INTRODUCTION

Outpatient Department in any hospital is considered to be shop window of

the hospital. There are various problems faced by the patients in outpatient

department like overcrowding, delay in consultation, lack of proper guidance

etc that leads to patient dissatisfaction. Now-a-days, the patients are

looking for hassle free and quick services in this fast-growing world. This is

only possible with optimum utility of the resources through multitasking in a

single window system in the OPD for better services.

The Sree Chitra Tirunal Institute for Medical Sciences and Technology

(SCTIMST) is an Institute of National Importance established by an Act of

the Indian Parliament. It is an autonomous Institute under the

administrative control of the Department of Science and Technology,

Government of India and is situated at Trivandrum, the capital city of state

of Kerala. It is a tertiary referral hospital with major specialties like

Cardiology, Cardiac surgery, Neurology, Neurosurgery. The hospital is 239-

bedded having three operation theater complexes and five ICU complexes.

About 12000 patients get registered per month. The patients are

1
categorized as per the socio-economic assessment by the trained Medical

Social Workers in to five socio-economic categories and patients are billed

accordingly. About 20% of the patients receive free treatment and another

40% of the patients get subsidized treatment. In order to improve the

satisfaction level of patients, infrastructure modification as per the

suggestions of the patients were taken up. It was felt that there is a need

to know the satisfaction level of patients and also get a feedback about the

services provided in the outpatient departments. Hence this study was

undertaken with objectives to study the awareness of patients about the

outpatient department services, to evaluate the performance of the services

in the patient’s perspective, and to identify the problems of the patients and

suggestive measures for improvement.

2
2. Need for the study

Patient satisfaction surveys are useful in gaining an understanding of user’s

needs and their perception of the service received. In a survey conducted by

Department of Public Health, Ireland the level of satisfaction among the

OPD attendees were 94%. Doctors and nurses were perceived as friendly by

61% and 72% and rude by 1% of patients, respectively. The study highlighted

the areas for improvement from the patient’s perspective.

Patient satisfaction is an important indicator in evaluating the quality of the

patient care in the outpatient department. In a study conducted at

Magdeburg, Germany only 3.6% of patients were dissatisfied. It revealed

that patient’s participation in their care has a special place with regard to

patient satisfaction. While auditing patients experience and satisfaction

with Neurosurgical care at the National Hospital, London, it was found that

most aspects of the patients care had 70-80% of satisfaction.

Poor patient satisfaction can lead to poor adherence to treatment with

consequently poor health outcomes. In another study conducted on a sample

of dermatology outpatients, out of 1385 randomly selected patients, 722

3
patients agreed to participate, 424 fulfilled the inclusion criteria and 396 of

these patients (93.4%) completed the study. Overall satisfaction was

reported by 60% of patients.

From these examples it is evident that the satisfaction of patients

attending the OPD is to be assessed periodically. From the present study in

a tertiary care hospital in India, it is seen that 90-95% of patients are

satisfied with the services offered in the hospitals. The waiting time for

most of the patients are with-in one hour in various departments, except in

some occasions where it is prolonged. 96.5% of the patients were satisfied

with the time spent by the doctors in consultations. The assessment of the

services provided by nurses, security, receptionist, attendees etc also

showed that 90-95% of patients were satisfied with the hospital services.

The study also revealed that some of the patients waiting time were

prolonged and that the friendliness of the nursing staff needs to be

improved.

4
3. Objectives:

The present study has the following objectives:

1. To examine patient satisfaction and recommendation of a hospital, with a

special focus on the correlation of these measures to patient ratings of

interpersonal and technical performance of the hospital.

2. To measure the level of patient satisfaction based on various factors.

3. To study the genesis and concept of patient satisfaction with particular

reference to technical performance of the hospital.

4. To access and analyze the patient satisfaction Programs in Gayatri

Hospital.

5. To appraise the executive department programs in the organization.

6. To make necessary suggestions to bring about meaningful relationship

between patients and staff efforts and efficiency of organization.

5
4. Scope of the Study:

The study covers the Visakhapatnam based patients only. A small

sample is taken from a huge population and it may not provide the actual

picture of level of satisfaction of out-patients.

But the study provides an insight into the mindset of the patients

towards the hospital and its services through valuable information regarding

various parameters that determine the level of patient satisfaction. These

valuable insights are useful to understand patients better, so as to serve

them better.

6
5. Methodology:

Research in common pursuance refers to a search for knowledge in a

scientific and systematic way for pursuant information on a specified topic.

Once the objective is identified that next step is to collect the data

which is relevance to the problem identified and analyze the collected data

in order to find out the hidden reasons for the problem. There are two types

of data namely.

1. Primary Data

2. Secondary Data

1. PRIMARY DATA

Primary data is to be collected by the concerned project researcher

with relevance to his problem. So the primary data is original in nature and

is collected first hand.

Collection of primary data

There are several methods of collecting primary data particularly in

surveys and descriptive researches. Important ones are as follows:

7
 1. Observation Method

2. Interview Method

3. Questionnaire

4. Schedules and

5. Other methods which include

 Through projective techniques with hospital staff

 In depth interviews with patients

6. LIMITATIONS

 This study has few limitations. It considered only the outpatient

population. Thus, the results cannot be generalized to inpatient

populations. The sample size was small considering fewer patients in

diagnostic categories.

 Time is not sufficient to study the available information.

 The Doctors could not spend much time due to their routine work load.

 The time limit for the project is only 45 days, for that does not cover

all related fields.

8
HOSPITAL INDUSTRY PROFILE

The health care industry, or medical industry, is an aggregation of sectors

within the economic system that provides goods and services to treat

patients withcurative, preventive, rehabilitative, and palliative care. The

modern health care industry is divided into many sectors and depends

on interdisciplinary teams of trained professionals and paraprofessionals to

meet health needs of individuals and populations.[1][2]

The health care industry is one of the world's largest and fastest-growing

industries.[3] Consuming over 10 percent of gross domestic product (GDP) of

most developed nations, health care can form an enormous part of a

country's economy.

