LOVELY PROFESSIONAL UNIVERSITY DEPARTMENT OF MANAGEMENT

Report on Summer Training

PATIENT SATISFACTION REGARDING HEALTHCARE SERVICES PROVIDED AT SEVEN HILLS HOSPITAL, VISAKHAPATNAM.

Submitted to Lovely Professional University

In partial fulfilment of the Requirements for the award of Degree of Master of Business Administration Submitted by: Tanna Sagar Reg. no.: 11102615 Roll no.: Q2104 B30

DEPARTMENT OF MANAGEMENT LOVELY PROFESSIONAL UNIVERSITY JALANDHAR NEW DELHI GT ROAD PHAGWARA PUNJAB

Declaration

I do, hereby, declare that the dissertation entitled PATIENT SATISFACTION REGARDING HEALTHCARE SERVICES PROVIDED AT SEVEN HILLS HOSPITAL, VISAKHAPATNAM is an authentic work developed by me at, SevenHills hospital, Visakhapatnam, under the guidance of Mrs. Sunita Asst. Manager (Admin. Department) and Mr. G Bhanu Murty (Asst. Manager) and is submitted as a partial fulfilment of the degree of MBA Hospital and Healthcare Management to be awarded by Lovely Professional University.

I also declare that, any or all contents incorporated in this dissertation have not been submitted in any form for the award of any degree or diploma of any other institution or university.

TANNA SAGAR Roll No. Q2104B30 MBA (Hospital and Healthcare Management) Lovely Professional University

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Acknowledgement

I take this opportunity to express my profound sense of gratitude and respect to all those who helped me throughout the duration of the project. I express my sincere gratitude and thankfulness towards Mr. M.R.S. Prasad Manager-HR and Mr. Rathnakar Gen. Manager for their valuable time and guidance. I feel privileged to offer my sincere thanks and deep sense of gratitude to my Guide Resp. Mrs. Sunitha for expressing confidence in me and providing support, help & encouragement in completing the project. I am grateful to all my friends for providing critical feedback & support whenever required. Last but not the least I thank the Almighty for bestowing his blessings. I regret any inadvertent omissions. (Tanna Sagar)

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Table of content: 1. Abstract.. 3 2. About the Hospital. 4 3. Patient Satisfaction 10 4. Need and objective of the study 12 5. Review of literature... 13 6. Research Methodology.. 17 7. Data Analysis. 19 8. Problems Observed and Recommendations...24 9. Conclusion. 25 10. References 26 11. Questionnaire... 28

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Chapter 1

Abstract
This project reports on the development and psychometric properties of the patients receiving health care service. The instrument used contains 18 items tapping each of the seven dimensions of satisfaction with medical care like general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with doctor, and accessibility and convenience.

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Chapter 2

Seven Hills Healthcare Private Limited

About
Seven Hills Group has over two decades of experience in the healthcare sector, providing quality healthcare and valuable expertise, supported by a team of compassionate and dedicated medical professionals offering state of the art in-patient and outpatient facilities, focusing on the comfort and safety of our patients and their loved ones. Seven Hills Group currently has two hospitals, located in the cities of Mumbai, Maharashtra and Visakhapatnam, Andhra Pradesh

Aim
To provide quality healthcare to the people in Visakhapatnam and its adjoining areas

Location
Seven Hills Hospital is situated on a panoramic hillock called Rockdale Layout in the heart of the city very accessible from the airport and railway station. It is a healthcare landmark and a household name for quality healthcare to more than 50 million people across six states - Andhra Pradesh, Orissa, Chhattisgarh Jharkhand, and parts of West Bengal and Bihar.

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The disciplines of medicines covered in the hospital are:

General Surgery Internal Medicine Obstetrics & Gynaecology Paediatrics Neonatology Ear-Nose-Throat Dental Surgery Facio Maxillary Ophthalmology Anaesthesiology Cardiology Pulmonary Medicine Cardio Thoracic Surgery Gastroenterology Surgical Gastroenterology Laparoscopic Surgery Neurology Neuro Surgery Nephrology Renal Dialysis Urology Endocrinology Plastic Surgery Nuclear Medicine Surgical Oncology

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Outpatient services
Seven Hills Hospital has set a benchmark in unmatched features, world-class expertise, quality care, ethical practice, and reasonable costs.

With the aim of providing world class quality care, the Out Patient area contains 40 air conditioned outpatient clinics in all the disciplines of medicines with attached individual clinic patients waiting areas to ensure your comfort and privacy.

With full time morning and evening clinics Seven Hills provides for a large number of patients due to convenience of timing.

