SUMMARY OF CONTENTS

* Introduction

* Healthcare industry – an overview

* Objective

* Method

* Observation

* Analysis

* Discussion

* Conclusion

* Recommendation

* Acknowledgment

1
 PART - I

COMPANY PROFILE

*Brief introduction of Hospital

*History (very brief) of the organization

2
 PART – II

* Introduction

* Healthcare industry – an overview

* Objective

* Method

* Observation

* Analysis

* Discussion

* Conclusion

* Recommendation

* Acknowledgment

3
 PART 3

* Appendix

* Bibliography

* References

* Glossary

4
 INTRODUCTION IN GENERAL

Health and health care need to be distinguished from each other for no better
reason than that the former is often incorrectly seen as a direct function of the
latter. Health is clearly not the mere absence of disease. Good Health confers on a
person or group’s freedom from illness - and the ability to realize one's potential.
Health is therefore best understood as the indispensable basis for defining a
person's sense of well being. The health of populations is a distinct key issue in
public policy discourse in every mature society often determining the deployment
of huge society. They include its cultural understanding of ill health and well-
being, extent of socio-economic disparities, reach of health services and quality
and costs of care and current bio-medical understanding about health and illness.

Health care covers not merely medical care but also all aspects pro preventive
care too. Nor can it be limited to care rendered by or financed out of public
expenditure within the government sector alone but must include incentives and
disincentives for self care and care paid for by private citizens to get over ill
health. Where, as in India, private out-of-pocket expenditure dominates the cost
financing health care, the effects are bound to be regressive.

Heath care at its essential core is widely recognized to be a public good. Its
demand and supply cannot therefore, be left to be regulated solely by the invisible
had of the market. Nor can it be established on considerations of utility
maximizing conduct alone. What makes for a just health care system even as an
ideal? Four criteria could be suggested- First universal access, and access to an
adequate level, and access without excessive burden. Second fair distribution of
financial costs for access and fair distribution of burden in rationing care and
capacity and a constant search for improvement to a more just system.
Third training providers for competence empathy and accountability, pursuit of
quality care and cost effective use of the results of relevant research.

5
6
AN OVERVIEW OF HEALTHCARE

7
8
information, multiplicity of agencies, dual reporting systems etc.

OBJECTIVE

9
 To asses up to what mark in a particular hospital patient’s needs are
satisfied.

 To improve & enhance the service to satisfy patients need.

 The strategy is to use various measures, technology to provide:

• Effective early medical intervention

• Deliver expert health care

• Minimize in convenience caused to patients and health workers from poor

logistic & long travels

• Waiting time for fulfillment of health care formalities in a health care center.

 Increasing the role of health care centers to provide health education

emphasizing

• Family planning

• Hygiene

• Sanitation

• Prevention of communicable diseases

 Making availability of trained and well qualified doctors, paramedical staff,

and ancillary staff to adequately serve the rural & urban population so that
medical needs of patient can be satisfied.

10
 Implementing various measures to reduce the time & formalities during
hospitalization.

 Making procedure in medico legal emergencies in such a way as not to

delay treatment in fulfilling of legal or ethical requirements.

 To implement latest technology in hospital so as to provide hi- tech

Medicare this will enhance patient’s satisfaction.

11
 OBSERVATION

It is not clear in the literature what measures are needed to achieve success.

“Observations occur after a program has been established and are used to
determine what has been achieved as a result of the program, such as outcomes
or impacts, attainment of goals, unintended consequences or comparisons with
alternative programs.”

With this in mind, there are a number of observations that have been used both in
and outside health care. Observations were made in an effort to inform the
development of an evaluation framework for large-scale health record projects.

DISCUSSION

12
It can be done only after collecting the data and all observations have been made.
Lord Mahavira Homoeopathic Medical College & Hospital is a prime hospital in
Ludhiana providing hi tech medical care and providing all type of facilities for
treating the disease while maintaining quality by means of ISO guidelines.

13
 CONCLUSION

Understanding how individuals and organizations make systems workable in

practice requires focusing on the micro-level practices of those developing,
using, and repairing such systems over time and the ways in which power, social
networks, human interpretations, and materiality come into play. Consideration of
such issues will, we believe, add significantly to our understanding of how
organizations work over time.

14
 PART 1

Introduction about hospital

15
Dictionary defines the ‘Hospital’ as an institute providing medical treatment and
nursing care for sick or injured people. With the changing era the concept of
hospital is being changed. Hospitals are now known as social institutes. Hospital
is no longer “Doctor’s workshop” but it is an organization of sophisticated
technology and evidence based medical care.

Hospitals are complex to manage where the highest caliber and best informed
management is required. Management style of all developed, developing and
under developed countries are different but they are faced with the similar
problems on claims of patients.

In developing countries like India the health care expenses are mostly out of
pocket expenditures. Health care consumer pays each and every penny for the
services rendered. The consumer search for the best available services paying
the affordable cost. This intensifies the competition in the healthcare providers to
serve at the lowest possible cost without compromising the quality services.

Health care scenario is fast changing all over the world. Today Indian health care
industry is business driven and one can see entry of all sorts of service providers
to be a part of this massive multi crore businesses, growing at the rate of 13%
annually1.Globalization and privatization have also changed the functioning of the
health care system. The privative health network is spreading fast throughout the
country.

Economical, political, social, environmental and cultural factor influence the

health care and the delivery of the health care services. Today the competitive
market leaves no space for the error. Slowly but surely the health care market is
changing from being primarily a seller’s market to buyer’s market.

16
Today the health care industry is facing 3 C’s.

 Competition
 Consolidation
 Consumerism

Concept of satisfaction
Consumer driven market has not left the health care business untouched. The
most valuable asset of any business is the customer. The patient is the ultimate
user and the customer of the healthcare industry. Hospitals are an indispensable
part of our health care which predominating provides curative healthcare

17
services. Society looks upon the hospital for their welfare and it is hospitals duty
to meet the demands. Improved socio- economic status, easier access to medical
care, increasing literacy, information available at finger tip, print and electronic
media has changed the mindset of Indian patient and their attainders.

Today consumers face a vast array of the product brand, choice, pricing and
supplier. Customer is the value maximizes within the bonds of search cost and
mobility. They form expectation of value and act upon it. The customer chooses
the marketing offer that gives him most value. Then they compare the actual value
they receive and in consuming the product to the value expected. This affects
their Satisfaction. To track a customer, satisfaction surveys are one of the vital
tools. Customer satisfaction is important to the marketer because it is generally
assumed to be significant determinant of repeat sales, positive words of mouth
and customer loyalty.

Satisfaction is an important element in the evaluation stages. It refers to the

consumer state of being rewarded. Patient uses and experiences all the services
provided by the hospital during his stay in the hospital. So he only can be the
best judge about the facilities provided. After using the services, he may become
satisfied or dissatisfied.

Key element of customer satisfaction or

dissatisfaction:

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 Expectations: The seeds of customer satisfaction are sowed
during the pre-purchase phase when consumers develop expectations or
beliefs about what they expect to receive from the product. These
expectations are carried forward and again activated at the time of reusing.

 Performance: During the usage of services the customer

experiences the actual product in use and perceives its performance on
the dimensions that are important to us.

 Comparison: It will be done after usage with pre-usage

expectations.

 Confirmation/Disconfirmation: Comparison of
expectations with actual performance results in satisfaction or
dissatisfaction.

 Discrepancy: If the performance levels are not equal, it will end in

discrepancy.

Factors influencing patient satisfaction

19
A patients coming to hospital has his own requirements and set of thoughts. They
want it to be fulfilled by the service they choose, to become satisfied. There are
five factors which influences the patient satisfaction are:

 Reliability: It is the ability to perform promised service dependably

and accurately.

 Responsiveness: It is the willingness to help the patients and

provide prompt service.

 Assurance: It is the knowledge and courtesy of all staff including

medical, paramedical, administrative, technical, and their ability to
convey trust and confidence.

 Empathy: It is the provision of caring and individualized attention to

patients.

 Tangibles: It is the appearance of physical facilities, equipment,

and personal and communication materials.

Requirements of patient satisfaction

survey

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Worldwide studies have shown that the Patient satisfaction survey is required
outcome of the hospital. Now a day’s patient prefers to go to high technological
based health care system that offers a value added services.

