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A training report submitted in partial fulfillment of the requirement for the award of the Degree of the MBA (IIP), Gauhati University on

Employee retention based on employment satisfaction



108-A, Indraprastha Extension Opp. Sanchar Apartments Patparganj, Delhi- 110092

Under Organization Guidance of :

Under Organization Guidance of :

Mr. Dinesh Negi Assistant Manager-HR MAX Super Specialty Hospital

Dr. C. D Gautam Director Academy of Hospital Administration NOIDA

Prepared and submitted by:

Dr. Ashish Pawar PT G.U. Roll No. 09-01-0948

This is to certify that Mahnaz Ansari, a student of the Gauhati University has prepared her training report entitled Employee retention based on employment satisfaction at MAX Balaji Hospital-PPG, under my guidance. She has fulfilled all requirements under the regulation of the MBA (IIP), Gauhati University, leading to MBA (IIP) degree. This work is the result of her own investigations in the project; neither as a whole nor any part of it was submitted to any other university or educational institution for any research of diploma. I wish her all success in life and future endeavor.

Director C. D Gautam(retd gen) Director Acadamy of Hospital Administration NOIDA


I hereby declare that the training report conducted at



Under the guidance of Mrs. Rajni Singh

Submitted in partial fulfillment of the requirements for the Degree of MASTERS OF BUSINESS ADMINISTRATION (Industry Integrated) TO


Its my original work and the same has not been submitted for the award of any other degree/fellowship or other similar titles or prizes.

Place: Noida Date: 22 Dec 2010

Dr. Ashish pawar PT

G.U. RollNo. 09-01-0948

Chapter 1: introduction 1.1: general intro about the sector. 1.2: industry profile a. origin and development of the industry b. growth and present status of industry c. future of the industry Chapter 2: profile of organization 2.1: origin of the organization 2.2: growth and development of organization 2.3: present status of organization 2.4: functional departments of the organization 2.5: organization structure / organization chart 2.6: product and service profile of the organizations competitors 2.7: market profile of the organization Chapter 3: discussion on training 3.1: students work profile (role and responsibility), tools and techniques used 3.2: key learning Chapter 4: study of selected research problem 4.1: statement of research problem 4.2: statement of research objectives 4.3: research design and methodology Chapter 5: analysis 5.1: analysis of data 5.2: summary of findings Chapter 6: summary and conclusions 6.1: summary of learning experience 6.2: conclusions and recommendations Appendix Annexure like Bibliography

"Success of any Endeavour is always due to the contribution from different people". Learning is doing. Practical study is essential for any Professional Curriculum otherwise it will merely leap in dark. Apart from classroom study it is necessary to get acquainted with the day to day working of the organization. To fulfill the above objective every student has to undergo practical study before he she can consider himself herself fully qualifying as a Potential Manager. During the course of our training, I learnt that Understanding is one thing and Executing is another. This study helped me to judge the difference between classroom studies of management and practical reality of management in an organization. I would like to express my sincere gratitude to Mrs. Vaneeta Mittal (Training co-ordinator) for giving me the opportunity to work and learn with MAX Super Specialty Hospital. I would like to convey my sincere thanks to Mr. Vivek Gupta, for suggesting this topic. A sincere word of thanks goes to Mr Dinesh Negi and Dr. C. D Gautam (Internal Guide, Faculty Academy of Hospital Administration) for guiding me about each aspect related to my topic of Employee retention based on employment satisfaction, and taking keen interest in solving my every small problem, clearing all my doubts and helping me to think, behave and act from manager's point of view. I would also like to express my thanks to Ms Isha Chauhan for her continuous support and guidance throughout the project. I wish to place my special thanks and gratitude to Mr. Bhagwat Singh Bisht for all his direct and indirect help extended towards me. I would like to thank Ms. Jeenu Valecha for her important time and expert advice on crucial HR functions. I am particularly grateful for the helpful and supportive nature of Ms. Mandeep kaur I have had she was the key person to make this project come true.

Dr. Ashish Pawar PT

The delivery of modern health care depends on an expanding group of

trained professionals coming together as an interdisciplinary team. The health-care industry incorporates several sectors that are dedicated to providing services and products dedicated to improving the health of individuals. According to market classifications of industry such as the Global Industry Classification Standard and the Industry Classification Benchmark the health-care industry includes health care equipment & services and pharmaceuticals, biotechnology & life sciences. The particular sectors associated with these groups are: biotechnology, diagnostic substances, drug delivery, drug manufacturers, hospitals, medical equipment and instruments, diagnostic laboratories, nursing homes, providers of health care plans and home health care. According to government classifications of Industry, which are mostly based on the United Nations system, the International Standard Industrial Classification, health care generally consists of hospital activities, medical and dental practice activities, and other human health activities. The last class consists of all activities for human health not performed by hospitals or by physicians or dentists. This involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratiories, pathology clinics, ambulance, nursing home, or other para-medical practitioners in the field of optometry, hydrotherapy, medical massage, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc. In India, healthcare delivery has changed from a predominantly public- funded system. This has led to the emergence of new drivers of the healthcare, which are instrumental in changing the overall face of healthcare delivery in India. However, these new facet need in-depth analysis and radical rethinking, if India has to scale up to the level of developed world in terms of healthcare.

The rising corporate sector in India increases the need for corporate governance of hospitals and healthcare institutions, which ultimately creates the need for skilled and highly qualified doctors, nurses and trained healthcare managers in sufficient number, besides an urgent and mammoth need for capacity building; there is also a requirement in terms of standardization of healthcare services throughout the country. The upward trend in gross domestic product in India is heartening, as it is indirectly aiding the 5% of GDP, which is the total healthcare spending. It is important to understand that, much of the private healthcare spending is actually out of pocket expenses paid by individual patients. The public health spending in India is around 1% for quite some time. However, this has boost in the form of new umbrella program of the government namely the National Rural Health Mission (NRHM). In India healthcare services which have largely remained non-equitable, need to be strengthened. These services will benefit through capacity building and redistribution both in terms of health workforce and health recourses. Consequently, this non equitable healthcare delivery system usher in an invisible and untapped new window of opportunity the opportunity for healthcare financing mechanism to be instituted especially in rural areas. There are various critical area like medical insurance reproductive and child health, issues like high maternal mortality rate or infant mortality rate etc are the area where both medical and non-medical professionals seek to start and peruse their careers. EXCEPT for the birth of a child, hospital visits are more often than not unpleasant. If we have been lucky (with the patient's recovery, accurate diagnosis and timely treatment and service), we look back with a sense of relief. But if it has been a disastrous experience we would rather take pleasure in spreading the good word about. That's how critical an administrator's role is in an infirmary. Much has changed in how a hospital is projected today. They are more like profit centers and require business managers to project the right image. Hospital management has indeed come of age. A hospital now hires a health care manager solely for the purpose of keeping the hospital well oiled and running smoothly, providing the maximum benefit to both patients and the staff!

The work of a health care management professional is therefore to completely devote himself to the efficient running of the hospital or health centre. This effectively leaves doctors and associated staff to accomplish their work uninterrupted. The responsibilities of a health care management professional are wide ranging, necessitating multitasking. As a hospital manager, administrative, human resources, supply, infrastructure and equipment management come under his purview. This includes a host of other responsibilities such as employing contractual services, including catering, laundry, support services, hospital help etc. Management of medical supplies and equipment is an important aspect of the job. As an administrator, he also has a say in the policy matters of the hospital, and in collaborations and partnerships with other health service providers. Man management however, is the most important aspect of the job, since a hospital manager has to deal with in-house staff and others at various levels, right from the medical staff to the governing board, including visiting dignitaries. However, this doesn't lessen the importance of gaining an understanding of finance. The hospital administrator or manager also has to be `figures-savvy' with the accounting processes and procedures to curtail any misappropriation of funds. The hospital manager's role however differs according to the size of the organization. A smaller medical or health centre may employ a manager to handle day-to-day administrative work, which involves billing, maintenance, equipment supply, etc. He may work closely with doctors, if it's a group practice and have a say in decision making. A bigger place may require the services of a manager in key aspects as well. Business strategy, administration, work-flow plans, drafting reports, budget plans and managing outreach programmes, seminars etc. But every role that a health care management professional plays in the hospital is integral to his ability as a communicator and administrator, skills which need to be honed well. Also attention to detail, self-discipline, a passion for qualitative service, and an ability to negotiate would help the manager stay admirably afloat.


A. ORIGIN AND DEVELOPMENT OF THE INDUSTRY Ancient times 1. Supernatural theory of Disease: All human suffering attributed to the wrath of Gods or the evil spirits Health care logically consisted of appeasing Gods by prayers, Rituals and Sacrifices, Witchcraft, Jhad-Phoonk, charms, amulets 2. Theory of Humors Indian Medicine Ayurveda ( All over India ) Yoga, Naturopathy, and Siddha ( Tamil speaking areas ) Ayurveda ( knowledge of life, prolongation of life ) ( 5000 BC ) Developed from the Atharva veda- one of the four Vedas Tridosh theory of disease - ( doshas /humors are Vat(wind), Pitta ( gal )and Kapha ( Mucus) Dhanvantry - Hindu God of Medicine, Atreya ( physician ) Charaka (physician- Charak samhita ), Sustruta ( surgeon) and Vaghbhata- Laws of Manu- Code of personal Hygiene Sidha System - Involved the use of Mercury, Sulphur, Iron, Silver, Gold, Copper salts for therapeutic purposes Chinese Medicine - Claimed to be the worlds first organized body of medical knowledge ( 2700 BC ) Two Principles : o Yang (the active masculine principle) and o Yin (the negative feminine principle) Good health means balance between these two opposing forces The great doctor is one who treats not someone who is already ill but someone not yet ill

Therapies: Hygiene, Dietetics, Hydrotherapy, message, drugs, acupuncture, Early pioneers of immunization (practiced variolation to prevent small pox)

Egyptian Medicine 2000 BC. Advanced system of medicine including specialization such as Eye doctors, Head doctors, Tooth doctors They believed that disease was caused by absorption from the intestine of harmful substances which gave rise to putrefaction of blood and formation of pus Pulse was the speech of the heart Diseases were treated with cathartics, enema, bloodletting and a wide range of drugs such as castor oil, opium, turpentine, tannic acid, gentian, sienna, minerals and root drugs Egyptian Papyri have detailed accounts of diseases such as worms, eye diseases, polio, Diabetes, rheumatism schistosomiases, paralysis

Mesopotamian Medicine Contemporary of Egyptian civilization- 6000 years ago Liver considered the seat of life Demons were considered the cause of disease Herb doctors, knife doctors, spell doctors Hammurabi- the great King of Babylon ( 2000 BC ) formulated The Code of Hammurabi- a set of drastic Health Laws ( Code of Health Practices, fees payable for satisfactory services and penalties for harmful therapy

Greek Medicine (460-136 BC) Four humors: Blood, Phlegm, yellow bile, black bile.

All the humors are assigned temperaments.

The drugs are also assigned temperaments as per their action on the body and are used to correct the body temperament. Aesculapius- a great Greek Physician, Two daughters- Hygeia ( the Goddess of Health)and Panacea ( the Goddess of Medicine ) who gave rise to dynasties of Hygienists & Healers. Hippocrates (460-370BC) the Father of Medicine heralded the era of observation and reasoning How? Why? The Code of medical ethics- Hippocratic Oath

Roman Medicine- mostly based on the Greek system

Middle ages Unani Tibb system (500-1500 AD) Based largely on the Greeco-Roman medical literature translated into Arabic The Arabs developed their own system called- The- Unani System of medicine Therapeutic agents : Developed wide range of syrups, oils, poultices, plasters, pills, powders, alcoholates and aromatic waters Built many hospitals with separate wards for males and females and for different diseases Unani medicine was introduced in India by the Muslim rulers in 6th century AD

Homeopathy Propounded by Samuel Hahnman ( 1755-1843) of Germany (came to India around 1810-1839) Involved the treatment of disease by using small amounts of a drug that, in healthy persons, produces symptoms similar to those of the disease being treated.

