This document presents the design of a study on patient feedback systems at Kasturba Hospital in Manipal, India. The objective of the study was to assess patient satisfaction levels and identify factors influencing satisfaction through analyzing patient feedback. A questionnaire was administered to 198 inpatients and 144 outpatients to collect primary data on demographics, satisfaction with various hospital services, and opinions. Secondary data on the hospital profile was also collected. Preliminary findings show high confidence levels in treatment among most patients. Further analysis through chi-square testing will examine relationships between education, confidence, and recommendation behavior.

1. A STUDY ON THE PATIENT
FEEDBACK SYSTEM AT
KASTURBA
HOSPITAL, MANIPAL
Presented by:
Shreekanth Dangi
(091203002)
MIM, Manipal

2. Introduction
“A hospital is an integral part of a social and medical
organization, the function of which is to provide for the
population complete health care, both curative and preventive
and whose out-patient services reach out to the families and
its home environment; the hospital is also a centre for the
training of health care workers and biosocial research”

3. Marketing techniques can be applied to a broad set of problem faced by
hospitals.
 Where should the hospital locate a new branch or ambulatory care unit?
 How can the hospital estimate whether a new proposed service will draw enough
patients?
 How can the hospital attract more consumers to preventive care services, such as
annual medical check-ups and cancer screening tests?
 How can a hospital successfully compete in the recruitment of highly trained
specialists who are in short supply?
 What marketing programme can attract nurses, build community goodwill, and
attract more contribution?
Marketing orientation of hospital services will result in:
1. Improved satisfaction of clients
2. Improved attraction of resources and
3. Improved efficiency in activities.
Introduction…

4. Satisfaction is the consumer’s fulfilment response. It is
judgment that a product or service feature, or the product or
service itself, provides a pleasurable level of consumption
related fulfilment.
Achieving hospital patient satisfaction and the quality patient
experience:
 Pride fully advance your healthcare mission
 Attract and retain talented staff
 Win patient loyalty
 Secure the position of provider of choice in your
competitive healthcare marketplace.
Patient satisfaction

5. Principle of achieving patient satisfaction
 The quality patient experience doesn’t happen by accident.
 Anxiety is the rust of life, destroying its brightness and weakening its
power.
 Some emotions don't make a lot of noise.
 Patients and families want care and service to feel personal.
 Ineffective accountability is evidence that we are not serious. The allies
of accountability:
 Feisty determination
 Clear expectations
 Clear agreements
 Sound measurement and feedback
 Courageous conversations
 Consequences
 The more strongly your hospital’s culture supports the quality patient
experience, the more sustainable are impressive levels of patient
satisfaction.
Patient satisfaction…

6. Design of the project

7. Design of the project
Objective
To identify the level of patient satisfaction and determine the
factors effecting patient satisfaction through patient feedback
system.
Scope of study
The scope of the study is limited to Kasturba Hospital located
at Manipal targeting the in-patient and out-patients visiting
the hospital.
Finally the study is aimed to help Kasturba Hospital to
analyse the effectiveness of the present feedback system and
to improve the efficacy and effectiveness of the feedback
system and to reduce the gap by initiating measures to
resolve the problems exist if any.

8. Type of research: Descriptive research
Data collection method: The data collected was both primary and secondary
in nature.
Primary data
 The primary data was collected through means of as Structured Questionnaire,
targeted towards both In-patients and Out-patients.
 No of items in questions:
 Questions related to demography
 Questions related to satisfaction level toward different parameter of hospital
 Questions related to opinions and suggestions
Secondary data
 Secondary data means that data which is already available.
 Secondary data is important to understand the different parameters which exist
in the hospital and the history of the hospital.
Design of the project…

9. Sampling plan
 Sample population: The target population under this study are the
patients and patient relatives visiting Kasturba hospital, Manipal.
 Sample target: In-patient and out-patient corresponding to almost
all departments of the hospital have been taken into consideration.
 Sampling method:
 Non-probability conveniences sampling for the patients.
 Complex random sampling design is cluster sampling.
 In out-patient from various departments two patients are selected.
 In in-patient three from each department are selected as sample.
 Selection of the respondents is based on the easy availability of the
respondents, willingness to fill the questionnaire and return the filled
questionnaire promptly.
Design of the project…

10.  Sample size
In-patient: 198 (66*3)
Out-patient: 144 (72*2)
 Limitation of the study
1. Some patients were not helpful in responding to the questionnaire
due to stress of the hospital environment and aliment.
2. There wide difference among the respondents on the basis of
demography, education and intellectual abilities. So, there is non-
uniformity in the understanding of questionnaire.
Design of the project…

