CHAPTER-1

INTRODUCTION

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 INTRODUCTION

Patient satisfaction has been an important issue for health care managers - various
dimensions of patient satisfaction have been identified, ranging from admission to
discharge services, as well as from medical care to interpersonal communication well
recognized criteria include responsiveness, communication, attitude, clinical skill, amenities,
food services etc. It has also been reported that the interpersonal and technical skill of
health care provider are two unique dimensions involved in patient assessment of hospital
care.

In order to maintain satisfied customers, a reliable methodology to monitor levels of

satisfaction must be employed. Organizations must constantly monitor the effects of
management decision in terms of customer and establish benchmarks for future
evaluation.

Patient satisfaction is an attitude a person’s general orientation towards a total experiences

of health care. It is achieved when the patients perception of the quality of care and
services that they receive in health care. Setting has been positive, satisfying and meets their
expectations. One of the significant trends in the development of modern health care is
the involvement of patients/clients in the management of their care and treatment. Person
centered health care respects the dignity and value of each person. It is entirely desirable
and proper that the views of patients should be sought on their experiences and
expectations of health care.

Modern organizations currently collect feedback from the patients as it can influence the
whole quality improvement agenda and provide an opportunity for organizational learning
and development. Satisfaction, like many other psychological concepts, it easy to
understand but hard to define satisfaction is not some pre-existing phenomenon waiting
to be measured, but a judgement people form over time as they reflect on their
experience.

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 CHAPTER-2
REVIEW OF LITERATURE

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 REVIEW OF LITERATURE

PATIENT SATISFACTION [1]

A patient is a person who is receiving medical care or who for by a particular
doctor or dentist when necessary.
Patient satisfaction is a measure of the extent to which a patient is content with the health care
which they received from their health care provider.
A patient is any recipient of health care services. The patient is most often ill or injured and in
need of treatment by a physician, physician assistant, advanced practice registered nurse,
veterinarian or other health care provided. An in-patient on the other hand is “admitted” to the
hospital; and stays over night or for an in determinate time, usually several days or weeks.
Treatment provided in this fashion is called inpatient care. The admission to the hospital involves
the production of an admission note the learning of the hospital is officially termed discharge and
involves a corresponding discharge note.
Employee satisfaction and retention have always been important issues for physicians. Satisfied
employees tend to be more productive, creative and committed to their employers.
Family physicians who can create work environments that attract, motivate and retain hard-
working individuals will be better positioned to succeed in a competitive health care
environment that demands quality and cost-efficiency. What's more, physicians may even
discover that by creating a positive workplace for their employees, they've increased their own
job satisfaction as well.
Without acceptable levels of patient satisfaction, health plans may not get full accreditation and
will lack the competitive edge enjoyed by fully accredited plans.
In health care, patient satisfaction is "the degree to which the individual regards the health care
service or product or the manner in which it is delivered by the provider as useful, effective, or
beneficial."
This is a component of the physician-patient relationship. However, in health care delivery,
patient satisfaction may conflict with quality of care. One study found "in a nationally
representative sample, higher patient satisfaction was associated with less emergency department
use but with greater inpatient use, higher overall health care and prescription drug expenditures,
and increased mortality. Similarly, academic teaching hospitals may provide better outcomes
than private hospitals, but patients are more satisfied with private hospitals.
The concept of patient experience is surprisingly complex and generally linked with patient
satisfaction. As reimbursement and performance policies have become more normative within
healthcare, the patient experience has become a metric to measure payment systems for quality.
However, we still have much to learn about the concept of patient experience and its influence
on how patients report satisfaction with their care. This article discusses challenges for

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measurement of the patient experience, such as lack of consistent terminology and multiple
contributing factors, by reviewing a brief selection of selected literature to help readers
appreciate the complexity of measurement [1].

HOSPITAL CUSTOMER SATISFACTION [17]

The health care industry is making rapid progress now a days and the competition among the
health care service provider is also increased, because they are facing different challenges like
competitive pressure, changing cost structure monitoring public and private groups and because
of it they are to reassess their strategies at every step. Because in that era its realize that customer
satisfaction is the key element to enhance the profitability and long term viability and success.
Research related to the consumer satisfaction and behavior in the field of services industry has
progress in upcoming years and also measured the dimensions of customer’s satisfaction.
Customer satisfaction is increase with the experience of that service in which they involved. In
health care services delivering of the customer satisfaction is also imperative because client are
well educated and are more aware than in the past they can client check the options available to
them.
Therefore, in health care services customers are highly involved and because of it health care
service providers need much care and competence while providing to customers The study
examines the involvement of customers in health care services which describe that if there is
high Involvement of customer then they become associated with greater expectations and
performance for the unclear dimension of service, but sometimes customer’s involvement is low
when the performance is predicted.
Over the past several years, the issue of patient/customer satisfaction has gained increased
attention from executives across the healthcare industry. As a result, industry leaders have been
focusing theirat Attention on improving patient/customer satisfaction through various initiatives.
However, despite their many efforts and successes, evidence shows that more work in this area is
still needed (ACHE, 2006).
First one is the parking facilities because parking is starting point of customer’s dissatisfaction,
as patient look for the facilities that are more favorable to them and which do not require them to
walk enough.

Lack of signage can also have the negative impaction customer satisfaction because people do
not want to waste too much time to find the place they are supposed to be. Because patient
expect the clear indication where they want to go but these are the variables in which customers
are not involve directly.
The other factor is the expectation as customers compare the experience when they receive the
services from one health care and others. One main factor in health customer satisfaction is the
actual outcome of service which delivers by the doctor and due to this they improve or get better
and as well as the care or medication they receive is more likely to report feeling satisfied with
their experience.
There are some other different variables which have an impact on customer satisfaction such as
service quality, Access mechanism, skills and physician behavior because in Indian these

5
variables are very important than others variables the reason behind is that in Indian there is little
focus on the access mechanism quality specially in government hospitals. Service quality is the
most important factor to determine the customer satisfaction, there are two dimension of service
quality one is the technical quality and second one is the functional quality. The quality is
different from others variables because for the effectiveness quality is necessary variable which
definitely enhance the productivity of the hospital and it give effectiveness to the principle of the
natural services. Access mechanism (cost, technology), technology is producing better results
than before i.e., time saving. And the other is cost of servicers if patient feel that they are paying
the price according to the services which they are received then from doctor but there is less
resources deliver to the public sectors due to this reason revenue is not meet the expenses and
decrease the capacity of deliver the services to patient.
Doctor is the most important factor regarding the affect on customer satisfaction it can be the
attitude and treatment that patients receive from doctors, nurses and other health care
professional which can satisfy them or dissatisfy as well. Patients want, and should expect to
receive, professional care that is courteous, polite, caring and empathetic [17].

PATIENT SATISFACTION WITH HEALTH CARE [2]

Measuring and reporting on patient satisfaction with health care has become a major industry.
The number of MEDLINE articles featuring “patient satisfaction” as a key word has increased
more than 10-fold over the past two decades, from 761 in the period 1975 through 1979 to 8,505
in 1993 through 1997. Patient satisfaction measures have been incorporated into reports of
hospital and health plan quality, and armies of consultants make a good living selling software
packages to health care providers eager to assess their customers' reactions by telephone, fax, and
modem.
On one side of the aisle is an uneasy alliance of consumer advocates, marketing specialists, and
proponents of patient-centered care. On the other side are skeptics who believe that focusing on
patient satisfaction diverts attention from what ought to be our principal concerns in an era of
resource constraints: inappropriate care; underuse of necessary care; and clinical outcomes such
as morbidity, mortality, and health status. These critics have a point. Compared with measures of
technical quality, data on patient satisfaction are easy to collect, and many health care
organizations have succumbed to the temptation to stop there. Nevertheless, helping patients
achieve their goals is a fundamental aim of medicine. Because patients' goals and values vary
widely, are not predictable on the basis of demographic and disease factors alone, and are subject
to change, the only way to determine what patients want and whether their needs are being met is
to ask them. From this perspective, viewing care “through the patient's eyes” is an ethical and
professional imperative. Individual clinicians, medical groups, hospitals, and health care
outcomes usually turn not on whether measuring patient satisfaction is important, but on whether
satisfaction can be measured reproducibly and meaningfully.
If patient satisfaction is to take its place alongside morbidity, mortality, and functional status,
several critical measurement issues must be addressed. First, scale developers and end-users need
to be clear about what they are measuring. “Patient satisfaction” is not a unitary concept but
rather a distillation of perceptions and values. Perceptions are patients' beliefs about occurrences.
They reflect what happened. Values are the weights patients apply to those occurrences. They

6
reflect the degree to which patients consider specific occurrences to be desirable, expected, or
necessary [2].

