1. INTRODUCTION
Outpatient Department in any hospital is considered to be shop window of
the hospital. There are various problems faced by the patients in outpatient
department like overcrowding, delay in consultation, lack of proper guidance
etc that leads to patient dissatisfaction. Now-a-days, the patients are
looking for hassle free and quick services in this fast-growing world. This is
only possible with optimum utility of the resources through multitasking in a
single window system in the OPD for better services.
The Sree Chitra Tirunal Institute for Medical Sciences and Technology
(SCTIMST) is an Institute of National Importance established by an Act of
the Indian Parliament. It is an autonomous Institute under the
administrative control of the Department of Science and Technology,
Government of India and is situated at Trivandrum, the capital city of state
of Kerala. It is a tertiary referral hospital with major specialties like
Cardiology, Cardiac surgery, Neurology, Neurosurgery. The hospital is 239-
bedded having three operation theater complexes and five ICU complexes.
About 12000 patients get registered per month. The patients are
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2. categorized as per the socio-economic assessment by the trained Medical
Social Workers in to five socio-economic categories and patients are billed
accordingly. About 20% of the patients receive free treatment and another
40% of the patients get subsidized treatment. In order to improve the
satisfaction level of patients, infrastructure modification as per the
suggestions of the patients were taken up. It was felt that there is a need
to know the satisfaction level of patients and also get a feedback about the
services provided in the outpatient departments. Hence this study was
undertaken with objectives to study the awareness of patients about the
outpatient department services, to evaluate the performance of the services
in the patient’s perspective, and to identify the problems of the patients and
suggestive measures for improvement.
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3. 2. Need for the study
Patient satisfaction surveys are useful in gaining an understanding of user’s
needs and their perception of the service received. In a survey conducted by
Department of Public Health, Ireland the level of satisfaction among the
OPD attendees were 94%. Doctors and nurses were perceived as friendly by
61% and 72% and rude by 1% of patients, respectively. The study highlighted
the areas for improvement from the patient’s perspective.
Patient satisfaction is an important indicator in evaluating the quality of the
patient care in the outpatient department. In a study conducted at
Magdeburg, Germany only 3.6% of patients were dissatisfied. It revealed
that patient’s participation in their care has a special place with regard to
patient satisfaction. While auditing patients experience and satisfaction
with Neurosurgical care at the National Hospital, London, it was found that
most aspects of the patients care had 70-80% of satisfaction.
Poor patient satisfaction can lead to poor adherence to treatment with
consequently poor health outcomes. In another study conducted on a sample
of dermatology outpatients, out of 1385 randomly selected patients, 722
3
4. patients agreed to participate, 424 fulfilled the inclusion criteria and 396 of
these patients (93.4%) completed the study. Overall satisfaction was
reported by 60% of patients.
From these examples it is evident that the satisfaction of patients
attending the OPD is to be assessed periodically. From the present study in
a tertiary care hospital in India, it is seen that 90-95% of patients are
satisfied with the services offered in the hospitals. The waiting time for
most of the patients are with-in one hour in various departments, except in
some occasions where it is prolonged. 96.5% of the patients were satisfied
with the time spent by the doctors in consultations. The assessment of the
services provided by nurses, security, receptionist, attendees etc also
showed that 90-95% of patients were satisfied with the hospital services.
The study also revealed that some of the patients waiting time were
prolonged and that the friendliness of the nursing staff needs to be
improved.
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5. 3. Objectives:
The present study has the following objectives:
1. To examine patient satisfaction and recommendation of a hospital, with a
special focus on the correlation of these measures to patient ratings of
interpersonal and technical performance of the hospital.
2. To measure the level of patient satisfaction based on various factors.
3. To study the genesis and concept of patient satisfaction with particular
reference to technical performance of the hospital.
4. To access and analyze the patient satisfaction Programs in Gayatri
Hospital.
5. To appraise the executive department programs in the organization.
6. To make necessary suggestions to bring about meaningful relationship
between patients and staff efforts and efficiency of organization.
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6. 4. Scope of the Study:
The study covers the Visakhapatnam based patients only. A small
sample is taken from a huge population and it may not provide the actual
picture of level of satisfaction of out-patients.
But the study provides an insight into the mindset of the patients
towards the hospital and its services through valuable information regarding
various parameters that determine the level of patient satisfaction. These
valuable insights are useful to understand patients better, so as to serve
them better.
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7. 5. Methodology:
Research in common pursuance refers to a search for knowledge in a
scientific and systematic way for pursuant information on a specified topic.
Once the objective is identified that next step is to collect the data
which is relevance to the problem identified and analyze the collected data
in order to find out the hidden reasons for the problem. There are two types
of data namely.
1. Primary Data
2. Secondary Data
1. PRIMARY DATA
Primary data is to be collected by the concerned project researcher
with relevance to his problem. So the primary data is original in nature and
is collected first hand.
Collection of primary data
There are several methods of collecting primary data particularly in
surveys and descriptive researches. Important ones are as follows:
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8. 1. Observation Method
2. Interview Method
3. Questionnaire
4. Schedules and
5. Other methods which include
Through projective techniques with hospital staff
In depth interviews with patients
6. LIMITATIONS
This study has few limitations. It considered only the outpatient
population. Thus, the results cannot be generalized to inpatient
populations. The sample size was small considering fewer patients in
diagnostic categories.
Time is not sufficient to study the available information.
The Doctors could not spend much time due to their routine work load.
The time limit for the project is only 45 days, for that does not cover
all related fields.
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9. HOSPITAL INDUSTRY PROFILE
The health care industry, or medical industry, is an aggregation of sectors
within the economic system that provides goods and services to treat
patients withcurative, preventive, rehabilitative, and palliative care. The
modern health care industry is divided into many sectors and depends
on interdisciplinary teams of trained professionals and paraprofessionals to
meet health needs of individuals and populations.[1][2]
The health care industry is one of the world's largest and fastest-growing
industries.[3]
Consuming over 10 percent of gross domestic product (GDP) of
most developed nations, health care can form an enormous part of a
country's economy.