Out Patient areas have been designed to minimize the risk of cross infection

Pharmacy:
The hospital has well stocked in-house pharmacy department that provides all medicines directly to the respective floors and wards round the clock.

Welfare schemes
As a conscientious and responsible member of society, Seven Hills Hospital has conducted regular multi specialty free mega camps in the hospital and at various places outside the hospital as well. These camps are conducted by the super specialists and specialists of Seven Hills Hospital in order to screen the population for specific disorders to enable early diagnosis, prevention and access to specialty treatment and cure. These are camps conducted regularly and completely free of charge as a service to the people of the area.

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Government health package

Congenital Heart Disease has been an excruciating problem with an acute need of attention for a long time. Mortality and morbidity in infants and children was highest and survivors lived highly restricted lives. Govt of Andhra Pradesh perceived this need and has given Seven Hills Hospital the unique opportunity to put an end to the long standing suffering of congenital heart disease patients, by sponsoring this project.

These delicate surgeries are performed at Seven Hills Hospital at an unmatched success rate, improving the quality of life to those operated.

Numerous children of CHD below 12 years of age are operated on successfully with the help of the Govt of Andhra Pradesh Health Package.

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Chapter 3

Patient Satisfaction
Patient satisfaction has emerged as ac critical outcome of medical care due to increasing emphasis on consumers of services in the medical marketplace1. The extent to which different delivery system satisfy their patients is a major determinant of viability in this highly competitive environment. Patient satisfaction has been associated with patient adherence to medical recommendations2 , willingness to initiate malpractice litigation3, doctor shopping4 , and disenrollment from prepaid health plans5. The major characteristics of providers and health and medical care services that influence patient satisfaction are Art of care: The most frequently measured dimension of satisfaction pertains to the amount of caring shown towards patients, which is one of aspect of providers conduct. On the positive end of the satisfaction continuum, questionnaire items focus on such providers characteristics as concern, consideration, friendliness, patience, and sincerity in terms of abruptness, disrespect, and the extent to which providers embarrass, hurt, insult or unnecessarily worry their patients Technical quality: This dimension which also pertains to provider conduct focuses on the competence of providers and their adherence to high standards of diagnosis and treatment

1 2 3 4 5

Davies & Ware, 1988 Korsch, Gozzi, & Francis, 1968; Sherbourne, Hays, Ordway, Dimatteo, & Kravitz 1992 Vaccarino, 1977 Marquis, Davies, & Ware, 1983 Ware & Davies, 1983 10 | P a g e

Accessibility and convenience: Included in this dimension are all of the factors involved in arranging to receive medical care. Among the more frequently studied variable are time and effort required to get an appointment, distant or proximity to site of care, time and effort required to get to the place where the care is delivered, convince of location, hours during which care can be obtained, if help is available over the telephone at home. Finance: Ability to pay for services or to arrange for payment is an important in the receipt of care. Physical environment: Satisfaction with the physical environment in which care is delivered has usually been studied in inpatient settings Availability: Satisfaction with availability of health and medical care services and providers has rarely been measured in published surveys. Continuity of care: This is another infrequently measured dimension of patient satisfaction. It is generally defined in the terms of regularity of care from the same facility, location or provider. Outcome of care: This is measured in the terms of perception regarding the usefulness or helpfulness of medical care provider and specific treatment regimens in improving or maintaining health status

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Chapter 4

Need and Objective of the Study

The survey is used as dependent variable to evaluate provider services and facilities, on assumption that patient satisfaction is an indicator of structure, process, and outcome of care. Objective To know the level of satisfaction of the patients regarding the medical care provided To know the effectiveness of medical care provided

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Chapter 5

Review of literature
1. Barr, D. and Vergun, P. (2000). Using a New Method of Gathering Patient Satis-

faction Data to Assess the Effects of Organizational Factors on Primary Care Quality. Journal on Quality Improvement; 26(12): 713-723. The authors of this article argue that conventional methods of assessing patient satisfaction are insufficient. Traditionally, a survey (e.g. the nine-item Visit-Specific Satisfaction Questionnaire (VSQ)) is administered either after the encounter or by telephone at a later date. However, such instruments cannot capture the patients perspectives of the encounter or objective measurements of the system. The authors developed a means of collecting this information via a 67-item questionnaire (included in the article) that collected patient demographic information and health status, prior health care (continuity), and ancillary services utilized by the patient. Targeted to patients coming to a primary care office visit at a large multispecialty facility in northern California, the study achieved a response rate of 77.6 percent for a total sample size of 291.

2.

