A study on People Perception of Health Care Service with Special Reference to Government General Hospitals in Chennai City

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Vol-40-Issue 20-2020
Studies in Indian Place Names
UGC Care Listed Journal
Copyright ©2020 Authors
ABSTRACT:
To study the people perception towards Government General Hospitals. To study the Importance
and Impact of service quality in hospital.To find the most important dimensions of service quality
that affects the people’s perception of Government General Hospital.To determine the people’s
expectations from Hospital service.To analyse the people level of awareness about Government
General Hospitals.
INTRODUCTION
MEANING OF HEALTH CARE SERVICE:
Access to health care may vary across countries, communities, and individuals, largely influenced
by social and economic conditions as well as health policies. Health care systems are organizations
established to meet the health needs of targeted populations. According to the World Health
Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-
trained and adequately paid workforce, reliable information on which to base decisions and policies,
and well maintained health facilities to deliver quality medicines and technologies.An efficient
health care system can contribute to a significant part of a country›s economy, development and
industrialization. Health care is conventionally regarded as an important determinant in promoting
the general physical and mental health and well-being of people around the world. An example of
this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in
human history to be completely eliminated by deliberate health care interventions.
PRIMARY CARE:
Primary care refers to the work of health professionals who act as a first point of consultation
for all patients within the health care system.Such a professional would usually be a primary care
physician,suchasa generalpractitioner or familyphysician.Anotherprofessionalwouldbealicensed
independent practitioner such as a physiotherapist, or a non-physician primary care provider such
as a physician assistant or nurse practitioner. Depending on the locality, health system organization
A STUDY ON PEOPLE PERCEPTION OF HEALTH CARE
SERVICE WITH SPECIAL REFERENCE TO GOVERNMENT
GENERAL HOSPITALS IN CHENNAI CITY
Jothi Rishi Vigneshvar
Assistant Professor, Dept of Commerce, St.Joseph’s College(Arts & Science),Kovur.
S.Ramki
S.Saravanan

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the patient may see another health care professional first, such as a pharmacist or nurse. Depending
on the nature of the health condition, patients may be referred for secondary or tertiary care.
SECONDARY CARE:
Secondary care includes acute care: necessary treatment for a short period of time for a brief but
serious illness, injury, or other health condition. This care is often found in a hospital emergency
department. Secondary care also includes skilled attendance during childbirth, intensive care,
and medical imaging services.The term “secondary care” is sometimes used synonymously with
“hospitalcare”.However,manysecondarycareproviders,suchas psychiatrists, clinicalpsychologists,
occupational therapists, most dental specialties or physiotherapists, do not necessarily work in
hospitals.Some primary care services are delivered within hospitals. Depending on the organization
and policies of the national health system, patients may be required to see a primary care provider
for a referral before they can access secondary care. In countries which operate under a mixed
market health care system, some physicians limit their practice to secondary care by requiring
patients to see a primary care provider first. This restriction may be imposed under the terms of the
payment agreements in private or group health insurance plans. In other cases, medical specialists
may see patients without a referral, and patients may decide whether self-referral is preferred.
TERTIARY CARE:
Tertiary care is specialized consultative health care, usually for inpatients and on referral from
a primary or secondary health professional, in a facility that has personnel and facilities for
advanced medical investigation and treatment, such as a tertiary referral hospital.
Examples of tertiary care services are cancer management ,neurosurgery, cardiac surgery, plastic
surgery, treatment for severe burns, advanced neonatologyservices, palliative, and other complex
medical and surgical interventions.
QUATERNARY CARE:
Theterm quaternarycare issometimesusedasanextensionoftertiarycareinreferencetoadvanced
levels of medicine which are highly specialized and not widely accessed. Experimental medicine and
some types of uncommon diagnosticor surgical procedures are considered quaternary care. These
services are usually only offered in a limited number of regional or national health care centers.
Quaternary care is more prevalent in the United Kingdom
GOVERNMENT HOSPITALS IN CHENNAI :
ChennaiistheleadingcityofSouthIndiaandtheforemostcenteroffinancial,technological,scientific
and health care activities. It is the fastest developing city of the nation with the exploration in all the
major sectors. The city is full of all the major facilities which are essential for the residents such as
supermarkets, malls, etc. which provides you with best services along with proper etiquettes. Apart
from this, in this region of South India, there are many very good hospitals with all the amenities
and 24 hours emergency ambulance, doctors and wards. However, for better and perfect cure of
the various incurable diseases such as cancer, HIV/AIDS, etc., research is still going on, together
by the doctors and researchers from overseas. This all is done for the expediency and feasibility
of the citizens. Besides this, the medical facilities are of top notch quality, and unlike facilities in