Beginning of modern scientific medicine 1. Theory of Contagion (Fracastorious- Italian, early 16th century) 2. Transfer of infection via minute invisible particles from Person to person 3. Miasmatic Theory - Disease attributed to noxious air/ vapors 4. Germ Theory of Disease - 1873 (Louis Pasteur demonstrated germs in the air) 5. Theory of Multi factorial Causation of environmental, psychological factors) Allopathic Medicine The germ theory and the Theory of Multi- factorial causation of Disease lead to the development of a profound scientific body Of knowledge called the Allopathic medicine, defined as Treatment of disease by the use of A drug which produces a reaction That itself neutralizes the disease. Disease- (Social, economic, genetic,

Developments in india during the british period

Until the beginning of 19th century all medical practice in the country was traditional The modern system of medicine started somewhere in the 19th century 1825 1859 Quarantine act was passed Royal commission was appointed to investigate the extremely unsatisfactory

condition of health in the British Army. The commission recommended: Establishment of commissioner of Public Health in each presidency Need for protection of water supplies Construction of drains Prevention of epidemics in civil population for safeguarding the Health of British army in India 1897 The Epidemic Diseases Act was promulgated 1904 Plague commission recommended: Reorganization and expansion of public health Department,

Establishment of lab facilities for research, Production of vaccines and sera Central malaria Bureau founded at Kasauli

1911 Indian Research Fund Association (now ICMR) EST. 1919 Montague Chelmsford Constitutional reforms: Transfer of public health and sanitation and Vital statistics to provinces Decentralization of health administration in India

1930 Est. of All India Institute of Hygiene & Public Health, Calcutta 1935 Health activities were grouped in three Lists: Federal, Provincial and Concurrent 1937 Central Advisory Board of Health set up To co-ordinate public health activities

Drug Act was passed 1943-46 Health Survey & Development Committee (Bhore Committee) submitted its report. This became the basis of most of the health Planning & Development in the country

Developments in the post- independence era

Position at the time of Independence: No formal health policy framed by that time. The system of Health care was rather primitive, mainly curative and the services were provided through: Hospitals and dispensaries in the public sector located mainly in the larger population /urban centers Charity / missionary/trust run hospitals Private clinics of allopathic doctors Practitioners of Alternate Systems of Medicine- Ayurveda, Unani, Homeopathy, Siddha A large percentage of doctors (quacks) with some informal training were practicing medicine not restricted to any particular system of medicine but on the basis of nuskhas passed on over the generations. Medical services for Armed Forces Medical services for railway employees (Limited level)

Development of health services in independent India

In 1949 the constituent assembly adopted the Constitution of India in which Article 246 covered all the Health subjects and Article 47 of the constitution under the Directive Principles of GOI. State Policy States: That the State shall regard the raising of the level of Nutrition and standard of living of its people and the improvement of public health as among its primary duties 1. Formation of Min. of Health & the DG H S at central level and Min. of Health and D H S at state level 2. Est. of Central Bureau of Health Intelligence (1961) 3. Formation of a Central Council of Health with Union M of H as chairman and state health ministers as members, to coordinate the implementation of health policies 4. Appointment of Health Committees from time to time HEALTH COMMITTEES 1946 Bhore Committee (Health Surv. & Develop. Committee)

1962 Mudaliar Committee( Health Surv. and Planning Committee ) 1963 Chadah committee 1965 Mukerji committee 1966 Mukerji committee 1966 Jain Committee 1967 Madhok Committee ( Arrangem. for Maintenance Phase of NMEP) ( Strategy for Family Plg Program) ( Basic health Services at Block level ) ( Hospital Services Review ) ( Review of working of NMEP )

1967 Jungalwala Committee ( Integration of Health Services ) 1971 Verma Committee ( W Gp for Hosp Adm & Eng Set up )

1973 Kartar Singh committee ( Multipurpose Workers ) 1975 Srivastav Committee ( Gp on Med Edu & Supp Manpower )

5. Health activities were carried out on the basis of reports and recommendations of these expert committees. 6. Enactment of various health legislations 7. Formation of professional councils such as IMC, NCI, DCI, PCI, AICTE, ICMR, Central Council for Research in Ayurveda and Sidha 8. Implementation of various National Health programs* NATIONAL HEALTH PROGRAMS 1949 1957 1952 1953 1954 1955 1956 1960 1962 1962 1963 1963 1976 1978 1984 STD Control Program ( Pilot Project ) STD Control Program National Family Planning Program National Malaria Eradication Program\ Diarrhoeal diseases Control Program National Water supply and Sanitation Program National Filaria Control Program National Leprosy Control Program National Goiter Control Program National Small Pox Eradication Program (05 Jul 1975) National TB Control Program National Trachoma Control Program The Applied Nutrition Program National Program for Prevention of Visual Impairment And Control of Blindness Universal Immunization Program Pulse Polio Program Guinea Worm Eradication Program

7. Starting of institutions of professional education and training for doctors, nurses & paramedics for speedy augmentation of trained manpower. 8. Est. of AIIMS, NIHFW, PGIs, National Institute of Virology, Population Council of India, NACO and other Professional institutions 9. Development/ expansion of Health Services for Armed Forces and Railways

10. Introduction of Central Government Health Scheme (1954) 11. The Central Health Education Bureau (1956) 12. Establishment of a system of graded health care Especially in the rural areas by establishing PHCs, CHCs And hospitals and starting a Rural Health Mission in 2005 with targets to be achieved by 2012. 13. Implementation of a National Health Policy in 983, Revised in 2002 14. Enactment of Consumer Protection Act and bringing The Health Services under the Act. (1986) 15. National population Policy, 2000 16. Major boost to indigenous drug industry with more than 2000 drug firms competing with the best in the World

Present health care organization in the country

Policy planning mostly at the central level Legislative Powers divided between Center & States Union List : Professional councils, Professional education & training, Medical degrees, Est. of central institutes Med. Research, Drugs & cosmetics, HOTA, MTP State list : Public Health, Sanitation, Hospitals Concurrent List : Population Control, Family planning, Medical profession, Prevention of transmission of infectious / contagious diseases

B. GROWTH AND PRESENT STATUS OF INDUSTRY The healthcare industry in the country, which comprises hospital and allied sectors, is projected to grow 23 per cent per annum to touch US$ 77 billion by 2012 from the current estimated size of US$ 35 billion, according to a Yes Bank and an industry body report published in November 2009. The sector has registered a growth of 9.3 per cent between 2000-2009, comparable to the sectoral growth rate of other emerging economies such as China, Brazil and Mexico. An increasing number of public and private healthcare facilities are expected to propel demand for the industry, accounting for another US$ 6.7 billion in this period. Indian healthcare market (including healthcare delivery, pharmaceuticals, medical and diagnostic equipment and supplies) currently estimated at US$ 34.2 billion. Healthcare delivery and pharmaceuticals account for nearly 75% of the total healthcare market. Private healthcare is estimated to be the largest component of the healthcare sector by 2012, expected to double to US$ 38 billion by 2012.

Source: The Business World

Table 1.1

The Indian Healthcare market has grown from US$ 22.8 billion in the year 2005, at a CAGR of 16%. Market is expected to grow to US$ 50.2 billion and US$ 78.6 billion by 2011 and 2016 respectively.

Healthcare Market Growth Perspective Share of tertiary care in the total healthcare market is around 15-20%. Market for tertiary care expected to grow at a faster rate, due to rise in complex in-patient ailments such as heart diseases and cancer. The per capita healthcare expenditure in India grew by 9.3% between the years 1993-94 and 2001-02. Public spending on healthcare currently at 0.9% of GDP, expected to double to 2% of GDP.

Source: The Business World

Graph 1.1

With rise in income levels and increasing adoption of health insurance, the demand for tertiary care is expected to grow. The average annual growth in health expenditure by the BRIC countries is estimated at 11% for the 2006-11 period, reaching about US$ 413 billion by the year 2011.

Source: The Business World


Medical Infrastructure Current State Current Hospital beds per 1000 population stands at 1.11. Most private hospitals operate as a proprietorship or partnership business. Corporate Hospitals account for approximately 10% of the total private ownership. Use of technologically advanced diagnostic equipments and excellent infrastructure are making India a medical value travel hub.

Source: India Chronicle: 2007

Table 1.3

Special Economic Zones Under the SEZ Act 2005 Healthcare has been defined as an approved service. For a sector specific zone, a hospital with minimum bed strength of 25 is stipulated and this goes up to 100 beds for a multi product SEZ. With the latest approvals, given by an inter-ministerial Board of Approval, the total number of formally approved SEZ is now at 395, of which, 154 have been notified by the Law ministry. Medical Education & Manpower Indias Advanvtage

Manpower Statistics Number of Doctors - 660,801 Number of Nurses - 1,371,121

Medical Education 229 recognized medical colleges of which 106 were established through the private route 25,000 medical graduates pass out each year 136 medical schools admit more than 6,000 PG trainees in their programs.

Indian System of Medicine :

Increased National Acceptance : Provision and practice of alternative medicine like Ayurveda, Pranic Healing, Aroma Therapy, Music Therapy, Meditation and Yoga. Russia, US, Japan, Australia, Netherlands, South Africa, Argentina, UK, France and Italy have accepted Ayurveda as a medical system and have shown interest in the Ayurveda curriculum and research.

Healthcare Players Now Targeting Smaller Cities : Increasing focus on unexplored regions of India in terms of healthcare. Growing need for improved healthcare infrastructure in tier II & III cities is required. Better access owing to development of new national/international airports e.g. Visakhapatnam, Nagpur

C. FUTURE OF THE INDUSTRY Shift to Lifestyle Related Diseases Incidence of communicable diseases likely to decrease at a fast pace, non-communicable diseases to overtake. In 2006, cardiac, oncology and diabetes collectively accounted for 13 % of the hospitalization cases. In terms of value, these three ailments accounted for 36 % of the inpatient revenues. These ailments are estimated to account for 16.8 % and 20.0 % of the hospitalisation cases in years 2011 and 2016,respectively.

Source: Business line 2007

Graph 1.2

Growing Middle Class and Patient Preferences: Favourable increase in percentage of working class population from 32% in 2006 to 36% in year 2016.Growing general awareness, literacy rates and patient preferences in healthcare decisions. National Health Policy, 2002 laying strong emphasis on the policy goal of better engaging patients in their healthcare decisions.

Source: Crisinfac 2006

Graph 1.3

Holistic Wellbeing Blend of Modern and Traditional medicine Hospitals and wellness centres now looking at a comprehensive and holistic approach towards treating their patients. Tie-ups of hospitals with holistic health centres have helped combine traditional healthcare knowledge and practices with the conventional system

Wellness Centres- As Centres of HolisticWell Being The Golden Palms Spa And Resort Bangalore The Ananda Spa in Rishikesh The Ayurvedgram in Bangalore The Vedic Village: Spa And wellness Centre in Kolkata Soukya in Bangalore

Services Offered in Wellness Centres Diet and Nutrition Gym and Fitness Yoga

Tai Chi (Chinese therapy for improving flexibility, coordination and stress reduction) Herbal Medicine Humour therapy Healing touch therapy Stress Management including Relaxation and Meditation Biofeedback Acupuncture including techniques such as EFT (Emotional Freedom Technique) Pranic and Crystal Healing

Quality Driven Approach: Accreditations It has become an imperative for healthcare institutions in India to guarantee quality healthcare to all. In India, QCI (Quality Council of India) operates the national accreditation structure and obtains international recognition for its accreditation schemes

International Accreditation Bodies Present in India JCI (Joint Commission International) Launched in 1999, Currently JCI surveys nearly 20,000 health care programs through a voluntary accreditation process. The World Health Organization (WHO) designated the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and Joint Commission International as its Collaborating Centre for Patient Safety in 2005.

JCI Accreditated Organizations Indraprastha Apollo Hospital, Delhi Apollo Hospital, Chennai Apollo Hospital, Hyderabad Asian Heart Institute, Mumbai Shroff Eye Hospital, Mumbai Wockhardt Hospital, Mumbai Fortis Healthcare, Mohali

Accreditation Bodies In India - NABH Launched in 2005, NABH is a constituent board of Quality Council of India, set up to establish and operate the accreditation programme for healthcare organizations in India. NABH has standards specific to the Indian healthcare setting, major aspects being the assurance of uniform access, assessment, care of patients and protection of patients rights.