Hall, J., and Dornan, M. (1988). Meta-Analysis of Satisfaction with Medical

Care: Description of Research Domain and Analysis of Overall Satisfaction Levels. Social Science and Medicine; 27(6): 637-644. The authors conducted a meta-analysis of 221 studies to examine consumer satisfaction with medical care. The authors begin by describing the general characteristics that could describe satisfaction instruments. Directness of the question relates to how directly a patient was asked about their satisfaction (how satisfied were you vs. describe the care you received). Specificity refers to how general of an encounter is being measured, ranging from measures of a health system in general to measures of a specific visit. Type of care refers to the type of service being accessed (e.g. ambulatory care). Dimensionality refers to the aspects of the care being measured Other results discussed included: patients were more satisfied with physicians with less experience; general satisfaction studies had lower satisfaction ratings than specific event focused studies.
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The authors then present theories for results found. Presumably patients were more satisfied with newer doctors because they spend more time with patients, and displayed more technical and interpersonal competence (supported by other literature). They presented several hypotheses for why more specific encounters were rated higher than studies focusing on satisfaction with health care in general. The first is related to temporality and cognitive process, in that negative experiences are remembered for a longer period of time. Since most general satisfaction surveys were not administered immediately after an encounter, they may be influenced by the more negative experiences of those being interviewed. Additionally, general satisfaction survey respondents may draw on more generic (and potentially negative) views of health care rather than a specific encounter with a health care provider, whereas patients evaluations of my care specifically may have more positive views. In either case, these attitudes and perceptions could skew the results.

3.

Hall, J. and Dornan, M. (1990). Patient Sociodemographic Characteristics as

Predictors of Satisfaction with Medical Care: A Meta-Analysis. Social Science and Medicine; 30(7): 811-818. This paper reviews the evidence of the relationship between patient satisfaction and patient characteristics using quantitative meta-analytic techniques. The authors used standard and accepted methods for identifying published quantitative analyses of patient satisfaction where information on the association among patient characteristics and satisfaction were presented. One hundred and ten published reports were included in the analysis that met the authors criteria for inclusion. For each study, each correlation was extracted and coded as to which of the 11 aspects of care it pertained to; the 11 aspects of care were: access, cost, overall quality of care, humaneness of providers, competence of providers, information given by providers, bureaucracy, Physical facilities, providers attention to psychosocial problem, continuity of care and ou tcome of care. The paper also reports several interesting contrasts among variables, such as sex and ethnicity. The authors conclude by stating that in overall terms, it appears that patient satisfaction is associated with age and education and nearly significantly associated with social and marital status. The authors continue to state that the associations may be due to response patterns on the part of the groups identified or they may be mediated by events and processes that occur during the medical care encounter.

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4.

Inui, T. and Carter, W. (1985). Problems and Prospects for Health Services Re-

search on Provider-Patient Communication. Medical Care; 23(5): 521-538. In this review of studies of provider-patient communication, the authors assert that even with the vast knowledge available on biological processes and disease mechanisms, communication between health care provider and patient is an extremely important aspect of health care. Attempting to measure this, however, requires interdisciplinary activities, since merely measuring satisfaction at the conclusion of an interaction cannot measure all the nuances of communication (both verbal and non-verbal). They then spend some time describing the methods of systematic analysis of these interactions, citing that many of the methods have generic similarities: strategies utilized direct observation; emphasis on specific processes such as verbal communication; multiple classifications to categorize encounters; and an approach to quantify the events. The authors also argue that it is important to understand pre-encounter state in order to place post-encounter measures into perspective. This could include patient expectations of the encounter, degree of prior exposure to the health care provider, and demographic characteristics, all of which can ultimately affect how a patient interprets the encounter. The authors conclude that it is important to augment measures that categorize a specific type of interaction (the example they gave was verbal communication) with measures of other types of interaction, such as body language. They also point out that for chronic diseases, addressing symptoms and providing support rather than a cure is often the goal, once again pointing to the importance of communicating effectively with patients through the course of their treatment 5. Sitzia, J. and Wood, N. (1997). Patient Satisfaction: A Review of Issues and Con-

cepts. Social Science and Medicine, 45: 1829-1843. Sitzia and Wood review the literature and suggest that patient satisfaction could be assessed by measuring 1) the degree to which patients believe that care possesses certain attributes and 2) the patients evaluation of those attributes. They suggest that satisfaction is not single concept made up of multiple determinants, but that there exists three independent models of satisfaction, each associated with one determinant. Thus, there is the need for the familiar, the goals of help-seeking and the importance of emotional needs. Furthermore, there is evidence that there are two states of satisfaction, stable ones related to health care generally and dynamic ones related to specific health care interactions.

