1st year project

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the management asp

The researcher, a student of Master of Hospital Administration has

been introduced to ect of a 350 bedded hospital called Samaritan Hospital,

Pazhaganad.

Health is the fundamental right in the world. WHO defines Health is a

state of complete physical, mental and social well being not merely an absence of

disease or infirmity.

Hospital as a complex organization has captured the imagination of the modem

people-professionals and non-professionals alike. At one time, hospitals were

more a refuge for the ill and needy than places for medical treatment. From these

early beginnings the hospital continued through the nineteenth century to be a

haven for the homeless and impoverished. The dramatic developments in medical

science and technology in the late nineteenth and early twentieth centurys

revolutionized the role and functions of the hospital. No longer is it a place for the

ill and poor to go to die; it became the primary institution for treatment.

Hospitals belong to that class of organisations which attempt. as their primary

task, to alter the state of human material. Humans are self-activating, potentially

recalcitrant, fragile and are invested with all sorts of characteristics provided by

cultural definitions. Their self- activating naiure means that the work done on

them must be performed under special circumstances designed to limit their

ability to frustrate efforts to change. '' A hospital is basically, fundamentally and

above all, a man system. It is a complex, human-social system. Its raw material is

human. its product is human, its work is mainly done by human hands, and itsobjective is human-direct service to people, service that is individualised and

personalised(Basi1 Georgopoulous, 1964). In this context hospitals definitely fall

in the category of human service organisations. Basically the goals of the hospital

can be classified as central goal, supportive


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goals and extended goals. Central go31 is the ultimate goal of providing care to

patients.

Supportive goals are care and custf~dyw hich help to achieve therapeutic goal.

The

extended goals are education and research which we find in teaching hospitals. Inan ideal

hospital situation we need a suitabl: mix of custody, care, education and research

to

facilitate therapy. Advancing technology together with changing medical practices

have

created new and exciting goals. Hospitals typically employ a large number of

professionals, both physicians and experts and have a high degree of

specialisation of

labour. They have developed distinctive structures, psycho social systems andmanagement practices in order to accomplish their goals. Because of increasing

need for

coordination of specialised activities, managerial systems in hospitals have

become more

comprehensive. It is this factor that promoted the researcher to select the topic in

the area

of hospital administration.

Hospitals are influenced by three factors: the cultural system which sets

legitimategoals, the technology which determine:; the means available for reaching these

goals, and

the social structure of the hospital in which specific techniques are embedded in

such a

way as to permit goal achievement. The three factors are found

interdependent(Char1es

Perrow 1961). Technology influence structure- the arrangements necessarj to

implement

goals. Tasks are embedded in a structure. Structure too, can be a relativelyautonomous

element in organisations, just as belief' system and technology are relatively

autonomous

Structure can operate in an autonomous fashion, resisting or bringing about

changes in


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technology and in goals. In the present study this perspective is adhered to .Thus

in this

discussion, we can say hospital which is viewed as a complex organisation is

concerned

with three variables, goals( or in a broader sense, belief systems andvalues),technology

(techniques necessary for the execution of the task) and structure (the

arrangement of

tasks and persons including lines of authority, responsibility and communication).

They

are interdependent rather than strictlj. independent or dependent upon one

another. A

probe into the organisational charactelistics both structural and functional

aspects seemsto be imperative at this juncture ba:jed on the assumption that apparent changes

in

structural and functional aspects woulc reflect in the functioning of the hospital.

Present situation of Hospitals in India

There are opinions that allege that hospitals are gradually becoming impersonal

despite the fact that its purpose, approach and the main objective is to alleviate

human

sufferings. In some cases, it is argued that impersonaiity of this institution is due

to higherdependency on technological sophistic:ation. From the administrative angles.

hospitals in

India are more tradition bound in their outlook and their approach to problen~sw

hich they

confront. The organisational structure c~fth e present day hospital is more

monolithic and

rigid in nature which does not lend itself to meet the changing demands of the

medical

care. These different versions of functioning of the present day hospital areindications to

the fact that hospitals are becoming increasingly important centres for health

care.

The administrators or medical superintendents of the present day hospitals have


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much less authority, power and discrelion than what is being enjoyed by his

managerial

counterparts in industry because hospilal is not and cannot very well be organised

on the

basis of single line of authority. The si~nultaneousp resence of lay, semi-professionals and

professional lines of authority in hospital create a number of administrative and

managenlent problems.

It is in this perspective that hospital is visualised as formal quasi-bureaucratic and

quasi-authoritarian organisation which heavily relies on conventional hierarchical

work

arrangements rather than on rigid impersonal rules, regulations and procedures.