In the midst of the mushroom growth of the hospital, it is necessary to satisfy the
patient. Human satisfaction is a complex concept that is related to a no of factors
including lifestyle, past experience and future expectations and the value of both
individual and society. In the literature of hospital administration, there are very
few studies have been done on patient satisfaction survey with the services
provided by the health care organizations.

When a patient comes to the hospital, he/she is in the phase of physical mental
and emotional disturbance with lots of queries and anxiety. The patient expects
that he/she should be treated quickly, courteously and correctly.

Like all other customers the patient also wants 3 ‘C’s

 Convenience

 Care

 Reasonable cost

Role of patient satisfaction survey

21
Measurement of patient satisfaction stands poised to play an increasingly
important role in the growing push towards accountability among health care
providers. In today’s competitive world, Patient satisfaction is a bench marks of
the success any health care provider. It is important inputs from the patients to
grow the organization.

Wide range of roles of the patient satisfaction survey can be summarized as:

 To monitor quality of care provide

 To measure efficiency of the hospital

 To access the room for improvement

 To find out deficiencies of the system and administration

 To meet expectations and demands of the patients

 To co-ordinate the effectiveness of the treatment

 To access the employees ability and capacity

22
  To access and change the marketing strategy

 To continue relationship

 To access and change customer relationship management

strategy, if required.

COMPANY PROFILE
History of the Organization

Lord Mahavira Homoeopathic Medical College & Hospital is a 50 bedded

multi specialty hospital located in Ludhiana. The hospital offers quality, cost
effective and value added health care. It is a hospital of acute care, and is open to
all communities. It is a not-for-profit non-governmental health service provider.

It is registered with the Charity Commissioner as a charitable trust of the Lord

Mahavira Health Service and has invested heavily in a modern and extensive
range of high-quality equipment to meet specialized needs and strives to make its
services accessible to a wide spectrum of people, including the poor, offering
high quality medical care at affordable prices. The hospital functions within the
framework which is committed towards improving the health and living conditions
of people in this developing country of ours.

23
 History of the Hospital

The Hospital was established in June 1972 as a small, 16-bed hospital in rented
premises. The Hospital grew in size over the years till it inevitably had to shift to
larger premises. Such a shift became possible in 1995 by the munificent donation
to the hospital.

In 1996, professional management was brought in. Over the following years the
hospital expanded its services and increased the bed strength and services in
response to growing demand.

Current Status: Today, having served the community for over 25 years,
the Lord Mahavira Homoeopathic Medical College & Hospital has 50 beds [soon to
cross the 75 mark] and state of the art clinical facilities.

In the charitable outpatient clinics, specialists offer services free of cost. Nearly

24
10,000 patients are seen in these clinics annually while another 15,000 patients
attend the [paid] consultation clinics, taking the outpatient visits to more than

25,000 per year. Over 5000 patients are admitted annually.

Vision of the hospital

The Vision of Lord Mahavira Homoeopathic Medical College & Hospital
is to be considered one of the best non profitable multi-specialty hospitals in
Ludhiana, providing high quality clinical services while working towards
becoming an “institution” combining elements of patient care, clinical research
and post-graduate medical education. It is the only multi specialty

Homoeopathic hospital in the whole of Punjab.

Mission of the hospital:

The mission of Lord Mahavira Homoeopathic Medical College & Hospital

is to provide quality medical care of high standards, at affordable costs, to all its
patients including the weaker sections of the community through Homoeopathy
so as to spread this system of medicine i.e. Homoeopathy so that people can get
homoeopathic treatment for any type of illness without any side effects to their
body.

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 Services offered

The hospital offers:

Homoeopathic OPD Dermatology,

ENT Gastro Enterology, Gynecology and Obstetrics,
Hematology, Infertility,
Intensive Care, Medicine,
Oncology (medical), Ophthalmology,
Pediatrics, Pathology,
Physiotherapy, Physical and Clinical Psychology,
Respiratory Medicine, Microbiology,
Rheumatology, Radiology,
Urology, Emergency Services,
Homoeopathy, Cancer Rehabilitation,
Pharmacy (Homoeopathy), Dietary,
Allergy

The hospital comprises of wide range of diagnostic services.

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 Accommodation

A Deluxe: Single occupancy (air-conditioned with television, refrigerator,

telephone, attached bath and couch for attendant)

A Twin Sharing: Twin occupancy (shared bath, couch for attendant with direct
telephone at nursing station to receive in-coming calls) Economy Class:
Quadruple occupancy (four patients sharing room with partition for privacy. A
reclining chair is available for attendant, with common bath and toilet facilities for
each floor.

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 Review literature
Research in the area of "Hospital Administration in India" is still in its infant
stage. Studies related to patient behavior and satisfaction are also not many.

Reviews of patient satisfaction survey by Indian researcher:

To mention a few important research works carried out in India, a reference can
be made to Veer Prasad who examined why the hospital administrator should
take patient satisfaction seriously as a measurement. He further explained the
procedures to evaluate the patient satisfaction.

Chaskar R.P. tried to examine the satisfaction levels of the patients and to study
the complaints with regard to various services and to assess whether such
complaints affect the overall image of the hospitals. He made some suggestions
for improving the quality of patient care.

Thimmappayya established a relationship between hospital status, employee

satisfaction and service leading to patient satisfaction.

Trakroo listed some of the factors which affect the satisfaction level of patients
utilizing outpatient services. They include unusually long time at Registration,
irritable behavior of registration clerk, lack of facilities for toilet, drinking water,
lack of proper space for waiting, too long waiting time for doctor’s consultation,
undesirable behavior of doctors and communication gap between doctor and
patient. Balaraman C.S, Jagannadhan T Sethuraman has also studied

patient satisfaction.

28
Reviews of patient satisfaction survey by
foreign researcher

David Nash, M.D., (Associate dean and director, Thomas Jefferson University's
Office of Health Policy and Clinical Outcomes) says, Perhaps the largest context
in which patient satisfaction is currently measured involves hospitals using
patient surveys to assess and improve their "hotel-motel" functions and do a
better service job to maintain a competitive posture in their markets.

Press Ganey Associates, headquartered in South Bend, Indiana, is the hospital

industry's leading independent vendor of patient satisfaction measurement and
improvement services.

Patient satisfaction data regarding inpatient and ambulatory care play a

significant role in the strategy and tactics a hospital uses in delivering patient
services says David Longnecker, M.D., senior vice president and corporate chief
medical officer of the University of Pennsylvania Health System. In a competitive
health care environment, patients want and expect better health care services
than they did in the past, and medical centers are concerned about maintaining
their overall image, he adds.

29
Longnecker notes in response to patient satisfaction data, Penn changed the way
its telephone system interfaces with patients and, over the past 18 months, has
implemented a service excellence program in its clinical practices devoted to
increasing the awareness of office staff to the needs and expectations of patients
focusing on issues such as improving telephone etiquette, reducing delays and
scheduling appointments efficiently.

Marshall Webster, M.D.-President of UPMC's Physician Services Division and

president of University of Pittsburgh Physician Practice Plan, have used the
results from Press Ganey patient satisfaction surveys to make changes such as
adjusting patient appointment patterns for more realistic scheduling.

Udvarhelyi says that satisfaction is related to the overall effectiveness of

communication between physician and patient, which he says is necessary for
achieving good outcomes, while ineffective communication can lead to poor
quality. "Satisfying the patient and addressing their concerns is an outcome in
and of it," says Udvarhelyi. "The patient is the best judge of whether their needs
are being met.

Press Ganey argues that satisfaction data represents real events that transpire
between providers and patients, and that it needs to be seen as equivalent to
clinical indicators as a parameter of quality of care. The patient is the final arbiter
of what the experience of care has been, says Wolosin: "If you do not pay
attention to it at some level, you will not understand how your processes can be
improved so that the patient can walk away with an experience that is
multidimensional okay."

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A recent Institute of Medicine report outlined six characteristics of quality health
care: that it is safe, equitable, evidence-based, timely, efficient and patient-
centered, notes Longnecker. The latter three goals, he says, are directly
influenced by patient satisfaction.