11. Hospital profile

12. Kasturba hospital was
established in 1961
under the acumen and
leadership of late
Padamshree Dr. T.M.A.
Pai, an internationally
renowned doctor,
educationist, banker,
industrialist and
philanthropist.
Hospital profile

13.  Premier healthcare institution providing quality tertiary
care.
 Patients both domestic and international.
 Beds: 2050
 It has a dedicated team of 323 full-time consultant doctors
of national and international repute, 311 resident doctors
and 2200 paramedical, nursing and other supporting staff
working round the clock for delivering compassionate care.
 Hospital is the first Medical College Hospital in Karnataka
to get the prestigious Accreditation from National
Accreditation Board for Hospital & Health Care Providers
(NABH) on 14 September 2009.
 ISO 9001:2008 certified
Hospital profile

14. • Mission Statement: Kasturba Hospital is committed to be the
most preferred and comprehensive hospital through clinical
excellence, patients’ centricity and ethical practices to meet the
health care needs of the community.
• Quality Policy: Kasturba Hospital is committed to meeting patient
needs and increasing patient satisfaction through continual
improvement of its services, quality management system and by
empowerment of staff.
Hospital profile

15. Findings

16. Findings
In out-patients and in-patients most of the patients are male and most
of them earn their living as private employee followed by students.
Out-patients In-patients

17. In both in-patients and out-patients the education level is graduation
for majority the patients.
Findings…
Out-patients In-patients

18. Most of the out-patients come to the hospital for the reason that it is the only good
hospital in the area hand and it is a good old hospital at the same time the reason for
the selection of the hospital for the in-patient are majorly the advance medical
facility at the hospital and good old hospital.
Out-patients In-patients
Findings…

19. Most of the respondents for the out-patients were the patients themselves
whereas in the case of the in-patients the respondents were the friends and
the relatives who came to visit the patient.
Findings…
Out-patients In-patients

20. Out-Patients
Findings related to parameters

21. What is your e ducational le ve l? * How confide nt you fe e l about Kasturba hos pital, Manipal about the tre atm ent?
Cross tabulation
2 5 0 0 7
.6 4.9 .8 .6 7.0
0 9 0 0 9
.8 6.3 1.0 .8 9.0
1 29 11 2 43
3.9 30.3 4.8 3.9 43.0
8 57 5 11 81
7.4 57.0 9.1 7.4 81.0
2 0 0 0 2
.2 1.4 .2 .2 2.0
13 100 16 13 142
13.0 100.0 16.0 13.0 142.0
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
primary
secondary
inter(10+2)
graduate
post graduate
What is your
educational
level?
Total
Strongly
confident Confident
Somew hat
confident
Somew hat
lack of
confident
How confident you feel about Kasturba hospital, Manipal
about the treatment?
Total
 Null hypothesis: Patient confidence level on Kasturba hospital is independent
from education level.
 Alternative hypothesis: Patient confidence level on Kasturba hospital is
dependent on education level.
Chi-square test

22. Chi-square test

23. Chi-square test
 Null hypothesis: Recommendation by patient to friends and relative about hospital
is independent of the confidence level of patient.
 Alternative hypothesis: Recommendation by patient to friends and relative about
hospital is dependent of the confidence level of patient.

24. Chi-square test

25. Findings for out-patients
Excellent Very good Good Fair Poor score
Enquiry 4.9% 29.9% 36.8% 28.5% 0.0% 3.115
Registration 4.2% 24.3% 54.2% 13.2% 4.2% 3.114
Waiting 0.7% 7.6% 16.7% 43.8% 31.3% 2.029

26. Excellent Very good Good Fair Poor Score
Pharmacy 0.0% 27.1% 50.0% 11.8% 11.1% 2.931
Laboratory 5.6% 24.3% 54.2% 11.8% 4.2% 3.156
Radiology 5.6% 27.1% 41.7% 19.4% 6.3% 3.066
Scheduling 0.0% 13.7% 30.2% 49.6% 6.5% 2.511
Findings for out-patients

27. Findings for out-patients
Excellent Very good Good Fair Poor Score
Receptionist 0.7% 31.9% 55.6% 11.1% 0.7% 3.208
Nurse 36.8% 43.8% 12.5% 6.9% 0.0% 4.105
Consultant/Doctors 31.9% 29.2% 29.2% 9.0% 0.7% 3.826

28. Findings for out-patients
Excellent Very good Good Fair Poor Score
Parking 0.7% 23.8% 32.2% 18.2% 25.2% 2.569
Cleanliness 6.3% 39.9% 44.1% 8.4% 1.4% 3.416
Signage 8.5% 31.0% 47.2% 12.0% 1.4% 3.335
Ambience 7.6% 14.6% 31.9% 29.9% 16.0% 2.679
Lift 2.8% 9.1% 18.2% 42.0% 28.0%