NABH accredited Hospitals B.M. Birla Heart Research Centre, Kolkata MIMS Hospital, Calicut Max Super- Speciality Hospital, New Delhi Max Devki Devi Heart and Vascular Institute, NewDelhi Kerala Institute of Medical Sciences, Thiruvananthapuram Moolchand Medcity, New Delhi

NABH: Accreditations to be launched Blood Banks Diagnostic Centres Dental Hospitals/Clinics Ayurveda Hospitals PG trainees in their programs

Health Cities: The evolving concepts in Healthcare in India

NABH accredited Hospitals Major corporate hospital groups in India are making significant investments in setting up stateof-the-art Health Cities in major Indian cities Around 15-20 Health Cities are expected to come up in India in the next 5 years Health Cities are looking at catering to larger populations by offering facilities such as hotels, residential facilities, recreational facilities of spa, gym and even golf courses Greater emphasis on Education, Research & Development

Source: The Economic times, Reality Plus, July 2007

Table 1.4

Other Health City Plans in the Pipeline MIOT hospitals, Chennai have plans to set up a multispecialty medical city Reliance ADAG has expressed interest in building a 60 acre health city in Kolkata CMCH, Ludhiana has initiated a US$ 12.2 million MediCity project in Ludhiana

Graph 1.3

Hospotels- An Emerging Novel Concept There is an increasing trend of hotels being included within the hospital campus. Medical centres want to provide comprehensive services to their visitors and patients attendants in addition to basic health services. Several large hospitals now also have tie-ups with leading star hotels and airlines for their international patients

Table 1.4

Food Majors Looking at Hospitals for their Outlets Value added service to patients and attendants Hotel and restaurant chains are actively getting into opening food outlets at hospitals

Health Insurance The Indian health insurance market has emerged as a new and lucrative growth avenue for both the existing players as well as the new entrants. According to a latest research report "Booming Health Insurance in India" by research firm RNCOS released in April, 2010, the health insurance market represents one the fastest growing and second largest non-life insurance segment in the country. The Indian health insurance market has posted record growth in the last two fiscals (2008-09 and 2009-10). Moreover, as per the report, the health insurance premium is expected to grow at a CAGR of over 25 per cent for the period spanning from 2009-10 to 2013-14. Current and Future Scenario Revenue attributable to insurance or Third Party Administrators (TPAs) has grown from 2% in 2001-02 to 16% in 2005-06 Total credit billing has increased to 32% in 2005-06 and it is further likely to increase to 50% by 2011-2012 Domestic health policy premiums have shown a 47% increase in the first quarter of 2006 The number of policies issued as Mediclaims, ESIS, and CGHS are 4,631,534, 8,400,000 and 1,040,000 respectively.

Source: The Hindu: Healthcare, 2006

Graph 1.4

Voluntary health insurance market, estimated at US$ 86.3 million currently, is growing fast. Total medical insurance premium income to grow to US$ 3.8 billion by 2012. Over 80 % of private health insurance is concentrated with four leading players ICICI Lombard, Bajaj Allianz, Royal Sundaram and Iffco Tokio

Graph 1.4

Investments in Healthcare As per data released by the Department of Industrial Policy and Promotion (DIPP), the drugs and pharmaceuticals sector has attracted FDI worth US$ 1.66 billion between April 2000 and January 2010, while hospitals and diagnostic centers have received FDI worth US$ 761.18 million in the same period. Healthcare major, Fortis Hospitals plans to invest US$ 53.7 million, to expand its facilities panIndia. Moreover, in March 2010, Fortis Healthcare announced the largest overseas acquisition by an Indian company in the healthcare space. It bought the entire 23.9 per cent stake held by TPG Capital in Singapore's Parkway Holding Ltd for US$ 686 million. Asia's leading hospital chain, Columbia Asia Group, which already has six hospitals in the country, plans to ramp-up its operations in India by opening eight more multi-specialty community hospitals with a total capacity of 800 beds by mid-2012. The group has earmarked a total investment of US$ 177.1 million for the 14 hospitals. Medical Tourism According to a new report published by RNCOS, titled "Booming Medical Tourism in India" released in September 2009, medical tourism in India has emerged as the fastest growing segment of the tourism industry despite the global economic downturn. High cost of treatments in the developed countries, particularly the USA and UK, has been forcing patients from such regions to look for alternative and cost-effective destinations to get their treatments done. The Indian medical tourism industry is presently at a nascent stage, but has an enormous potential for future growth and development. As per the market research report, India's share in the global medical tourism industry will climb to around 2.4 per cent by the end of 2012. Moreover, medical tourism is expected to generate revenue of US$ 2.4 billion by 2012, growing at a CAGR of over 27 per cent during 20092012. The number of medical tourists is anticipated to grow at a CAGR of over 19 per cent in the forecast period to reach 1.1 million by 2012.

Impelling Technology Life cycles of high end medical equipments becoming shorter due to high level of innovation Telemedicine being used by major healthcare providers to provide quality care especially in eye, cardiac and other surgeries for the rural poor in India Teleradiology being used to leverage the time difference advantage with other developed nations

IT Driven Tools and Services in Healthcare Hospital management systems Decision support systems that improve diagnosis and treatment Telemedicine and electronic record generator Current Trends in Medical Technology Micro-processor based implantables in patients CPU-driven technology supported by artificial intelligence Robotics in OTs, Path-labs/Research Laser Technology in surgery Instrumentation in medical and surgical practices Biotechnology, Genomics, Molecular Biology and Stem cell research.

Current Trends in Medical Technology Five on five innovations for cardiac and diabetic patients to be monitored with sensors installed in homes or devices such as mobiles Helping Hand Pill dispenser Virtual Doctor Checkups at home Digital Pen Electronic Medical Records

Areas of Opportunity The fast growth in the Indian healthcare sector has created various pockets of opportunities for investors. An Ernst and Young and another industry body report released in 2007 highlights several such areas within the healthcare sector.

The medical equipment industry is around US$ 2.17 billion and is growing at 15 per cent per year. It is estimated to reach US$ 4.97 billion by 2012.

The medical textiles industry is projected to double to reach US$ 753 million by 2012. Clinical trials have the potential to become a US$ 1 billion industry by 2010 and the health services outsourcing sector has the potential to grow to US$ 7.4 billion by 2012, from US$ 3.7 billion in 2006.

The US$ 2.2 billion Indian wellness services market is expected to grow at about 30-35 per cent for the next five years on the back of rising consumerism, globalization and changing lifestyles, according to an Ernst and Young and another industry body study titled "Wellness-Exploring the untapped potential" released in April 2009. Mergers And Acquisitions M&A route allows healthcare providers with immediate brand recognition and an aggressive scale up in new geographies With M&A, new standards in healthcare services have been ushered in by large corporate hospitals Merger of smaller hospitals and nursing homes with larger healthcare entities has led to better healthcare service delivery Singapore-based Parkway Group Healthcare PTE Ltd. has firmed up plans of acquiring tertiary care hospital projects in Class A and B cities of India, especially in the South with one operational in Hyderabad. The Asian Heart Institute, Mumbai plans to invest US$ 7.32 million for expansion activities and is actively exploring acquisition targets outside Mumbai

Government Initiative The Government launched the National Rural Health Mission (NRHM) in 2005. It aims to provide quality healthcare for all and increase the expenditure on healthcare from 0.9 per cent of GDP to 2-3 per cent of GDP by 2012. During the 2009 Interim budget, the government hiked the allocation for NRHM by US$ 423.7 million over and above US$ 2.5 billion. Moreover, the government announced a US$ 64 million initiative in October 2009 to promote domestic manufacture of medical devices such as stents, catheters, heart valves and orthopedic implants that will lead to lower prices of this critical equipment. According to Union Budget 2010-11, the Finance Minister, Mr. Prefab Mukherjee increased the plan allocation for Ministry of Health and Family Welfare from US$ 4.2 billion in 2009-10 to US$ 4.8 billion in 2010-11. Moreover, in order to meet revised cost of construction, in March 2010 the government allocated an additional US$ 1.23 billion for six upcoming AIIMS-like institutes and upgradation of 13 existing Government Medical Colleges. Exchange rate used: 1 USD = 45.16 INR (as on February 2010) 1 USD = 44.83 INR (as on March 2010)



Founded in 1985, Max India Ltd. is a Public Limited company listed on the NSE and BSE of India with over 30,000 shareholders. Max India Limited is a multi-business corporate entity driven by the spirit of enterprise with a focus on people and service oriented businesses. Prominent shareholders of the company are Mr. Analjit Singh and a leading private equity firm, Warburg Pincus. The balance shareholding is held by the public and Institutional Investors. The companys vision is "to be one of Indias most admired corporate for Service Excellence." Towards this end, it has established businesses that are today recognized as being at the fore front of service excellence, in each of the industry sectors where it operates. Performance, Trust and Service Excellence are enshrined in Max India Groups Vision, Mission and Values

MAX Healthcare- Caring for you for life

Max Healthcare is India's first truly integrated healthcare system, offering three levels of clinical service (primary, secondary, tertiary) within one system. They believe in the concept of total patient care and deliver care by combining medical and service excellence.MAX Healthcare is committed to quality care that not only addresses the illness but also concentrates on the overall wellness of the patients.

Silent feature:
A team of highly qualified and trained doctors, nurses and patient care personnel to provide the highest standards of care A team of highly qualified and trained doctors, nurses and patient care personnel to provide the highest standards of care Over 1500 leading doctors, 280 corporate clients and a patient base in excess of 8,00,000 Clean and comfortable facilities at all locations Fully computerized health records 24 hour - Chemist, Ambulance, Patient Diagnostic and Emergency Services Regular educational and health camps to help educate patients on various health issues, so that they make informed choices A complete preventive healthcare programme - MAX 360 and one of its kind 'Platinum preventive health programme


Establish niche service businesses in Life Insurance, Healthcare and clinical research Life Insurance and Healthcare convergence Rank amongst top three players in each niche Partner with best-in-class world leaders Create trust and service excellence in all Business 1. Protecting Life through its life insurance subsidiary Max New York Life, a joint venture between Max India and New York Life, a Fortune 100 company 2. Caring for Life through its healthcare company, Max Healthcare Institute Limited, a subsidiary of Max India Limited 3. Enhancing Life through its health insurance company, Max Bupa Health Insurance, a joint venture between Max India and Bupa Finance Plc., UK which is set to launch after statutory approvals 4. Improving Life through its clinical research business, Max Neeman, a fully owned subsidiary of Max India. Create trust and service excellence in all Business

In addition to these "life-centered" businesses, Max India manufactures specialty products for the packaging industry through its division - Max Speciality Products. MSP too, has a strong service excellence orientation that strives on building long lasting partnerships with marquee customers.

Max India Group Key Milestones as on 31st March 2009.

Consolidated Revenue CAGR of 57% in 3 years, marking impressive performance The total investment in various businesses of Rs. 1,800 Crore triples to Market Valuation of Rs. 5,000 Crore

The total investment in various businesses of Rs. 1,800 Crore triples to Market Valuation of Rs. 5,000 Crore The total consumer base increased from 2.5 million in 2007-08 to 3.5 million in 2008-09.

Quality initiative, accreditation and awards

Objectives: Satisfying customer needs Enhancement of quality systems Effective performance measurement & compliance systems Continuous Improvement loop Engage every employee in quality drive

FICCI Healthcare Excellence Awards In the inaugural edition of FICCI Healthcare Excellence Awards, Max Super Specialty Hospital, Saket was adjudged one of the Best Hospitals for Excellence in Healthcare Delivery One of the critical criteria for award qualification was to demonstrate some resultbearing initiatives in the hospital, where Max Healthcare presented a Six Sigma project on Improving Fill rate in Pharmacy. Through this project the organization was able to demonstrate significant improvement in medicines fill rate at Max Chemist and reduction in wastages in Pharmacy leading to increased revenue in Pharmacy & resultant improvement in customer satisfaction index. D L Shah National Award on 'Economics of Quality' Max Healthcare received the Prestigious DL Shah National Award on 'Economics of Quality' from Quality Council of India, conferred during the National Quality Conclave held in New Delhi on February 6, 2009. Max Healthcare is the first organization in the country from the Healthcare sector to receive this award. The Award was received by Dr Pervez Ahmed, CEO & MD - Max Healthcare, Shubhra Verma and Ridhi Malhotra.