While satisfaction measurement is still being used primarily to monitor and

improve service excellence, some hospitals are beginning to ask more
sophisticated, clinically-oriented patient satisfaction questions, such as whether a
person felt safe during hospitalizations and whether they observed a medical
error occur, says Nash. "As the science of the measurement improves, I'm sure
we'll be asking patients their concerns in these areas," he adds.
The Pucker Institute13working with American Hospital Association has

interviewed 3,50,000 patients. From this data the researcher defined

the Eight “Dimensions of Care”

 Respect for the patient’s values, preferences and expressed

needs

 Access to care

 Emotional support

 Information and education

 Coordination of care

 Physical comfort

 Involvement of family and friends

 Continuity and transition

31
 PART 2

INTRODUCTION
32
Health care sector is an emerging sector, set to revolutionize the domestic
scenario with the entry of big corporate houses in to the sector in last two years.
Health care institutions of today is no more a simple institution, it has become a
very dynamic and complex organization running with activities of customer care.
The industry enjoys both public and private participation.

The industry is comprised of public sector organization and private sector

companies and industry associations. It is administered publicly through ministry
of health, which sets policy and standards and provides governances funding for
direct provision of services. The growth rate demands for professionalization of
services.

Service is provided by hospitals, other health facilities and programs such as

long term care. The growth rate of hospital depends on quality of service provided
by a hospital & up to what level patient gets satisfied in a hospital.

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AN OVERVIEW OF HEALTHCARE
INDUSTRY

INTRODUCTION

34
Healthcare is basically the service to life. The dignity of human life and concern
for the suffering brethren permeates the healthcare activities. The Greek concept
of healthcare was much closely associated to divine worship and sacred acts. The
Egyptians also considered this in a spiritual aspect. To heal is a divine action, in
the view of almost all civilizations. Hence health care has traditionally been
considered as a service. The intention of those who learned and practiced
medicine in ancient times was “service for humanity”.

Over the ages we see a gradual change in approach towards health care. The
availability of medical knowledge, increase in consumer awareness, information
technology explosion and wider application of technology in medicine favored
this change. By the introduction of Industrial Dispute Act of India in 1947,
hospitals are explicitly considered as industries. Later, by the application of
Consumer Protection Act (1986) in health care, the approach to the field has
changed fully. Now it is considered as an industry as any other business firm. The
beneficiaries are not just ‘patients’ or ‘sick’; rather they ‘customers’ ‘consumers’
and ‘prayers’. The hospitals, doctors and paramedical personnel are the
providers.

HEALTH CARE PROCESS

35
The process of health care can be compared to any industry. They take in- puts,
process them and produce out-puts. The health care industry also does the same.
The in-take is not just the patients. The resources taken by hospital are: men,
money, materials, machines and time. The major difference is that it requires men
with very specialized training. The time and effect of process is unpredictable and
absolutely relative for each patient. The end product is most of time improved
health and sometimes failure or even death.

SERVICE
Service is no longer a by-product of industry, but has become a powerful
economic engine in its own growth. The features of a service are:

 Perish ability: The time element is very crucial. If the service is not used
now, it is lost forever.

36
  Changing Demand: change in time, season etc have considerable
impact on demand for service. E.g.: Demand for traffic facilities at peak time
and non peak time.

 Intangibility: Service is a mental phenomenon; it has no tangible form.

E.g.: legal advice, finance broker, family counseling etc.

 Inseparability: Personal service cannot be separated from the individual

who provides it. E .g: physician consultation, an expert opinion etc.

 Heterogeneity: No two providers give the same service in the same form
and manner. E.g.: Differences in traveling under two transport companies.

 Pricing of services: demand, completion, time, skill and experience of

the provider etc play a vital role in determining the pricing. There is no
standardized form of pricing for services. E.g.: fee for consultation by a
fresh doctor and a very experienced specialist. Fee for a senior expert
advocate and a fresher. Services can be classified as:

• Industrial service, and

• Consumer service.

Industrial services are those sold in the business market, to facilitate the
process of production, finance and marketing.
Examples are: financial services, insurances services, transport and warehousing
services, engineering services, office services, advertising etc.

37
The consumer services are those sold to the consumer. Examples: Food,
Hotels and Motels, Personal care, Entertainment, Care of properties, Transport,
Communication etc. However there is no specific wall that separates the two.

Industry Service Hospitals

Industries
Raw material Physical Willing Unwilling/ forced
substances customers
End Product Customer delight Indefinite
Activities Routine, Planned Planned, Continuous, non
deferrable deferrable
Timing Scheduled Scheduled Round the clock
Authority Vertical Vertical/ team Multiple lines
Performances Measurable Relatively No standard
measurable evaluation
possible
Relations formal Formal/ Situational
situational

Based on the model of Pragna Pai, “Effective Hospital Management”

HOSPITAL

“A hospital is an integral part of social and medical organization, the function of

which is to provide for the population complete health care, both curative and
preventive, and whose outpatient services reach out to the family and its home

38
environment; the hospital is also a center for the training of health workers and
bio – social research.”(WHO)

History and Origin of Hospital

The history of hospitals can be traced back to the period before Christ (BC 786-
285), when the Greek built temples for the care of sick and named them
“Aescalapia” to perpetuate the memory of their great physician Aescalapius. He is
believed to have cured many people suffering from various illnesses. Mythology
says he is son of Apollo, the god of healing. Hippocrates who is considered to be
father of medicine was his descendent.

39
Diseases were considered to be a punishment of god or nature. Hence men used
to blame and leave for fate those who had any sort of diseases. It was
Hippocrates who discarded the superstitions and started practice of medicine
based on scientific principles.

St. Jerome is supposed to be the first one to mention the word ‘hospital’ which
has its roots in Latin word ‘hospitalis. He used the word to describe a hospital
established by Fabiola in Rome in AD 390.

The history of Arab (Mohammedan) medicine speaks about Rhazes( 865- 925 AD )
who practiced in a hospital in Persia . In 542 AD the earliest hospital was founded
in hotel Dieu in Paris. It said that a hospital named ‘St.Bartholomew’s hospital
was founded in London in year 1123. The Spanish built the first hospital in Mexico
City in 1524. In the North America, the first general hospital, Pennnsylvania
hospital opened in 1751, Bellevue hospital in New York in 1736 and
Massachusettes hospital in 1811.

In the Indian subcontinent, the origin of hospitals can be traced back to the time
of Buddha, followed by Ashoka. The most notable of the early hospitals were
those built by King Ashoka( 273- 232 BC). The modern system of medicine was
introduced in India in the 17th century; the East India Company established its first
hospital at Chennai (Madras) in 1664 for its soldiers and in 1668 for civilians.

40
 FUNCTIONS OF HOSPITALS
Hospitals existed until the last century to treat and cure the sick. The recent past
gave importance to preventive and rehabilitative functions. Preventive functions
include immunization, health education, early detection of diseases, antenatal
care etc. Rehabilitation function serves physical, social and psychological
aspects of life. Curative, rehabilitative and preventive functions are known as the
‘service functions’ of the hospitals. Hospitals perform some other important
functions also, namely teaching, training and research.

41
The functions of a hospital can be summarized as follows:

 Cure: cure of sick and the injured.

 Prevention: prevention of disease and promotion of health

 Rehabilitation: minimize the sufferings due to sickness and lead to

maximum independence.

 Research: support and facilitate research in medicine and allied

branches.

 Training: training at real life situations for doctors, nurses and allied
health professionals.

SERVICES IN A HOSPITAL
The services in a hospital can in general be classified in to

 Out-Patient (OP) and

 In-Patient (I P)

42
The out-patient services give ambulatory medical care to patients who are not
confined to bed. When such care is given in a hospital, it is called OP service. The
same can also be done in a clinic.

IP service give medical care to patients with lodging and other facilities in an
atmosphere artificially created to give the patient homeliness. Continuous
observation, assistance of expert hands, preparedness to face emergencies and
availability of equipment are major factors that necessitate the stay in hospital.