But it is a

highly departmentalized, highly professionalised and highly specialisedorganisational

that cannot function effectively without relying heavily for its internal co-

ordination the

modification, action, self discipline and voluntary informal adjustments of many

of its

members. It is said that coordination of efforts in any hospital is in dispensable to

organisational functioning , because no st of the work in the hospital situation is

highly

interaction in character.a. D~fferenriationo factivirie.~

Extensive differentiation and specialisation of activities are evident in the

hospital. To do its work, the hospital relies on an extensive division of labour

among its

members. upon a complex organisational structure which encompasses many

different

departments, staffs, offices and positions, and upon an elaborate system of

coordination

of tasks. functions and social interactions". The tasks of the hospital are carriedout by a

large number of co-operating participants whose educational background.

training, skills

and functions are diverse and heterogenous. Much of the treatment task is

performed by


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the doctors , who require the ccllaboration and assistance of many paramedical

professional personnel. The medic:al staff is specialized because of the growing

complexities of medical technology. The nursing staff includes graduate

professional

nurses in various supervisory and non-supervisory positions, practical nurses andnurse's

aides. In addition there are the hospital administrator and his staff, which include

a

number of supervisory personnel heading such departments and services as

dietetics,

admissions, maintenance, pharmacy, medical records, house keeping and laundry.

Also,

there dre medical technicians who work in the laboratories, x-ray departments

and otherunits. Apart from these direct particip.mts in the hospital system, there is usually

a board

of trustees that has overall, institutions1 responsibility for the organisation.

b.Administrative organisation and medical staff

A major differentiation of acivities occurs because of distinction between the

administrative organisation and the medical staff The administrative organisation

is

headed by the board of trustees, which appoints the hospital administrator as the

chiefexecutive. Under him are the various departmental directors who are in charge of

functional activities such as medicztl records ,laboratories. dietetics. house

keeping

personnel records, public relations and accounting.

The other part of dual differentiation is the medical staff, which is engaged in

treatment or cure process. The medical staff is made up of licensed, practising,

self

governing physicians who are engaged in independent practice and are really

"guests" ofthe hospital .The functions and relationships of the medical staff to other

segments of the

hospital are based on legal position of the doctor. The hospital as an organisation

cannot


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practice medicine. Only physicians are legally licensed to practice medicine on

patients.

The medical staff in the various hospitals are in almost complete charge of

medical policies and medical practice. They have their own organisation within

theoverall hospital organisation, have their own constitution. rules and regulations

and are in

the main: self-disciplining bodies. They do have, however to abide with certain

fundamental hospital policies and generally operating in a manner that would not

jeopardize the accreditation of the hospital.

c. Coordination ofactivities

A high degree of differentiatifsn and specialisation creates critical problems of

coordination in the hospital. Georgopoulos and Mann (1962) say "because of this

extensive division of labour and accompanying specialisation of works, practicallyevery

person working in the hospital depends upon some other person or persons for

the

performance of his own organisationsl role". Specialists and professionals can

perform

their functions only when a considelable array of supportive personnel and

auxiliary

services is put at their disposal at all t mes. Doctors, nurses and others in the

hospital donot and cannot function separately or independently of one another. Their work

is

mutually supplementary. interlocking and interdependent. In turn, such a high

interdependence requires that the varicus specialized functions and activities of

the many

departments, groups and individual members of the organisation be sufficiently

coordinated, if the organisation is to function effectively and attain its objectives.

Consequently the hospital has developed a rather intricate and elaborate system

ofinternal coordination. Without coordirlation, concerted effort on the part of its

different

members and continuity in organisational operations could not be ensured.

The hospital is dependent very greatly upon the motivation of its members for the


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attainment of good coordination. Formal organisational plans, rules, regulations

and

controls may ensure some minimum coordination, but of themselves are

incapable of

producing adequate coordination, for only a fraction of all the co-ordinativeactivities

required in this organisation can be programmed in advance. One of the primary

forces

ensuring voluntary coordination is the overall value system emphasizing the

patient's

welfare.

Changing scenario in hospitals

The technological revolution c.arried with it a revolution in structure and goals

(Berheim 1948; Freeman 1956; Lentz 1956; Perrow 1960; Wessen 195l).Technological

developments however had two cons:quences. First the new treatment and

diagnostic

facilities become the key resources of the hospital and had to be controlled by

those who

understood and used them - the doctors. Second with medical advancement,

more private

patients were treated in hospitals. Since doctors brought them in, he came to play

afinancial role in the hospital and coilld demand more say about hospital

operation.