For purpose of finance and management, the health care industry is typically

divided into several areas. As a basic framework for defining the sector, the

United NationsInternational Standard Industrial Classification (ISIC)

categorizes the health care industry as generally consisting of:

1. hospital activities;
2. medical and dental practice activities;
3. "other human health activities".

9
This third class involves activities of, or under the supervision of, nurses,

midwives, physiotherapists, scientific or diagnostic laboratories, pathology

clinics, residential health facilities, or other allied health professions, e.g. in

the field of optometry, hydrotherapy, medical massage, yoga therapy, music

therapy, occupational therapy, speech therapy, chiropody, homeopathy,

chiropractics, acupuncture, etc.[4]

The Global Industry Classification Standard and the Industry Classification

Benchmark further distinguish the industry as two main groups:

1. health care equipment and services; and

2. pharmaceuticals, biotechnology and related life sciences.

The health care equipment and services group consists of companies and

entities that provide medical equipment, medical supplies, and health care

services, such as hospitals, home health care providers, and nursing homes.

The latter listed industry group includes companies that produce

biotechnology, pharmaceuticals, and miscellaneous scientific services. [5]

Other approaches to defining the scope of the health care industry tend to

adopt a broader definition, also including other key actions related to health,

10
such as education and training of health professionals, regulation and

management of health services delivery, provision of traditional and

complementary medicines, and administration of health insurance.[6]

Providers and professionals

See also: Health care provider and Health workforce

A health care provider is an institution (such as a hospital or clinic) or person

(such as a physician, nurse, allied health professional or community health

worker) that provides preventive, curative, promotional, rehabilitative or

palliative care services in a systematic way to individuals, families or

communities.

The World Health Organization estimates there are 9.2 million physicians,

19.4 million nurses and midwives, 1.9 million dentists and other dentistry

personnel, 2.6 million pharmacists and other pharmaceutical personnel, and

over 1.3 million community health workers worldwide, [7] making the health

care industry one of the largest segments of the workforce.

The medical industry is also supported by many professions that do not

directly provide health care itself, but are part of the management and

11
support of the health care system. The incomes of managers and

administrators, underwriters andmedical malpractice attorneys, marketers,

investors and shareholders of for-profit services, all are attributable to

health care costs.[8]

In 2011, health care costs paid to hospitals, physicians, nursing

homes, diagnostic laboratories, pharmacies, medical devicemanufacturers

and other components of the health care system, consumed 17.9

percent [9] of the Gross Domestic Product (GDP) of the United States, the

largest of any country in the world. It is expected that the health share of

the GDP will continue its upward trend, reaching 19.6 percent of GDP by

2016.[10] In 2001, for the OECD countries the average was 8.4

percent [11] with the United States (13.9%), Switzerland (10.9%), and

Germany (10.7%) being the top three. US health care expenditures totaled

US$2.2 trillion in 2006.[12] According to Health Affairs, US$7,498 be spent

on every woman, man and child in the United States in 2007, 20 percent of

all spending. Costs are projected to increase to $12,782 by 2016. [13]

12
Delivery of services

The delivery of health care services—from primary

care to secondary and tertiary levels of care—is the most visible part of

any health care system, both to users and the general public. [14] There are

many ways of providing health care in the modern world. The place of

delivery may be in the home, the community, the workplace, or in health

facilities. The most common way is face-to-face delivery, where care

provider and patient see each other 'in the flesh'. This is what occurs in

general medicine in most countries. However, with modern

telecommunications technology, in absentia health care is becoming more

common. This could be when practitioner and patient communicate over

the phone, video conferencing, the internet, email, text messages, or any

other form of non-face-to-face communication.

Improving access, coverage and quality of health services depends on the

ways services are organized and managed, and on the incentives

influencing providers and users. In market-based health care systems,

for example such as that in the United States, such services are usually

paid for by the patient or through the patient's health

13
insurance company. Other mechanisms include government-financed

systems (such as the National Health Service in the United Kingdom). In

many poorer countries, development aid, as well as funding through

charities or volunteers, help support the delivery and financing of health

care services among large segments of the population. [15]

The structure of health care charges can also vary dramatically among

countries. For instance, Chinese hospital charges tend toward 50% for

drugs, another major percentage for equipment, and a small percentage

for health care professional fees.[16] China has implemented a long-term

transformation of its health care industry, beginning in the 1980s. Over

the first twenty-five years of this transformation, government

contributions to health care expenditures have dropped from 36% to

15%, with the burden of managing this decrease falling largely on

patients. Also over this period, a small proportion of state-owned

hospitals have been privatized. As an incentive to privatization, foreign

investment in hospitals—up to 70% ownership—has been encouraged.[16]

14
Medical tourism

Medical tourism (also called medical travel, health tourism or global

health care) is a term initially coined by travel agenciesand the mass

media to describe the rapidly growing practice of traveling across

international borders to obtain health care.

Such services typically include elective procedures as well as complex

specialized surgeries such as joint replacement(knee/hip), cardiac

surgery, dental surgery, and cosmetic surgeries. However, virtually every

type of health care, including psychiatry, alternative treatments,

convalescent care and even burial services are available. As a practical

matter, providers and customers commonly use informal channels of

communication-connection-contract, and in such cases this tends to mean

less regulatory or legal oversight to assure quality and less formal

recourse to reimbursement or redress, if needed.

Over 50 countries have identified medical tourism as a national industry.

[17]
 However, accreditation and other measures of quality vary widely

15
 across the globe, and there are risks and ethical issues that make this

method of accessing medical care controversial.