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Components of satisfaction consist of: structural, technical and interpersonal aspects of care. Expectations are critical as they form the basis for the subjective assessment of care that is the rating of satisfaction. There can be different expectations for different aspects of care and patients with lower expectations tend to be more satisfied. Satisfaction cannot be interpreted as a measure of quality of care and must be interpreted in the context

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Chapter 6

Research Methodology
Method is a way of doing something and methodology is a set of methods used in a particular area of activity. The research methodology employed in the research is as given by Philip Kotler. Developing the problems and research objective Developing the information sources. Collecting and analyzing the information Presenting the information Research problem: Patient Satisfaction regarding Healthcare provided by Seven Hills Hospital Research design: Research Design is a series of advanced decisions that taken together comprise a master plan or model for the conduct of an investigation. So research design provides a framework of plan for study, which guides the collection, measurement, analysis, and interpretation of the data. The research carried out here is descriptive in nature. Study Design and Sampling The prospective study was designed to examine the influence of specific characteristics of providers, patients, and health systems on outcomes of care. Briefly, data were obtained from patients visiting physicians in Seven Hills Hospital (Seven Hills Health Care Private ltd.) in Visakhapatnam. Samples of 60 patients consisting of adults (ages 18 and over) were taken. Subjects With respect to demographic characteristics, study participants averaged 55 years of age; 80% were male. Measures Patient satisfaction with medical care: Patient Satisfaction Questionnaire consists of 18 items tapping seven aspects of satisfaction with care: general satisfaction (2 items), technical quality (4 items), interpersonal manner (2 items), communication (2 items), financial aspects (2 items), time spent with doctor (2 items), and accessibility and convenience (4 items). To control for acquiescent responding, the instrument contains both positively-worded and negatively-worded items. Participants were asked to indicate how they feel about the medical care they receive in general, with no reference to a specific time frame or visit. Responses to each item are given on a 5-point scale ranging from strongly agree to strongly disagree
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Sampling method: The sampling method involved is convenience sampling method.

Method of data collection It can be done through primary. To collect primary data a survey will be conducted on Patient Satisfaction through a questionnaire, which will be filled by the patients and their attendees in SevenHills hospital. Various questions will be asked to gain maximum information from the respondents. Scaling technique Scaling techniques is used in this survey, for understanding the relation between patient satisfaction with care provided in the hospital and its effects. Answers of the respondents are elucidated by asking them to indicate their level of agreement on a given five point Likert scale with values ranging from 1 (strongly disagree) to 5 (strongly agree).

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Chapter 7

Data Analysis
Patient satisfaction survey data analysis

Demographic profile: 60 samples were taken to conduct study of which 47 were males and 13 are female Results: Aspects Questionnaire 3. The medical care I have been receiving is General satisfaction Mean 3.2

just about perfect 17. I am dissatisfied with some things about the medical care I receive 2. I think my doctors office has everything needed to provide complete medical care 4. Sometimes doctors make me wonder if their diagnosis is correct
2.8

3.1 3.2

Technical Quality

6. When I go for medical care, they are careful to check everything when treating and examining me 14. I have some doubts about the ability of the doctors who treat me 1. Doctors are good about explaining the reason for medical tests 13. Doctors sometimes ignore what I tell them 5. I feel confident that I can get the medical care I need without being set back financially

3.1 3.9

3.3

Communication

2.7 3.2

Financial aspect

7. I have to pay for more of my medical care than I can afford

3.5

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12. Those who provide me medical care someTime spent

3.3

times hurry too much when they treat me

15. Doctors usually spend plenty of time with 3.9

me 8. I have easy access to medical specialists I need

Accessibility and Convenience

3.0 2.8

9. Where I get medical care people have to wait too long for emergency treatment 16. I find it hard to get an appointment for medical care right away 18. I am able to get medical care whenever I need it

2.5

3.4

Interpretation: From the survey,

General satisfaction strongly

agree agree incertain disagree

strongly disagree
Aspect General satisfaction 1 12% 2 28% 3 40% 4 12% 5

40 percent of the patients are uncertain if they are receiving perfect medical care or not. 28 percent agrees with this and feels that the medical care provided is good.
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Technical quality

strongly agree agree incertain disagree strongly disagree

Aspect Technical quality

2 40%

3 10%

4 50%

Most of the patients disagrees that the physicians office has everything that is required for providing complete medical care.

