a dissertation report on analysis of patient satisfaction max polyclinic by mohammad yaser hussain

a Dissertation Report

on

ANALYSIS OF PATIENT SATISFICATION IN I.P.D.

MAX POLYCLINIC AND DIABETIC CENTRE- HYDERABAD

Submitted by

MOHAMMED YASER HUSSAIN

Regd. No: 1308018481

Academic session 2013-2015

in partial fulfillment of the requirement

for the award of the degree

MASTER OF BUSINESS ADMINISTRATIONin

HEATH CARE SERVICES MANAGEMENT

From

SIKKIM MANIPAL UNIVERSITY

DECLARATION

I hereby declare that the project report entitled submitted on “ANALY-SIS OF PATIENT SATISFICATION IN I.P.D. MAX POLICLINIC AND DIABETIC CENTRE HYDERABAD ”here by solemnly declare that this dissertation is an original work of mine and this has not been submitted to any other institute / university towards any other degree /diploma .Partial fulfillment of the requirements for the degree of Master of Business Administration (MBA) to Sikkim- Manipal University, In-dia, is my original work and not submitted for the award of any other de-gree, diploma, fellowship or any other similar title or prizes.Whatever information furnished in this project is true and to the best of my knowl-edge.

Place : HYDERABAD Course title - MBA (HCSM)

SIKKIM MANIPAL UNIVERSITY Academic session 2013-2015

ACKNOWLEDGEMENT

Every endeavor in itself is an impression of the efforts of not only those who pursue it but of those as well who provide guidance and motivation towards its successful completion. Likewise,this project bears an imprint of all those who helped me at various stages and it would be unfair on my part not to thank them .

I would like to extend a word of gratitude towards Dr. M A Wahab Zubair. Director of Max Poly Clinic and Diabetic Centre, for giving me an opportunity to undergo this dissertation project with Max poly clinic.

I sincerely thanks to Dr. M A Wahab Zubair for guiding me and my project guide ,who provided me with his unending support from the very beginning of the project,which helped in timely completion of the project.

I sincerely thanks and unbounded gratitude towards my family for giving me support and moral encouragement for enlightening my way whenever any kind of support was required to complete the project.

Finally, I thanks to the staff of Max Polyclinic and Diabetic Centre for their co-operation.

MOHAMMED YASER HUSSAIN

B-PHARM -MBA

Bonafide Certificate

Certified that this project report titled” Analysis of patient satisfication in IPD” is the Bonafide work of “ MOHAMMED YASER HUSSAIN ”with ROLLNO -1308018481 who carried out the project work under my supervision.

Signature Signature

HOD Faculty in charge

CONTENTS

Chapter 1. Introduction. 6

1.1 Project Introduction.

1.2 Max Ploy Clinic and Diabetic Centre Profile.

1.3 Executive Summary.

Chapter 2. Aims and Objectives 10

Chapter 3. Review of Literature. 12

Chapter 4. Methodology 42

4.1 Research Design.

4.2 Data Collection Method.

4.3 Sampling Design.

Chapter 5. Analysis, Interpretation, Finding and Discussion. 45

Chapter 6. Conclusion and Recommendation. 60

Appendix 65

Bibliography 67

CHAPTER 1

1.1 INTRODUCTION OF THE TOPIC

Hospitals are increasingly becoming sensitive to the needs of the patients as will the community. It is no longer the sellers [providers] market. Except for the totally free service provided by the Government run hospitals and a few hospitals run by the civic hospitals.

According to Dona Bedian

“Patient satisfaction may be considered to be one of the desired outcomes of care, even on element of health status itself” and that “information about patient satisfaction should be as indispensable to assessment of quality as to the design and management of health care system.

During the recent years the use of patient satisfaction surveys has increased in health care industry due in part to the belief that perception of quality is an important factor in demand for services and that survey result may have significant effect on provider behaviour. According to Ware “patient satisfaction is a determinant of a healthcare provider or system. Use of services complaints and malpractice suits”.

Use of patient satisfaction survey as a tool for quality improvement has become extensive in almost all western countries. Most hospital have a system of obtaining routine feedback from all the discharge patients. The quality improvement task force of the joint commission of accreditation of the health care organization in USA is also encouraging hospitals to mandate surveys are

conducted in private hospitals.

But the actual value of patient satisfaction surveys, as a tool for continuous quality improvement is a matter of debate among the academicians and hospitals managers.

DETERMINANTS OF PATIENT SATISFACTION

From the search of cotemporary literature, the major determinants of the patients satisfaction identified by different researchers could be summarized as follows. In order to evaluate the quality of survey Wolley emphasized on the follow determinants.

Satisfaction with out come Continuity of care Patient Expectation Patient relationship with doctors, nurses and other staff.

The advances in science and technology made hospitals highly labour intensive and capital intensive. This made much of the hospitals in the private hospitals force to comply with the concept of TQM.

The core concept of TQM is customer satisfaction i.e., patient satisfaction as far as the hospital is considered. The mindset of the customer [patient] coming to a hospital is quite different to a customer coming to other service industries like

hotel, or airlines.

The approach and behaviour of tea stall, the physical and technological facilities, general cleanliness and hygiene, cost of treatment etc has a significant impact on the satisfaction of the patient.

Patient satisfaction can be effective to assess and measure following factors such as:

Major source of attraction for patients coming to hospital Satisfaction of various services Demographic factors Geographic factors

Patient satisfaction survey is reliable, a yardstick to assess the quality of health care extended by health institute. Such surveys manifest the patients’ perspective of ganging the quality of health care provided, their expectation and their need. It also enables to infer as to how well equipped doctors, hospitals and health planners are

in satisfying the patients needs and expectations measure of patients satisfaction become imperative in modern days as the patients in the central customer and information and experience provided from his perspective enables the healthcare provided to identify the area of strength and improvement opportunities within a single system.

Secondly it helps to measure satisfaction as an out come of care and helps to patient’s behavior.

Thirdly it generates doctor for theoretically importance and for practical purpose such as planning administration as an evaluation of health care services.

Satisfaction is a subjective method to assess the need and out come of the care provided by the healthcare systems. Satisfaction itself encompasses the perceived need of patient expectations of care provided by the hospital experience of care during the stay in hospital.

Since measuring satisfaction is a subjective assessment of health care and not the final out come, survey using patient satisfaction. Schedule interview a tool, which is used to measure patient satisfaction as amore objective way to assess the satisfaction level.