Following the shift in power from trustees, representing community goals (charity

goals),

to doctors, representing the interests of their- business profession, there appears

to be a

of power to the administrative staff, perhaps in uneasy alliance with a revitalised

trustee group. This shift in power (Perrow 1960, 1963) would appear to be a

logicaltransformation for many hospitals, since the growing complexity of medical

techniques

requires increasing differentiation and nterdependence of units, coordination of

resources


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and personnel and rationalisation of -:he supportive structure. This leads to

increasing

importance of agency contacts, so that the administrator is in a position to

influence

internal affairs of the hospital through manipulating external relations (Perrow1961,

1963). Finally with the growing impo-tance of administration, there has been a

growing

professionalisation of administrators. Social work professional are also working as

administrators in hospitals. This theon:tical context emphasis the relevance of the

present

study on organisational climate in hojpital settings. This research work is based on

the

present situation of the hospital. The rtsearcher has attempted to understand thestructural

and functional factors of the hospital and felt that fostering changes in this

direction

aimed at realisation of the hospital goal would be meaningful and relevant in the

area of

hospital administration. Apparent changes in structural and functional factors of

the

hospital would help the hospital employees not to be impersonal in the behaviour

andwork in consensus with the main purp3se of hospital that is to alleviate human

sufferings.

Undoubtedly for the efficient running of hospitals it requires a great amount of

resourcefulness, imagination , innovation and administrative tactics on the part of

the

staff or in other words, many problem may arise due to lack of proper planning,

real

motivation, proper communication and co-ordination among the team of

personnel-incharge. Thus it is presumed that a systematic study and adequate understanding

of the

organisational characteristics would bc of immense use to practitioners and

administrators

in increasing the organisational effect..veness of the hospitals.


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Friedson(l963) noted in his preface to a group of studies on the hospital that

virtues of studying the hospital for social scientists are that it is ubiquitous, varies

widely

and significantly in its characteristics and is more accessible than most

organisations. Hesaid that variations in hospitals should provide an attractive impetus to

comparative

studies , although in fact there has been very few of these.

Samaritan Hospital situated 10 Kms east to Aluva and 25 Kms north

east of Kochi in the state of Kerala. This hospital is the biggest unit of service in

the medical field owned by religious congregation of the Sisters of the Destitute

In our country, three quarters of our population are rural, yet three

quarters of medical centers are spent in cities, where three quarters of the

doctors live. So when the Sisters of the Destitute decided to enter the medical

field, they close the villagers as their areas of their activity. From their past

experiences they convinced that it is one of the best ways of sharing the love of

God to the developing communities.

Back in 1962, when sisters started a small dispensary in Pazhanganad,

it was a remote village with little village road or transport facilities. Most of the

villagers were agricultural labourers or farmers with small holdings of land. This


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dispensary could handle minor medical needs of the locality. The needs of the

community challenged the sisters to bring medical facilities to the villagers. Thus

in 1969 a 70 bedded hospital, christened Samaritan Hospital was inaugurated in

Pazhanganad. Fr. George Valyarambath and mother Rose Mary are considered as

the founders of this hospital.

The main objectives of the hospital are the following:

To cater the health needs of the people without discrimination of caste,creed and religion.

To give best possible health care facilities to all at affordable cost.The name Samaritan Hospital reminds one of the parables of Jesus told

to teach us what kind of a neighbour and friend one ought to be. The hospital

took the words of Jesus Christ, As you do unto the least of your brethren, you do

it unto me (Mt.25/40) as its motto and guiding principle.

Though it was initially planned to be a general hospital, the needs of

people of the locality forced the management to extend the facilities to the

specialties. Gradually separate departments of Internal Medicine, General Surgery

etc. were started.

The beginning of this well equipped hospital did not deter the sisters

from their primary aim of serving the villages. They were conducting medical

camps, health camps, immunization programmes etc.

During these medical camps, the most important finding was that the

incidence of heart disease, especially rheumatic heart disease, was high in the


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villages. Poverty, lack of qualified medical aid in the rural areas are the reasons for

such diseases. The hospital authorities after much deliberation and planning,

decided to develop, the departments of Cardiology and Cardiac surgery in 1972

and these departments started providing much needed cardiac care which was

not then available anywhere else in the state of Kerala. Open heart surgery was

also done here for the first time in the state in that year.

The hospital is located in village Kizhakambalam, 10 km, from

Alwaye, on the Alwaye Thripunithura road and about 25 km from Cochin. Public

transport facility to reach the hospital is available from Alwaye, Cochin,

Perumbavoor and Thripunithura.

The mission of the congregation is the care of the destitute and the

care of the destitute and the sick irrespective of their religious convictions. The

sisters began their ministry by setting up homes for the destitute, the aged and

the sick. The congregation also operates homes for the dying and the terminally ill

and for the rehabilitation of the mental and physically challenged. More than 300

members of the congregation are engaged in teaching in educational ministry.

1. To make quality health services available affordable and accessible to all,

especially in the underserved areas.

2. To promote health education, training and research.


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3. To manage, maintain and develop Samaritan Hospital and any other hospital or

dispensary as a charitable organization and on a non-profit basis in the true spirit

of Christian services, ideals and principles.

4. To co-operate and collaborate with the government and other agencies to

make health care accessible to all.

5. To encourage multi dimensional programs on promotion of health and

prevention of diseases in communities.