For purpose of finance and management, the health care industry is typically
divided into several areas. As a basic framework for defining the sector, the
United NationsInternational Standard Industrial Classification (ISIC)
categorizes the health care industry as generally consisting of:
1. hospital activities;
2. medical and dental practice activities;
3. "other human health activities".
9
10. This third class involves activities of, or under the supervision of, nurses,
midwives, physiotherapists, scientific or diagnostic laboratories, pathology
clinics, residential health facilities, or other allied health professions, e.g. in
the field of optometry, hydrotherapy, medical massage, yoga therapy, music
therapy, occupational therapy, speech therapy, chiropody, homeopathy,
chiropractics, acupuncture, etc.[4]
The Global Industry Classification Standard and the Industry Classification
Benchmark further distinguish the industry as two main groups:
1. health care equipment and services; and
2. pharmaceuticals, biotechnology and related life sciences.
The health care equipment and services group consists of companies and
entities that provide medical equipment, medical supplies, and health care
services, such as hospitals, home health care providers, and nursing homes.
The latter listed industry group includes companies that produce
biotechnology, pharmaceuticals, and miscellaneous scientific services.[5]
Other approaches to defining the scope of the health care industry tend to
adopt a broader definition, also including other key actions related to health,
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11. such as education and training of health professionals, regulation and
management of health services delivery, provision of traditional and
complementary medicines, and administration of health insurance.[6]
Providers and professionals
See also: Health care provider and Health workforce
A health care provider is an institution (such as a hospital or clinic) or person
(such as a physician, nurse, allied health professional or community health
worker) that provides preventive, curative, promotional, rehabilitative or
palliative care services in a systematic way to individuals, families or
communities.
The World Health Organization estimates there are 9.2 million physicians,
19.4 million nurses and midwives, 1.9 million dentists and other dentistry
personnel, 2.6 million pharmacists and other pharmaceutical personnel, and
over 1.3 million community health workers worldwide,[7]
making the health
care industry one of the largest segments of the workforce.
The medical industry is also supported by many professions that do not
directly provide health care itself, but are part of the management and
11
12. support of the health care system. The incomes of managers and
administrators, underwriters andmedical malpractice attorneys, marketers,
investors and shareholders of for-profit services, all are attributable to
health care costs.[8]
In 2011, health care costs paid to hospitals, physicians, nursing
homes, diagnostic laboratories, pharmacies, medical devicemanufacturers
and other components of the health care system, consumed 17.9
percent [9]
of the Gross Domestic Product (GDP) of the United States, the
largest of any country in the world. It is expected that the health share of
the GDP will continue its upward trend, reaching 19.6 percent of GDP by
2016.[10]
In 2001, for the OECD countries the average was 8.4
percent [11]
with the United States (13.9%), Switzerland (10.9%), and
Germany (10.7%) being the top three. US health care expenditures totaled
US$2.2 trillion in 2006.[12]
According to Health Affairs, US$7,498 be spent
on every woman, man and child in the United States in 2007, 20 percent of
all spending. Costs are projected to increase to $12,782 by 2016.[13]
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13. Delivery of services
The delivery of health care services—from primary
care to secondary and tertiary levels of care—is the most visible part of
any health care system, both to users and the general public.[14]
There are
many ways of providing health care in the modern world. The place of
delivery may be in the home, the community, the workplace, or in health
facilities. The most common way is face-to-face delivery, where care
provider and patient see each other 'in the flesh'. This is what occurs in
general medicine in most countries. However, with modern
telecommunications technology, in absentia health care is becoming more
common. This could be when practitioner and patient communicate over
the phone, video conferencing, the internet, email, text messages, or any
other form of non-face-to-face communication.
Improving access, coverage and quality of health services depends on the
ways services are organized and managed, and on the incentives
influencing providers and users. In market-based health care systems,
for example such as that in the United States, such services are usually
paid for by the patient or through the patient's health
13
14. insurance company. Other mechanisms include government-financed
systems (such as the National Health Service in the United Kingdom). In
many poorer countries, development aid, as well as funding through
charities or volunteers, help support the delivery and financing of health
care services among large segments of the population.[15]
The structure of health care charges can also vary dramatically among
countries. For instance, Chinese hospital charges tend toward 50% for
drugs, another major percentage for equipment, and a small percentage
for health care professional fees.[16]
China has implemented a long-term
transformation of its health care industry, beginning in the 1980s. Over
the first twenty-five years of this transformation, government
contributions to health care expenditures have dropped from 36% to
15%, with the burden of managing this decrease falling largely on
patients. Also over this period, a small proportion of state-owned
hospitals have been privatized. As an incentive to privatization, foreign
investment in hospitals—up to 70% ownership—has been encouraged.[16]
14
15. Medical tourism
Medical tourism (also called medical travel, health tourism or global
health care) is a term initially coined by travel agenciesand the mass
media to describe the rapidly growing practice of traveling across
international borders to obtain health care.
Such services typically include elective procedures as well as complex
specialized surgeries such as joint replacement(knee/hip), cardiac
surgery, dental surgery, and cosmetic surgeries. However, virtually every
type of health care, including psychiatry, alternative treatments,
convalescent care and even burial services are available. As a practical
matter, providers and customers commonly use informal channels of
communication-connection-contract, and in such cases this tends to mean
less regulatory or legal oversight to assure quality and less formal
recourse to reimbursement or redress, if needed.
Over 50 countries have identified medical tourism as a national industry.
[17]
However, accreditation and other measures of quality vary widely
15
16. across the globe, and there are risks and ethical issues that make this
method of accessing medical care controversial.
