Hospital Industry1

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Hospital Industry

CHAPTER TITLE PAGE NO.

Acknowledgement 3

1) Introduction 4

Motivation 5

Research 6


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objective

Research

problem

6

Variables 6

Scope and

Limitations

7

2) Literature Review 8

3) Methodology 18

4) Findings and results 24

5) Recommendations &

Conclusions

25

Bibliography 26

Annexure 27

AcknowledgementI wish to thank my guide Prof Gowri Joshi for her continuous support. Without her, this project would

not have been possible. I would also like to thank all my professors who have helped me during this

project.

I also wish to thank to all the people in the project with whom I have interacted and who have provided

me with valuable insights.


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A special thanks to all the respondents I met during the survey for the project.

Introduction

A hospital as a health care organization has been defined in varied terms as an institution involved in

preventive, curative, palliative or rehabilitative services. However, the definition given by WHO is quite

exhaustive and exclusive, in which it is defined as, an integral part of the medical and social

organization which is to provide for the population complete health care, both curative and preventive,

and whose out-patient services reach out into the family in its home environment. The hospital is also a

centre for the training of health workers and for bio-social research.


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Hospitals, these, days also provide bio-social research, teaching and training facilities for all the

members of the hospital, and a health team which includes not only doctors and nurses, but also Para-

professionals, paramedical, pharmacists, etc. operationally, a hospital could be viewed as consisting of

service facilities for out-patient, in-patient, general wards, emergency, special wards, intensive care

units, operation theatre, delivery suite, and support services, such as pharmacy, radiology and imaging,

blood bank, laboratory, etc.

Most of the hospitals are professionally managed, with the objective of providing prompt, adequate,

continuous and satisfactory services to the patient because their prime consideration is providing

quality health care.

Motivation

A hospital is an institution for health care providing patient treatment by specialized staff and

equipment. A hospital today is a center for professional health care provided by physicians and

nurses. A hospital is a place which is quintessential for mankind. Everyone needs a hospital, and

is dependent on the doctor whenever they are fall sick. Hence, I was willing to know about the

human resource management techniques adopted in hospitals so that they could achieve

maximum level of patient satisfaction, by providing good services. People working in this

industry have to perform their work in a very professional manner as there is no space for

errors because it can cost a person his or her life. And hence to provide good services, these


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people should be properly trained and proper incentives should be given to them so that they

enjoy their job. I selected this project because I was willing to know the level of patient

satisfaction in private hospitals like Lilavati. I was once admitted in Lilavati and hence was

aware of its services and was willing to know the level of patient satisfaction.

Research objectives

1. Understand the process of development of human resources which is mainly done bytraining, performance appraisal and career development

2. Find out the level of patient satisfaction

Research problem


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There are certain industries which are quintessential for mankind to survive. The hospital

industry can be counted one amongst them. This industry has certain responsibilities towards

society which cannot be avoided at any cost. Hence, it is absolutely necessary for it to operate

in a very professional manner as there is no scope for errors as it can cost a person his/her life.

This project will try to cover what is required for this industry to function in an efficient andeffective manner. Effectiveness of a hospital is to a large extent dependent on quality of service

delivered and the work effort expanded by its employees. Therefore, the HRM function is

critical and cardinal for the efficient and effective operation of a hospital as an organization. A

hospital is largely dependent on the employees. A hospital has to take care of its employees in

order to attain maximum level of patient satisfaction.

Variables

Independent variable-Hr policies and practices in hospital industry

Dependent variable- Level of Patient Satisfaction

Scope

The hospital industry is quintessential for mankind. Everyone needs medical care. This project shows the

HR policies and practices that are adopted in various hospitals and its impact on the performance of the

hospitals employees. Hr policies adopted by any hospital have a direct effect on the level of patient

satisfaction. It will help establish a correlation between the two variables that will in turn help the

industry judge the positive effects of good HR practices and adopt best practices within the industry to

increase customer satisfaction and thus increase recall rate and profits for the organization. It will serve

as a vital tool to gauge the relevance of good HR practices and the cost involved in adopting them.