1. Effective collaboration with the government national and international

agencies for accessing vaccines and medicines and for participating the various

diseases control programs will be encouraged.

2. Patients and families will be counseled and enabled to comply with treatmentregimens and prevention methods to control the transmission of disease.

3. Patients with HIV/AIDS, Tuberculosis, Leprosy and other debilitating diseases

will be admitted and treated in the health care institutions with provision for

treatment, including surgery.

4. The health care institutions will conduct awareness programs against smoking,

alcohol and drug abuse.

5. The institution will encourage their staff and students to have a multi

disciplinary approach to health care.


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Bed strength of the hospital - 350 Number of departments in the hospital - 21 Number of Doctors - 36 Number of staff including paramedical staff - 204 Average OP per month - 150275 Average IP per month - 16501 Major operations per month - 120 Minor operations per month - 50 Labour cases per month - 60

School of Medical Laboratory Technology (1972) School of Nursing (1976) College of Nursing (2002)

The administration of the hospital is done through different bodies.


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It consists of Superior General and General Council, Provincials,

medical counsellors, director, administrator, Medical Superintendent, Nursing

Superintendent, Principal of college of Nursing and Principal of Medical Lab

Technology.

The members of the administration body are Director,

Administrator, Medical Superintendent and Nursing Superintendent.

Internal management body includes the Director, Administrator,

Medical Superintendent, Nursing Superintendent, Principal of College of

Nursing, Principal of Medical Lab Technology, Principal of School of Nursing

and canteen-in-charge.

The day to day activities of this hospital is running under the

leadership of Director, Administrator, Medical Superintendent and Nursing

Superintendent.

Cardiology Department Super specialty


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General Medicine Department of Gynaecology Department of General Surgery Department of Ophthalmology Department of ENT Department of Paediatrics Department of Orthopaedic Surgery Department of Anesthesiology Department of Urology Department of Radiology Department of Dentistry Department of Emergency Medicine Department of Dermatology Department of Psychiatry Department of Pain and Palliative

These are the main clinical departments in Samaritan Hospital

Pazhanganad. These departments are functioning well.


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Laboratory Pharmacy Physiotherapy Casualty House keeping ICU ICCU Neonatal ICU Surgical ICU Medical ICU Blood Bank Pathology CSSD Securities Ambulance Canteen Central Store X-ray


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ECG EEG Endoscopy Linen and Laundry Auditorium Hostels PRO TMT MRD

These are the supportive facilities and departments in Samaritan

Hospital, Pazhanganad. These departments and facilities help the doctors and

clinical departments for their smooth functioning.


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The role of the hospital has changed dramatically over the last two

centuries. In the beginning, the aim was to isolate the sick and to protect the

healthy from infection. By the nineteenth century, with the development of

anesthetic, and antiseptic, the idea that hospitals were about life, care and cure,

began to drawn.

In any hospitals the inpatient services are of prime importance. Every

in-patient unit should be designed to serve the functional goals. It should ensure

The lowest possible operating cost The most efficient operation Provision for highest quality patient care


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Provide the most desirable patient comfort and environment Greatest degree of satisfaction for patient, relatives and staff.

During the current century, four major events have occurred to bring

about to bring about a dramatic change in the delivery of health care.

Economic and evolving payment mechanisms for health care. The explosive development in the knowledge base of the basic

sciences upon which medicine rests.

Rapid advances in medical technology. The increased sophistication, knowledge and behavior of patients.There are a number of change factors that will have a significant impact

on the provision of health facilities in future such as biotechnology, information

technology, medical technology, consumer expectation and new disease. The

likely impact of these change factors can be explored at the level of the individual

hospital departments, for example inpatient wards, hospital level or local district

health authority level.


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The functions of an inpatient unit are better understood by looking at

the three primary components that constitute the unit, namely the patient

rooms, the nurse control station and service areas.

The patient area, which may consist of private and semi-private rooms

and multi-bed general wards, is designed to be safe and aesthetically pleasing

treatment area that is conducive to speedy recuperation. It must contain space

for equipment, staff and the various needs of the patients. It should be located

and designed in such way that the nurse can observe patient rooms and direct the

traffic entering and leavening the unit and at the same time carry on the activities

associated with the care and safety of the patients. The functions of the work

area relate to handling materials necessary for the s have a patient care, handling

and maintaining communications and patient records ,social and physical needs

of patients and the specific needs of staff.

In patients units have a close with the operating rooms, pharmacy,

central stores, laboratory and the dietary. In maintain this relationship; there

highly depended on vertical transportation and an efficient communication

system. The location of these facilities must be considered form the point of view

of their relationship to the inpatient units.


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The size of inpatient unit and the distribution of different categories of

beds should be decided during the planning stage. Whether or not the unit should

be a unitary ward serving one clinical unit under one consultant should also be

decided at that time. Consideration should be given to the cost of construction of

the unit, staffing requirement and the distance between the nursing station and

patients rooms and supply points. Any duplication of facilities and equipment

should be avoided. In short the unit should function efficiently.