In these days of intense of competition, hospital will find it very difficult to get patient. Retaining the already exiting patients is also very important in enhancing the profit and for this patient satisfaction has to be ensured at high level. Some studies have found out that its cost 5times more to get a new customer than it to keep a current customer.

There is quoted statement in the patient satisfaction if you don’t measure it, you can’t improve the quality of patient satisfaction survey needs to be conducted regularly.

EXECUTIVE SUMMARY

Max Polyclinic & Diabetic Centre

The Max Polyclinic was started in the year 2008 by a team of highly professional doctors to provide health care to the population at a rate they can afford. It conducts the free health care camps on certain days in a month.

The diagnostic facilities include the pathology department which has separate sections for the clinical pathology, microbiology and histopathology with equipment like automated biochemistry analyzer, ABG and electrolyte analyzer, computerized stress analyzer and ECG etc. are also available.

The polyclinic is of 45 bed strength. The facilities include,

Pediatrics General medicine Diabetic services Day care centre Diagnostic laboratory Asthma clinic Poisoning Care

Chapter 2

AIMS AND OBJECTIVE

o To study the patient are satisfied from the services provided by the maxploy-clinic and diabetic centre.

o To increase the efficiency of the hospital

o To determine the hospital image

Chapter3

REVIEW OF LITERATURE

Patient satisfaction: The Indispensable Outcome

Surveys say a lot about quality and are continuously conducted by HMOs and accrediting bodies. The authors suggest medical groups follow suit.

BY ROGER BOLUS, PH.D., AND JENNIFER PITTS, PH.D.

“Why measure satisfaction when the health plans we contract with already do it?”

“How can we conduct a satisfaction survey that won’t disrupt office work flow?”

“How “How do we translate satisfaction findings into something that will make a

difference?”

Questions like these reflect just a few of the concerns that many medical groups have about measuring patient satisfaction. While most large managed care organizations collect satisfaction data continuously for purposes of accreditation and quality assurance, the medical groups that contract with them often survey only irregularly, if at all.

They often fail to realize the potential benefits of regular surveys. If not already, then very soon, this will be an area of concern for medical groups as they are increasingly being held accountable for the satisfaction data collected by MCOs they contract with. Groups that do understand the advantages certainly face a number of challenges.

Let’s consider the growing importance of patient-satisfaction data for medical groups, and look at sine innovative approaches that may help provider groups see satisfaction as a valuable management tool. The yardstick

Patient-centered outcomes have taken center stage as the primary means of measuring the effectiveness to health care delivery. It is commonly acknowledged that patients reports of measuring the effectiveness of health care delivery. It is commonly acknowledged that patients reports of their

Heath and quality of life, and their satisfaction with the quality of care and services, are as important as many clinical health measures.

Health care organizations are operating in an extremely competitive environment, and patient satisfaction has become key to gaining and maintaining market share. All major players in the health care arena use satisfaction information when making decisions. Also, because much satisfaction data reflects care delivered by physician and other provider groups, this information is receiving close attention from MCOs, consumers, employers, and accrediting organizations.

The scrutiny is based on data collected by MCOs, which may or may not accurately reflect the care delivered by individual provider groups. This underscores the need for medical groups to collect reliable and unbiased satisfaction information from their own patients on an ongoing basis.

External review

Accountability has become the buzzword of the 90s. More physicians are compelled to show that they have acceptable levels of patient satisfaction. In fact, a number of standards-setting organization and consumer groups have begun using patient satisfaction as a key indicator of health care quality.

Without acceptable levels of patient satisfaction, health plans may not get full accreditation and will lack the competitive edge enjoyed by fully accredited plans. Most MCOs now undergo some kind of formal accreditation, and therefore measure satisfaction.

Feeling increasing pressure, many health plans are beginning to provide incentives to physicians to produce high levels of patient satisfaction. U.S.Healthcare was among the earliest to factor satisfaction with physicians into its annual .

Compensation formula.

Similarly, Health Net, a large network-model HMO in California, has offered significant annual bonuses to medical groups that perform particularly well on its annual patient survey. [See “The Increasing Importance of Measuring Patient Satisfaction” for evidence of this trend.]

It may be prudent for smaller provider groups to collect their own physician-specific data to demonstrate acceptable satisfaction levels to the MCOs with which they contract. Valid patient-satisfaction information can provide practices with leverage in negotiating future contract with MCOs, and supplies ammunition that can be used to counter unfavorable evaluations. By conducting their own surveys, practices will also be able to identify and resolve potential patient-satisfaction problems before they are recognized as problematic by MCOs.

The reality is that medical groups face a number of challenges implementing patient-satisfaction survey programs. While most large health plans have the resources to conduct surveys or to hire vendors, measuring patient satisfaction can be costly for small practice groups, especially in the face of shrinking operating margins.

Provider groups often lack the expertise necessary to plan and manage the task, and tight budgets may limit their ability to outsource. Other challenges include ensuing that data collection creates minimal hassle for practice staff, obtaining acceptable response rates and reliable data, properly analyzing and reporting survey findings, and translating findings into information that can be used for program planning and quality-improvement efforts. [See” Critical Decisions in the Survey Process, “for some decisions that a group must make when designing a survey [program,.]

Technological solutions

Recent technological advances provide managers with solutions to many of the problems associated with measuring satisfaction, including development of new survey instruments with known reliability and validity, use of innovative data-gathering technologies, improvement in measurement and statistical applications, and technologies that simplify development of interesting and effective presentations of survey findings.

Today’s health care consumers are more sophisticated than in the past and now demand increasingly more accurate and valid evidence of health plan quality.

With this in mind, the National Committee for Quality Assurance has developed a member-satisfaction survey as a part of its HEDIS quality standards,

and is in the process of reviewing an updated version based on the Consumer Assessment of Health Plans Survey for 1999. CAHPS was developed through a cooperative agreement with the Agency for Health Care policy, Rand Corp., Research Triangle Institute, and Harvard University.

A lot of work went into developing these questionnaires, resulting in lessons that can be applied to satisfaction survey programs at the medical-group level. Focus groups described issues of most relevance for patients; and cognitive testing determined the most understandable wording of questions. Tests determined the validity of the instruments.