ANIL NEERUKONDA HOSPITAL PROFILE

Anil Neerukonda Hospital started Medical College in the year 2012-13 with

an intake of 150 students with the kind permission given by the Ministry of

Health and Family Welfare as per the recommendations of the Medical

Council of India. The College and the Hospital are situated in a sprawling

campus and has a total built-up area of 10,00,000 sq.ft comprising of 8

buildings. The entire necessary infrastructure is composed of fully-

equipped laboratories, air-conditioned lecture halls attached with a 920

bed Teaching Hospital as per MCI norms. Our teaching staff consists of

many renowned professionals from all over India.

Anil Neerukonda Hospital provids affordable health care to the needy people

of the society on non-profit basis with state of art facilities and modern

medical equipment.

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Our Mission

Anil Neerukonda Hospital is committed to provide the highest quality of

services and excellent international patient care in a cost-effective manner.

Our Vision

 To be at the forefront of the healthcare industry in India, to

gain National recognition for our quality of services

particularly for medical services.

Anil Neerukonda Hospital will continue to make the medical

care for diverse clients more affordable while strictly

adhering to the highest standards of excellence.

Anil Neerukonda Hospital will continue to engage in the

17
 improvement and promotion of its health services and put a

high premium on the professionalism amidst the diversity of

its staff through continuing medical education.

Our Values

Compassion, quality, integrity and trust are the beliefs that

every citizen of the world is entitled to quality health care

and should be regardless of creed, race or color, and that

every person is endowed with an inalienable right to pursue

happiness.

Location

18
 Anil Neerukonda Hospitalis located in

Sangivalsa,Visakhapatnam, the capital city of Andhra Pradesh.

It is recognized as the world leading hospital for cosmetic

surgery with over 20 years of quality service. Anil Neerukonda

Hospitalaims to provide an international standard service and

excellent patient care.  

Anil Neerukonda Hospitalconsists of many

departments dedicating to all treatments

as well as medical care. The hospital is

equipped with modern facilities and

completed state-of-art medical facilities to ensure the safety with 95 OPD

examination rooms and delivery rooms, ICU, dialysis machines, nursery room,

emergency room, and laboratory. It has 920 beds capacity and serves at

least 2,000 out-patients daily.

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 VIP patient room is equipped with air

condition, LCD TV with satellite, big couch

for companion, refrigerator, safety box

to keep valuable belongings, in room toilet,

and balcony. Internet corner is also provided in the hospital. Your companion

can stay with you at the hospital without extra charge. There is a big &

comfortable couch for companion.

Everyday Anil Neerukonda Hospital has received numerous patients from all

over the state. The medical staffs at Anil Neerukonda Hospital are highly

trained and skillful. There are 105 full-time doctors, specializing in their

own medical field of specialization and 120 part-time health professionals

along with 800 caring, considerate and compassionate nurses and staff at

your service.

When you get to the hospital please contact Miss Krishna at the Desk with

your enquiry where she will be there to assist you and direct you to the

20
appropriate doctor.

Neurology is the specialist branch of Medicine that deals with the nervous

system. This includes the brain, spinal cord, peripheral nerves and muscles.

The special senses of smell, vision, hearing and balance also often involve

neurologists usually overlapping with ophthalmologists (eye specialists), and

Ear Nose and Throat (ENT) surgeons. Neurosurgeons, not Neurologists,

perform any surgical procedures required but the two specialities, by

necessity, have to work closely together.

Upcoming department with enthusiastic faculty with future vision to acheive

video EEG, DBS, preop temporal loberations evaluation and so on.

21
GROWTH:

The Anil Neerukonda Educational Society foundation was established with

the noble objective of providing needed research in cardiology, to achieve

indigenization of the fast growing range of hard ware products, devices and

disposables in the field to provide excellent academics at different levels

and to strive to bring down the ever bargaining cost of cardiac health.Anil

Neerukonda Educational Society under the able leadership of its founder,

chairman DR, B R Prasad . The Anil Neerukonda Educational Society

foundation has relentlessly pursued those objectives and can now look back

22
with some satisfaction on the work done towards this end in the first few

years of its experience.

Quality Anil Neerukonda Hospital was an inevitable off shoot of the

zeal to achieve the above mentioned objective. And it has the purpose of

giving a practical shape to this pursuit. The Anil Neerukonda Hospital,

Visakhapatnam is the first of the project of Quality established in July

2013 in leased premises ,the Hospital needs little to be said in its praise as

the direction it has then and its achievements are now very well known, the

immense credibility it has established is just a reflection of this. Dr B R

Prasad is himself, the chairman of Anil Neerukonda Hospital

The Anil Neerukonda Hospital stated with 200 beds .It has never

shrinked from its responsibility of looking after the economically deprived

sections of the population. It is to the credit of the hospital that nearly

20% of accommodation is allocated under general ward category where the

tariffs are highly subsidized.

23
The hospital has so far been an exclusive cardiac Anil Neerukonda Hospital

with few supporting departments such as internal medicine and pulmonology,

it has on its panel specialists from all the branches who visit on call.

The hospital runs on extremely busy intensive coronary Anil Neerukonda

Hospital unit attending to all cardiac emergencies .The unit is staffed with

an in house cardiologist around the clock, supported by junior doctors, an

anesthetist, a large number of technicians and nursing staff and others.

Laboratory services are available continuously. Emergency services such as

primary angioplasty for a person with developing heart attack are performed

at all times of day or night.

Anil Neerukonda Hospital felt the need to introduce other specialties that

could serve the population with the same professional competence and

commitment as cardiac team with this in view neurology and other neurology

services were being started. This has brought under one roof highly

qualified, competent and dedicated professionals who would provide the Anil

Neerukonda Hospital and service to people. Anil Neerukonda Hospital

foundation started a research and development institution.