It is recommended that minimum size of a one- bed patient room be

not less than 11.61 sq. meters (125sq.ft.) with a width of at least 3.81 meters

(12.ft and 6 in). Many hospitals find it advisable to keep all one-bed rooms

sufficiently large to accommodate two beds should be exigencies arise. This also

provides flexibility to increase the bed capacity in the future. The twobed rooms

should be at least 1.86 sq meters (160sq.ft.) in size and provided with cubicle

curtains for visual privacy. The four bed rooms should have a minimum floor area

of 29.722 sq. meters (320 sq. ft.) There should be at least 0.37 sq. meters (four

feet) of space between the beds, and sufficient space between the bed and the

wall to allow the nurse and equipment to pass.

As a rule, patient bed should be placed parallel to the exterior window

wall so that patient cannot only have visual contact with the outside world, they

can also avoided looking at the wall or facing outside glare from the window .This

principle is often given the go by for the sake of expediency.


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The nurses station is the pivot of the in-patient around which all the

activities of the unit revolve. It should therefore be located as centrally as possible

to the activities of the unit. It should be located near the entrance, elevator,

stairway and the corridor, and provide optimal visibility of the patient wings.

It is common to plan ward accommodation in multi-storied buildings,

each floor plan resembling a template of the plan on the floor above. However

many hospitals have inpatients areas horizontally spread in single or twostory

buildings linked by horizontal corridors. Although horizontal planning has

limitations, it saves time in internal movements than is possible with a vertical

inpatient block.

Due to increasing complexities of nursing procedures, technical

advancement in medicine ,understanding the concept of hospital infection and

changing expectations of patient, the nursing organization have undergone

considerable change during the recent past; the design of the nursing unit has

changed accordingly.


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Nursing supervision is deliberately maximized in critical care units,

where the patient is very ill and need for privacy is reduced. When the patient is

getting better, observation can be reduced. Gradually, the recovering patient is

transferred to a medically less sophisticated unit. Different kinds of units that

offer varying degrees of patient adjusted care are replacing standard nursing

units.

A system of progressive patient care has been adopted in most

hospitals which has a considerable effect on nursing unit design. Under the

system, the inpatient area is divided into various sections based on the intensity

and type of nursing care required which are as follows.

The intensive care unit is for patients in acute stage of illness who are

unable to communicate their needs. They require continuous observation and

extensive nursing care with personnel specially trained for the job. The aim is to

first support life in crisis, prevent threat to life, and then to eliminate the cause of

dysfunction by specialized treatment and extensive nursing care. There for, the

unit is equipped with life saving equipment, and all necessary life saving drugs and

supplies are immediately available.

The intermediate care unit is for patients who are moderately ill

including patients transferred from intensive care unit who require moderate

amount of nursing care. A large proportion of all hospital patients will be directly

admitted to this unit.


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The self care unit is for those patients who, after acute phases of illness

is over, or are admitted for diagnostic procedures and are able to look afterthemselves. Nursing care required for this category of patients will be minimal.

The long time care unit is for patients requiring prolonged nursing care

and services not normally available at home, including adjustment to disabilities

by physical and rehabilitation therapy.

The basis of progressive patient care system is the amount of and type

of nursing care required and the degree of dependence of the patient on others.

The design of the nursing unit and facilities to be provided differ from intensive

care through intermediate, selfand long term care units. However it is debatable

whether the system results in economy in bed utilization because, if each section

is capable of taking only patients of a particular category, bed utilization would

get adversely affected due to fluctuations in demand in each category.

A review of studies made by several authors in India and abroad shows

that there are some common characteristics of every effective and ineffective of


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organization. In other words, presence of certain factors results in success and

lack of these results in hospital failure. These factors are

Excellent organizations take exceptional care of their customers, be

they patients, or students in academic institutions or public, or industries for

consumer and industrial product. These organizations believe in superior services,

and superior quality. The organizational value systems from top to lower levels,

encourage knowing the consumer or patient, invites their inputs in planning

products or services, or various aspects.

Excellent organizations constantly believe in creativity and innovation.

The organizational leaders managers and professionals consistently keep in

contact with the development in the environment and seek ideas from their

employees and customers to upon the product and services. These organizations,

continuously adapt to the changing environment in terms of introduction of

technology, processes, packaging, distributions etc. They also continuously

experiment with management and job, designs techniques which can result in

more effective utilization of human resources, provide greater job satisfaction,

and utilize more knowledge and skills.


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Effective organizations are continuously engaged in planning .solid

planning is a necessity. Keeping in view the internal and external demands as well

as resources, effective organizations continuously plan. To decide what the goals

should be, what the priority should be, what new markets to reach, what new

services to begin, how to introduce new technologies ,how to change the

processes, what new materials can be used, what additional sources of material

are available? In what directions should the organization diversify? How to

implement the governments policies and provisions? How best to exercise the

social responsibility of the business?