While the NCQA and CAHPS questionnaires were developed for use with health plan populations, and many of the questions may have applicability for medical group practices, measures have been specifically designed for office-practice settings. For example, the American Medical Group Association supports a well-validated 13-item visit-specific standardized survey of patient satisfaction.

Findings can be reported at the clinic, department, or physician level, or in the context of national and regional satisfaction benchmarks. In this manner, medical groups and physicians can see how they compare to relevant peer groups.

Each of these surveys provides different information about consumer perceptions of health care the distinction between the surveys is important and should be carefully weighed when considering the intended use of survey findings.

These questionnaires can be used off the shelf by medical groups, or they can provide a starting point for customized instruments. If there is reason to believe that standardized surveys don’t fully reflect medical groups, patient population, patient experiences, or the particular office setting, it may be wise to use supplemental questions or a customized survey designed to provide additional information.

The lessons learned from the NCQA and CAHPS projects can be applied when designing new questions or questionnaires.

New ways to collect data

Don’t underestimate the expense of collecting satisfaction data. Reliance on paper-and pencil survey methods often resulted in disruption of office work flow and burdened an already overworked staff. Recently, however, a number of technological innovations have been developed to reduce staff burden and long-term costs. Examples include in-office computer kiosks [i.e., cabinets that allow patients to see a computer monitor

And type on a keyboard] and hand-held devices that present one question at a time to patients and require hen to press one key to respond

Patients can use this equipment to complete satisfaction surveys immediately after their office visits with minimal direction from office staff. Even the Internet has served as a means for efficiently collecting patient-satisfaction data select populations.

Patients with Internet access can complete satisfaction surveys online after returning home, or they fan gain access through a computer terminals in the doctor’s office. The data collected with each of these technologies are automatically entered into a data file that is ready to be processed and analyzed.

This can cut down dramatically on the time and costs associated with transferring data from paper-and-pencil questionnaires. Even paper-and-pencil surveying can be automated; for example, a fax machine can transmit patient responses to a central processing and reporting service. All of the technologies described above reduce the administrative burden faced by medical offices, which is especially important when implementing a program.

Effective reporting

Whether medical groups produce their own survey reports or use the services of a vendor, report content will depend on the goals of the satisfaction program. To get the most out of the data, groups may want to compare findings for their own patients with external norms or standards or with internal benchmarks they may want to make a longitudinal analysis.

For example, if a standardized survey is used that has normative information available; it will be possible to compare group-level data with regional or national populations. For selected surveys, norms may even be available by

medical specialty. With either customized or standardized surgery’s it is possible to compare group-level findings with internal benchmarks or objectives. Data can also be compared before and after program improvement or process change to determine its effectiveness. It is also valuable to report findings for different subgroups within a medical group; for example, satisfaction levels for different specialty categories, different office sites, or even individual physicians.

Developing and implementing a sound patient-satisfaction measurement program that takes advantage of many of these innovations may require expertise not often available in medical-practice settings. In response to this and other market needs, service organizations have recently been created that provide products and services to support efforts to measure patient satisfaction.

Groups considering implementing a satisfaction-survey program will need to consider several factors including cost-effectiveness objectivity, and program quality. Outside resources can address each of these Considerations.

Using outside experts to design, implement, and maintain a satisfaction-survey program can actually be cost-effective because it allows staff member to conduct thief daily business uninterrupted A serious consideration id the need for independent objective assessment.

NCQA now recognizes the importance of objectivity in satisfaction measurement and requires that satisfaction data used for health plan accreditation purposes be collected by an outside survey vendor.

Finally, an outside expert can be expected to employ rigorous evacuation methods to ensure data quality and effective reporting of satisfaction findings.

As we move into the next millennium, the measurement of patient satisfaction is becoming less of a luxury and more of a necessity for medical groups. It is increasingly important that a patient-patient-satisfaction program be done well, using sound protocol and methods

Survey findings can be used for accreditation and marketing. In this era of increasing competition and high patient demand for health care excellence, medical

groups cannot afford to forgo the insights they can derive from patient-satisfaction surveys.

About the authors: Roger Bolus, Ph.D., is direct or of outcomes and analytic services for Pfizer Health Solutions. His responsibilities include designing and carrying out evaluation activities associated with the various PHS products.

Jennifer Pitts, Ph.D., is a senior project scientist at Pfizer Health Solutions. Before joining PHS, she was an Agency for Health Care and Research postdoctoral fellow at the UCLA School of Medicine.

Pfizer Health Solutions, which has 30 professionals on its staff, is a wholly owned subsidiary of Pfizer Inc.

The new health care accountability: Voice of the patient has a new legitimacy Member satisfaction is measured as a part of the National Committee for Quality Assurance s HEDIS quality analysis.

Employing the Consumer Assessment of health Plans Survey, member satisfaction is factored into the formulas for decisions regarding accreditation. In collaboration with specialty, state, and local medical societies, the AMA has developed American Medical Accreditation Program, in which physicians who meet strict quality standards can receive individual accreditation In addition to standardized measures of clinical results and health status, patient satisfaction is considered a key result of patient care.

The Foundation for Accountability is a not-for-profit organization whose stated mission is to help consumers make better health care decisions. FACCT is comprised of consumer organizations and health care purchasers calculated to represent nearly 80 million consumers. Among its many efforts, FACCT has developed consumer-focused quality measures that include a patient satisfaction instrument. The increasing importance of measuring patient satisfaction one needs only to look at the available data to realize the growing importance of monitoring patient satisfaction. Beginning in 1996,

Hewitt Associates, the international management consulting firm, began to develop an extensive health plan database: the Health Value. The database includes health plans responses to an extensive questionnaire about operations, quality-

improvement programs, provider contracting, and other activities. The survey has been conducted annually since 1996 and contains responses from over 500 plans.

Among the questions that have been asked:

Whether plans feed satisfaction-survey results to medical groups [for plans with data for 1996 and 1998] whether member satisfaction with providers is incorporated unto the compensation formula [for plans with data in 1996, 1997, and 1998]

The HHV1 survey indicates a growing trend in the use of satisfaction data by health plans. Over 80 percent of the reporting health plans now feed this information back to medical groups as part of quality important, a similar percentage include this data as part of physician reimbursement

When the perceived out come of care meets with expectation, quality is considered high. Continues quality improvement is the work towards achieving needs and wants of the patients as for as hospitals are concerned.