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Limitations

The limitations that I faced while undertaking this project were

y I faced immense trouble in convincing the high authorities of the hospital to let me undertakethis research project in their premises.

y There was a lack of support from the top management of the hospital.y I also faced high level of resistance by the employees to disclose their internal policies.y

The patients and their family and friends were hesitant in talking freely to a complete strangersince this industry involves a high level of trust in a doctor-patient relationship.

y Also the sample size covered by me is too small to generalize the findings for the entirepopulation.

y Demographic and income variations are other hurdles that I faced while working on this project.

Literature review

Human resource plays a very significant role in effective performance of a hospital which depends to a

great extent on the quality of its staff. The better the quality, the higher the level of performance.

Hospital is a place where, on one hand, we have highly skilled personnel such as doctors and on the

other; we have unskilled workers such as sweepers.


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playing dual role. Now, it has been felt that healthcare institutions are not delivering results largely due

to inefficient management.

Therefore there is a trend to bring management professionals for hospital administration/management

jobs. Doctors may not have much say in routine administrative matters and therefore, they are resisting

the changes although they, too, are very much convinced that they are not best suited for management

jobs and it will be in overall interest if they concentrate on clinical jobs only. Not being in the

management job may lessen their authority/power on hospital staff and they find it difficult to accept

these changes. 3) Doctors are not taught management in medical colleges. For them, hospital means

doctor and doctor means hospital. So, they are not educationally equipped to appreciate the roles of

management professionals in hospital administration. 4) Doctors were respected in the society. Now,

monetary and other related factors have eroded this position. There is customer-supplier relationship

between the patient and the doctor. Service of a doctor has become a commodity which is being sold

off.

Therefore, a need is being felt to hand over the management jobs to management experts only.

Doctors, now, have started realizing it. So, doctors and management both need to change their attitude

towards each other. Also, the management professionals need to introduce the essence of participative

management while dealing with doctors. Doctors simply must not be ignored on the ground that it is

none of their business. CME programme of doctors, too, need to be modified. Apart from the clinical

subjects, CME should cover the various areas of hospital management. They should also cover the

subjects such as development of personality traits and similar other topics so that it can prepare the

doctors to adapt themselves easily to the need of hours.

Also, there is need to develop positive attitude towards all the jobs of the hospital. A doctor may have to

be in operation theatre, say for six hours and it may at appear tough but there is no shortcut to it.

Similarly, a hospital administrator sits in the office and manages the affairs from there. There must not

be seen any luxury in it. It is the demand of management profession. He cannot move now and then. He

has to sit in the office and keep watch on various activities going on in the hospital. Since, he is virtually

responsible for everything in the hospital; he cannot assign all the tasks to himself. He has to delegate

and keep the control in his hands and play the role of a co-coordinator. Now, no comparison should be

made between two jobs. The underlining spirit should be - all jobs are important. Therefore, handling

the staff is a real challenging job.


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Sacking/suspension/discharge is a easy way out to get rid of the staff we do not like but retaining them

in job is a real difficult job and only an able hospital administrator can do it.

Human resources in hospitals: The changing face

Human Resources functions as a management tool is fast changing. The psyche people at work have also

undergone a sea change. Hospitals unlike other industry are a different entity when compared to other

industries. The role of this department and its head has a role cutout and exclusive. Unlike any other

industry, the advent of technology, modernization, computerization, newer diagnostic and intervention


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techniques, has not reduced the need of human labor in hospitals, which is now an industry. On the

contrary, there is a quantum growth in the need to appoint specialized manpower at various levels of

patient care, which has emanated from the thought process of those professionals and promoters, who

are enlightened with the need to induce QC in patient care. Hospitals shall always remain human

intensive.

The role of the HR manager in a hospital is multifaceted and complicated too. Manpower planning and

recruitment involves a lot of thought process. Training and development has to be a qualitative and

quantitative activity, especially for those who are employed as junior doctors, nurses, front office, ward

staff, housekeeping/ward attendants, F & B etc. Since these are the people who come in contact with

the patient or his attendant, "FIRST". It is they who create the first impression and therefore, make or

mar the reputation of the hospital. "The first four minutes and the last two minutes".I

n a scenario,where human labor is intensive, the need for an efficient human resources department [hrd] is a

prerequisite.

It is debatable as to what qualitative experience should the front office, ward staff, possess. While some

hospitals tend to appoint staff with experience in a hospital, this is debatable, especially when we are

dealing with established Psyche and mindsets. Large multinationals prefer to select freshers or

candidates from a different Industry, since they are sans mindsets and are easily moldable, by rigorous

training.

