Summer training Project in CMRI

Name: Ebrahim Khan. College: NSHM College of Management & Technology. Course: Bachelor in Hospital Management. Semester: 5th Department: Marketing. Topic:CUSTOMER SATISFACTION IN OUTPATIENT DEPARTMENT (OPD) Duration: 13th June 15th August 2011

Index
1. ACKNOWLEDGEMENT 2. EXECUTIVE SUMMARY 3. INTRODUCTION. 4. OBJECTIVE. 5. METHODOLOGY. 6. LITERATURE REVIEW 7. DISCUSSION AND RESULT . 8. PROBLEM IDENTIFICATION 9. RECOMMENDATION 10.CONCLUSION 11.BIBLIOGRAPHY

Acknowledgement
It is a privilege to present my project entitled Customer Satisfaction in OPD. In this project an honest effort is made by me to critically analyze the level of satisfaction of the patients, and the marketing strategies of this institute. My acknowledgement goes to the following persons though not necessarily on the order I am stating. First of all I would like to thank the COO Mr Rupak Barua & Senior Personnel Manager Mr.Ashoke Choudhury from the bottom of my heart for giving me the opportunity to perform my work in Calcutta Medical Research Institute. I want to convey my gratitude Ms.Manali the honorable HR executive, the project would have not have been complete without her inspiration. I also express my profound gratitude to Mr. Sombrata Roy, the Deputy General Manager Marketing, CMRI. The encouraging word of the Marketing Coordinator Ms.Dipika Thappa worked like magic. Mr. Shyam Sundar Dey, Deputy Manager Marketing has been very helpful throughout the training session. Apart from these, I want to thank each and every staff of CMRI as they had guided & helped us politely and guided me in every possible way. I would take this opportunity to thank our respected principal of NSHM College of Management & Technology Mr. Mukul Mitro. I would like to thank our batch Coordinator Mrs. Nabaneeta Dutta for her constant inspiration and priceless suggestions and the other entire facultys of NSHM for guiding me all the way through the project.

Ebrahim Khan

Executive Summary
The Out-patient department is one of the most important departments. All the patients suffering from the diseases of minor, serious, acute and chronic arte examined. It should be designed to provide services to one par cent of the population of the area. It should be large enough to avoid congestion. The functions of the out-patients services are-provision of diagnostic, curative, preventive & rehabilitative services on an ambulatory basis.Out-patient department should be so planned that the building is separate from the indoor area. It should be well connected to the laboratories, x ray department and other sup portative services. It should have enough accommodation to avoid congestion. Depending upon the size of the hospital and resources separate areas of examination for the specialist should be provided.OPD services otherwise called as Ambulatory Care Services. It is a shop window for patients, like windowshopping in a super market where articles are laid down to chose and pick.OPD is the mirror of the hospital, which reflects the functioning of the hospital being the first point of contact between the patient and the hospital staff. Patients visit the OPD for various purposes, like consultation, day care treatment, investigation, referral, admission and post discharge follow up. Not only for treatment but also for preventing and promotive services like, health check up, Immunisation, Physio-therapy and so on. The Ambulatory Care Services is gaining popularity and is in demand due to Day Care Services and patient need not stay at hospital. This is helping both the patient and hospital as patient remains at house near the relatives and the hospital is benefited by less demand on hospital beds there by reducing cost on in patients. Therefore, providing the best OPD Services is one of the primary goal of Hospital Administrator.

INTRODUCTION
According to World Health Organization A hospital is an integral part of a social and medical organization, the function of which is to provide for population complete health care, both curative and preventive, and whose outpatient services reach out to the family and its home environment, the hospital is also centre for training of the health worker and bio-social research. A hospital is an institution for healthcare providing patient treatment by specialized staff and equipment. Today, hospitals are usually funded by the public sector health organization, health insurance companies or charities including by direct charitable organization donations. According to curriculum of West Bengal University & Technology for the summer training project ,I had the opportunity to undergo an in-house training at the CULCUTTA MEDICAL RESEARCH INSTITUTE (CMRI), Kolkata, where I was able to experience how the hospital functions to provide the best of the class health care service to its patients. As a student of Bachelor in Hospital Managemnt such practical training is required for the first hand knowledge about how hospital administration programmes are implemented and maintained in todays high-tech hospitals with modern philosophy and outlook towards the patients and their relatives.