The DL Shah National Award on 'Economics of Quality' was given to Max Healthcare for a Six Sigma project on standardization and consolidation of housekeeping items. Through this project the organization was able to demonstrate significant improvement in quality by reducing complexity, better resource utilization, better vendor management that resulted in improved efficiency and service delivery to internal customers, patients and ultimately reduced costs. NABH Accreditation for Blood bank The Blood Bank at Max Healthcare was awarded the 'NABH Accreditation for Blood Bank' on February 6, 2009. The newly formed accreditation standard, measures the organizations compliance against stringent criteria on Blood Safety, Process Compliance, Infection Control and Monitoring. "Getting the 'NABH Accreditation for Blood Banks' is the result of the dedication and hard work put in by the entire team working at the Blood Bank, who have untiringly committed to maintaining the highest quality standards. The award is an endorsement of these practices and an overall commitment of Max Healthcare towards these quality benchmarks, said Dr. Pervez Ahmed


Max Super Specialty Hospital and Max Devki Devi Heart & Vascular Institute at Saket, the two tertiary care hospitals of Max Healthcare, are the first two hospitals of North India to have received the prestigious accreditation from National Accreditation Board for Hospital & Healthcare Providers at the 2nd National Quality Conclave in February, 2007. The accreditation is recognition of Max Healthcare's commitment to provide the highest quality of care to its patients. Getting an NABH certification fully endorses the fact that: The quality of patient care at the hospital is ethical, safe and at par with defined levels. The patient's interests are kept foremost. The patient and his/her family's rights are respected. The system reinforces a culture of continuous improvement. Objective criteria are used to provide evidence of high quality of care


Max Labs 24x7 at MSSH, Saket has been accredited by The National Accreditation Board for Testing and Calibration Laboratories (NABL) with effect from 9th April, 2007 till 8th April, 2009. The first surveillance audit of NABL (ISO 15189: 2007) was carried out on 5th and 6thJuly, 2008 successfully. Max Healthcare laboratories have successfully obtained NABL accreditation in the field of medical testing for the following disciplines: Clinical biochemistry Clinical pathology Hematology Immunohaematology Microbiology and serology Histopathology Cytopathology

ISO 9001:2000 & ISO 14001:2004 The value of the ISO 9001:2000 & ISO 14001:2004 certification lies in the fact that it is internationally recognized and is an assurance to the customer/patient that a quality system is in place which the hospital constantly complies with. This certification also ensures that the culture of quality, processes and standardization spreads within the organization leading to 'customer satisfaction' through regular assessment and review.

Five Hospitals of Max Healthcare are ISO 9001:2000 certified. They are located at MHVI-Saket, Max Balaji - Patparganj, Max Hospitals at Pitampura and NOIDA and Max Med Center Panchsheel.

Max Hospital - Pitampura has also been certified for ISO: 14001:2004.

New Projects
Shalimar Bagh Dehradun Bhatinda Mohali Greater Noida Rs. 160 Cr investment at Patparganj 10 expand facility10 400 Beds Rs. 75 Cr investment at Saket to make thee Oncology Program comprehensive through addition of 90 Beds Rs. 60 Cr investment at Dehradun for 150 Bed Multi-specialty Hospital Project Roll out cost of Rs. 980 Crores (Between 2001 to 2009) Funded by: - Max India Warburg Pincus / 1FC / Other Strategic Investors


MAX Super Specialty Hospital, Patparganj Max Super Specialty Hospital at Patparganj has been certified with 'Gold' rating by Indian Green Building Council under LEED rating system for Green Buildings. It is a resource-efficient and environment-friendly building equipped with eco-friendly, energy and water efficient equipments and non-toxic and recycled materials. It is the first of its kind LEED - Gold certified Green Hospital in North India. Infrastructure - Max Super Specialty Hospital, Patparganj is conveniently located amidst the serene environment of East Delhi, approximately 15 kilometers away from New Delhi Railway Station and 35 kilometers away from the domestic airport. It is easily accessible from all the satellite townships of NCT, Delhi Max Super Specialty Hospital, Patparganj is a centrally air-conditioned hospital spread across 13 floors and 2,30,000 sq. ft. covered area with a total bed capacity of 250 beds with Classic Deluxe, Single Deluxe, Standard (twin sharing) and Economy (5 beds). It has one super-specialty Cardiac OT, one dedicated Neuro and Ortho OT, two Transplant OTs and three modular operation theatres, one Cardiac Cath Lab with DYNA CT which is first in Delhi, fully equipped with coronary care unit, Neuro ICU, Transplant ICU, Medical ICU High Dependency Unit, Surgical ICU and Pediatric ICU, Neonatal ICU and Nursery Services & Facilities - Max Super Specialty Hospital, Patparganj is a centrally air-conditioned hospital with a total bed capacity of 250 beds with Classic Deluxe, Single Deluxe, Standard (twin sharing) and Economy (5 beds). OTs & ICUs - Max Super Specialty Hospital, Patparganj has one super-specialty Cardiac OT, one dedicated Neuro and Ortho OT, two Transplant OTs and three modular operation theatres, one cardiac cath lab with DYNA CT which is first in Delhi, fully equipped with coronary care unit, Neuro ICU, Transplant ICU, Medical ICU High Dependency Unit, Surgical ICU and Pediatric ICU, Neonatal ICU and Nursery


New Building FLOOR Basement 3 SERVICE Radiation Oncology IGRT LINAC Brachytherapy CT Simulator Mould Room Basement 2 Staff Parking Mortuary Basement 1 Triage Chemotherapy Day Care Nuclear Medicine Radiology (CT, MRI, X Ray, Fluroscopy, Bone Densitometry, Ultrasound, Mammography) Ground Floor OPD (Consultation Rooms) TMT, ECHO, ECG, PFT, EEG & EMG Urodynamics Sample Collection IPD Registration Optical Room & Laser Room Treatment Room First Floor Medical ICU Surgical ICU CCU Neuro Surgery ICU Cathlab Waiting Lounge

Second Floor

CTVS ICU Transplant ICU OT Complex

Third Floor

Max Labs Executive Office Doctor's Lounge

Fourth Floor

HDU 1 Bed No : 1401 1431

Fifth Floor

HDU 2 Bed No : 1501 1532

Sixth Floor Seventh Floor

Bed No : 1601 1634 Bed No : 1701 1732 VIP Suite

Eighth Floor

Bed No : 1801 1832 VIP Suite

Ninth Floor

Bed No : 1901 1932 VIP Suite

Table 2.1

Old Building FLOOR Basement SERVICE MRD Pharmacy Bio-Medical Engineering Physiotherapy House Keeping Engineering Laundry Ground Floor Accident and Emergency Short Stay Unit (SSU) Registration/Reception/Admission OPD Chemist Blood Bank Administrative Block Pathology Lab Kitchen Waiting Lounge First Floor PHP Lounge OPD TMT/ECHO/ECG/PFT/EEG Dialysis IP Billing/TPA Help Desk Intensive Care Unit (ICU1) Bhai Mohan Singh Wards Bed No : 2204-2212 Bed No : 2214-2227 Bed No : 3201-3209

Second Floor

Cath Lab Intensive Care Unit Coronary Care Unit Bed No :2304-2314 Bed No : 2316-2335 Bed No : 2399A-2399C

Third Floor

Minor OT Operation Theatre Surgical ICU CTVS ICU Neuro ICU Neo-Natal ICU Paediatric ICU Nursery Labour Room Bed No : 2406-2416

Table 2.2

Bed Capacity New Building Census / Service Noncensus Census Medical ICU Surgical ICU CCU Neuro- Surgery ICU CTVS ICU Transplant ICU HDU 1 Bed No : 1401 - 1431 (SR - 21, DR- 8) HDU 2 Bed No : 1501 - 1532 (SR - 21, DR- 8, Economy- 5) Bed No : 1601 - 1634 (SR - 23, DR- 8, Economy- 5) Beds 12 8 10 8 7 2 8 29 4 34 36

Bed No : 1701 - 1732 (SR - 21, DR- 8, Economy- 5, 35 VIP Suite- 1) Bed No : 1801 - 1832 (SR - 21, DR- 8, Economy- 5, 35 VIP Suite- 1) Bed No : 1901 - 1932 (SR - 21, DR- 8, Economy- 5, 35 VIP Suite- 1) Subtotal (Census Beds) Non Census Triage Chemotherapy Day Care Treatment Room Subtotal (Noncensus Beds) Total Beds (Census+Noncensus) 263 8 8 2 18 263

Table 2.3

Super Specializations Cardiac services Oncology Neuro sciences Urology & kidney transplant

Specialty Services and Surgeries Specialty Services Interventional Cardiology Nephrology including Dialysis Emergency and Trauma Services Maternity Services Nuclear medicine Psychiatry Dentistry Pediatrics Dermatology Internal Medicine Chronic Care Programmes in Diabetes, asthma, Arthritis and Hypertension Blood Bank Comprehensive Diagnostic Services Fully Automated Pathology Laboratory Audiometry 24 Hour Pharmacy

Surgery Aesthetic & Reconstructive Surgery CTVS

Dental Surgery ENT Facio Maxillary Surgery General Surgery Gynecology Minimal Invasive Surgery Neurosurgery Ophthalmology Orthopedics and Joint Replacements Pediatric Surgery Urology

General services Cardiology dentistry dermatology endocrinology eye and ENT gastroenterology & endoscopy GI Surgery General & minimally invasive surgery internal medicine mental health services orthopedic trauma and joint replacement oncology (medical and surgical) Neurosurgery neurology obstetrics and gynecology pediatrics nephrology pediatrics endocrinology

pediatric surgeon neonatology Pediatric development & behavior Physiotherapy & rehabilitative services Plastic surgery Pulmonology Nephrology & dialysis services

Other Facilities Rheumatology Vascular surgery

Diagnostics 4D ECHO Light 3D USG 16 Slide CT LINAC Brachytherapy 3D Mapping EPS Ensite Velocity 3D Mapping EPS IMRT & IGRT (Dual Energy Linear Accelerators) Cone Beam CT Scan (On Board Imager) Immunoassay Analyzer Chemi luminescence Analyzer State of Art Biochemistry Analyzer DX 800 Gamma Camera

Diagnostics - Radiology Services Urology MRI Unit X-ray

High-resolution ultrasound Mammography Bone densitometry

Cardiac Services Angiography Angioplasty EP Study RF Ablation with 3D Mapping

Diagnostics Cardiology Echocardiography 2-D color Doppler ECG TMT holter monitoring Angiography

Diagnostics Pathology Max Preventive Health Programme At Max Super Specialty Hospital, Patparganj, they are totally committed to the age old adage 'Prevention is better than cure'. Our Preventive Healthcare Programme comprises a comprehensive set of tests, which have been specially designed keeping your needs in mind.

Endoscopy Procedures Dialysis Services and Renal Transplant Unit The hospital has a specialized dialysis unit conforming to international standards to provide haemodialysis to patients who have reached end - stage kidney disease, requiring renal replacement therapy

TPAs Emergency services

Highly trained ambulance staff World-class communication infrastructure Fully equipped advanced cardiac life support ambulances State-of-the-art emergency response and management system Common emergency telephone number - 4055 4055

Lab Services 24 *7

Max Labs is a 24x7 facility providing services for Max Patients, walk-in patients and non-Max clients as well.



1. Apollo Hospitals Enterprise Ltd Manages a network of 41 specialty hospitals and clinics with a bed capacity of over 9,000 across the country and abroad Besides the recently launched Health City in Hyderabad, plans to launch similar facilities pan India Has tied up with insurers like BUPA (UK), Vanbreda (Belgium) and Mondial (France) to direct inflow of foreign patients to India Joint venture with Singapore-based Parkway Group Healthcare PTE Ltd. Has tied up with Indian Oil Corporation (IOC) to set up its pharmacies at the latters petrol stations.

Apollo Group : Business structure Service Brand name No. of units 25 15 50 415 Retail Pharmacy- Direct access to patients, low capital requirement for hospital pharmacies, higher bargaining power with pharma companies. Access to huge medical network; helps expand reach and achieve growth Access to patients, medical network, and claim processing Caters to health Information needs of U.S. based Physician groups and hospitals Details Has hospitals all over India and abroad

Hospitals Owned Apollo Hospitals Managed Clinics Pharmacy Apollo Clinics Apollo Pharmacies


Apollo Telemedicine Networking Foundation (ATNF) (As a TPA) Apollo Health Street

Over 60 -

Insurance Outsourcing (BPO)

2. Fortis Healthcare Has a chain of hospitals with an installed bed capacity of about 1,790 beds Operations across North India - Delhi, Noida, Mohali, Amritsar, Faridabad, Raipur and Srinagar Expansion plans through mergers and acquisitions Has a joint venture with Real Estate player DLF to set up hospitals across the country with an investment of about US$ 1.5 billion Owns a pharmacy chain by the name of Fortis Health world and plans to open 250 outlets with an investment of US$ 195 million all over India Has announced the signing of a definitive agreement (the pre-IPO) for allotment of 670,000 equity shares to VASCO Inc. for an investment amount of US$ 2.6 million

3. Wockhardt Hospitals 8 hospitals across India, of which 5 are owned Total bed size of the group is 1,390. Has tie-ups and association with Harvard Medical International: USA, Blue Cross And Blue Shield: USA, Bupa: U.K., AEA International: Singapore and others. Plans to build 15 new multi specialty hospitals in Tier-II cities in the country. Public-Private Partnership with the Government of Gujarat to manage the 275-bed Palanpur Civil General Hospital in Gujarat Company plans an IPO by the end of this year

4. Manipal Health Systems Chain consists of 1. 9 primary centers at 7 rural locations 2. 8 secondary hospitals at urban and semi-urban locations 3. 3 tertiary hospitals at urban and semi-urban locations.