The advent of corporate hospitals has changed the mindset of healthcare conscious people. Medical

tourism, debates it further. A school of thought feels it prudent, to appoint people from the hotel

industry, who are expected to possess faces and etiquettes in hospitality.

The nurses are the frontiers in a hospital, who need constant up gradation, training and development.

They have to be constantly reminded of bedside manners. It is also perfunctory that their numbers are

adequate. It differs from hospital to hospital. A broader perspective study revealed that on an average,

about 20% of patient in a hospital are completely dependent, 40% are partially dependant and 40% are

fully ambulant. It is observed that an average nurse works for 265 to 290 days a year. Therefore, as a

thumbrule, 30% of the total nurses required should be added to the figure, due to leave necessities,

which are religious, and for ceremonies like marriage. At least 15% should be male nurses. While doing


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this exercise, it should be kept in mind that on an average, 60-65% beds are occupied at any given point

of time. A section of the nurses should periodically be withdrawn from their posts and subjected to class

room training, purely to upgrade them. It is a pre-requisite, that all nurses have the basic knowledge of

working on a computer, since modern HIS software calls for online entries at all levels and departments.

Hospitals work 24 X 7 and are never closed. It is therefore perfunctory that requisite personnel are

available round the clock. Festivals in our country are dime a dozen, beside offs, EL, CL, SL et al. It may

not be prudent to suggest that the employee recruitment mix ratio should be based on religions and

could be a better way of handling absenteeism, ensuring that, whatever be the festival or holiday, 66.5

% of the staff is available, at a given shift, enough for such exigencies.

To be successful, employees with leadership can be categorized into:

- Technical

Those who belong to this category are highly specialized people, who deal with procedures, are

analytical, conceptual, touch me nots, could be the doctors and nurses.

- Human

Those who belong to this category are those who implement to achieve the goals of the organization,

through the help of their subordinates and are deft in handling men and material. They are expected to

have a high level of motivation and inevitably with an infectious attitude. They are available always, on a

whistle, since for them, functionally, customer satisfaction is paramount.

- Conceptual

Those who belong to this category are those who understand the nitty-grittys of the PCDS [Patient Care

Delivery System] have the ability to co-ordinate and can induce changes, with the first hand knowledge,

as to how such changes can affect the chain and command. They are expected to visualize the larger

picture of things to come. In fact their ability to take a decision and their personality as a whole essays

the fabric of the organization. These handfuls few are the top level decision makers of the organization.

Human Resources, therefore needs to recruit an admix of the above, to be successful in their respective

objectives. Be that as it may, the base line elucidates that whoever and wherever, the ability and skill to


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deal with Human beings with their respective idiosyncrasies, is the key.

The power vested by default in the department of Human Resources is considerable. But it has to be

understood that powers should be utilized to solve issues rather than use it for fascist attitudes. He

should understand that the psyche in changed management issues is to delegate powers, trust and

encouraging efficiency in subordinates, that makes the organization more efficient and successful. A

tight fist has faded knuckles.

Human beings are the most important resources in health care. Machines and gadgets which are

integral parts of health care require the human touch, expertise, and commitment for their full utility

and application in delivery of health care. Therefore planning of human resources is the key to anyhealth care provision. The objective of human resource (HR) policy is to a) attract, recruit, retain and

develop competent personnel and b) create a continuously learning health care organization.

I. TARGET HUMAN RESOURCES

IN HEALTH CARE

The patient unquestionably is the focus of all health care personnel. While doctors, nurses, hospital

attendants, technologists, clinical assistants and pharmacists are directly involved in providing OPD and

ward care, administration, public relation, security, catering, laundry, electronics, civil, electrical and air


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conditioning maintenance are involved in supporting the former for providing safe health care. Planning

needs to be done for all these personnel and not only for the direct care givers.

II. IMPROVEMENT OF HUMAN

RESOURCES

This is done through three ways such as a) Work system, b) employee education, training and

development, and c) employee well being and satisfaction.

a) Work system:

The aim of work system improvement is to get co-operation and collaboration among all employees.