OBJECTIVES
The objectives of this study are: 1. To investigate the influence of physical facilities towards the Outpatient satisfaction. 2. To explore at what extent OPD staffs acts a meaning indicator to measure Outpatient satisfaction. 3. To assess the influence of hospital services inspiring the outpatient satisfaction. 4. To study the functioming of the OPD department.

Methodlogy:
1) General study of the OPD department of hospital. 2) Observational study to collect data regarding general administration of department. 3) Cross-sectional study of department. 4) Record study of present and past status of every department.

Venue: Calcutta Medical Research Institute, 7/2, Diamond Harbour Road, Kolkata 700 027

LITERATURE REVIEW
Concept of Satisfaction: Satisfaction is an important element in the evaluation stage. It refers to the consumers' state of being adequately rewarded. Adequacy of satisfaction is a result of matching the actual past experience with the expected reward. Patients form certain expectations prior to the visit. Once patients come to the hospital and experience the facilities, they may then become either satisfied or dissatisfied. Satisfaction or dissatisfaction refers to emotional response to the evaluation of service, consumption, experience. It will have five key elements. They are: 1. Expectations: The seeds of patient satisfaction are sowed during the prepurchase phase when consumers develop expectations or beliefs about what they expect to receive from the product. These expectations are carried forward and again activated at the time of reusing. 2. Performance: During the usage of services the patients experience the actual product in use and perceive its performance on the dimensions that are important to us. 3. Comparison: It will be done after usage with pre-usage expectations. 4. Confirmation/Disconfirmation: Comparison of expectations with actual performance results in satisfaction or dissatisfaction. 5. Discrepancy: If the performance levels are not equal,discrepancy results. Factors Influencing Patient Satisfaction Every human being carries a particular set of thoughts, feelings and needs. The wishing list might be of value for those who want to know the real person within the patient. One must admit that there are a lot of things which could be altered. By getting to know the patients a little more to get their views on the care one ought to come closer to what the patients consider as a good care. It can be said that there are five determinants of patient satisfaction, they are 1. Reliability: the ability to perform promised service dependably and accurately.

2. Responsiveness: the willingness to help the patients and provide prompt service. 3. Assurance: The knowledge and courtesy of employees and their ability to convey trust and confidence. 4. Empathy: the provision of caring and individualized attention to patients. 5. Tangibles: the appearance of physical facilities, equipment, personal and communication materials. Excellently managed healthcare organisations are having the following practices. 1. Top service hospitals are patient obsessed. They have a clear sense of their target customers and their needs. 2. The best service hospitals set high service quality standards. The standards must be set appropriately high, which leads to patient satisfaction. 3. Culture, subculture and social classes are important in determining the satisfaction levels. Culture is the fundamental determinant of an individual's wants and behaviour. It refers to a set of feelings of the patient or his relatives. Social class reflects sex, income, occupation, education, area of residence and recreational preferences, etc. which are important in determining the satisfaction levels. 4. The patient's behaviour is greatly influenced by social factors like reference groups, ideas, beliefs. Reference groups here refer to peers, relatives, neighbours and friends. The family members are the important persons in influencing the patient. 5. The person's satisfaction is influenced by the psychological factors such as perception, learning and attitudes. Apart from the above, other factors that influences the patient satisfaction include availability of adequate staff, availability of physical facilities and equipment, design of the ward, cleanliness, environment, availability of clinical services, work load of the staff, behaviour of the doctors, nursing staff, paramedical staff, effectiveness of management functions, the leadership styles of administrators, communication channels, policies and procedures etc. Patient satisfaction is a fundamental requirement for the clinical, management and financial success of any organization that provides healthcare. One of the major

challenges of the dynamic health care environment is keeping up with constantly escalating patients expectations. This requires having various mechanisms in place for remaining in touch with and responding to those expectations is an essential organizational commitment in today's competitive healthcare market place. This helps in building a good image of a hospital. This particular name depicts an impression of quality service in the hospital industry. It gives us a picture of an advanced & very effectively equipped organization with the various machines of latest technology & with some of the best names in this field. The quality of health system is sure to augment the already formidable reputation the institution enjoys as one of the most comprehensive & advanced health care providers The concept of O.P.D (Patient Satisfaction) is totally based on the principles of management that is firstly the managers have to plan properly how the floors & wards will run smoothly. Secondly, organizing the system so that the hospital runs, manage & balance various groups of people. They also have to manage both patient & patient parties & to handle difficult situations. Staffing should be done accurately so that both patient & patient party does not suffer any problem & above all is directing & controlling all the staffs of the floors & wards in a right direction so that the organization gains profit & can reach its ultimate goal