In view of patient satisfaction patient relationship management acquires great significance. For managing relationship with patient, the hospital management has to first identify the different occasions when representatives of the organizations have opportunities to interact with the patients and bystanders. Often hospitals tend to look at the services of doctors and nurses alone, but as for as patients are concerned, the service of the security staff to receptionist, lift operator, waiter in the canteen, house keeping staff etc. have an impact as they assess the quality of the hospital. The impression a patient and by standees forms about the hospital depends on how the hospital employees and representatives deals with the patient and by-standard’s at the various interactions. Johan Calzon calls this interaction as “moments of truth”

Primary reasons for a hospital existence is to provide care for patients and satisfy their needs “Satisfaction is measure of the patient attitude towards his physician the medical care being received and the health care system”

With the increasing emphasis on quality health care there is a tendency to involve the patient to a greater extend in evaluating the quality of care provided. Thus patient satisfaction has been suggested as criteria for measuring quality of care.

Every patient should feel that he is considered and cared for. To give satisfaction the nurse should recognize the carious needs of the patient and meet them with out any delay

The main purpose of the ward/room is to satisfy the wants and needs of the patient the ward/room must provide the best possible atmosphere for the patient satisfying the social as well economic need of the patient within acceptable cost. Every patient admitted to the hospitals should be considered as unique person in terms of both personal needs and extent of illness. Anthropologist Clyde Kluckhohn wrote. Every man in certain respect like no other man: every man certain respect like some other man: every man in certain respect like all other man. There is a tendency among nurses to identify the patient either by bed number or by the disease they suffer from. It is very important that nurses should address the patients by his or her name.

Now we have to see why continuous quality improvement is needed as far as hospitals are concerned. In earlier days hospital was set to poor and weaker section of the society in those days there was only little advance in medicine. And hospitals were mainly a shelter for destitute.

The environment in with the hospital are working has also underwent change the supreme Court of India’s ruling that the hospital can also come under the preview of the consumer protection act 1986, has forced hospitals to take steps to improve the quality, witch otherwise would give the hospital loss of money as well reputation. Again the introduction of Insurance Regulatory Bill [IRB] will be another change in the government as far as hospitals are concerned. The private insurance companies will go in for various health insurance schemes, which would force to hospital to undergo quality improvement programmes. These and other

rapid change in the external environment would force to hospital to undergo continuous quality improvement and thereby bring change in the organization.

To day there is tough competition between the hospital different hospitals to attract patient. The hospitals are forced to accept the patients [customers 0 as king, for their survival. To serve them better we have to understand the concept of the service better. Though a service is obviously different from physical product it is still product. A service product-any incident of doing for other for fee can be distinguished from a commodity by one or more, and usually several of the following service characteristics.

1. A service is produced at the instant of delivery it can’t be created in advance or held in the readiness.

2. A service cannot be centrally produced inspected, stock pilled or ware housed. It usually is delivered wherever: the customer is, by people who are beyond the immediate influence of management.

3. The service cannot be demonstrated, nor can be sample be sent for cus-tomers in advance of service.

4. The person receiving the service has nothing tangible; the value of service depends on his or her personal experience.

5. The experience cannot be sold to a third party, but the nature of the experi-ence can be conveyed to third party.

6. If improperly performed, a service cannot be re called or repeated, and then reparations or apologies are only means of recourse for customer satisfac-tion.

7. Quality assurance must happen before production, rather than after produc-tion, would be the case in manufacturing industry where service is delivered at instance

8. Delivery of service usually require human interaction to a greater extend. Service provider and service receiver comes in a contact in a personal way to create service.

9. Receives expectations of the service are integral to his or her satisfaction with the out come. The quality of service is a subjective matter.

10.The more the customer must encounter during the delivery of the service, the less likely it is that he or she will be satisfied with the service.The three important characteristics that differentiate outstanding service

organizations from mediocre one includes.

Though a service organization, the service provided by the hospital is different from other service organizations such as bank, hotels and restaurants. People may go to hotels and restaurants in a happy mood, while going to hospital is a nightmare for almost for all persons. So the mindset of the patient in the hospital will be different, unlike the customers of service organizations.

Now let us consider the concept of patient satisfaction as per the opinion of eminent authors

According to Philip Kotler “satisfaction is a state felt by a person who experienced a performance or out come that has fulfilled his or her expectations.”

Mrs. Prem Misra says, “The literal meaning of satisfaction is to fulfill the desire expectations. Needs or demand of person. Satisfaction is a psychological phenomenon resulting from meeting the basic needs of human beings. The needs may be physical, psychological, social or spiritual. All these needs are interrelated and inter dependent. The fulfillment of one need affects the need in the other area”.

Dr O.P. Sharma in his improving patient satisfaction says, “In the current era of scarce hospital resource, high cost of hospital operations and increasing demand of hospital services. The improvement of patient satisfaction assumes great significance for the hospital administrators in particular and the public in general. Patient and their relatives can be almost fully satisfied in existing

conditions available in our hospitals. No extra funds are necessary. Change in attitude and approach is required.”

Dr. C.M. Francis says,” patient satisfaction is often a better indictor of quality of art of car, quality of nursing care, quality of facilities provided then quality of technical aspects of care per se”.

As per S.I Goel and R, Kumar “The inpatient services are the costliest in terms of expenditure in a hospital and therefore must be used judiciously and effectively make the patient feel that a word is a temporary home to the patient, till they are discharged.”

When a hospital has to undergo a charge, it must find out the needs of the patients. Need assessment can be done through patient satisfaction survey. Though this needs, wants and attitudes of the patient can be found out an assessment of consumers need is necessary steps that precede the provision of service.

Health care organization must systematically study patient needs, wants, perceptions, preferences and satisfaction, using surveys, focus groups and other means. A marketing orientation holds that the main task of the organization is to determine the needs and wants of the target market and to satisfy through the design, communication, pricing and delivery of appropriate and competitively viable services.

Mac Stravic indicates four errors that hospitals and related health care organizations often make concerning needs.

It may ignore unmet needs and satisfy itself that as long as it serves all who enters its door it has fulfilled its obligation.

It may provide service in excess of need, perhaps excusing itself on the ground that is providing what the consumer wants.

It fully accepts its obligation to serve community but fail to ration the com-munities scares resources.

The biggest danger in health care services facilities need oriented approach is that obligating not cost is usually placed first.