24
THE Anil Neerukonda Hospital MODEL:

They operate on physician driven model. This means that all the main

constituents of the Anil Neerukonda Hospital movement ,the promoters,

administrators and service providers are physician .The center of the Anil

Neerukonda Hospital model is the patient and the overriding motive of all

Anil Neerukonda Hospital activities is to provide quality medical Anil

Neerukonda Hospital at an affordable cost. Technology training and team

work from the every core of the Anil Neerukonda Hospital model which also

emphasizes a comprehensive and continuous education and training of every

individual involved in the patient Anil Neerukonda Hospital Every effort will

be taken to ensure that their growth is decided by the patients needs and

not one decided by their corporate requirements.

FUNDAMENTAL REASON FOR EXISTENCE:

 To make quality medical Gayatri affordable and accessible considering

quality, cost, access.

 Timeless unchanging core values.

 Putting the patient first above ones own interest.

25
 MISSION:

 To provide the best and cost-effective Anil Neerukonda Hospital

accessible to every patient through integrated clinical practice,

education and research.

VISION:

.To evolve as a unique university-based health-centre where the quest for

new knowledge would continuously yield more effective and more

compassionate Anil Neerukonda Hospital for all.

 To nurture a new generation of professionals of long –life

commitment, dedication, knowledge, skills, wisdom and values.

 To strive for public trust and maintain medicine’s humane and noble

place amongst professions.

 To be globally competitive in health Anil Neerukonda Hospital and

related businesses integrating local culture and ethos.

 To promote development of indigenous products and systems,

adapting appropriate technologies generating clinical skills and

26
 removing barriers before patients accessing it through institutional

partnership.

OBJECTIVES:

To bring down the cost without compromising on quality. To indigenize

all the costly disposables in the next 10 years.

Cost of angiogram below Rs.7, 500.

Cost of angioplasty below Rs.40, 000.

Cost of stent below Rs.75, 000

A Day stay in ICCU to be below Rs.3, 000.

POLICIES:

 Sensitivity to pain and suffering shall be accorded highest

priority to every employee.

 Same treatment for same illness, irrespective of ability to pay.

 Tests will be done only when medically necessary

 Selection of all employees shall be on the basis of merit.

27
  Compulsory continuous medical education to lab health Anil

Neerukonda Hospital personnel.

 All departments shall be run by full time consultants.

 Round the clock availability of cardiologists, C.T. Surgeons

neurologists, anesthetists, labs and technicians.

VALUES:

Practice Practice medicine as an

Integrated team of

Compassionate

Physicians, Nurses and

Allied professionals.

Education Learn to serve through

continuous training and

education of physicians, nurses and

allied heath professionals

28
 Research Conduct basic and

clinical research

programs to improve

patient Anil Neerukonda Hospital and to

benefit society.

Mutual Respect Treat everyone with

respect and dignity.

Commitment to quality Continuously improve all processes that

support patient Anil Neerukonda

Hospital, education and research.

29
 Work Atmosphere Foster team work, personal

responsibility, integrity,

innovation, trust and

communication and celebrate success.

Societal commitment Support the society we live in and assist

patients with limited financial resources.

Finances Allocate resources within the

context of a system rather than

its individual entities.

30
CULTURE OF Anil Neerukonda Hospital:

The best interest of their patient is the only interest they consider. They at

Anil Neerukonda Hospital, combine an emphasis on the pure science of

medicine with a keen appreciation for each person’s humanity. Their caring

staff, advanced medical Anil Neerukonda Hospital, accessibility and

efficiency is what make them different from others –the preferred choice

of the international patient .Every employee devotes the necessary attention

to ensure that every patient’s visit to Anil Neerukonda Hospital is convenient

and worthwhile. The culture at Anil Neerukonda Hospital bears testimony to

the fact that:

“They are dedicated to the needs of their patients .They serve with a

special attitude, special Anil Neerukonda Hospital so that all patients gain

the maximum benefit from their visit to Anil Neerukonda Hospital

“It uses a collaborative approach where each physician can call on the

expertise of medical specialists and sub specialists. This team work helps

physicians arrive at an accurate diagnosis and the most effective course of

treatment. Each patient benefits from the experience and skills of many

31
physicians. Anil Neerukonda Hospital continues to offer superior value with

an efficient, streamlined approach to medical Anil Neerukonda Hospital that

emphasizes accurate diagnosis and effective treatments.

“It is patient centered organization and focus on one thing-the needs of the

patient. The needs of the patient come first.

“It provides the best Anil Neerukonda Hospital to every patient through

integrated clinical practice, education and research.”

“Comprehensive evaluation with timely, efficient assessment and treatment.

Availability of the most advanced, innovative diagnostic and therapeutic

technology and techniques.”

“The Anil Neerukonda Hospital organization recognizes the importance of

good communication with the patient’s personal doctor. Upon the patient’s

return home, Anil Neerukonda Hospital physicians send all pertinent medical

information to the home doctor to assist in continued good Anil Neerukonda

Hospital. It functions cooperatively to bring skilled, compassionate Anil

Neerukonda Hospital to patients from around the world.

32
MEDICAL SPECIALITIES IN Anil Neerukonda Hospital:

SURGICAL:

● Cardio-Thoracic

● Dental

● ENT

● General, Gastrointestinal and Laparoscopic

● Gynecology

● Hand Surgery

● Neuro Surgery

● Surgical Oncology

● Ophthalmology

● Orthopedic Surgery & Trauma Services

● Urology

33
MEDICAL

● Anesthesia

● Blood Bank

● Cardiology

● Dermatology

● Endocrinology

● Gastroenterology

● Internal Medicine / Coronary & Critical

● Life Style Clinic

● Nephrology

● Neurology

● Oncology

● Physiotherapy

● Psychiatry

34
DIAGNOSTICS

● Cardiology

● Gastroenterology

● Neurology

● Nuclear Medicine

● Radiology (Imagelogy)

35
ORGANISATION STRUCTURE

PATIENTS

Doctors and Nurses

Paramedics and House keepers

Departmental Manager

Support Manager

Directors
36
In structure, we see patients, are at high priority, at quality Anil

Neerukonda Hospital the main criteria is putting the patient first above

ones own interest.” They are treated as Elite Group of the organization.