Young, Gary J. JD, Meterko, Mark, Desai, Kamal R , 2000. There are a growing number of efforts to compare the service quality of health care organizations on the basis of patient sssatisfaction data. Such efforts inevitably raise questions about the fairness of the comparisons. Fair comparisons presumably should not penalize (or reward) health care organizations for factors that influence satisfaction scores but are not within the control of managers or clinicians. On the basis of previous research, these factors might include the demographic characteristics of patients (e.g.-age) and the institutional characteristics (e.g.-size) of the health care organizations where care was received. The goal of this study was to examine the extent to which a patient's satisfaction scores are related to both

his/her demographic characteristics and the institutional characteristics of the health care organization where care was received. Conducted an analysis of secondary data from the Veterans Health Administration (VHA), US Department of Veterans Affairs. The database contained patient responses to self-administered satisfaction questionnaires and information about demographic institutional characteristics of the hospitals where patients received their care. Among demographic characteristics, age, health status, and race consistently had a statistically significant effect on satisfaction scores. Among the institutional characteristics, hospital size consistently had a significant effect on patient satisfaction scores. Study results can be interpreted as justifying the need to adjust patient satisfaction scores for differences in patient population among health care organizations. However, from a policy perspective, such adjustments may ultimately create a disincentive for health care organizations to customize their care. Study of patient satisfaction in SMHS hospital10, Kashmir, The study of patient satisfaction was carried out in the SMHS Hospital on the inpatients. A sample of 100 inpatients (both male & female) between 15 to 70 years age from Medical, Surgical, ENT, Ophthalmology, Dermatology, Burn Wards were included in the study. Questionnaire was Developed and responses collected from the patients of long stay directly. Data thus collected was scrutinized, analyzed and inferences were drawn: 1. Opinion about admitting & registration procedures. 2. Opinion about services in ward. 3. Opinion about nursing services. 4. Opinion about Nutrition & Dietary services. 5. General information about attitude of doctors, laboratory Services, Radiology Services, Hospital linen etc. 6. Marketing questions for e.g. willingness to recommend this Hospital to friends and relatives etc.

7. It contained also the back ground information of the patients Name, Age, duration of stay, Bed/Ward, Sex, Residence. In the outcome related to quality care, the credit points are number Of lives saved, number of patients recovered and rehabilitated. Debt points are deaths, complications due to drugs or procedural errors, hospital infections and so on. The study of patient satisfaction with the Hospital services at SMHS Hospital was carried out to elicit the patients opinion about the quality of services at SMHS Hospital and to analyze the various factors which influence patients satisfaction or dissatisfaction with the hospital services. The SMHS Hospital is 710 bedded teaching hospitals which are spread in a large share. It has many Well reputed associated hospitals like Bone & Joint Surgery Hospital, Gynecology Hospital (Lalla Ded) Pediatric Hospital, Psychiatry Hospital and Chest Diseases Hospital. It has a good laboratory back up. It has facilities of C.T. Scan and MRI. It has got well established laundry Department, CSSD Depts. and Blood Bank etc. The opinions of 100 patients were studied using the patient satisfaction questionnaire schedule. Patients response was categorized as poor, average, good and excellent. The hospital administrators should be aware of the needs and expectations of the public as per the Feedback of the public relations department and accordingly take policy decisions. These measures play a significant role in patients satisfaction. A good communication between the patient and provider of health care is vital factor for patient satisfaction. There should not develop any communication bridge between the Doctor and the patient. From the aggregate of scores of 21 questions of satisfaction questionnaire, it was found that 14.3% patients considered the services at SMHS Hospital as excellent,

69.9% considered it as good, 9.1% say that it was average and 6.7% of patients were poorly satisfied with the services. G. Cohen11, A picture of patients' satisfaction with interpersonal aspects of hospital-based care (including out-patient and accident and emergency services) was obtained from a postal survey of the general population of Lothian Region in south-east Scotland. Results were broadly in agreement with other national surveys and emphasized the high importance patients attach to being encouraged to ask questions about their treatment and having their choices explained, including the right to a second opinion. Dissatisfaction decreased markedly with age, and also showed a weaker but significant association with measures of psychosocial health and pain. Social class was associated with feeling patronized or ignored by doctors. The opposite directions of the associations of satisfaction with older age and poorer health respectively, and the necessary correlation between age and health, imply that the effects of health status and age on satisfaction should be estimated from a multivariate model. Michael P. Leiter, Phyllis Harvie and Cindy Frizzell This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses perception of their work are discussed.

