"To Find Out The Reason for not Visiting Hospital Again After The Treatment At The Referral Hospital & Community health Centre "

~By Keyur Modi Page 1
A
Multidisciplinary Action Project Report
On
“To Find Out The Reason for not Visiting Hospital Again
After The Treatment At The Referral Hospital &
Community health Centre Mandvi”
At
“The Referral hospital & Communality Health
Center,
Mandvi, Surat.”
Offered By:
Gujarat Technological University, Ahmadabad
Prepared By:
MR. KEYUR R. MODI
MBA (Semester-III)
Month & Year: November-2019

SR NO. PARTICULERS PAGES
NO.
CHAP.-1 GENRALINFORMATION 1-25
1.1 About the Healthcare industry
1.2 Schemes for healthcare provide by Government
1.3 Challenges face by Hospital
1.3 History of the Referral Hospital
 Facility Provided by Hospital
 Camp Organization
 Organization Chart
 Vision – Mission & SWOT Analysis
CHAP.-2 DIAGNOSIS PHASE: 28-33
2.1 Background of the Study
2.2 Analysing Problem and Importance of the Study
2.3 Main objectives & Limitation of the Study
CHAP.-3 DESIGN AND ANALYSIS PHASE 34-52
3.1 Research Methodology adopted for data collection
3.2 Sources and tools of data collection
3.3 Data Analysis and findings
CHAP.-4 IMPLEMENTATIONPHASE: 53-56
4.1 Identifying alternative courses of action
4.2 Determining the solution to be proposed
4.3 Methodology adopted for solution implementation
4.4 Project outputs / key deliverables
4.5 Tangible and intangible benefits delivered to the organization
4.6 Future recommendations
BIBLIOGRAPHY: 57
ANNEXURE: 58-65
TABLE OF CONTAINS

CHAPTER:1: GENERAL INFORMATION
ABOUT THE HEALTH CARE INDUSTRY
Healthcare Industry in India comprise of Hospitals, Medical devices, Clinical trials,
outsourcing, Telemedicine, Medical tourism, Health insurance and Medical tools. Any
companies which are involved in products or services related to health and medical care are
represented in healthcare sector and further categorized under six main industries. These
industries include:
 Pharmaceuticals
 Biotechnology
 Equipment
 Distribution
 Facilities
 Managed health care
Majorly there are two types of health care industry: -
1) Public sector
2) Private sector
1) Public Sector: -
A Government hospital, on the other hand, is completely and entirely run by the
government’s funding and money. Everything from the construction to the fees of the
doctors to the equipment, medicines is based on the government plan. Hence, each
and every thing is being taken care of by the local government body. A public hospital
is measured to be a preferable alternative for the not-so-rich lot of people who, despite
sensitive illness, cannot afford the heavy fees of a private hospital. It is very ironical
to see that a hospital that is governed by the government, which has clearly more
funds than a group of people or one person only, does not offer that level of service
that can be count on in most of the times. However, this can be due to the fact that a
government has a limited budget allocation to health care as it has a lot of things in its
hands such as defense, education, economy, etc.

The primary health centre is the first point of contact between a village community
and a medical officer and provides curative and preventive services to 30,000 to
40,000 people. It serves as a referral unit for six sub centres and has four to seven
beds for patients.
Community health centres are managed and maintained by state governments and
required to have four medical specialists supported by 22 paramedical and other staff,
with 30 beds, laboratory, X-ray, and other facilities. It covers 90,000 to 120,000
people.
Finally, an existing facility like a district or sub divisional hospital or a community
health centre is named as a fully operational first referral unit if it is equipped to
provide round-the-clock emergency obstetric care and blood storage. District hospitals
function as the secondary tier of public providers for the rural population of a total of
628,808 government beds, 196,282 are in rural areas. Government hospitals operate
within a yearly budget allocation.
Physicians working in government services earn salaries and are not permitted to
work in private practice in most states. Other staff members like nurses and
technicians also earn fixed salaries.
2) Private Sector:
A private hospital is one which is owned and governed by individual or many people
who are managing the whole finances on their individual. Not just finances, even the
whole funds process and the administration, staff, all the doctors, everything is under
control of that private organization. It has been seen that most of the people go for
private hospitals and they prefer them any other option. This might be due to the
service provided and the opinion that all the equipment used are reliable, of good
quality, and better. However, the reality of private hospitals being much more
expensive and costly can also not be denied. The number of facilities and the kind of
individual care and attention given to the patient in a private hospital is
unquestionable. These little yet highly paying services provided in a private hospital
makes it the first choice for any patient who can affordable the charges. Since no one
wants to risk their lives and get into more problems caused by even the slightest of
negligence on the part of treatment, private hospitals remain to be popular.

Indian Health Care:
A healthy country they say is a wealthy nation. Healthcare is main part to the society because
people get unkind, accidents and emergencies do arise and the hospitals are wanted to
identify, treat and handle different types of ailments and sicknesses
India has a vast health care system, but there remain many differences in quality between
rural and urban areas as well as between public and private health care. Despite this, India is
a popular for destination medical tourists, given the relatively low costs and high quality of
its private hospitals. International students in India should expect to rely on private hospitals
for higher medical care.
Study in India offers a figure of healthcare challenges that students from developed countries
may be unused to, so it is important to know how the health care organization in India
operates in the event you need it. Health care in India is a vast system and can be much like
the rest of the country full of complexity and paradoxes.
India's Ministry of Health was built up with autonomy from Britain in 1947. The legislature
has made wellbeing a need in its arrangement of five-year designs, every one of which
decides state spending needs for the coming five years. The National Health Policy was
supported by assembly in 1983. The arrangement went for all-inclusive social insurance
inclusion by 2000, and the program was refreshed in 2002.
The India’s health care system is primarily administered by the states. India’s formation tasks
each with providing health care for its people. In order to deal with lack of medical coverage
in rural areas, the national government launched the National Rural Health Mission in 2005.
The National Rural Health focuses resources on rural areas and poor states which have weak
health services with the aim of improving health care in India’s poorest regions.
Overall in India, we have 35426 government hospitals which have 1377013 beds. But
unfortunately, merely 2% of the doctors serve in rural India, which comprises 68% of our
population. As well 71% of rural population choose private hospitals and another 64% of
households in rural areas choose private players.
We have many private hospitals are there in India. Now a day we can see a multinational
hospital for every ward. It has become large profit grossing business. In India People bargain
to buy vegetables, fruits and other things. But these same people spend Lakhs of making

money out of it. In India if we go to government hospitals, we do not have proper
facilities/services or if we go to private hospitals. We will end paying huge amount.
PRIVATE AND PUBLIC
The health care system in India is worldwide (Universal). That being said, there is great
inconsistency in the quality and coverage of medical treatment in India. The Healthcare
between states, Rural and urban areas can be vastly different. Rural areas often suffer from
physician shortage, and disparities between states mean that residents of the poorest states
like Bihar often have less access to adequate healthcare than residents of relatively more
affluent states. The state government provide health services and education related to health,
on the other hand central government provide or offers the administrative and technical
services.
Lack of adequate coverage by the health care system in India means that many Indians turn to
private healthcare providers although this is an option generally inaccessible to the poor. To
help pay for healthcare expenditure, insurance is available, often provided by employers, but
most Indians lack health insurance, and out of pocket costs make up a large portion of the
spending on medical treatment in India.
On the other hand private hospitals in India offer World class quality health care at a fraction
of the price of hospitals in developed countries. This aspect of health care in India makes it a
popular aim for medical tourists. India also is a higher target for medical tourists seeking

alternative treatments, such as Ayurvedic medicine. India is a popular destination for students
of alternative medicine.
Knowing the Indian health care method and taking practical health and safety precautions
should help ensure that your time in India is a healthy and enjoyable one!
Healthcare is defined as the diagnosis, treatment, prevention and management of disease,
illness, injury, and the preservation of physical and mental well-being in humans. Healthcare
services are delivered by medical practitioners and allied health professionals. Here are some
facts that will give you an idea of the present state of health services in India.
 India has the world’s biggest number of medical colleges and number of medical
professionals qualifying every year.
 India is one of the world’s largest producers and biggest exporters of medicines.
 There is a consider raise in the healthcare facilities.
 A large number of medical tourists visit to India in every year for treatment. They get
treatment in world category and high end hospitals.
 In India also provided 108 services for Emergency Treatments.
On the other hand, there are some facts about the state of healthcare in our country that gives
a completely different picture.
 Almost half of the children are undernourished as they do not get adequate nutritious
food to eat.
 Very big amount of population is not capable to get clean drinking water leading to
water- borne diseases.
 Approximately, half a million people die from tuberculosis every year. Malaria is also
another disease which has not been brought under the power. Around two million
people suffer from malaria every year.
 Compared urban areas to rural areas suffer from lack of sound healthcare
facilities/Services. The ratio of qualified medical practitioners and population is very
small. People have to travel large distances to reach healthcare specialist and
sometimes poor transportation and communication Services cause delay in treatment
and people die from minor or curable diseases only because they don’t get prompt and
timely treatment.

