1

Introduction of ESIC
Employees' State Insurance Scheme of India is an integrated social security scheme tailored to provide social protection to workers and their dependants, in the organized sector, in contingencies, such as, sickness, maternity and death or disablement due to an employment injury or occupational hazard. The ESI Act, (1948) applies to following categories of factories and establishments in the implemented areas: * Non-seasonal factories using power and employing ten (10) or more persons * Non-seasonal and non power using factories and establishments employing twenty (20) or more persons. The "appropriate Government" State or Central is empowered to extend the provisions of the ESI Act to various classes of establishments, industrial, commercial or agricultural or otherwise. Under these enabling provisions most of the State Govts have extended the ESI Act to certain specific class of establishments, such as, shops, hotels, restaurants, cinemas, preview theatres, motors transport undertakings and newspaper establishments etc., employing 20 or more persons. The ESI Scheme is mainly financed by contributions raised from employees covered under the scheme and their employers, as a fixed percentage of wages. Employees of covered units and establishments drawing wages up to Rs.10,000/- per month come under the purview of the scheme for social security benefits. However, employees earning up to Rs.50/- a day as wages are exempted from payment of their part of contribution. The State Govts bear one-eighth share of expenditure on Medical Benefit within the per capita ceiling of Rs.900/- per annum and all additional expenditure beyond the ceiling. Employees covered under the scheme are entitled to medical facilities for self and dependants. They are also entitled to cash benefits in the event of specified contingencies resulting in loss of wages or earning capacity. The insured women are entitled to maternity benefit for confinement. Where death of an insured employee occurs due to employment injury, the dependants are entitled to family pension.

COMPANY PROFILEThe Medical Services are rendered by the Department of Employees State Insurance Scheme (Medical) Services popularly known ESIS (M) Services as per the memorandum of agreement by the State Government with ESI Corporation. According to Para 25 of the agreement the State Government and ESI Corporation whenever the rate of certification in the State exceeds the average of the country rate over and above 25%, then the State Government has to bear the entire exceeded expenditure on sickness benefit. The Scheme started functioning from 27th July 1958 at Bangalore with a humble beginning with strength of 12 ESI Dispensaries, 100 bedded ESI Hospital catering more than 48,000 beneficiaries with the wage limit of Rs.400/- p.m.

FACILITIES AVAILABLE IN THE DEPARTMENT

1. 2. 3. 4.
5.

6. 7.
8.

Inpatient and Out-patient facilities Drugs and Dressings Laboratory Investigations and Imaging Services Artificial Limbs, Aids and Appliances Integrated family welfare, Immunization and Child Health Care Services Ambulance Services Tie-up arrangement with private Hospitals and Nursing Homes where the ESI Hospital / Facilities are not available. Tie-up arrangement for Super Specialty treatment.

1. IN-patient and OUT-patient facilities: In-Patient ESI Hospitals- referred from Diagnostic Centre and
Dispensaries

Out-Patient i. provided at Dispensaries

ii.ESI Hospitals and Diagnostic Centre (referred from Dispensaries)
3

2. DRUGS AND DRESSINGS

All Drugs and dressings (including vaccines and sera) that may be considered necessary and generally in accordance with the E.S.I.C drug formulary are supplied free of charge.

3. LABORATORY INVESTIGATIONS AND IMAGING SERVICES:

Imaging and investigations including CT Scan, MRI, Echocardiography and laboratory facilities are provided free of cost to IPs and their families at state level specialty hospitals or other institutions having tie up with E.S.I. Scheme.

Figure showing the laboratory inside the ESIC hospital

Figure showing the lab technician working inside the ESIC laboratory.

4. ARTIFICIAL LIMBS, AIDS AND APPLIANCES:

Insured Persons and their family members are provided following artificial limbs, aids and appliances as part of medical care under the E.S.I Scheme:1. Artificial limbs 2. Hearing Aids 3. Spectacles (Frame costing not more than Rs.100/-and replacement of frames not to be made earlier than 5 years) : to Insured Persons only 4. Artificial Dentures, teeth 1. Wigs (replacement not earlier than 5 years) to female beneficiaries only 1. 2. 3. 4. 5. 6. 7. 8. 9. Cardiac pacemaker Wheel Chair / tricycle Spinal supports (jackets, braces etc.,) Cervical collars Walking calipers, surgical boots etc. Crutches Hip prosthesis, total hip Intra Ocular Lens (IOL) Any other aid or appliances prescribed by the specialist as part of treatment.
5

The expenditure on artificial limbs, aids and appliances is met from the shareable pool of expenditure on medical care.