Jeffrey L. Jackson, Judith Chamberlin and Kurt Kroenke, Correlates of patient satisfaction at varying points in time were assessed using a survey with 2-week and 3-month follow-up in a general medicine walk-in clinic, in USA. Five hundred adults presenting with a physical symptom, seen by one of 38 participating clinicians were surveyed and sthe following measurements were taken into account: patient symptom characteristics, symptom-related expectations, functional status (Medical Outcomes Study Short-Form Health Survey [SF-6]), mental disorders (PRIME-MD), symptom resolution, unmet expectations, satisfaction (RAND 9-item survey), visit costs and health utilization. Physician perception of difficulty (Difficult DoctorPatient Relationship Questionnaire) and Physician Belief Scale. Immediately after the visit, 260 (52%) patients were fully satisfied with their care, increasing to 59% at 2 weeks and 63% by 3 months. Patients older than 65 and those with better functional status were more likely to be satisfied. At all time points, the presence of unmet expectations markedly decreased satisfaction: immediately post-visit (OR: 0.14, 95% CI: 0.07 0.30), 2-week (OR: 0.07, 95% CI: 0.040.13) and 3-month (OR: 0.05, 95% CI: 0.030.09). Other independent variables predicting immediate after visit satisfaction included receiving an explanation of the likely cause as well as expected duration of the presenting symptom. At 2 weeks and 3 months, experiencing symptomatic improvement increased satisfaction while additional visits (actual or anticipated) for the same symptom decreased satisfaction. A lack of unmet expectations was a powerful predictor of satisfaction at all time-points. Immediately post-visit, other predictors of satisfaction reflected aspects of patient doctor communication (receiving an explanation of the symptom cause, likely duration, lack of unmet expectations), while 2-week and 3-month satisfaction reflected aspects of symptom outcome (symptom resolution, need for repeat visits, functional status). Patient satisfaction surveys need to carefully consider the sampling time frame as well as adjust for pertinent patient characteristics.

DISCUSSION:
About the hospital

Braj Mohan Birla (1895-1982) is widely regarded as one of the doyens of Indian industry. A man of many parts, he was admired not only for his contributions to the industrial productivity and technology advancement, but also for his social commitments. Despite his many preoccupations as a captain of industry, he found the time and energy to initiate pioneering projects for scientific research, education, health, Social welfare. Along with his wife, Mrs. Rukmani Devi Birla, he conceived and implemented a number of projects dedicated to the welfare of humanity at large. The Calcutta Medical Research Institute (CMRI) is one of the many expressions that speak of his concern for the sick and underprivileged.

Mr. G. P. Birla

Mrs. G. P. Birla

A Commitment: The G P / C K Birla Group, over the years has been playing an active role in nation building in many ways. The Group is known for its philanthropic works as well. Innumerable charities and trusts for the uplift of the underprivileged have been set up. Technology museums, planetary, educational institutions and hospitals testifydh"

Mrs. C. K. Birla to the G P / C K Birla Group's commitment to educating the people and serving the sick and the needy. Late B. M. Birla, the founder of The Calcutta Medical Research Institute was known as a Visionary, Philanthropist and Doyen of Indian Industry. He always found time to set-up pioneering projects like scientific research, education, health and social welfare. With the unfailing support of his wife, Mrs. Rukmani Devi Birla, he initiated numerous project dedicated to the welfare of humanity at large. Infact, he built a strong platform for a self-reliant India, The Calcutta Medical Research Institute (CMRI) was set up in 1969. An ISO 9001: 2000 certified institution, CMRI today is one of the most advanced multi-specialty and research centers in India. A landmark medical institution with more than 400 beds, CMRI has tie up with Cleveland Clinic Foundation, the No. 1 Heart Hospital in America for 10 years in a row, to provide international healthcare VISION, MISSION & COMMITMENT OF CMRI VISSION: To be the leading multispecialty healthcare & research institute in eastern India with world class standards of quality & service. MISSION: To offer the highest standards of medical treatments with utmost care compassion & commitment to all sections of the society at best value-for-money costs. COMMITMENT: To constantly upgrade our human & technological resources in order to keep pace with best global development in medical science. OBJECTIVES OF CMRI:

Mrs. Ganga Somany

Mr. C. K. Birla

Top management has established the following objectives, which are measureable and consistent with the quality policy. The objectives are as follows:

To provide efficient, effective, timely care with a human touch to our patients. To provide effective quality systems through feedback mechanism for continual improvement. To create a congenial work environment, provide can the job training and quality concepts or systems to all concerned. To provide facilities for proper disposal of waste as per the prevailing statutory and regulatory requirements.

SOME OF THE SERVICES AVAILABLE: 6 days a week OPD clinic open from 8:00 a.m to 4:00p.m. Regular Speciality clinic for medicine & surgery. Gastroenterology, Opthalmology, ENT, Dental and Maxillofacial Surgery, Plastic Surgery, Orthopedics, and Joint replacement Surgery, Neuron Sciences, Gynecology, Laproscopic, & Endoscopic Surgery and many other departments. Day care procedures carried out regularly. Critical care at CMRI has been scientifically designed and equipped with state of the art facilities. 24 hour emergency services. Round the clock NABL accredited highly modernized Pathological Laboratory with latest equipment. Health check up facilities. Eye care at its best in association with LV Prasad Eye institute, Hyderabad. Liver clinic, Diabetes clinic, Arthritis clinic, Paediatric immunization clinic. Plastic, Cosmetic and Hand reconstructive surgery. One of the most advanced Joint replacement centre in Eastern India, offering the latest method of Computer Assisted Surgery (CAS) for painful joints.

Other specialities of CMRI: Cardiology. Cardio Thoracic Surgery. Plastic Surgery. General medicine. Opthalmic. Emergency and Trauma care. Gastroenterology. Nephrology. Neurosciences. Oncology. Orthopedics. Orthodentistry. Pediatrics & Surgery. Dermatology. Clinical pathology. Endocrinology. Family Medicine.

OUTPATIENT DEPARTMENT(OPD): OPD is the First point of contact between patient and hospital staff . It is a part of the hospital with allotted physical facilities and medical and other staff in sufficient numbers, with regularly scheduled hours to provide care for patients who are not registered as inpatients. It is visited by large section of community .The human relation skill/ Public relation functions are of utmost importance in the OPD of a hospital, it is necessary the OPD staff should always be polite, cheerful, cooperative & efficient. OPD is a very important wing of hospital serving as a mirror.

FUNCTIONS OF OPD Outpatient Department is one of the department of the hospital which cares for the ambulatory patient who come for diagnosis, treatment and follow up. The role and functions of outpatient services include: 1. To provide for the community a major source of specialist diagnostic medical opinion by mixing the knowledge, skills and ability of the specialist and supported by the resources of the hospital. 2. These include not only the physical resources but also the materials and machines, which facilitates early diagnosis with support of paramedical staff and other allied health profession 3. To treat on ambulatory and domiciliary basis all cases which can be treated in the Outpatient Department. 4. To refer patients for admission to the hospital of those who need it. About 80% of total admissions are through OPD. 5. To carry out after care and medical rehabilitation, when necessary, after discharge from hospital. 6. To promote health of the individuals under care in the Outpatient Department by means of health education. 7. To train medical students, house physicians and other professional staff such as nurses and technicians with valuable and diversified clinical experiences. 8. To carry out preventive and promotive services through provision of immunization,screening, antenatal, counselling, family welfare clinics etc. 9. To compile, collate and analyze records of patients using outpatient services for epidemiological, social clinical research and for periodic assessment of clinical outcomes etc.