The services in a hospital can be classified in to clinical, diagnostic, supportive

and administrative based on their nature. The clinical services give medical
consultation, surgeries, counseling and prescription by a physician. They are
done under various branches like General Medicine, General Surgery, Pediatrics,
Obstetrics & Gynecology, Orthopedics, ENT, Ophthalmology, Psychiatry,
Anesthesiology, Dermatology ( Skin & VD ), Dentistry and super speciality
branches like Cardiology, Nephrology, Neurology, Respiratory medicine, Plastic
surgery, Cardio thoracic surgery, Neurosurgery, Uro-genital surgery, Pediatric
surgery, Medical Oncology, Surgical Oncology etc. The diagnostic services
include Radiology, Pathology, Biochemistry, Microbiology and Nuclear Medicine.

There are some other branches of medical science, which are usually found in
teaching hospitals, namely: Community Medicine, Forensic medicine, Anatomy,
Physiology and Pharmacology etc.

DEPARTMENTATION IN HOSPITALS

43
For effective functioning of organizations, the 3D’s called

 Departmentation

 Delegation and

 Decentralization
are required, Hospitals are no exceptions for this. Physicians can shoulder the
task of management in small hospitals and clinics. But in bigger hospital it is not
easy. The increased application of professionalism and competitive market
demands full time managers. At the same time doctors also have to be very
careful and deeply involved in patient care to assure quality and complaint less
care delivery. Hence the departmentation in hospitals usually go in three major
categories:

 Clinical

 Administrative and

 Supportive

The clinical departments include the various medical branches, diagnostic

services, therapeutic services, nursing services and pharmacy.

The supportive services include housekeeping, laundry, dietary, sterile supplies,

security, maintenance, mortuary, electrical and medical gas supplies, refrigeration
and air conditioning, computer, communication and IT, library and waste
management unit.

They work behind the curtain, often unnoticed in the performance of health care
delivery. But without them the on- stage performance is nearly impossible. The

44
administrative services focus on the business aspects of hospitals. They include
finance, purchase, personnel, marketing, public relations, medical records,
statistics, plant management, billing and quality management unit.

The above classification is not a final word in departmentation. Every hospital has
its own tailor made departmentation. Sometimes the administrative services go
widespread to enhance the functioning of clinical departments. It is the task of the
hospital administrator to organize the various departments in a way which suits
best for his hospital so as to ease the functioning and reduce problems.

COMPONENTS OF HOSPITAL

A hospital is not just a building. It is rather an operating system that works 24

hour a day, 365 days a year and can never stop once it start running. It is a
social institution, which is in continuous interaction with the society. Its
components are various. They include the hardware and the software. The
hardware of hospital includes building, furniture, equipment, installations, and
materials, both consumables and non-consumables. The software means

 The staff: skilled, semiskilled & unskilled employed in medical,

paramedical, supportive services and administration.

45
  Patients: present and potential

SYSTEM MODEL OF HOSPITAL

Hospital can be considered as a system, which has a give and take relationship
with the community that surrounds it. Usually the management of any hospital
considers that the friends of the hospital are the nearby hospitals, health
administrators, government machinery and so on. But the truth is that the
community surrounds the hospital, each and every family in that area is the
best friend of the hospital. The hospital takes the resources from the
community and serves them, educate them and make profit which is again
given back to the society in the form of new facilities and provisions. Health
education, formal and informal, training of personnel and employment
opportunities are some of the visible immediate benefits the society receives.
Health education is done in a systematic fashion through various programs and
in an informal and one-to-one mode in the OPD’s.

46
 The system model of a hospital

Resources Medical care

COMMUNITY
Resources HOSPITAL

47
 Patients Health Education

Infrastructure Training

Support/good
Employment
will

CLASSIFICATION OF HOSPITAL

There are different types of hospital serving the humanity. There are differences
among hospitals in there structure, functions and performances. Hospitals do
not lend themselves to easy classifications. There are different classifications
of hospital based on the objective of the hospital, the system of medicine they
follow, the size, the level of care, the nature of ownership, revenue generation,
the geographic location etc.

 OBJECTIVE: On the basis of objective, hospitals can be

classified into three.

• General Hospitals: these are hospitals set apart for treatment

of patient with common diseases. Different specialties that are
common are found in such hospitals. General Medicine, General

48
 Surgery, Obstetrics & Gynecology and Pediatrics are necessary in
general hospitals.

• Specialty Hospitals: Specialty hospitals provide exclusive and

specialized medical care with high degree of expertise. They may
also cater one or more than one specialties in the same
institution. E.g.: Cardiac hospital, Eye hospital, Mother and child
hospitals, Brain and spine hospital etc.

• Teaching-cum- research Hospitals: These are hospitals,

which give patient care in association with training of health care
personnel, both medical and allied health professionals. Medical
college hospitals, Research institutions, hospitals with nursing or
allied health training etc., all come in this category.

 SYSTEM OF MEDICINE: Depending on the system of

medicine followed in hospitals, they can be classified into

• Allopathic hospital

• Ayurveda hospital

• Homoeopathic hospital

49
 • Naturopathic hospital

• Unani hospital

• Multi-system hospital: these hospitals practice two or more

systems of medicine in the same campus, as different units. Ex:
Allopathic and Ayurvedic, Allopathic and Homoeopathic etc.

 OWNERSHIP: ownership is a major factor that influences the

entire process and management in all hospitals. Based on ownership we
can classify hospitals in to following:

• Government / Public hospitals: hospitals owned by union & state

governments or local bodies like panchyat, municipality, corporation etc.
The aim is to avail medical service to society, not profit. They may be
general or specialty.

• Semi-government hospitals: hospitals run in private-public

partnership. E.g.: co-operative hospitals

• Voluntary agencies / trust owned: voluntary agencies run hospitals,

based on their mission. They are usually not profit oriented. Trusts
hospitals are run by trust or registered authorites. They have to be

50
 established under an act of the state or central government like Public
Trust Act, 1982 or Societies Registration Act.

• Private hospitals: these are hospitals owned by individuals or families,

running on profit motive.

• Corporate hospitals: these are hospitals with high–class provisions

for the affluent with a profit motive, owned by corporate agencies. The
management will be public limited company established under the
Companies Act.

• Charitable hospitals: these hospitals are owned by charitable trusts,

individuals, churches or religious firms. They run to serve the poor and
suffering with subsidized rates.

 SIZE OF HOSPITAL: Though there is no standard criterion

acc to size, the general understanding of classification related to size,
is:

• Small hospital: small hospitals have a bed capacity of less than 100.

• Medium size: 100 to 300 beds (may go up to 500)

• Large hospitals: more than 500 beds

51
  REVENUE GENERATION: according to revenue
generation, hospitals are classified into free, non-profit & profit.

• Free: in this hospitals, all the services are done free of cost. E.g.: Sai Baba
Hospital

• Non-profit: these hospitals are for no profit & no loss their concern for
revenue is to run hospital.

• Profit: these hospitals are clearly for profit & welfare of the stakeholders.
E.g.: Allolo, Wockhart etc.

 LEVEL OF CARE: Depending on the level of care also

hospitals can be classified:

• Primary care: hospitals give basic and emergency medical assistance.

• Secondary care: these attend to all sorts of complaints falling under

different specialties, relatively with fewer complications. They attend
referral cases from primary care centers also.

• Tertiary care: they provide medical care on a referral basis with high
degree of specialization and skill, usually for more complicated cases.
Usually they do not attend primary cases. Reference from a lower care
centre is the usual entry route for treatment.

 LOCATION: Geographic location of the hospital has also been a

factor in classifying hospitals.

52
 • Village / Panchayat: hospitals situated in small villages or panchayat.
They often enjoy support by local self –governing agencies. Tax and
expenses on power, water etc., will be less for them.

• Town hospitals: hospitals in small or big towns

• City / metro hospitals: they are situated in cities or metros. Usually the
expenses in running the hospital will be high and consequently the charges
also will be high.