5. INTEGRATED FAMILY WELFARE, IMMUNISATION AND MATERNITY CHILD HEALTH PROGRAMME:

ESIC is implementing the integrated Family Welfare, Immunization and Maternity and Child Health Programme in the form of child survival and safe motherhood programme. Now, it has been expanded to cover reproductive health and Sexually Transmitted Diseases. The various services provided under the programme are in line with Government of Indias programme. The different formats / proforma for ante-natal, post natal, immunization services etc., are same as adopted and circulated by Government of India from time to time. At present various services provided are as follows:a. Family Welfare: Insured persons and their spouses are provided facilities of Family Welfare viz. Vasectomy, Tubectomy operations, Intrauterine device insertion, medical termination of pregnancy, supply of condoms, distribution of oral pills etc. b. Immunization Vaccination and Preventive Inoculation: Vaccination and preventive inoculations are provided free of cost to IPs and their families as per national immunization schedule. c. Maternity Services: Antenatal Care, Confinement and Post Natal Care. Antenatal and Post-Natal care and confinements facilities are provided free to insured women and wives of IPs. Medical Bonus of Rs.250/- per confinement is payable when confinement of insured Women or spouse of IP occurs at a place where facilities under the E.S.I Scheme are not available.
6

6. AMBULANCE SERVICE OR REIMBURSEMENT OR

CONVEYANCE CHARGES:
a. Ambulance Service: IPs and members of their families are entitled to free ambulance service for visiting Specialist Centres, Hospitals etc., for Specialist consultation or admission or any investigation, provided that the patient is so ill that he / she is not able to travel by ordinary modes of conveyance. The facilities are available in Hospitals. Necessity for transport of sick persons by ambulance is to be strictly decided by IMO/IMP in accordance with the nature of disease and condition of the patient and whether or not transport by means other than an ambulance will be in the interest of the health of the patient. For emergency, ambulance services are provided round the clock. Ambulance vans are provided as per prescribed Norms by the Corporation. In case of areas having lesser number of IPs arrangements should be made with other Organisations like District Hospitals Municipal Hospitals and Red Cross Society etc., to hire their ambulance for ESI Patients. Contractual arrangements may be made with private parties, in areas where own ambulance is not available and arrangement with other organisations is not possible. b. Reimbursement of Conveyance Charges: In the absence of availability of an ambulance and where needed in an emergency, any other quick form of transport may be used and amount so spent subject to the maximum rate prescribed by the Government / Transport authority (both ways) is reimbursed to IPs. To avoid hardship to IP and his family who have to go to any hospital or medical institution for admission, specialist consultation or investigation, but whose condition is not such as to need an ambulance, provision has been made for the payment of conveyance charges, if hospital / medical institution to which the case is referred to, is at an outstation or is at a distance of more than 8 kms from the ESI Dispensary or the clinic of the panel doctor. The charges are restricted to actual II class railway fare or cost of a single seat in public conveyance both ways whichever is feasible.

If the beneficiary is not in a fit condition to travel without escort for reasons to be recorded and so certified by IMO / IMP, the conveyance charges are also allowed for an escort. The IMO / IMP should keep a separate account of such payments in the prescribed Register and send a quarterly statement of this expenditure to the Director/AMO by the 15th of the month following the quarter ending in March, June, Sept and December. The returns received from different areas in the State may be consolidated area-wise by the Director / AMO and quarterly statement sent to the Corporation. The expenditure on conveyance charges forms part of the Medical Care under the E.S.I. Scheme and hence shareable between the Corporation and the State Government in the usual ratio within ceiling prescribed. c. Domiciliary Treatment: An Insured Person and his family members are entitled to free medical attendance by IMO / IMP at their residence when the condition of the patient is such that he / she cannot reasonably be expected to attend the dispensary / clinic. Conveyance allowance for Domiciliary visit: i) For the domiciliary visit, the IMOs are paid conveyance allowance. The quantum of this allowance is decided by the State Government in consultation with the Corporation. ii) The IMPs are not paid any domiciliary conveyance allowance. In their case, it is included in the capitation fee upto a distance of 5 km, between the clinic of IMP and IPs residence. The IMOs / IMPs are required to maintain record of domiciliary visits in a register month-wise. The columns in this register are given under the chapter "Sickness Absenteeism and Recording". d. Hearse Van: A dead body van / hearse van may be provided on contractual basis in each E.S.I. Hospital.
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7. TIE-UP ARRANGEMENT WITH PRIVATE HOSPITALS

where the ESI Hospital / Facilities are not available.
o

(a) In order to give better treatment to the IPs and their family members the Department is having a tie-up arrangements with Private Hospitals and Nursing Homes.