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Intrapersonal manner

strongly agree agree incertain disagree strongly disagree

Aspect Intrapersonal manner

2 20%

3 30%

4 50%

50 percent of the patient disagrees with the statement that their doctor acts too businesslike and impersonal with them

Communication

strongly agree agree incertain disagree strongly disagree

Aspect Communication

1 12%

2 28%

3 40%

4 12%

The patients agree that doctors explain them the reason for undergoing medical diagnosis.

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Financial aspect

strongly agree agree incertai n disagree strongly disagree

Aspect Financial aspect

2 50%

3 10%

4 40%

The hospital is producing the medical services at affordable prices which is denoted by 50 percent patients agrees it

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Problems observed & Recommendations

During the training period in the hospital the following are few observations in inpatient and outpatient departments. The registration facilities for outpatient dept. is well placed in the hospital one near the entrance and other near the doctors cabins but the patients are facing problems in getting the information regarding the physicians details The outpatient dept. is located in the first floor and the only way is by staircase which poses difficulty for the patients to reach the physicians. Wastage of time is observed when the patient is needed to undergo any diagnostic procedure and has to return to the physician. The admission process is done in the ground floor, and the patient has to come there from the physician which is incontinent for the patients and a time taking process Due to the deficiency of equipment, time consumption is more The shifting process from admission dept. delays a great deal if any diagnostic procedures are advice by the physician.

Recommendations Information centres can be placed near the entrance to help and guide the patients. Construction of a way which can be used only by patients Providing serial numbers for the patients at the counters before undergoing the diagnostic procedures, which should be don orderly Admission dept. can be shifted near to the outpatient dept. which decreases the incontinence to the patients Supply of required equipments.

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Conclusions
From the survey in SevenHills hospital, the medical care provided by the hospital is satisfactory. But being a super speciality hospital, there are areas that should be improved to provide the patients a well satisfied feel from the hospital. By implementing the recommendations the most important factor time loss can be minimized.

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References
1. Baker R. Development of a questionnaire to assess patients' satisfaction with consultations in general practice. Br J Gen Pract 1990; 40: 487-490. 2. Baker R. The reliability and criterion validity of a measure of patients' satisfaction with their general practice. Fam Pract 1991; 8: 171-177. 3. Department of Health and the Welsh Office. General practice in the National Health Service: a new contract. London: HMSO, 1989. 4. Department of Health. Medical audit in the family practitioner services. HC (FP) (90)8. London: DoH, 1990. 5. Fitzpatrick R. Measures of patient satisfaction. In: Hopkins A, Costain D (Eds). Measuring the outcome of medical care. London: Royal College of Physicians of London, 1990. 6. Fitzpatrick R. Surveys of patient satisfaction. I: important general considerations. BMJ 1991; 302: 887-889. 7. Hulka B, Zyzanski S, Cassel J, Thompson S. Scale for measurement of attitudes towards physicians and primary health care. Med Care 1970; 8: 429-433. 8. Mitchie S, Kidd J. Happy ever after. Health Serv J 1994; 3: 27. 9. Ware J, Snyder M, Wright W, Davies A. Defining and measuring patient satisfaction with medical care. Evaluation Program Plann 1983; 6: 247-263. 10. Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994; 38: 509-516.

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Sir/Madam, On the following pages are some things people say about medical care. Please read each one carefully, keeping in mind the medical care you are receiving now. (If you have not received care recently, think about what you would expect if you needed care today.). We are interested in your feelings, good or bad, about the medical care you have received. Name: Age/Sex:

How strongly do you AGREE or DISAGREE with each of the following statements? (Circle one number on each line)
Strongly agree agree Uncertain Disagree Strongly disagree

1. Doctors are good about explaining the reason for medical tests 2. I think my doctors office has everything needed to provide complete medical care 3. The medical care I have been receiving is just about perfect 4. Sometimes doctors make me wonder if their diagnosis is correct 5. I feel confident that I can get the medical care I need without being set back financially 6. When I go for medical care, they are careful to check everything when treating and examining me 7. I have to pay for more of my medical care than I can afford

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Strongly agree agree

Uncertain

Disagree

Strongly disagree

8. I have easy access to medical specialists I need 9. Where I get medical care people have to wait too long for emergency treatment 10. Doctors act too businesslike and impersonal towards me 11. My doctors treat me in very friendly and courteous manner 12. Those who provide me medical care sometimes hurry too much when they treat me 13. Doctors sometimes ignore what I tell them 14. I have some doubts about the ability of the doctors who treat me 15. Doctors usually spend plenty of time with me 16. I find it hard to get an appointment for medical care right away 17. I am dissatisfied with some things about the medical care I receive 18. I am able to get medical care whenever I need it

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Your valuable suggestions:

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