 What is the Role of Government in Health care System?
 The structure of India considers the “right to life” to be fundamental and
obliges the government to make sure the “right to health” for all.
 To a significant extent, India’s health sector has been shaped by its federal
structure and the federal–state divisions of responsibilities and financing. The
states are responsible for organizing and delivering health services to their
residents. The central government is responsible for international health
treaties, medical education, and prevention of food adulteration, quality
control in drug manufacturing, national disease control, and family planning
programs. It also sets national health policy including the regulatory
framework and supports the states.
 The draft National Health Policy prepared in 2015 proposes that health be
made a fundamental right and views government’s role as critical.If accepted,
it would clarify, strengthen, and prioritize the role of government in shaping
the health system.
 The key Entity for health system Governance?
 Public actors in the Indian health care system include the Ministry of Health
and Family Welfare, state governments, and municipal and local bodies.
 Each state has its own Directorate of Health Services and Department of
Health and Family Welfare. District-level health services provide a link
between each state and primary care services.
 Other agencies involved in health system governance include the Insurance
Regulatory and Development Authority, which regulates the health insurance
industry, and the National health Authority, which is to become the authority
for development of an integrated health information system.29 There is lack of
clarity in India with respect to which entities are responsible for regulating the
private sector and for ensuring quality of care, as there are multiple agencies
under different ministries.

 How Can we Improve Health Sector in India?
1) Increase health-care spending to 2.5%of GDP
At the moment, the Indian government spends about 1% of its gross domestic product
on health care, according the Organization for Economic Cooperation and
Development. Mr. Reddy would like to see it spend 2.5% of GDP by 2017.
“We hope they’ll increase it despite the slight slowdown in economic growth,” said
Mr. Reddy. “While public spending is high as a portion of GDP, low priority is
accorded to health.”The report puts Indian public spending at 33% of the GDP, of
which only 4% is spent on health care. Compare this to Thailand, a country with a
robust health-care system, where health spending makes up 14% of total public
spending.
2) Pay for it with taxes, not user fees
The government should use existing tax revenues to pay for this system. As the tax
base widens, the government could also consider levying a specific income tax to
support the national health-care program, in which case user fees on people above a
certain income would be equivalent to charging them twice.User fees don't actually
help the system pay for itself, said Mr. Reddy. That's because they generate their own
expenses like paperwork and salaries for staff to handle billing and collections.And
even minimal user fees can deter the poor from seeking care, he said.
3) Spend more on primary care
Additional funds shouldn’t go only to maintaining the present health system, with its
skewed spending choices. Much as in education, Indian health spending has often
favoured treatment at hospitals in large cities over more widely available basic and
preventive care. The increase in spending should be accompanied by changes in how
that money is spent. Over time, 70% of public spending should be on primary care,
the report says. “By directing your health financing mainly into tertiary care you’re
not providing the population or providers with any incentive for preventive care,” said
Mr. Reddy.

Primary care is distinguished from other levels of care by the medical qualifications
of the attending doctors and the sophistication of the facilities needed to provide it.
Pre-natal check-ups and regular deliveries would be primary care, for example, while
a caesarean-section delivery would be secondary care. Mr. Reddy said offering better
primary care earlier could help reduce the number of cases where diseases or
complications progress to a point where they require travel for more expensive and
more aggressive treatment. Indian health spending also favors cities over the
countryside – according to the report, urban areas have four times as many health
workers per 10,000 people as rural areas.
4) Developan all-India public health service
The committee suggested the country needs an all-India service of public health
workers along the lines of the system that Tamil Nadu has, which some observers say
is the best in India.In general, to make a national health system that works, the report
says that more medical and nursing schools will need to be set up and millions more
basic health workers will be required, particularly in villages.“We need doctors, we
need nurses, we need community health workers,” said Mr. Reddy. “We need a multi-
layered health work force.”
5) Buy more drugs in bulk
Out-of-pocket spending on medicine has gone up in India, and now accounts for
almost three-fourths of all private health-care spending. Again, Mr. Reddy suggested
the Indian government could take a cue from Tamil Nadu, which purchases drugs in
bulk and provides many medicines for free to patients. That would involve
significantly increasing public spending on drugs from around $1 billion now.

Schemes for Health Care Provided by Government
1) Ayushman Bharat:
Ayushman bharat yojana or PMJAY provides free treatment up to Rs 5 lac. Per year
approx 50 crore poor people of the country. Ayushman bharat yojana was launched in
Ranchi (Jharkhand) on 23 September, 2018 by the Prime Minister Narendra Modi.
Main goal:
 It will offer a benefit cover of Rs 5 lac per family per year (approx. 50 corers
beneficiaries)
 It is matter of great concern that approximately 63% of India’s population still
pays for health and hospitalization expenses by their own. Besides using their
income and saving, people borrow money or sell their assets to meet their
health care needs, there by pushing 4.6% of the population below poor quality
Line.
 In order to solve this type of problem, Prime Minister Narendra Modi
launched the ambitious Ayushman Bharat Yojna so that the people get
treatment without being trapped into vicious circle of poverty.
2) Rashtriya Swasthya Bima Yojna:
Launched: 1 April 2008, 11 year ago
Prime Minister(s): Dr. Manmohan Singh

Details of the RSBY: -
According to the RSBY as launched in 2008 –
 Every BPL family holding a valid ration card may enroll to avail the insurance
benefits as extended by the scheme.
 Rs 30 will be charged as a one-time registration fee.
 Up to 5 members of the family including one head of household, spouse and
three dependent persons (children or parents) may be covered under the
insurance scheme.
 Each family is entitled to claim (cashless) inpatient medical care up to RS
30,000 per annum.
 The hospitalization may be done in any of the empanelled hospitals.
 Pre-existing ailments will be covered from Day 1 of the enrolment.
 Each family may also claim transport expenses of RS 100 per hospitalization
subject to a maximum of RS 1000 per family per annum.
 The RSBY was rolled out in 25 states of the country on 1 April, 2008. By
February 2014, a total of 36 million families have been covered under the
scheme.
3) Pradhan Mantri Bhartiya Janaushadhi Priyojana :-
Launched: 2008 by UPA
Prime Minister(s): Narendra Modi

Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana Kendra (PMBJP) is a campaign
launched by the Department of Pharmaceuticals, Government of India, to provide
quality medicines at affordable prices to the masses through special Kendras known
as Pradhan Mantri Bhartiya Jan Aushadhi Kendra.
Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana Kendra (PMBJPK) have been set
up to provide generic drugs, which are available at lesser prices but are equivalent in
quality and efficacy as expensive branded drugs. BPPI (Bureau of Pharma Public
Sector Undertakings of India) has been established under the Department of
Pharmaceuticals, Govt. of India, with the support of all the CPSUs for co-
coordinating procurement, supply and marketing of generic drugs through Pradhan
Mantri Bhartiya Jan Aushadhi Kendra.
It has been launched by the current Prime Minister of India, Shri Narendra Modi, in
the year 2014 for the noble cause – Quality Medicines at Affordable Prices for All.
The campaign was undertaken through sale of generic medicines through exclusive
outlets namely "Jan Aushadhi Medical Store” in various districts of the country.
In September 2015, the 'Jan Aushadhi Scheme' was revamped as 'Pradhan Mantri Jan
Aushadhi Yojana' (PMJAY). In November 2016, to give further impetus to the
scheme, it was again renamed as "Pradhan Mantri Bhartiya Janaushadhi Pariyojana"
(PMBJP). There are 4200 centres available in India.
Benefits:
 The Jan Aushadhi initiative will make available quality drugs at affordable
prices through dedicated stores selling generic medicines which are available
at lesser prices but are equivalent in quality and efficacy as expensive branded
drugs. Some comparative prices are Prices in Rs. as of (Sep 2013)
4) Pradhan Mantri Matritva Vandana Yojana :-
Launched: 2016
Prime Minister’s: Narendra Modi