The next preference is given to doctors and nurses, they are the people who

give emotional support and satisfaction to the patients. The more comfort

they give the more satisfied is the patient, here the nurses play a very

important and vital role, they look after every aspect of the patient starting

with their food to their medicines, for this they have to be very patient,

humble and pleasing.The next comes Paramedics and House keeping, the

more cleanliness the more attractive the hospital, so the housekeeping

people play a crucial role in attracting the people to opt the hospital.

Pharmacist is the one who delivers the prescribed medicines given by the

physician, the more pro active they are the more willingness to buy the

medicines from within the premises. Next comes the Departmental manager,

who looks after the departments, its functions and the procedures to be

37
followed. He is the person who is responsible for all activities to be carried

for attaining the objectives.

ORGANIZATIONAL HIERARCHY

CHAIRMAN

VICE CHAIRMAN

BOARD OF DIRECTORS

HOSPITAL ADMINISTRATOR

GENERAL MANAGER

38
 DEPUTY GENERAL MANAGER

MANAGER

ASSISTANT MANAGER

SUPERVISOR

REGULAR STAFF
ORGANIZATION POLICIES:

EMPLOYEE BENEFIT:

 Provident Fund: All the employees will contribute 12% of their basic

salary which is 60% of their Gross 25% H.R.A 15% conveyance.

 All the employees who are on the pay roll are eligible for this and

trainees after completion of their training get the eligibility on

regularization.

 From the employee contribution of P.F. 8.33% will go to the pension

fund and remaining 3.67% will be added to P.F.

EMPLOYEE WELFARE:

39

ASSISTANT MANAGER
  All the members are covered under Medi claim policy for self and

family members.

 Each member is covered for 50,000 insurance

 Insurance coverage will be done after 3 months of service.

SALARY/WAGES:

 Attendance is taken from the swipe machine in time office and

uploaded into the pay roll management system.

 Pay roll is managed in the pay roll package

 Monthly statement like loss of pay, canteen deduction, pharmacy

allowance. Nursing allowance, New joining, Resignation, Monthly

increments, Doctors, Night shifts, Managers etc., are prepared along

with salaries.

 Salaries are deposited into savings bank account directly.

40
LEAVE MANAGEMENT:

Being an essential service regular attendance for work is a vital factor in

ensuring smooth and uninterrupted operation. This require that employee

plan their leave in order to guide to staff on subject of leave. There are:

Casual leave : 12 per year

Sick Leave : 12 per year

Earned Leave : 15 per year

Maternity Leave : 180 days

Compensatory off : Day

Leave on loss of pay /special Leave

GRIEVANCE OF EMPLOYEES:

41
All complaints arising out of employment shall be submitted to the Manager

or any other person authorized on his behalf.

The following procedure should be adopted by the employees in the order

stated.

a. Representation of the HOD.

b. Representation of the Head of HOD

TRANFERS: All the employees are subjected to transfer as follows:

1. Intra Dept. 2. Inter Dept 3. Inter Hospital

a. Permanent

b. Probationer

c. Temporary

d. Trainee

e. Internees

f. Honorary Trainee

42
 g. Contract Labour.

ADMINISTRATION:

In any Organization, HR Department plays a very important role.

All the major activities will be dealt in HR Department such as

preparation of full and final settlement, maintaining record of each

employee of Organization, pay roll following up of appraisal of

potential, rewarding the “BEST ASSOCIATE AWARD” from various

Departments of Organization based on their performance, skills,

qualities, responsibilities.

WORKING HOURS AND CONDITIONS:

There are shifts for the employees working in the

Organization. For Administrative department the working hours are 8

AM to 5 PM.

SHIFTS:

MORNING:AFTERNOON:

M1 - 7AM-4PM MS - 12PM-9AM

43
 R1 - 8AM-3PM A -1PM-8AM

M2 - 9AM-6PM A1 - 2PM-10AM

M4 - 11AM-8PM

NIGHT:

N - 6AM-4PM R - 8PM-5AM

N1 - 9AM-9PM R2 - 8PM-9AM

N3 - 10AM-2PM

PERSONAL DEPARTMENT DETAILS:

Anil Neerukonda Hospitalis strongly driven by the philosophy that HR is

the strongest, valuable of all resources of any Organization. Human

nature is very complex and to harness and get the best for the benefit of

the Organization, as well as individual utmost Anil Neerukonda Hospital is

exercised right from the stage of selection through out the entire

process of HRD.

44
 MANPOWER REQUIREMENT:

 To take specification for Job requirement in the prescribed format

for all jobs opening in the Organization.

 All the vacancies are displayed in the notice board for employees to

apply. The same is to facilitate equal opportunities for employees of

Organization.

 All openings are intimated to employment exchange.

 All vacancies arise, either due to resignations or New openings, first

option is given to existing employees in the Organization and they will

undergo for selection based on their job opening.

 To competence requirement for all positions in the Organization the

GM-HR should consult with the HOD’S

SELECTION AND RECRUITMENT:

 The vacancies are identified in each Department and selection is made

with the profile of the person needed for filling the vacancy. The first

option is given to the existing employees.

45
 For all openings, the HR Department personnel conduct preliminary

interview and the ratings are given.

 Whenever freshers are recruited for job opening, selection process

includes, written test, wherein candidate is required to score 60%

marks for further Interviews and Selections.

 Short listed persons are called for Interviews by the Hospital

Administrator for suitable place and date.

INDUCTION/ORIENTATION:

 Introduce the employee to the staff.

