“Most key factors for hospital relationship and patient’s

management”
(1) (2)
Dr.J.Kavitha , U. Ali Rahoma and (3) Dr.J.Thirubhuvan

(1) Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India (2) Omer El- Mukhtar University,
Faculty of Medical Technology, Tobruk, Libya. Tel: +218-92-5358557, E-mail:
Usama_rahoma@Yahoo.com,
Usama_rahoma@Yahoo.com, and (3) Omer El- Mukhtar University, Professor-Hospital
Administration, Faculty of Medical Technology, Tobruk, Libya. Tel: +218-91-4706504, E-mail:
profjthiru@gmail.com

Summary

Customer’s or patient’s relationship and physician’s relationship

with the hospital are an integral part of a hospital. Because the name
and fame of the hospital not only depended on them, also on the part
of generating revenue, if the proper relationship maintained. Few areas
to be guided are counseling and supervision, inculcating motivation
and confidence, effective guidance and medication and homely
approach. This article focuses on the most key factors for hospital
relationship and patient’s management.

Key words:
Customers or patient’s relationship, physician’s relationship,
counseling and supervision, motivation and confidence, effective
guidance and medication, and homely approach.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
 “Most Key Factors for Hospital Relationship and Patient’s
Management”

1.1 Introduction

When hospitals and physicians work well together, they can

better provide patient care efficiently and cost-effectively. But
hospitals and physicians face many challenges today that can
undermine their close working relationship. For optimal relationships
with physicians, hospitals need to combine a strategy to align
economic interests and share revenues with strategies to
communicate better, build trust, and include physicians in decision
making. This will certainly increase the relationship with the patients
and the hospitals.

Nowadays the patients care with the hospitals has become an

important task of developing the business activity in the hospitals
irrespective of private and public hospital enterprises. There are quite
a good number of hospitals as an example where they had to loose the
business or sell out the hospital due to the poor performance of the
patients system. Hospitals like Manoj Hospitals in Chennai from the
Bharathiraja Group, Anna Heart foundation from Anna Arivalayam
Chennai, Prashant Hospitals and Child care Pvt Ltd from the
Thiayagaraja group in chennai, Malar Hospitals, Chennai had to be
closed their services rendered for the patients due to the poor
performance of patient’s relationship. Now all these hospitals are
under the management of Apollo group of hospitals.

A study undertaken by CMC Medical Hospitals suggest that the

number of patients care management implemented in the years 1995
and 2000 with regards to provision or sending information of their next
visit to the hospital, appointment with the Doctor information, medical

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
examination details, type of medication to be undergone and etc has
stabilized the growth rate of the patients visit from 10 million to 15
million during the period only for the general check up and other
preliminary visits. This result had shown more than 100 percent growth
of the patient’s movement in the hospital compare to the years 1990
and 1995. Such result has brought a tremendous changes in the
hospital in infrastructure developments, development of various
medications, installation of new equipments, purchase of various
medical tools and technology and introducing various medical and
non-medical courses, development in transportation, banking and
other hospital services.

The development has even made socio, economic, cultural, and

infrastructural changes and development in the region of CMC where it
is located. This is all because of the well being of the patient’s care and
hospital relationship with patients (Guru Kumar Govindan David
(2003). Hospitals should play major role to feel all the patients homely
and care. Moreover the Customer’s or patient’s relationship and
physician’s relationship with the hospital are an integral part of a
hospital. Because the name and fame of the hospital otherwise not
only depended on them, also on the part of generating revenue, if the
proper relationship is maintained. Most of the key areas to be guided
are counseling and supervision, inculcating motivation and confidence,
effective guidance and medication and homely approach. (Kumaraguru
(2002).

1.2 Objective of the study

 To examine the Hospital relationship aspects.

 To learn more about the patients care management.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
  To enhance the best possible method of keeping a good contact
with the patients.
 To ascertain the importance of hospital Vs patients relationship.

1.3 Scope of the study

This article is a micro study about prerequisite key factors for

hospital relationship and patient’s management. A bird’s eye view on
this article is how the possible cordial relationship to be ascertained
between the providers (Hospital) and the user (patients). The article
discusses as the success of the patients management is nothing but
the success mantra of a hospital management. The various approaches
adopted and discussed in this article would be certainly a basis for any
private or governmental based hospitals.