The scheme was launched in 2010 as Indira Gandhi Matritva Sahyog Yojana
(IGMSY). It was renamed as Matritva Sahyog Yojana in 2014 and again as Pradhan
Mantri Matru Vandana Yojana (PMMVY) in 2017.
Pradhan Mantri Matru Vandana Yojana (PMMVY), previously Indira Gandhi
Matritva Sahyog Yojana (IGMSY), is a maternity benefit program run by the
government of India. It was introduced in 2016 and is implemented by the Ministry of
Women and Child Development. It is a conditional cash transfer scheme for pregnant
and lactating women of 19 years of age or above for the first live birth. It provides a
partial wage compensation to women for wage-loss during childbirth and childcare
and to provide conditions for safe delivery and good nutrition and feeding practices.
In 2013, the scheme was brought under the National Food Security Act, 2013 to
implement the provision of cash maternity benefit of ₹6,000 (US$87) stated in the
Act. Presently, the scheme is implemented on a pilot basis in 53 selected districts and
proposals are under consideration to scale it up to 200 additional 'high burden
districts' in 2015-16.Previously the pregnant women were given 6000 but in PMMVY
they receive 5000 in three instalments.
The scheme, rechristened Maternity benefits programme is set to cover the entire
nation. Prime Minister Narendra Modi, in his 2017 New Year’s speech, announced
that the scheme will be scaled up to cover 650 districts of the country.
The announcement assumes significance as India accounts for 17% of all maternal
deaths in the world. The country’s maternal mortality rate is pegged at 130 per

100,000 live births, whereas infant mortality is estimated at 43 per 1,000 live births.
Among the primary causes of high maternal and infant mortality are poor nutrition
and inadequate medical care during pregnancy and childbirth.
Objectives:
● Promoting appropriate practice, care and institutional service utilization during
pregnancy, delivery and lactation.
● Encouraging the women to follow (optimal) nutrition and feeding practices, including
early and Exclusive breastfeeding for the first six months.
● Providing cash incentives for improved health and nutrition to pregnant and lactating
mothers.
● IGMSY provides financial assistance as grant-in-aid to state governments.
5) Janani Shishu Suraksha Karyakaram :-
Introduction
Government of India has launched the Janani Shishu Suraksha Karyakaram (JSSK) on
1st June, 2011. The scheme is to benefit pregnant women who access Government
health facilities provided for their delivery. Moreover, it will inspire those who still
choose to deliver at their homes to select for institutional deliveries. All the States and
UTs have initiated implementation of the scheme.

Situation
High out of pocket operating cost being incurred by pregnant women and their
families in the case of institutional deliveries in form of drugs, User charges,
diagnostic tests, diet, for C –sections.
The New Initiative
In view of the difficulty being faced by the pregnant women and parents of sick new-
born along-with high out of pocket expenses incurred by them on delivery and
treatment of sick- new-born, Ministry of Health and Family Welfare (MOHFW) has
taken a major initiative to evolve a consensus on the part of all States to provide
completely free and cashless services to pregnant women including normal deliveries
and caesarean operations and sick new born (up to 30 days after birth) in Government
health institutions in both rural and urban areas.
 The following are the Free Entitlements for pregnant
women:
 Free and cashless delivery
 Free C-Section
 Free drugs and consumables
 Free diagnostics
 Free diet during stay in the health institutions
 Free provision of blood
 Exemption from user charges
 Free transport from home to health institutions
 Free transport between facilities in case of referral
 Free drop back from Institutions to home after 48hrs stay
 The following are the Free Entitlements for Sick newborns baby till
30 days after birth. This has now been expanded to cover sick
infants:
 Free treatment
 Free drugs and consumables
 Free diagnostics
 Free provision of blood
 Exemption from user charges

 Free Transport from Home to Health Institutions
 Free Transport between facilities in case of referral
 Free drop Back from Institutions to home
 Key features of the scheme
 The initiative entitles all pregnant women delivering in public health
institutions to absolutely free and no expense delivery, including caesarean
section.
 The entitlements include free drugs and consumables, free diet up to 3 days
during normal delivery and up to 7 days for C-section, free diagnostics, and
free blood wherever required. This initiative also provides for free transport
from home to institution, between facilities in case of a referral and drop back
home. Similar entitlements have been put in place for all sick newborns
accessing public health institutions for treatment till 30 days after birth.This
has now been expanded to cover sick infants:
 The scheme aims to eliminate out of pocket expenses incurred by the pregnant
women and sick new borne while accessing services at Government health
facilities.
 The scheme is estimated to benefit more than 12 million pregnant women who
access Government health facilities for their delivery. Moreover, it will
motivate those who still choose to deliver at their homes to opt for institutional
deliveries.
 All the States and UTs have initiated implementation of the scheme.
6) Pradhan Mantri Surakshit Matritva Abhiyan:-

Introduction
 The Pradhan Mantri Surakshit Matritva Abhiyan has been launched by the
Ministry of Health & Family Welfare (MOHFW), Government of India. The
program aims to provide assured, comprehensive and quality antenatal care,
free of cost, universally to all pregnant women on the 9th of every month.
 Honorable Prime Minister highlighted the aim and purpose of introduction of
the Pradhan Mantri Surakshit Matritva Abhiyan in the 31st July 2016 episode
of Mann Ki Baat.
 PMSMA guarantees a minimum package of antenatal care services to women
in their 2nd / 3rd trimesters of pregnancy at designated government health
facilities.
 The programme follows a systematic approach for engagement with private
sector which includes motivating private practitioners to volunteer for the
campaign developing strategies for generating awareness and appealing to the
private sector to participate in the Abhiyan at government health facilities.
 Target beneficiaries: -
 The Programme aims to reach out to all Pregnant Women who are in the 2nd
& 3rd Trimesters of pregnancy.
 Public Health Facilities to access services under PMSMA: -
 Rural Areas - Primary Health Centers, Community Health Centers, Rural
Hospitals, Sub - District Hospital - District Hospital - Medical College
Hospital.
 Urban Areas - Urban Dispensaries, Urban Health Posts, Maternity Homes.

CHALLEGS FACED BY REFERRAL HOSPITAL IN INDIA: -
Despite the implementation of National Rural Health Mission since 2005 to provide quality
healthcare to population in rural India, there are some formidable challenges confronting
public hospitals.
These challenges are associated with the social, economic, cultural and political scenarios of
the country. It is unfortunate that, sometimes even basic healthcare becomes unaffordable to
many common people due to the policies framed by governing bodies.
Deficient infrastructure, insufficient manpower, high patient load, vague quality of services
and cost burden are the major challenges currently confronting public hospitals in India.
Most of the public hospitals in India are devoid of basic infrastructure, which also includes
amenities like water, electricity, beds, medical and paramedical manpower. On the other
hand, improper distribution of available infrastructure leads to undermining of merely
available resources. Unavailability of any of the resources like water, electricity would render
the functioning of existing facilities worthless.
Under National Health Mission (NHM), government has provided financial assistance to
states to build or upgrade the existing facilities at healthcare centres. Up to 33% of these
funds can be spent by high focus states whereas other states can spend up to 25%.
Deficit of human resources in health sector occurs majorly at two levels: regions – between
rural and urban areas and sectors – between the public and private sectors. Healthcare
professionals have put themselves beyond the reach of the rural population due to their
unwillingness to serve in rural, tribal and hilly areas.
On the other hand, healthcare personnel seem to be more inclined towards for-profit
privately-owned hospitals in the urban areas. According to a study, the deficiency of
manpower in rural healthcare is as high as more than 90% in states like Chhattisgarh,
Jharkhand, and Rajasthan, while being at nearly 86% in Uttarakhand, and Odisha. According
to WHO, India stands 52nd among the 57 countries facing human resources deficit.