 Explain him the Organization History, Hierarchy, Grade structure

 Appraise him the rules and regulations of the organization

 Put him under training in Departments to understand the role of

each Department where he/she is going to work.

46
  Maintain induction training record.

PERFORMANCE APPRAISAL:

 The performance Appraisal is carried out once every year for all

associates and after the completion of one year for new recruits.

 Trainees will be assessed of their performance after completion of

3/6 months.

 After their potential appraisal they are recommended for

promotion.

TRAINING:

 At least 20 managers undergo Management development training in a

year.

 To maintain record related to competence, education, awareness, and

training for all associates.

 Induction, training is given for newly recruited personnel.

47
  On the job training is given to all staff depending upon recruitment.

FEED BACK:

After returning from the training the effectiveness of training is

verified by the HOD and forwarded to General Manager-HR for perusal of

Management.

Anil Neerukonda Hospital TOMORROW:

9 years, 9 centers, services that span a multi specialty spectrum

and the immeasurable trust of our patients. That’s Anil Neerukonda Hospital

today. yet, we at Anil Neerukonda Hospital look at the years gone by, and

the milestones passed, as just the beginning. We have a successful and

48
human model, an approach that identifies and HR Managementes the

important constituents of medical Anil Neerukonda Hospital.

So, we will grow with our patient’s needs, through the

competence of our physicians, till we have touched every one who requires

our services. Till then, at Anil Neerukonda Hospital the efforts of the past

will continue, unabated.

INTRODUCTION

Patient satisfaction is an evaluation of quality of care, an outcome variable in

its own right, and is an indicator of weaknesses in the service.[1] Studies

indicate that global satisfaction is affected by many factors other than the

quality of service delivery; it may include factors such as patients’

49
demographics, diagnosis,[4,5] treatment programme, and chronicity of

disease. Among demographic characteristics, age, health status, and race

had a consistent, statistically significant effect on satisfaction scores and

among the institutional characteristics, hospital size had a consistent and

significant effect on patient satisfaction scores.

Factors for high satisfaction

In a meta-analysis, greater patient satisfaction was found to be significantly

associated with greater age, less education, being married, and having higher

social status.[8] A study on patient satisfaction with outpatient psychiatric

care showed a high general satisfaction with treatment.[9] Satisfaction was

highest in areas of treatment planning/treatment design, treatment

accomplishment, and relationship to staff. A somewhat lower level of

satisfaction was noted concerning information and co-influence of the

patient.[9] Level of satisfaction was not related to social and psychiatric

background characteristics. Patients with longer time in therapy showed a

higher level of satisfaction.[10]

50
Holcomb et al. found that severely ill inpatients who reported fewer

symptoms, higher quality of life, and a higher level of functioning at

admission tended to be more satisfied with their services. In addition,

patients who were employed at admission, and therefore most likely

functioning at a higher level in the community, rated their treatment more

positively.[10] In a study of mental health services, the strongest and most

consistent predictors of satisfaction were older age and better self-

reported health.[4] Longer length of stay was also associated with greater

satisfaction on a majority of subscales. Findings among female and minority

veterans were mixed across measures.

A Finnish study on satisfaction of psychiatric inpatients found that, in

general, patients were quite satisfied with their care. Of seven different

satisfaction areas, they were most satisfied with staff-patient relationships

and reported highest dissatisfaction in the areas of information,

restrictions, compulsory care, and ward atmosphere/physical milieu. Younger

and female patients were less satisfied with staff-patient relationships than

older patients and men.[11]

51
A study by Ito et al. reported that older patients tend to be more satisfied

with psychiatric care than younger patients.[12] Patients with schizophrenia

and mood disorders rated the psychiatric care more positively, whereas

patients with personality disorders rated negatively. Patients with neurosis

rated the care positively in informed consent, but negatively in other items.

In another study, patients with schizophrenia had higher levels of

satisfaction with services and life than others, and a statistically significant

relationship was found between life satisfaction and service satisfaction for

schizophrenics, and those with affective and adjustment disorders.[13]

Focusing on modifiable service delivery factors, staff teaching efforts

regarding medication, illness management, substance abuse, outpatient

treatment, and living skills were significantly associated with greater levels

of satisfaction with care, controlling for demographic and clinical variables.

[14] This may reflect the value consumers place on staff time, attention, and

communication.

Factors for low satisfaction

52
A meta-analysis conducted by Lehman et al. revealed that chronic patients

express less satisfaction with their treatment as compared to non-chronic

patients. No differences were found in rates of patient satisfaction

between inpatient and outpatient programs.[5] In a study by Barker et al.,

patients with a diagnosis of a non-affective psychotic illness, particularly

those who lacked insight were significantly less satisfied with their care.[15]

Respondents were more satisfied with personal rather than professional

qualities of the doctors, and less satisfied with their empowerment and

doctors’ availability.[15]

In a child psychiatric hospital, those who reported abusive behaviour were

significantly less satisfied with the hospital experience than those who did

not report abuse. The participants’ perception of clinical improvement was

weakly related to their satisfaction.[16] In a study by Gigantesco et al., the

satisfaction with services expressed by psychiatric outpatients and their

relatives was fairly good, with the exception of poor satisfaction with

information about treatment and involvement in the treatment program. The

satisfaction of inpatients and their relatives was significantly lower, with

the issue of information giving by staff appearing particularly critical.[17]

53
Among patients, variables associated with dissatisfaction were being an

inpatient, having a diagnosis of psychosis, being in contact with services for

more than six years, and being single.

In a study by Bjørngaard et al., satisfaction was associated with treatment

outcome, better health as assessed using Health of the Nation Outcome

Scales (HoNOS), being female, advanced age, and with having less

psychiatric team severity indicated by the teams’ mean Global Assessment

of Functioning (GAF) score. Patients with a schizophrenia spectrum disorder

were more satisfied when treated as inpatients and day patients, as

compared with outpatient treatment. Patients in other diagnostic categories

were less satisfied with day treatment.[18]

Negative correlations have been reported between patient satisfaction and

personality pathology.[19] Patient satisfaction was significantly affected by

symptom reduction and to some extent by personality pathology, while

duration of the hospital stay, age, and sex contributed minimally.

