Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Declaration
------------------------Signature of student
Certificate
I, the Principal of Ramniranjan Jhunjhunwala hereby
certify that Kunal Bharat Mehta, student of Third
year Bachelor of Management studies has
completed his project on Management practices
at hospitals in the academic year 2005-2006. The
information submitted is true and original to best
of my knowledge
______
_______
Signature of
Signature of
Project guide
Principal
Acknowledgement
Kunal Mehta
Executive summary
The job of medical care, today, is no more a one man show.
Modern
hospital
organization
involves
heterogeneous
group of
16
a. On basis of objectives 16
b. On basis of ownership 17
c. On basis of medicine.. 18
d. On basis of size.. 18
3. Identification Of Activities At Hospitals
19
Medical services. 19
Customer care Department. 20
Nursing Services.21
7
50
10
11
Market
Indias healthcare industry is estimated at Rs 1,500 billion or USD 34
billion. This works out to USD 34 per capita which is 6 per cent of GDP.
Of this 15 per cent is publicly financed, four per cent is from social
insurance, one per cent private insurance and the remaining 80 per cent
being out of pocket as user fees (80 per cent of which goes to the private
sector). Two thirds of the users are purely out-of pocket users and 90 per
cent of them are from the poorest section.
Healthcare statistics
12
India has 5,03,900 doctors, 7,37,000 nurses, 162 medical colleges, 143
pharmacy colleges and 3,50,000 chemists. There are 15,097 hospitals
accounting for 8,70,161 hospital beds in India. There is an extensive
three-tiered government healthcare infrastructure comprising 23,000
Primary Health Centers (PHC) and 1,37,000 sub-centers serving the
semi-urban and rural areas and 3000 (CHC) Community Health Centers
A Healthy Business
Traditionally healthcare has been one of the crucial sectors for any
economy. For most of the developed countries, healthcare spending
accounts for more than seven percent of GDP. Today, healthcare is the
largest industry in the world with revenues of$2.8 trillion. In the US,
healthcare is a $1.4 trillion industry, accounting for 13.7 percent of GDP
and is estimated to expand to a size of $2.2 trillion by 2008.
In India, the industry is worth about Rs.100, 000 crore and
accounts for nearly five percent of GDP. Amit Bagaria, CEO of Asian
Health Services says, Not many people realize that it is close to Rs
100,000 crore industry and employs 60 lakh people directly and 20 lakh
indirectly. Compare this with the Information technology, which is Rs
40,000 crore and employs only three lakh people. Another important
finding is that in the development cycle of an economy, for the last 25
years before a nation reaches developed status, healthcare is the fastest
growing industry. The industry is expected to register a 17 per cent
growth and reach a size of more than Rs 2,25,000 crore by 2005-06
Healthcare industry growth
(000 Rs crores)
13
Indian Stand
Potential
The potential of health services sector is immense in India as there are
more than 140 million upper and middle class, growing at over four per
cent per annum with combined annual income of over Rs 820,000 crore.
14
15
growing at 12 per cent per annum, which is almost double the market size
in 1993.
With India becoming a healthcare destination, Health Tourism Industry,
stands at Rs 1200-1500 crores, and growing at a rate of 30 per cent
annually is bound to grow at a faster rate.
Lower production costs and skilled workforce has attracted multinationals
to set up R & D and production centres in India. In the long run these
R&D centres will help develop low-cost medicines for the Indian market.
16
Hospital
Teaching cum
research
General
Hospital
Special Hospital
1. Teaching-cum-Research Hospitals
These hospitals are teaching based. They are found engaged in
advancing knowledge, promoting the research activities and
training the medicos. As for example, All-India Medical Institute,
New Delhi, Post-Graduate Medical Education and Research
Institute, Chandigarh, etc
2. General Hospitals
The general hospitals also offer teaching and research facilities but
these objectives are secondary. The main objective in the general
hospitals is to provide medical care. As for example, different
medical colleges and district and sub divisional hospitals.
3. Special Hospitals
The main objective of special hospital is to provide specialized
medical services. These hospitals concentrate on a particular organ
of the body or a particular disease. These are multispeciality /
superspeciality / criticare type of hospitals.
17
Hospital
Private
Hospital
Government
Hospital
Trust run
Hospital
1. Government hospital
The government hospitals are owned, managed and controlled by
the government whereas the semi-government hospitals are found
acting as an autonomous body.
