions received, Training & Development
MEMBERSHIPS & ACHIEVEMENTS
Professional Associations, Recognition and Notable accomplishments
PREFERENCES & INTERESTS
Career goals, Types of positions sought
Geographic preferences
CAPACITY FOR GROWTH
Potential for advancement, upward mobility and growth in the company
Recruitment & Placement Process

• Phases of Commissioning
– Specialists/Consultant Panel and not necessarily
on pay roll in initial phases
– Nursing Director as a part of core team, next
probably Nursing Supervisors & In-Charges; lastly
Staff Nurses (about a month of actual
commissioning)
– Organizational Structure, defining job roles and
responsibilities, job description
• Orientation programs list & Trainings
• Actual Orientation Plan and Materials
Innovations!!!!!!!!!!!!!
Thank you……….

Usha Manjunath, Ph.D.

Dean-Academics & Student Affairs, IHMR, Bangalore

usha@iihmr.org
• Question: How to carry out manpower planning for a new hospital and its
importance?
- Dr.Aravinth Reddy, Chennai
• Answer: Manpower planning is extremely important for a hospitals effective
functioning. It depends on type of hospital, number of beds, number of departments,
bed distribution in various rooms/wards/intensive care etc.
• Manpower planning is an important issue for any hospital since it accounts for
around 30 per cent of operational cost for any hospital. Most hospitals operate on
excess man power. “Ideally, total hospital employee to bed ratio should be a
minimum of four per bed,” As competition increases and margins come under
pressure, hospitals will have no option but to rationalise manpower, which would
mean downsizing.
• Most times, downsizing results in chaos, mainly because of improper manpower
planning. A multi-skilled workforce is required to carry multiple tasks in order to
maintain optimum employee per bed ratio, a key to boost and sustain profits. To
achieve this, manpower planning becomes crucial.
• Also doing a salary survey is beneficial by which you get to know the competitive
compensation structure in market and accordingly you can design salary structure
for your hospital. Manpower planning tells you about the total number of employees
you need department wise for smooth running of hospital
• Manpower: Staffing of the operating room, in terms of anaesthetists, nurses and other support
staff is important for efficient running of theatre and this number should be on par with the clinical
activity. Experts also feel that the way forward in operation theatre management is to have a
'Theatre Management Group' with strong leadership and appropriate membership with authority
to take action. Theatre managers should monitor the actual use of operating room and co-
ordinate with the surgeons, anaesthetist and other theatre personnel. The importance of each
activity should be known to all and most importantly all the activities should be documented and
periodically monitored.
• "A good surgical registrar is a must. His responsibility begins when a surgical patient comes to
emergency room. He should see that the patient is admitted and all arrangements are made in
such a way that he understands the need for surgery," believes Dr Paramesh.
• Indian Spinal Injuries Centre has a dedicated OT coordination committee, which meets regularly
to get inputs from the OT users.
• Dr Chakravarthy believes in having a dedicated staff with designated duties. According to him, it
is not a good idea to 'multi task' the staff in the OTs. Dedicated staff performing specific duties not
only improves efficiency, but also increases job satisfaction. It is a common practice in India for
nurses and the technicians to multi task in cleaning the equipment, the floor and the walls of the
OTs in tandem with other administrative staff.
• At Wockhardt Hospital, Bangalore, OT nurses only do nursing-related jobs. "We have a separate
team of 'boys' who do the cleaning and sterilisation of the OT walls and floors. They go from one
OT to another doing this job repeatedly. At regular intervals, their efficiency in handing back the
OT in 'ready' state is assessed. Incentive-oriented training offered to them has made efficiency
the buzz word and brought attrition to an all-time low," shares Dr Chakravarthy.