 Some of the other challenges faced by the referral hospital:-
Training and Awareness challenges:
Training can leave employees frustrated and confused about their job description
because of too few staff in hospital and awareness is not properly given by the staff
because they are not properly trained.
Medicinal and technologicaladvancementchallenges:
Medicinal and technological advancement is more important because hospital is in
village area and advance medicinal and technology is not more using in hospital so its
improvement is an important for hospital.
Healthcare regulatory challenges:
Most of the regulations are in place to ensure that the hospitals protect the patient’s
health, records and follow the instruction given by the doctor for healthcare but many
patients are not following the instructions of healthcare.
Healthcare rising costs:
Healthcare cost is rising because of new technologies and new medicinal.
Ethical challenges:
Ethical issue in healthcare is a common. Nearly every decision that’s made has ethical
implications for patients, for provides and for healthcare leaders.

DOCTORS FACED THE PROBLEMS IN GOVERNMENT
HOSPITAL:
 Caring for the chronically ill.
 Managing mental illness.
 Improving communication with patients and other providers.
 Keeping up with technology.
 Using technology to engage patients.
 Surviving compensation changes
 Time/ energy essential for preceding authorization
 Lack of negotiate power with payers
 Remaining dedicated to medicine
 Maintenance of certification time and money investment
 Lack of electronic health records (EHR) interoperability
 Increasing costs for patients
 varying patient’s attitudes
 Effect of patient’s satisfaction scores

HISTORY OF REFERRAL HOSPITAL
We selected Referral hospital in Mandvi. This is established on 14th February 2006 and
located in Mandvi, District- Surat. They are registered on 28th February 2006. There
Registered Number is GUJ/1399/SURAT. And There Saarv/Trust Registered Number is
F/1297/SURAT on 28th February 2006.
This is established by the government for health and welfare of family by Gandhinagar,
C.H.C-2005-1320-B dated on 20-July 2005. Referral Hospital Registered Telephone Number
is 02623-221163.Referral Hospital (GOVERNMENT HOSPITAL) is worked under in ROGI
KALYAN SAMITI.

The population of MANDVI TALUKA was 1.96 Lakhs. This provides health care free at the
point of use for any Indian citizens.
All facilities are available to the patients free of cost or at very nominal charges in certain
cases. Referral hospital offer a range of emergency, primary and visiting allied and mental
health services and also provide the ambulance service. The hospital provided all the
treatment at free of cost. In this Referral Hospitals There are Various types of Facility is
Provided which is helps to the Patients.
Following are the Health Committee Members of Hospital:
NO. NAME DESIGNATION
1 Shree A. G. Bhagora President
2 Dr. Parimal M. Chaudhari Director
3 Dr. Dipak D. Vasava Member
4 Shree Anandbhai M. Chaudhari Member
5 Shree Ashok A. Modh Member
6 Shree J. G. Chauhan Member
7 Shree Ilaben Chaudhari Member
8 Dr. Ashish Upadhyay Member

FACILITIES PROVIDED BY REFERRAL COMMUNITY
HOSPITAL:
● O.P.D(Out Patient Department)
● Laboratory
● X-RAY Department
● Sonography
● Operation Theatre (emergency)
● Operation Theatre (Planning operation)
● E.C.G (Electrocardiography) Check-up
● Physiotherapy Treatment
● Labor Room
● Pediatrics Ward
● Ambulance Services
● Pharmacy
● Certificate Services
 Illness Certificate
 Physical fitness
 Handicapped Certificate
 Mental Handicapped Certificate
 Age certificate
 Deaf-Dumb certificate
 Blind certificate
● Medico-legal certificate
 PostMatam Report
 Police N.O.C to family member
● Dentists Facilities (It will all Facilities provided Related Teeth)

 Doctors in Mandvi Referral Hospital:
1. Dr. Parimal M. Chaudhari
(Superintendent – Class -1)
2. Dr. U. M. Poochhwale
(R.M.O – Class-1)
3. Dr. Dipak D. Vasava
-(Class-2)
Camp Organised by Referral Hospital:
● Pulse Polio Day.
● AIDS Awareness Lecture.
● Free Health Check-up Camp.
● Gynecologist check-up camp.
● T.B Awareness Lectures & Free Treatment our Areas.
● Free dental Check-up & awareness Camp.
● Janani Shisu Suraksha yojna.

ORGANIZATIONAL CHART:
Hospital Director
Senior
Doctors
Junior
Doctors
Senior Nurses
Junior Nurses
Warden
Housekeeping
Member
Gatekeeper Drivers
Compounder
Accountant

VISION:-
Increase life Expectancy and improve Physical Quality of life so that they Attain the Highest
level of Physical, Mental, and Spiritual health and contribute towards the Development of the
Country.
MISSON
 Provide Quality Health care Services.
 Provide Preventive and curative health Services.
 Strengthening Health system to ensure healthy communities through a team of
commitment and value-based Professionals.
SWOT ANLAYSIS
STRENGTHS
 Low CostProviding Treatment.
 Experienced Senior Staff
 Strong Information System
 Central Location
 Old Facility
WEAKNESSES
 Lack of Staff Development.
 High Nurse/Patient Ratio.
 Patient Load.
 Lake of Specialist Doctors.
 Lack of Technology.
OPPURTUNITIES
 Coordination with NGO.
 Improved Safety System.
 Strong Referral System.
 Organization & technology
Development.
 Increase in the aging Population.
THREATS
 Competitors have New Products.
 Small Semi-urban Nursing
Home.
 Misinformation.

CHAPTER:2: DIAGNOSOS PHASE
BACKGROUND OF THE STUDY:
 In the government hospital, patients are not visit to the hospital because patients are
not aware properly about facilities provided by hospital this study is done to know the
reason for not visit again in hospital after treatment.
 Here, we take the survey of 200 patients and got the reasons for not visit government
hospital which is done through filling up questionnaire.
 In this Study The find out the Problems for not Visited the hospital Again after
treatment, to checked the satisfaction level of the patient, Providing Facility is proper
or not?, Some other Problems faces to the patient. With the help of problems we gives
a proper Solutions To the Hospitals.
REASONS WHY PEOPLE ARE NOT PREFER TO GO IN
GOVERNMENT HOSPITALS:
1. Shortage ofdoctors:
At the moment not more than one doctor are working in the hospitals. If you compare this
number to the large number of patients, lack of medical care is inevitable. The turnover
rate of doctors is very high.
2. waiting lines:
The recurring concern of all hospital and emergency departments is that workflow is not
efficient and patients spend a lot of time waiting for their turn. Patient satisfaction
decreases and the hospital are not able to treat as much patients as wanted.
3. Overcrowding:
Overcrowding in emergency departments is a problem in many countries around the
world. Emergency departments overcrowding causes problems for patients and staffs,
including increased waiting times, increased ambulance diversion, increased length of

stay, increased medical errors, increased patient’s mortality, and increased harm to
hospitals due to financial losses.
4. Medicines is not available:
Patients also complained that most medicines prescribed by doctors were often not
available at the government pharmacies. Patients have to buy costly medicines from
market even though the government claims to provide medicines free of cost.
5. Lack of Quality and Quantity Of Medicine:
Lack of quality and quantity of medicines. Same limited numbers of medicines are
prescribed to everyone. Medicines are exhausted quickly and C MO only purchases those
medicines which give him more commission. We are often forced to write medicines
from external because they are simply not presented at the hospitals. I have never seen
medicines related to cardiac problems, hormonal problems, thyroid problems at the
hospital. Most medicines at hospitals are simply not protected for pregnant women
6. No other hospital in rural area:
There is no hospital available in rural area. There is a great need of hospitals in rural area.
If there are good hospitals in rural area, lives of hundreds of villagers may be saved. The
government should establish a hospital in every village.
7. Uncertain water-and electricitysupply:
The hospital has two water- drill- holes with groundwater pumps. In additional, the
hospital is joined with the public electricity grid. Very often, occasionally for several
hours or even days, power cuts occur.
8. Drug supply by government is not reliable:
Under normal circumstances, the hospital is provided by the government- run “Medical
Department Store”. The hospital has to buy the necessary drugs in local, private
pharmacies to a much higher price.
9. Insufficient laboratory equipment:
Many devices in the laboratory are very simple and invalid. Naturally, this leads to great
problems in the diagnosis of various diseases.