2. Private hospital
These types of hospitals are owned privately and have no
government interference. They provide quality service to there
customers. These hospitals are internally managed.
3. Trust run hospitals
These types of hospitals are under control of the trust and all the
decisions related hospitals are taken by trustees of the hospital
18
Hospital
Teaching
Hospital
District
Hospital
Tehsil/Taluka
subdivisional
Hospital
Primary
Health
Centres
19
MEDICAL SERVICES:
The medical staff doctors are the
back bone of hospital organisation.
Doctors may be classified under three
categories:
Highly professional - specialized
doctors, Honorary specialized doctors
and General Doctors) with some / no experience and no specialization
in any branch of medical science).
Highly professional, well trained and experienced doctors are the real
asset of hospital organisation general duties of doctors include
diagnosis of illness or state of illness, instruction to patients,
instruction to nurses or the matron about the patients needs by way of
medicines and other facilities, consulting the medical record of
20
direct
interface
with
the
21
NURSING DEPARTMENT
Nursing services form an integral
part of any hospital. Nursing is
both art and science and its a
profession that calls for commitment,
maturity (emotional) and an ability to access and
synthesize information quickly and correctly. The nursing staff acts
as abridge between doctor and patient.
Nursing department works through nursing staff that is competent
and humane in its functioning. The staff provides assistance to doctors to
carry out treatments efficiently. The nursing staff works in operation
theatre, intensive care unit, surgical intensive care unit, intensive cardiac
care unit and out patient wards and rooms.
Normally nurse patient ratio is maintained at 1:1 in ICU, ICCU and
SICU while in other clinical wards it is headed with one head nurse with
30-35 nurses.
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DIETETICS DEPARTMENT
The meal for a patient has an important role in treatment plan. The
dietetics department prescribes and provides well planned meals to
patient in accordance with there therapeutic needs. Dietetics department
also does counseling of patients to adapt and incorporate dietary
modification in their daily routine to promote better health status.
Dietetics department acts as a link between the dietary prescriptions given
by the doctors and the likes and dislikes of the patients. It monitors and
executes the therapeutic diet orders through Foods and Beverages
services.
PHARMACY DEPARTMENT
It is the area of increasing
importance. This department is often
combined with central sterilization and
stores. The staff has to be well trained
and has to be looked after properly at all
levels by the pharmacists.
23
PATHOLOGY DEPARTMENT
The pathology department provides valuable services in the
diagnostic areas through various tests.
The department has various sections such as Biochemistry, Hematology,
Serology and Microbiology.
The pathology department conducts following tests:
Routine and special tests in Hemet
Routine and special tests in biochemistry
Hormone Assays
Drug levels
Infection Serology markers
DEPARTMENT OF RADIO-IMAGING
Radio imaging department plays a vital role in diagnostic work-up
of every patient. The department has all advanced modalities/machines
available to perform the Radio imaging for diagnostic purposes.
24
25
OUTPATIENTS SERVICES
Out patients services constitute
one of the important functions which
most hospitals under in their areas
encompassing
attention
to
those
ENGINEERING SERVICES
A hospital is described by some administrators as a ship at high
seas. Almost all kinds of emergencies that arise in a ship are required to
be attended to in a hospital. Sudden failure in some of the installations in
operation theatre I.C.C.U, Kidney units etc. can seriously jeopardize the
life of patients. Here some hospitals administrative have advised
experience marine engineers in hospitals. These engineers possess the
know-how to deal with sudden situations that arise and have to be dealt
with without outside help.
26
WARD SERVICES
Ward is the heart of the hospital where the patients are kept. The
major objective of the hospital is to take care of the sick and injured.
Other purposes are research in medical field, training and teaching of
medical nursing and many other personnel. All these functions are carried
out mostly in ward or depend on those personnel who spent most of their
time in wards.
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28
Wockhardts
achievements
24th largest wealth creator
Ranked amongst the 50 most valuable companies in India
Rated among the Top 10 emerging Corporate in India (Economic
Times, 1999)
Wockhardt employs 2700 people of which more than 1300 constitute
the field force covering 1, 50,000 Doctors
35% of total sales come from International Business
Listed on Bombay Stock Exchange, National Stock Exchange and on
Luxembourg Stock Exchange
R&D programme rated among the top 3 in the country with R&D
spend of 7% of sales - one of the highest in the country.