THE IMPORTANCE OF PATIENT SATISFACTION [3]

1. Satisfied patients will share their positive experience with five others, on average, and
dissatisfied patients complain to nine (or more) other people. The Internet promotes rapid and
wide dissemination of these opinions.
2. Because the cost of obtaining a patient is high, losing patient is a substantial loss of
investment. You may have attracted a patient through advertising or an insurance contract. And
for each new patient, you must establish a patient record and gather payment information. Every
interaction with the patient, payer (confirming coverage, etc.), physician’s office (obtaining files,
results of physical, etc.), pharmacy (ordering or refilling a prescription), or laboratory (following
up on test results) represents a portion of your investment in that patient.
3. There is evidence of a reciprocal relationship between patient satisfaction and continuity of
care (which is associated with better patient outcomes). Conversely, dissatisfaction and
complaints can mean not only loss of business/investment, but also increased risk of malpractice
lawsuits. Accreditation, business improvement, and risk management are not the only reasons
patient satisfaction is important.
Surveying patient satisfaction can offer patients an opportunity to participate in their care by
reporting their care experiences and building engagement. The value of patient reporting has
traditionally been questioned because of the level of most patients’ clinical knowledge in
comparison with that of providers. However, this view may need to be reconsidered, not only
because of the increased socioeconomic importance of patients’ active involvement in their own
health care, but also because of the findings of: reliable patient reporting for certain aspects of
care from specialist and primary care providers. Relationships between patient
dissatisfaction/complaints and poor outcomes Patients ability to accurately report their disease
category.
Patient satisfaction surveys represent real-time feedback for providers and show opportunities to
improve services/decrease risks. However, many organizations/providers do not know how to
use the patient satisfaction information they receive. This may be because providers often seek
yes/no responses or ratings on a Likert scale without asking patients to report on their care
experience [3].

MEASURING PATIENT SATISFACTION [4]

Patient satisfaction is at the core of patient centered medicine.   Improved patient satisfaction
not only leads to an enhanced patient experience-something every sick or injured patient
deserves-it is also associated with improved treatment outcomes.  In 2008, researchers
demonstrated that improved patient satisfaction was correlated with higher quality hospital
care “for all…conditions measured.”  More recent work has begun to identify exactly how this
correlation works.  Furthermore, improved patient satisfaction has even been correlated with

7
reduced in-patient mortality, “suggesting that patients are good discriminators of the type of
care they receive.”
Despite the correlation between higher patient satisfaction rates and improved outcomes,
measurement of patient satisfaction remains controversial among many health care providers.  
Physicians, in particular, often chafe when organizations, such as The Commonwealth Fund
through their site WhyNotTheBest, or the Centers for Medicare and Medicaid Services though
their physician compare website, begin to publicly report doctors’ patient satisfaction data. 
Additionally, employed physicians often fret when patient satisfaction is included in their
reimbursement metrics.
Certainly there are instances in which sound medicine may lead to a lower rate of patient
satisfaction; infrequently, satisfaction can correlate, not with high quality care, but with the
fulfillment of patients’ a priori wishes for their treatment.  A good example of this problem is
the difficulty in refusing to fill narcotics prescriptions and steering a patient toward alternative
pain relief modalities when the physician has good evidence that a patient has a problem with
narcotics abuse.  While the doctor in this example is practicing good medicine, it is highly
unlikely that the patient will leave the office anything other than deeply disappointed.
Despite these relatively rare cases, many studies show a deep chasm between how patients
and doctors view medical care, and thus demonstrate the need to measure patient satisfaction
rates.  Patients and their doctors can view the same episodes of care quite differently so,
without patient satisfaction measures, we are left with an incomplete or even misleading
picture of patient care [4].

FACTORS INFLUENCING PATIENT SATISFACTION [1]

Patient satisfaction with an encounter with health care service is mainly dependent on the
duration and efficiency of care, and how empathetic and communicative the health care
providers are. It is favored by a good doctor-patient relationship. Also, patients who are well-
informed of the necessary procedures in a clinical encounter, and the time it is expected to take,
are generally more satisfied even if there is a longer waiting time. Another critical factor
influencing patient satisfaction is the job satisfaction experienced by the care-provider [1].

OUTPATIENTS AND IN-PATIENTS [5]

An outpatient (or out-patient) is a patient who is hospitalized for less than 24 hours. Even if the
patient will not be formally admitted with a note as an outpatient, they are still registered, and the
provider will usually give a note explaining the reason for the service, procedure, scan, or
surgery, which should include the names and titles and IDs of the participating personnel, the
patient's name and date of birth and ID and signature of informed consent, estimated pre- and
post-service time for a history and exam (before and after), any anesthesia or medications
needed, and estimated time of discharge absent any (further) complications. Treatment provided
in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a
formal hospital admission or an overnight stay. This is called outpatient surgery. Outpatient
surgery has many benefits, including reducing the amount of medication prescribed and using the
physician's or surgeon's time more efficiently. More procedures are now being performed in

8
a surgeon's office, termed office-based surgery, rather than in a hospital-based operating
room .Outpatient surgery is suited best for healthy patients undergoing minor or intermediate
procedures (limited urologic, ophthalmologic, or ear, nose, and throat procedures and procedures
involving the extremities).
An in-patient, on the other hand, is "admitted" to the hospital and stays overnight or for an
indeterminate time, usually several days or weeks, though in some extreme cases, such as
with coma or persistent vegetative state  patients, stay in hospitals for years, sometimes until
death. Treatment provided in this fashion is called in-patient care. The admission to the hospital
involves the production of an admission note. The leaving of the hospital is officially
termed discharge, and involves a corresponding discharge note. Misdiagnosis is the leading
cause of medical error in outpatient facilities. While patient safety efforts have focused on in-
patient hospital settings for more than a decade, medical errors are even more likely to happen in
a doctor’s office or outpatient clinic or center.
DAY PATIENT
A day patient or (day-patient) is a patient who is using the full range of services of a hospital or
clinic but is not expected to stay the night. The term was originally used by psychiatric hospital
services using of this patient type to care for people needing support to make the transition from
in-patient to out-patient care. However, the term is now also heavily used for people attending
hospitals for day surgery [5].

PATIENT-CENTERED HEALTH CARE [6]

The doctor-patient relationship has sometimes been characterized as silencing the voice of

patients. It is now widely agreed that putting patients at the centre of healthcare, by trying to
provide a consistent, informative and respectful service to patients, will improve both outcomes
and patient satisfaction.
There are many reasons for why health services should listen more to patients. Patients spend
more time in healthcare services than any regulators or quality controllers. Patients can recognize
problems such as service delays, poor hygiene, and poor conduct. Patients are particularly good
at identifying soft problems, such as attitudes, communication, and 'caring neglect’ that are
difficult to capture with institutional monitoring.

IN-PATIENT CARE
In-patient care is the care of patients whose condition requires admission to a hospital. Progress
in modern medicine and the advent of comprehensive outpatient clinics ensure that patients are
only admitted to a hospital when they are extremely ill or have severe physical trauma.
There are times when a person becomes so ill that they are at risk of hurting themselves or others
and hospitalization becomes necessary even though the individual does not wish to enter a
hospital. While seeking help voluntarily is always preferable, if that is at all possible, the
decision to hospitalize involuntarily can be more caring than it seems if that is the only way your
family member or friend can get the care they need, especially if there is a risk of suicide or harm
to others [6].