Mrs. Pragna Pai gives a table indicating the differences between the following :

Public Private
Ownership Government Individual/trust/agency
Fees Minimum/no fees Moderate to high
Monitory Usually loss Profit or no loss
Workload No control Can be regulated
Admission criteria For all who require hospitalization Selective admission
affordability necessary

Services bias Curative, preventive,promotive, Curative,

rehabilitative, field services rehabilitative,
institution based
Types of services Essential preferred over optional Revenue generating &
low risk preferred
Technology & Available, not optimum Maximization
sophistication
Types of patients Poor, medico legal, infected, unknown Middle, upper class,
disaster victims rights reserved
Housekeeping & Often unsatisfactory Well maintained
physical upkeep
Recruitment criteria Based on govt. policy Need based
Motivation Based on job security, job satisfaction, Revenue generation,
frustration & dedication ego, competition, job
insecurities

53
 OTHER HEALTH CARE FACILITIES

There are a few other healthcare centers that may not come under the above
classification.

 CLINIC: Oxford dictionary sees clinic as a place forgiving medical advice.

Dorland’s dictionary explains it as an establishment where patients are
admitted for study and treatment by a group of physicians practicing
medicine together.

 POLYCLINIC: this is modern model of healthcare center. In this many

physicians practice under the same roof, independent of each other; but
may have cross consultations for the benefits of the patients.

 DIGNOSTIC CENTER: centers where diagnostic services are provided,

laboratory, radiology, pathology or combination of these.

 DRG’s: Diagnostic Related Groups: these are chains of diagnostic centers,

which have a wider network of facilities.

54
  COMPANY HOSPITALS: large scale industries with large no of employees
are supposed to give basic medical assistance and provision for
emergency care.

 ISOLATION HOSPITALS: healthcare institution established exclusively for

the care of patients suffering from communicable diseases requiring
isolation from other healthy member of society.
Objective Medicine Ownership Location Size Care
General Allopathic Govt./ Village Small Primary
public

Specialty Ayurvedic Semi govt. Town Medium Secondary

Teaching Homoeopathic Trust City Large

Research Unani PRIVATE Very large Tertiary

Siddha Corporate
Charitable

CLASSIFICATIONS

55
 OBJECTIVE

 To asses up to what mark in a particular hospital patient’s needs are

satisfied.

 To improve & enhance the service to satisfy patients need.

 The strategy is to use various measures, technology to provide:

• Effective early medical intervention

• deliver expert health care
• minimize in convenience caused to patients and health
workers from poor logistic & long travels
• Waiting time for fulfillment of health care formalities in a health
care center.
• Increasing the role of health care centers to provide health
education emphasizing:

 family planning

 Hygiene

 Sanitation

 prevention of communicable diseases

56
 Making availability of trained and well qualified doctors, paramedical staff,
and ancillary staff to adequately serve the rural & urban population so that
medical needs of patient can be satisfied.

 Implementing various measures to reduce the time & formalities during

hospitalization.

 Making procedure in medico legal emergencies in such a way as not to

delay treatment in fulfilling of legal or ethical requirements.

 To implement latest technology in hospital so as to provide hi- tech

Medicare which will enhance patient’s satisfaction

57
 RESEARCH AND METHODOLOGY

Aim:

The basic aim of this study was to find out the satisfaction level of the patients
with the medical, nursing, administrative and ancillary services available at the
LORD MAHAVIRA HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL.

Objectives:
 to evaluate the patient satisfaction level

 to access the available services

 to study requirements of the patient’s

 to find out patient approach for continuity and transition

Methodology:
The exploratory research was carried out to gain in depth understanding of
patient satisfaction and their perception of services quality.

The study was carried out at LORD MAHAVIRA HOMOEOPATHIC

MEDICAL COLLEGE & HOSPITAL, Ludhiana. The study further aims to
access the views and experiences of the patient at the actual time of delivery of
the services.

58
The entire study was conducted in the
following steps:

 Review literature: The research in the area of

patient satisfaction survey is few. The researcher has reviewed
literature from the different journals and with the help of internet
surfing.

 Informal discussion: Informal discussion was

done with the faculty member of med varsity and the authorities of
the Lord Mahavira Homoeopathic Medical College & Hospital where
the study was carried out.

 Questionnaire: The Patient Satisfaction

Questionnaire was developed by Dr. Ware which formed the core part
of the questionnaire used in this study. Response to each item in the
PSQ is obtained with the help of a rating scale, consisting of five
categories ranging from excellent to poor.

The items in case of PSQ gives sub scale assignment of each item.
Satisfaction with consultant, reception, admission procedure,
nursing care, cleanliness, food and beverages, ward doctors were
included to survey general satisfaction level during hospital stay.
Suggestion and comments were welcomed by the researcher.

 Sample selection: The researcher has excluded

the patient belongs to following category:

59
  < 16 years of age
 Patient with severe cognitive impairments (e.g. Alzheimer’s
patients)
 Any patient with severe sensory motor impairments

 Sample size: 40.

 Personal Interview: The researcher has

personally interviewed,

 The indoor patients

 The follow up patients (previously hospitalized patients)

 Data Analysis: The collected data was analyzed and

described in the statistical and chart manner.

 Discussion: Data was discussed in the detail by the

researcher.

 Conclusion: The researcher concluded the survey on

the basis of the analysis of the data.

 Recommendations: The researcher has

submitted the recommendation on the basis of the statistical data,
discussion and comments from the respondents.

60
 Data Analysis: Personal profile of the patient:

The summary of patients’ personal data:

1. PERSONAL PROFILE

1.1 Age 20-30 31-40 41-50 51-60 >60

03 03 02 14 18
1.2 Sex Male Female
12 28
1.3 Accommodation Economy AC NON-Ac Deluxe
34 02 04
1.4 Educational Qualification Undergraduate Graduate Postgraduate Doctor
32 44 -
1.5 Annual Income <1 Lac 1-3 Lac 3-5 Lac > 5 Lac
29 07 - 05
1.6 Medical Insurance Yes No
07 33
2. ADMISSION PROCEDURE Excellent V. good Good Fair Poor
2.1 Behavior of reception staff 28 10 - 02
2.2 Adequacy of information at 24 14 02
reception
2.3 Insurance query at reception 01 30 20 01
2.4 Registration process 12 28
2.5 Was your room ready at the time 35 05
of your admission
3. PHYSICAL COMFORT Excellent V. good Good Fair Poor
3.1 Room Comfort 12 06 09 11 02
(Space, ventilation, ambience)
3.2 Utility & Linen availability 05 03 29 02 01
(Fan, water supply, light)
3.3 Cleanliness of the room 06 32 - 02 -
4. CARE AND SERVICES
4.1 Services of your consultant’s 40 - - - -
explanation regarding the disease,
diagnosis and treatment
4.2 Daily consultant visits 40 - - - -
4.3 Services of Laboratory & - 40 - - -
Radiology investigation
4.4 Services of Medical Officer 19 12 07 02 -
4.5 Services of Nursing care - 20 12 06 02
4.6 Services of Food services - 05 16 17 02
4.7 Services of House keeping 05 29 06 - -
4.8 Services of Physiotherapist - 23 - - -
5. CONTINUTY & TRANSITION YES NO CAN’T SAY

61
5.1 Did u get value for money? 39 01 -
5.2 If required, would you like use the 39 01 -
same health care services if
needed?
5.3 Would you be proud to 39 01 -
recommend this organization to
your family and friends?

* Distribution of respondents by age:

Age Group(years) No. of respondents % of respondents

20-30 03 7.5
31-40 03 7.5
41-50 02 5
51-60 14 35
>60 18 45

* Distribution of respondents by age:

62
* Distribution of respondents by sex:

Gender No. of respondents % of respondents

Male 12 30
Female 28 70

* Distribution of respondents by sex:

63
* Distribution of respondents by
accommodation:

Class No. of respondents % of respondents

Economy 34 85
Twin sharing 02 05
Deluxe 04 10

* Distribution of respondents by class:

64
As the hospital is charitable organization, the researcher has concentrated more
on the economy class to find out the satisfaction level in them.

* Distribution of respondents by education:

Educational Qualification No. of respondents % of respondents

Undergraduate 32 80
Graduate 04 10
Post graduate 04 10
Doctorate - -

* Distribution of respondents by education:

65
 * Distribution of respondents by annual
income:
Annual Income (Rupees) No. of respondents % of respondents
< 1 Lac 31 77.5
1-3 Lac 07 17.5
3-5 Lac - -
>5 Lac 02 5

* Distribution of respondents by annual

income:

66
Most of the patients whom researcher has interviewed were belongs to lower
middle class.

* Distribution of respondents by having

medical insurance:
Medical Insurance No. of respondents % of respondents
Yes 07 17.5
No 33 82.5

67
Though the study is limited to the few no of patients, the researcher has tried to
find out the % of the patient having medical insurance visiting this hospital. It was
found that all the patients having medical insurance policies have chosen this
hospital for the treatment because of the consultant’s expertise and the good
services of the hospital.