Studies in India

54
There are very few studies in India that measure patient satisfaction with

psychiatric services provided by the healthcare organizations.[20] A study

on perception of satisfaction in a drug-dependence treatment center in

India, more than 90% of the patients and their attendants appreciated the

services provided. Most of them (90-94%) were satisfied with supply of

drugs, good quality of clinical care, and cleanliness of the hospital.[20] The

overall level of patient satisfaction achieved was about 65%.[21] Corruption

appears to be highly prevalent and was the top cause of dissatisfaction

among patients. Other important areas of hospital services contributing to

patient dissatisfaction were poor utilities like water supply, fans, lights, etc;

poor maintenance of toilets and lack of cleanliness; and poor interpersonal or

communication skills.

MATERIALS AND METHODS

The study sample was recruited from the patients attending outpatient

department of Psychiatry, Anil Neerukonda Hospital, Visakhapatnam, in

55
South India. The department of psychiatry offers outpatient care in

addition to the provision of short-stay 60-bed hospital, support by clinical

psychologists, and social workers.

All patients aged 18-60 years, receiving psychiatric treatment for at least

six months from the institute were considered for the study. Patients who

were uncooperative, unable to spend time for the evaluation related to the

study, having confusional states, and impaired cognition, who could not

engage in conversation because of severity of disorders, and who did not

give consent were excluded. Informed consent was obtained from all

participants, and they were reassured regarding confidentiality.

Institutional ethics committee approved the study.

From the log of pre-registered patients coming for follow-up on a given day,

a random list was generated by random number tables. Among these

patients, those who fulfilled the recruitment criteria were approached for

the study. About 2-3 patients could be evaluated for the study in a day. The

recruitment continued for one month.

56
Demographic variables were collected using a proforma used in the institute,

which included: Age, sex, marital status, education, employment status,

family pattern, and address of residence. A semi-structured interview

schedule was used at Mental Health Institute to aid for psychiatric history

taking. The diagnoses were based on the DSM-IV-TR criteria. We assessed

the severity of psychiatric disorder using Clinical Global Impression (CGI)

severity scale.[22] It has scores from 0 to 7; higher scores suggest greater

severity.[22] The functioning level was assessed by GAF.[23] Higher scores

of GAF indicate better functioning.

We used Patient Satisfaction Questionnaire-18 (PSQ-18) to assess

satisfaction.[24] It was translated to the local language telugu following

translation-retranslation procedure.[25] It has seven subscales: General

satisfaction (GS), technical quality (TQ), interpersonal aspects (IPM),

communication (COM), financial aspects (FIN), time spent with doctor

(TWD), and accessibility and convenience (AC), which give scores in these

domains. A composite score (CS) is also calculated. Higher value indicates

more satisfaction.

57
Continuous variables were compared using independent t-test or analysis of

variance (ANOVA). Significance was set at standard 0.05. Statistical

analyses were performed using SPSS-22 for windows.

The sample size was 60; out of 68 patients who were found eligible for

inclusion and approached, 8 (11.7%) patients could not participate in the

58
study interview considering the severity of symptoms and were excluded.

The sociodemographic and clinical profile of the excluded patients were

comparable to that of included sample. The study sample consisted of 30

females (50.0%); half were between 18-34 years of age; 60% ( n=36) had less

than 10 years of education, 50% were employed, 73.3% (n=44) were married,

63.3% (n=38) belonged to nuclear families, and most of them (66.6%, n=40)

were from rural background. Proportions of different primary diagnoses as

observed were anxiety disorder (n=22, 36.6%), major depressive disorder

(MDD; n=18, 30.0%), bipolar disorder (n=10, 16.6%), and schizophrenia (n=10,

16.6%).

Sociodemographic variables and patient satisfaction

Composite scores were comparable between genders, age groups, educational

groups, employment groups, marital status, and type of family. Comparing the

genders, subscale scores of general satisfaction was significantly more in

female patients, and that of communication was more in males. Older group

(age 35-60 years) compared to the younger group (18-34 years) had

significantly higher scores in TQ, IPM, and TWD, whereas significantly lower

59
score in financial aspects. Patients with less than 10 years of education

reported significantly more scores on accessibility and conveyance than

those with more years of education. Patients who were employed had

significant higher scores in communication, but lower score in general

satisfaction than those who were unemployed. Married patients had

significantly higher score on TQ and AC, but lower score on financial

aspects. There was no difference in subscale or composite scores based on

type of family-extended or nuclear.

Clinical variables and patient satisfaction

Among the diagnostic categories, the difference between composite scores

was statistically significant; patients with MDD had the highest, followed by

those with anxiety disorder, bipolar, and the least was with schizophrenia

patients. Subscale scores of TQ and IPM were highest in patients with MDD,

FIN in patients with bipolar disorder, and AC in patients with anxiety

disorder. Based on CGI, individuals with higher scores (3 or more) had

significantly higher score on IPM. However, the composite scores were

comparable. Considering the level of functioning, patients with higher GAF

60
score (60 or more) had significantly higher score on TWD but lower score on

IPM, with no difference in the composite score. There was no correlation

between PSQ-18 total score with age or CGI severity.

DISCUSSION

This study assessed the satisfaction level of the psychiatric patients who

received at least six months of care from outpatient department of a

hospital in South India. It attempted to address, to an extent, the paucity

of information on patient satisfaction on psychiatric services in an Indian

set-up.