ANIL NEERUKONDA HOSPITAL PROFILE
Anil Neerukonda Hospital started Medical College in the year 2012-13 with
an intake of 150 students with the kind permission given by the Ministry of
Health and Family Welfare as per the recommendations of the Medical
Council of India. The College and the Hospital are situated in a sprawling
campus and has a total built-up area of 10,00,000 sq.ft comprising of 8
buildings. The entire necessary infrastructure is composed of fully-
equipped laboratories, air-conditioned lecture halls attached with a 920
bed Teaching Hospital as per MCI norms. Our teaching staff consists of
many renowned professionals from all over India.
Anil Neerukonda Hospital provids affordable health care to the needy people
of the society on non-profit basis with state of art facilities and modern
medical equipment.
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17. Our Mission
Anil Neerukonda Hospital is committed to provide the highest quality of
services and excellent international patient care in a cost-effective manner.
Our Vision
To be at the forefront of the healthcare industry in India, to
gain National recognition for our quality of services
particularly for medical services.
Anil Neerukonda Hospital will continue to make the medical
care for diverse clients more affordable while strictly
adhering to the highest standards of excellence.
Anil Neerukonda Hospital will continue to engage in the
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18. improvement and promotion of its health services and put a
high premium on the professionalism amidst the diversity of
its staff through continuing medical education.
Our Values
Compassion, quality, integrity and trust are the beliefs that
every citizen of the world is entitled to quality health care
and should be regardless of creed, race or color, and that
every person is endowed with an inalienable right to pursue
happiness.
Location
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19. Anil Neerukonda Hospitalis located in
Sangivalsa,Visakhapatnam, the capital city of Andhra Pradesh.
It is recognized as the world leading hospital for cosmetic
surgery with over 20 years of quality service. Anil Neerukonda
Hospitalaims to provide an international standard service and
excellent patient care.
Anil Neerukonda Hospitalconsists of many
departments dedicating to all treatments
as well as medical care. The hospital is
equipped with modern facilities and
completed state-of-art medical facilities to ensure the safety with 95 OPD
examination rooms and delivery rooms, ICU, dialysis machines, nursery room,
emergency room, and laboratory. It has 920 beds capacity and serves at
least 2,000 out-patients daily.
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20. VIP patient room is equipped with air
condition, LCD TV with satellite, big couch
for companion, refrigerator, safety box
to keep valuable belongings, in room toilet,
and balcony. Internet corner is also provided in the hospital. Your companion
can stay with you at the hospital without extra charge. There is a big &
comfortable couch for companion.
Everyday Anil Neerukonda Hospital has received numerous patients from all
over the state. The medical staffs at Anil Neerukonda Hospital are highly
trained and skillful. There are 105 full-time doctors, specializing in their
own medical field of specialization and 120 part-time health professionals
along with 800 caring, considerate and compassionate nurses and staff at
your service.
When you get to the hospital please contact Miss Krishna at the Desk with
your enquiry where she will be there to assist you and direct you to the
20
21. appropriate doctor.
Neurology is the specialist branch of Medicine that deals with the nervous
system. This includes the brain, spinal cord, peripheral nerves and muscles.
The special senses of smell, vision, hearing and balance also often involve
neurologists usually overlapping with ophthalmologists (eye specialists), and
Ear Nose and Throat (ENT) surgeons. Neurosurgeons, not Neurologists,
perform any surgical procedures required but the two specialities, by
necessity, have to work closely together.
Upcoming department with enthusiastic faculty with future vision to acheive
video EEG, DBS, preop temporal loberations evaluation and so on.
21
22. GROWTH:
The Anil Neerukonda Educational Society foundation was established with
the noble objective of providing needed research in cardiology, to achieve
indigenization of the fast growing range of hard ware products, devices and
disposables in the field to provide excellent academics at different levels
and to strive to bring down the ever bargaining cost of cardiac health.Anil
Neerukonda Educational Society under the able leadership of its founder,
chairman DR, B R Prasad . The Anil Neerukonda Educational Society
foundation has relentlessly pursued those objectives and can now look back
22
23. with some satisfaction on the work done towards this end in the first few
years of its experience.
Quality Anil Neerukonda Hospital was an inevitable off shoot of the
zeal to achieve the above mentioned objective. And it has the purpose of
giving a practical shape to this pursuit. The Anil Neerukonda Hospital,
Visakhapatnam is the first of the project of Quality established in July
2013 in leased premises ,the Hospital needs little to be said in its praise as
the direction it has then and its achievements are now very well known, the
immense credibility it has established is just a reflection of this. Dr B R
Prasad is himself, the chairman of Anil Neerukonda Hospital
The Anil Neerukonda Hospital stated with 200 beds .It has never
shrinked from its responsibility of looking after the economically deprived
sections of the population. It is to the credit of the hospital that nearly
20% of accommodation is allocated under general ward category where the
tariffs are highly subsidized.
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24. The hospital has so far been an exclusive cardiac Anil Neerukonda Hospital
with few supporting departments such as internal medicine and pulmonology,
it has on its panel specialists from all the branches who visit on call.
The hospital runs on extremely busy intensive coronary Anil Neerukonda
Hospital unit attending to all cardiac emergencies .The unit is staffed with
an in house cardiologist around the clock, supported by junior doctors, an
anesthetist, a large number of technicians and nursing staff and others.
Laboratory services are available continuously. Emergency services such as
primary angioplasty for a person with developing heart attack are performed
at all times of day or night.
Anil Neerukonda Hospital felt the need to introduce other specialties that
could serve the population with the same professional competence and
commitment as cardiac team with this in view neurology and other neurology
services were being started. This has brought under one roof highly
qualified, competent and dedicated professionals who would provide the Anil
Neerukonda Hospital and service to people. Anil Neerukonda Hospital
foundation started a research and development institution.
