This document summarizes a study on patient care quality in public district hospitals in Tamil Nadu, India. The study examined 34 variables related to patient care quality as perceived by patients. It found that patients' expectations generally exceeded their perceptions of quality. Some key findings: - Rural patients gave higher ratings than urban patients for doctors' knowledge, analytical nature, and test performance ability. - There were significant perception differences between urban and rural patients for 14 of the 34 variables. - Factor analysis identified five important factors of patient care quality: empathy, patients' needs, relationship, professionalism, and responsiveness. The study suggests that while Tamil Nadu has invested in healthcare, public hospitals need more autonomy

1. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME
43
A STUDY ON PATIENTS CARE QUALITY IN PUBLIC
DISTRICT HOSPITALS IN TAMILNADU
Dr. C. Jothi Baskara Mohan
Associate Professor & Head (I/C),
Dr P.Uma Rani
Assistant Professor, Department of Business Administration,
Thiagarajar College, Madurai.
ABSTRACT
Health Care delivery systems involve a variety of stakeholders. These include the doctors,
nurses, pharmacists and other supportive staff on the one hand and the communities who utilize the
services on the other. They organize themselves and interact with each other in highly complex
decentralized settings the quality of service—both technical and functional—are a key ingredient in
the success of service organizations (Grönroos, 1984). Technical quality in health care is defined
primarily on the basis of the technical accuracy of the diagnosis and procedures. Several techniques
for measuring technical quality have been proposed and are currently in use in health-care
organizations. Information relating to this is not generally available to the public, and remains within
the purview of health-care professionals and administrators (Bopp, 1990). Functional quality, in
contrast, relates to the manner of delivery of health-care services. This paper examines and measures
the quality of services provided by Government hospitals. Empirical research is used to determine
patients’ expectations and perceptions of the quality of service, and a comprehensive scale is
adapted. Results based on testing the mean differences between expectations and perception indicate
that patients’ perceived value of the services exceed expectations for all the variables measured, and
the implications are discussed.
Key words: Patient Care Quality, Public District Hospitals.
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2. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
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INTRODUCTION
India is one of the fastest emerging economies of the world and the fourth-largest in the
world as measured by the purchasing power parity (Sunil, 2007) has not exhibited similar
achievements on the health side. India is currently the second fastest growing economy in the world,
with a GDP growth rate of 8.1 per cent at the end of the first quarter of 2005-06 (EOI, 2006), but in
terms of the health indicators, India performs poorly.
The two important weaknesses of the public health system in India is lack of availability of
health personnel in the rural areas and inadequate quality of care (Ramesh Bhat, 2000). Often the
behaviour of the doctors, nurses and supportive staff is cited as one of the major reasons for the
cause of poor perception on the health care services (Bhat and Maheswari, 2005)..
But the health conditions in India have improved considerably on account of the sustained
efforts towards the promotion of health care. There has been progressive increase in the outlay of
health plans since 1950-51 as can be observed from the following table.
Outlay of Health Plans (1950-2017)
Plans and their periods
Total Plan Outlay Public
Sector (Rs.Crore)
Health Plan Outlay
Including Family Welfare
(Rs.Crore)
First Plan (1951-56) 2356.0 164.0
Second Plan (1956-61) 4800.0 307.0
Third Plan (1961-66) 8098.0 341.8
Three Annual Plans (1966-69) 6756.5 215.3
Fourth Plan (1969-74) 15902.0 749.0
Fifth Plan (1974-79) 30322.0 1179.0
One Annual Plan (1979-80) 12601.0 384.4
Sixth Plan (1980-85) 71000.0 2028.0
Seventh Plan (1985-90) 180000.0 6649.2
Two Annual Plans (1990-92) 137033.5 1934.5
Eighth Plan (1992-97) 412000.0 8400.0
Ninth Plan (1997-2002) 875000.0 20504.7
Tenth Plan (2002-2007)
Eleventh plan(2007-2012)
Twelfth Plan (2012-2017)
893183.0
892652 .0
994918.0
36378.0
30001.8
39482.3
Source: R.C.Goyal (2012) Hospital Administration and Human Resource Management,
Prentice Hall India,
The above table shows that the Government has been constantly keeping sufficient funds out
of the total plan outlay of the five year plans for the health plans of the country.

3. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME
45
The present situation demands high quality medical care and high quality patient care, they
can be achieved through the efforts of well motivated, disciplined and well rewarded work force in
the hospitals. This paper examines the need for patient care quality in government hospitals.
STATEMENT OF THE PROBLEM
The government hospitals and the health care centers find it difficult to cope up the
increasing pressure. The private hospitals have been proved to be expensive and not serving the
interest of masses. Hence the development of the human resources becomes very vital to achieve the
task of health for all.
In order to suggest programmes to develop and improve the quality of health care personnel,
it is needed to measure the different dimensions of the Patient care quality in the government
hospitals and hence this study focuses on the different Variables Related to Patient Care Quality of
Doctors.
OBJECTIVES OF THE STUDY
The objectives of the study is confined to
i) To reveal the profile of the patients and their perception on patient care quality of the doctors
and the hospitals.
ii) To analyze & interpret the variables that reflects patient care quality.
iii) To suggest suitable measures to improve the patient care quality and achieve excellence in
overall health care quality.
RESEARCH DESIGN
Since the present study focuses on the perception of doctors and patients on the patient care
quality of doctors and hospitals, the sample pair has been identified initially (one doctor and one
patient) in each hospital. The sample pair represents the doctors working in the government hospitals
and the patients who are getting the treatment from those doctors. An initial effort has been made to
identify the sample pair as done by the previous researchers (Rohins et al., 2005 Las Chinger et al.,
2001). In total 10 pairs have been purposively selected from the government hospitals in each district
head quarters. The total sample size came to 580 which consist of 290 doctors and 290 patients.
Hence the applied sampling procedure for the present study is ‘purposive sampling’.
VARIABLES INVOLVED IN PATIENT CARE QUALITY
Even though, the required qualities of doctors are too many, the present study confines to
thirty four variables. The patients are asked to rate these variables at five point scale according to
their order of perception from very high to very low. The assigned marks on these scales are from 5
to 1 respectively. The mean scores of each variable in patient care quality among the urban and the
rural patients have been computed separately in order to exhibit the patients’ perception. The‘t’ test
has been used to find out the significant difference among the two group of patients regarding their
perception on patients care quality. (Refer Table 1)

4. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
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MANAGERIAL IMPLICATIONS
The highly perceived patient care quality among the urban patients is, personal concern were
of utmost importance for the hospital, checking the patient before writing prescriptions and
communication with other doctors, since their respective mean scores are 3.0239, 3.2144 and 3.0143.
Among the rural patients, these variables are doctors’ knowledge, systematic and analytical nature
among the doctors and capability of performing test on patients since their respective mean scores
are 3.8184, 3.4509 and 3.6457. Regarding the perception on patient care quality the significant
differences among the urban and rural patients have been noticed in the case of 14 variables out of
34 variables since their respective‘t’ statistics are significant at five per cent level.
MAJOR FINDINGS
The important perception of patients on patient care quality of doctors explains all variables
in patient care quality to the extent of 85.22 per cent. The important patient care quality of doctors,
the variables in each factor, their Eigen value and their reliability co-efficient are explained in the
Table 2
The important patient care quality factor is empathy since its Eigen value and the per cent of
variation explained by the factor are 3.8184 and 18.42 per cent respectively. It consists of six
variables with the reliability co-efficient of 0.8145. It reveals that the variables included in ‘empathy’
factor explain it to the extent of 81.45 per cent. The second and third important patient care quality
factors are ‘patients’ needs and ‘relationship’ since their Eigen values are 3.0449 and 2.5496
respectively. The per cent of variation explained by these two factors are 16.29 and 15.11 per cent
respectively. The patients’ needs consist of five variables with the reliability co-efficient of 0.7208
whereas the relationship consists of 5 variables with the reliability co-efficient of 0.7644.