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AIDET: FIVE STEPS TO ACHIEVING SATISFACTION [7]
AIDET is a framework for Sharp's staff to communicate with patients and their families as well
as with each other. It is a simple acronym that represents a very powerful way to communicate
with people who are often nervous, anxious and feeling vulnerable. It can also be used as we
communicate with other staff and colleagues, especially when we are providing an internal
service.
1. Acknowledge
Greet people with a smile and use their names if you know them. Attitude is everything. Create a
lasting impression.
"Good morning/afternoon, Ms. Jones. We've been expecting you and we're glad you are here."
2. Introduce
Introduce yourself to others politely. Tell them who you are and how you are going to help them.
Escort people where they need to go rather than pointing or giving directions.
"Mrs. Smith, you will be seeing Dr. Hoegrefe today. He is an excellent physician. He is very
good at listening and answering patient questions. You are fortunate that he is your physician."
"Mr. White, Dr. Williams would like you to have an X-ray in our radiology department. We have
an excellent team of radiology technicians who use state-of-the-art equipment. I'm confident you
will have a great experience."
3. Duration
Keep in touch to ease waiting times. Let others know if there is a delay and how long it will be.
Make it better and apply service recovery methods when necessary.
"Dr. Heart had to attend an emergency. He was concerned about you and wanted you to know
that it may be 30 minutes before he can see you. Are you able to wait or would you like me to
schedule an appointment for tomorrow?"
4. Explanation
Advice others what you are doing, how procedures work and whom contact if they need
assistance. Communicate any steps they may need to take. Make words work. Advise others
what you are doing, how procedures work and whom to contact if they Talk, listen and learn.
Make time to help. Ask, "Is there anything else I can do for you?"
5. Thank you
Thank somebody. Foster an attitude of gratitude. Thank people for their patronage, help or
assistance. Use reward and recognition tools.
"Thank you for choosing Sharp. It has been a privilege to care for you."
"Thank you for your call. Is there anything else I can do for you? I have the time [7]."

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CUSTOMER RELATIONSHIP [8]
Patient loyalty is a critical criterion for healthcare customer relationship management (CRM). An
integrated framework with a case-based prediction model and a constraint-based optimization
model is proposed to support the decision making of healthcare providers. This research first
adopts a case-based prediction mechanism to forecast the possible loyalty level. We also
proposes a constraint-based optimization approach as a subsequent mechanism to determine the
optimum values of case features that may lead to the optimal patient loyalty. The potential use of
this framework helps a decision maker allocate resources to increase the loyalty level for the
given target patient segmentation.

PATIENT CARE
Patient Care is a national health care advocacy and transparency company. We help our members
understand the complicated health care system and make informed decisions about health care
spending. From explaining the codes on a confusing medical bill, to cost and quality research
before a planned procedure, Patient Care makes sense [8].

PATIENT EDUCATION [9]

Patient education is the process by which health professionals and others impart information to
patients and their caregivers that will alter their health behaviors or improve their health status.
Education may be provided by any healthcare professional who has undertaken appropriate
training education, education on patient communication and education is usually included in the
healthcare professional's training.
Health education is also a tool used by managed care plans, and may include both
general preventive education or health promotion and disease or condition specific education.
Important elements of patient education are skill building and responsibility: patients need to
know when, how, and why they need to make a lifestyle change. Group effort is equally
important: each member of the patient’s health care team needs to be involved.

The value of patient education can be summarized as follows:

 Improved understanding of medical condition, diagnosis, disease, or disability.
 Improved understanding of methods and means to manage multiple aspects of medical
condition.
 Improved self-advocacy in deciding to act both independently from medical providers
and in interdependence with them.
 Increased Compliance – Effective communication and patient education increases patient
motivation to comply.

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  Patient Outcomes – Patients more likely to respond well to their treatment plan – fewer
complications.
 Informed Consent – Patients feel you've provided the information they need.
 Utilization – More effective use of medical services – fewer unnecessary phone calls and
visits.
 Satisfaction and referrals – Patients more likely to stay with your practice and refer other
patients.
 Risk Management – Lower risk of malpractice when patients have realistic expectations.
The competencies of a health educator include the following:
 Incorporate a personal ethic in regards to social responsibilities and services towards
others.
 Provide accurate, competent, and evidence-based care.
 Practice preventative health care.
 Focus on relationship-centered care with individuals and their families.
 Incorporate the multiple determinants of health when providing care.
 Be culturally sensitive and be open to a diverse society.
 Use technology appropriately and effectively.
 Be current in the field and continue to advance education.
There are many areas where patient education can improve the outcomes of treatment.

Support groups have been shown to be a helpful method for dealing with depression in this
population. Preoperative patient education helped patients with their decision making process by
informing them of factors related to pain, limb loss, and functional restriction faced after
amputation.
In the case of arthritis, patient education was found to be administered through 3 methods,
including individual face to face meetings with healthcare professionals, patient groups, on line
support programs. Category I evidence was found for individual, face to face counseling.
Meeting with rheumatologists, occupational therapists, physical therapists, nurses, and other
healthcare providers was found to be effective in creating adherence to treatment, medication,
and for improving overall patient health. In the case of Rheumatoid Arthritis, patient education
has been shown as an effective non-pharmacological treatment [9].

PATIENT OUTCOME [10]

A patient-reported outcome (PRO) is a health outcome directly reported by the patient who
experienced it. It stands in contrast to an outcome reported by someone else, such as a physician-
reported outcome, a nurse-reported outcome, and so on. PRO methods, such as questionnaires,
are used in clinical trials or other clinical settings, to help better understand a treatment's

12
efficacy. The use of digitized PROs, or electronic patient-reported outcomes (ePROs), is on the
rise in today's health research industry [10].

HOSPITAL-PATIENT RELATIONSHIP [11]

Interactions between hospital staff or administrators and patients. Includes guest relations
programs designed to improve the image of the hospital and attract patients.

DOCTOR - PATIENT RELATIONSHIP

The doctor-patient relationship is central to the practice of health care  and is essential for the
delivery of high-quality health care in the diagnosis and treatment of disease. The doctor–patient
relationship forms one of the foundations of contemporary medical ethics. Most universities
teach students from the beginning, even before they set foot in hospitals, to maintain a
professional rapport with patients, uphold patients’ dignity, and respect their privacy [11].

NURSE-PATIENT RELATIONSHIP [12]

A therapeutic nurse-patient relationship is defined as a helping relationship that's based on

mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and
assisting with the gratification of your patient's physical, emotional, and spiritual needs through
your knowledge and skill. The nurse-patient relationship is an interaction aimed to enhance the
well-being of a "client," which may be an individual, a family, a group, or a
community. Peplau’s theory is of high relevance to the nurse-client relationship, with one of its
major aspects being that both the nurse and the client become more knowledgeable and mature
over the course of their relationship. Peplau believed that the relationship depended on the
interaction of the thoughts, feelings, and actions of each person and that the patient will
experience better health when all their specific needs are fully considered in the relationship [12].

PATIENT RIGHTS AND RESPONSIBILITIES [13]

 A patient or his/her representative has the right to be informed of patient rights in

advance of receiving or discontinuing patient care, whenever possible.
 A patient has the right to medical and nursing services without discrimination based upon
age, race, ethnicity, color, religion, culture, language, physical or mental disability,
socioeconomic status, sex, sexual orientation, gender identity, national origin or source of
payment.
 A patient has the right to receive visitors whom she or he designates, including but not
limited to, a spouse, a domestic partner, another family member, or a friend. Patient
visitation is only restricted when the visitor’s presence infringes on others’ rights, safety,
or is medically or therapeutically contraindicated for the patient.

13
 A patient has the responsibility to provide accurate and complete information about
present complaints, pain, past illnesses, hospitalizations, medications, demographics, and
matters relating to his/her health.
 A patient is expected to ask questions and tell caregivers if he/she does not understand
his/her care or treatment.
 A patient has the right to good quality care and high professional standards that are
continually maintained and reviewed.
 A patient has the right to respectful care given by competent personnel.
 A patient has the right to receive medical and nursing care in a safe setting and to be free
from all forms of abuse and harassment.
 A patient has the right to be free from seclusion and restraints that are not medically
necessary.
 A patient has the right to information about pain and pain relief measures and health care
providers committed to pain prevention and control.
 A patient who presents to the Emergency Department has the right to receive at least a
medical screening exam, regardless of the patient’s ability to pay, and the right to have
any emergency medical condition stabilized or to be transferred appropriately.
 A patient has the right, upon request, to be given the names of all health care providers
directly participating in his/her care.
 A patient has the right to assistance in obtaining consultation with another physician at
the patient’s request and expense.
 A patient has the right to expect emergency procedures to be implemented without
unnecessary delay.
 A patient who is mentally capable (and if not, the patient’s guardian, next of kin, or other
authorized representative) has the right to participate in development, implementation,
and revision of his/her plan of care.
 A patient, or his/her authorized representative, has the right to full information in
understandable terms, concerning his/her diagnosis, treatment and prognosis, including
information about alternative treatments and possible complications.
 A patient has the right to make informed decisions concerning his/her care. A patient
does not have the right to demand medically unnecessary treatment or services.
 A patient has the right to be informed by his/her physician of his/her right to refuse any
drugs, treatment or procedures, and of the medical consequences of such refusal.
 A patient has the right to make advance directives and to have health care personnel
comply with these directives, within the limits of the law.
 A patient has the right to decide whether or not to participate in research, investigation, or
clinical trials.
 A patient’s refusal to participate in research or discontinuing participation at any time
will not jeopardize his/her access to care, treatment and services unrelated to the research.