Efficient organizations believe in creating a work environment and

culture for a highly committed work force. Such hospitals are able to create work

environment and culture where people like to work, realize their knowledge and

skills, utilize their creativity and feel a sense of belongingness. This results in an

atmosphere of turned on people. The organization constantly works with each

employee as to how more or better the employee can contribute.

Excellent organizations have sound financial controls. Since financial

are limited and are the determining factors in the nature and extent of

operations, sound financial planning is necessary.


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Excellent or effective organizations have leadership at various levels

which enables planning and implementations of the above factors- a leadership

which has values of the leaders result in utilization of the resources and

adaptability to the environment .the leaders provide the hospital with a vision

that the hospital may be able to achieve. Leadership means vision, trust,

compassion and developing leadership in the younger generation for the

organizational renewal and continuity.

Excellent organization have organizational structures which are

appropriate to the needs of the organization, which are goals and objective

oriented ,which enable effective communication, coordination, delegation,

effective utilization of resources , feedback, adaptability and flexibility.

Hospitals have undergone a remarkable change both in the

industrialized nations and developing countries. They are, or should be dynamic

institutions and in any society the only thing constant are change. The hospitals

have to adopt a concept of providing Primary Health Care (from the centre of

excellence to community support). Directly or indirectly, every person from birth


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to death, at one time to another, pins hope on the positive outcome of the health

services, these institutions provide. There has been very rapid change in last three

decades in functioning of hospitals due to technological advances and knowledge

explosion which had direct bearing on patient care. For example

Emergence of corporate hospitals. Hospital-based approach to group practice and Role of hospital in primary health care.

Now- a-days lot of importance is to quick turnover of patients to reduce

cost and thus to save many. To supplement the hospital cost, various types of

insurance programmes are also offered. Costly diagnostic services cannot be

provided, in all hospitals. Thus, there should be proper choice of place and

services to be rendered. Tertiary care cannot be provided in all places due to high

cost and lack of availability of trained manpower.

Patient satisfaction can be the ultimate goal of some hospitals or means

to achieve an ultimate goal, for example, a mission hospital may be ultimately

committed to healing; a corporate hospital for profitability and a steel plant

ultimately concerned with production of steel. However, the health workers in an

institution are committed to providing best health care. The following are the

organizational and management factors and the factors from patients

perspective which contribute to patient satisfaction.


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Philosophy and value systems of the Hospital/Management Congenial atmosphere and importance for patient care Infrastructure for health care Quick and efficient handling procedure Being treated as a human being Efficient staff Periodic communication about illness and recovery, participation in

decision making

Information about cost-benefit Efficient and appropriate billing systems Warm feeling of send-off Get well and Thank You Notes Accessibility, transport, accommodation for relatives.

Criticalness of the disease Caringwaiting ,attending

Concern for welfare-Empathy-Love Communication to patient and relatives Comfortcheerful atmosphere Closeness-Distance Cost of care


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Competency of the doctors-nurses Cooperation from staff and relatives Cleanliness of the hospital.

The central element in medical practice is the interaction between the

health care providers in the hospital which consists of the physician, nurse,

patient relatives and the patient which leads to effectiveness of the medical care

and satisfaction of the patient. The following are the factors influencing the

interaction, the role of physician, and opinions of the patients regarding the

effectiveness of the patient physicians and nurses.

In a doctor patient relationship, the patient is emotionally dependent

upon the doctor. In a state of illness the patient cannot behave logically and the

doctor must take this into account. The physicians are supposed to treat patient

alike, equal in matters of health illness. The physicians has the privilege to

examine patients physically and to question the about intimate details of their

private lives.


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The doctor is expected to be neutral in judgment and to exercise

emotional control. The doctor is supposed to treat the patient according to the

patients needs and the health standards of the community. The physician is

expected to maintain a dynamic balance, between attitudes of the detachment

and concern. According to Dr. G.S. Ambedkar, a Senior Anesthesiologist of India,

the doctor by the unique nature of his profession, can cultivate lifelong

friendship; soft words of reassurance, gentle stroking of the hands of a frightened

patient, are enough to mitigate fears, especially when the patient is to undergo

surgery. The effectiveness of the professional dependents primarily on the

knowledge, sincerity of purpose and capacity to develop patients faith. Mutual

understanding goes a long way in doctor-patient relationship.

The patient and the relatives expect the physician or the hospital to

play the role of an enabler to enable the patient to move from:

State of sickness to health State of pain/aches to no pain State of dependence to autonomy or independence State of passivity to activity State of hope to hope


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State of anxiety and worry to no anxiety/no worry State of submissiveness to assertiveness State of cheerfulness to smiling and cheerfulness From a feeling of not being alive to being alive State of no energy to being energetic.