MHS is building another 600-bed multi specialty hospital in Devanahalli, Bangalore Joint venture with Pantaloon Retail for comprehensive retail healthcare foray Plan to invest over US$ 195 million in healthcare business in the next fve years.

5. Narayana Hrudayalaya First-of-its-kind cardiac care hospital in Bangalore, set up by the Asia Heart Foundation (AHF) Capability to perform 25 major heart surgeries and over 20 cardiac catheterizations a day Hub for telecardiology networks with a Joint Venture between the Governments of seven hill states and West Bengal, Karnataka Health Systems and ISRO A 5,000-bed Health City is coming up at, Bangalore, which will comprise of 10 hospitals

6. Columbia Asia First healthcare provider to enter through the FDI route Opened the frst community healthcare multi-specialty facility at Bangalore Planning to invest US$ 15. 85 million to set up more hospitals in Bangalore, tied-up with GE, to collaborate on a number of initiatives for creating a medical institute of world-class standards

7. Global Hospitals The US$ 9.75 million facility functions from 2 locations in Hyderabad Invested US$ 36.58 million to set up BGS Global Hospital in Bangalore Tied up with the Sureka Group, to set up a 300-bed transplantation and tertiary care centre in Kolkata, planning to establish a US$ 240 million health city in Chennai on the 46-acre hospital site

New Entrants/Key Foreign Players

1. Artemis Health Institute Delhi-based Apollo Tyres has made a foray with the launch of its US$ 48.78 million project, Artemis Health Institute in Gurgaon First hospital in entire northern India to offer Image Guided Radiation Therapy (IGRT) to its patients. Artemis plans to grow into a 10-hospital chain by 2012 2. Naresh Trehans MediCity Reputed medical professional, Dr Naresh Trehan, is promoting a US$ 250 million world-class integrated healthcare facility known as MediCity Has been envisioned as a multi-disciplinary high-tech medical institute spread over 43 acres in Gurgaon Apollo would examine the possibility of investing in the proposed MediCity and merger of the MediCity with Apollo Group may also considered in the future

3. Aditya Birla Memorial Hospital A multi-specialty hospital located at Pimpri-Chinchwad in Maharashtra The quaternary healthcare centre with 500 bed facility is spread over 16 acres

4. Reliance ADAG Healthcare A 700 bed facility in Mumbai inaugurated in 2007. Planning a pan India chain of hospitals; has begun talks with leading private hospitals in Delhi, Mumbai and Bangalore for possible acquisitions and joint ventures

Foreign Players
Harvard Medical International and Cleveland Clinic have entered the country through joint ventures Pacific Healthcare Holding has opened their first hospital in Hyderabad. Parkway Group from Singapore, Emaar from the Middle East and Prexeus Health Partners from the US have announced plans


45000 40000 35000 30000 25000 20000 15000 10000 4658 5000 1296 0 02-03 03-04 108.49% 04-05 72.39% 05-06 194.98% 06-07 78.30% 07-08 52.03% 08-09 13.48% 2702 13740 24499

42265 37246

Graph 2.2 Facility- wise Revenue FY08-09


12,000 10,000 8,000 6,000 4,000 2,000 0

PSH-N PSH-S PPA NOD PPG GGN 1,354 532 3,288 1,796 3,111 7132





Revenue (Rs/Lacs)

Graph 2.3

Facility- wise Admissions & Surgeries FY08-09

15,000 11,928 12,000 8613 7,276 6,000 3,473 3,000 NOD PPG GGN PPA MHVI IAMS MSSH 4,923 3638



No of Surgeries

Graph 2.4 Facility-wise Occupancy FY

100 80 60 40 20 0



81 45 53



Avg Occupancy/ Percentage (%)

Graph 2.5

Facilities to be rolled out Speciality / Multi-Speciality Tertiary / Super-Tertiary



Shalimar Bagh

Greater Noida


Saket South

No of Beds






Table 2.1


3.1: STUDENTS WORK PROFILE (ROLE AND RESPONSIBILITY), TOOLS AND TECHNIQUES USED Human Resource is that element within a company which deals with the human aspects/needs of workers. At Max Super Specialty Hospital, it was fortunate to undergo training and enhance knowledge in the Human Resource department. Work profile: As a management trainee here at first the overall induction of the department was done by the Guides and gave us a picture of what will be the work profile during the training period. Further ground level work was started, which included work like file management, understanding the forms and formats and their importance. The employee files according to the centralized checklist were checked. Understood the proper way of managing the data as it involved the management of the original documents of the new employee and learned the proper numeric segregation of the different employees in different departments as per their employee ID. Apart from the file management there were various other ground work like distributing tea/coffee coupons to the employees at the start of the month and maintaining the registers like Trainees attendance Missed punched entries New joinee attendance Outdoor duty entries Grievance register Accidents etc. Sometimes calling was done to the employees for different issues like submission of their documents, salary account opening, scanning of finger prints of new employees for the biometric system or any other required information was cleared through telecommunication. Other than the groundwork some other HR functions were handled like joining formalities of nurses, pharmacists, support staff and physician. The new employees were helped in understanding the various forms and format. And an idea about the insurance benefits and other

benefits like provident funds and gratuity was given and an employee manual was handed over to them for detailed information about MSSH and various other rights and benefits. Along with all the crucial HR functions other activities like Employee Engagement were also observed and participated with the HR team. Tools and techniques used during training: Learned working on HRIS (Human Resource Information System) Data entries were done in MS Excel like making dependent details for insurance and various other details were entered in HRIS through excel sheet.


A. Recruitment Policy
It is to ensure that persons of the right caliber and talent in terms of qualifications, skill, experience, attitude and competence are recruited to the organization so as to effectively deliver medical care and service of the highest standards of excellence. To provide guidelines and standards for company recruiters to follow so as to ensure that there is consistency in recruitment practices across different functions/programs. It is to ensure transparency, accountability and responsiveness in the recruitment process. All recruitments shall be anchored by HR of the relevant Unit/location.

Selection process Manpower requirement prepared in consultation with Business/Function Head HR raises hiring request through online system

HR posts vacancies

Interested Employees apply

HR shortlists CVs and sends to Div/Fun Heads

Permission of current Div/Fun Heads


Interviews conducted
Rejected External sources are used

Divisional Heads shortlists the candidates

Transfer orders given

A candidate shall go through one or more assessment processes that may or may not include assessment / aptitude / IQ / skill tests and interview conducted by a panel of more than two senior employees, including the function/ program specialist. The interview proceedings will be recorded in the interview evaluation form. Final recommendations of the panel will also be recorded on the form. All personnel short-listed for PL4, ML3 and Leadership levels shall invariably be met by the Functional Chief/Director and Chief of HR, before a final decision is taken.

Reference Checks As the name suggests, it is the process of screening / verifying a person's background information prior to employing him in your organization. All the candidates who have been selected for the final round of interview are supposed to provide the HR dept. two professional references. Hiring an undeserving candidate can unnecessarily increase costs, harm the organizations harmony and put confidential information into jeopardy and thus, according to the policy guidelines, reference checks are made compulsory. This ensures that before the candidate joins in, his conduct and his professional capabilities are checked. This would assist the selection process. Pre-employment Health Check-up All employees joining Max Healthcare or its associate or partner hospitals are required to undergo a complete medical examination. This is to ensure that they are of sound health so as to carry out safely and effectively the requirements of their job. Outstation candidates may be permitted to get the pre-employment investigations done outside Max Healthcare but will be required to submit the reports for review by a Max Healthcare physician. Investigations done outside Max Healthcare should be from a Hospital/Nursing home established for indoor care and treatment of sickness and injuries which, has been registered either as a hospital or nursing home with local authorities, is under the supervision of a registered and qualified medical practitioner and has at least 15 inpatient beds. The cost incurred for preemployment check up, to the limit prescribed, will be borne by Max Healthcare.

Rehiring An employee who has left Max Healthcare may be rehired provided he has the relevant qualifications and competence for the role. The decision on rehire shall only be made after a due process of selection. In deciding on the rehire his/her performance while in the company earlier shall be considered; and only if their performance as evidenced from previous records is seen to be fully competent and effective shall they be hired.

Internal Job Posting (IJP) Before notifying a vacancy externally in Operation Levels and Professional level 1 HR shall invariable issue an Internal Job Posting (IJP) inviting applications from qualified internal candidates. Employee applications against IJPs shall be routed through the Unit HR who shall obtain the approval of the reporting Manager before forwarding it to the sourcing HR organization. Applications that are not approved and forwarded by the Reporting Manager shall be forwarded to the Home HR office for information. Candidates who apply through IJP would need to qualify the normal selection process to be declared fit for appointment. Employees selected against an IJP shall usually be relived within 30 days of selection.

Hiring, of Employee Relatives The company does not discourage recruitment of family members (i.e. immediate blood relatives & spouse) to the organization. However, specific approval will be required from the CMD's office for the appointment of a relative of an employee. A relative shall not be recruited to a role where the employee can directly or indirectly influence decisions concerning recruitment, employment, promotion, or compensation of the relative.

B. Pre-engagement medical check-up policy The Pre Engagement Health Checkup is designed to assess the medical fitness of prospective candidates prior to their engagement & Institute Preventive measures that will reduce individual risk and ensure safety in workplace.

a) It is Mandatory for all defined in the applicability to undergo Medical Examination before joining duties, b) HR keeps a record of the names of applicable that have been sent for Pre-engagement Health Check-up. c) At the time of issuing offer of association, the candidate will be handed over the Max Healthcare Pre Engagement Health Check up Performa Instruction sheet & Preengagement Checkup Performa, d) The Performa Instruction Sheet will be signed by the HR Manager, e) The candidate will report to the hospital on the scheduled date and time (intimated to him/her by HR) along with Pre engagement Health Check up Performa Instruction sheet & Pro engagement Checkup Performa. f) All the candidates will have to furnish the desired details and declaration in the part 1 of the Max Healthcare Pre engagement Health Check up Performa. No further process will take place if the part 1 of the Performa and declaration is not duly filled and signed by the candidate. Consent of the candidate will be taken for sharing the results of the pre engagement tests with the company. g) The company will bear all the cost incurred for the Pro-engagement Health Check-up. h) Declaration of being fit / unfit is confidential and will be shared only between the doctor, Candidate and the HR Manager. However, the reports With all the documents must reach to HR within 48 hours from the date of check-up.

The Duty Manager of the concerned hub will ensure that all the Pre engagement health reports must reach to Home/Unit - HR for personal records within the stipulated period of time. If the candidate is declared unfit, the doctor will have to define reasons for the same. The medical report will be sent to the HR Manager who in turn will send the report to the Head HR /operations Head for a final decision. The time taken from report submission to HR, then to the Head HR and back to HR will not exceed 71 working hours. The HR Manager will convey the result to the candidate. A copy of the medical reports will be handed over to the candidate. No infectious markers will be taken up for Pro-engagement tests. If during the examination of the candidate, the RMO / FP require the need for any additional investigation, s/he can do that within cost of Rs. 1000. If any investigation will cost more than Rs. l000, prior permission will

be taken from the HR Manager. If at this moment, the HR Manager and the Operations Heads in consultation with the RMO / FP feels that die candidate is not suitable for the job as his / her medical condition can result in disruption of the duties, the candidate will not be selected for the job. The HR manager will convey the same to the candidate. If it is found during the course of association that the candidate has willfully withheld information with regard to his health that interferes with his work, his/her association will be terminated with immediate effect without assigning any reason.