14
  When medically permissible, a patient may be transferred to another facility only after
he/she or his/her next of kin or other authorized representative has received complete
information and an explanation concerning the needs for and alternatives to such a
transfer.
 A patient has the right to participate in the development and implementation of his/her
discharge plan, which includes being informed of his/her continuing health care
requirements following discharge and the means for meeting them.
 A patient has the right to have all records pertaining to his/her medical care treated as
confidential, except as otherwise provided by law or third party contractual arrangements.
 A patient has the right to access his/her own medical information within a reasonable
time.
 A patient’s access to medical records may be restricted by the patient’s attending
physician for sound medical reasons, consistent with applicable law.
 A patient’s authorized representative may have access to the information in the patient’s
medical records, even if the attending physician restricts the patient’s access to those
records.
 A patient or his/her authorized representative has the right to be informed about
unanticipated outcomes of care, treatment and services that relate to sentinel events.
 A patient has the right to every consideration of privacy concerning his/her own medical
care program.
 A patient has the right to an environment that preserves dignity and contributes to a
positive self-image, such as the provision of privacy during personal hygiene activities.
 A patient has a right to withhold consent for electronic monitoring or recording during an
examination, except when there is a medical need for continuous observation.
 A patient has the right to give or withhold informed consent to produce or use recordings,
films, or other images of the patient for purposes other than provision of care.
 A patient has the right to examine and receive a detailed explanation of his/her bill.
 A patient has a right to information and counseling on the availability of known financial
resources for his/her health care.
 A patient has the responsibility to assure that the financial obligations for his/her health
care are fulfilled in a reasonable period of time.
 A patient who is a Medicare beneficiary has a right to receive a notice of non-coverage
and the patient’s discharge rights.
 A patient cannot be denied the right of access to an individual or agency that is
authorized to act on his/her behalf to assert or protect the rights set out in this document
[13]
.
PATIENT COMPLAINTS, GRIEVANCES WITH HOSPITALS [14]

1. Sleep deprivation from clinicians coming to do tests and draw blood in the middle of the
night.

15
2. Noisy nurses' stations that can interfere with sleep.
3. Personal belongings being lost.
4. Staff not knocking before entering the room, which can be interpreted as a sign of
disrespect.
5. Not keeping whiteboards updated. Updated whiteboards allow patients to know who is
caring for them. Patients would also appreciate a notebook where they can keep important
information and take notes.
6. Lack of clear communication and not updating the patient or family members if the patient's
condition changes.
7. Messy rooms where surfaces aren't wiped down, or the bathroom smells.
8. Feeling unengaged in their care or like they are not being listened to.
9. Lack of orientation to the room and hospital. Patients would like to know how to work the
television and how to order food.
10. Lack of professionalism from hospital staff, especially when they are on break. "While you
may be on your break, you are still a hospital employee and a reflection of the hospital," the
article reads [14].

PATIENTS' BILL OF RIGHTS [15]

Adopted in 1995
All patients should be guaranteed the following freedoms:
 To seek consultation with the physician(s) of their choice;
 To contract with their physician(s) on mutually agreeable terms;
 To be treated confidentially, with access to their records limited to those involved in their
care or designated by the patient;
 To use their own resources to purchase the care of their choice;
 To refuse medical treatment even if it is recommended by their physician(s);
 To be informed about their medical condition, the risks and benefits of treatment and
appropriate alternatives;
 To refuse third-party interference in their medical care, and to be confident that their
actions in seeking or declining medical care will not result in third-party-imposed
penalties for patients or physicians;
 To receive full disclosure of their insurance plan in plain language, including:
1. CONTRACTS: A copy of the contract between the physician and health care plan, and
between the patient or employer and the plan;
2. INCENTIVES: Whether participating physicians are offered financial incentives to reduce
treatment or ration care;

16
3. COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
4. COVERAGE: Benefits covered and excluded, including availability and location of 24-hour
emergency care;
5. QUALIFICATIONS: A roster and qualifications of participating physicians;
6. APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need
approval of a committee or any other individual, and who decides what is medically necessary;
7. REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
8. APPEALS: Grievance procedures for claim or treatment denials;
9. GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan [15].

QUALITY CARE [16]

Many view quality health care as the overarching umbrella under which patient safety resides.
For example, the Institute of Medicine (IOM) considers patient safety “indistinguishable from
the delivery of quality health care.” Ancient philosophers such as Aristotle and Plato
contemplated quality and its attributes. In fact, quality was one of the great ideas of the Western
world. Harteloh reviewed multiple conceptualizations of quality and concluded with a very
abstract definition: “Quality is an optimal balance between possibilities realized and a framework
of norms and values.” This conceptual definition reflects the fact that quality is an abstraction
and does not exist as a discrete entity. Rather it is constructed based on an interaction among
relevant actors who agree about standards (the norms and values) and components (the
possibilities).
Work groups such as those in the IOM have attempted to define quality of health care in terms of
standards. Initially, the IOM defined quality as the “the degree to which health services for
individuals and populations increase the likelihood of desired health outcomes and are consistent
with current professional knowledge.” This led to a definition of quality that appeared to be
listings of quality indicators, which are expressions of the standards. These standards are not
necessarily in terms of the possibilities or conceptual clusters for these indicators. Further, most
clusters of quality indicators were and often continue to be comprised of the 5Ds-death, disease,
disability, discomfort, and dissatisfaction-rather than more positive components of quality.
The work of the Indian Academy of Nursing Expert Panel on Quality Health focused on the
following positive indicators of high-quality care that are sensitive to nursing input: achievement
of appropriate self-care, demonstration of health-promoting behaviors, health-related quality of
life, perception of being well cared for, and symptom management to criterion. Mortality,
morbidity, and adverse events were considered negative outcomes of interest that represented the
integration of multiple provider inputs. The latter indicators were outlined more fully by the
National Quality Forum Safety is inferred, but not explicit in the American Academy of Nursing
and National Quality Forum quality indicators.
The most recent IOM work to identify the components of quality care for the 21st century is
centered on the conceptual components of quality rather than the measured indicators: quality

17
care is safe, effective, patient centered, timely, efficient, and equitable. Thus safety is the
foundation upon which all other aspects of quality care are built.

PATIENT SAFETY
A definition for patient safety has emerged from the health care quality movement that is equally
abstract, with various approaches to the more concrete essential components. Patient safety was
defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of
care delivery that (1) prevents errors; (2) learns from the errors that do occur; and (3) is built on a
culture of safety that involves health care professionals, organizations, and patients. The glossary
at the AHRQ Patient Safety Network Web site expands upon the definition of prevention of
harm: “freedom from accidental or preventable injuries produced by medical care.”
Patient safety practices have been defined as “those that reduce the risk of adverse events related
to exposure to medical care across a range of diagnoses or conditions.” This definition is
concrete but quite incomplete, because so many practices have not been well studied with respect
to their effectiveness in preventing or ameliorating harm. Practices considered having sufficient
evidence to include in the category of patient safety practices are as follows:
 Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk.
 Use of preoperative beta: Blockers in appropriate patients to prevent preoperative
morbidity and mortality.
 Use of maximum sterile barriers while placing central intravenous catheters to prevent
infections.
 Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative
infections.
 Asking that patients recall and restate what they have been told during the informed-
consent process to verify their understanding.
 Continuous aspiration of subglottic secretions to prevent ventilator-associated
pneumonia.
 Use of pressure-relieving bedding materials to prevent pressure ulcers.
 Use of real-time ultrasound guidance during central line insertion to prevent
complications.
 Patient self-management for warfarin to achieve appropriate outpatient anticoagulation
and prevent complications.
 Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in
critically ill and surgical patients, to prevent complications.