Managed by the "Best" Board of Directors in the pharmaceutical
industry (Source: Business Today, May, 1997 survey.)
"Pursuit of growth with excellence in the field of pharmaceuticals and
healthcare" Profitability through:
Quality of products and services
Increasing investment in R & D
Competent scientific and managerial manpower
29
Salient features
A very spacious hospital with carpet area per bed of around 1100 sq.ft.
A 222 bedded hospital, which includes 100 Intensive Care beds, with
all its services.
Highest Nurse: Patient Ratio of 1:5 due to which they are better
equipped to handle patient's complex health conditions. This is one of
the highest nurse patient ratios in India.
The management comprises of highly qualified professionals, who
have brought with them rich experience which enables the hospital to
be run on truly professional lines.
Central Music System.
Central Paging System.
Central Fire Detection with interlined Central Sprinkler System.
Well controlled & safe climate with soothing ambience are special
features of the hospital.
100% standby power backup for the hospital with critical areas like
Operation theatres and ICU further backed up with UPS.
Linen and Laundry Services
A high class Cafeteria on Level 3
A well setup Chemist Shop.
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Ambulance services.
Fully computerized system with high end Application Servers &
Backup Servers.
Drawing upon the resources of Harvard Medical School and its affiliated
institutions, HMI is creating unique programs for Wockhardt hospitals
committed to high quality healthcare. The guiding principles used by
HMI in this relationship are to maintain medical integrity, objectivity and
academic independence.
Technology
The Wockhardt Hospital provides you with the new generation cutting
edge medical technology and the world-class quality treatment with
care. We possess advanced state-of-the-art
facilities and infrastructure benchmarked with
the
best
hospitals
in
the
world.
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surgery
Key Expertise
Wockhardt Hospitals has conceptualized unique facilities and services,
some of which are pioneering global achievements in hospital services:
1. Virtual Family Visit
2. Life Link
3. Health Angel
4. Monitor Your Patients Live
5. Wockhardt Cardiac Line
6. Touch - Screen - Kiosks
7. Specialized
Services
In
Urology,
Gastro-Entrology
Ophthalmology
8. Laboratory and Imaging services
9. Intra-ocular lens implant and phaco-surgery for Cataracts
10.A state-of-the-art Dental Department
34
and
35
Being a service sector there is no particular product but for them their
service is the product for marketing. They strive to create a culture that
supports
empowerment,
continuous
improvement
and
customer
Quality
Management
of
Wockhardt
Hospital
38
Introduction
The Employees' State Insurance Corporation (ESIC) of India is one of the
largest social security organizations providing medical insurance cover
and delivering of medical care to 35 million beneficiaries through 140
hospitals and 1500 dispensaries. The objectives of this study are to
understand the costing of medical care at ESI hospitals and suggest
systems for e-governance to facilitate the coordination between ESIC,
ESIS and the beneficiaries. Towards this, selected a large ESI hospital,
namely, the ESI General Hospital at Bapunagar, Ahmedabad and gained
very useful insights about the systems currently in practice for offering
medical benefits to the insured persons and their beneficiaries. This
working paper brings out our detailed analysis of the working of ESI
hospital, Bapunagar in delivering medical care under the ESI scheme.
On papers, the ESI Corporation appears gigantic with 140 hospitals
spread all over the country; boasting a capacity of 26,000 beds and
employing 14,000 doctors and 45,000 paramedics. More than 3.5 crore
39
people are covered under the ESI scheme with annual revenue of a
whopping Rs 1,510 crore. Despite this, the scheme has been largely
unable to provide quality healthcare services due to poor infrastructure,
cumbersome procedures and lack of professionalism.
Though a massive premium is collected under the scheme, hardly 16-18
per cent (around Rs 244 crore) of the revenue is spent on the
beneficiaries. Three TPAs Chennai-based Apollo Hospitals, Mumbaibased Sedgwick Parekh Health Management Services and Pune-based
ICAN Medicare Pvt. Ltd have made a bid for the scheme, it is learnt.
Each TPA is said to have presented a different model which the
Corporation is looking into. It is definitely a positive sign that at least
our proposals are being considered, says George Mathew M, managing
director, ICAN Medicare.