C. Provident fund Employee Provident Fund is a social security benefit to employee by compulsory saving by an employee during his employment. a) Under Provident Fund rules in which employer and employee make equal contributions to a Provident Fund Account. b) An employee who was not previously a member of the Provident Fund Scheme will be required to join the scheme. c) The entire contribution amount gets deposited in a PF trust named Max India Employee Provident Fund Trust. d) Under this rule Family means: i. In case of male member - wife, children, dependent parents, and deceased son's widow and children. ii. In case of female member husband, children, Dependents dependent parents and Deceased son's widow & children. (e) A member of Employee's Provident Fund covered under following scheme: i. ii. iii. Employee's Provident Fund Employee's Pension Scheme Employee's Deposit Linked Insurance parents, husband's

Employee's Provident Fund Scheme New Employees are required to fill in form no. 2 (PF Nomination Form) and if they are already a member of the Provident Fund Scheme they are required to fill in form 13 for transfer of PF funds to Max India- Max Healthcare. Loan against Provident Fund a) An individual may take a non-refundable loan against his/her Provident Fund, provided he/she has completed five years of membership of Provident Fund and has a minimum balance of Rs l000. b) A period of three years must elapse before a second loan is granted. c) Not more than three advances/loan shall be admissible to a member up to his date of Superannuation age under this rule. d) Loans may be granted for the following purpose. i. ii. iii. iv. v. vi. vii. For the construction or purchase of a home, For medical expenses in case of ill-health For wedding or the post-matriculation education of children For individual in whose homes the electricity has been cut. For payment of physically handicapped individual For the financing of an individual's life insurance policy To meet any unforeseen expenditure in case of damage caused to property by neutral calamities of an exceptional nature. viii. To pay the cost of overseas passage for any member of the family.

To defray the expenses of wedding, funeral or any other ritual which he or she performs.

Transfer of PF Account A provident Fund member, on leaving an establishment and joining another establishment can seek transfer of his Provident Fund Balances to his new Provident Fund Account. He/she has to fill up Form 13 and by submit it to present employer. Final Withdrawals a. A member of the Provident Fund may withdrawal the full amount to his/her credit in the following circumstances: b. On retirement from service after attaining the age of 58 years.

c. On retirement on account of total and permanent incapacity due to bodily or mental infirmity duly certified by medical officer. d. Migration from India for permanent settlement abroad, or for taking employment abroad. e. On death of a member, the Provident Fund Amount is payable immediately to the nominee/s if there is no valid nomination the Provident Fund Amount is Payable equally to all the eligible member of his Family. f. On termination or retrenchment of employment. g. On availing of a voluntarily retirement scheme offered by the company.

Employee's Pension Scheme A member is required to fill nomination form (form no, 2) providing details of person who are entitled to receive the pension in the case of the member's demise. An unmarried member may nominate a person entitle to receive the pension benefit. Later on, when the members acquire a family/ such a nomination will become redundant. It is a responsibility of an individual to inform the pension authorities when there is a change in their family status.

Pension Amount Pension amount depends on two elements: (a) Pensionable salary: It is the average of an individual's salary during his/her last 12 months service. (b) Pensionable service: It is the period of service during which a contribution to the pension fund made. The Formula for Calculating Pension Pensionable Salary X Pensionable Service = Monthly Pension 70

Out of 12% of employer's contribution in PF 833% go to pension account. As per provision of Employee Pension Scheme 1995 out of the total contribution made by the employer, 833% or Rs. 541/- (or such percentage or amount prescribed by EPS time to time) whichever is less will be transferred to Pension Fund maintained by the RPFC.

Pension Claim Form 10 C for withdrawal before completion of 10 years & Form 10 D in the following cases: a. On total or Permanent incapacity (irrespective of service period) b. After rendering 10 years of service and on leaving the service between 50-57 years. c. In Case of death, nominee/Family member can use. d. The form 10 D should be forwarded only through employer and age of children should be supported by the school certificate. e. To Claim the Family pension widow may submit only one application on his/her behalf and on behalf of two children. Pension once sanctioned passed on to all the eligible beneficiaries. f. On grant of pension, the member will be informed. He may collect his copy of Pension Payment Order from disbursing agency (Bank/Post Office).

D. Gratuity To provide retrial benefit to employees as recognition of continuous service, a separate gratuity trust has been created for Max. The trust has taken a gratuity policy from the life insurance corporation of India.

1. Every employee, irrespective of his salary on completion of five years continuous service is entitled to receive gratuity 2. Gratuity will become payable at the time an individual's service is terminated either upon. a. Superannuation b. Retirement or resignation c. On death or disablement due to accident or diseases. 3. The condition of five years of continuous employment is not necessary is service is terminated due to death or disablement. 4. When an employee completes one year of service, he/she is required to submit Form F in duplicate to the company, within 30 days of the completion of one year of service. Employee may change the nomination of his/her gratuity by filling out form H, in duplicate to the company.

5. The amount payable as gratuity is calculated by multiplying 15 days salary by the number of years of service which an individual has completed. 6. As soon as gratuity becomes payable the company is to determine the amount due to an employee. The company must give notice of this to die employee or his/her legal heir in Form L. This form is also to be sent to the controlling authority of that area. 7. Gratuity is to be paid in cash or by demand draft of cheque, along with the interest thereon. If the gratuity amount is less than Rs.1000/- it may be paid by postal money orders if the employee desires. 8. Gratuity is payable at the rate of 15 days salary for every year of completed continuous service. For This purpose, salary* is to be considered to be basic salary plus dearness allowance as per last drawn salary'. A month, for this purpose is taken to be 33 days. For example; an employee who has completed 20 years of continuous service and whose basic salary as per last drawn salary is Rs. l0000 then his gratuity calculation will be as under:

15 x20 no. of years of completed service) Rs.l0000 (Last salary drawn 26 Total Gratuity amount will be Rs.115383/-

= 115385

9. In the case of the death of an employee, the gratuity is payable to his/her nominee. In case an employee dies before completing 5 years of continuous service, gratuity is nonetheless due to his/her nominee. Nomination is defined as specifying a member of his/her family to receive the gratuity due to an employee in case of his/her death. 10. Gratuity may be forfeited in entirety if an employee is found guilty of misconduct during the course of employment.

Procedure to Claim Gratuity A separating employee eligible for gratuity will make an application to the Company for Payment of Gratuity as per Form I (Annexure-T). The form duly filled will be submitted to the HR Department on the day of separation.

E. Accident insurance policy In order to provide financial security to employee or his/her dependents in case of untoward incidence. This policy offers compensation in case of death or bodily injury)' to the insured person, directly and solely as a result of an accident, by external, visible and violent means. Bodily injury means any injury resulting Permanent Total disablement or Temporary Total disablement or Permanent Partial disablement.

Capital Sum Insured against individual BENEFITS - PERSONAL ACCIDENT Band OLVOL2&OL3 PL1 Pl_2,PL3,MLl&ML2 ML3 & Above Rs.200,000 Rs. 400,000 Rs.700,000 Rs. 1200,000 Self

From December 2006 onwards the policy is renewed as per above mentioned table. Physical loss to an individual due to an accidental injury' (including fatal).When an accident injury being the sole and direct result (during the period of insurance) in:

Types of casualties Death Permanent Total Disablement

Capital Sum Insured 100 % of Sum Insured 100% of Sum Insured

Loss of two limbs/Two eyes or one 100 % of Sum Insured limb and one eve Loss of one limb or one eye Permanent Partial Disablement 50% of Sum Insured Depend on the kind of disablement

Procedure Intimation of fatal or serious accident should be intimated to HR Department within 24 hours of its occurrence. In the event of such case, the claim form duly filled in, along with necessary

Documents. death certificate, permanent total disability of permanent partial disability, police FIR, panchnama, doctor certificate, sick leave record, percentage loss of capacity assured by competent doctor or medical board etc. as the case may be, should be submitted to HR Department as soon as possible for claim.

Policy will not pay under following cases i. Compensation under more than one clause for same period of disability not exceeding capital sum insured. ii. iii. iv. Any payment after admission of a claim for 50% /100% of Capital Sum insured, Any claim in the same period of insurance exceeding the Capital Sum insured, Suicide, attempt there at, VD, criminal breach of law, accidental death/injury under influence of liquor/drugs, v. vi. vii. Pregnancy related claim, War and nuclear perils, Circumcision or structures or vaccination or inoculation or change of life or beauty treatment of any description or dental or eye treatment or nervous breakdown or intentional self- injury.

F. Probation & Confirmation

To provide the company and the individual opportunity to understand the job role completely and assess whether there is a fit both in terms of expectations of the role and demonstrated competence on the job. All new employees shall be on probation for a period of 6 months, unless otherwise stated in their appointment letter. During this period the employee will have opportunity to understand the demands of the role and demonstrate competence and the company will have opportunity to assess fitness of the person for continuance and confirmation in the role On completion of six months service, an employees' performance during probation shall be assessed and if found satisfactory and effective his services shall be confirmed. The Employee Manager/ Department Head shall be responsible for assessing an employees performance during probation. HR shall facilitate this process and shall make available to the Manager the Probation Appraisal Form to conduct the assessment

An employees' services may be terminated or probation extended if his performance on job is not found satisfactory. Probation period shall generally not be extended beyond 6 months. The company's decision on confirmation of services or extension of Probation or

termination, as the case may be, shall be communicated to the employee in writing.

G. Leave policy To provide all employees with the opportunity to take time off from work for rest and recreation, to fulfill social obligations, to meet personal needs and avail leave in case of illness, For the purposes of this policy the Leave year shall run from April to March each year Employees are eligible for following Leaves: Personal Choice Days Sick Leave Maternity Leave Public & Restricted Holidays 28 working days for every completed year of service 08 days for every completed year of service As per Maternity Benefit Act,1961 As per list of holidays circulated by HK department in the beginning of the year.

Personal Choice Days An employee may earn a maximum of 28 days Personal Choice Day Leave per Financial year. (a) For Existing employee, Beginning of every month ( on or before 05th day of the month) 233 leave credited in Employee's Account (b) An employee intending to avail PCD shall apply at least 5 days before he intends to go on leave. (c) PCD may either be suffixed or prefixed to weekly off or Paid Holiday. (d) If an employee falls sick either during the period of sanctioned PCD and he is desirous of applying for extension of leave, then in such cases, he may be sanctioned only PCD to the extent it is in his credit and thereafter Sick Leave may be sanctioned if due to him. (e) If any weekly off or Paid holiday falls during the period of sanctioned PCD the same shall not be treated as PCD.

(f) An employee is encouraged to avail leave credited to his account each year. If because of certain operational problems he is unable to avail the leave during the year, 15 or unutilized leaves (whichever is minimum) of each completed year will be carried forward to the next year. The maximum accumulation in his account inclusive of leave credited in the year cannot exceed 45 days. Leaves not availed or carried forward shall lapse at the end of the year. (g) An employee shall normally not be eligible to avail PCD during the Notice Period. (h) On the day of leaving the services of the company by way of superannuation or otherwise, the PCD to the credit of employee shall be encashed. (i) PCD cannot be encashed during employment with the company. (j) Advance PCD may be sanctioned at the discretion of the Departmental Manager in the following circumstances: i. ii. iii. On the occasion of an employees wedding Serious illness, Death in the family.

If an employee leaves the organization in midyear then Advance PCD availed in excess of prorata eligibility shall be adjusted in his/her full and final settlement of accounts.

Sick Leave

(a) An employee is eligible for 8 days Sick Leave (SL) per annum. (b) Beginning of every month (on or before 03" day of the month), 0.66 leave credited in employees' account. (c) Sick leave may be accumulated up to a maximum of 32 days, thereafter, further accumulation will automatically lapse. (d) SL may either be suffixed or prefixed to weekly off or Paid Holiday (If any) and weekly off or paid holiday falls during the period of SL the same shall not be treated as SL. (e) Sick leave taken for duration of more than 3 days shall be accompanied by a Medical Certificate from a registered Physician. (f) If an employee on Sick Leave is desirous of extending leave, extension may be granted to the extent of Sick Leave to his credit and thereafter SL may be sanctioned if due to him.

Leave Encashment on Separation: At the time of separation of employee, leaves in employee's account will be encashed on Basic management/Executive non-practicing allowance.

Unauthorized Leave/Absence: (a) Absenteeism from work without any communication and approval from concern authority

will be considered as unauthorized leave/absence. (b) All such unauthorized leaves will be considered as Leave without pay and if any weekly

off or holiday falls during the period of unauthorized/leave absence then the same shall not be treated as PCD.

I. Local Conveyance Policy

The objective of the conveyance reimbursement policy is to ensure that employees have the means to move from one place to another while traveling for company's work within Delhi & NCR. Reimbursement Entitlement (a) Employee using their own conveyance for official work shall be reimbursed on cost incurred as per the following rules; (i) four wheeler for business purpose: Rs5 per KM. (ii) Two wheeler for business purpose: Rs.2.5 per KM. (b) Employee using Public Transport for official work shall be reimbursed on cost incurred on the basis of their band eligibility.