10.Proper treatment is not available:
Sometimes when patient admitted in hospital proper treatment is not provided to them.
Improper treatment will leads to wrong mind set among the public that’s why public will
not rely on government hospital.
11.Not proper cleanness:
Here, employees who are including in cleaning department are not more responsive for
their job and not work properly which will lead to unhygienic environment towards
patients and other general public.
12.Sometimes doctors are not available
In government hospital availability of doctor is low which will lead to negative impact
towards public that doctors are never available in hospital.

ADVANTAGES OF GOVERNMENT HOSPITALS
The most important advantages of the Internet of Things in that healthcare
organization can take advantage of include the following:
1. DecreasedCosts:
The cost of treatment in government hospitals is very low in similarity to the bills of a
private hospital. The government hospitals are funded completely by the government and
hence there are even free treatment facilities to poor families. Apart from these aids, the
government also provides monetary help to patients of poor families towards their good
health through government hospitals. When healthcare providers take advantage of the
connectivity of the healthcare solutions, patient monitoring can be done on immediate
basis, thus significantly cutting down on avoidable visits by doctors. In particular, home
care facilities/services that are advanced are guaranteed to cut down on hospital stays and
re-admissions.
2. Treatment to complex ailments:
The government hospitals are better equipped to contract with serious and critical
situation like severely burnt cases. In these cases when the patients rush private hospitals
in order to get improved individual care, they simply refuse to take the patient in and they
have to be rushed to government hospitals immediately. Government hospitals have
specialists to take care of the majority of the severe ailments.
3. Remove discrimination:
Government hospitals eliminate unfairness among patients. Discrimination among
patients can come in the form of financial terms. cultural unfairness in hospitals mainly
root from medical givers preferring the patients to have the same blood in them wherein
they have this mindset that they belong to that country due to same ethnicity, beliefs, and
colour. Racial unfairness rarely applies to hospitals though however, financial
discrimination is another story. Government hospitals treated equally to all patients if
they are financially capable or not, the government ensures quality healthcare for
everyone.

4. Improved Disease Management:
When patients are monitored on a continuous basis and health care providers are able to
access real time data, diseases are treated before they get out of hand.
5. Affordable:
Government hospitals are funded publicly and they are not run for the purpose of profit,
so it is affordable for all people who are not afford to pay rather than private hospitals.
Objectives of the Referral Hospital:
● To Provide Comprehensive Primary Health care to the Community through the
Primary Health Centers.
● To develop hospital services at the primary, secondary & tertiary levels in
terms of infrastructure.
● To improve training to doctors, nurses & other paramedical staff to upgrade
their skills & knowledge to improve quality health care in the referral Hospital.
● To promote Awareness of Health Care Among all Sections of the Indian
People.
● To achieve and continue an suitable standard of quality of care.
● To Providing a Quality Service of Each Patients.
● To make the services more Responsive and sensitivity to the needs of
community.
● Provide Knowledgeable staff in numbers of sufficient to provide an appropriate
level of care and Frequency of visit in the Home

 OBJECTIVES OF THE STUDY:
 PRIMARY OBJECTIVE
“To find out the reasons the patient for not visiting the hospital again after
treatment At the Referral Hospital &Community Health Center Mandvi”
 SECONDARYOBJECTIVES
 To find the reasons the patient not visiting the hospital after
treatment.
 To examine the satisfaction level of the patient towards referral
hospital.
 To examine the Awareness of the Medical Camp for patient towards
referral Hospital.
 LIMITATION OF THE STUDY:
 Limited time.
 Since The Patient were very busy in their work load, it took more time for me
to get the data.
 Sometime respondent did not respond well to the entire question in the
questionnaire.

CHAPTER:3: DESIGN AND ANALYSIS
PHASE
Research Methodology
 ResearchProblemStatement:
“To examine the reason why patients are not visiting the hospital again, after
the treatment”
 Researchdesign:
For the study of find out the patient for not visiting the hospital again after
treatment At the Referral Hospital & community health center Mandvi. There
are Main Three types of Research design depend on the nature of the problem
and objective of the study.
 Exploratory Research Design
 Descriptive Research Design
 Causal Research Design.
We have used Descriptive Research Design for the present study.
 Sample Method:
For the sampling we have used Non-Probability Sampling method and under
non- Probability method we have used convenience sampling method.
 Population: Patients of Mandvi Region (In Referral Hospital, Other Villages)
 Sample Size: 200 Respondents.
 DATA COLLECTION METHOD:
Data can be collectedby:
1) Primary source and
2) Secondarysources

 Primary Data: Collected through a questionnaire, distributed
personally to the respondent.
 Secondary Data: Collected from related research papers, company
data base, books & websites.
 Survey Method:
By using the Questionnaire Survey Method (PRIMARY SOURCE) further
study is done.
 Time Period: July 2019- November 2019
 Statisticaltool: We have used MS Excel.
 Measurementscale:
Likert scale is being used to measure the Responses of the patients.

DATA ANALYSIS AND FINDINGS
1.Do you have knowledge aboutgovernment hospital?
A. Yes
B. No
 Interpretation:-
 From this chart 100% respondents are knowledge about the government
hospitals.
2.Are you visited the referralhospital?
A. Yes
B. No
 From this chart 100% respondents are visited the referral hospital.
100%
0%
Do you have knowledge about
government hospital ?
YES
NO
100%
0%
Are you visited the referral hospital ?
YES
NO

3. How many times you have visited?
A. One times
B. Tow times-
C. Three times
D. More the four times
 From the above chart show to 38 % respondents are visited in hospital one
times. 37% Respondents who are visited in hospital two times. 20%
respondents who are visited in hospital three times. And 5 % respondents who
are visited in hospital more than four times.
38%
37%
20%
5%
How many times you have visited?
ONE
TWO
THREE
MORE THAN FOUR

4.Are you satisfiedwith the treatments of the ReferralHospital?
A. Strongly Satisfied
B. Satisfied
C. Neutrals
D. Dissatisfied
E. Strongly dissatisfied
 From the above chart show to 4% respondents are Strongly Satisfied, 16%
respondents are Satisfied, 33% respondents who are Neutrals, 38%
respondents who are Dissatisfied, 9% respondents who are Strongly
dissatisfied.
4%
16%
33%
38%
9%
Are you satisfied with the treatments of
the Referral Hospital ?
Strongly Satisfied
Satisfied
Neutrals
Dis-satisfied
Strongly Dis-satisfied

5.Please rate your Level agreement to the given statement measuring the
reasons onwhich you are agreedor not agree.
(SA=Strongly Agree, A=Agree, N=Neutrals, D=Disagree, SD=Strongly Disagree)
No. Reasons Strongly
Agree
Agree Neutrals Disagree Strongly
Disagree
1 Sometimes doctors not
available
44 84 58 11 3
2 Proper treatment is not
available
42 72 61 22 3
3 waiting lines 49 65 53 31 2
4 Shortage of doctors 42 69 58 28 3
5 Overcrowding 43 81 48 26 2
6 Proper Medicines is not
available
32 71 69 24 4
7 Lack of Quality in Medicine 35 55 79 26 5
8 Insufficient laboratory
equipment
22 62 78 35 3

 It can be seen that in above the chart of Level agreement to the given
statement measuring the reasons on which you are agree OR not agree that
highest responded that Strongly Agree to Sometimes doctors not available.
Average responded that Overcrowding, Proper Medicines is not available,
Lack of Quality in Medicine, and Insufficient laboratory equipment. below
average responded are Proper treatment is not available, Shortage of doctors
and waiting lines.
Sometime
s doctors
not
available
Proper
treatment
is not
available
waiting
lines
Shortage
of doctors
Overcrow
ding
Proper
Medicines
is not
available
Lack of
Quality in
Medicine
Insufficien
t
laboratory
equipmen
t
Strongly Agree 44 42 49 42 43 32 35 22
Agree 84 72 65 69 81 71 55 62
Neutrals 58 61 53 58 48 69 79 78
Disagree 11 22 31 28 26 24 26 35
Strongly Disagree 3 3 2 3 2 4 5 3
0
10
20
30
40
50
60
70
80
90
Level agreements to the given statements measuring the
reasons onwhich you are agree ornot