24
25. THE Anil Neerukonda Hospital MODEL:
They operate on physician driven model. This means that all the main
constituents of the Anil Neerukonda Hospital movement ,the promoters,
administrators and service providers are physician .The center of the Anil
Neerukonda Hospital model is the patient and the overriding motive of all
Anil Neerukonda Hospital activities is to provide quality medical Anil
Neerukonda Hospital at an affordable cost. Technology training and team
work from the every core of the Anil Neerukonda Hospital model which also
emphasizes a comprehensive and continuous education and training of every
individual involved in the patient Anil Neerukonda Hospital Every effort will
be taken to ensure that their growth is decided by the patients needs and
not one decided by their corporate requirements.
FUNDAMENTAL REASON FOR EXISTENCE:
To make quality medical Gayatri affordable and accessible considering
quality, cost, access.
Timeless unchanging core values.
Putting the patient first above ones own interest.
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26. MISSION:
To provide the best and cost-effective Anil Neerukonda Hospital
accessible to every patient through integrated clinical practice,
education and research.
VISION:
.To evolve as a unique university-based health-centre where the quest for
new knowledge would continuously yield more effective and more
compassionate Anil Neerukonda Hospital for all.
To nurture a new generation of professionals of long –life
commitment, dedication, knowledge, skills, wisdom and values.
To strive for public trust and maintain medicine’s humane and noble
place amongst professions.
To be globally competitive in health Anil Neerukonda Hospital and
related businesses integrating local culture and ethos.
To promote development of indigenous products and systems,
adapting appropriate technologies generating clinical skills and
26
27. removing barriers before patients accessing it through institutional
partnership.
OBJECTIVES:
To bring down the cost without compromising on quality. To indigenize
all the costly disposables in the next 10 years.
Cost of angiogram below Rs.7, 500.
Cost of angioplasty below Rs.40, 000.
Cost of stent below Rs.75, 000
A Day stay in ICCU to be below Rs.3, 000.
POLICIES:
Sensitivity to pain and suffering shall be accorded highest
priority to every employee.
Same treatment for same illness, irrespective of ability to pay.
Tests will be done only when medically necessary
Selection of all employees shall be on the basis of merit.
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28. Compulsory continuous medical education to lab health Anil
Neerukonda Hospital personnel.
All departments shall be run by full time consultants.
Round the clock availability of cardiologists, C.T. Surgeons
neurologists, anesthetists, labs and technicians.
VALUES:
Practice Practice medicine as an
Integrated team of
Compassionate
Physicians, Nurses and
Allied professionals.
Education Learn to serve through
continuous training and
education of physicians, nurses and
allied heath professionals
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29. Research Conduct basic and
clinical research
programs to improve
patient Anil Neerukonda Hospital and to
benefit society.
Mutual Respect Treat everyone with
respect and dignity.
Commitment to quality Continuously improve all processes that
support patient Anil Neerukonda
Hospital, education and research.
29
30. Work Atmosphere Foster team work, personal
responsibility, integrity,
innovation, trust and
communication and celebrate success.
Societal commitment Support the society we live in and assist
patients with limited financial resources.
Finances Allocate resources within the
context of a system rather than
its individual entities.
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31. CULTURE OF Anil Neerukonda Hospital:
The best interest of their patient is the only interest they consider. They at
Anil Neerukonda Hospital, combine an emphasis on the pure science of
medicine with a keen appreciation for each person’s humanity. Their caring
staff, advanced medical Anil Neerukonda Hospital, accessibility and
efficiency is what make them different from others –the preferred choice
of the international patient .Every employee devotes the necessary attention
to ensure that every patient’s visit to Anil Neerukonda Hospital is convenient
and worthwhile. The culture at Anil Neerukonda Hospital bears testimony to
the fact that:
“They are dedicated to the needs of their patients .They serve with a
special attitude, special Anil Neerukonda Hospital so that all patients gain
the maximum benefit from their visit to Anil Neerukonda Hospital
“It uses a collaborative approach where each physician can call on the
expertise of medical specialists and sub specialists. This team work helps
physicians arrive at an accurate diagnosis and the most effective course of
treatment. Each patient benefits from the experience and skills of many
31
32. physicians. Anil Neerukonda Hospital continues to offer superior value with
an efficient, streamlined approach to medical Anil Neerukonda Hospital that
emphasizes accurate diagnosis and effective treatments.
“It is patient centered organization and focus on one thing-the needs of the
patient. The needs of the patient come first.
“It provides the best Anil Neerukonda Hospital to every patient through
integrated clinical practice, education and research.”
“Comprehensive evaluation with timely, efficient assessment and treatment.
Availability of the most advanced, innovative diagnostic and therapeutic
technology and techniques.”
“The Anil Neerukonda Hospital organization recognizes the importance of
good communication with the patient’s personal doctor. Upon the patient’s
return home, Anil Neerukonda Hospital physicians send all pertinent medical
information to the home doctor to assist in continued good Anil Neerukonda
Hospital. It functions cooperatively to bring skilled, compassionate Anil
Neerukonda Hospital to patients from around the world.
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33. MEDICAL SPECIALITIES IN Anil Neerukonda Hospital:
SURGICAL:
● Cardio-Thoracic
● Dental
● ENT
● General, Gastrointestinal and Laparoscopic
● Gynecology
● Hand Surgery
● Neuro Surgery
● Surgical Oncology
● Ophthalmology
● Orthopedic Surgery & Trauma Services
● Urology
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34. MEDICAL
● Anesthesia
● Blood Bank
● Cardiology
● Dermatology
● Endocrinology
● Gastroenterology
● Internal Medicine / Coronary & Critical
● Life Style Clinic
● Nephrology
● Neurology
● Oncology
● Physiotherapy
● Psychiatry
34
37. In structure, we see patients, are at high priority, at quality Anil
Neerukonda Hospital the main criteria is putting the patient first above
ones own interest.” They are treated as Elite Group of the organization.