1.4 Limitation of the study

 The article is based on the secondary data mostly and
observations made in the hospitals visited in around Bangalore
only.
 Time, disparity, diversity, accessibility, and connectivity in order
to collect data are major limiting factor.
 In most of the hospitals there were no patient’s relations
manager or Director, so necessary data was found enough.
 Lack of training with the Doctors with regards to PCM(Patients
care management or PRM (patients relationship management)

1.5 What is patient’s relationship and hospital relationship?

Patients care is all about the well being of the patients and the
confidence inculcated in their mind to encounter the illness. The
relationship play a large role by the hospitals (that includes Doctors,

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
nurses and other information providers) with the patients when the
‘Patient’s care’ is started. Patients relationship coupled with the
patients care become an integral part of the task with hospitals for
hospital relationship (Cherian, K.M (2000).

According to AIIMS, New Delhi, the following seven techniques can help
increase patient satisfaction and loyalty.

1. Give patients a card that asks them to list the three most important
questions that they want to ask the doctor or nurse. This allows
patients to think about what is important to them.

2. Knock on the door before entering the examination room in order to

give the patient time to prepare for the visit.

3. Make sure you have the right chart, and review it before entering
the room. You will appear informed and truly interested in the patient.

4. Spend the first minute or so discussing non-medical topics. It can

put new patients at ease to talk openly, and lets patients know you
care.

5. There is a medicinal value in tactful touching. Research has showed

that touching, such as a handshake or gentle pat on the shoulder, can
help create a stronger bond between the health care professional and
patient.

6. Provide correct picture of disease and expenditure of medication

and be truthful and trustworthy in order to be prepared for the
financial arrangements if the case is severe.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
7. Provide necessary non hospital supporting services information such
as insurance, hotels and accommodations, banking, transportation
rentals and bookings and emergency care facilities.

In addition, Effective patient counseling is not simply the

provision of information. Information is prerequisite to compliance, but
the timing and organization of the message and involvement of the
patient are also critical in determining what the patient understands
and remembers. The counseling encounter should be thought of as an
opportunity for information exchange. You are the expert on drug
therapy, but patients are experts on their daily routines, how they
understand their illness and their treatments, whether they anticipate
any problems taking the medicine as prescribed, and so forth. Each of
these points needs to be assessed if counseling is to be effective. The
counseling checklist provided here was developed to increase the
probability that the patient will comply with the treatment regimen. It
is assumed that before the pharmacist counsels the patient, he or she
will first assess the appropriateness of the drug therapy.

The most important key areas to which hospitals need to concentrate

for hospital relationship and patient’s management are as follows:

1. Counseling and supervision (Arivalagu (2001),

2. Inculcating motivation and confidence (Jayalakshmi visanathan
(2006),
3. Effective guidance and medication (Kamala Devi Gemini
Ganesan (2006)and
4. Homely approach (Unni Krishnan (2000)

1. Counseling and supervision:

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
– Introduce yourself: It is important for patients to know they are
speaking with the counter staff or pharmacist. They may be reluctant
to ask questions or express concerns if they believe they are speaking
to a technician or clerk. Administering staff should greet the patient.
Extend your hand, and state your name: “Hello, I’m Ram, may I help
you.” This begins the relationship.

– Identify to whom you are speaking: If you are talking to the

patient directly, information is less likely to be confused or distorted
than if you are talking to the patient’s agent, who must pass the
information on to the patient. In third party communication, written
information becomes even more important than when directly
communicating with the patient. The nurse or administering staff or
Pharmacists may need to call patients if they believe that the
information truly needs to be communicated directly to them.

– Ask if the patient has time to discuss the medicine: If patients

do not have time to listen, the information will be ineffective. The
information should be written and/or the patient should be contacted
at a more convenient time. For a new patient, a database should be
established so that appropriate decisions may be made in the future.

– Explain the purpose/importance of the counseling session:

People listen and learn more effectively when they are given reasons
for what is being asked of them. For example, patients are less likely to
take tetracycline with food or dairy products if they are told that
decreased absorption and effectiveness of the drug may result. For
new patients, it will be necessary to explain why the information being
gathered is needed.