29. In-Patients
Findings related to parameters

30.  Null hypothesis: Patient confidence level on Kasturba hospital is independent
from education level.
 Alternative hypothesis: Patient confidence level on Kasturba hospital is
dependent on education level.
Chi-square test
What is your educational level? * How confident you feel about Kasturba hospital, Manipal about the treatm ent?
Crosstabulation
0 4 0 0 4
.3 2.9 .2 .5 4.0
0 17 0 2 19
1.5 14.0 1.2 2.4 19.0
0 12 2 14 28
2.1 20.6 1.7 3.6 28.0
10 94 10 9 123
9.4 90.4 7.5 15.7 123.0
5 17 0 0 22
1.7 16.2 1.3 2.8 22.0
15 144 12 25 196
15.0 144.0 12.0 25.0 196.0
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
Count
Expected Count
primary
secondary
inter(10+2)
graduate
post graduate
What is your
educational
level?
Total
Strongly
confident Confident
Somew hat
confident
Somew hat
lack of
confident
How confident you feel about Kasturba hospital, Manipal
about the treatment?
Total

31. Chi-square test

32. Chi-square test
 Null hypothesis: Recommendation by patient to friends and relative about hospital
is independent of the confidence level of patient.
 Alternative hypothesis: Recommendation by patient to friends and relative about
hospital is dependent of the confidence level of patient.

33. Chi-square test

34. Findings for in-patients
Excellent Very
good
Good Fair Poor Score
Friendliness of reception staff 5.6% 62.1% 28.3% 4.0% 0.0% 3.693
Promptness 16.7% 32.3% 30.3% 19.2% 1.5% 3.435
Information provided by the
reception staff
11.6% 28.3% 57.6% 2.0% 0.5% 3.485

35. Findings for in-patients
Excellent Very good Good Fair Poor Score
Explanation given about the
treatment
21.2% 41.9% 26.8% 9.8% 0.5% 3.741
Explanation given about the
problem
16.4% 35.9% 32.8% 14.4% 0.5% 3.533
Consultation provided by the
doctors
36.0% 56.9% 6.1% 1.0% 0.0% 4.279
Answers to your enquiries 11.9% 50.3% 29.5% 8.3% 0.0% 3.658

36. Findings for in-patients
Excellent Very
good
Good Fair Poor Score
Cleanliness of room/toilet 12.2% 36.5% 38.6% 12.7% 0.0% 3.482
Décor and Ambience 2.5% 12.7% 37.1% 40.6% 7.1% 2.629
Supply and cleanliness of
linen
17.9% 54.9% 25.1% 2.1% 0.0% 3.886

37. Findings for in-patients
Excellent Very good Good Fair Poor Score
TV 0.0% 4.6% 12.8% 29.6% 53.1% 1.691
Telephone 0.5% 7.7% 25.5% 38.3% 28.1% 2.145
Lights 6.1% 30.5% 49.2% 13.7% 0.5% 3.280

38. Findings for in-patients
Excellent Very good Good Fair Poor Score
Receptionist 9.7% 35.7% 44.4% 10.2% 0.0% 3.449
Doctors 31.8% 55.1% 13.1% 0.0% 0.0% 4.187
Nurses 33.8% 42.4% 19.7% 4.0% 0.0% 4.057
House-keeping 3.1% 26.5% 42.3% 21.9% 6.1% 2.983

39. Findings for in-patients
Excellent Very good Good Fair Poor Score
Pharmacy 20.8% 54.3% 22.8% 2.0% 0.0% 3.936
Laboratory 23.5% 49.5% 20.4% 6.6% 0.0% 3.899
Radiology 11.7% 49.5% 32.7% 6.1% 0.0% 3.668
Scheduling of tests and
services
9.6% 40.4% 40.9% 8.6% 0.5% 3.500

40. Findings for in-patients
Excellent Very good Good Fair Poor Score
Food & Beverage 4.1% 19.5% 34.4% 29.2% 12.8% 2.729
Lift services 10.4% 17.6% 35.2% 35.2% 1.6% 3.000
Parking area 12.2% 21.9% 37.8% 28.1% 0.0% 3.182
Security services 12.7% 29.4% 45.7% 9.1% 3.0% 3.394
Facilities for visitors 3.6% 51.5% 30.1% 13.3% 1.5% 3.424

41. Hospital feedback

42. 1. Hospital feedback system provides single score for all the parameters.
That is not an extensive feedback which can provide detailed
information regarding the good and the poor parameter of the hospital.
2. The sampling method is not scientific and not designed properly to give
samples across all departments of the hospital.
3. Although patients visiting hospital is almost same each month, the
sample size vary in the hospital feedback. The sample size take per
month is irrespective of the patients visiting that month.
4. There is no proper method for the selection of the respondents for the
hospital feedback. Some of the respondents are not willing to give
feedback. In that case they end up fill the questionnaire for the sake of
formality and provide fake response.
Hospital feedback