6.Please rate your Level agreement to the given statement measuring the
purpose for Information about government hospital facilities (Lab
Equipment Services like, X-ray, Scanning, ECG etc.)Provided By the
ReferralHospitals Basedon your Perceptions.
NO. Particulars Very
good
Good Medium Bad Very
Bad
1 Behaviors of the hospital staff 7 26 127 34 6
2 Availability of Latest Technology 4 38 63 85 10
3 Availability of Nurses 7 33 67 80 13
4 Availability of Specialist 4 31 70 74 21
5 Formalities in Registration 9 34 61 63 32
6 Space Availability for intensive
care
9 30 62 62 36
7 Time Consumed for Report 7 24 63 62 44

 Above chart gives information that Level of agreement to the given statement
measuring the purpose for Information about government hospital facilities
that medium behavior of the hospital staff, bad facilities of the Available of
latest technology. Availability of nurses is bad, Medium and bad situations for
Availability of specialist, Formalities in Registration, Space Availability for
intensive care, and Time Consumed for Report.
Behaviour
of the
hospital
staff
Availability
of Latest
Technology
Availability
of Nurses
Availability
of
Specialist
Formalities
in
Registratio
n
Space
Availability
for
intensive
care
Time
Consumed
for Report
Very Good 7 4 7 4 9 9 7
Good 26 38 33 31 34 30 24
Medium 127 63 67 70 61 62 63
Bad 34 85 80 74 63 62 62
Very Bad 6 10 13 21 32 36 44
0
20
40
60
80
100
120
140
AxisTitle
Measuring the purpose for informationabout
governments hospital facilities

7.Are you Aware of the Medical-Camp Conducted by the Referral
Hospital?
A. Yes
B. No
 From the above chart show to 57% respondents are Aware of the Medical
Camp Conducted by the Referral Hospital, 43 % respondents who are not
Aware of the Medical Camp Conducted by the Referral Hospital
8.Are you aware of the Doctors Qualification& Specialization?
A. Yes
B. No
Interpretation:-
From the above chart show to 48 % respondents are aware of the Doctors Qualification
& Specialization.52% respondents who are not aware of the Doctors Qualification &
Specialization.
57%
43%
Are you aware ofthe Medicalcamp
Conducted by the referralhospital ?
Yes
No
48%
52%
Are you aware ofthe doctors Qualification&
Specialization?
Yes
No

9.Rate on Dietary Services Provided By the Hospital on your Satisfaction
Perceived. (HS=High Satisfied, S= Satisfied, N=Neutral, D=
Dissatisfied, HD=HighDissatisfied)
N
o
Particulars High
Satisfied
Satisfied Neutral Dissatisfied High
Dissatisfied
1 Hygienic Conditions
Of the Canteen
7 32 105 51 5
2 Quality of the food 6 32 70 86 6
3 Quantity of the Food 5 28 69 93 5
4 Taste 4 31 61 80 24
5 Freshness 6 24 69 71 30
6 Room Services 6 34 67 54 39
7 Delivery time 4 24 73 75 24
8 Staff Serving Food 8 27 63 67 35
9 Provision For Dietetic
Food
10 21 69 59 41

 In above chart that Rate on Dietary Services Provided By the Hospital on their
Satisfaction Perceived that responded are neutrals by hygienic conditions of
the canteen and room services, dissatisfied by quality and quantity of food,
delivery time, staff serving food and provisions for dietetic food in hospital.
Hygienic
Conditio
ns Of the
Canteen
Quality
of the
food
Quantity
of the
Food
Taste Freshnes
s
Room
Services
Delivery
time
Staff
Serving
Food
Provision
For
Dietetic
Food
Highly Satisfied 7 6 5 4 6 6 4 8 10
Satisfied 32 32 28 31 24 34 24 27 21
Neutrals 105 70 69 61 69 67 73 63 69
Dissatisfied 51 86 93 80 71 54 75 67 59
Highly Dissatisfied 5 6 5 24 30 39 24 35 41
0
20
40
60
80
100
120
Rate on Dietary service provided by the hospital

10.Do you prefer any Medical Insurance Scheme provided by Referral
Hospital?
A. Yes
B. No
 From above the chart show to 36 % respondents who are prefer any Medical
Insurance Scheme provided by Referral Hospital. 64% respondents who are
not prefer any Medical Insurance Scheme provided by Referral Hospital
11.Are you receiving any Communication from the Referral Hospitals after
your Treatment?
A. Yes
B. No
 From the above chart shows that 36 % respondents are receiving any
Communication from the Referral Hospitals after their Treatment, 64 %
respondents not receiving any Communication from the Referral Hospitals.
36%
64%
Do you prefer any medical insurance
Scheme provided by referral hospital ?
Yes
No
36%
64%
Are you receiving any Communication from
the Referralhospital afteryour Treatments ?
Yes
No

12.Are you satisfied with the Ambulance Services of the Referral
Hospital?
A. Yes
B. No
 From the above chart show tthat 55 % respondents are satisfied with the
Ambulance Services of the Referral Hospital, 45 % respondents are not
satisfied with the Ambulance Services of the Referral Hospital
13.Are you satisfied with the accessibility of the Hospitals from your
home?
A. Yes
B. No
 From the above chart show that 44 % respondents are satisfied with the
accessibility of the Hospitals from their home and 56% respondents are not
satisfied with the accessibility of the Hospitals from their home.
55%
45%
Are you satisfiedwith the Abulance services
of the referralHospital ?
Yes
No
44%
56%
Are you satisfiedwith accessibilityof the
Hospital from your home ?
Yes
No

Personal Deails:-
1. GENDER :
A. Male
B. Female
 From the above chart we found that 66% respondents are male and 34%
respondents are female.
2. AGE :
A. <18 c. 31-45
B. 19-30 D. >46
 From the above chart we found that 11% respondents are less than 18 ages,
46% respondents are between 19 -30 years old , 35 % respondents are
between 31-45 years and there is a 8% respondents are more than 46 years old.
66%
34%
GENDER
Male
Female
11%
46%
35%
8%
AGE
Less than 18
19-30
31-45
More Than 46

3. Marital Status:
A. Married
B. Unmarried
 From the above chart we found that 74 % respondents are Married, 26%
respondents are unmarried.
4. EDUCATIONAL QUALIFICATION :
A. SSC
B. HSC
C. Graduate
D. Post Graduate
 From the above chart we found that 28% respondents are uneducated, 28%
respondents are SSC, 28% respondents are HSC, 12% respondents are
Graduate, and 4% respondents are Post Graduate.
74%
26%
Merital Status
Merried
Unmerried
28%
28%
28%
12%
4%
EDUCATION
Uneducated
SSC
HSC
Graduated
Post-Graduated

5. INCOME (Monthly):
A. <10,000
B. 10,000-20,000
C. 20,000-30,000
D. >40,000
 From the above chart found that 32% respondents are less than 10000 income,
52% respondents are between 10000-20000 income. 13 % respondents are
between 20000-30000 income. 3% respondents are more than 40000 income.
6. OCCUPATION :
A. Farmer C. Private Employee
B. Government Employee D. Self Employed
.
 From the above chart we found that 35% respondents are farmers, 26%
respondents are Government Employees, 21% respondents are private
employees, and 18% respondents are self employees.
32%
52%
13%
3%
INCOME
Less than 10000
10000-20000
20000-30000
More than 40000
35%
26%
21%
18%
OCCUPATION
Farmer
Goverment Employee
Privet Employee
Self Employee

FINDINGS
 100% respondents are said that they have information about government
hospital, majority of the respondents have knowledge about government
hospital.
 100% respondents are said that visited from the referral hospital.
 39% has responded that one time visited from hospital, 37 % has two times,
20% has visited from three time and 4% has more than four has visited from
referral hospital.
 38% has responded that dissatisfied with the treatment and 33% has natural the
referral hospital treatment. 16% has satisfied the treatment.8% has strongly
dissatisfied and 5% people have satisfied the referral hospital treatment.
 Majority of Respondents has agreed with the statement of doctors are not
available.
 Majority of Respondents has agreed with the statement of proper treatment is
not Available & also agreed with the Waiting lines, Shortage of doctors,
Overcrowding, Proper Medicines are not available.
 Majority of Respondents has Naturals with the Lack of Quality in Medicine &
Insufficient Laboratory Equipment.
 Majority of Respondents has naturals (medium) Review regarding behavior of
staff, space availability for intensive care and time consumed for report.
 Majority of Respondents has Bad Review regarding Availability of latest
technology, availability of Nurse, availability if Specialist, and Formalities in
Registration.
 43 % respondents who are not aware of the Medical Camp Conducted by the
Referral Hospital.
 48 % respondents are aware of the Doctors Qualification & Specialization.
 Majority of Respondents has Neutrals with Hygienic conditions of the canteen,
and Provision for Dietetic food.