18
  Use of antibiotic-impregnated central venous catheters to prevent catheter-related
infections.
Many patient safety practices, such as use of simulators, bar coding, computerized physician
order entry, and crew resource management, have been considered as possible strategies to avoid
patient safety errors and improve health care processes; research has been exploring these areas,
but their remains innumerable opportunities for further research.
The National Quality Forum attempted to bring clarity and concreteness to the multiple
definitions with its report, standardizing a Patient Safety Taxonomy. This framework and
taxonomy defines harm as the impact and severity of a process of care failure: “temporary or
permanent impairment of physical or psychological body functions or structure.” Note that this
classification refers to the negative outcomes of lack of patient safety; it is not a positive
classification of what promotes safety and prevents harm. The origins of the patient safety
problem are classified in terms of type (error), communication (failures between patient or
patient proxy and practitioners, practitioner and nonmedical staff, or among practitioners),
patient management (improper delegation, failure in tracking, wrong referral, or wrong use of
resources), and clinical performance (before, during, and after intervention).
The types of errors and harm are further classified regarding domain, or where they occurred
across the spectrum of health care providers and settings.
The root causes of harm are identified in the following term:
 Latent failure: Removed from the practitioner and involving decisions that affect the
organizational policies, procedures, allocation of resources.
 Active failure: Direct contact with the patient.
 Organizational system failure: Indirect failures involving management, organizational
culture, protocols/processes, transfer of knowledge, and external factors.
 Technical failure: Indirect failure of facilities or external resources.

CHANGING HEALTH CARE DELIVERY SYSTEM

Health care delivery system (HCD) system in the United States is in crisis. Access is limited,
costs are high and increasing at an unacceptable rate, and concerns are growing about the quality
of service. Many, including the Institute of Medicine, believe the system should be changed
significantly in two ways: (1) HCD enterprises should be reengineered to make them more
productive, efficient, and effective; and (2) substantially more effort should be devoted to a
strategy of prevention and management of chronic diseases instead of the current heavy reliance
on the treatment of diseases. Although operations research can make substantial contributions to
both areas, the focus of this paper is on: (1) reengineering HCD enterprises, particularly areas in
which operations research can provide valuable support to senior health care managers; and (2)
enterprise-level HCD simulation models to determine the re-engineering initiatives with the
biggest payoffs before implementation.
HCD enterprises are very large, complex operational systems comprised of large numbers of
people and machine elements. Tens of thousands of people are involved as providers, patients,
support staff, and managers organized into specialties, departments, laboratories, and other

19
organizations that are considered independent service units (“stovepipes”). Machines include
durable medical equipment, information technologies, communications equipment, expendable
supplies, rehabilitation equipment, and so on. These elements are affected by many clinical and
administrative processes, most of which are probabilistic (i.e., uncertain) and change
significantly over time.
Perhaps most important, these processes involve large numbers of interactions within units,
among units, and across processes. Decisions by enterprise managers regarding one unit may
have second, third, and fourth order effects, which may be more significant than the first order
effect. HCD enterprises are driven by endogenous and exogenous human decisions made by
providers, patients, insurers, administrators, politicians, government employees, and others.
Demand and supply issues have complex feedback effects. A great many resources are required
for the development and operation of an HCD enterprise.
We need better ways of analyzing systems of this magnitude. The operations research
community has been involved with HCD enterprises for more than 40 years working on a wide
range of problems, such as inventory for perishables; management of intensive care units;
laboratory and radiology scheduling; relieving congestion in outpatient clinics; nurse staffing,
scheduling, and assignments; and layouts for operating and emergency rooms.
These efforts have focused on the small, stovepipe units, referred to by Don Berwick as clinical
and support “microsystems,” and have produced some useful information for unit managers but
have not addressed enterprise-level reengineering and planning issues (the so-called
“macrosystem”). Macrosystem issues have interactive effects across the enterprise and have
large cost, access, and effectiveness impacts.
Some of these interrelated issues are listed below:
 The mix of health services necessary to support a given population.
 The staff required (e.g., specialties, numbers, locations) to provide necessary services.
 The impacts of changing demands (e.g., aging populations, effects of preventive
measures).
 The impacts of new HCD models (e.g., home health care, task performance substitution).
 The effects of centralized radiology services.
 The impacts of primary care outreach.
 Facility capacity for the next 20 years and the best way to provide it.
 Operational changes to adapt to regulatory changes (e.g., Medicare).
These and other macrosystem issues can be addressed quantitatively using enterprise-level
simulation models that represent all of the elements, units, and processes in the enterprise as well
as the interactions among them. Because analyses of these issues are necessarily prospective, the
models must be structural rather than statistical. Statistical models, which are usually used in
economics and the social sciences, use existing system data to develop aggregated statistical
relationships between system inputs and outputs (i.e., the model). Statistical models are used
primarily retrospectively, that is, for making inferences and evaluations. In contrast, structural
models are usually developed in the engineering and physical sciences by modeling the detailed

20
physics of each process and activity. Structural models are used prospectively, that is,
for predictions and planning. Statistical models are less appropriate to prospective analyses of
future systems because the data used to develop statistical models are intrinsically tied to the
existing system [16].

21
 CHAPTER-3
HOSPITAL PROFILE

22
 HOSPITAL PROFILE
Fortis Healthcare Ltd. presently has a network of 62 hospitals with the capacity to increase in-
patient beds to ~10,000 beds. These hospitals include multi-specialty hospitals as well as super-
specialty centers providing comprehensive tertiary and quaternary healthcare to patients across
specialties including cardiac care, orthopaedics, neurosciences, oncology, renal care,
gastroenterology, mother and child care to name a few.
Recently, Fortis created history in Indian healthcare sector by announcing the landmark deal of
acquiring 10 hospitals from Wockhardt and 16 hospitals from Parkway. With the acquisition,
Fortis has a bed capacity of 10,000 beds and a network of 62 hospitals. Jointly with its Mauritius
based local partner, the company acquired majority stake in leading private hospital, ‘Clinique
Darne’. Rechristened as ‘Fortis Clinique Darne, the hospital is one of the most modern medical
centers in Mauritius, combining the traditions of dedicated personal care with hi-tech facilities
and offering wide range of general and specialized medical services in a caring and friendly
environment.
Fortis acquired Escorts Healthcare System in September 2005 and today runs one of the largest
Cardiac Programs in the world. The amalgamation of the Fortis-Escorts competencies is setting
benchmarks for healthcare delivery in India. Fortis Healthcare Limited was incorporated in 1996
to develop a world-class integrated healthcare system delivery in India, comprising of super
specialty areas along with multispecialty care at the tertiary level (serving as Hubs)/ as well as
the secondary hospitals (serving as Spokes). Using the hub and spoke model, Fortis believe it
will be positioned to penetrate the market in various cities, increase the brand recall and capture
a large share of the growing healthcare market. Fortis took its first step towards becoming a
world class provider of integrated healthcare delivery in India, by setting up Fortis Hospital,
Noida a 250 bed multi-specialty Hospital.

23
THE FORTIS LOGO

“AHEALINGPASSION”
The Fortis Healthcare Limited Logo defines the commitment to patient care. The logo reflects
their Endeavour to achieve excellence in healthcare delivery system by bringing together the best
of technology, medical expertise, and patient care. The logo also implies the human values that
govern every facet of our organization. The 2 nurturing hands along with a red dot on the top
depicts- “nurturing hands caring for human life”
GREEN is a colour of healing and depicts WELLBEING and RED is symbolic of steadfast
focus, dynamic zeal and enthusiasm.
MISSION:
 To become an Integrated Healthcare delivering organization guided by quality, excellence,
technology and compassionate patient care.
 To establish Fortis Hospital Noida as a major corporate hospital in healthcare delivery system
in the region.
VISION:
Globally respected health care organization recognized for Clinical Excellence and Distinctive
Patient Care.
FORTIS MALAR HOSPITAL

Fortis Malar Hospital a manifestation of the founder's vision of "creating a world-class integrated
healthcare delivery system in India, entailing the finest medical skills combined with
compassionate patient care”. From the pursuit of this mission emanates a passion to excel.
Located at South Chennai, Fortis Malar Hospital equipped with has 3 operating theatres and 180
operational inpatient beds, brings a wealth of medical expertise with the finest talents amongst

24
doctors, nurses, technicians and management professionals in an environment that enables them
to deliver the highest quality of healthcare through state-of-the art facilities that aims to leave no
stone unturned in perfecting ever enhancing patient centric care.
The highlight of this facility is its five super specialty centers setup to render state of the art
medical care:
 Escorts Heart Institute at Malar Hospitals
 Malar Institute for Renal Sciences (MIRS)
 Malar Specialty Centre for Joints (MSCJ)
 Malar Health care for Obstetrics and Gynaecology
 Malar Health care Centre for Diabetes (MHCD)

DEPARTMENTS

1. Medical administration
2. Zonal operations
3. Administration – food & beverages, security, housekeeping
4. Patient care services
5. Engineering
6. IT department
7. HR department
8. Sales & marketing
9. Finance
The Hospital is equipped with:
 250 bed multi specialist tertiary care hospital.
 8 ICUs with 63 beds: Medical, Surgical, Liver Transplant, Kidney Transplant, Cardiac,
Neuroscience, CTVS and Neonatal ICU.
 5 OTs
 All laboratory services of world class standard like histopathology, microbiology,
biochemistry and haematology are present.
 Ambulances which transport patients to the hospital emergency.