- Haria Hospital - Usha Hospital Beds are also reserved for IPs in Government and other Private Hospitals in the State.

8. TIE-UP ARRANGEMENT FOR SUPER SPECIALITY TREATMENT

In case super-specialty / specialty treatment is not available in ESI Institutions for illness like heart surgery, neurosurgery, bone marrow transplantation, dialysis, cancer treatment, etc tie-up arrangements had been made with the reputed hospitals possessing these facilities. The Corporation has decided to keep Rs.50/- per I.P family unit per annum out of the ceiling of Rs.600/- with Regional Offices as a corpus. This fund is to be utilised for deposit / reimbursement for such treatments against the sanction by the Director of ESIS (M) Service

Grant of ex-gratia payment:

In the event of death, marked disability, loss of limb, or part of limb of an Insured Person or family member due to adverse reaction of drug / injection an ex-gratia payment upto Rs.5,000-/ may be allowed.

Reimbursement to employers under Regulation 69:

Reimbursement of medical expenses for providing Emergency Treatment / First aid to the Employer is provided under Regulation 69. Under Regulation 69, every employer has to arrange for First-aid Medical care and transport of accident cases till the injured IP is seen by the IMO / IMP and such employer is entitled to reimbursement of expenses incurred in this regard upto the maximum of scale prescribed from time to time. However, reimbursement is not permissible, if the
9

employer is required to provide such medical aid free of charge under any other enactment. The cost of provision of such emergency treatment would be reimbursed to the employer by the Director / AMO (ESI Scheme) of the respective State and, therefore, all claims duly supported by relevant receipts and vouchers should be sent to the Director for verification and payment.

Reimbursement of expenses incurred in respect of medical

treatment under regulation-96 A. Regulation 96 A reads as follows: - Claims for reimbursement of expenses incurred in respect of medical treatment of IP and his family may be accepted in circumstances and subject to such conditions as the Corporation may be general or special order specify. The following conditions have been laid down under this Regulation: o

Full authority is vested with the State Government concerned to reimburse expenditure in respect of medical treatment of IP and his family. It may be left to the discretion of the State Government to decide the Authority within their machinery who will approve the expenditure in question; and Time limit for submission of the claims for reimbursement is one year.

The State Government has to keep in view the following points while considering the cases of reimbursement of expenditure on Medical Care:
i.

Whether such facilities for which reimbursement is recommended are notavailable in the ESI Hospitals. ii. Whether the hospital, where the IP was referred or proposed to be referred was / is the nearest hospital having required facilities / services.

ii.

The committee meets on the 3rd working Friday of every month to hear complaints relating to administration of medical benefits.

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STATE FAMILY WELFARE CELL

The State Family Welfare Cell was established on 23-5-1997 at Directorate. The work profile of the Assistant Director is mainly to the Family Welfare immunisation and implementation of National Health Programmes.

ESI STATE AIDS CELL

ESI State AIDS cell was established in the month of March 2000, Assistant Director / Programme Director is assisting in implementation of National AIDS Control Programme in the Department and also Blood Transfusion Services.

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12

INTRODUCTION OF TQM
The TQM has been buzz word of todays organization. Total Quality Management is the process of instilling quality throughout an organization and its business processes. The system of Total Quality Management aims at achieving success and customer satisfaction through embedding an awareness of quality all the way through a business, through planning and feedback. It is a system of activities directed at achieving delighted customers, Empowered employees, higher revenues and lower costs. International Organization for Standardization (ISO) has defined TQM as: TQM is a management approach for an organization, centered on quality, based on the participation of all its members and aiming at long term success through customer satisfaction, and benefits to all members of the organization and society (ISO 8402: 1994) Total Quality Management was the first quality management method to transform entire industries, rather than work at just one company at a time. Quality has been a tradition in India and monuments, relics, handicrafts, gems jewellery and craftsmanship have woven quality into our heritage. But while Quality was a way of managing business in US and Japan in 1950s, it was not so in India. The Quality Movement was consolidated in the 1980s in Indian industries to bring about a synergy of resources by the pioneering efforts of confederation of Indian industries (CII). Walter Shewart , the father of statistical control, visited India for a short period of three months during 1947-48 and initiated the SQC Movement through visits to factories , personal discussions and lectures. Dr Edward Deming who taught the Japanese the means of applying plando-check-Act cycle came to India in early 1950s. While the Japanese attributed their success to the learnings from two American Gurus, Dr Deming and Dr Juran, the rest of the world was lagging behind until the 1970s when the effect began to hurt the businesses. The formal launch of TQM Movement in the US in the early 1980s triggered a movement for quality in India and in 1982; the quality control circle was born. The movement f Quality circles were consolidated by Quality Circle Forum in India (QCFI). Prof. Ishikawa , founder of quality movement in was invited by CII to come to India to address the Indian industry in 1986.