The Labour Ministry has directed the Employees State Insurance
Corporation, ESIC to set up a model Hospital with modern computerized
facilities and services in each state. He said that ESIC is going to make
ten of its hospitals totally computerized in the near future. The
Corporation would also establish two to three hospital of specialized
nature for treating Cancer, Kidney and Coronary diseases. Shri Yadav
said that he would have no objection to open 50% of occupancy of such
hospitals to general public on payment basis in order to run these
hospitals efficiently. The Labour Minister also disclosed that his Ministry
is making a proposal to take back such ESIC hospitals which are not
reportedly run by the State Governments properly. ESIC is at present
managing 9 of 140 hospitals directly. Shri Yadav said that the coverage of
the ESIC is not enough and should be extended to bring in more workers
within its ambit.
40
25
No of implemented center
687
Employers
2.54 lakhs
Insured person
79.10 lakhs
Insured women
13.40 lakhs
Beneficiaries
307 lakhs
38
Branch/pay offices
808
ESI hospitals
143
ESI annexure
43
ESI Beds
27099
Specialists
322
ESI Dispensaries
1452
7100
2511
41
8 Crores
Inpatients
4.5 lakh
1,97,564.00 lakhs
1,17,048.00 lakhs
42
Model Hospitals
43
To ensure that there are proper secondary care facilities for the
beneficiaries, the E.S.I.C has decided to set up one Model Hospital in
each State. The proposed Model Hospitals are being identified out of the
existing Hospitals to provide all modern infrastructure facilities, staff and
equipments as per E.S.I. norms and to act as referral hospitals for the
entire State to provide state of art secondary care services.
The Model Hospital will have all general specialties along with support
services of Radiology, Laboratory, Store and Pharmacy, Operation
Theatres,
Medical
Records,
Dietary
services,
Laundry,
CSSD,
Library
etc.
To
facilitate
community
services,
staff
44
An average
recruitment cycle for the recruitment of medical officers took one and
a half to two years to complete with no certainty of the successful
candidates joining the organization. The respondents (doctors) felt
that this could be shortened by adhering strictly to the established
protocols for speeding up the process.
Performance appraisals
The performance appraisal was done on the basis of annual
confidential reports (ACRs).
Officers (IMOs) and specialists felt that the reporting and the
reviewing officers usually did a generalized/subjective reporting
than a customized/objective appraisal and reporting in the absence
of output indicators. The role of the reviewing officer was unclear,
since he/she was too far away and not really associated with the
manner of working of the individual being reported upon. It was felt
that this mechanism sometimes results to identical appraisal between a
non-optimal and an optimally performing worker. This was a major
concern for the respondents. Also identified gaps were practically not
followed up for remedial action. These perceptions have the risk of
transforming as demoralizing and de-motivating factors for an
efficient employee.
45
this
training.
Content
areas
were
informally
communicated by headquarter.
46
47
Introduction
Bombay
Hospital
and
Medical
Research
Centre
- an institution in itself
Mumbai, the centre for quality medical care not only across India,
but also the South Asia. A city that has a rich medical history. Situated in
South Mumbai is the Bombay Hospital and Medical Research Centre, the
medical hub of India's biggest metropolis.
Established over five decades ago, in 1952, The Bombay Hospital
was the result of the enormous philanthropy displayed by Shri
Rameshwardas Birla, Founder Chairman of the Bombay Hospital Trust. It
began as a 440 bed hospital whose objective was, in its founders words,
to render the same level of service to the poor that the rich would get in
a good hospital.
Today, the hospital has grown to house over 830 beds, some of the
countrys most advanced diagnostic & surgical equipment, and offers a
comprehensive range of specialized medical services. The objective
however, remains unchanged. This is why 33% of the patients treated are
in the general ward and pay only for their medicines and consumables.
The free OPD at the hospital successfully treats in excess of 1,00,000
patients
each
year.
48
It is on this sound foundation that the hospital has based its pursuit of
excellence in every field of medical specialization. This has seen fruition
in the form of the Medical Research Centre now known as the M P Birla
Medical Centre.