25
SERVICES AVAILABLE AT FORTIS SUPER SPECIALTY SERVICES
 Cardiology
 Cardiac Surgery (ADULT & PEDIATRICS)
 Nephrology
 Urology including renal transplant
 Pulmonology & thoracic Surgery
 Endocrine & Metabolic Disease
 Joint Replacement
MULTI-SPECIALITY SERVICES

 Internal medicine
 Critical care medicine
 General surgery & minimal Access Surgery
 ENT
 Paediatrics
 Paediatrics Surgery
 Gynaecology including gynaecology
 Surgical Oncology
 Medical oncology
 Dermatology & cosmetology
 Cosmetic & plastic surgery
 Geriatric medicine
 Rheumatology
 General orthopaedics & hand surgery
 Ophthalmology
 Dentistry
 Physiotherapy including domiciliary physiotherapy
 Clinical nutrition & dietetics
 Neurology
 Neurosurgery
 Gastroenterology

26
 CHAPTER-4
RESEARCH METHODOLOGY

27
 RESEARCH METHODOLOGY
This chapter deals with research methodology selected by the investigator in order to conduct the
study entitled “A study on in- patient satisfaction in Fortis Malar Hospital, Chennai.’’

STATEMENT OF THE PROBLEM

A study on in-patient satisfaction in Fortis Malar Hospital, Chennai.

OBJECTIVE
1. A study to evaluate in-patient satisfaction in Fortis Malar Hospital.

2. To suggest methods to improve the in-patient satisfaction.

RESEARCH APPROACH
The research approach adopted in the study was qualitative approach. It includes collection of
information’s, opinions and attitudes directly from the subject of the study through questionnaire
schedule. Type of research adopted was descriptive. As it was a fact finding study.

SETTING OF THE STUDY

The study was conducted for a period of one month from 1 st February to 28th February
2017 at Fortis Malar Hospital, Chennai.

TYPE AND SOURCE OF DATA

There are two types of data: primary data and secondary data.

Primary data are those data which are collected directly from the study area and secondary
data are those information which are collected from books, journals and registers and so on.

In this study the researcher used only primary source of information.

METHODS OF DATA COLLECTION

Data was collected using questionnaire which was directly administered to the respondents of
this study.

28
POPULATION
The population consists of all the in-patient who visited the hospital, during the period of
the study.

SAMPLE AND SAMPLING TECHNIQUE

The researcher selected 100 in-patients as sample. Convenient sampling technique was used to
get the desired sample size.

INCLUSION CRITERIA
The in-patients admitted in the ward and room were included the study.

EXCLUSION CRITERIA
The in-patients in critical care unit were excluded from the study.

LIMITATION
The study was limited to a period of one month ie, from 1st February to 28th February 2017.

TOOLS AND TECHNIQUES

The tool used for the study was questionnaire. The questionnaire was divided into two parts.
Part-A consists of demographic data. Part-B consists of questions related to in-patient
satisfaction.

NO.OF
SI NO. ITEMS QUESTIONS QUESTIONS
1 Questions related to demographic data 1,2 2

2 Questions related to the satisfaction of 3,18,19 3

treatment
3 Questions related to staff 4,5,6,8,9,10,14 7

4 Questions related to facilities provided 7,11,12,13,15,16,17 7

5 Questions related to the needs of patient 20 1

PLAN OF ANALYSIS
The collected data was analyzed using tables and graphs and in simple percentages.

29
 CHAPTER-5
DATA ANALYSIS AND INTERPRETATION

30
TABLE NO: 1
Frequency table showing gender of respondents.

RESPONSES FREQUENCY PERCENTAGE

Male 60 60%
Female 40 40%
Total 100 100% ILLUSTRATION
NO: 1
Diagram showing gender of respondents.

Gender
70%
60%
60%

50%
40%
40% PERCENTAGE

30%

20%

10%

0%
MALE FEMALE

The above diagram revealed that 60% of the respondents were male and 40% were female.

31
TABLE NO: 2
Frequency table showing age wise distribution of respondents.

RESPONSES FREQUENCY PERCENTAGE

Below 20 12 12%
20-40 24 24%
40-60 28 28%
Above 60 36 36%
Total 100 100%

ILLUSTRATION NO: 2
Diagram showing age wise distribution of respondents.

Age
40%
36%
35%
30% 28%
25% 24%
PERCENTAGE
20%
15% 12%
10%
5%
0%
BELOW 20 20-40 40-60 ABOVE 60

The above figure shows that 12% of the respondents were in age group below 20, 24% were in
the age group 20-40, 28% were in the age group 40-60and 36% were in the age group above 60
years.

32
TABLE NO: 3
Frequency table showing respondents opinion about the satisfaction with treatments given.

RESPONSES FREQUENCY PERCENTAGE

Yes 100 100%
No 0 0%
Total 100 100%

ILLUSTRATION NO: 3
Diagram showing the opinion about the satisfaction with treatments given.

Satisfaction Towards Treatments

120%
100%
100%

80%
PERCENTAGE
60%

40%

20%
0%
0%
YES NO

The above figure revealed that 100% of the respondents were satisfied with the treatment
provided in the hospital.

33
TABLE NO: 4
Frequency table showing whether the patients are satisfied with doctor’s care and concern.

RESPONSES FREQUENCY PERCENTAGE

Satisfied 84 84%
Somewhat satisfied 16 16%
Not-satisfied 0 0%
Total 100 100%

ILLUSTRATION NO: 4
Diagram showing whether the patients are satisfied with doctor’s care and concern.

Satisfaction With Doctors Care And Concern

90% 84%
80%
70%
60% The above
50% PERCENTAGE figure

40% revealed
30%
that 84% of
respondents
20% 16%
were
10%
0% satisfied
0% with
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED
doctor’s
care and concern and 16% of the respondents were somewhat satisfied with doctor’s care and
concern.

34
TABLE NO: 5
Frequency table showing that the opinion of the respondents about the time and care from
doctors and staffs.

RESPONSES FREQUENCY PERCENTAGE

Yes 100 100%
No 0 0%
Total 100 100%

ILLUSTRATION NO: 5
Diagram showing that the opinion of the respondents about the time and care from doctors and
staff.

Sufficient Time and Care From Doctors

And Staffs
120%
100%
100%

80% PERCENTAGE

60%

40%

20%
0%
0%
YES NO

100% of the respondents said that they were satisfied with the care given by the staff and the
time spent for the patient care.

35
TABLE NO: 6
Frequency table showing the respondents rating on doctor-patient relationship.

RESPONSES FREQUENCY PERCENTAGE

Excellent 44 44%
Very good 44 44%
Good 12 12%
Poor 0 0%
Total 100 100%

ILLUSTRATION NO: 6
Diagram showing the respondents rating on doctor-patient relationship.

Doctor-Patient Relationship
50%
45% 44% 44%
40%
35%
30% PERCENTAGE
25%
20%
15% 12%
10%
5%
0%
0%
EXCELLENT VERYGOOD GOOD POOR

The figure shows that, 44% of the respondents rated doctor-patient relationship as excellent,
another 44% rated it as very good and 12% rated it as good.

36
TABLE NO: 7

Frequency table showing whether the patients are satisfied with the communication facilities
provided in hospital.

RESPONSES FREQUENCY PERCENTAGE

Yes 98 98%
No 2 2%
Total 100 100%

ILLUSTRATION NO: 7
Diagram showing whether the patients are satisfied with the communication facilities provided in
hospital.

Communication Facilities Provided

120%
98%
100%

80%
PERCENTAGE
60%

40%

20%
2%
0%
YES NO

The above figure revealed that 98% of the patients were satisfied with the communication
facilities provided in hospital and 2% not at all satisfied.

37
TABLE NO: 8

Frequency table showing the rating of nursing care.

RESPONSES FREQUENCY PERCENTAGE

Excellent 28 28%
Very good 54 54%
Good 18 18%
Poor 0 0%

Total 100 100%

ILLUSTRATION NO: 8
Diagram showing the rating of nursing care.