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foreign countries, treatments for which are no doubt, very expensive and cannot be afforded by
every person.Thus, Chennai provides you with several government hospitals and prominent private
hospitals. In the government hospitals, the treatment and medicines are given on the reasonable
rates. So, it is very important to know about the major hospitals of Chennai beforehand..
FACILITIES AT THE HOSPITAL:
The facilities include 14 dedicated operation theatres, laboratories, CT scan and MRI scans. Upon
completion, the premises will have two blocks, namely, the hospital and a college with eight
departments. The 400-bed hospital will also have a 500-seater conference hall. It will also have
a hospital management information system with a storage capacity of 60 terabytes specifically to
store patient information, including investigations and the treatment given. Other facilities would
include two cath labs with diagnostic imaging equipment separately for the heart and brain, an
emergency room near the entrance to the building, Wi-Fi connectivity, mobile phone signal boosters,
battery cars on every floor and in the compound and 150 surveillance cameras. The intensive
care units have seventy electro-hydraulically operated imported beds with digital touch screens.
Drinking water is dispensed by means of 10 water dispensers on each floor, which are sourced
from the reverse osmosis plant with a capacity of 6,000 liters of water per hour, operated by remote
monitoring software.
GOVERNMENT GENERAL HOSPITAL, CHENNAI:
Government General Hospital is a major state-owned hospital situated in Chennai, India. The
hospital with 3,000 beds is funded and managed by the state government of Tamil Nadu. Founded
in 1664 by the British East India Company, it is the first medical institution in India. In the 19th
century, the Madras Medical College joined it. As of 2018, the hospital receives an average of 12,000
outpatients every day.
INFRASTRUCTURE:
As the city of Chennai falls under seismic zone III, the structure is designed to be quake resistant. A
framed structure with pile foundation is used in the superstructures. The tower blocks are constructed
with structural glazing, aluminum composite panel cladding and Novakote finish.The total plinth area
of Tower Block I is 31,559 square meters and Tower Block II is 33,304 square meters. The ground level
is raised up to 1.40 meters (4’7”) to avoid water stagnation and to allow gravity flow of rainwater. Each
tower block has three staircases and eight lifts and the building has a ramp with access to all floors.
A separate fire-escape staircase and garbage disposal lift are found at the rear side of the building.
Construction of an eight-storey block to house 23 outpatient departments began in August 2016 at a
cost of ₹ 1014.5 million. It will add to the hospital an additional 432,000 square feet when it is opened in
July 2019. The new block will have four bed-cum-passenger elevators and four passenger elevators.The
building has a 1,000 KVA generator with automatic main failure panel. An air-conditioning plant caters
to the needs of operation theatres, ICUs, IMCUs, blood bank and special wards. A digital EPABX system
has been installed with battery power backup The hospital has 52 operation theatres, besides intensive
care units and post-operative wards. The hospital requires around 1,400 cubic meters of oxygen a day,
which is supplied through 1,052 outlets using cylinders. The hospital consumes around 300 oxygen

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cylinders every day.The hospital has become the first government-run institution in the state to install a
tank to store liquid oxygen. The tank, with a capacity to hold 13,000 liters of oxygen, would cater to the
needs of the entire hospital when it becomes operational.
OPERATIONS:
The hospital has a reputation of being one of the best in the state and ranks among the top ten in the Indian
subcontinent.The entire hospital block has been remodeled with the reconstruction of the massive twin
towers.Thesereplacetheoriginalhospitalbuildings,whichweremorethanacenturyold.Whilethehospital
is managed by the medical superintendent, the dean is the head of the Madras Medical College (MMC)
attached to the hospital. By 2006, the hospital started treating about 8,000 to 10,000 outpatients every day.
Thehospitalalsoperformedthreeopen-heartsurgeriesfreeofcostdaily.By2013,thenumberofoutpatients
per day increased to 10,000 to 12,000.The hospital contributes to the second largest number of deceased
organ donations in Tamil Nadu.In March 2012, the hospital performed its 1,000th kidney transplant, the
highest in any government hospital in the country, of which about 90 were cadaver transplants.As of 2013,
thehospitalhasa22percentshareinorgantransplants,thehighestamonghospitalsinthecity.
CANTEEN:
A corporation canteen is under construction on a 5,000 sq ft land and will be the biggest of its kind
in the city. It can accommodate the 12,000 outpatients, 3,000 inpatients and thousands of staff and
visitors at the hospital. The canteen is expected to open by mid-September 2013. The canteen will
have ramps for differently-abled and possibly have separate counters for them.
FUTURE DEVELOPMENTS:
In March 2011, the state health department announced setting up of a genetic lab at the hospital
to help in the early diagnosis of such diseases.In June 2012, the first skywalk in Chennai
connecting Chennai Central, Park Railway Station and the hospital was planned at a cost of ₹ 200
million.It will be 1 km long, linking the hospital with nine points, including Chennai Central Railway
Station, Evening Bazaar, Government Medical College and Ripon Buildings on Poonamallee High
Road. Here is the list of all the leading government and other hospitals located in Chennai, Tamil
Nadu.
OBJECTIVES OF THE STUDY:
●
● To study the consumer perception towards Government General Hospitals.
●
● To study the Importance and Impact of service quality in hospital.
●
●
To find the most important dimensionsof servicequality that affects the people’s perception
of Government General Hospital.
●
● To determine the people’s expectations from Hospital service.
●
● To analyse the people level of awareness about Government General Hospitals.
SCOPE OF THE STUDY :
The entire study is based on perception of health care service regarding government general
hospital But, the study was conducted only with 100 People. The research was planned to cover