The degree to which the physician/nurse/or the hospital can play this

enabling role would influence effectiveness of the institution.

Series of survey studies conducted by many organizations with

outpatients and inpatients of over 50 hospitals in different parts of the country

indicate that the traits of good physicians/nurses are:

Doctor/Nurse take interest in the patient and in the welfare of the patient Gives implications of test results Explains about the seriousness of the disease Information given is truthful ,honest, and sincere Is available and accessible Is listening and sympathetic Is kind and sympathetic Gives hopes and encouragement Is intelligent, has knowledge, skills and training Inspires confidence Has human nature and treats others as a human being Is kind hearted


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In doctor patient relationship, there is a need for mature

interdependency. The physician or the nurse must be compassionate. According

to the Block of Mathews (1, 4-14), Jesus went forth, and saw a great multitude,

and was moved with compassion towards them, and he healed all the sick.

According to His Holiness, Dalai Lama, the power of compassion is the healing

factor. According to Dr. N.H. Anitha, if the doctor has compassion, even with

modest and poor facilities, he can do a lot towards healing and health. Mutual

understanding goes a long way in doctor patient relationship. The patients own

courage faith and psychological status also play an important role in the

management of a disease and in the healing process.

Whatever be the reasons every hospital has to continuously plan,

asses, monitor, director and control related activities so as to ensure full

satisfaction of the patients. The best judge is the client himself and the best

advertisement is mouth to mouth advertisement. Hence analysis of patient

satisfaction is essential to make the services effective and efficient.


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3. RESEARCH METHODOLOGY

3.1. TITLEA study on organization climate in Samaritan Hospital, Pazhaganad.

3.2. OBJECTIVES3.2.1. GENERAL OBJECTIVE

To study about organization climate in Samaritan Hospital, Pazhaganad.

3.2.2. SPECIFIC OBJECTIVESTo assess the present satisfaction level of the in-patients of Samaritan

Hospital, Pazhaganad.

To analyze the activities of the in-patient departments.To suggest improvement, if any, for the betterment of the inpatients

departments.

3.3. STUDY DESIGNIt is a descriptive study as it is concerned with estimation of the satisfaction

of in-patients in Samaritan Hospital, Pazhaganad. The investigator is trying to

obtain data by means of survey of in-patients.


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3.4. DEFINITIONS

3.4.1. THEORETICAL DEFINITIONS3.4.1.1. In-Patient

In-patient is a person who is admitted in the hospital for the care and cure of

an ailment through the diagnostic, therapeutic or preventive services of the

hospital.

3.4.1.2. SatisfactionAccording to Revised and Updated Illustrated Oxford Dictionary satisfaction

means the state of being pleased or contended. It refers to the positive emotional

response that individuals and groups have about the fulfillment of a need or

desire.

3.4.2. OPERATIONAL DEFINITIONS3.4.2.1. In-patient

In-patient means a person who is admitted in the hospital for the care

and cure of an ailment through the diagnostic, therapeutic or preventive

services of Samaritan Hospital, Pazhanganad.

3.4.2.2. High SatisfactionA score between 4.2 and 5 in the survey result towards a particular

variable, question or statement is indicative of being highly satisfied with that

variable, question, or statement.

3.4.2.3. Satisfaction


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A score between 3.4 and 4.2 in the survey result towards a particular

variable, question or statement is indicative of being satisfied with that variable,

question, or statement.

3.4.2.4. Moderate SatisfactionA score between 2.6 and 3.4 in the survey result towards a particular

variable, question or statement is indicative of being moderately satisfied with

that variable, question, or statement.

3.4.2.5. DissatisfactionA score between 1.8 and 2.6 in the survey result towards a particular

variable, question or statement is indicative of being dissatisfied with that


3.4.2.6. High DissatisfactionA score between1 and 1.8 in the survey result towards a particular

variable, question or statement is indicative of being highly dissatisfied with that


3.5. UNIVERSEThe In-patients of Samaritan Hospital, Pazhanganad for the period from

the 13th

to 27th

Sep. 2010 is the universe of the study.

3.6. SOURCE OF THE DATASource of Primary Data


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Nurses of Samaritan Hospital and In-patients of Samaritan Hospital from

the period of 13th

to 27th

Sep. 2010.

Source of Secondary DataInternal records, registers and journals are available in the hospital.

3.7. SAMPLE DESIGNIn this study multi-phase sampling was used.

3.7.1. Stratified SamplingAs far as the in-patients are concerned stratified sampling is the most

appropriate method to get response for every department. Since data for each

department is to be got, stratification according to department was essential.

There are 13 departments in the hospital [except Casualty, Psychiatry and

Aneasthesiology]. Therefore, stratified sampling was used.