 Majority of Respondents has dissatisfied with Quality of the food, Quantity of
the food, taste, Freshness, Room services, Delivery time, and staff serving
food.
 36 % respondents who are prefer any Medical Insurance Scheme provided by
Referral Hospital and 64% respondents who are not prefer any Medical
Insurance Scheme provided by Referral Hospital
 55 % respondents who are satisfied with the Ambulance Services of the
Referral Hospital and 45 % respondents who are not satisfied with the
Ambulance Services of the Referral Hospital
 45% responded that said yes with satisfied the accessibility of the hospital from
home.55% has not satisfied.

CHAPTER:4: IMPLEMENTATION PHASE
 Identifying Alternatives Courses of Action
There are several results that describe that to examine the reasons why patient are not
visiting the hospital again, after the treatment in Referral Hospital and Community
Health Centre. There are alternative solutions like,
1. Availability of doctors through brings them outside and arranges camp for
people’s treatment.
2. If in sudden Epidemic arise than Referral Hospitals Teams should Provide
suitable medicines & other treatments through Door to Door services in
Nearby Villages & Areas.
3. Emergency departments overcrowding causes problems for patients and
staffs, including increased waiting times. So increase the doctor’s staff of
emergency word.
4. If there is a lack of laboratory equipment in government hospital then it’s
mandatory that government allocate funds for laboratory equipment, or there
are several private laboratories available in the market so there is secondary
alternative option for laboratory equipment.
In Government hospital there is a large stock of medicines but it is not reliable. Most
of the people are not rely on medicine that are provided by referral hospital and
community health centre. So, if they want to overcome that problem they give
prescription to people and people buy it from outside the medical and it also ensure
that the price of that medicine are low.

 DETERMINING THE SOLUTION TO BE PROPOSED:-
There are number of solutions are to be collected through research so it’s proposed to
be given as for;
1) Hospital facilities:
There are equipments like patient’s bed, medical equipments and air
circulation facilities and good environmental facilities to be repaired and
create for patient for improving patient facilities.
2) Availabilities of doctors:
They have to arrange camp in rural area and hospital for people and they get
good medical facilities.
3) Drugs and medical equipment:
To provide drugs which is affordable for people to purchase and arrange
laboratory equipments in low cost in private laboratories.
 METHODOLOGY ADOPTED FOR SOLUTION
IMLEMENTATION:-
 The focus group discussion with management and a team of doctors at
referral hospital for discussing alternative action to improve patients revisit
for medication. The focus group member discussed about feasibility of
solution implementation in available resources.
 Based on the focus group discussion in short term infrastructure facilities
will be taken care within a month and for the recruitment doctors, improve
facility of the patients. They will initiate the process as per government
policy.
 PROJECT OUTPUTS:-
 The present study is based on “To examine the reasons why patient are not
visiting the hospital again, after the treatment.” In that study we used
descriptive research design and it is based on questionnaire survey method.
The objective of that study is “To examine the reasons why patient are not
visiting the hospital again, after the treatment.”

 From that study we reach to the conclusion that Majority of respondents has
information about government hospital and majority of respondents are said
there is a government hospital in their area.
 Majority of respondents are not satisfy with the treatment of the hospital and
they said there is not a good medical facility provided by hospital.
 Majority of respondents are preferred to go I government hospital because the
feature of the hospital is not good, the medicine provided by government
hospital are not reliable, and the advice is not suitable for treatment. Lack of
Quality and Quantity of Medicine
 Mostly respondents are visiting the government hospital for the treatment
advice for their illness.
 Majority of respondents are uneducated. The main problem in this hospital is
shortage of doctor and medicine that are provided by government are not
reliable, for that government has to provide more fund and good salary to
doctors, compensation, rewards.
 TANGIBLE AND INTANGIBLE BENEFITS DILIVERD
TO THE ORGANIZATION:-.
 Tangible Benefits:-
 Numbers of Patient Re-visit Increase
 Quantitative data indicated Dissatisfaction of patients &
Reasons
 Intangible Benefits:-
 Trust Increase
 Behavior of Staff
 Relationships Building

 FUTURE RECOMMENDATIONS:-
 All the patients in the hospital wants a good quality treatment, it is costly to
provide a good patient quality care; so government has to allocate more funds
for this purpose.
 Strengthen monitoring, support, and mentorship systems in order to achieve
good quality of care.
 Improve the clean room services, good food services and delivery time of food
for patients.
 Provide the Medical Insurance Schemes for poor patients.
 Communication skills develop between doctor and patients for their health
after treatments.
 The staff of the government hospital has to improve their behavior with the
patients, because there are mostly people are not satisfy with the service of
staff.
 To overcome problem of shortage of doctor’s governments has to provide a
good salary to doctors, appreciate their work, and give rewards.
 Create a culture of shared accountability.
 Prepare the clinical staff to work with caregivers.
 Set clear guidelines by doctors for all hospital staff to improve the good
behavior with patients.

 BIBLIOGRAPHY
 https://www.internationalstudentinsurance.com/india-student-
insurance/healthcare-system-in-india.php
 http://www.ihatepsm.com/blog/health-care-delivery-india
 https://www.slideshare.net/jamesmacroony/healthcare-
delivery-system-in-india
 https://en.wikipedia.org/wiki/Public_health_system_in_India
 https://www.nhp.gov.in/national-health-insurance-schemes_pg
 https://www.oxfamindia.org/blog/15-healthcare-schemes-india-
you-must-know-about

QUESTIONNAIRE
We Students of S.Y.MBA at the Mandvi Education Society, Mandvi. Doing this
Multi-disciplinary Action Project Research Training on “To find out the Reasons for
not Visiting The Hospital Again After The Treatment at The Referral Hospital &
Community Health centre Mandvi”. This Study is for Academic Purpose Only. No
Information shall be disclosed anywhere. Please Spare few Minutes to answer the
Following question:
1) Do you have Knowledge about Referral hospital?
A. Yes
B. No
2) Are you visitedthe Referral Hospital?
A. Yes
B. No
3) How many times you have visited?
A. One time
B. Two times
C. Three times
D. More the Four times
4) Are you satisfiedwiththe treatments of the Referral Hospital?
A. Strongly Satisfied
B. Satisfied
C. Neutrals
D. Dissatisfied
E. Strongly Dissatisfied
5) Please rate your Level agreement to the given statement measuring the
purpose for which you are satisfied OR not satisfied.(SA=Strongly Agree,
A=Agree, N=Neutrals, D=Disagree, SD=Strongly Disagree)
No. Purpose SA A N D SD
1 Sometimes doctors not available

2 Proper treatment is not available
3 waiting lines
4 Shortage of doctors
5 Overcrowding
6 Proper Medicines is not available
7 Lack Of Quality in Medicine
8 Insufficient laboratory equipment
6) Please rate your Level agreement to the given statement measuring the
purpose for Information about government hospital facilities (Lab
Equipment Services like, X-ray, Scanning, ECG etc.)Provided By the
Referral Hospitals Based on your Perceptions.
NO. Information Very
good
Good Medium Bad Very
Bad
1 The behavior of the hospital staff
2 Availability of Latest Technology
3 Availability of Nurses
4 Availability of Specialist
5 Formalities in Registration
6 Space Availability for intensive care
7 Time Consumed for Report
7) Are you Aware of the Medical Camp Conducted by the Referral Hospital?
A. Yes
B. No
8) Are you aware of the Doctors Qualification& Specialization?
A. Yes
B. No