Another important aspect of patient satisfaction is the awareness of the patient rights awareness should be on the patient that they are free and equal partners in

the health care process. The patient has the right to consider it, respectful care of all time with recognition of his personal dignity regardless of race, creed, sex, or ability to pay. He has the right to obtain the minute details regarding his treatment and various investigative procedures.

The strive for continuous improvement should be in the mind of every employee in the organisation. There has to be commitment of “Do it right the first time”. They have to be made understood they won’t get a second chance to create a first impression, which will be the impression in the mind of the patient. The customer would push for better price, improved service, speedier delivery of service.

Hospitals are increasingly becoming sensitive to the needs of patients as well as the community it is no longer the seller’s [providers] market, except for the totally free service provided by the Govt. run hospitals and a few hospitals run by the civic authorities.

According to Dona Bedian “patient satisfaction may be considered to be one of the desired outcome of care, even an element of health status itself and that information about patient satisfaction should be as indispensable to assessment of quality as to the design and management of healthcare systems.”

During the recent years the use of patient satisfaction survey has increased in health industry due in part to the belief that perception of quality is an important factor in the demand for services and the survey result may have significant effects on provider behaviour according to Ware “Patient satisfaction is a determinant of a healthcare provider or system. Use of services complaints and malpractice suits”

Use of patient satisfaction survey as a tool for quality improvement has become extensive in almost all western countries. Most hospital have a system of obtaining routine feedback from all the discharge patients. The quality improvement task force of the joint commission of accreditation of the health care organization in USA is also encouraging hospitals to mandate surveys are conducted in private hospitals.

But the actual value of patient satisfaction surveys, as a tool for continuous quality improvement is a matter of debate among the academicians and hospitals managers.

Vouri’ Listed following deficiency in patient’s satisfaction measures.

Patients lack knowledge to accurately assess the technical competence of medical personal further more their physical or emotional status can easily impede judgment

Patients are influenced by non-medical factors such as the interpersonal skill of the provider. A good beside manner can easily mask doubtful technical quality.

Patients are often too reluctant to disclose what they really think because of their sense of dependency or prier failure in patient-physician communication.

Patients cannot accurately recall aspects of the delivery process more over patient surveys or even face interviews are impact means for measuring highly subjective phenomena”.

Surveys generally very widely in design. Content, administration and overall sophistication in analysis and computation of result. The usefulness of the survey, instruments, administration and analysis.

According to Irwin Press “Patient satisfaction is good medicine & good business.”

These words close Irwin Press’comprensive book about patient satisfaction, and they say it all: patient satisfaction is required to succeed in today’s health care industry. In his book, Irwin Press, who is an icon in patient satisfaction, answer every conceivable question about measuring patient satisfaction. More valuable, he debunks the usual excuses for mediocre or poor patient satisfaction [our patient are sicker, we have a trauma centre, our patients are less sophisticated, etc] and he provides concrete examples of ways other organizations have made marked

improvements in their patient satisfaction scores- to the benefit of patients, employees and the bottom line us studies that indicate satisfied patients often recover faster and better from treatment this leads to goodwill for the organization, positive word-of mouth promotion, and more customers at your hospital. When patients are satisfied it also indicates that the staffs are content with their jobs and they perform their jobs well, resulting a decreased turnover, are and less money spent on finder’s fees.

In today’s health care market the traditional term for referring has changed. In many private health care organizations the term customer has replaced the word patient when the term customer is used it is considered inclusive of all individuals who receive services. For hospital similar to the healthcare organizations, the primary aim of health service delivery is clearly satisfying the customer.

FACTORS AFFECTING PATIENT SATISFACTION

Hospitals must be conscious of the need to provide in the service re ndered by them all time. The process involves all activities and all departments in the hospitals. All functions must be carried out so that they are done right at the first time. The medical care there may There are several factors, which are affecting the standard of patient satisfaction these include,

Physical factors.

Service factors.

Technological factors.

Cost factors.

Communication.

PHYSICAL FACTORS:

To provide quality care the basic physical infrastructure is necessary. The location of the hospital is an important physical factor. Ideally it should be away from densely populated area. But at the same time it should be easily accessible by various modes of transportation such as road, rail etc.

The lay out should be provided with sufficient ventilation, good light and ventilation to enter fresh air. The physical structure and good environment will create of good impression in the minds of the people. Hospital should provide seating arrangements, adequate toilet and drinking facilities. Here should be signboards since the patients may find it difficult to identify the various places they have to go.

The availability of good physical facilities attracts not only new patients it will also help the old patient to remain with the hospital. Supplies and equipments are also essential to facilitate the service and the service and they should be always in working conditions to give maximum out put besides these there are several other factors which provides satisfaction to the patients like waiting room with adequate seating arrangement, parking facilities with adequate patients like waiting room with adequate seating arrangement, parking facilities with adequate space, good front office with inquiry of reception staff. Availability of specialist doctors, availability of facilities, like modern equipments machines etc are very important inpatients satisfaction.

Physical facilities to be provided include public telephone booth with STD/ISD facilities, recreation facility, newspaper etc. Assisting the patient with those physical services necessary for his well being and comfort which cannot for himself unaided and planning such services to meet his individual, needs as they are affected by his physical condition and his emotional reaction”

The physical facilities of the hospital should be such that the attendants and their relatives feel secure and comfortable within and around hospital. Another aspect that is concerned with the physical facility is with the cleanliness of the hospital. Only in proverbial terms cleanliness in next to godliness. But so far as hospitals are concerned cleanliness equally important along with being good. The toilets, the floor, the canteen etc should be kept clean always. The physical facility of the hospital should be such that the patients and relatives feel secure and comfortable within and around hospital. They should have a feeling that hospital is a second home.

SERVICE FACTORS:

Service factors includes professional services as well I as nursing service A service is defined as any activity or benefit that one can offer to another that is essentially intangible an does not result in the ownership of anything. Its production May of may not be tied to a physical product”

The performance of the hospital is measured only by quality of service provided to the public. Hospital should try to, establish cordial equitable and therefore mutually profitable relations between the hospital and their beneficiaries, the patients mostly complain of discourteous behavior of hospital staff, especially at the lower level. This irritates the patient and there relatives. The test of efficiency of a hospital is the satisfaction of the patients and the relatives.