Admission Procedure:

¿ Distribution of respondents based on the

behavior of reception staff:

Rating Excellent Very good Good Fair Poor

No.of respondents - 28 10 - 02

68
% of respondents - 70 25 - 5

¿ Distribution of respondents based on the

behavior of reception staff:

¿ Distribution of respondents based on the

adequacy of information available at
reception:

Rating Excellent Very good Good Fair Poor

No. of respondents - 24 14 - 02
% of respondents - 60 35 - 05

69
¿ Distribution of respondents based on the
adequacy of information available at
reception:

¿ Distribution of respondents based on the

insurance query at reception:

Rating Excellent Very good Good Fair Poor

No. of respondents - 01 03 02 01
% of respondents - 14.28 42.85 28.57 14.28

70
 ¿ Distribution of respondents based on the
insurance query at reception:

Distribution of respondents based on the

registration Process:

Rating Excellent Very good Good Fair Poor

No. of respondents - 12 28 - -
% of respondents - 30 70 - -

Distribution of respondents based on the

registration Process:

71
¿ Distribution of respondents based on the
room ready at the time of admission:

Rating Excellent Very good Good Fair Poor

No. of respondents - 35 05 - -
% of respondents - 87.5 12.5

¿ Distribution of respondents based on the

room ready at the time of admission:

72
¿ Distribution of respondents based on the
room comfort:

Rating Excellent Very good Good Fair Poor

No. of respondents 12 06 09 11 02
% of respondents 30 15 22.5 27.5 5

¿ Distribution of respondents based on the

room comfort:

73
It was found that the patients occupying the deluxe room or twin sharing have
found the room most comfortable.

¿ Distribution of respondents based on the

utility & Linen availability:

Rating Excellent Very good Good Fair Poor

No. of respondents 05 03 29 02 01
% of respondents 12.5 7.5 72.5 5 2.5

¿ Distribution of respondents based on the

utility & Linen availability:

74
¿ Distribution of respondents based on the
cleanliness of the room:

Rating Excellent Very good Good Fair Poor

No. of respondents 06 32 - 02 -
% of respondents 15 80 - 5 -

¿ Distribution of respondents based on the

cleanliness of the room:

75
95% of the patients have appreciated the cleanliness of the room and the hospital.
Cleanliness is one of the most important considerations in choosing a hospital.
It is also an important factor to prevent non socominal infections.

¿ Distribution of respondents based on the

services of the consultant:

Rating Excellent Very good Good Fair Poor

No. of respondents 40 - - - -
% of respondents 100 - - - -

¿ Distribution of respondents based on the

services of the consultant:

76
The researcher has tried to find out the behavior and communication of the
consultant with the patients in regard to diagnosis, treatment, prognosis and risk
factors involved in the medical or surgical treatment. It was found that all the
patients have shown 100% satisfaction with their consultants and rated it as
excellent.

¿ Distribution of respondents based on the

daily visits of consultant:

Rating Excellent Very good Good Fair Poor

No. of respondents 40 - - - -
% of respondents 100 - - - -

¿ Distribution of respondents based on the

daily visits of consultant:

77
¿ Distribution of respondents based on the
services of Laboratory and radiology:

Rating Excellent Very good Good Fair Poor

No. of respondents - 40 - - -
% of respondents - 100 - - -

¿ Distribution of respondents based on the

services of Laboratory and radiology:

78
Any delays in the laboratory, radiological or diagnostic reports delay the
treatment of the patients. It was found that the patients were satisfied with the
laboratory and radiology services and rated it as very good.

¿ Distribution of respondents based on the

services of ward doctors:

Rating Excellent Very good Good Fair Poor

No .of respondents 19 12 07 02 -
% of respondents 47.5 30 07 05 -

¿ Distribution of respondents based on the

services of ward doctors:

79
¿ Distribution of respondents based on the
services of nursing care:

Rating Excellent Very good Good Fair Poor

No. of respondents - 20 12 06 02
% of respondents - 50 30 15 5

¿ Distribution of respondents based on the

services of nursing care:

80
¿ Distribution of respondents based on the
services of Food:

Rating Excellent Very good Good Fair Poor

No. of respondents - 05 16 17 02
% of respondents - 12.5 40 42.5 5

¿ Distribution of respondents based on the

services of Food:

81
¿ Distribution of respondents based on the
services of Housekeeping:

Rating Excellent Very good Good Fair Poor

No. of respondents 05 29 06 - -
% of respondents 12.5 72.5 15 - -

¿ Distribution of respondents based on the

services of Housekeeping:

82
 Dist ¿
ribu
tion
of
respondents based on the services of
Physiotherapist:

Rating Excellent Very good Good Fair Poor

No of respondents - 23 - - -
% of respondents - 100 - - -

¿ Distribution of respondents based on the

services of Physiotherapist:

83
All hospitalized patients don’t require the physiotherapy. 23 patients out of
40interviewd patients required the services of physiotherapist. All of them were
found very happy and satisfied with the services provided by the
physiotherapists.

¿ Distribution of respondents based on the

value for money:

Feed back Yes No Can’t say

No. of respondents 39 01 -
% of respondents 97.5 2.5 -

¿ Distribution of respondents based on the

value for money:

97.5% of the patients were found the value for the money paid to the organization
as a part of their treatment.

84
 Distribution of respondents based on the use of
4.5.2
same health care services if needed again:

Feed back Yes No Can’t say

No. of patients 39 01 -
% 97.5 2.5 -

¿ Distribution of respondents based on the use of

same health care services if needed again:

97.5% of the patients were found to have positive approach to use the same
hospital services in future if needed.

85
 ¿ Distribution of respondents based on the
recommendation to family and friends:

Feed back Yes No Can’t say

No. of patients 39 01 -
% 97.5 2.5 -

¿ Distribution of respondents based on the

recommendation to family and friends:

97.5% of the patients were found willing to recommend the hospital to their
friends and relatives.

86
 DISCUSSION

The researcher has found high level of satisfaction in the patients during hospital
stay.

As the hospital is a charitable organization, the researcher has concentrated more

on the economy class to find out the satisfaction level in them. Most of the
patients whom we had interviewed belongs to lower middle class.

Due to lack of the education I found lots of difficulties while collecting the right
information. Few of the patients have refused to give feed back as they found
worried that it will affect their treatment.

It is necessary to find out the Satisfactions level, not only in the patients but the
attenders also. Because most of the time the attenders who go for registration
and some other administrative formalities. I had interviewed not only the patients
but attenders also. To have a combine opinion I had interviewed patients during
visiting hours.

95% of the respondents were found satisfied with the behavior of the reception
staff and information provided by the reception and rated it between excellent to
good and only 5% found it poor.

All the respondents found the registration process easy and were satisfied with
the behavior of the staff of the admission, billing and cash counter.

7 patients out of 40 found to have medical insurance. 50% of the respondents

found the administrative services helpful for their insurance procedure, while 29
% of the respondents have rated the services as fair and 14% found it poor.

87
It was found that sometimes the patients have to wait for few hours to get room
due to full occupancy. But all the patients found their room ready at the time of

the allotments.

68% of the respondents found the room comfortable in regards with space
ambience and ventilation. 27% of the respondents found the room ok, while 5%
of the respondents found it poor. It was suggested to have less no of beds in the
room especially in the economy class.

In a couple of rooms it was found that the window facing beds are not having
curtains and so the privacy of those patients is not being maintained.

93% of the patients were found satisfied with the utility and linen services in the
rooms.

95% of the respondents have appreciated the cleanliness of the room and the
hospital. Cleanliness is one of the most important considerations in choosing a
hospital. It is also an important factor to prevent nosocominal infections.

It was found that all the patients were very happy and highly satisfied with the
services of their consultant doctors in regards to their skill, behavior,
communication with the patients regarding diagnosis, treatment, prognosis and
risk factors involved in treatment. Such a high satisfaction level of the
respondents is a crown on hospitals head.