Rank The Level Of Nursing Care

60%
54%
50%

40%
PERCENTAGE
30% 28%

20% 18%

10%
0%
0%
EXCELLENT VERYGOOD GOOD POOR

The figure revealed that 28% of the respondents opined that the level of nursing care was
excellent, 54% opined that it was very good and 18% opined that the level of nursing care was
good.

38
TABLE NO: 9
Frequency table showing whether the nurses are empathetic towards patients.

RESPONSES FREQUENCY PERCENTAGE

Yes 100 100%
No 0 0%
Total 100 100%

ILLUSTRATION NO: 9
Diagram showing whether the nurses are empathetic towards patients.

Nurses Empathetic Towards Patients

120%
100%
100%

80%
PERCENTAGE
60%

40%

20%
0%
0%
YES NO

All the respondents opined that nurses were empathetic towards patients.

39
TABLE NO: 10
Frequency table showing opinion about nurse-patient relationship.

RESPONSES FREQUENCY PERCENTAGE

Excellent 50 50%
Very good 25 25%
Good 25 25%
Poor 0 0%
Total 100 100%

ILLUSTRATION NO: 10
Diagram showing opinion about nurse-patient relations.

Nurse-Patient Relationship
60%
50%
50%

40%
PERCENTAGE
30% 25% 25%

20%

10%
0%
0%
EXCELLENT VERYGOOD GOOD POOR

50% opined that the nurse patient relationship was excellent, 25% opined that it was very good
and another 25% opined that it was good.

40
TABLE NO: 11
Frequency table showing whether the patients are satisfied with cleanness and sanitation
provided in the hospital.

RESPONSES FREQUENCY PERCENTAGE

Satisfied 70 70%
Somewhat satisfied 24 24%
Not-satisfied 6 6%
Total 100 100%

ILLUSTRATION NO: 11

41
Diagram showing whether the patients are satisfied with cleanness and sanitation provided in the
hospital.

Cleanness And Sanitation Done In The Hospital

80%

70%
70%

60%

50%

PERCENTAGE
40%

30%
24%

20%

10%
6%

0%
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED

42
70% were satisfied, 24% were somewhat satisfied, and 6% were not satisfied with the cleanness
and sanitation provided by the hospital.

43
TABLE NO: 12
Frequency table showing the opinion about the laundry services.

RESPONSES FREQUENCY PERCENTAGE

Very good 28 28%
Good 72 72%
Poor 0 0%
Total 100 100%

ILLUSTRATION NO: 12
Diagram showing the opinion about the laundry services.

Opinion About The Laundry Services

80%
72%
70%
60%
50%
PERCENTAGE
40%
30% 28%

20%
10%
0%
0%
VERY GOOD GOOD POOR

The above figure shows that, 28% of the respondents rated laundry services as very good and
72% rated it as good.

44
TABLE NO: 13
Frequency table showing the satisfaction with team management procedure involved in health
care process.

RESPONSES FREQUENCY PERCENTAGE

Satisfied 80 80%
Somewhat satisfied 20 20%
Not-satisfied 0 0%
Total 100 100%

ILLSTRATION NO: 13
Diagram showing the satisfaction with team management procedure involved in health care
process.

Team Management Procedure

90%
80%
80%
70%
60%
50% PERCENTAGE

40%
30%
20%
20%
10%
0%
0%
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED

80% were satisfied with the team management procedure involved in health care process and
20% were somewhat satisfied.

45
TABLE NO: 14
Frequency table showing whether the physician explain the patient progress regularly.

RESPONSES FREQUENCY PERCENTAGE

Yes 100 100%
No 0 0%
Total 100 100%

ILLUSTRATION NO: 14
Diagram showing whether the physician explain the patient progress regularly.

Patient Progress
120%
100%
100%

80%
PERCENTAGE
60%

40%

20%
0%
0%
YES NO

All the respondent opined that the physician explain their progress regularly.

46
TABLE NO: 15
Frequency table showing whether the respondents are satisfied with the hospital environment
related to the health care.

RESPONSES FREQUENCY PERCENTAGE

Satisfied 74 74%
Somewhat satisfied 22 22%
Not-satisfied 4 4%
Total 100 100%

ILLUSTRATION NO: 15
Diagram showing whether the respondents are satisfied with the hospital environment related to
the health care.

Satisfaction With Hospital Environment

80% 74%
70%
60%
50%
PERCENTAGE
40%
30%
22%
20%
10% 4%
0%
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED

74% were satisfied, 22% were somewhat satisfied and 4% were not satisfied with hospital
environment related with health care.

47
TABLE NO: 16
Frequency table showing whether the respondents are enjoying the facilities provided.

RESPONSES FREQUENCY PERCENTAGE

Yes 94 94%
No 6 6%
Total 100 100%

ILLUSTRATION NO: 16
Diagram showing whether the respondents are enjoying the facilities provided.

Entertainment Facilities
100% 94%
90%
80%
70%
60% PERCENTAGE
50%
40%
30%
20%
10% 6%
0%
YES NO

94% of the respondents enjoyed and 6% did not enjoyed the facilities provided by the hospital.

48
TABLE NO: 17
Frequency table showing the attitude of respondents towards hospital.

RESPONSES FREQUENCY PERCENTAGE

Positive 98 98%
Negative 2 2%
Total 100 100%

ILLUSTRATION NO: 17
Diagram showing the attitudes of respondents towards hospital.

Attitude Towards Hospital

120%
98%
100%

80%
PERCENTAGE
60%

40%

20%
2%
0%
POSITIVE NEGATIVE

98% of the respondents had positive attitudes and 2% had negative attitudes towards the hospital.

49
TABLE NO: 18
Frequency table showing which type of treatment is given first priority.

RESPONSES FREQUENCY PERCENTAGE

Preventive 16 16%
Curative 72 72%
Palliative 8 8%
Rehabilitative 4 4%
Total 100 100%

ILLUSTRATION NO: 18
Diagram showing which type of treatment is given first priority.

Type Of Treatment
80%
72%
70%
60%
50%
PERCENTAGE
40%
30%
20% 16%
10% 8%
4%
0%
PREVENTIVE CURATIVE PALLIATIVE REHABILITATIVE

72% opined curative care, 16% opined preventive care, 8% opined palliative care, and 4%
opined rehabilitative care were the type of treatment that should be given first priority.

50
TABLE NO: 19
Frequency table showing whether the patients are satisfied with the investigations, treatments
and services provided.

RESPONSES FREQUENCY PERCENTAGE

Satisfied 82 82%
Somewhat satisfied 14 14%
Not-satisfied 4 4%
Total 100 100%

ILLUSTRATION NO: 19
Diagram showing whether the patients are satisfied with the investigations, treatments and
services provided.

Satisfaction With Services

90%
82%
80%
70%
60%
50% PERCENTAGE

40%
30%
20% 14%
10% 4%
0%
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED

82% were satisfied, 14% were somewhat satisfied and 4% of the respondents were not satisfied
with the investigation, treatment and services provided by the hospital .

51
TABLE NO: 20
Frequency table showing whether the patients are satisfied with meeting their physical, mental,
social and spiritual needs.

FREQUENC
RESPONSES Y PERCENTAGE
Satisfied 74 74%
Somewhat satisfied 18 18%
Not-satisfied 8 8%
Total 100 100%

ILLUSTRATION NO: 20
Diagram showing whether the patients are satisfied with meeting their physical, mental, social
and spiritual needs.

Satisfaction With Meetings

80% 74%
70%
60%
50%
PERCENTAGE
40%
30%
20% 18%

10% 8%

0%
SATISFIED SOMEWHAT SATISFIED NOT SATISFIED

74% were satisfied, 18% were somewhat satisfied and 8% were not satisfied with meeting their
physical, mental, social and spiritual needs.

52
CHAPTER-6
FINDINGS

53
 FINDINGS
The study revealed that,

1.60% of the respondents were male.

2. 36% of the respondents were in the age group above 60 years.

3. All the respondents were satisfied with the treatment provided in the hospital.

4. 84% respondents were satisfied with doctor’s care and concern.

5.100% of the respondents were satisfied with the care from doctors and staff and the time they
spent for the patients.

6. 44% of the respondents rated doctor-patient relationship as excellent and another 44% rated it
as very good.

7. 98% of the patients were satisfied with the communication facilities provided in hospital.

8. 54% opined that the level of nursing care was very good.

9. All the respondents opined that the nurses were empathetic towards them.

10. 50% of the respondents rated nurse-patient relationship as excellent.