The next two patient care quality factors are professionalism and carefulness since their
Eigen values are 2.0641 and 1.7342 respectively. Both these factors consist of four variables with the
reliability coefficient of 0.8339 and 0.6996 respectively. The last factor identified by the factor
analysis is ‘responsiveness’ since its respective Eigen value and the per cent of variation
explained by it are 1.2369 and 9.45 per cent respectively. It consists of three variables with the
reliability coefficient of 0.7401.
SUGGESTIONS
The commitment, competencies and skill of the doctors in the health system have significant
implications for any sector reform process. This study suggests that although Tamilnadu has invested
in a large way in its health system development, the sector faces a number of challenges to ensure the
professional and the organizational commitment of the doctors. Meeting the health care needs of the
population goes beyond the budget allocations. The state has to invest in developing the leadership
quality, the supervision skills, and developing autonomy in its public health institutions. Along with
making public health institutions responsible to local governance, the department has to also give
autonomy to its medical officers in popularization and synchronization of the health programmes.
CONCLUSION
Because perceived quality is an important measure in influencing consumers’ value perception
and, in turn, in affecting consumers’ intention to purchase products or services (Bolton & Drew,
1988; Zeithaml, 1998), the findings of the present study are of importance for hospital administrators
with respect to the non-clinical aspects of service quality.

5. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
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Government efforts to decrease its expenditure on health care, and to modernize hospitals
through the accreditation exercise, have successfully improved the level of service quality. In
general, in comparison with the government health-care providers seem to be doing a better job in
achieving customer satisfaction with regard to patient care quality.
REFERENCES
1. Abu Naser Ahmed Tshtique, Md. Shapriar Akter and Suntu Kumar Glosh (2006), “Customer
Expectations and Perception towards health services through SERVQUAL model–An
Evaluation of Medical Diagnosis Service in Bangladesh”, Pakistan Journal for Medical
Research 10(1&2), April-October.
2. Ahamed, K.Z., and Raida, A.B., (2003), “The association between training and organizational
commitment among the white-collar workers in Malaysia”, International Journal of Training
and Development, 7(3).
3. Bhat, R. and Maheswari, S.K., (2005), “Human Resource Issues and its implication for Health
Sector Reforms”, Journal of Health Management¸7(1).
4. Englehardt, C.S. and Simmons, P.R., (2002), “Creating and organizational space for learning”,
the learning organization, 9(1).
5. Ervin, N.E., Walcoft – Mc Quigg, J., Chen, S.C., and Upshaw, H.S. (1992), “Measuring
patients’ Perception of Care Quality”, Journal of Nursing Care Quality, 6(4).
6. Evans, D., Edejer, T., Lawer, J., Frenk, J. and Murray, C. (2001), “Measuring Quality: from
System to the Provider”, International Journal for Quality in Health Care, 13 (6).
7. SATHYAJITH S and Dr. R. HARIDAS, “Job Satisfaction among Nurses of Private Hospitals
in Kerala” International Journal of Management (IJM), Volume 4, Issue 2, 2013, pp. 176 - 179,
ISSN Print: 0976-6502, ISSN Online: 0976-6510.
8. S. Karthikeyan and Dr. A. Savarimuthu, “Hospitals as Learning Organizations: An Explication
through A Systems Model” International Journal of Management (IJM), Volume 6, Issue 1,
2015, pp. 573 - 584, ISSN Print: 0976-6502, ISSN Online: 0976-6510.
TABLE 1
Perception of the Patients on the Variables Related to Patient Care Quality of Doctors
Sl.No. Variables
Mean score among patients in
t-statistics
Urban Rural
1. Doctors did their Test 2.2563 3.1415 –2.5969*
2. Doctors were Courteous 2.0672 2.9342 –2.7334*
3.