2. Inculcating motivation and confidence:

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
– Ask the patient what the physician told him/her about the
drug and what condition it is treating: Find out what the patient
knows or understands about his or her disease. There is no reason for
the pharmacist to present information that the patient already has
mastered. Generally speaking, in any effective counseling session, the
patient should speak more than the healthcare provider. The purpose
of the session is to ensure that patients leave the pharmacy with
knowledge about the proper use of the medication. It really doesn’t
matter whether the patient gets this information from the pharmacist
or physician. Accurate information that the patient supplies should be
supported and praised. Inaccurate information should be corrected,
and information that is omitted should be added. Use any available
patient profile information.

– Prior to providing information, ask the patient if he/she has

any concerns: Often, patients will not vocalize concerns about the
drug(s) they are about to take or the condition the doctor is treating
unless they are asked. It is important to address these concerns
immediately, with as much understanding as possible. Until the
concern is addressed, the patient will not register or internalize any
other information that is provided. The pharmacist should make every
effort to understand the concerns of the patient and treat the concerns
with the attention they deserve.

– Listen carefully and respond with appropriate empathy: These

skills are absolutely essential to an effective counseling session. The
relationship between the patient and practitioner is a key variable in
predicting compliance with treatment regimens. Patients need to view
healthcare providers as competent, trustworthy professionals who care
about what happens to them. Listening and empathic responding are
effective.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
3. Effective guidance and medication:

- Tailor the medication regimen to the patient’s daily routine:

Making a connection between taking a dose of medication and a
regular daily task will enhance compliance. This could include
identifying when the patient wakes up and goes to bed or which meals
the patient eats. Pharmacists should not assume that patients follow a
common routine (e.g., eating three meals a day). They should ask
patients about their routines before suggesting a plan.

– Tell the patient how long it will take for the drug to show an
effect: If patients are not told when to expect onset of action, they
may believe the medication is not working. Patients may cease taking
a medication, or they may take too much because they believe one
dose did not work.

– Tell the patient how long he/she might be taking the

medication: Patients need to have a reasonable expectation of how
long they will need to take the medication. This helps them get into a
“mind set” of compliance. It also helps to eliminate unrealistic
expectations. Moreover, it gives patients a chance to express concerns
about the length of treatment.

– Tell the patient when he/she is due back for a refill (and the
number of refills needed): Patients need to plan in order to be
compliant, and this information assists them in doing so. The
information may be given in the form of a verbal contract. The
pharmacist could say, “Mrs. Sathya, the doctor has given you a 30-day
supply. Therefore, I’ll see you on June 30th for your refill. See you
then?” By doing this, the nurse lets the patient know when to come
back in. Stating the date may also remind the patient if there is a
scheduling conflict.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
– Emphasize the benefits of the medication: Nurses should make
every effort to support the chosen therapy and tell patients about the
benefits of the treatment before they discuss potential side effects.
This not only helps to put side effects in perspective, but it also
promotes patient confidence in the therapy. Lack of confidence in the
chosen therapy results in a higher incidence of noncompliance.

– Discuss major side effects of the drug: The more specific nurse’s
or pharmacists’ advice can be the better. Will the side effects go away,
and if so, within what period of time? Are there steps the patient can
take to prevent, alleviate or manage the side effects? What should
they do if side effects don’t go away or become intolerable? Effective
counseling helps patients understand the extent of the risk they are
taking by using a medication. It is possible that some patients will not
want to know about any side effects, and some will want to know all
possible side effects. Pharmacists must develop a flexible approach to
the dissemination of information. Leaflets are an excellent way to
provide patients with additional information.

– Point out that additional, rare side effects are listed in the
information sheet: An information sheet summarizing facts about the
medication should be given to the patient at the end of the counseling
session. Emphasize the rarity of some of the side effects listed, and
encourage the patient to call if he/she has any concerns about these.

– Use written information to support counseling when

appropriate: For literate patients, written information has been shown
to reinforce verbal instruction. It gives the patient tangible information
to refer to in case he/she forgets what the pharmacist has said. In
addition, it can be used to promote more effective counseling. Written
information may be given to patients to look over while their

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
prescription is being filled. This can prepare patients to ask better
questions and the pharmacist will do less talking.

– Discuss precautions (e.g., activities to avoid) and beneficial

activities (e.g., exercise, decreased salt intake, diet, self-
monitoring): It should not be assumed that the physician has
discussed these things with the patient. Ask patients what they have
been told, and discuss if necessary.