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areas like people perception, people awareness level, Reasons for selecting government hospitals,
people satisfactory level of various services providing by government hospitals, etc.
REVIEW OF LITERATURE
LITERATURE ON DEMOGRAPHICS.
The first stage of literature deals with the demographic variables and their effect in health-care
scenario. By going through the literature, many studies of demographic variables in health-care
industry have been examined, and they are discussed as follows:
●
●
Rosenthal et al. (1997) studied the influence of demographic variables on sexually
transmitted diseases (STDs).The study proved that the factors like age and gender will
affect the psychological condition of adolescents with STDs. The study revealed that, along
with age and gender, the number of life partners and the attitude of an individual will play
a pivotal role in the STD acquisition.
●
●
Schwartz and Frohner (2005) studied the importance of the demographic variables
among multiple sclerosis patients. The study also focussed on the study of quality of life
inventory and expanded disability status to predict the mental health dimension of the
patient groups using various questionnaires.
SECOND STAGE: LITERATURE ON SERVQUAL
We have classified the literature review for service quality in hospital in a chronological order. The
picture depicts the literature survey of the origin of the ‘SERVQUAL’ concept, its modifications, its
applications to study the patients’ satisfaction and its comparison of public and private hospitals
using SERVQUAL. The first subdivision of the review deals with literature related to SERVQUAL origin.
The scope and tremendous applications of service quality have been foreseen by Parasuraman
et al. (1985). Initially they developed a service quality model which evolved through an exploratory
survey consisting of five gaps related to customer and marketer. This guided to develop ten
determinants in order to measure the perceived service quality. Dean (1999) modified the
SERVQUAL scale and identified four dimensions which are stable. The dimensions used by them
are ‘assurance, tangibles, empathyand reliability and responsiveness’. Here, the fourth dimension is
a fusion of two dimensions. They compared the service quality dimensions in different health-care
settings like medical centre and maternal and child health centres.
Kilbourne et al. (2004) modified the SERVQUAL scale into four-dimensional modified scale
including ‘tangibles, responsiveness, reliability and empathy’. They studied the overall satisfaction
of patients from various hospitals of the United States and United Kingdom. Even many studies
modified the SERVQUAL scale which can be applicable precisely to hospitals.
RESEARCH METHODOLOGY
The process used to collect information and data for the purposes of making business decisions. The
methodology may include publication research, interviews, surveys and other research techniques,
and could include both present and historical information.