Health care employees look for good systems in place so that their endeavors would yield favorable

results without any wasteful activities. They would like to participate and feel important in laying down

these systems. A system that is thrust on them often breeds cynicism as they do not own it.I

n order toown the system they have to actively participate in designing it. While doing so a cross functional team

across various sections brings about greater effectively and cohesion than an intra departmental team.

Some of the examples of such teams are given under the following headings:

(i) Design/organize formal/informal, temporary or long term units (teams). Infection control team, waste

management team and quality improvement (QIP) team are some of the examples that have been doing

good quality work in Tata Main Hospital.

(ii) Encourage and motivate innovation through quality circle (QC), value engineering (VE) and

suggestions.

There are over 104 quality circles actively functioning in TMH. These are small circles of five members

picked up from supervisors and workers who take small local problems and solve them with

organizations support. Employees are encouraged to do cost savings without affecting the quality

through intra or inter departmental teams. Suggestions are encouraged from the employees and

wherever appropriate those are implemented.

(iii) Encourage higher learning, give them higher responsibilities and help them identify their training

needs.

(iv) Encourage multi skilling and rotate their jobs wherever possible so that there is no boredom with

the repetitive type of job. This has been implemented amongst the hospital attendants who rotate in

various areas with different job specifications in the hospital.

(v) Performance management system:


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Every level of employees must work with a purpose and their work must be Sr. Spl. & HOD, Tata Main

Hospital 14 evaluated against their target from time to time so that they achieve their target at the year

end. In TMH, this is done by giving targets to all doctors and officers in the form of key result areas

(KRAs) which are reviewed twice a year. The annual appraisal identifies the super achievers who are

recognized as fast trackers. They move aggressively and groom rapidly.

(vi) Compensation, recognition and reward practices

This could be non monetary or monetary. Non monetary recognition could be formal by a letter or

informal by a pat on the back in front of other employees. Monetary recognitions are through

promotions, special increment, joint department council (JDC) award or long service awards after 20 yrs,

25 yrs, 35 yrs and 40 yrs of service.

(vii) Communication meetings at all levels

Communication upward and down-ward helps inculcate among the employees a sense of oneness in theorganization. This is done at a pre-decided interval regularly in TMH.

(viii) Recruiting and hiring new employees while recruiting employees, the hospital must first identify

the job requirement and while interviewing, an attitudinal and altitudinal survey of the candidate must

be done. Transparency must be practiced while explaining to the candidate his/her future growth in the

organization. The new employee should be made familiar to the working of the hospital through

induction to various areas before he/she is finally posted to his/her place of work.

(b) Employee education, training

And development

Employees education, training and development should be a continuous process. Their training needs in

terms of technical, managerial and behavioral aspects should be identified. Short term goals of training

need to be directed towards customer satisfaction and reduction of cycle time and long term goals

should be towards better technology. The important thing is to link their training with the patients need

in the hospital they are working in. In TMH, the deployment of training has been done through regular

continuing medical education (CME) for doctors, nurses and technologists, bed side teaching for doctors

& nurses, training through joint departmental councils (JDC) for hospital attendants in subjects such as

waste management and oxygen therapy. Communication with patients (or relatives) was identified

through periodic surveys as one of the weakest l inks with our employees at all levels. This was

repeatedly addressed through motivation, attitude and time management (MAT) programme which

was designed by a group of highly motivated employees drawn from all sections in TMH. Having a


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training programme in place is not enough. There has to be an evaluation system in place for monitoring

the effectiveness of training. The parameters which need to be monitored should be directly related to

patient well-being. Some such parameters could be catheter induced infection rates, mortality and

morbidity parameters, feedback from patients and relatives, number of admissions for the same

ailment and above all retaining the customer.

(C ) Employee well being and satisfaction

Employee satisfaction is essential for a motivated work force. It will do what a state of the art

technology cannot do in health care. This issue could be addressed under three heads such as i) work

environment ii) work climate and iii) employee's satisfaction.

(i) Work environment: A healthy work environment needs to be created where employees feel safe to

work.U

niversal precautions need to be enforced; proper disposal of waste should be implemented;periodic health checkup for all the employees need to be done and hepatitis B vaccination should be

compulsorily given to all the employees. The organization needs to identify and safeguard against unsafe

practices. Serious 15 efforts have been made in the past two years in TMH to achieve the desired goals

for all the employees in the aforesaid areas.