Band ML3 & above PL l, PL2 PL3, ML1 & ML2 For operational level (OL1, OL2 & OL3) Taxi Taxi


Auto Rickshaw/Bus fare up to reasonable limit

(i) All travel beyond 500 kms (one way) is considered long distance travel and is covered by the domestic travel policy. (ii) Travel between any of the company's offices and an individual's residence is not considered local travel. Local conveyance reimbursement cannot be claimed if the employee is visiting any of Max locations directly from his/her residence. In case, the distance between employee's residence and the location visited for official purpose is more than the distance between the employee's residence and the deputed location, the employee can claim the differential amount.

J. Inter-Unit Transfer
Transfer refers to the redeployment of an employee from one Unit/location to another with the purpose of optimum utilization and retention of Human -Resource Organizational need. The company reserves the right to shift or redeploy an employee from one location to another to meet organizational / business needs. In case of movement of employee from Max Healthcare to other entity or vice versa then his/her monetary interest will be safe guard as per below mentioned rules:

An employee who seeks a transfer from one location to another may send his application for the same to the Head/Manager HR of the location who shall consult the employees reporting Manager and forward the application to recipient location HR Head/ Manager for need based action during the year. The transfer shall be considered only if there is an approved and budgeted position.

K. Performance appraisal policy

It is the company's endeavour to have appropriate systems and processes in place that help to align employees energies and efforts to organization goals and objectives. One such process is the Performance Appraisal Process. The Performance Appraisal process is a formal structured process wherein the employee has opportunity to discuss and obtain feedback from his/her Supervisor on his/her performance during the previous year, to understand how best his/her performance can be enhanced to achieve team & organization objectives, to share his/her views on support required to enhance performance and to plan his/her work efforts for the year ahead.

Performance Year A formal Employee Performance Appraisal is conducted at least once every year. The Performance Year for the purposes of Appraisal runs synchronous with the financial year i.e. from April to March each year. Performance Parameters Employee performance is evaluated on the following six parameters Patient / Customer Care Revenue Growth/ Cost Management Business Process Orientation & Documentation People & Learning Job Knowledge Discipline

The Annual Employee Appraisal also includes a section wherein the following behavioral attributes & values displayed by an employee at work are also assessed to ensure that results are delivered in accordance with Max Values and tenets.

Quality Orientation Team work Caring Integrity Transparency & Openness Process

The Appraisal process shall be conducted at the end of each performance Year usually during the period April to June each year. There are four players in the process the employee, his/her Manager, Functional Manager and the reviewer and accepting authority. The employee will have opportunity to self appraise, thereafter he/she discusses his/her performance with her/his Manager & Functional Manager to arrive at a performance rating for the year gone, the performance comments and rating are then reviewed by the Reviewer to ensure that the process is transparent, objective and fair. The final rating shall be the basis of deciding salary review and or performance award for an employee. In deciding a review and /or award the company shall take account the merit and performance of the employee as well as business performance and affordability.

L. Professional development policy/reimbursement

Professional Development Allowance/ Reimbursement (PDA) is available as a compensation element to employees at Leadership levels, ML1 ML2 PL3 and PL4 band levels to claim expenses incurred on Professional Programs/ Courses or Journals that they subscribe to for professional development. (a) An employee may opt to have PDA as a compensation element within his compensation plan. (b) Tie PDA may be claimed as a reimbursement of expenses incurred on Professional Courses/Programs/ Journals. Original receipts and proof of expense should be submitted to claim this reimbursement. (c) In order to claim the PDA as a reimbursement the employee is expected to forward reimbursement form with the supporting documents to HR who will verify that the Journal/Program pertains to the employees discipline program. (d) Unutilized PDA shall be paid to the employee at the close of the financial year after deduction of appropriate taxes.

M. Employee separation policy

To ensure smooth transition of employee's separation. The policy articulated herein is to ensure consistency in approach when dealing with employees who may exit the company in any of the following circumstances. a) Resignation b) Retirement c) Dismissal

(a) Resignation: An employee may resign from the services of the company after giving appropriate notice of resignation. Notice period required for each band shall be as follows:

1. The period of notice shall generally be stated in an employee's appointment/ contract letter. Notice Period shall start from the date of receipt of the resignation by the management/immediate senior. 2. An employee is expected to work during notice period and ensure appropriate handing over of responsibilities. 3. An employee cannot avail any PCD during notice period. The Line Manager and HR Manager, only in exceptional circumstances may waive notice period when it is felt that the continued presence of the employee at work is likely to compromise data confidentiality or be prejudicial to the interest of work. 4. The authority to accept or reject resignation shall vest with the employees Reporting Manager HR shall anchor the clearance process arising out of the resignation of an employee. 5. An employee shall obtain clearance certificate in the prescribed format from all relevant departments. (Annexure I Enclosed).

6. An exit interview (optional on employee's choice) will be conducted by the Human Resources Department before the employee leaves the company. The purpose of this interview is to elicit from the employee, his/her reasons for leaving the employment of the company, and to understand his/her views on the strengths and weaknesses of the company. 7. HR Department will send clearance certificate to outside payroll vendor for employee's full & final payment.

(b) Recovery: (i) Notice Period: Pay in lieu of notice may be accepted in exceptional circumstances -Pay in such cases is defined as fix pay (Basic Pay + Management/Executive/Non Practicing Allowance). The authority to accept pay in lieu of notice shall vest with the employees Manager with the concurrence of Zone/ Unit HR. (ii) Imprest/Advance: Accounts Department will recover any imprest/advance given to employee from his/her full & final. Any further Imprest/ Advance will be given only in exceptional circumstances/ with specific approval of Department Head along with CFO/ Financial Controller. (iii) Advance Leave: Should an employee leave during the year the leave credit shall be appropriately adjusted to reflect the actual number of months served during the leave year.

(iv) LTA: Separating employee shall also be eligible for pro-rata LTA for that calendar year and not the full amount, along with full & final settlement. However, if such employee has claimed entire amount in the beginning of financial year then adjustment will be done on pro-rata basis (actual number of months of his/her service in the respective year) in his/her full & final settlement. No application for LTA advance will be accepted during the notice period.


To analyze the Employment Satisfaction by survey based on questionnaire in order to increase the employment retention by recommendations.


To analyze the data collected by questionnaire and to recommend some measures in order to improvise the policies for increasing the employee satisfaction so that employment retention will increase.


Research methodology is a way to systematically solve the research problem .it may be understood as a science of studying how research is done scientifically. The study of research methodology gives us the necessary training in gathering materials, arranging them, participating in filed when required and training in techniques for the collection of data appropriate for a particular problem.

What is research? According to Clarifford Woody (1944) research comprises defining and redefining problems, formulating hypothesis or suggested solution, collecting, organizing and evaluating data, making deductions and reaching conclusions and last carefully testing the conclusion to determine whether they fit the formulating hypothesis. Thus in research we talk not only of the methods used but also the logic behind the method we use in the context of our research, so the result can be evaluated by the researcher or others concerned. Research Methodology is the most practical way of obtaining and analyzing data and it plays an important role in project. All the methods used by the social research in their fact & finding mission constitute methodology. Methodology is defined as The study of methods by which gets knowledge; it deals with the cognitive processes imposed on research by problems arising from the nature of its subject matter. The motive of researcher is to uncover truth or fact method comprises the procedure used for generating, collecting, and evaluating the data. Methods are ways of obtaining information for assessing explanations. Methodology thus prepares the investigator to adopt techniques to neutralize the scientist to uncover truth, find the explanation for the assurance of a similar phenomenon .Research methodology is the description, explanation and justification of various methods of conduct of research. Research Design A descriptive research design is selected by the researcher as in the project of Employee retention descriptive study is undertaken in many circumstance when researcher is interested in knowledge the characteristics of the groups such as age, sex, educational level, occupation or income; making projection of a certain things; or determining the relationship between two or more variables, descriptive study may be necessary.

Type of Research The research methodology is adopted for this research work is descriptive type wherein 267 workers & company executive of MAX were taken as sample unit. Methods of data collection 1. Primary Source 2. Secondary Source

1. Primary Data: It is the data which is collected for the first time by investigator to serve a particular purpose; such a data is of original nature & is first hand information. The sources from where these data can be collected are known as a primary source.

Methods of Primary Data Collection:1. 2. Interview Observation method

1. Interview The interview is an important research technique in descriptive research. Personal interview method require person asking questions in face to face interaction with the correspondents to know his own personal opinion, attitude & reaction to the question. Interview provides either quantitative or qualitative data. 2. Observation Method In this method a good report establishment of respondent with researcher plays a very important and major role. The researcher is present in the industry from where he makes observation and from there he collects the relevant data according to the careful observation of respondents state

of mind, integrity of thought, emotional stigma attached, aggressive and other related tendencies and the physical posture of the respondent forms the core of this observation method.

Research approach

Contact method

Its a type of method through which the researchers is able to make contact with individual. Personal contact method is used for the survey i.e. data collection. Apart from this the informal discussion with the employees and workers of MSSH, PPG also helped in collection of valuable information to HR department researchers.

Research instruments

Preparation of Questionnaire The Questionnaire was framed by HR department in such a fashion so that actual views of the workers can be obtained. A number of statements reflecting different types of opinions are included. The respondents are to indicate only how far they agree or disagree with a particular problem or statement. A great care was taken in framing the questionnaires so that the employees can respond to them without an element of hurting their feelings. Structured and disguised After care full detailed study questioner was framed and included in the questionnaire. All the questions are having five alternatives in the form of Never, Rarely, Sometimes, Often & Always. The questionnaire is framed on question related to Teamwork, Training & Learning, Safety & medical Policies, Process, Policies & Goals, Dyad relationship, Career growth, Culture & Welfare, PSM and Motivation.

Sampling plan
Sample Unit A decision has to be taken concerning a sampling unit before selecting sample. Sampling unit may be a geographical one such as state, district, village, etc. Since the project is on employee satisfaction to give recommendation for employee retention whole MSSH was taken as sample unit. Sample size : 264 : Non Probability Sampling Procedure

Sample Procedure

Non Probability Sampling Sampling can be defined as a part of population. This sampling method involves deliberate selection of particular units of universe for constituting a sample which represents the universe.

In this research study 264 respondents were studied to get the relevant information in order to give recommendation for employee retention strategies.

Sampling techniques
Convenience Sampling: In this project convenience sampling has been used as sampling techniques because in this type, population is not divided, whoever eligible from executive as well non executive level are considered. For this project information are collected from worker & Company Executive by using Questionnaire method & interview. Scope of Study: The scope of the study covers MSSH PPG. The study covered employees from all level. 2. Secondary data : Questionnaire

A questionnaire is a form of data collection instrument utilization a common set of questions about a particular research area. This is made available to respondents who are expected to read, understand & write the answer in the space. A questionnaire is set of in ordered & logical sequence starting with simple factual questions progressively to more complex subjective questions. The questionnaires were distributed among the eligible participant & their immediate superior & were to be filled by them. The researcher explained the question to the participants who were unable implications of the given questions & helped in filling up the questionnaire. This research includes questionnaire having 24 questions distributed in 10 different categories which is distributed among 264 employees and the response was used for analysis to give recommendation for improving employment retention. Internet Sites Standard operating procedures. Online portal of Max employees. Monthly Magazine on Health Care Employees Handbook


5.1: Analysis of data

To analyzing the results of the survey, the researcher first grouped a surveys cased or how each responder reacted to the different statements. Respondents scoring either 4 or 5, More True, become one group (1/2 Group). Those seeing 1,2&3 Less True, became a second (1/2 Group). Similar Questions was grouped in separate category as shown in Table 5.1. Each survey statement was analyzed and response percentiles were calculated for each analysis group. These statements are listed in sample Questionnaire Annexure 1. The survey was done for old, fresher and new employee to analyze their satisfaction level and the result was used to formulate new HR policies for employee retention. 87 77 65 22 13 respondents was working in max fro < 6 months >6months<1yr 1 yr<3 yrs 3yrs<5 yrs >5yrs

24-support staff, 51-paramedical staff, 136-nursing staff, 24- medical staff and 29 -front office staff where taken as respondents for the survey. The proportion of no. of responders in each work group reflects the proportion of work force involved in running a hospital.

Limitations of Study
While every attempt was been made to compile one validate data. Certain limitations exist which must now be examined. The survey used for this project made no attempt to distinguish the age, sex, education, location, or economic status of any of the respondents. It is possible that the sample may not be reflective of the demographics of the MSSH population. Entire recommendation was based on the survey conducted by HR department which was analyzed by researcher. As the researcher used the secondary data validity remains questionable. Due to the limited time, scope and budget of this research effort, it will not be possible to track respondents over the next several years. As this is the case, the researcher will have no opportunity to determine whether respondents have remained with or departed from their current company during the next few years.