The next preference is given to doctors and nurses, they are the people who
give emotional support and satisfaction to the patients. The more comfort
they give the more satisfied is the patient, here the nurses play a very
important and vital role, they look after every aspect of the patient starting
with their food to their medicines, for this they have to be very patient,
humble and pleasing.The next comes Paramedics and House keeping, the
more cleanliness the more attractive the hospital, so the housekeeping
people play a crucial role in attracting the people to opt the hospital.
Pharmacist is the one who delivers the prescribed medicines given by the
physician, the more pro active they are the more willingness to buy the
medicines from within the premises. Next comes the Departmental manager,
who looks after the departments, its functions and the procedures to be
37
38. followed. He is the person who is responsible for all activities to be carried
for attaining the objectives.
ORGANIZATIONAL HIERARCHY
38
CHAIRMAN
VICE CHAIRMAN
BOARD OF DIRECTORS
HOSPITAL ADMINISTRATOR
GENERAL MANAGER
39. ASSISTANT MANAGER
DEPUTY GENERAL MANAGER
MANAGER
SUPERVISOR
ORGANIZATION POLICIES:
EMPLOYEE BENEFIT:
Provident Fund: All the employees will contribute 12% of their basic
salary which is 60% of their Gross 25% H.R.A 15% conveyance.
All the employees who are on the pay roll are eligible for this and
trainees after completion of their training get the eligibility on
regularization.
From the employee contribution of P.F. 8.33% will go to the pension
fund and remaining 3.67% will be added to P.F.
EMPLOYEE WELFARE:
39
ASSISTANT MANAGER
REGULAR STAFF
40. All the members are covered under Medi claim policy for self and
family members.
Each member is covered for 50,000 insurance
Insurance coverage will be done after 3 months of service.
SALARY/WAGES:
Attendance is taken from the swipe machine in time office and
uploaded into the pay roll management system.
Pay roll is managed in the pay roll package
Monthly statement like loss of pay, canteen deduction, pharmacy
allowance. Nursing allowance, New joining, Resignation, Monthly
increments, Doctors, Night shifts, Managers etc., are prepared along
with salaries.
Salaries are deposited into savings bank account directly.
40
41. LEAVE MANAGEMENT:
Being an essential service regular attendance for work is a vital factor in
ensuring smooth and uninterrupted operation. This require that employee
plan their leave in order to guide to staff on subject of leave. There are:
Casual leave : 12 per year
Sick Leave : 12 per year
Earned Leave : 15 per year
Maternity Leave : 180 days
Compensatory off : Day
Leave on loss of pay /special Leave
GRIEVANCE OF EMPLOYEES:
41
42. All complaints arising out of employment shall be submitted to the Manager
or any other person authorized on his behalf.
The following procedure should be adopted by the employees in the order
stated.
a. Representation of the HOD.
b. Representation of the Head of HOD
TRANFERS: All the employees are subjected to transfer as follows:
1. Intra Dept. 2. Inter Dept 3. Inter Hospital
a. Permanent
b. Probationer
c. Temporary
d. Trainee
e. Internees
f. Honorary Trainee
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43. g. Contract Labour.
ADMINISTRATION:
In any Organization, HR Department plays a very important role.
All the major activities will be dealt in HR Department such as
preparation of full and final settlement, maintaining record of each
employee of Organization, pay roll following up of appraisal of
potential, rewarding the “BEST ASSOCIATE AWARD” from various
Departments of Organization based on their performance, skills,
qualities, responsibilities.
WORKING HOURS AND CONDITIONS:
There are shifts for the employees working in the
Organization. For Administrative department the working hours are 8
AM to 5 PM.
SHIFTS:
MORNING:AFTERNOON:
M1 - 7AM-4PM MS - 12PM-9AM
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44. R1 - 8AM-3PM A -1PM-8AM
M2 - 9AM-6PM A1 - 2PM-10AM
M4 - 11AM-8PM
NIGHT:
N - 6AM-4PM R - 8PM-5AM
N1 - 9AM-9PM R2 - 8PM-9AM
N3 - 10AM-2PM
PERSONAL DEPARTMENT DETAILS:
Anil Neerukonda Hospitalis strongly driven by the philosophy that HR is
the strongest, valuable of all resources of any Organization. Human
nature is very complex and to harness and get the best for the benefit of
the Organization, as well as individual utmost Anil Neerukonda Hospital is
exercised right from the stage of selection through out the entire
process of HRD.
44
45. MANPOWER REQUIREMENT:
To take specification for Job requirement in the prescribed format
for all jobs opening in the Organization.
All the vacancies are displayed in the notice board for employees to
apply. The same is to facilitate equal opportunities for employees of
Organization.
All openings are intimated to employment exchange.
All vacancies arise, either due to resignations or New openings, first
option is given to existing employees in the Organization and they will
undergo for selection based on their job opening.
To competence requirement for all positions in the Organization the
GM-HR should consult with the HOD’S
SELECTION AND RECRUITMENT:
The vacancies are identified in each Department and selection is made
with the profile of the person needed for filling the vacancy. The first
option is given to the existing employees.
45
46. For all openings, the HR Department personnel conduct preliminary
interview and the ratings are given.
Whenever freshers are recruited for job opening, selection process
includes, written test, wherein candidate is required to score 60%
marks for further Interviews and Selections.
Short listed persons are called for Interviews by the Hospital
Administrator for suitable place and date.
INDUCTION/ORIENTATION:
Introduce the employee to the staff.
Explain him the Organization History, Hierarchy, Grade structure
Appraise him the rules and regulations of the organization
Put him under training in Departments to understand the role of
each Department where he/she is going to work.