Doctors was interested me as a
Person
2.3472 2.5646 –0.3969
4.
Doctors talked me Frankly and
Politely
2.6162 2.8583 –0.4424
5.
Doctors explain each procedure
and test to me
2.0144 2.9193 –2.8163*
6.
Doctors worked hard to prevent
me from worrying
2.2042 2.9908 –2.2065*
7.
Doctors carried out my test
completely and carefully
2.4494 2.3441 0.2644
8.
Doctors work upto my
expectations
2.1403 3.0676 –2.5883*
9.
My personal concern were of
utmost importance for the
hospital
3.0239 2.2616 2.1739*

6. International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online),
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Sl.No. Variables
Mean Score among Patients in
t-statistics
Urban Rural
22. Doctors’ Personal Care 2.6673 3.2145 –1.2962
23. Doctors were capable of
performing test on me
2.9902 3.6457 –1.9969*
24. Doctors are systematic and
analytical
2.3414 3.4509 –2.0624*
25. Doctors have sufficient
knowledge
2.5103 3.8184 –.31403*
26. I have enough confidence in my
doctor
2.4432 3.6062 –2.9192*
27. Doctors respond in follow-up
treatment
2.6617 2.9197 –0.4546
28. Doctors took extra effort to enrich
their Service
2.2086 2.4145 –0.3969*
29. Doctors response on my Frequent
Visit
2.4441 2.6536 –0.4103
30. Doctors discussed the medical
issues with me
2.8184 2.9908 –0.2172
31. Doctors are having Caring
Attitude
2.2413 3.0565 –2.1096*
32. Doctors explained frankly to me 2.9193 2.0446 2.6867*
33. Doctors are able to recall my
History
2.0414 2.3311 –0.7339
34. Doctors spend enough time to
examine me
2.4146 2.9197 –1.2445
*Significant at five per cent level.
Sl.No. Variables
Mean Score among Patients in
t-statistics
Urban Rural
10. Doctors respond to My Questions 2.3939 2.2616 0.3164
11. Doctors are gentle and Sympathetic 2.2445 2.8986 –1.8183
12. Doctors made me feel Comfortable 2.9908 2.8184 0.2642
13.
Doctors check me before writing
prescriptions
3.2144 2.7671 1.4547
14. I have complete trust on doctors 2.4503 3.4541 –2.8968*
15.
Doctors gave medical advice in an
understandable way
2.9519 2.3039 1.6817
16.
Doctors Correctly Diagnose the
Disease
2.6083 3.1443 –1.3969
17.
Doctors spent extra time to remove
my fear and concerns
2.1443 2.2654 –0.2446
18.
Doctors took care of me
immediately
2.6869 2.9903 –0.4591
19.
Doctors communicate freely to
other doctors
3.0143 2.3069 2.0917*
20. Doctors Respond to my Request 2.4145 2.8914 –1.0229
21.
Doctors asked my permission
before performing any test.
2.0964 2.2145 –0.5083

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Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME
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Important Patient Care Quality of Doctors (PCQD)
Sl.No. Important PCQD
Number of
Variables in
Reliability
Co-
efficient
Eigen
Value
Per cent
of
Variation
explained
Cumulative
Per cent of
Variation
explained
1. Empathy 6 0.8145 3.8184 18.42 18.42
2. Patients’ needs 5 0.7208 3.0449 16.29 34.71
3. Relationship 5 0.7644 2.5496 15.11 49.82
4. Professionalism 4 0.8339 2.0641 13.24 63.06
5. Carefulness 4 0.6996 1.7342 12.71 75.77
6. Responsiveness 3 0.7401 1.2396 9.45 85.22
Total 27
KMO measure of sampling adequacy:
0.7949
Bartletts test of sphericity: chi-square value:
99.04*
*Significant at zero per cent level.