(ii) Work climate: Every employee needs to be provided with certain awareness programmes

and facilities for him or her to feel proud and being looked after by the organization. AIDS

awareness programme, cooperative society, injury on duty (IOD) facility, subsidized (no

profit - no loss) canteen facility, academic activity and library are some of the measures

TMH has provided to improve the work climate.

(iii) Employees satisfaction: This is not an easy area to tackle. There are few hospitals where most of the

employees are satisfied. Human mind is not satisfied with what it has achieved and therefore to expect

that employees will be satisfied with certain facilities is far from being true; however the organization

must collect feedbacks through formal/informal assessment methods and relate these findings to

identify improvement priorities. This will at least make the employees feel that management is sincere

about its concern for them. DNB course was started in TMH after identifying a long standing need of the

graduate doctors in TMH.

III. CONCLUSION


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A satisfied human resource is valuable and has no alternative. Human beings needs

Are dynamic and therefore to satisfy those the health care organization has to be dynamically thinking.

Only then our most important customer, the patient, can get his just need fulfilled. Employee's growth

and development should be the result of both the employers responsibility and the employees

initiative. Appropriate timely rewards and recognition go a long way in retaining a motivated employee.

Inspite of providing all the help and resources if certain human resources cant be molded to fit into the

organizations needs, the organization should not hesitate to leave them behind. Tatas H.R philosophy

attract good people, retain the better people and advance the best people is a right step in this

direction. It may appear a bit harsh but at present it appears to be the only scope for a fast changing

health care organization.

Research Methodology

Research Design


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The research design is descriptive in nature. Research is descriptive when there is lots of theory and

study been done on the topic. There was theoretical research done on this topic.Descriptive research ismostly used and the basic reason for carrying out descriptive research is to identify the cause of

something that is happening. The research type being descriptive, secondary research will form the base

of the study. Also I floated a questionnaire amongst people from diverse background to gain an in depth

understanding on my topic of study.

Sampling Design

The sampling technique used for the study is convenience sampling which is anon-probability

sampling technique.It involves the sample being drawn from that part of the population which

is close to hand. That is, a sample population selected because it is readily available and

convenient. As time was a major constraint, I selected a sample of50 people.

Data collection methodology

Both primary and secondary methods were used for data collection. I floated a questionnaire amongst

people from diverse background to gain an in depth understanding on my topic of study.50

respondents were a part of the sample that filled the questionnaire to facilitate my study.

Secondary research i.e. various research papers and portals on the internet would act as a base

for the theoretical part of the study. Sites like Wikipedia, EBSCO etc. would form the core part

of the secondary research.

Primary data analysis

1)Patient satisfaction regarding services

According to the primary data collected from the hospital, 80% of the patients are satisfied of the

service provided by the hospital staff. And 20% patients were hesitant about their remarks due to many


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factors which made them believe that the services provided were not up to the mark. the services

provided is very good and the doctors make us feel at home. We feel very comfortable at this hospital

was a remark made by a satisfied patient who was admitted in Lilavati hospital.

2)Patient satisfaction regarding the cost involved

When i conducted the sample survey, 20 out of50 people said that they had no issues paying a bit extra

for the service provided. Only people who belong to a rich family are ready to pay for the treatment.They admitted that even though the costs regarding treatment are on the higher side they are inevitable

costs which cannot be ignored. Although people admitted in government hospitals like K.E.M and J.J, felt

that the treatment provided is similar in these hospitals but at a lower cost and hence they preferred

government hospitals.

80%

20%

quality of services

Satisfied

Not satisfied


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3)Patient satisfaction regarding technology available

Patients admitted in Lilavati hospital said that as compared to other medical clinics and hospitals, they

felt Lilavati had better facilities and better technology for their treatment. A patient who was been

treated said that the hospital has the technology to cure the disease at even a very highly critical level

and it was a cake walk for the doctors and that he had no issues choosing this hospital over others for

his treatment regarding technology. While a few patients who have been treated outside India said the

technology could get better. 42 out of50, felt that the technology available was satisfactory.

