Short slide To Perfection

Short slide To Perfection

The sliding scale concept introduced at Global Hospitals, Hyderabad has helped in assessing the resource requirement of the Hospital. Nayantara Som gives an insight into this concept

Most hospitals grapple with allocation and distribution of resources, be it human capital or material. That’s where Hyderabad-based Global Hospitals has an edge through its sliding scale concept, an innovative technique in healthcare, introduced in March 2007.

The concept helps in optimum allotment of resources in proportion to the total manpower in any department of the hospital. The tedious task of manually assessing the resources available in proportion to the total employee strength is now a thing of the past. Though recent, the sliding scale concept has made a world of difference to the hospital in the lengthy processes involved in the optimal assessment of resources or keeping equilibrium in the total manpower.

“A tool employed by the army regularly since World War II, the sliding scale applies a rational assessment of the resource requirements”

– Dr (Major) GVJ Prabhakar General Manager Operations

Global Hospitals Hyderabad

According to Dr (Major) GVJ Prabhakar, General Manager, Operations, Global Hospitals, who introduced the concept, “A tool employed by the army regularly since World War II while working out logistics, the sliding scale applies a rational assessment of the resource requirements. Since the requirements of resources vary depending on the demand and other factors, a base scale is essential.”

Applying the Concept

As in the defence forces, at a hospital level too, the requirement of manpower and other resources like medical and non-medical supplies varies depending on the patient turnover, number of tests, X-rays, procedures and surgeries. Hence, taking a cue from their counterparts in the army, Global Hospitals introduced this scale for optimal allocation of their resources, by avoiding acute wastage of resources on one hand and an appalling shortage of staff employees on the other. S Pratap, Senior General Manager, Commercial, Global Hospitals, explains, “We basically wanted to avoid shortages in both material and human resources, delays, excess manpower or inventory losses at the Hospital.” Given the patient occupancy per month and availability of employees, this scale is primarily used to plan for optimum availability of resources at all times.

At present, the human resources department and the material resource department are using this concept. Unlike other instances, here no core team or committee was formed to implement this concept. “Here, the entire human resources department is involved for its smooth implementation. It is integral to our HR policies,” adds Major Prabhakar.

Operating Protocol

Accordingly, the HR department has now structured the skeleton of the sliding scale where the required manpower or resources, in various areas of the Hospital like house keeping, OT, labs, radiology, cath lab is calculated against an assigned amount of work. “The number of surgeries, number of cath procedures and occupancy level of patients is accordingly worked out. Now, for an increase in workload of a specified quantum, an increase in the member of the staff is planned,” says Major Prabhakar. The department monitors the workload in this fashion regularly and employs additional staff as required.

Practical Examples

The nursing department has benefitted from the concept

Consider an example. If the initial patient bed occupancy is 200 against a nursing work force of 400 nurses, this works out to be two nurses per patient. If the patient occupancy increases to 220, then given the patient-nurse ratio, the total nurse force requirement would be 440. Hence, to fill the deficit of nursing staff and maintain the perfect equilibrium, the human resources department will now need to recruit 40 nurses into their total workforce.

This is applicable in other departments too. For instance, in laboratories, initially, if one reagent kit is used to perform 10 tests and the total number of tests in a month is 1,000, the particular laboratory needs to keep 100 kits for its tests. Thus, if the number of tests in a month increases to 1,500, the requirement would rise to 150 kits. Similarly, the materials department’s procurement of various consumables, reagents, drugs is calculated to a fixed defined quantum of activity and for a predetermined increase in this activity, the additional requirement of these consumables is planned. The purchase and procurement department in the meantime keeps monitoring, and adding additional resources from time to time without the departments raising the required indents.

Since its inception, the scale is often used in the nursing department. Says Pratap, “The scale is applicable to all departments. However, it has been observed that it is the nursing department which is the first to be affected if there is an increase or decrease in the patient occupancy rate.”

As per the responsibilities assigned to every strata in the hierarchical pyramid, manpower in the army is broken down into two distinct categories-those stationed at peace stations and those in operations (those who have to fight a war or insurgency). At a particular time and place, army requirements of manpower and material resources such as supplies and artillery are often variable at unit level depending on the deployment in the field. The sliding scale concept is useful to work out and plan for the resource requirements at various unit levels. Says Major Prabhakar, “If manpower has to be moved from a peace station say Zone A to Zone B there will be an automatic increase in the manpower force in Zone B. The sliding scale then is utilised to systematically allot and plan out the resource requirements due to this increase in manpower.” Since the concept calls for careful documentation, the logistics is thus worked out systematically without an iota increase in the workload.


Three months hence, at Global Hospitals, the sliding scale concept has made life easier for human resources in particular and the administration of the Hospital as a whole. “Shortage in the workforce has been avoided and the patients will not have to suffer in the long run,” Pratap avers. “This exercise obviates the need for the various departments to assess their needs and then forward the request for additional manpower or material resources. This ensures timely availability of resources at all times.”

Major repetitions are avoided because the documentation, calculation and criteria for this index were defined in the beginning itself. This removes the cumbersome process of taking the approval of the managerial authority every time there is a need to recruit a sizable number of staff. “Once the documentation and the criteria of the sliding scale is fixed, it is approved by the manager. After that the HR department has the full authority to recruit people without consulting and requiring the approval of the managerial authority,” says Major Prabhakar.

Universal Cure

The sliding scale concept has also served as an interlink between the HR department and the various other departments in the Hospital. “It has definitely brought an element of transparency between the HR department and other departments.

Also, the policies of the hospital administration have become lucid and clear for the HR team, making administration and implementation a smooth process,” says Pratap. Shortcomings like delay and shortage of resources in crucial situations have been rectified at the Hospital leading to its growth and productivity.

With the pressure of workload showing a nosedive and delays and shortages pushed into the background, other Indian hospitals can definitely contemplate adopting the concept for a smooth work process.