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Introduction of TQM in hospitals

Quality has become one of the most important factors in global competition today. Intensifying global competition and increasing demand by customers for better quality have caused more and more companies to realize that they will have to provide quality product and /or services in order to successfully compete in the marketplace. To meet the challenge of this global revolution, many businesses have invested substantial resources in adapting and implementing total quality management (TQM) strategies. Total Quality Management refers to the deep commitment of an organization. Each and every step taken by the organization to improve the quality of products and services the organization providing to the customers are called Total Quality Management. TQM is relative newcomer to the management. In health care industry all hospitals provide the same type of service, but they dont provide the same quality of service. To achieve service excellence, hospitals must strive for zero defects retaining every customer that they can profitably serve. Zero defects require continuous efforts to improve the quality of the service delivery system and hence this concept of TQM is having a lot of relevance in this sector. We might have come across situation like long wait for the services from the doctors, nurses and other hospital staffs, low quality of treatment received from doctors which leave repeated surgeries and expenditure for patients, which can even lead to their death, all these can be avoided by improving the total service quality. A traditional belief regarding TQM is that high quality costs more. But by implementing a proper quality system we can control the cost by: a. Reducing unnecessary interventions. b. Getting it right first time e.g. cost of repeat surgery c. Avoidable complications e.g. post-operative infections. d. Imbalances of resources: Lack of theatre time or lack of access to diagnostic facilities leading to increased length of stay. e. Employee turnover and consequent training costs.

Quality control and quality assurance

There is a difference between these two. Quality Control is an after event phenomenon (just like a post mortem exercise). It consists of a set of checks and inspections to be carried out after the mistake has occurred. For example, a patient visits the ophthalmic OPD for alleged refractive error problem. The doctor prescribes the suitable
14

glasses. Patient wears the glasses but there is no improvement. Patient comes back and registers his grievances about the poor service by the hospital. Now, reasons need to be found out. So, hospital starts finding out the fault (note this is happening after the mistake has occurred). The likely reasons may be as hereunder: 1. Patient has not been checked up by the qualified ophthalmic assistant/ doctor. 2. There is no standard check list which may serve as guidelines for a thorough check-up. 3. If there is a checklist, the doctor/ophthalmic assistant has escaped one or more checks and the problem was not correctly diagnosed. 4. Doctor instead of carrying the complete check up, believed (what patient told) and concluded it to be refractive error problem but the root of the problem lies somewhere else. 5. If everything (as stated above) is in order, may be, the diagnostic equipment is not properly calibrated and it gives error and hence the wrong eye glass number. There may be one or more reasons as stated above. So, quality control will focus on finding out the reasons and take corrective actions. On the other hand, quality assurance stresses on prevention of the mistake. The aim is to detect the mistake at an early stage, so emphasis remains on all aspects of a job so that mistake is detected as soon as it takes place. The stage inspection is a must before proceeding further. In the above case, QA strategy will be as hereunder. It will ensure that 1. Patient is examined by an authorized qualified doctor/ophthalmic assistant 2. Patient is examined as per the standard valid checklist 3. All data pertaining to various checks will be maintained 4. All checks are carried out in actual and there is no escape 5. Only valid calibrated diagnostic equipment are used for the check-up QA stresses on documentation and the mistake is detected at an early stage and suitable corrective action is taken.

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Quality management system

Working on the concept of QA, the hospital can work for the establishment of a system (more precisely quality system) in its various departments and sections to ensure that whatever is done and wherever it is done, it is done as per the documented procedures with necessary checks and inspections to make sure that quality is in-built into the system. If such a system is established, it will be called a Quality Management System.

Standard for a quality management system

In absence of clear-cut guidelines, any hospital can go for any system suiting its test and elude the patient by claiming that it has established a QMS. Therefore, there is a need for a standard which will give the customer/patient confidence about the assurance of the quality of the service of a hospital. There exist such standards namely ISO-9000 quality system standards the details of which are described as follows.