Any delays in the laboratory, radiological or diagnostic reports delay the

treatment of the patients. Though most of the pathology samples and reports are
being collected by the nursing staff, but sometimes the patients are needed to go
to the laboratory for diagnostic procedure like Echo, C T scan, sonography. The
respondents were found very satisfied with the services.

88
The consultant doctors cannot be available for all 24 hours in the hospital. It is a
duty of the ward doctor to take care of the patients in the absences of the
consultants. Most of the patients have rated the services between excellent to
good.

Nursing care is one of the most important factors to find out the satisfaction level
of the patients. 80% of the respondents have found it good. While 15% of the
respondents have found it ok. 5% of the respondents were found dissatisfied with
the nursing services. The respondents have found the late attending nursing calls
due to heavy work.

Food and beverages services of the hospital were found good by 52% of the
respondents.

While 43% of the patients found it ok. Few respondents had complained about the
quality of food. Some of them had complained about the more or less same menu
every day.

The housekeeping department was rated between excellent to good.

All hospitalized patients don’t require the physiotherapy. 23 patients out of 40

interviewed patients required the services of physiotherapist. All of them were
rated it as very good and found satisfied with the services provided by the
physiotherapists.

98% of the patients found value for the money. “Quality care at affordable rate” –
is becoming a new slogan for any health care provider.

98% of the respondents have showed positive approach towards revisiting the
same hospital for the treatment in future if needed. The researcher has found 6
patients have availed the services of the same health care provider in past as well.

89
98% of the respondents were found willing to recommend the hospital to family
and friends. This mouth to mouth publicity of the hospital cannot be replaced with
any of the marketing strategy.

LORD MAHAVIRA HOMOEOPATHIC COLLEGE & HOSPITAL is a prime

hospital in Ludhiana providing hi tech medical care. Hospital has all type of
facilities for treating the disease. Great care has been taken for providing best of
treatment for every patient. Some patients told me that even doctors from aboard
are consulted if required for the benefit of patient. Management and senior
consultants are very helpful to poor patients. Poor patients are given treatment at
very less cost. Great care is taken to avoid nosomical infections.

Patients were very happy with doctors, medical &paramedical staff. Emergency
service is very quick. Highly trained staff is appointed in emergency & ICU unit.
Patients and relatives says that hospital has a great name & fame regarding the
treatment. Ambulance service is quick and provided at very reasonable charge.

Provision for treatment for these patients whose cost will be provided by third
party or any other corporation on completion of treatment is also provided by
hospital. There is no delay on treatment part of these patients on account of
completing the formalities. Cure rate of patients is quite satisfactory. Most of the
doctors are specialist having zeal to serve the patients. They are ready round the
clock to serve the patients.

Continued medical education programmes are arranged for doctors, paramedical

staff and ancillary staff which help in treating the patients with up to date
knowledge. Patients have told that hospital participate in all the health
programmes started by government. In short hospital is best medicare center for
the treatment of patients.

90
 PATIENTS EXPECTATIONS FROM A
HOSPITAL

During my survey process I have asked all patients, about their expectations from
a hospital. All of them told that it should have quality of treatment with each and
every type of facilities, which must be cost effective so that we can get treatment.
Patient also told that medicine should also be cost effective so that we can buy
easily. Most of the patients complain of long lines in billing process & indoor
admission process. A health care administer must keep in his mind all these
things so as to satisfy the patients.

WHY PATIENT’S SATISFACTION IS

NECESSARY?

91
In today’s competitive world, the customer becomes the focus of attention of any
organization both in manufacturing sector and in service sector. The quality of the
product or the service provided to customer comes under a magnifying glass to
be scrutinized by the buyer and the market. Organizations are becoming very
sensitive to the needs of the customer not only to gain their good will, but also to
avoid facing their wrath. Today customer is willing to pay the price for value. The
keyword as far as the value of a product or service is concerned is quality.
The quality of a service or a product is the vital factor for the survival and growth
of any organization. Quality is engine of economy and the fabric of corporate
organization.
Changes in the economic scenario in the country during last six years have
forced a no. of organizations both manufacturing and services, to embark on
programmes related to assured quality and standardization of process. In order to
ensure delivery of quality products or quality services, at consistent level to the
customer. Quality means conformation to the standards, both stated and
implemented at a given time. Over a period of time and at a price customer can
afford to pay, or is willing to pay.
Quality in the health care industry is assuming greater significance in
developing world not only to give the best in the field of medicare to the people
but also ton attracts patients from other countries which result in foreign
exchange in flow.

92
Modern marketing concept also stresses upon the ‘PROFIT THROUGH

HUMAN SATIFICATION. The word human is used not the customers which
means customer’s requirement and ecological constraints. Public relation theory
also says that profit can be made by good public relations which in form can be
made good by becoming responsive to public & satisfying the needs of public. So
also satisfied patient will have good image of hospital which they will distribute
or advertise in general public free of cost. So in every aspect patient satisfaction
is necessary.

CONCLUSION
Developing strong patient relationships with high level of satisfaction is
challenging but it is a realistic goal. Human satisfaction is complex. Relationship
does not form over night. According to a behavioral scientist, relationship

93
consists of six different stages, Contact, Involvement, Intimacy, Deterioration,
Repair, and Dissolution.

It is important to note that the statistics of data can be changed significantly with
the change in sample size. Health status has shown the non linear relationship
with the patient satisfaction. The study was limited to 40 patients. More number
of patients can be studied to form concrete conclusion.

Quality service is not a fad but a long-term reality that directly affects medical
care, patient outcome. There would not be any scope to improve the services;
unless such bold steps at measuring patient satisfaction is pursued.

A latest concept of consumer delight has added a new dimension to health care
industries.

Limited available resources have to be stretched to meet the unlimited needs. The
Darwin’s theory of the natural selection and survival of the fittest has time again
prove itself. This even in the health care industry, today quality means not just
good services but cost effective & efficient services.

COMMENTS

94
Lord Mahavira Homoeopathic Medical College and Hospital is one of the most
renowned Hospitals bearing a good image in Ludhiana and even in Punjab for
standard homoeopathic medical care. People come from different places of
Punjab for taking homoeopathic treatment in this hospital. All patients are given
homoeopathic treatment for their diseases. Today, people are preferring to take
homoeopathic treatment for their illness because

• Homoeopathic medicines do not have side effects and the medicine is very
simple to take.
• Medicines are cost effective as compared to the allopathic medicines which
are very costly as compared.
• Those diseases which are not curable in allopathic system of medicine are
curable by homoeopathic medicines.
• Various diseases for which surgery is required can be treated with the help
of homoeopathic medicines.

Day by day scope of homoeopathic medicines is increasing. Homoeopathy

provides a rapid, gentle and permanent cure for suffering of patients. That is the
reason why people are opting for this system of medicine. Further, more people
are allergic to various allopathic drugs are well treated by this pathy. Patient
considers this pathy as disease-root destroying pathy.

L.M.H. Medical College is striving more and more for providing standard health
care to suffered ones. All doctors are highly qualified, and experienced. They are
very generous and sympathetic to poor people. For poor people they give
treatment free of cost. There is no bias on basis of caste, religion, rich or poor. All
are treated equally.

Government must boost these hospitals as it will improve the economic condition
of the country. Because the expenditure required for establishing these hospitals
and expenditure required for homoeopathic medicines is very less as compared

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to Allopathic Hospitals and allopathic medicines. So boosting this system of
medicine will decrease the burden of government in health care sector.

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 RECOMMENDATIONS

Statistical data analysis, detailed discussion of the data, comments from the
respondents, leads the researcher to recommend the following:

It is recommended to increase the capacity of occupancy of the hospital to serve

more people.

There are no facilities for the attainders to stay in the hospital campus. It is
recommended to provide proper waiting room and dormitory facilities for patient
attainders.

It is recommended to provide food for the attainders inside the hospital campus.
A canteen is found an urgent need in the hospital campus.

After the eco-tourism and beach-tourism now the government and corporate
hospitals are promoting medical tourism. In such era the hospitals should be
prepared with all the ancillary services to be provided to the patients and the
attainders. It is recommended to have some international accreditations
certification like JCIA to serve the international patients.