11. 70% opined that they were satisfied with cleanness and sanitation facility.

12. 72% opined that laundry services were good.

13. 80% were satisfied with the team management procedure involved in health care process.

14. All the respondents opined that the physician explain their progress regularly.

15.74% of the respondents were satisfied with hospital environment.

16.94% of the respondents enjoyed the facilities provided by the hospital.

17. 98% of the respondents had positive attitude towards the hospital.

18. 72% of respondents opined that curative care treatment should be given the first priority.

19. 82% were satisfied with the investigation, treatment and service provided by the hospital.

20. 74% were satisfied with the physical, mental, social and spiritual needs.

54
 CHAPTER-7
RECOMMENDATIONS

55
 RECOMMENDATIONS
1. The level of nursing care should be improved.

2. It is better to increase the number of in-patient rooms for providing efficient treatment.

3. Increase the number of nurses in all shifts, for providing better care to in-patients.

56
CHAPTER-8
CONCLUSION

57
 CONCLUSION
The study entitled in-patient satisfaction in Fortis Malar Hospital was done to evaluate the
satisfaction of in-patients and to suggest methods to improve the in-patient satisfaction.

The researcher found that majority of the patients satisfied with treatments, doctor’s care and
concern, nursing services, hospital environment and other facilities provided by the hospital.

Researcher concluded the study by forwarding some suggestions such as,

1. The level of nursing care should be improved.

2. It is better to increase the number of in-patient rooms for providing efficient treatment.

3. Increase the number of nurses in all shifts, for providing better care to in-patients.

58
 CHAPTER-9
BIBLIOGRAPHY

59
 BIBLIOGRAPHY
1. Patient satisfaction and factors influencing patient satisfaction- https://en.wikipedia.org

2. Patient satisfaction with health care- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496942/

3. Importance of patient satisfaction-http://www.aaahc.org

4. healthaffairs.org/blog/2014/05/09/measuring-patient-satisfaction-a-bridge-between-patient-
and-physician-perceptions-of-care/

5. https://en.wikipedia.org/wiki/patient

6. https://en.wikipedia.org/wiki/Inpatient_care

7. www.sharp.com/about/the-experience/aidet.cfm

8. Customer relationship and Patient care-www.ask.com

9. https://en.wikipedia.org/wiki/Patient_education

10. https://en.wikipedia.org/wiki/Patient-reported_outcome

11. Hospital-patient relationship and doctor-patient

relationship-https://en.wikipedia.org/wiki/Doctor-patient_relationship

12. https://en.wikipedia.org/wiki/Nurse-client_relationship

13. https://en.wikipedia.org/wiki/Patient rights and responsibilities

14. www.beckershospitalreview.com/quality/10-most-common-patient-complaints-grievances-
with-hospitals.html

15. https://en.wikipedia.org/wiki/Patients%27_rights

16. Quality care, patient safety and Changing health care delivery system; Girdhar J Gyani,
Alexander Thomas, 1st edition, year of publishing-2014.

17. Text- Administrative Medical Assistants, authors: Wilburta Q Lindh, Marilyn S Pooler, Carol
D Tamparo.

18. Hospital Administration: C M Franziz, Mario C de Souza, 3 rd edition, year of publishing-

1991, 1995, 2000.

60
CHAPTER-10
ANNEXURES

61
 LIST OF TABLES

SI NO. CONTENTS PAGE NO.

1 Frequency table showing gender of respondents 30

2 Frequency table showing age wise distribution of respondents 31

3 Frequency table showing respondents opinion about the 32

satisfaction with treatments given
4 Frequency table showing whether the patients are satisfied with 33
doctors care and concern
5 Frequency table showing that the opinion of the respondents about 34
the time and care from doctors and staffs
6 Frequency table showing the respondents rating of doctor- patient 35
relation ship
7 Frequency table showing whether the patients are satisfied with the 36
communication facilities provided in hospital
8 Frequency table showing the rating of nursing care 37
9 Frequency table showing whether the nurses are empathetic 38
towards patients
10 Frequency table showing opinion about nurse-patient relationship 39

11 Frequency table showing whether the patients are satisfied with 40

cleanness and sanitation provided in the hospital
12 Frequency table showing the opinion about the laundry services 41

13 Frequency table showing the satisfaction with team management 42

procedure involved in health care process
14 Frequency table showing whether the physician explain the patient 43
progress regularly
15 Frequency table showing whether the respondents are satisfied 44
with the hospital environment related to the health care
16 Frequency table showing whether the respondents are enjoying the 45
facilities provided
17 Frequency table showing the attitude of respondents towards 46
hospital
18 Frequency table showing which type of treatment is given first 47
priority
19 Frequency table showing whether the patients are satisfied with 48
investigations, treatments and services provided
20 Frequency table showing whether the patients are satisfied with 49
meeting their physical, mental, social and spiritual needs

62
 LIST OF DIAGRAMS

SI NO. CONTENTS PAGE NO.

1 Diagram showing gender of respondents 30

2 Diagram showing age wise distribution of respondents 31

3 Diagram showing the opinion about the satisfaction with treatments 32

given
4 Diagram showing whether the patients are satisfied with doctors 33
care and concern
5 Diagram showing that the opinion of the respondents about the time 34
and care from doctors and staffs
6 Diagram showing the respondents rating on doctor-patient 35
relationship
7 Diagram showing whether the patients are satisfied with the 36
communication facilities provided in hospital
8 Diagram showing the rating of nursing care 37
9 Diagram showing whether the nurses are empathetic towards 38
patients
10 Diagram showing opinion about nurse-patient relationship 39

11 Diagram showing whether the patients are satisfied with cleanness 40

and sanitation provided in the hospital
12 Diagram showing the opinion about the laundry services 41

13 Diagram showing the satisfaction with team management 42

procedure involved in health care process
14 Diagram showing whether the physician explain the patient 43
progress regularly
15 Diagram showing whether the respondents are satisfied with the 44
hospital environment related to the health care
16 Diagram showing whether the respondents are enjoying the 45
facilities provided
17 Diagram showing the attitude of respondents towards hospital 46

18 Diagram showing which type of treatment is given first priority 47

19 Diagram showing whether the patients are satisfied with the 48

investigations, treatments and services provided
20 Diagram showing whether the patients are satisfied with meeting 49
their physical, mental, social and spiritual needs

63
 QUESTIONNAIRE
Dear Sir/Madam

I am Kessiya Markose, studying MBA in Hospital Management. As a part of my project

work on “A study to evaluate in-patient satisfaction in Fortis Malar Hospital Chennai”. I am
interested in knowing your opinion about the following items. Your identification data will be
retained confidential. I request you to kindly fill this questionnaire and return to me.

PART –A
1. Gender

Male [ ] Female [ ]

2. Age

Below 20 [ ] 20-40 [ ] 40-60 [ ] Above 60 [ ]

PART -B
3. Are you satisfied with the treatments given in here?

Yes [ ] No [ ]

4. Are you satisfied with the doctor’s care and concern for you?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

5. Do you get sufficient time and care from doctors and staffs?

Yes [ ] No [ ]

6. What is your suggestion regarding doctor-patient relationship?

Excellent [ ] Very good [ ] Good [ ] Poor [ ]

7.Are you satisfied with the communication facilities provided in here?

Yes [ ] No [ ]

8. Rank the level of nursing care?

Excellent [ ] Very good [ ] Good [ ] Poor [ ]

64
9. Are the nurses empathetic towards patients?

Yes [ ] No [ ]

10. What is your suggestion about nurse-patient relationship?

Excellent [ ] Very good [ ] Good [ ] Poor [ ]

11. What is your opinion about the cleanness and sanitation done in the hospital?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

12. What is your opinion about the laundry services?

Very good [ ] Good [ ] Poor [ ]

13.How is the team management procedure involved in health care process?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

14.Does the physician explain to you the prognosis of your condition regularly?

Yes [ ] No [ ]

15.Are you satisfied with the hospital environment related to the health care?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

16. Are you enjoying the facilities provided here like television, accommodation etc?

Yes [ ] No [ ]

17. What is your attitude towards hospital?

Positive [ ] Negative [ ]

18. What type of treatment to be given the first priority?

Preventive [ ] Curative [ ] Palliative [ ] Rehabilitative [ ]

19. Are you satisfied with the investigations, treatments and services provided in here?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

20. Are you satisfied in meeting your needs such as physical, mental, social and spiritual?

Satisfied [ ] somewhat satisfied [ ] Not-satisfied [ ]

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