ISO-9000/ Quality system standards

ISO stands for International Organization for Standardization. It is an international body. Most of the countries including India are members of it. This international body works for developing various standards for bringing uniformity and request their member - countries to ratify the standards and implement them in their countries. Most of the existing standards are for products. It enlists the technical specifications to be met by a product before the same is certified. The ISO-9000 is different from it. There are three kinds of certificate available under ISO-9000 scheme, namely ISO-9001, ISO-9002 & ISO-9003. These certificates are not awarded to a product. Instead, they are given to a system. The hospital, too, is a system and therefore, it can work for getting ISO certification. It is worth mentioning here that there is no certificate like ISO-9000. ISO 9000 is not a standard. It is a set of guidelines which help towards working for the establishment of a quality system. The quality standards are ISO-9001, ISO 9002 and ISO-9003. Therefore, the organization will be certified either for ISO-9001 or ISO-9002 or ISO9003. If an organization is engaged in design, production, installation and servicing of the product/service, it is suited for ISO-9001. If the design activity is omitted, it should go for ISO-9002 and in case of being
16

engaged in inspection and testing; it has to go for ISO 9003. A hospital produces service, so it does the production job; it provides service to the patient so it does the installation job and it carries out follow-up services/ consequent check-ups as per the patients request and so it does servicing job, too (the after sales service). So apparently, a hospital is suitable for ISO-9002 certification. Does it mean that the hospital does not design its service? No, it will be wrong presumption. Some of the reputed hospitals are providing innovative services and design is nothing but an innovative process. So, new services are designed. But, normally, majority of the hospitals do not do so and they act as providers of the existing services and therefore, ISO-9002 is the most suitable quality system certification for a hospital.

Total quality management

ISO 9000 certification is not an end in itself. It may be looked upon as a process to achieve the target of TQM. Also, it is worth mentioning here that TQM must not be viewed as a static goal. The system targeting for TQM must be a open system which is continuously influenced by the intrinsic (factors within the system) and extrinsic factors (environmental factors). So, the TQM is a moving target which keeps on changing depending on various social, economic and environmental factors. None of the activity whether minor or major in an organization, can escape the ambit of TQM. Doctor is important and so is a sweeper. The OPD is important and so is the security. There is enough emphasis on human resource development, too. Training is the regular and on-going process for TQM. ISO-9004 a set of guidelines can help a lot for introducing TQM in an organization.

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18

Implementation of Total Quality Management

Implementation of total quality management (TQM) in health care delivery systems has been well accepted in many countries and has brought continuous improvement in different areas of the health care delivery system, as well as controlling the rise of health care costs. The TQM philosophy and process are based on a data-oriented system which requires the participation of all staff members in an organization. This was followed by a training program for mid-level managers, concentrating mostly on problem-solving methods. Subsequently, the staff in the clinical, Laboratory and administrative departments of the hospital were included in the training program. The training consisted of an overview of the philosophy and processes of TQM, including data collection, analysis of the data and problem-solving. Each group was taught about data collection processes and about analysis of this data, including how to use the information obtained as the basis for decision-making. Optimal standards for data collection were defined for each unit based on the infra-structure of the organization and matched to the knowledge and skill levels of the staff. Mid-level managers, grouped into the quality circles they had formed, then conducted a thorough analysis of the data that had been collected and put forward appropriate alternatives for the solution of problems. In order to ensure coordination between units and to allow for consultation during problem-solving sessions, a system of TQM was established within the Hospital. All unit heads were asked to prepare monthly quality assurance reports, including a discussion of their findings and future plans to improve quality and efficiency in their units. The TQM Coordination Group assembled data from the units and presented them to the senior managers of the hospital at their monthly meeting. By means of these reports, the senior Managers were able to evaluate developments in the hospital, and the proposals of different units were discussed as an important source of information for decision-making. Implementation of the TQM system has achieved the following successful results:

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 Unit heads became more conscientious about improving quality and efficiency in their units. Hospital performance measurements showed significant improvements in bed occupancy rates and in operations performed. As a result of increased demand for services additional out-patient facilities were annexed to a clinic currently in operation. Continuously rising bed occupancy rates played a significant role in the decision to start construction of a new hospital with a capacity of 100 beds. Successful results of the implementation in health services in the hospital units resulted in the introduction of a TQM system in the departments of higher education within the university.

Factors having impact on TQM implementation

In health care industry, success of TQM applications depends on a strong leadership that must be implemented by the top management. Role of top management and quality policy has the highest impact on TQM. Top management of the hospitals determines an appropriate organization culture, vision, and quality policy. On the other hand, the top management must provide adequate resources to the implementation of quality efforts. Another factor is employee relations. Its effect is by building quality awareness in the employees and by the recognition of employee for superior quality performance. Finally process management, which includes such sub-factors as process monitoring, supervision, and preventive equipment maintenance, is having least impact on TQM implementation.