The sympathetic and courteous behavior of the hospital staff would have a good and lasting effect on the patients and relatives. The hospital today is more than the combination of medical and therapeutic treatment by specialist, greater and refined medical and surgical knowledge and ever better and more effective facilities and equipments it includes these factor as the care of its efficient operations but an additional dimensions one which is to be ignored or at least minimized is the human and social element in the structure of the organization”

Health care organization need to know wants perception and preference of the customer. After knowing this health care organizations can provide according to their needs wants which should give satisfaction to the patient. They may expect better performance for their satisfaction. “A responsible organization is the one that makes the every effort to sense, serve and satisfy the needs and wants of its clients and the public and the publics, within the constrains of its budget and good clinical practice”

The medical, nursing, paramedical and other staffing the in the hospital should be skilled and competent. Their attitude should be customer friendly. The commitment to the organization to quality of service must be clearly communicated to all its employees.

It is very important for the hospital to have a clear ‘service strategy” “A service strategy is a distinctive formula for delivering service. Such as strategy is

keyed to a well-chosen benefit premises that is valuable to the customer and that establish an effective competitive position”

The ability to define and articulate a vision of service is more and more needed in hospitals. The premium will be on setting the strategy direction of the company in terms market oriented service strategy. Another way of defining service strategy is to describe it as an organizing principle that allows people in a service enterprise to channels their efforts to better oriented service that makes significant difference in the eyes of the customer. This principle can guide every one from the top management on the down to in and staff employees. The principle must take assessment that says this is what we are, this is what we do and this is what our believe in” Adherence to this principle helps the hospitals make service decision within its realm of concern. Another aspect of service is the value the hospital is offering to its customers.

This point of view focuses on the nature of customers experience with the service it revolves around the notion that value in the mind of the customer is what counts an not necessarily value in the eyes of the company.

TECHNOLOGICAL FACTORS:

The twentieth century saw rapid advancement in science and technology. The advancement of medical sciences indeed revolutionizes the concept of hospital itself. New and new investigations procedures and being worked out. Many hospitals are finding it difficult to cope with rapid change in technology.

Technology is needed to a greater extend, but amount of modernized techniques or sophisticated equipments may not contribute to the satisfaction of the patient. Even while using technology the human aspect of care should be considered. Technology only assists in giving correct diagnosis and treatment. The socio economic aspect the patient should be considered when we go in for high tech treatment.

The pace at which medical technology is advancing the entire process of patient care is becoming mire and more compels. The advance in medical science and technology have become to the rescue lf modern government in organizing

massive combat against disease, both individually and collectively on an international scale and have raised the life expectancy rates every were, by creating better conditions form modern living thus the quests for meeting new demands of health become an on going process as long as man and nature war each other

The advent of science and technology has made the modern hospital situation more and more complex.

COST FACTOR

One of the important aspects with the patient satisfaction is the economic satisfaction of the patient, there should be balance between quality and cost. With the advancement of technology the cost of treatment is becoming high as a result of which high-class treatment is becoming unaffordable to the vulnerable sections of the society.

Usually a person undergoing treatment will be in a financially disadvantageous position; during his days in the hospital have will be deprived of his income. Many a times the patient will have to depend on his near ones for his treatment. Along with physical pain, the financial burden will cause agony to the patient and the hospital will have to consider this also.

“The current trend in rising cost of medical care is publishing it of a level beyond the reach of the majority which is incompatible not only with demand on spend able income, but also with social, policies availability of access to health services. Health is recognized as an investment, as improved health of the people contribute to enlarging the resources and out put of the economy. It is also accepted fact that improved health care and modern society decreases that access to healthcare and modern society decreases that access to health care as a human right, regardless of person’s ability to pay. This big challenge to today’s health care administration and the need to deal with the variable and un budget able nature of medical care cost”

A hospital must accurately determent the cost of providing all it service through a proper system of accounting. An important administrative function is to determine then schedule of changes for the service to be rendered. The change

must be reasonable at sufficient income must be generated. The first requirement as to find out the actual cost for providing each of the service”

In addition to the price of fees which we collect patients incur three other costs:

The time cost and trouble of looking into information locating the hospital and traveling, which could be termed as effort cost.

The fear about his disease and treatment, trouble and pain, side effects, recovery time and extend of recovery could be termed as efforts cost.

Waiting time of the patient has to be considered as waiting cost.

This effort psychic and waiting cost also influence patient satisfaction to greater extend.

Adam Smith rightly said, the real price of everything what every thing real costs to the man who wants to acquire it, it is the tool and the trouble of acquiring it”

COMMUNICATION FACTORS:

Like any other service industry, communication is an important factor of customer satisfaction in hospitals too. Even the attitude of employee is an important aspect of communication. Communications with individuals and families in the community allow as gaming their confidence as well as to change the attitude and behavior for adapting useful health practices.

“Communication is the touching of mind by mind, of person with person whether it-be one man to a thousand. It can include conversation. Interview, dialogue, visual technique carefully used: This is of great significance as any wrong communication or misunderstanding can be responsible for damages to patient as well as to the hospital. There is a need to issue orders, instructions, and prescriptions to be carried out clearly and understandably.

Better techniques of communication can contribute to the improvement of health management by securing the floe of information needed for the effective functioning of the organization at minimum cost. Communication such as signboards, information enquiry ect s important. The lack of ability of Doctors,

nurses and other staff to explain the things properly is a major source of dissatisfaction by many patients.

Efficient communication is essential to all aspects of effective administration. Staff must be adequately and currently informed about plans, methods, schedules, problems and progress. It is clear that instructions, knowledge and information be so clearly presented as to make misinterpretation to misunderstanding impossible. Training should be imparted to staff to enhance their communication skills.

PATIENT SATISFACTION IS THE MAIN GOAL OF TOM

A family physician approach to total quality management [TQM]

TOM in the family practice is an organized approach to achieve maximum patient satisfaction, by involving and respecting the patient. Doctors, suppliers and the staff member in the clinic. Total quality management enables continuous improvements in the process used to prepare and deliver clinic s products and services to its patients. The emphasis is on preventing problems and not waiting for them to occur. In a nutshell patient satisfaction is the primary objective of TOM.

Family physicians in India he interested in practicing TQM

All family physicians in the subcontinent would like to have a list of satisfied patients by improving [he quality of practice. They would like to deliver more professional satisfaction, improve the employee productivity and moral, augment the clinic revenue and recognized as a quality conscious doctor. Therefore, I see every reason that family physicians would be keen to practice TOM which is going to give more personal satisfaction, improve the employee productivity and morale. Among the clinic revenue and he recognized and quality conscious doctor. Therefore, I see every reason that family physical would be keen to practice TOM, which is going to be the mantra of the next millennium.