43. 5. Hospital feedback system has the questions that are open ended. More
of complains, suggestion and comments are asked in the questionnaire
which cannot provide statistical information and they are not even easy
to follow.
6. There are no dedicated staffs for the survey done for the hospital
feedback system from the customer care and feedback department. As
they are taken by the nursing and attending staffs. They don’t show
much interest in the survey to be done.
7. The hospital feedback system uses local languages like Malayalam,
Kannada along with English. This is easy to understand to the local
patients.
Hospital feedback

44. 8. Hospital feedback system uses an automated computer program to
generate report each month. Which requires translation of complains
and suggestions provided by the respondents from local languages to
English. This increases the chance of error and even makes the process
complicated.
9. The reports generated are sent to the concerned departments for the
proper action to be taken.
Hospital feedback

45. CSI score of Out-patients
OP
Year Month No of feedback Forms CSI SCORE
2011 Jan 2422 4.22
Feb 2132 4.26
Mar 3067 4.33
April 2510 4.27
May 2392 4.29
June 1886 4.43
July 1834 4.58
August 1934 4.59
Sept 1454 4.59
October 1106 4.52
November 1500 4.41
• Minimum CSI score required as per ISO standard is 3.5 for the out-patients
• Total Out-patient visit in October 2011- 54631

46. CSI score of In-patients
Year Month No of feedback forms CSI Score
2011 Jan 1244 3.11
Feb 985 2.37
March 1770 3.26
April 1961 3.25
May 1687 3.26
June 1252 3.29
July 1217 3.11
August 1129 3.31
Sept 996 3.31
October 964 3.40
November 773 3.36
Minimum CSI score required as per ISO standard is 2.5 for the in-patients
Total In-patient visit in October 2011- 5779

47. Suggestions
For the improvement of Hospital feedback
system

48. 1. Multi score feedback system
2. The sample method of the respondent is not scientific. Proper sampling
of respondents should be done keeping in mind the following points as:
a. Sample should cover across all the departments of the hospital.
b. Sample Size should be justifiable with the respect to the total patient
visiting the hospital for a given time period.
c. Respondents should be selected keeping in mind the willingness of
the respondents to participate in the feedback process.
3. Patients from various walks of life visit Kasturba Hospital.
Understanding of the questionnaire is very important. Respondents
should be selected on the basis of their understanding. Or they should
be assisted to understand the questionnaire clearly.
Suggestions

49. 4. Instead of asking open ended question in the questionnaire, more
emphasis should be on the close ended questionnaire.
5. Dedicated staff is needed who can assist the patients in responding to
the questionnaire.
6. The computer application used in not up to date and the functions of the
application is not well known to the staffs working with it. New
application should be placed which is more user friendly and practical.
7. Technology like touchscreen monitors and feedback application can be
used to get patient feedback instantaneously and storing it
electronically. The real time score can be generated which could be
very useful in pin pointing the problem area.
Suggestions…

50. Following suggestion are based on the finding about the patient satisfaction
regarding the hospital services:
1. Hospital should position itself as advance hospital which has been
serving the society since long time because these factors are drawing
most of the patients to the hospital.
2. Proper counselling and explanation is required to be given to the patients
regarding treatment and problem to improve the confidence level of
patients towards the treatment and services provided by the hospital.
3. Waiting time for the out-patients is high. It should be minimised by
using proper appointment system like appointment over telephone or
automated tokens.
4. Some steps should be taken to improve the transfer. One of the steps
which can be taken to improve the patient file management can be use of
electronic media to store the information.
Suggestions…

51. 5. There is dissatisfaction among the patients regarding the décor and
ambience. So, these need to be improved by use of some wall paintings,
brighter white colour walls and use of tiles in the wards.
6. Lift service is very important for hospital. There is dissatisfaction with
the lift service. So, the lift service has to be improved as many patients
find it difficult to go up to third floor.
Suggestions…

52. Conclusion

53. • The hospital feedback system has many weak points which are affecting
the efficiency to determine the satisfaction level of patients toward the
services provided by the hospital.
• There is large difference in the result obtained by the study done here
with comparison to the result obtained by the hospital feedback system.
• Hospital feedback system show high level of satisfaction in case of the
out-patient departments and little low level of satisfaction in case of in-
patient.
• Patient satisfaction and the quality of the service at the hospital can be
obtained by continues improvement at different level of the hospital
function. There is a need for involvement at managerial as well as at
operational level. So, a feedback system is needed that can product
extensive report for every level of hospital.
Conclusion