The dimension of quality

Various dimensions of quality that need to be addressed are effectiveness, efficiency, technical competence, safety, accessibility, interpersonal relations, and amenities. Healthcare quality does not mean that care is given by the most learned and highly experienced professors of medicine, but the system is devised in such a way that in any situation most ordinary yet adequately trained doctor can deliver appropriate treatment to the needy patient. Quality is therefore based on the principle saving. Quality calls for the principles of elimination of waste, elimination of re-work and elimination of duplication. Implementing quality in healthcare therefore means that the provision of training in quality methodologies and collection of necessary data for documentation of status and level of care.
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Quality assessment can be done on the basis of the following factors:

a. Qualification of the treating doctor b. Training status of the staff c. Attendance to safety of care d. Existence of a quality system e. Excellence of service aspect of healthcare f. Doctors commitment to quality

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REASERCH METHODOLOGY
22

The purpose of methodology is to describe the process involved in research work. This includes the overall research design, data collection, field study and analysis of data. Research Design: The methodology for the research study is descriptive and is as follows:

Objectives:
The objective is to study the people perception about ESIC Hospital in Vapi.

To study the various services provided by ESIC hospital and their impact on patients, whether they are satisfied with the present service or not.

Data collection tools : Primary sources of data : Primary sources are original sources from
which the researcher directly collects data that have not been previously collected e. g.., collection of data directly by the researcher on brand awareness , brand preference, brand loyalty and other aspects of consumer behavior from a sample of consumers by interviewing them,. Primary data are first hand information collected through various methods such as observation, interviewing, mailing etc.

Secondary sources of data : These are sources containing data which

have been collected and compiled for another purpose. The secondary sources consists of readily compendia and already complied statistical statements and reports whose data may be used by reaserchers for their studies e.g., census reports, annual reports , and financial statements.

DATA ANALYSIS:
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1. QUESTIONNAIRE 2. PIE CHART QUESTIONNAIRE: This is the most popular tool for the data collection. A questionnaire contains questions that the researcher wishes to ask his respondents which is always guided by the objective of the survey. PIE CHART: This is very useful diagram to represent data, which are divided into a number of categories. This diagram consist of a circle divided into a number of sectors, which are proportional to the value they represent. The total value is represented by the full circle.

LIMITATIONS : Results of the study are dependent on the nature and number of respondents i.e. the study has captured only the perceptions of service receivers- patients; and the sample size of the study 100 patients- due to limited response rate and other operational constraints. BENEFICIARIES: The present study allows the hospital administrators to benchmark their hospitals with other private hospitals by comparing the mean value of the dimensions of Service Quality.

24

DATA ANALYSIS
25

Source: Questionnaire

1.

Are you coming for regular checkup? YES NO

49% 51%

YES NO

The sample drawn shows that out of 100% of respondents, 49% come for the regular check ups in this hospital while 51% dont come for the regular check ups.
INTERPRETATION:

As majority of the respondents are not coming for regular check ups, it is suggested to hospital administrators to come up with awareness programs among the patients.
OBSERVATION:

2.

What you think about the services provided by this hospital ? VERY GOOD GOOD SATISFACTORY POOR

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OPINION ABOUT PROVIDED SERVICES

1% 48%

20% VERY GOOD GOOD SATISFACTORY 31% POOR

INTERPRETATION: The sample drawn on probability basis shows that

out of 100% of respondents, 48% are satisfied with the services provided by the hospital. 31% found the services good while 20% found the services very good. Only 1% of respondents are not at all satisfied with the hospital services.
OBSERVATION: As majority of the respondents are satisfied with the

hospital services, the hospital should maintain the same standard and it is suggested to come up with suitable measures to reduce the negative opinion among the respondents. Few suggestions to further develop the services of the hospital: Utilize and apply medical information systems that encourage the use of evidence-based medicine, guidelines and protocols as well as electronic prescribing in inpatient and outpatient setting. This is possible through the implementation of the EHR (Electronic Health Record); this will in time, encourage healthcare data collection, transparency, quality management and efficacy and appropriateness of care. Develop good partnership with private healthcare sectors that design newer ways to deliver healthcare. An example of this includes outpatient radiology and diagnostic testing centres.

3. Are you concerned about the qualification of the doctors before getting diagnosed? YES NO

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QUALIFICATION CONSIOUSNESS

6%

YES NO

94%

INTERPRETATION: The above pie chart shows that only 6% of

respondents are concerned about the doctors qualification before getting diagnosed while 94% are not concerned about the same.

OBSERVATION: As majority of the respondents are not concerned about

the doctors qualification, it is the sole responsibility of healthcare administrators to appoint qualified doctors as well as other medical and non medical staff. It is recommended to develop patients knowledge with the help of posters which should be in regional language.