The Bombay Hospital presently ranks among the finest multispecialty tertiary level medical centers in the country. The internationally
renowned panels of doctors and consultants in every field of
specialization have, at their disposal, cutting-edge equipment. Supported
by a highly trained and professional nursing staff. Little wonder then, that
the Bombay Hospital attracts patients from every strata of society. Be it a
factory worker from rural India, a high-flying executive from a multinational company or the likes of former Prime Minister and Governor of
Maharashtra.
The Bombay Hospital has 830 beds, of which 300 beds are free
and another 200 beds are heavily subsidized. About 60% of the operations
performed by our surgeons are free or against very nominal charges.
On this bedrock of charity relentlessly building the bedrock of
excellence in the Hospital by continuously refurbishing its spaces,
installing
the
most
modern
medical
equipment
and
injecting
49
A patient being treated in one of the many Deluxe Rooms of the hospital
51
52
There has been a sea change in the accountability and todays managers
realize that it is equally important for their institutions to excel in the
clinical arena and delivering consistently on patient service expectations.
As enterprise expands what will become critical is that the healthcare
system speaks a common language irrespective of the specialties.
What is the pattern of administration for Wockhardt?
All our hospitals are professionally managed by group of professionals
who are both by education and by experience experts in the field of
hospital management.
Wockhardt is associated with Harvard Medical International (HMI).
Do you in some ways follow the administrative pattern of HMI?
Wockhardts association with HMI has benefited us immensely in setting
systems in the clinical and administration which conforms to the standard
followed by Harvard Medical School. What has emerged is a focus on
training and education on an ongoing basis within our healthcare system.
54
hospital
project?
55
come across cases where promoters have copied reports from other
hospitals. The result is that banker is reluctant to fund as there is a
question mark on project feasibility. This delays the project further and
also increases the costs, explains Dr Kamle. Concurs Dr Kothari,
Financial feasibility report must work like a bible and project finances
must be tied up accordingly. Project management is all about completing
with quality and containing cost. What is also essential is frequent
project assessment, he adds.
Infrastructure
Dr B V Venkatesh, administrator, HOSMAT hospital, Bangalore says the
process of budget allocation for hospital infrastructure is two fold. A
hospital has to allocate 70 per cent of its budget for good quality
infrastructure.
Quality
infrastructure
will
definitely
reduce
the
56
Medical equipment
Allocation for medical equipment generally accounts for 30-40 per cent
of the total cost. Experts say it is very important to stick to the allocated
figure. However, this is hardly the case. Not more than 10 per cent of
people think of budgetary allocation while shopping for equipments.
Most buy them because it is a fad to install sophisticated equipments.
This is also true for implementing process management tools, says Dr
Kamle. Having said that it is important to realize that at these competitive
times, it always pays to acquire cutting-edge technologies. Apollo Delhi
ploughs back 80 per cent of its revenue every year in to technology up
gradation, according to managing director Dr Yogi Mehrotra. Similarly,
Wockhardt Hospitals, Bangalore spends around Rs 1.5 crore every year.
Says Dr M E Yeolekar, dean, Lokmanya Tilak Municipal General
Hospital, In up gradation of equipments, departments like cardiology,
orthopedics, obstetrics, gynecology, radiology and diagnostic are given
priority since there is a high turnover of patients here. Hospitals tend to
discourage purchase of expensive equipment with limited utility.
Equipments for rare disorders always take a backseat. Funds are
canalized in buying equipments, which serve multiple departments and
for diverse ailments. For instance, a C-Arm serves the departments of
surgery, orthopedics and different other sub-specialties.
57
Human resources
Human resources form a most important link in hospital management.
This function accounts for 12-18 per cent of the project cost. Here again,
hospital adopt different strategies. The popular one is to lure specialists
from other competing hospitals. This, feel experts, could be detrimental
in the long run since the sense of ownership is lost in financial
bargaining. Dr Kamle feels that hospitals should employ full-time
specialists and encouraging them by providing remuneration along with
perks and foreign trips proportionate to the work generated for the
hospital. This, say others, will instill a sense of ownership in their minds
resulting in overall growth in business prospects.