46
47. Maintain induction training record.
PERFORMANCE APPRAISAL:
The performance Appraisal is carried out once every year for all
associates and after the completion of one year for new recruits.
Trainees will be assessed of their performance after completion of
3/6 months.
After their potential appraisal they are recommended for
promotion.
TRAINING:
At least 20 managers undergo Management development training in a
year.
To maintain record related to competence, education, awareness, and
training for all associates.
Induction, training is given for newly recruited personnel.
47
48. On the job training is given to all staff depending upon recruitment.
FEED BACK:
After returning from the training the effectiveness of training is
verified by the HOD and forwarded to General Manager-HR for perusal of
Management.
Anil Neerukonda Hospital TOMORROW:
9 years, 9 centers, services that span a multi specialty spectrum
and the immeasurable trust of our patients. That’s Anil Neerukonda Hospital
today. yet, we at Anil Neerukonda Hospital look at the years gone by, and
the milestones passed, as just the beginning. We have a successful and
48
49. human model, an approach that identifies and HR Managementes the
important constituents of medical Anil Neerukonda Hospital.
So, we will grow with our patient’s needs, through the
competence of our physicians, till we have touched every one who requires
our services. Till then, at Anil Neerukonda Hospital the efforts of the past
will continue, unabated.
INTRODUCTION
Patient satisfaction is an evaluation of quality of care, an outcome variable in
its own right, and is an indicator of weaknesses in the service.[1] Studies
indicate that global satisfaction is affected by many factors other than the
quality of service delivery; it may include factors such as patients’
49
50. demographics, diagnosis,[4,5] treatment programme, and chronicity of
disease. Among demographic characteristics, age, health status, and race
had a consistent, statistically significant effect on satisfaction scores and
among the institutional characteristics, hospital size had a consistent and
significant effect on patient satisfaction scores.
Factors for high satisfaction
In a meta-analysis, greater patient satisfaction was found to be significantly
associated with greater age, less education, being married, and having higher
social status.[8] A study on patient satisfaction with outpatient psychiatric
care showed a high general satisfaction with treatment.[9] Satisfaction was
highest in areas of treatment planning/treatment design, treatment
accomplishment, and relationship to staff. A somewhat lower level of
satisfaction was noted concerning information and co-influence of the
patient.[9] Level of satisfaction was not related to social and psychiatric
background characteristics. Patients with longer time in therapy showed a
higher level of satisfaction.[10]
50
51. Holcomb et al. found that severely ill inpatients who reported fewer
symptoms, higher quality of life, and a higher level of functioning at
admission tended to be more satisfied with their services. In addition,
patients who were employed at admission, and therefore most likely
functioning at a higher level in the community, rated their treatment more
positively.[10] In a study of mental health services, the strongest and most
consistent predictors of satisfaction were older age and better self-
reported health.[4] Longer length of stay was also associated with greater
satisfaction on a majority of subscales. Findings among female and minority
veterans were mixed across measures.
A Finnish study on satisfaction of psychiatric inpatients found that, in
general, patients were quite satisfied with their care. Of seven different
satisfaction areas, they were most satisfied with staff-patient relationships
and reported highest dissatisfaction in the areas of information,
restrictions, compulsory care, and ward atmosphere/physical milieu. Younger
and female patients were less satisfied with staff-patient relationships than
older patients and men.[11]
51
52. A study by Ito et al. reported that older patients tend to be more satisfied
with psychiatric care than younger patients.[12] Patients with schizophrenia
and mood disorders rated the psychiatric care more positively, whereas
patients with personality disorders rated negatively. Patients with neurosis
rated the care positively in informed consent, but negatively in other items.
In another study, patients with schizophrenia had higher levels of
satisfaction with services and life than others, and a statistically significant
relationship was found between life satisfaction and service satisfaction for
schizophrenics, and those with affective and adjustment disorders.[13]
Focusing on modifiable service delivery factors, staff teaching efforts
regarding medication, illness management, substance abuse, outpatient
treatment, and living skills were significantly associated with greater levels
of satisfaction with care, controlling for demographic and clinical variables.
[14] This may reflect the value consumers place on staff time, attention, and
communication.
Factors for low satisfaction
52
53. A meta-analysis conducted by Lehman et al. revealed that chronic patients
express less satisfaction with their treatment as compared to non-chronic
patients. No differences were found in rates of patient satisfaction
between inpatient and outpatient programs.[5] In a study by Barker et al.,
patients with a diagnosis of a non-affective psychotic illness, particularly
those who lacked insight were significantly less satisfied with their care.[15]
Respondents were more satisfied with personal rather than professional
qualities of the doctors, and less satisfied with their empowerment and
doctors’ availability.[15]
In a child psychiatric hospital, those who reported abusive behaviour were
significantly less satisfied with the hospital experience than those who did
not report abuse. The participants’ perception of clinical improvement was
weakly related to their satisfaction.[16] In a study by Gigantesco et al., the
satisfaction with services expressed by psychiatric outpatients and their
relatives was fairly good, with the exception of poor satisfaction with
information about treatment and involvement in the treatment program. The
satisfaction of inpatients and their relatives was significantly lower, with
the issue of information giving by staff appearing particularly critical.[17]
53
54. Among patients, variables associated with dissatisfaction were being an
inpatient, having a diagnosis of psychosis, being in contact with services for
more than six years, and being single.
In a study by Bjørngaard et al., satisfaction was associated with treatment
outcome, better health as assessed using Health of the Nation Outcome
Scales (HoNOS), being female, advanced age, and with having less
psychiatric team severity indicated by the teams’ mean Global Assessment
of Functioning (GAF) score. Patients with a schizophrenia spectrum disorder
were more satisfied when treated as inpatients and day patients, as
compared with outpatient treatment. Patients in other diagnostic categories
were less satisfied with day treatment.[18]
Negative correlations have been reported between patient satisfaction and
personality pathology.[19] Patient satisfaction was significantly affected by
symptom reduction and to some extent by personality pathology, while
duration of the hospital stay, age, and sex contributed minimally.