4. How will you rate the hygiene and cleanliness practiced by this hospital ? VERY GOOD GOOD SATISFACTORY POOR

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OPINION ABOUT HYGIENE

6% 35%

13% VERY GOOD GOOD SATISFACTORY POOR 46%

INTERPRETATION: From the above graph we can clearly observe that

46% of respondents are satisfied, 13% found good while 6% found the hygiene practices very good in the hospital. But 39% of respondents are not satisfied with the cleanliness and hygiene.
OBSERVATION: As majority of the respondents are satisfied, the hospital

should maintain the standard and it is suggested to further improve the hospital hygiene and cleanliness. Medical hygiene involves keeping germs and bacteria off of hospital and surgical equipments . It include proper cleaning of equipment and hands to make sure hospital items are not contaminated. Proper sanitation is also required in patients room, wash rooms and toilets. The responsible workers should always be advised by their seniors to maintain proper sanitation so as to avoid any type of contamination. Food hygiene is also necessary. This involves keeping food at proper temperature and ensures the products are fresh.

5. How will you rate the accommodation provided by this hospital ? VERY GOOD GOOD SATISFACTORY POOR

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OPINION ABOUT ACCOMODATION

7%

16%

45%

32%

VERY GOOD

GOOD

SATISFACTORY

POOR

INERPRETATION: The above pie chart shows that out of 100% of

respondents, 45% are satisfied with the accommodation provided by the hospital, 32% found this service good while 16% found this very good. Only 7% respondents are not satisfied by the accommodation service.

OBSERVATION: Majority of the respondents are satisfied with the

accommodation provided by this hospital. So the hospital should maintain the same standard and it is suggested to come up with suitable measures to reduce the negative opinions among the service receivers.

6. What you think about the food quality provided by this hospital ? VERY GOOD GOOD SATISFACTORY POOR

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OPINION ABOUT FOOD FACILITY

18%

20% VERY GOOD GOOD SATISFACTORY POOR

35%

27%

INTERPRETATION: From the above graph we can conclude that 35% of

respondents are satisfied, 27% found good and 20% found the food facility very good. Only 18% of respondents found the food facility very poor.

OBSERVATION: Here majority of the respondents are satisfied with the

food facility so the hospital should maintain the same standard. It is suggested to come up with suitable measures to reduce the negative opinion among the service receivers. This service can be further improved by taking care of the food hygiene and freshness. The meals should be provided in time by the staff. Hospital can also start canteen facility for both inpatients and outpatients.

7. Does this hospital has enough number of Nurses to serve the patients? YES NO

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OPINION ABOUT NUMBER OF NURSES

44% YES NO 56%

INTERPRETATION: The sample drawn on probability basis shows that

out of 100% respondents, 56% found that the hospital does not have enough number of nurses.

OBSERVATION: Majority of the respondents are not satisfied by the

services provided by the nurses due to lack of nurses. So it is suggested to the hospital administrators to fill all the vacancies of nurses to avoid the inconvenience faced by the patients.

8. Does this hospital has enough number of Doctors to treat the patients? YES NO

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OPINION ABOUT NUMBER OF DOCTORS

43% YES NO 57%

INTERPPETATION: The sample drawn on probability basis shows that

57% of the respondents found that the hospital is having enough number of doctors. While 43% of the respondents found lack of doctors.

OBSERVATION: As majority of the service receivers found that the

hospital is having enough number of doctors, the hospital should maintain the same standard. Proper training and guidance to doctors will improve their skills. Filling all the vacancies of doctors will reduce the waiting time of patients.

9. Do you get all the prescribed medicines from the hospital dispensary ? YES NO

33

OPINION ABOUT MEDICINES PROVIDED

20%

YES NO

80%

INTERPRETATION: From the above pie chart we can observe that the

80% of respondents have positive opinion about the medicines provided by the hospital dispensary.

OBSERVATION: As majority of the respondents are satisfied with the

availability of medicines from the hospital dispensary, the hospital should maintain the same standard. It is suggested that if any medicine is out of stock in hospital, then it is the responsibility of the hospital to provide that medicine from the private chemist shop to the patient.

10. The severe cases are attended in this hospital or sent to other TIEUP hospitals? SAME HOSPITAL OTHER

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OPINION

34% SAME HOSPITAL OTHER 66%

INTERPRETATION: Here the pie chart shows that 66% of respondents

agreed that most of the time the severe cases are transferred to other tieup hospitals.