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PRIMARY DATA :
Data collected by the investigator himself/ herself for a specific purpose. the primary data for
this research was collected through a direct survey with the respondents guided by a structured
questionnaire. the questions were structured and direct as to make respondents understand easily.
I have used questionnaire as my research tool which was one of the source of the primary data.
DATA COLLECTION TECHNIQUES:
Information you gather can come from a range of sources. Likewise, there are a variety of techniques
to use when gathering primary data.
TOOLS USED FOR DATA COLLECTION :
Surveys or questionnaires are instruments used for collecting data in survey research. They usually
include a set of standardized questions that explore a specific topic and collect information about
Demographics, Opinions, Attitudes, Behaviours and perception.
CONSTRUCTION OF QUESTIONNAIRE :
A questionnaire is a data collection format that consists of numbers of questions printed or typed
in a define order or a set of forms. In this case the questionnaire was designed in a clear cut form to
get a information regarding the people perception of government general hospitals.
SAMPLING PLAN :
The determination of sampling size and sampling technique are given in the definite form under
sampling plan.
SAMPLING SIZE :
A sample size is taken for the study is 100 respondents.
SAMPLING TECHNIQUE :
The technique used for sampling is convenience sampling. convenience sampling refers to the
collection of the information from members of the population who are conveniently available to
provide it. It is the best way of getting some basic information quickly and efficiently.
STATISTICAL TOOLS USED FOR DATAANALYSIS :
There are:
●
● Simple Percentage Method
●
● Chi – Square Test
●
● One Way Anova
SIMPLE PRECENTAGE METHOD :
Percentage analysis is the method to represent raw streams of data as a percentage (a part in
100 - percent) for better understanding of collected data. Percentage Analysis is applied to create a
contingency table from the NO. OF RESPONDENT distribution and represent the collected data for
better understanding.

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CHI – SQUARE TEST :
A chi-squared test, also written as χ2 test, is any statistical hypothesis test where the sampling
distribution of the test statistic is a chi-squared distribution when the null hypothesis is true.
Without other qualification, ‘chi-squared test’ often is used as short for Pearson’s chi-squared
test. The chi-squared test is used to determine whether there is a significant difference between
the expected frequencies and the observed frequencies in one or more categories.In the standard
applications of this test, the observations are classified into mutually exclusive classes, and there
is some theory, or say null hypothesis, which gives the probability that any observation falls into
the corresponding class. The purpose of the test is to evaluate how likely the observations that are
made would be, assuming the null hypothesis is true.
ONE WAY ANOVA
The one-way analysis of variance (ANOVA) is used to determine whether there are any statistically
significant differences between the means of two or more independent (unrelated) groups
(although you tend to only see it used when there are a minimum of three, rather than two groups).
For example, you could use a one-way ANOVA to understand whether exam performance differed
based on test anxiety levels amongst students, dividing students into three independent groups
(e.g., low, medium and high-stressed students).
ANOVA
EMERGENCY SERVICES Sum of
Squares
DF Mean
Square
F Sig.
RESPONSE OF
THE DOCTORS AT
EMERGENCY
B e t w e e n
Groups
40.202 2 20.101 14.130 .000
W i t h i n
Groups
137.988 97 1.423
Total 178.190 99
E X P L A N A T I O N
ABOUT PATIENTS
B e t w e e n
Groups
46.839 2 23.419 19.831 .000
W i t h i n
Groups
114.551 97 1.181
Total 161.390 99
SPEED OF WORK
B e t w e e n
Groups
21.238 2 10.619 7.601 .001
W i t h i n
Groups
135.512 97 1.397
Total 156.750 99

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SPACE AVAILABILITY
FOR INTENSIVE CARE
B e t w e e n
Groups
48.658 2 24.329 17.060 .000
W i t h i n
Groups
138.332 97 1.426
Total 186.990 99
AVAILABILITY OF
SPECIALIST
B e t w e e n
Groups
66.416 2 33.208 19.813 .000
W i t h i n
Groups
162.574 97 1.676
Total 228.990 99
INFERENCE:
The above table shows H0 is rejected because the calculated value is more than the table value at
1 % level of significance. Hence there is all emergency services provided by government hospitals
are not equal.
FINDINGS SUGGESTIONS
●
●
I noticed that out of 100 respondents, maximum of 43% respondents are induced by
relatives to select the government hospitals ,30 %of them are induced by friends,17 %of
them are induced by neighbours and minimum of 10% respondents are induced by others.
Therefore the majority of respondents are induced by relatives to choosing the government
hospitals.
●
●
I found that out of 100 respondents, the majority respondents are prefer the Satisfactory
level is neutral for all the admission procedures.
●
●
I noticed that out of 100 respondents, the majority respondents are prefer the dissatisfied
for all the Diagnosing service.
●
●
Iidentifiedthatoutof100respondents,themajorityrespondentsarepreferthe satisfactory
level is neutral for all the nursing service.
●
●
I stated that out of 100 respondents, the majority respondents are prefer the satisfactory
level is neutral for all the dietary service.
●
●
I found that out of 100 respondents, the majority respondents are prefer the satisfactory
level is neutral for all the lab equipment service.
●
● I noticed that out of 100 respondents, the majority respondents are prefer the satisfactory
level is neutral for all the emergency service.
●
●
I identified that out of 100 respondents, the majority respondents are prefer the Satisfactory
level is neutral for infrastructural facilities provided by government hospitals.
●
● I found that out of 100 respondents, the maximum 25% respondents prefer waiting time
is major problem ,23% of them facing problem in lack of new techniques,20% of them are facing
lack of specialist doctors,17% of them are facing problem in procedural formalities for admission