5.2: Summary of findings

Over all comparison Cluster Teamwork Training & Learning Safety & Medical Policies Process Policies & Goals Dyad Relationship Career Growth Culture & Welfare PMS Motivation Grand Total Table 5.1 Satisfied 90% 88% 87% 85% 82% 81% 80% 79% 74% 72% 81% Dissatisfied 10% 12% 13% 15% 18% 19% 20% 21% 26% 28% 19%

Training & learning


Satisfied Dissatisfied


Safety & Medical Policies


Satisfied Dissatisfied



Satified Dissatisfied


Ploicies & Goals

18% Satisfied Dissatisfied


Dyad Relationship

Satisfied Dissatisfied


Career Growth


Satisfied Dissatisfied


Culture & welfare


Satisfied Dissatisfied


Medical Policies

Satisfied Dissatisfied




Satisfied Dissatisfied


Service wise

Service with Max < 6 months 6 months to < 1 years 1 year - <3 years 3 year - <5 years above 5 years Grand Total

Satisfied 32% 79% 80% 38% 72% 81%

Dissatisfied 18% 21% 20% 12% 28% 19%

Table 5.2

Band Wise
Band Managerial Operational Professional Grand Total Table 5.3 Satisfied 79% 81% 82% 81% Dissatisfied 21% 19% 18% 19%

Age wise
Age <25 yrs 25 yrs 35 yrs. 35yrs 45yrs 45yrs & above Grand Total Table 5.4 Satisfied 30% 82% 31% 64% 81% Dissatisfied 20% 13% 19% 36% 19%

Category wise
Category Customer Care Medical Nursing Paramedical Support Grand Total Satisfied 79% 80% 83% 80% 70% 81% Dissatisfied 21% 20% 17% 20% 30% 19%

Table 5.5


6.1: Summary of learning experience

This project was made in the HR department and my major part of work is to analyze the employee satisfaction in organization by analyzing a questionnaire based survey done by HR team and to give suggestions for employee retention based on that. A excel sheet of all the responses I got through questionnaire was analyzed to find out various areas that needs improvement in order to improve employee retention. Beside these I was also undergone the various recruitment and joining activities in the organization and also done calling for various purposes. I learned how he HR prepares all the employment engagement activities within the organization which in return increases the employee retention. How the HR maintains the interest of the employees and works in the direction for fulfilling their interests was observed closely.

As the HR vision statement of MAX says To create an institute of people with right mix of skills, competence & Attitude and to engage them constructively in delivering our promise of medical and service excellence same statement applies to my experience also. When I started my work in the department it was a completely different experience for me because I was working with the people having different attitude, skill and competence and to see them working as a team was a great learning experience for me.

Time Management
It is said that time is precious and volatile. Because money can be recouped after loosing but once time passes it doesn't come back. Being an HR specialization or any other, the time is important for everyone. An importance of the time is understood after working in a giant organization like MAX Hospital. How the work is scheduled so that everything will be at its place as and when asked by the auditors.

To plan is the first function of any management procedure. No further implementation can be done without having a proper planning system in an organization. One has to plan for even the smallest of things. What, How, Where, When, Why etc. questions are to be asked within and steps are taken accordingly and proper planning starts from a good organizer as that was in this organization. And HR department was the right place to see all the work done through planning.

Decision Making
Many a time decision making becomes a very typical task for various managers. Reaching a final decision often takes many days. Learning of selection process was important experience because selection of a good employee itself gives a multiple aid to the organization. Assisting the team in joining formalities given me a knowledge about the whole process.

Pressure Handling
Stress as well as pressure is often the discussing factors in a corporate. Those will always be there in the corporate world as one is given jobs of great responsibilities. But the skill is to work under pressure and give one's hundred percent was seen at the time of audit when whole department was working with planning and team work to handle the pressure of the final moments.

6.2: Conclusions and Recommendations

An employee leaving a company is like a stone thrown in a still pond: ripples of disruption spread through the organization, creating unbalance. In any business, this unbalance can be expensive. From the employer's perspective, employees are an investment. Interview is to make sure that an individual has good work ethic, motivation, and drive. Most of the time, employees are considered a financial investment. Yet there's much more to it than that. There is a significant emotional investment that is crucial to accelerating business strategies and reaching organizational goals. After a company has invested considerable time and money recruiting and training its employees, it must now determine how to make sure those valuable employees are productive and get them to remain loyal to its firm. Retention of employees is essential to maintain client relationships and keep recruiting and training costs in line. Losing an experienced employee almost always results in significant costs to any firm. The keys to employee satisfaction and retention are founded on strong leadership and sound management practices. If one can master these arts, they should have happy, loyal employees and clients, resulting in growth, profits and personal gratification. The research performed for this report indicates that overall satisfaction level of the organization was 81% which is very appreciable because getting 81% satisfaction in an matrix type of organization is not an easy task which shows the functionality of HR department in improving the employee retention. Different kind of employment engagement activities like Birthday party, painting competition for childrens, Dewali gifts, coupons, Christmas Celibration, reward and recognition activities like employee of the month etc. shows how functional and active HR department is. Although few areas need improvement like motivation is lacking (28%- Dissatisfied) which cant be taken as good sign for any organization because a motivated employee can do a lot of thing batter then others, on the other hand it will motivate other to work in the same manner. The gap of satisfaction in generation X and Y is clearly seen from Table 5.4 Few steps needed to be taken to reduce this gap. Managerial employees are more dissatisfied then professional employees as the data shows in Table 5.3 Dissatisfaction level is increasing as the duration of stay with MAX increase as shown in Table 5.2 employee with 3-5 yrs of stay are showing more satisfaction.

When considering the twenty four dimensions of the workplace examined in this research study, it is safe to conclude that altering even a few of an employees perceptions can help increase the desire to stay with the organization. The proper training of managers and supervisors to recognize the profile of each individual, coupled with training in how to turn around perceptions that the organization controls can considerably improve retention efforts. It is very unlikely that a current employee would honestly complete the survey used for this report for their current employer. However, understanding the dimensions which motivate retention, it is possible for an organization to create mechanisms to help each manager capture this important information while there is still time to positively intervene. Few of the recommendation to have employment retention based on this project are:1.

Write out the recognition, what the employee did, why it was important, and how the actions served your organization. Give a copy of the letter to the employee and to the department head and Place a copy in the employees file. Write a personal note to the employee. Perhaps have your supervisor sign it, too. Photocopy the note and place the recognition in the employees file.



Accompany the verbal recognition with a gift. Merchandise that carries the company logo, even certificates of appreciation reinforces the employee recognition. Recognize excellent performance, and especially, link pay to performance Everyone likes cash or the equivalent in gift cards, gift certificates, and checks. If you use a consumable form of employee recognition, accompany the cash with a note or letter. When the money has been spent, you want the employee to remember the recognition.



Present the recognition publicly, at an employee meeting, for example. Even if the employee is uncomfortable with publicity, it is important for the other employees to know that employees are receiving recognition. Success celebration : Recognize and celebrate success. Mark their passage as important goals are achieved.



Life style : Enable employees to balance work and life. Allow flexible starting times, core business hours and flexible ending times Transparent Recruitment Policy : The prestige of the Institution or organization reflects on account of the transparent recruitment policy. Specific guidelines should be framed to meet the various parameters in the recruitment section



Encourage creativity and innovation: Create an atmosphere where employees feel comfortable making suggestions and trying out new ideas. Invest in training: Training improves customer service and strengthens employee loyalty. Pre-work training should include a review of your policies and procedures, with special emphasis on the most important subjects. Every training program should begin by aligning business objectives with individual needs.



Help employees learn: Employers, faced with employees with insufficient education to perform their jobs, are investing more in remedial education for their people. The more an organization can demonstrate to candidates and new employees that it can help them achieve their original career goals, the more effectively that organization can be in recruiting and retaining those employees. Support: Employees will appreciate having adequate support. They need someone readily available to help when they have questions or encounter problems.



Corporate Culture: World-class companies always have in common World-class cultures. Leaders of such businesses recognize that their companies exist to satisfy a social need. Profits are not the goal, but are a byproduct of meeting the needs of customers and employees. Empowerment: Engage employees in decision-making; give them the authority to act in the best interests of the company. Provide training in resolving client problems and then trust them to make the right decisions.



Having Fun: People like to work in an environment that is enjoyable; they can get burned out if the work environment is totally serious and strictly business. Mentoring the employees: Mentoring involves 4 key ingredients namely, humility, inclusion, generosity and freedom.



Improve manager and employee relationships. Concentrate on the people that stay with you to learn what makes them happy then give them more of it! "People leave

managers, not companies. If you have a turnover problem, look first at your managers," Marcus Buckingham and Curt Coffman write in First, Break All the Rules.

Provide training in core management skills to every manager. Core management skills include how to: integrate performance management including goal setting, give and receive feedback, recognize and value employees, coach employee performance, handle employee complaints and problems, provide a motivating work environment, and hold career development discussions with employees

Thus we can say that attracting and retaining talent is not just a matter of higher salaries and more perks. It involves shaping the whole organization, its vision, values, strategy, leadership, rewards and recognition.

Above all, retaining employees is a matter of building loyalty. More often than not, the ability to develop loyalty is linked to the credibility of the top management. Building the right culture is an important step in improving employee loyalty. It involves understanding the existing values, clarifying business goals and strategy, defining the desired culture and introducing change management initiatives

1. Growth and present status of industry 2. Healthcare Market Growth Perspective 3. Medical Infrastructure Current State 4. Hospotels- An Emerging Novel Concept 5. Functional departments of the organization new building 6. Old Building 7. Bed Capacity New Building 8. Facilities to be rolled out 9. Business Outlook 10. Contribution 11. Quantum of Loans 12. Inter-Unit Transfer 12 13 14 21 36 38 40 53 54 61 63 77

1. Healthcare market growth perspective 2. Shift to lifestyle related diseases 3. NABH accredited hospitals 4. Health insurance 5. Organization structure / organization chart 6. Revenue growth yearly 7. Facility- wise revenue fy08-09 8. Facility- wise admissions & surgeries fy08-09 9. Facility-wise occupancy fy08-09 10. Facilities to be rolled out 11. Selection process 13 16 20 23 46 51 51 52 52 53 57

Academic books: K. Ashwathappa - human resource management

Articles: Bruce fern and b. Lynn ware the challenge of retaining top talent: the workforce attrition crisis Ms. Sumana bose, faculty, sinhgad institute of business management and research, hr a cause of attrition Ms. Ritu arora, dav institute of management, manpower retention in bpo industry


Articles form the web: Marc carroll giving attention to prevent attrition

Sudipta dev is attrition always bad for an organization? Http://


Dear Sir / Madam, This questionnaire is intended to know the employee perception towards the retention policies provided by this organization and the extent to which these retention policies are effective here, which is a part of my academic project. There are two parts in this questionnaire. Part A contains series of statements and Part B contains personal data. While answering part A, you are kindly requested to express your free frank opinion. Your choice is important

Indicate the extent to which each of the following statements you agree in your organization using the five point scale by marking a tick mark [] against that column. Statement No.

Statement Am I heard by my supervisor

Never Rarely Sometimes Often Always 9 7 18 66 163

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Do I see team work around Is there mutual trust Do I find organization communication effective Is there respect to suggestions given by me Am I satisfied with Medical policy Is max Spirit useful for me Does the institute have god HR policies as compared to industry Am I clear about my role Do the processes and procedures here makes it easy to do my work well Do I know who is responsible for what, who needs to be informed, and who is to be contacted for getting a solution .


12. 13. 14. 15. 16. 17. 18.

Am I happy to be a part of Max Healthcare Do I participate in celebrations and get together. Is training being provided useful for me. Do I have adequate learning opportunities on the job Is our Performance Appraisal System fair Do I have growth opportunities in the institution Do I have adequate working conditions (Space Equipments etc) Do people get recognition Am I being adequately paid Do I get reward for my performance Do I feel empowered (freedom to work) Do we focus on medical policies Do we have safety consciousness

19. 20. 21. 22. 23. 24.


1. Name / Emp. code (optional) : _________________________________ 2. Designation : ______________________________________ 3. Department / Branch : _______________________________ 4. Category: 5. Band : 6. Age : _____________________________________________ 7. Length of service in this organization : _________________ 8. The awards / rewards you received in this organization:

9. Signature (optional):

Any Suggestions:

**********THANK YOU**********