OBSERVATION: More percentage of cases are transferred to other Tie-

up hospitals. This will some time lead to waste of time and effort. So it is suggested to use latest technology treatment in the same hospital.

11. Are you getting the conveyance charge when shifting to other hospital in severe cases? YES NO

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OPINION

2%

YES NO

98%

INTERPRETATION: The sample drawn on the probability basis shows

that out of 100% of respondents 98% agree that they are getting conveyance charge while 2% disagree.

OBSERVATION: Majority of the respondents are satisfied with this

service. So the hospital should maintain the same standard and it is suggested to come up with suitable measures to reduce the negative opinions among the service receivers.

12. What is the waiting time in the queue of reception? Less than hour More than hour

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OPINION ABOUT WAITING TIME

28%

72%

LESS THAN 1/2 HOUR

MORE THAN 1/2 HOUR

INTEPRETATION: The sample drawn on the probability basis shows that

72% of the respondents believe that they take less than hour in the reception queue.

OBSERVATION: Here 28% of respondents are saying that they have to

wait more that hour in the reception queue. The waiting time in the reception queue can be reduced by introducing computers in the reception in place of manual paper work.

13.

Is the nurse caring ? NO

YES

37

OPINION

17%

YES NO

83%

INTERPRETATION: The sample drawn on probability basis shows that

out of 100% respondents 83% of respondents found the nurses to be very caring.

OBSERVATION: As majority of patients are satisfied with the services

provided by the nurses, it is recommended to maintain the same standard. It is suggested that by proper training and guidance this facility can be further improved.

14. Does the doctors spend enough time with you ? YES NO

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OPINION

38%

62%

YES

NO

INTERPRETATION: From the above pie chart we can observe that 62%

of the respondents are agreeing that the doctors are spending enough time with them.

OBSERVATION: As 38% of the respondents does not agree with this fact,

it is recommended to improve the doctor-patient ratio. Filling all the vacancies of doctors will increase the time spend with patients.

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FINDINGS
By calculating the number of responses, we found that most of the service receivers are satisfied with the services provided by this hospital.
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We also come to know while visiting the wards that there was a problem of hygiene and cleanliness in patients room.

While talking with the medical officers we come to know that there was a big problem of lack of doctors and nurses in this hospital. This lead to increase in waiting time for the patients. Majority of the respondents are absolutely satisfied with the medicines provided by this hospital. It has been found that due to lack of latest technology many severe cases are sent to other TIE UP hospitals.

Most of the respondents are satisfied with the conveyance charge provided to them by the hospital when shifting to other hospitals. Some percentages of respondents were there who are facing the problem of long waiting time in reception queue. This is due to the lack of computer system in reception.

We also found that the patients are least bothered about the qualification of doctors and nurses before getting diagnosed although most of them are satisfied with the treatment provided to them.

We also come to know that most of the respondents are satisfied with the food and accommodation provided by this hospital.

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RECOMMENDATION

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 Develop and implement national standards for examination by which doctors, nurses and pharmacists are able to practice and get employed. The government should appoint a commission which makes recommendations for the healthcare system and monitors its performance. Encourage business professionals to develop executive training programmes in healthcare sector. Implementation of Electronic Health Record; this will encourage healthcare data collection, transparency, quality management, patient safety, efficiency, efficacy and appropriateness of care. Computer help should be utilized for clinical decision making for selecting suitable tests, proper interpretation, and accuracy in diagnosis and update management. Develop multi-specialty group that have their incentives aligned with those of hospitals and payers. A tele-healthcare system can be implemented in the hospital. Perverse incentives between specialists, hospitals, imaging and diagnostic centers on one hand and referring physicians on the other need be removed and a level of clarity needs to be introduced Develop partnership with the private sectors that design newer ways to deliver healthcare. Special treatment techniques like ayurveda and yoga for the patients can be introduced. Management of healthcare institutions and healthcare professionals should gear up to meet the expectation and challenges of good patient care.

CONCLUSION:By adopting innovative methods and also by proper planning, quality of healthcare services can be improved to a great extend. By doing so
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patients satisfaction can be improved and also doctors will save their precious time which can be utilized for higher professional growth. Finally global quality healthcare delivery at doorstep in low cost would safeguard national health leading to economic growth.

The implementation requires time, effort and money in order for the health care organization to learn who their customers are and what they want. The result, which sometimes recognized after 2-3 years.

Introduction of Electron Health Record plays an important role in providing high quality services. This system will increase the quality of services by reducing the manual errors. Hence, the computerized system is positively advantageous over the present manual system.

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BIBLIOGRAPHY
www.esic.nic.in
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www.google.com www.scrid.co.in www.managementparadice.com

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