40%

60%

cost involved

satisfied

Not satisfied

84%

16%

Technology available

Satisfied

Not satisfied


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4)Patient satisfaction regarding the environment and hygiene

Most of the patients were satisfied regarding the environment and hygiene. As seen in the diagram,

about 90% were satisfied but people who had earlier taken treatment from outside the country were

not satisfied. People who earlier were admitted in government hospitals were not satisfied by thehygiene level maintained and the food provided to them in those hospitals and found Lilavati a better

choice. Few patients also complained that the bed sheets were not changed on regular basis in

government hospitals. Here 45 out of50 patients were satisfied.

5)Patient satisfaction regarding the attitude and behavior of the staff

Most of the patients were satisfied by the attitude and behavior of staff. They were happy with the way

they are treated in the hospital and find the staff very friendly. People who earlier were admitted in

government hospitals strongly opposed the behavior of the hospital staff in government hospitals. But

people who were admitted in hospitals outside India were not satisfied. Only 2 out of50, were not

satisfied.

90%

10%

Hygeine level

Satisfied

Not satisfied


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6)Patient satisfaction regarding the explanation of procedure of treatment

Most of the patients were satisfied by the explanation of the procedure of treatment. This helped them

to understand what exactly was wrong in them and what treatment is provided. But few patients

treated outside India felt that the procedure of treatment was explained in a better and more

understandable way. Here 36 out of50 were satisfied.

96%

4%

Attitude and Behaviour

Satisfied

Not Satisfied

72%

28%

Explanation of treatment

procedure

Satisfied

Not satisfied


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7)Patient satisfaction regarding accessibility

Most of the patients who were admitted in Lilavati felt that they did not have easy accessibility and felt

that they had to wait for a longer period of time get medical care. 38 out 50 were not satisfied.

8)Patient satisfaction regarding treatment available

The reaction of patients admitted were neither on the positive side nor on the negative side which

showed that the treatment provided were not up to the mark. People still felt that the treatment

available outside India is better. Out of50, only 27 patients were satisfied.

76%

24%

Satisfied

Not satisfied

54%

46%

Treatment available

SatisfiedNotsatisfied


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Findings and result

On the basis of the survey and analysis it was found that:

y The quality of services provided in Lilavati was much better than the services provided bygovernment hospitals

y The cost charged for the treatment was not justifiable as compared to that of the governmenthospitals but still people were willing to pay higher amount of money for getting better services.

y Technology available at the disposal of the patients was much higher than compared to thetechnology available at government hospitals.

y A high level of hygiene is maintained at the hospital.y The attitude and behavior of the hospital staff was friendlier as compared to the government

hospitals.

y Thus we can overall conclude that the quality of staff employed at private hospitals is muchbetter than those working at government hospitals.

y The patients treated at private hospitals are more satisfied than those at other hospitals.


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Conclusion and recommendations

All hospitals are more than just doctors and nurses that we see. The hospitals also function like any

other organization involved in the core activities like finance, Hr etc. Since all hospitals fall into the

service industry the people employed at the hospitals provide a competitive advantage to the

organization. The reason being that it is the employee of the company that provides service to the

customer through direct communication and its only in this sector that the production and consumption

of the product occurs simultaneously. Hence the importance of a superior quality of staff is vital to dish

out quality service to its customers. Thus the Hr policies and practices of an organization are crucial for

its success. Good recruitment procedures, healthy performance appraisals, strong training team and a

conducive working environment keep the employees happy which in turn motivates them to provide

quality service to customers and results high level of consumer satisfaction. I reached to this conclusion

during my survey at the hospital where I collected information on the HR practices through informal

communication and observation of the environment since I was not allowed by the hospital authorities

to conduct formal survey amongst hospital employees. Thus I conclude Happy Employees result in

Happy Customers.


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Bibliography

www.yahoo.com

www.google.com

www.health.net

ww.expresshealthcare.mgmt

References

Managing a modern hospital - A.V.Srinivasan

Human Resources Management- S.F.ChandraShekhar


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Annexure

QUESTIONNAIRE

Name:

Age:

Gender:

Hospital:

1. You have easy access to the medical specialists in the hospitalYes No

2. Quality of the services provided by the hospital were satisfactoryYes No

3. The fees charged by the hospital was justifiableYes No

4

.

High level of technology was availableYes No

5. The doctors explained the procedure of the treatment before starting the treatmentYes No

6. The treatment provided was satisfactoryYes No

7. High level of hygiene was maintainedYes No

8. The attitude and behavior of the hospital staff was friendlyYes No


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