Operations
While running a hospital, methodological calculation of economics must
be the norm. Profit centre mechanics demands that each department be
converted into a profit centre. Profit does not mean commercialism. The
money has to be ploughed back in so many ways like salaries, up
gradation, maintenance etc. Even a front office or house keeping gives
profits, though intangible, explains Dr Kamle. For instance, in case of a
department like radiology, depending on investment, costing is done,
revenues are calculated and budget is allocated on the basis of this
projected revenue. The head of department must be then entrusted with
the budget and is responsible to run it profitably, he elucidates.
Lokmanya Tilak Municipal General Hospital, with 1400-odd beds spends
around Rs 3.5 to 4 crore annually on its infrastructure maintenance.
Dr C P Kamle,
58
Future prospective
In order to capitalize on all these opportunities, we have to create a
conducive environment by:
Attracting investment
59
IT initiatives
60
61
Building
Building is another major area that one needs to look at carefully before
setting up a hospital. The facility for outpatients must be different from
those of the in-patients. Outpatients might bring in infections with them,
which might spread to the inpatient that has undergone an operation.
Hence an inpatient area must be accessible only to the inpatients.
Construct the hospital in a way that the two need not any time have to use
the same area.
Operation theatre
Gone are the days when loved ones of the patients waited outside eagerly
to know how an operation went on. All our operation theatres have an
observation gallery from where attendants can watch and see how the
operation proceeds. This way they would know exactly what was
happening in the room, which increases the awareness of operations
amongst the general public. At present this is being implemented in a few
hospitals but as awareness increases patients would look for a hospital
that is transparent. So while building a new hospital it is best to build it
according to the latest standards and guidelines though you might spend a
little more. Another facility that could be included is to be able to talk to
those in the observation gallery right from the operation theatre. This
further reduces their fear and assuring that the doctor is in touch with
them.
62
Equipment
Remember that a hospital is not a five star hotel. We need 5-star doctors
with good surgical skills. People do not come to the hospital for its
ambience. They come because of the efficient staff and the equipment
handled by them. While it is very important that your hospital is hygienic,
clean and comfortable it would be foolish to make it look like a 5-star
hotel and hike the prices.
Monitoring activity
Monitor every activity that happens at the hospital. In our hospital we
have cameras in the operation theatres and I an able to see what happens
in all the four operating theatres. A television is kept in the outpatient area
where they can also get a feel of what happens at the hospital. This kind
of a transparent atmosphere eases any fear.
Train your staff
The patient comes to the hospital as a last resort. When he comes in he
does not want to feel dejected further by the attitude of the staff. Hence
the staff needs to be trained to be courteous to people. Have a counselor
at the hospital that would be there for the patient both during pre and post
operation period. Our post operation counselor at the hospital dials all the
patients who have undergone the operation that particular day to ask them
how they feel etc.
63
Maintenance
Building a hospital is not over with developing infrastructure and starting
operations. The success of the property depends on constantly
maintaining
and
updating
the
facilities.
Employ
an
effective
64
Conclusion
The success of hospital is usually attributed to the skills of its
doctors and nurses, but there is a club of behind the scene personnel, who
are always on toes to keep the wheels of any healthcare facility smoothly
turning. Hospital administration is all about weaving the different units of
a hospital together into a cohesive whole. Management tools play
important role in the day to day functioning of a hospital.
A few hospitals have training programmes for their staff and use
incentives to ensure that their employees function in a competent and
professional manner. There must be coordination and understanding
between various departments and this can only be achieved if the
administrative and the medical staff have tolerance and respect for each
other.
Nowadays hospitals have to be hi-tech to be efficient in their
operations. Using HIPePS (Hospital information resource planning
system) makes the hospital keep all the patient records and all
government related information under password system. Wockhardt
Hospital uses Wipros HIPePS. This project work has made me
understand the management of hospitals from in depth.
Before selecting this topic as my final year project I was just
having the basic idea and I wanted to get more information on this topic.
The ECONOMIC TIMES has stated the hospitals to be the next big
business and good forex earner for the country so let us wait and see the
dream and statistics come true.
65
Bibliography
www.wockhardthospitals.com
www.bombayhospital.com
www.esic.nic.in
www.healthcaremanagement.com
Healthcare issue 2003-04 (Economic Times Group)
Modern healthcare magazine
Wockhardt induction guide
Human resource development in a government health
organization: views of doctors Vivek Handa, A.K. Sood &
Rajni Bagga
Annual Report of ESIC New Delhi (1995-96 & 2002-2003)
Inserts from
66