Sociodemographic variables and satisfaction

It was interesting to note that the composite patient satisfaction scores

were not significantly different between any of the sociodemographic

groups studied: Males and females, younger (18-34 years) and older (35-60

years) age groups, lower or higher educational groups, employed and

unemployed, married and unmarried, and extended or nuclear family

background are rural or urban background.

61
Interpersonal rapport and good doctor-patient relationship have been a

cornerstone of higher patient satisfaction. Respondents were more satisfied

with personal rather than professional qualities of the doctors.[15] In our

study, the highest level of satisfaction was noted in interpersonal aspects

(71.4%) and time spent with doctors (62.4%). General satisfaction level was a

little over 50% (57%).

Variability was seen in the subscale scores in many demographic groups

studied. Comparing the genders, even though subscale scores of general

satisfaction was significantly more in female patients, the score for

communication was significantly less than the males. It is important to

improve the communication with patients, especially female patients. Often,

the communication is directed to persons accompanying the female patients,

and the information is discussed with others rather than the female patient

directly. Communication with female patients needs specific attention, and it

should be in a way they can understand and appreciate the information.

Older age group (35-60 years) compared to the younger age group (18-34

years) had significantly higher scores and lower scores in TQ, IPM, and

62
TWD, whereas significantly less score in financial aspects. Patients with less

than 10 years of education reported significantly higher scores on

accessibility and conveyance than those with more years of education.

Patients who were employed had significantly higher scores in

communication, but lower score in general satisfaction than those

unemployed. Married patients had significantly higher score on TQ and

accessibility and conveyance but lower score on financial aspects. These

observed differences in satisfaction scores in different subscales among

various demographic groups suggest the complexities involved in the

patients’ perception of satisfaction.

Clinical variables and satisfaction

Among the diagnostic categories, the difference between composite scores

were statistically significant; patients with MDD had the highest scores

followed by those with anxiety and bipolar disorder, and the least score was

with schizophrenia patients. In a previous study, variables associated with

dissatisfaction included having a diagnosis of psychosis, being an inpatient,

being in contact with services for more than six years, and being single.[17]

63
In contrast to our finding, patients with a schizophrenia spectrum disorder

were more satisfied when treated as inpatients and day patients, as

compared with outpatient treatment.[18] Patients in other diagnostic

categories were less satisfied with day treatment.[18]

Subscale scores of TQ and IPM were highest in patients with MDD, FIN in

patients with bipolar disorder, and AC in patients with anxiety disorder

[Table 2]. Appropriate TQ of care was significantly associated with higher

levels of satisfaction in a different study.[27] Results of these analyses

studying the causal relationship between patient-reported interpersonal and

technical quality of care for depression indicated that patients who

reported high satisfaction with care were more likely to receive higher

technical quality depression care six months later as compared with those

who are less satisfied.[28]

Based on CGI, persons with higher scores (3 or more) had significantly

higher score on IPM. However, the composite scores were comparable.

Considering the level of functioning, patients with higher GAF score (60 or

more) had significantly higher score on TWD but lower score on IPM, with no

64
difference in the composite score. Clinical severity and functioning level

might not be directly influencing the overall satisfaction but they affect

various components of it.

About the waiting time, 57% said that they need to wait occasionally for long

hours and 15% said that they never waited for long hours to see the doctor.

65
With this regard, the responses of patients are projected in Figure 1. From

the data it is seen that most of the patients have responded that the

waiting time is with in one hour. The waiting time in the enquiry and Medical

Records Department (MRD) is less than 30 minutes for more than 70% of

the patients. However the waiting time for consultation seems to be delayed;

in some cases it extends to more than three hours.

Figure 1: Patients' response about waiting time

With regard to the availability of medical records in the out patient

department, majority of the patients were happy. When asked about the

66
comfort available in the out patient department, 75% of the patients had a

good opinion. With regard to the cleanliness in the hospital, 50% of patients

were highly satisfied whereas 15.5% said that the cleanliness can surely be

improved. With regard to the staggered appointment system followed at

SCTIMST, 94% of the patient was satisfied with the system and the same is

the case with the signage boards available in the Out Patient Department.

With regard to the time spent by the doctors during consultation 96.5% of

the patients were satisfied. With regard to the Doctors behavior 56% said

that Doctors were well behaved, compassionate and patient, while 35.5% felt

that they were well behaved but would have been better if they were more

patient. With regard to the privacy in consultation, 97.5% of the patients

were satisfied. To a question “Were you benefited” when compared to the

time spent for checkup, 79.4% responded that they were highly benefited

while 19.6% said that they were benefited but have to wait for long hours to

meet the doctor. To another question about their perception of benefit

compared to the money spent, 76% said that they were benefited and 23%

said that they were benefited but have to wait for long hours for

consultation.

67
About the services provided by the nursing staff, the patient responded as

per Figure 2. It is seen that majority of the patients are satisfied with the

care and explanation about the disease and treatment given to them by the

nursing staff. However the friendliness component of the nursing service

was rated to be only average by 40% of the patients.

Figure 2: Patients' response about the services of nursing staff

About the Support services in the hospital, patients responded as per Figure

3. It id found that the majority of the patients are satisfied with the

support services like Security, Accounts, Attenders and MSW. When asked

68
about recommending this hospital to others, 55.8% said that they would

always do so, while 30.2% said that they will do usually and 11.6% said that

they will some times recommend this hospital.

Figure 3: Patients' response about the support services of hospital

CONCLUSION

69
Patent Satisfaction with the psychiatric outpatient services in Anil

Neerukonda Hospital, Visakhapatnam was observed to be varied across

diagnostic groups: Patients with schizophrenia were least satisfied, whereas

patients with major depression had highest satisfaction with services. There

was a difference in satisfaction levels among the demographic and clinical

groups regarding various components of satisfaction. Patient satisfaction in

psychiatry is a complex issue with various influencing factors. It is essential

to study this further, as it has potential to improve clinical care.

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70
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74