Studies in India
54
55. There are very few studies in India that measure patient satisfaction with
psychiatric services provided by the healthcare organizations.[20] A study
on perception of satisfaction in a drug-dependence treatment center in
India, more than 90% of the patients and their attendants appreciated the
services provided. Most of them (90-94%) were satisfied with supply of
drugs, good quality of clinical care, and cleanliness of the hospital.[20] The
overall level of patient satisfaction achieved was about 65%.[21] Corruption
appears to be highly prevalent and was the top cause of dissatisfaction
among patients. Other important areas of hospital services contributing to
patient dissatisfaction were poor utilities like water supply, fans, lights, etc;
poor maintenance of toilets and lack of cleanliness; and poor interpersonal or
communication skills.
MATERIALS AND METHODS
The study sample was recruited from the patients attending outpatient
department of Psychiatry, Anil Neerukonda Hospital, Visakhapatnam, in
55
56. South India. The department of psychiatry offers outpatient care in
addition to the provision of short-stay 60-bed hospital, support by clinical
psychologists, and social workers.
All patients aged 18-60 years, receiving psychiatric treatment for at least
six months from the institute were considered for the study. Patients who
were uncooperative, unable to spend time for the evaluation related to the
study, having confusional states, and impaired cognition, who could not
engage in conversation because of severity of disorders, and who did not
give consent were excluded. Informed consent was obtained from all
participants, and they were reassured regarding confidentiality.
Institutional ethics committee approved the study.
From the log of pre-registered patients coming for follow-up on a given day,
a random list was generated by random number tables. Among these
patients, those who fulfilled the recruitment criteria were approached for
the study. About 2-3 patients could be evaluated for the study in a day. The
recruitment continued for one month.
56
57. Demographic variables were collected using a proforma used in the institute,
which included: Age, sex, marital status, education, employment status,
family pattern, and address of residence. A semi-structured interview
schedule was used at Mental Health Institute to aid for psychiatric history
taking. The diagnoses were based on the DSM-IV-TR criteria. We assessed
the severity of psychiatric disorder using Clinical Global Impression (CGI)
severity scale.[22] It has scores from 0 to 7; higher scores suggest greater
severity.[22] The functioning level was assessed by GAF.[23] Higher scores
of GAF indicate better functioning.
We used Patient Satisfaction Questionnaire-18 (PSQ-18) to assess
satisfaction.[24] It was translated to the local language telugu following
translation-retranslation procedure.[25] It has seven subscales: General
satisfaction (GS), technical quality (TQ), interpersonal aspects (IPM),
communication (COM), financial aspects (FIN), time spent with doctor
(TWD), and accessibility and convenience (AC), which give scores in these
domains. A composite score (CS) is also calculated. Higher value indicates
more satisfaction.
57
58. Continuous variables were compared using independent t-test or analysis of
variance (ANOVA). Significance was set at standard 0.05. Statistical
analyses were performed using SPSS-22 for windows.
The sample size was 60; out of 68 patients who were found eligible for
inclusion and approached, 8 (11.7%) patients could not participate in the
58
59. study interview considering the severity of symptoms and were excluded.
The sociodemographic and clinical profile of the excluded patients were
comparable to that of included sample. The study sample consisted of 30
females (50.0%); half were between 18-34 years of age; 60% (n=36) had less
than 10 years of education, 50% were employed, 73.3% (n=44) were married,
63.3% (n=38) belonged to nuclear families, and most of them (66.6%, n=40)
were from rural background. Proportions of different primary diagnoses as
observed were anxiety disorder (n=22, 36.6%), major depressive disorder
(MDD; n=18, 30.0%), bipolar disorder (n=10, 16.6%), and schizophrenia (n=10,
16.6%).
Sociodemographic variables and patient satisfaction
Composite scores were comparable between genders, age groups, educational
groups, employment groups, marital status, and type of family. Comparing the
genders, subscale scores of general satisfaction was significantly more in
female patients, and that of communication was more in males. Older group
(age 35-60 years) compared to the younger group (18-34 years) had
significantly higher scores in TQ, IPM, and TWD, whereas significantly lower
59
60. score in financial aspects. Patients with less than 10 years of education
reported significantly more scores on accessibility and conveyance than
those with more years of education. Patients who were employed had
significant higher scores in communication, but lower score in general
satisfaction than those who were unemployed. Married patients had
significantly higher score on TQ and AC, but lower score on financial
aspects. There was no difference in subscale or composite scores based on
type of family-extended or nuclear.
Clinical variables and patient satisfaction
Among the diagnostic categories, the difference between composite scores
was statistically significant; patients with MDD had the highest, followed by
those with anxiety disorder, bipolar, and the least was with schizophrenia
patients. Subscale scores of TQ and IPM were highest in patients with MDD,
FIN in patients with bipolar disorder, and AC in patients with anxiety
disorder. Based on CGI, individuals with higher scores (3 or more) had
significantly higher score on IPM. However, the composite scores were
comparable. Considering the level of functioning, patients with higher GAF
60
61. score (60 or more) had significantly higher score on TWD but lower score on
IPM, with no difference in the composite score. There was no correlation
between PSQ-18 total score with age or CGI severity.
DISCUSSION
This study assessed the satisfaction level of the psychiatric patients who
received at least six months of care from outpatient department of a
hospital in South India. It attempted to address, to an extent, the paucity
of information on patient satisfaction on psychiatric services in an Indian
set-up.
Sociodemographic variables and satisfaction
It was interesting to note that the composite patient satisfaction scores
were not significantly different between any of the sociodemographic
groups studied: Males and females, younger (18-34 years) and older (35-60
years) age groups, lower or higher educational groups, employed and
unemployed, married and unmarried, and extended or nuclear family
background are rural or urban background.