Large numbers of the patients have been found visiting the hospital who resides
out of the city, state and country. It is recommended to have 24 hours
communication facilities like STD, ISD Phone facilities, cyber café facilities inside
the hospital campus.

It was found that there are no separate wards for the medical or surgical patients.
There are more possibilities of infection in the surgical patients. Being in the
same ward the chances of the cross infections are increased, so it is
recommended to have separate wards for medical and surgical patients.

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The concept of medical insurance is growing in India. Most of the multinational
companies are availing group medical insurance policies for their employees.
Even small industries are also taking care of the employee’s health. Pre
employment check up is becoming a part of the recruitment. In such an era, it is
necessary to have a special help desk for medical insurance holder for corporate
clients.

The Food and beverages services required to be evaluated. It is recommended to

improve the quality of food for the patients.

The patient relation officer visits the patients once a week. It is recommended to
have a dedicated guest relation executive of guest relation team who tries to make
sure all the comforts of the patients and deals with the any complains.

As satisfaction is derived concept it is necessary to find out the sources of

dissatisfaction. ‘Care team rounds’ (including ward doctor, nursing in charge,
physiotherapist, dietician, guest relation team member) are recommended to
improve quality of the services of the hospitals and manage day to day activities
on daily basis. The complaints, comments and discomfort the patients can be
found easily on daily.

It is recommended to have patient feedback form. It should be collected at the

time of discharge of the patients.

It is found that the medical records of the patients are preserved only for five
years. The patients are getting special identification no. It is recommended to
make the department fully computerized and store the data in soft copies which
can be preserved for long time. Such preserved data can be use in future course.

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Patient education is a new concept in this competitive medical ward. It is
recommended to let the patient know about their rights and duties in the hospital.
A pamphlet of the “rights and duties of the patient” should be given at the time of
admission. A pamphlet of the ‘general guide lines to surgery’ can be prepared
and be given to patients for their knowledge.

Patient safety is a most important factor for a success of the hospital. It is

recommended to have hand rails on both the sides of the staircase. Few of the
respondents (specifically surgical patients) have suggested having hand rails in
the one side of the wall in the ward.

It is proved that better educated personnel gives the better services and it causes
client’s satisfaction. With such an idea, it is recommended to have frequent
educational programmes for the employees of the hospital. Lectures on
behavioral studies can be organized for the employees to improve the behavior of
the staff which ultimately reduces the complaints regarding behavioral issues and
lead to patients satisfactions.

Quality incentive payment system (QIPS) can be introduced as a part of bonus to

the employees to motivate employees.

Dissatisfactions arise when expectations go unmet. It is recommended to do

survey on the ‘expectation of the patients’. It is also recommended to repeat such
studies at regular interval of say six months. It would be useful guide for
managerial interventions.

A six sigma is a scientific concept provides measurement of every activity ion the
hospital by using various statistical tools. It is recommended to implement the
concept of six sigma in the hospital for total quality measurement.

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Hospital is situated in heart of Ludhiana city of Punjab is one of the private
hospitals providing world class medical facilities in every aspect.
For competing with other big and renowned hospitals & to have name & fame for
its quality & standard treatment following measures are given:

* Hospital must open its sub center in the whole Punjab so that its services
can be provided to rural people who due to various reasons cannot reach it
& thus unable to get good treatment for diseases.
* Hospitals can open various laboratory units in different districts especially
rural areas where the investigations cost are kept low so that very poor
patient can take benefit.
* As it is one of the prime hospitals it should tie up with all the civil hospitals
& various nonprofit charitable care centers and should provide treatment at
government rates for those patients who are referred by these tied up
hospitals. This will lead to public-private participation.
* Center for alternative system of medicine can be opened with appointment
of well qualified doctors of respective field. So those for every type of
treatment in which patient wants to use medicine of any pathy he can think
of one name. If this system is promoted, they will generate great revenue in
future at a very low cost.
* Although hospital has all things perfect regarding medical care, it can be
enhanced more by implementing:
• Laboratory information system
• Electronic record keeping system
• Using latest electrical energy saving equipment so as to reduce
energy consumption & cost of hospital.
• Tele medicine

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 PATIENTS SATIFICATION & ISO 9002
HOSPITAL

International organization for standardization is a worldwide federation of

national standard bodies form over 100 countries. Its mission is to promote
standardization throughout the world for facilitating the international
exchange of goods and services. The primary requirement for a hospital is
the application of these standards, to check and understand applicability of
standard clauses for the institutions. The interpretation of the clauses of
standards with reference to existing practice, as required by the standards,
will have to be formulated, applied and documented. Health care sector
institutions must work forward achieving the ISO certification which has a
great impact on patient on account of quality medicare for them.

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PART 3

APPENDIX

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 APPENDIX 1

PATIENT SATISFACTION SURVEY

(SUMMARY)

In today’s scenario role of health administrator is very wide. For growth of

organization/ hospital he has to strive for satisfaction of customer. He must
understand the needs of patients, difficulties faced by patient in hospital.
He has to take care of everything in a hospital so that no patient gets any
type of problem in hospital due to negligence or any other cause. By doing
so he can maintain the hospital environment quite fine so as to fulfill
patient’s expectations from hospital .Then and then only hospital will have
good image in contest to patients. This will give more opportunity to serve
the patient. The organization can make profit. So we can say patient
satisfaction is key factor for growth of a hospital.

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 APPENDIX 2

List of diagrams/Pictures/chart/graphs

An Improvisational Model of Change Management over Time (Pg. 14)

The model of Pragna Pai, “Effective Hospital Management” (Pg. 38)

The system model of a hospital (Pg. 48)

Mrs. Pragna Pai’s table indicating the differences between the Public & Private
Ownerships (Pg. 54)

CLASSIFICATIONS (Pg. 56)

The summary of patients’ personal data (Pg. 62)

Distribution of respondents by age (Pg. 64)

Distribution of respondents by sex (Pg. 65)

Distribution of respondents by accommodation (Pg. 66)

Distribution of respondents by education (Pg. 67)

Distribution of respondents by annual income (Pg. 68)

Distribution of respondents by having medical insurance (Pg. 69)

Distribution of respondents based on the behavior of reception staff (Pg. 70)

Distribution of respondents based on the adequacy of information available at

reception (Pg. 71)

Distribution of respondents based on the insurance query at reception (Pg. 72)

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Distribution of respondents based on the registration Process (Pg. 73)

Distribution of respondents based on the room ready at the time of admission

(Pg. 74)

Distribution of respondents based on the room comfort (Pg. 75)

Distribution of respondents based on the utility & Linen availability (Pg. 76)

Distribution of respondents based on the cleanliness of the room (Pg. 77)

Distribution of respondents based on the services of the consultant

(Pg. 78)

Distribution of respondents based on the daily visits of consultant (Pg. 79)

Distribution of respondents based on the services of Laboratory and radiology

(Pg. 80)

Distribution of respondents based on the services of ward doctors (Pg.81)

Distribution of respondents based on the services of nursing care (Pg. 82)

Distribution of respondents based on the services of Food (Pg. 83)

Distribution of respondents based on the services of Housekeeping

(Pg. 84)

Distribution of respondents based on the services of Physiotherapist

(Pg. 85)

Distribution of respondents based on the value for money (Pg. 86)

Distribution of respondents based on the use of same health care services if

needed again (Pg. 87)

Distribution of respondents based on the recommendation to family and friends

(Pg. 88)
APPENDIX 3

ABBREVIATIONS

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106
 BIBILOGRAPHY

1. Administrative thinkers by Avasthi & Avasthi

2. Administration of organization by Maheshwari

3. Management process & Organizational behaviour by

Nicholas Henry

4. Introduction to health care by Fr John Thekkekamra

5. Public relation & Organization by Smitha Nayak

6. Marketing Management by Sujatho & Umesh

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 GLOSSARY

* Health: the condition of being sound in body, mind &

spirit, especially freedom from physical disease or pain.

* Medicare: it is a programme of services that should be

available to the individual & thereby to community, all
facilities to medical and allied services necessary to
promote & maintain health of mind & body.

* Telemedicine: it is medical care from distance as

the word tele indicates.

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