3.7.2. Systematic SamplingAfter the stratification of inpatient department, systematic sampling

was used. Every 3rd

patient in the daily schedule of the mid night census book of

each ward chosen as the sample till the representative sample of that department

was got.

3.8. SAMPLE SIZE


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The rule of the thumb sample size is 10% of the population. The hospital

has got a yearly inpatient of around 15100. During the period of study 15 days

there can be 620 patients getting admission in the hospital. Since the rule of the

thumb sample size works out to be 62 in-patients as far as the 15 days of the

study is concerned.

Yearly IP = 15100

IP for 15 days = (15100*15)/365 = 620.55

10% of IP = 62

Accordingly it was calculated for each department.

Table no.1 showing the process of determination of representative sample

Sl.

No.

Department IP

2009

IP For 15

Days

10% Representative

sample

1. Cardiology 2509 103.11 10.311 10

2. Dental 7 0.28 0.028 3

3. Dermatology 6 0.26 0.026 3

4. ENT 194 7.97 0.797 3

5. Gen. Medicine I 2643 108.62 10.862 11


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6. Gen. Medicine II 3091 127.02 12.702 13

7. Gen. Medicine III 105 4.31 0.431 3

8. Gynaecology 1695 69.6 6.96 7

9. Ophthalmology 75 3.08 0.308 3

10. Orthopaedics 840 34.5 3.45 4

11. Paediatrics 2601 106.8 10.68 11

12. Gen. Surgery 928 38.1 3.81 4

13. Urology 391 16.06 1.606 3

Total 1508

5

78

3.9. SAMPLESELECTIONSample is chosen on department wise. Every 3

rdpatient in the daily

schedule of the mid night census book of each ward chosen as the sample till the

representative sample of that department was got.


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3.10. TIME BUDGETTable no.2 showing the preparation of time budget

Particulars No. of days

Topic Selection 3

Tool Preparation 10

Pilot Study 1

Data Collection 14

Processing of Data 15

Report Writing 15

3.11. PILOTSTUDYA pilot study was conducted on the first day of the study. Five patients

were administered with the interview schedule. The method of sample selection

before pilot study was to select every 3rd

patient admitted on the day of study in

each department. While interviewing the patient two of them opined that they

had been admitted in the hospital for the first time and they did not have much

experience about the hospital. So the methodology was changed and every 3rd

patient in the schedule of the mid night census was taken. Questionnaire was

found to be appropriate.


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3.12. METHODOFDATACOLLECTION3.12.1. INTERVIEW SCHEDULE

An interview schedule is prepared to evaluate the opinion of In-Patients.

The interview schedule has questions on demographic factors, common services

provided in the hospital, nursing services, medical services, dietary services,

housekeeping services, accommodation facilities and other services. There are 41

questions divided into five parts. The first part consists of 11 questions on

demographic factors and the second part consists of 7 questions on the common

service provided. The third part shows four subdivisions on nursing services,

medical services, dietary services, housekeeping services, accommodation

facilities and other services and 23 questions on the subdivisions. The fourth part

deals with the causes of selecting the hospital for treatment and the fifth part is

regarding recommendations of improvement.

3.13. PROCESSINGANDANALYSISOFDATA3.13.1. EDITING

No editing was needed as it was a fully structured interview schedule.

3.13.2. CODINGThe responses of the interview schedule were five types namely very good,

good, average, bad, very bad which were marked as A, B, C, D & E respectively in

the interview schedule. These responses were assigned the numeral of 5, 4, 3, 2 &

1 for A, B, C, D & E respectively.

3.13.3. CLASSIFICATION


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The questions were already classified into group as discussed in methods of

data collection. So the response is also classified in the same manner.

3.14. TABULATIONIt is the process of summarizing raw data and displaying the same in the

form of statistical table for further analysis. In this study the researcher must

find.

Total average score Variable wise average score Question wise average score Department wise average score Demographic factors wise average score.

3.15. CALCULATION OF RESPONSESA score between 1&1.8 - High Dissatisfaction

A score between 1.8&2.6 - Dissatisfaction

A score between 2.6&3.4 - Moderate Satisfaction

A score between 3.4&4.2 - Satisfaction

A score between 4.2&5 - High Satisfaction

3.16. INTERPRETATION&REPORTWRITING


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3.16.1. InterpretationThe data as per the above tables were interpreted by the investigator and

report is prepared.

3.16.2. Report WritingThe report is divided into five chapters. The first chapter deals with general

introduction. Second chapter is on Literature Review. The third chapter deals with

methodology and fourth chapter deals with analysis of the in-patient satisfaction

survey. The fifth chapter deals findings and suggestions.

3.17. LIMITATIONSIn the departments like ENT, Gen. Medicine III and Ophthalmology every

patient admitted in the hospital was chosen as the number of admissions during

the period of study was less than the representative sample of the study.

Departments of Dental, Dermatology and Urology did not have any admission

during the period of study.

1st year project

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