TQM is going to play such an important role in the 21st century

In the process of having professional skills little did we know that in addition to academic qualification and clearing to the responsibilities of being a physician, we would also have to fit into the roles of chief executive officer, chief financial controller and director of HR chances are all these extra responsibilities are eating into our personal times. Time that could be better utilized by learning the rules of efficient TOM in our practice instead of waiting in crises management.

TQM in family practice

Patient from the basis of survival for healthcare provider. Patient satisfaction is destined to become the number one criteria used for selecting heath provider a satisfied patient is loyal customer. A dissatisfied, patient could make a break your facility or practice. Patient dissatisfaction could stem from office setting employee and physician attitudes, quality, and healthcare offered.

Chapter 4

METHODOLOGY

“Research Methodology” is a way to systematically solve the research problem. It may be understood as a science of studying how research is done scientifically.

1.1 RESEARCH DESIGN

A research design specifies the methods and procedures for conducting a particular study. The research should specify the approach he or she intends to the proposed study. Research design applied in this study is exploratory research.

EXPLORATORY STUDY

The exploration is particularly useful when researchers a lack a clear concept of the problems they would encounter during the course of study. Through exploration, researcher would develop concepts more clearly, establish priorities, develop operational definitions and improve the final research design. Exploration may also save time and money.

Exploration serves other purposes as well. The area of investigation may be so new or so vague that researcher needs to do an exploration just to learn something about the dilemma to be faced by the manager. Important variables may not be known or thoroughly defined. Hypothesis for the research may be needed. Also, the researcher may explore to make sure that it is practical to do a formal study in the area. An exploration to discover if industry executives would divulge adequate information about their decision making on this topic was essential for the study’s success.

1.2 DATA COLLECTION METHOD

This is a process of collecting data from various sources.

SOURCES OF DATA COLLLECTION

Questionnaire: - Questionnaire is most common type of survey method. As its name implies Questionnaire consists of several items designed to elicit the require information

The I.P.D patient Questionnaire consists of 20 questions related to the hospital services provided to the patient. Some questions are open ended some are closed ended. [Based on Excellent, Good, Satisfactory, Unsatisfactory]

PROCEDURE: - survey samples of 70 IPD patients were taken. Single patient was conducted at a time and after establishing the good rapport with the patient Questionnaire were conducted on the patient.

METHOD OF DATA ANALYSIS:- scoring will be based on the calculation of the response given to the various attributes by the patient.

SAMLING DESIGN:-

A sample design is a definite plan for obtaining a sample from the given population. It refers to the technique or the procedure the researchers would adopt in selecting items for the sample

SAMPLING UNIT: MAX POLYCLINIC AND DIABETIC CENTRE, HYDERABAD

SIZE OF SAMPLE: 70 IN-PATIENTS

TYPE OF SAMPLING: RANDOM SAMPLING

CHAPTER. 5

ANALYSIS, INTERPRETATION, FINDINGS AND DISCUSSION

Exploratory Data Analysis [EDA]:- is search for clues and evidences. Exploratory data analysis is the first step in the search for evidence. EDA shares a commonality with exploratory designs not formalized ones. It is free to take many paths in unraveling the mysteries in the data to shift the unpredictable from the predictable.

A major contribution of the exploratory approach lies in the emphasis on visual representations and graphical techniques over summary static.

The present Exploratory Study involves identification of the level of satisfaction of the In-patient and problem facing by the In-patients and data presentation by using pie charts and graph charts.

Q .1 is this your first visit to this hospital?

[a] Yes [b] No

48%

52%

1

2

Findings: out of 48-70% patient have visited more than one time so that phenomena shows the good image of the Poly Clinic Centre and satisfaction of the patient. And 52% are new comers it gets still to patient. With this one can say that the popularity of Poly Clinic is high.

Q .2 why have you selected this Poly Clinic?

[a] Facilities [b] Location [c] Recommendation [d] Tie up with private company

46%

7%

43%

4%

1

2

3

4

Findings: the graph represent out of 70 patients 46% have come here because of its facilities and 43% were recommended by other doctors who shows good image and have super specialties in Polyclinic. Only 7% and 4% .

Q .3 you are admitted through.

[a] OPD [b] Emergency [c] Other Institute Referred

OPD 46%

Other Institute Refered

23%

Emergency 31% 1

2

3

Findings: 46% of patients are admitted through OPD that shows Polyclinic has got good, experienced and efficient doctors in OPD. 31% patients are admitted through emergency its efficient ambulatory services. 23% patients are admitted through

other institute it shows polyclinic marketing plays vital role in the promotion of polyclinic.


[a] OPD [b] Emergency [c] other institute or referred

13%

210% 3

6%

481%

1

2

3

4

Findings: This graph shows 81% patients say there is an immediate admission formality that shows efficiency and competency of the employees.

Q .5 Total serviced provided through the hospital.

[a] Excellent [b] Good

[c] Satisfactory [d] Unsatisfactory

Good,, 35%

Satisfactory, 19%

UN satisfactory, 0%

Excellent, 46%1

2

3

4

Findings: this chart shows out of 70 patients 46% patient says excellent, 35% patients say good. So we can say that services provided through the hospital are good.

Q.6 Communication through the staff.



Satisfactory. 18%

Un satisfactory,

2%Excellent, 24%

Good, 56%

1

2

3

4

Findings: this chart shows out of 70 patients 56% says good and 24% says excellent, 18% says satisfactory and 2% says UN satisfactory that shows nursing staff are polite caring for patient.

Q .7 Behaviour of staff, consultant and other doctor.



Satisfactory, 2, 11%

Un satisfactory, 3, 1%

Good, 1, 52%Excellent, 4,

36%1

2

3

4

Findings: this figure depicts doctor, nurses and other staff is good in nature and keeping the patient always happy with their attitude.

Q .8 Explanation about your health, illness and treatment.



Good, 1, 54%Excellent 4, 27%



1

2

3

4

Findings: this diagram shows 27% patient says excellent 54% says good so we can say doctors are taking good care and also explaining the illness and treatment of the disease. And 16% are satisfied with these services.

Q .9 Listening to your problem.