61
62. Interpersonal rapport and good doctor-patient relationship have been a
cornerstone of higher patient satisfaction. Respondents were more satisfied
with personal rather than professional qualities of the doctors.[15] In our
study, the highest level of satisfaction was noted in interpersonal aspects
(71.4%) and time spent with doctors (62.4%). General satisfaction level was a
little over 50% (57%).
Variability was seen in the subscale scores in many demographic groups
studied. Comparing the genders, even though subscale scores of general
satisfaction was significantly more in female patients, the score for
communication was significantly less than the males. It is important to
improve the communication with patients, especially female patients. Often,
the communication is directed to persons accompanying the female patients,
and the information is discussed with others rather than the female patient
directly. Communication with female patients needs specific attention, and it
should be in a way they can understand and appreciate the information.
Older age group (35-60 years) compared to the younger age group (18-34
years) had significantly higher scores and lower scores in TQ, IPM, and
62
63. TWD, whereas significantly less score in financial aspects. Patients with less
than 10 years of education reported significantly higher scores on
accessibility and conveyance than those with more years of education.
Patients who were employed had significantly higher scores in
communication, but lower score in general satisfaction than those
unemployed. Married patients had significantly higher score on TQ and
accessibility and conveyance but lower score on financial aspects. These
observed differences in satisfaction scores in different subscales among
various demographic groups suggest the complexities involved in the
patients’ perception of satisfaction.
Clinical variables and satisfaction
Among the diagnostic categories, the difference between composite scores
were statistically significant; patients with MDD had the highest scores
followed by those with anxiety and bipolar disorder, and the least score was
with schizophrenia patients. In a previous study, variables associated with
dissatisfaction included having a diagnosis of psychosis, being an inpatient,
being in contact with services for more than six years, and being single.[17]
63
64. In contrast to our finding, patients with a schizophrenia spectrum disorder
were more satisfied when treated as inpatients and day patients, as
compared with outpatient treatment.[18] Patients in other diagnostic
categories were less satisfied with day treatment.[18]
Subscale scores of TQ and IPM were highest in patients with MDD, FIN in
patients with bipolar disorder, and AC in patients with anxiety disorder
[Table 2]. Appropriate TQ of care was significantly associated with higher
levels of satisfaction in a different study.[27] Results of these analyses
studying the causal relationship between patient-reported interpersonal and
technical quality of care for depression indicated that patients who
reported high satisfaction with care were more likely to receive higher
technical quality depression care six months later as compared with those
who are less satisfied.[28]
Based on CGI, persons with higher scores (3 or more) had significantly
higher score on IPM. However, the composite scores were comparable.
Considering the level of functioning, patients with higher GAF score (60 or
more) had significantly higher score on TWD but lower score on IPM, with no
64
65. difference in the composite score. Clinical severity and functioning level
might not be directly influencing the overall satisfaction but they affect
various components of it.
About the waiting time, 57% said that they need to wait occasionally for long
hours and 15% said that they never waited for long hours to see the doctor.
65
66. With this regard, the responses of patients are projected in Figure 1. From
the data it is seen that most of the patients have responded that the
waiting time is with in one hour. The waiting time in the enquiry and Medical
Records Department (MRD) is less than 30 minutes for more than 70% of
the patients. However the waiting time for consultation seems to be delayed;
in some cases it extends to more than three hours.
Figure 1: Patients' response about waiting time
With regard to the availability of medical records in the out patient
department, majority of the patients were happy. When asked about the
66
67. comfort available in the out patient department, 75% of the patients had a
good opinion. With regard to the cleanliness in the hospital, 50% of patients
were highly satisfied whereas 15.5% said that the cleanliness can surely be
improved. With regard to the staggered appointment system followed at
SCTIMST, 94% of the patient was satisfied with the system and the same is
the case with the signage boards available in the Out Patient Department.
With regard to the time spent by the doctors during consultation 96.5% of
the patients were satisfied. With regard to the Doctors behavior 56% said
that Doctors were well behaved, compassionate and patient, while 35.5% felt
that they were well behaved but would have been better if they were more
patient. With regard to the privacy in consultation, 97.5% of the patients
were satisfied. To a question “Were you benefited” when compared to the
time spent for checkup, 79.4% responded that they were highly benefited
while 19.6% said that they were benefited but have to wait for long hours to
meet the doctor. To another question about their perception of benefit
compared to the money spent, 76% said that they were benefited and 23%
said that they were benefited but have to wait for long hours for
consultation.
67
68. About the services provided by the nursing staff, the patient responded as
per Figure 2. It is seen that majority of the patients are satisfied with the
care and explanation about the disease and treatment given to them by the
nursing staff. However the friendliness component of the nursing service
was rated to be only average by 40% of the patients.
Figure 2: Patients' response about the services of nursing staff
About the Support services in the hospital, patients responded as per Figure
3. It id found that the majority of the patients are satisfied with the
support services like Security, Accounts, Attenders and MSW. When asked
68
69. about recommending this hospital to others, 55.8% said that they would
always do so, while 30.2% said that they will do usually and 11.6% said that
they will some times recommend this hospital.
Figure 3: Patients' response about the support services of hospital
CONCLUSION
69
70. Patent Satisfaction with the psychiatric outpatient services in Anil
Neerukonda Hospital, Visakhapatnam was observed to be varied across
diagnostic groups: Patients with schizophrenia were least satisfied, whereas
patients with major depression had highest satisfaction with services. There
was a difference in satisfaction levels among the demographic and clinical
groups regarding various components of satisfaction. Patient satisfaction in
psychiatry is a complex issue with various influencing factors. It is essential
to study this further, as it has potential to improve clinical care.
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