9) Rate on Dietary Services Provided By the Hospital on your Satisfaction
Perceived.(HS=Highly Satisfied, S= Satisfied, N=Neutral, D= Dissatisfied,
HD=Highly Dissatisfied)
10) Do you prefer any Medical Insurance Scheme?
A. Yes
B. No
11) Are you receiving any Communication from the referral Hospitals
after your Treatment?
A. Yes
B. No
12) Are you satisfiedwiththe Ambulance Services of the Referral Hospital?
A. Yes
B. No
13) Are you satisfied with the accessibility of the Hospitals from your
home?
A. Yes
B. No
No. Particular HS S N D HD
1 Hygienic Conditions Of the Canteen
2 Quality of the food
3 Quantity of the Food
4 Taste
5 Freshness
6 Room Services
7 Delivery time
8 Staff Serving Food
9 Provision For Dietetic Food

Personal Details:-
1. GENDER :
A. Male
B. Female
2. AGE :
A. <18
B. 19-30
C. 31-45
D. >46
3. MARITAL STATUS:-
A. Married
B. Unmarried
4. EDUCATIONAL QUALIFICATION :
A. Uneducated
B. SSC
C. HSC
D. Graduate
E. Post Graduate
5. INCOME (Monthly) :
A. <10,000
B. 10,000-20,000
C. 20,000-30,000
D. >40,000
6. OCCUPATION :
A. Farmer
B. Government Employee
C. Employee
D. Self Employee

પ્રશ્ન પત્ર
મ ાંડવી એજ્યુકેશન સોસ યટી, મ ાંડવી ખ તે S.Y MBA ન વવદ્ય ર્થીઓ .“રેફરલ
હોસ્પપટલ અને કમ્યુનનટી હેલ્થ સેન્ટર મ ાંડવીમ ાં સ રવ ર બ દ ફરીથી હોસ્પપટલની
મુલ ક ત ન લેવ ન ાં ક રણો શોધવ મ ટે આ મલ્ટી -ીડનસલપ્લનરીનશશનપ્રોજેશટ
ીરસિરગેનનેટ્રકરીરહ્યએીન. ” આ અભ્ય સ ફક્ત શૈક્ષણિક હેતુ મ ટે છે .કોકમ િહતી
કોકણિએાય એરહેજાકજાવ મ ાંઆવશેનહન.ાપણકજાીનેનીીેઆણેપાનન
એવ જમ ટેર્થોડીવમવનટોઆણો.
1) શુાં તમને જાેફજાપ હોસ્પણટપ વવશે ની રિક જાી છે?
A. હ
B. ન
2) શુાં તમે જાેફજાપ હોસ્પણટપની મુપ ક ત પીધી છે?
A. હ
B. ન
3) જાેફજાપ હોસ્પણટપમ ાં તમે કેટપી વ જા છે પીધી મુપ ક ત )મ વસકમ ાં(?
A. એક વખત
B. જે વખત
C. ત્રિ વખત
D. ી જા ર્થી વધુ વખત
4) શુાં તમે જાેફજાપ હોસ્પણટપની સ જાવ જાર્થી સાંતુષ્ટ છો?
A. ખૂજ સાંતોષ
B. સાંતોષ
C. તટપર્થ
D. અસાંતોષ

E. સખત અસાંતોષ
5) ાપણ કજાી આણેપ વનવેદનમ ાં આણન પેવપ એગ્રીમેન્ટને જાેટ કજાો કે જેન આધ જાે
તમે સાંમત છો અર્થવ સાંમત નર્થી.
અંક ક રણો મજબ ૂત
સાંમત
સાંમનત તટપથ અસાંમત સખ્ત
અસાંમનત
1 કેટપીકવ જા ડોકટજાો ઉણપબ્ધ
નર્થી
2 યોાય સ જાવ જા ઉણપબ્ધ નર્થી
3 ાતીક્ષ હજાોળ
4 ડોકટજાોની તાંગી
5 ભીડ
6 યોાય દવ ઓ ઉણપબ્ધ નર્થી
7 દવ મ ાં ગુિવત્ત નો અભ વ
8 અપ ૂજાત પેજોજાેટજાી સ ધનો
6) ાપણ કજાીને સજાક જાી દવ ખ ન ની સુવવધ ઓ વવશેની મ િહતી (પેજટસ્ક્વણમેન્ટસેવ
જેમ કે, એક્સ -જાે , પકેવનિંગ, ટસીજી વગેજાે )નેાંય નમ ાંપેતઆણેપવનવેદનમ ાં
તમ જાપેવપએગ્રીમેન્ટનેજાેટકજાોતમ જાીજાેફજાપહોસ્પણટપોા જાતમ જાી
સાંભ વન ઓનેઆધ જાે ાદ ન કજાેપ છે.
અંક મ ીહતી ખૂબ સરસ મીીડયમ ખર બ ખૂબ

7) શુાં તમે જાેફજાપ હોસ્પણટપ ા જા સાંી ણપત મેિડકપ કેમ્ણર્થી વ કેફ છો?
A. હ
B. ન
8) શુાં તમે ડોકટજાોની પ યક ત અને વવશેષત ર્થી વ કેફ છો?
A. હ
B. ન
9) તમ જાી સાંતોષ ા પ્ત ર્થવ ણજા હોસ્પણટપ ા જા ાદ ન કજાવ મ ાં આવતી આહ જા
સેવ ઓનો દજા.
સરસ ખર બ
1 હોસ્પણટપ ન પટ ફનુ વતતન
2 નવીનતમ તકનીકીની
ઉણપબ્ધત
3 નસોની ઉણપબ્ધત
4 વનષ્િ તની ઉણપબ્ધત
5 નોંધિીમ ાં વવવધ (ન મનોંધિીની
ાિિય )
6 સઘન સાંભ ળ મ ટે એાય
ઉણપબ્ધત
7 િજાણોટત મ ટે સમય નો વણજા શ
અંક નવશેષ ખૂબ સાંતોષ તટપથ અસાંતોષ અત્યાંત

10) શુાં તમે કોક તજીજી વીમ યોએન ણસાંદ કજાો છો?
A. હ
B. ન
11) શુાં તમે તમ જાી સ જાવ જા ણછી જાેફજાપ હોસ્પણટપોમ ાંર્થી કોક સાંદેશ વ્યવહ જા ા પ્ત
કજાી જાહ્ ાં છો?
A. હ
B. ન
12) શુાં તમે જાેફજાપ હોસ્પણટપની એમ્બ્યુપન્સ સેવ ઓર્થી સાંતુષ્ટ છો?
A. હ
B. ન
સાંતોષ અસાંતોષ
1 કેન્ન્ટનની આજાોાયાદ સ્પર્થવત
2 ખોજા કની ગુિવત્ત
3 ખોજા કની મ ત્ર
4 ખોજા કનો પવ દ
5 પવચ્છત
6 રૂમ ની સેવ ઓ
7 આણવ નો સમય
8 આહ જા આણત પટ ફ ની સેવ
9 આહ જાયુક્ત ખોજા ક મ ટેની
એોગવ ક

13) શુાં તમે જાેફજાપ હોસ્પણટપની ઉણલ્જધત ર્થી સાંતુષ્ટ છો?
A. હ
B. ન
અંટ્રત નવટ્રતો:
1) રવત
A. પુરુષ
B. સ્ત્રી
2) ઉંમજા
A. ીછી ર્થી 81
B. 03-81
C. 54-08
D. વધુ ર્થી 54
3) વૈવ િહક સ્પર્થવત
A. ણિજાિીત
B. અણિજાિીત
4) શૈક્ષણિક પ યક ત
A. અભિ
B. 10 ણ સ
C. ણ સ 81
D. ગ્રેએયુટ (પન તક)
E. ણોપટ ગ્રેએયુટ (અનુપન તક)
5) આવક )મ વસક(
A. 83,333 ર્થી ીછી

B. 83,333 – 13,333
C. 13,333 – 03,333
D. 53,333 ર્થી વધુ
6) વ્યવસ ય
A. ખેડૂત
B. સજાક જાી કમતી જાી
C. ખ નગી કમતી જાી
D. સેલ્ફ કમતી જાી
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"To Find Out The Reason for not Visiting Hospital Again After The Treatment At The Referral Hospital & Community health Centre "

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