4. Homely approach

– Discuss drug-drug, drug-food, drug-disease interactions:

Patients generally are not aware that other medications, foods, or
diseases may interfere with the drug they are taking or affect the
condition for which they are being treated. For example, a patient with
high blood pressure should be told to ask the nurse or pharmacist
before taking any medicines for coughs or colds. The patient should
also be told why these precautions are necessary.

– Discuss storage recommendations, ancillary instructions

(e.g., shake well, refrigerate): Many patients still store their
medications in dark place or medicine cabinets in the bathroom—
probably the worst place in the house to keep medicine because of
heat and humidity. Give general storage recommendations for all
medicines, and specific storage recommendations (e.g., refrigeration)
and ancillary instructions to the patient.

– Explain to the patient in precise terms what to do if he/she

misses a dose: Actual times of day and specific examples should be
used to make this clear. The patient should then be asked, for
example, “What will you do if it is 3:00 in the afternoon and you realize

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
you have missed your noon dose?” The only way you can assess
whether patients understand is by asking them to repeat back the
information. If you ask them if they understand, patients may say yes
even if they do not.

– Check for further understanding by asking the patient to

repeat back additional key information: To fully assess whether
the patient understands the dosage regimen, you could say, “Mrs.
Kavitha, sometimes information can be a little confusing. Just to be
sure I was clear, could you tell me how you are going to take your
medication?” The same would be done with side effects, storage
conditions, etc. To better control the time this takes, more specific
questioning might be useful: “Mrs. Kavitha, what time will you take
your first dose?” Correct answers should be praised and incorrect
information should be corrected. Praising has been shown to reinforce
compliance.

Check for any additional concerns or questions: The counseling

session may have raised additional questions or concerns. The
pharmacist should ask if this is so and listen respectfully and carefully
to what the patient has to say.

Advice patients to always check their medicine before they

leave the pharmacy: This helps to familiarize patients with their
medicine and makes them a partner in ensuring an error has not been
made. The pharmacist should say, “Please always check your medicine
before you leave the pharmacy. If you have any questions or problems
about the way it looks, please notify me. I don’t intend to make any
mistakes, but it’s good to be cautious. You are the final check.” By
doing this you are emphasizing that this is a partnership in which the
patient also has responsibilities.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
– Use appropriate language throughout the counseling session:
On occasion, pharmacists use language that is unnecessarily confusing
(e.g., hypertension rather than high blood pressure; GI instead of
gastrointestinal or stomach). Many patients will not say they are
confused because they do not want to appear stupid. If you detect any
confusion, it may be helpful to ask, “Have I said something that has
confused or concerned you?” Language that is simple and
understandable promotes compliance.

– Maintain control of the counseling session: A great deal of

information needs to be covered in order to counsel the patient
effectively. Concerns take time to address. Therefore, keep superfluous
conversation to a minimum. “Small talk” is helpful to start the
counseling session, but it needs to be brief and simply serve to break
the ice.

– Organize the information in an appropriate manner: Generally

speaking, the most important information should be provided at the
beginning of the counseling session and repeated at the end. In
addition, support of the drug should precede side effects. This checklist
has been formulated to reflect the recommended organization of the
counseling session.

Conclusion:
The condition is that anything which is with precise, prompt,
proven and perseverance in disseminating the information to the
patients would strongly show the strong belief in them about their
cure. Certainly if the team of hospital follow the about stated factors,
would constitute an effective patients and hospital relationship. Hence
it is necessary to follow all the factors for well being of patients.

Reference:

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India
 1. Dr. Arivalagu (2001): Doctors- a medication, Chennai Oli.
2. Dr. Cherian, K.M (2000): Medical as soul treatment for
patients, MMM publications, Chennai, India.
3. Dr. Guru Kumar Govindan David (2003): ‘Hospital Vs
patients relationship’- an exclusive interview in the daily news
paper Times of India’, Tamilnadu on January 15th, 2001.
4. Dr. Jayalakshmi visanathan (2006): Patients care
management, a radio interview at 6.00 p.m
5. Dr. Kamala Devi Gemini Ganesan (2006): Patients care
management Internal and External phenomenon. Arthi
Publications, Orissa pg 36.
6. Dr. Kumaraguru (2002): Patients and their complications,
Chennai Oli.
7. Dr. Unni Krishnan (2000): Important aspects of medical
services, Chennai Oli.

Contact details of the Author: Asst Professor- Physiotherapy, E-mail: kavijo@gmail.com,

kavijo@gmail.com, India