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and minimum 15% respondents are facing lack of diagnosing amenities problems. Therefore the
majority of respondents prefer waiting time is a major problem.
SUGGESTIONS
On interaction with patients and their attendants, following suggestions came out for improvement:
ADMISSION:
There is procedure of issuing only one attendant’s pass. However, if a patient is sick or attendant
is a lady and the attendant has to go out to get any medicines, etc. then he has problem. The policy
of issuing two passes may have to be reconsidered.
ROOM PREPARATION:
There were many complaints of cockroaches and rodents in the ward. The pest control department
should do regular sprays and take effective measures for controlling them. Room preparation
should be improved by more cleaning, anti-pest and anti-rodent measures.
NURSES’ BEHAVIOR:
Due to high demand, low supply and poor salary, there is always shortage of nurses. Hence, the
working number of staff nurses has decreased. This has started showing in their efficiency and
behavior. More number of staff nurses should be posted for patient care. Management should devise
methods and increase salary to attract and retain good nurses.
TOILETS:
The cleanliness of toilets should be improved. It may be done twice a day. Frequent and surprise
checks by sanitary inspectors and administrators will instill a sense of responsibility and alertness
in sanitary attendants.. Although smoking is strictly prohibited in the hospital, still some people
including staff are found openly smoking in the hospital. The patients and their relatives should be
clearly informed in writing about the rules and regulations. This should be available in Hindi also.
EXPLANATION ABOUT DISEASE AND TREATMENT BY DOCTORS:
All tests to be carried out and treatment options and costs were not told at the time of admission,
which caused frequent delay in treatment and procedures and delay in payment. Patients require
more information about their disease and treatment. Patient should be explained in detail about the
tests and procedures to be carried out and these should be pre planned and if possible may be done
from the OPD itself. There were inadequate guidance’s for attendants about care of postoperative
patients.
BEHAVIOR OF DOCTORS:
People felt that the doctors have become less sensitive and empathetic to their problems. The
new generations of doctors should be trained and value of empathic care and soft skill must be re-
emphasized
BEHAVIOR OF ORDERLIES/SWEEPER’S:
Be patients were disturbed by frequency of visits by different staff at different time. The timing

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for activities like nursing, cleaning, ward rounds should be fixed, so that the patient is mentally
prepared for the same and can take rest at other time. Some people complained about the bad
behavior of hospital and sanitary attendants. There is less sensitivity about avoiding cross infection
in staff like washing of hands. There were also 2 complaints of theft (Mobile) by the attendants.
They should be trained about the importance of hand washing and other universal precautions,
before and after touching any patient. They should be regularly trained and sensitized about how to
improve their image and behavior.
CONCLUSION
The hospitals should identify people perception of post and pretreatment in a particular service
which is happened to satisfy a patient. In this study, the findings are carried out to find out the
perception towards government general hospitals, the patients are neutral with the services they
got from the government hospitals during the treatment. They are also neutral with the overall
service quality dimensions namely reliability, tangibility, responsiveness, assurance and empathy.
Most of the patients feel that the services are neutral. Customers actually looking forwards for the
better service and experienced staff (Doctors and nurses) in the government hospitals rather than
seeing the convenience of travel and cost of their treatments.
REFERENCES
[1]
Institute of Medicine. Improving information services for health services researchers: a
report to the National Library of Medicine. Washington, DC: National Academy Press; 1991.
[2]
Ginzberg E, editor. Health services research: key to health policy . Cambridge, MA: Harvard
University Press; 1991.
[3]
Institute of Medicine. Health services research: training and workforce issues . Washington, DC:
National Academy Press; 1995.
[4]
Institute of Medicine. Report on health services research . Washington, DC: National Academy
Press; 1979.
[5] Lohr KN, Steinwachs DM. Health services research: an evolving definition of the field. Health Serv
Res. 2002 Feb;37(1):7–9. [PubMed]
[6]
Altman SH, Reinhardt UE, editors. Strategic choices for a changing health care system
. Chicago: Health Administration Press; 1996. during medical visits. Am J Public Health. 2004
Dec;94(12):2084–90. [PMC free article] [PubMed]
[7]
Averill RF, Goldfield N. Wallingford, CT: 3M Health Information Systems; 2003.All patient refined
diagnosis related groups (APR-DRGs) version 20.0: methodology overview.

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