Satis factory, 2, 15%

Excellent 3, 23%

Good , 1, 62% 1

2

3

4

Findings : 23% patient says excellent, 62% say good, 15% says satisfactory and no-one is un satisfied it shows all the nurses and doctor are doing their work properly i.e. they are doing their work efficiently and also effectively.

Q .10 Time period taken by the doctors for your treatment




Excellent 3, 23%

Satisfactory 1, 22%Good , 4, 53%

1

2

3

4

Findings : 23% patients says excellent,53% says good, 22% say satisfactory and 2% says unsatisfactory that shows, doctor and nursing staff are attending the patient in time.

Q .11 Services and facilities in the ward.



Excellent 3, 31%

Unsatisfactory 2, 3%


Good, 4, 49% 1

2

3

4

Findings: 31% patients says excellent, 49% says good, 17% says satisfactory and 3% says unsatisfactory that shows the hospital employees are performing their task in good manner and hospital accessories are in order.

Q .12 Preparation of the room



Unsatisfactory2, 2%

Excellent 3, 28%

Satisfactory 1, 23%

Good4, 47%1

2

3

4

Findings: 28% patients says excellent, 47% says good, 23%say satisfactory and 2% say un satisfactory that shows good co-ordination among the housekeeping staff.

Q .13 Toilet facilities in the ward



Good 3, 48%

Excellent 2, 12%

Unsatisfactory 1, 20%Satisfactory

4, 20%

1

2

3

4

Findings: 12% patients say excellent, 48% says good, 20% says satisfactory, and 20% says unsatisfactory that shows house keeping staff is effective but not efficiently performing task.

Q .14 Diagnostic services in the poly clinic



Good1, 66%

Satisfactory2, 12%

Un satisfactor

y 3, 1%

Excellent4, 21%

1

2

3

4

Findings: 66% patient say good, 21% say excellent 1% un satisfactory 12% say satisfactory,

Q. 15 Discharge procedure:-

[1] Time taken by the doctors and staff



Un satisfactory1

, 2%

Excellent2, 10%

Good 3, 29%Satisfactory 4, 59%

1

2

3

4

Finding: this chart shows the information that hospital administration should look after billing process and need to speed up the billing activity.

[2] Attitude of billing staff.



Good, 4, 57%

Excellent, 3, 5%

Unsatisfacory, 2, 1%

Satisfactory 1, 37% 1

2

3

4

Findings: this diagram shows that the billing staff attitude is good. And are polite in nature

[3] Charges of the hospital services



Un satisfactory

1, 54%

Satisfactory, 2, 7%

Excellent1, 3, 4%

Good 4, 35% 1

2

3

4

Findings: this chart shows room charges are okay but the general ward charges are slightly high that should be reduced to some extent.

Q .16 Hygiene status of the poly clinic



Good 1, 48%

Satisfactory2, 14%

Un satisfactory,

3, 0%

Excellent, 4, 38% 1

2

3

4

Findings: this chart reveals that 38% patients say excellent, 48% say good, 14% say satisfactory no-one say unsatisfactory that shows good hygienic conditions in the poly clinic. Hygiene status is notable issue in the hospital- --[poly clinic] that has been maintained here properly.

Q .17 Would You Recommend This Poly Clinic to Others?

[a] Yes [b] No

No1, 4%

Yes 2, 96%

1

2

Findings: Most of the patients i.e. out 70, 97% patients are interested to recommend the polyclinic if any body falls sick.

Chapter 6

CONCLUSION & RECOMMENDATION

Overall views about the polyclinic

Basically, the Max polyclinic & Diabetic Centre is run by a union of three doctors specialized in three different specialties.

Management system has well designed fragments of different units. On the other hand all units effectively and harmoniously are to overcome the one goal, customer satisfaction.

Inner view about Polyclinic:

All the clinical staff [nurses and other employees], consultants should have better co relation and create patient friendly ambience, whereas in practicality, it has been observed that there is a communication gap.

Toilet services and regular cleanliness is the status of hygiene of a polyclinic. There is not enough toilet facility in patients relatives waiting area.

In short toilet facility of the clinics should be redesigned well to maintain hygiene status of a clinic.

The waiting area seems to be congested to accommodate the waiting patients and need to be renovated suitably.

Even though all departments are performing their tasks up to the mark, there is a need to do process improvements. Process improvements are major and first and foremost concept in the Total Quality Management [TQM].

To endure in the 21st century market, most of the organizations are practicing the Total Quality Management concepts. The hospital administration needs to practise the TQM to give sophisticated services to the patients not only efficiently but also effectively.

MAXPOLYCLINIC AND DIABETIC CENTRE

HYDERABAD

PERFORMA FOR IN-PATIENT

Q.1 Details of the Patient

o Patient nameo Addresso Phone no.

Q.2 Is this your first visit to this hospital?

[a] yes [b] No

Q.3 why have selected this hospital?

[a] Facilities [b] location

[c] Recommendation [d] Tie up with private company


[a] OPD [b] Emergency [c] other institute or referred

Q .5 Admission formalities were completed.

[a] Immediately [b] Delay

[c] After receiving the deposit

[d] Any other

Q .6 Total serviced provided through the hospital.



Q .7 Communication through the staff.



Q .8 Behaviour of staff, consultant and other doctor.



Q .9 Explanation about your health, illness and treatment.



Q .10 Listening to your problem.



Q .11Time period taken by the doctors for your treatment



Q .12 Services and facilities in the ward.



Q .13 Preparation of the room



Q .14 Toilet facilities in the ward



Q .15 Diagnostic services in the poly clinic



Q. 16 Discharge procedure:-

[1] Time taken by the doctors and staff



[2] Attitude of billing staff.



[3] Charges of the hospital services



Q .17 Hygiene status of the poly clinic



Q .18 Please gives your valuable suggestion so we can make best tomorrow better than today.

PATIENT’S SUGGESTION

There are no facilities specially designed by the hospital for senior citizen and retired employees.

Doctors should explain patient’s relatives about patient’s health in more de-tailed manner by giving them enough time.

Juice shop should be provided in hospital. Discharge and billing procedure is taking long time so it should be reduced. Toilets should be cleaned regularly and fresheners should be used. In private ward relatives bed is congested and furniture should be re orga-

nized. Make sure that water services like taps and lights services like fans, switch-

boards are in order. Visiting hours must be started in the morning. Even though services provided by nurses and supporting staff are satisfac-

tory there is a scope for improvement. They need to be more helpful to the patient as well as their relatives

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