ABOUT OPD OF CMRI

In CMRI Hospital OPD is divided into GENERAL OPD and SPECIALITY CLINIC: GENERAL OPD General OPD is located in the GROUND FLOOR, SOUTH BLOCK of the hospital building. First entrance of the OPD Door, Two Reception counters and Help desk are located. Twentyone rooms (1 to 21) are engaged in general OPD. Management of consultants and doctors are done by the Medical Officer (M.O) who is sitting in the Room no. 1. The General opd charge for consulting is Rs. 100 for the first visit patient and issued a Health Priviledged Card and the old patient with the PRIVILEDGED CARD is Rs. 75. General OPD is the place where patients come for consultation of doctors of different fields. Around 350 patients are coming for consultation with the doctors daily. Both First come First serve and Appointment systems are served over here. Patients both directly come and take the appointment and appointments are given over phone in the front office receptions. In General OPD the patients will get the particular service that they are needed. Such as an orthopedic patient will get an orthopedic doctor, general medicine patients will get medicine doctors and so on. All the different types of treatments are done in there respective departments. Around 30 to 50 doctors visit in a schedule way. Each doctor has a particular days/dates to visit and each of them has been allocated with a particular chambers with the name plates been given on the doors. There are two receptionists, one HELP DESK reception. The billing and requisition, different types of patient queries and information are helped over here in the HELP DESK. To visit doctors chambers a computerized system has situated following which patients will visit as per their serial number by the help of machine named Q MANAGEMENT SYSTEM

REGISTRATION: Registration module is the first entry point for a patient to get the treatment in a hospital. It encompasses various activities related to registration, appointment and scheduling, payment collection and verification, recording out patients consultation, treatment details, referral details, reporting, issuing lab requests and storing the patients history. The system generates patients id numbers (PUKA) for the out patients. The (PUKA) is issued for future identification of the patients and recording their essential data. Registration is also essential for the delivery of lab reports. The system also generates referrals for clinical investigations. The investigations which are to be carried for the patients would be accessed on-line by labs. The system would help to schedule the visit of the patients by fixing the appointments with the doctors as per their availability dates. BILLING: Billing is the system where bills are generated and payments are collected against them. The system has options of both Centralized Billing and Decentralized Billing. In centralized billing, the patient clears all monetary dues to the hospital at one central payment counter. In decentralized billing the bills are generated at one place and payments are collected at the respective service counters of the department where the services are rendered. Main Features of Billing Charge slip generation Collection of payments Refund and adjustments Running bill generation Final bill generation

Invoice generation

THE NEW SPECIALITY WING

The new speciality clinic wing at CMRI houses dedicated facilities for Gastroenterology, Eye, ENT, Skin, Dental, Plastic Surgery, Orthopedics, Neuro Sciences & Laparoscopic Surgery. Each department has been equipped with stateof-the-art facilities and designed to be self contained, so all routine diagnostics and day-care procedures can be carried out within the department, for speedy treatment and maximum patient comfort.

Corporate life might bring home big bucks and glamorous lifestyle, but sometimesendless hours of work and high streets levels leave little time to think about ones health. Thats where our speciality clinic steps into make the lives of corporate executives simpler and healthy by addressing problems that are official to professionals in todays stressful scenario. CMRIs specialty clinic offers the convenience of finding all related speciality and services under one roof. With our professional nursing staff and doctors on site 24 hours a day we have the ability to cope with any level of infirmity or dependency. Our patients fest reassured by the promise that they will receive the highest standards of care and attention. Along with which a favorable staff-to-patient ratio ensure personalized care. A majority of programs at our speciality clinic include consultation, investigation and regular follow-ups with specialties.

SPECIALITY CLINIC Speciality Clinic is a place where patients come for consultation of doctors of different fields. Around 350 patients are coming for consultation with the doctors

daily. Both First come First serve and Appointment systems are served over here. Patients both directly come and take the appointment and appointments are given over phone in the front office receptions. Speciality Clinic is located in the 1st floor of the South block building of the hospital. In this clinic the patients will get the particular service that they are needed. Such as an orthopedic patient will get an orthopedic doctor, general medicine patients will get medicine doctors and so on. All the different types of treatments are done in there respective departments. Even physiotherapy and pathology are also available here. This clinic offers the special facilities which are not available in general OPDs that is why we call it speciality clinic. Uncounted number of doctors visit this clinic in a schedule way. Each doctor has a particular days/dates to visit and each of them has been allocated with a particular chambers with the name plates been given on the doors. There are two receptions, one main reception one orthopedic and one ENT reception. There are also two other receptions one in Cosmetic Clinic and another in Eye department. The billing and requisition, different types of patient queries and information are helped over here. To visit doctors chambers a computerized system has situated following which patients will visit as per their serial number by the help of machine named Q MANAGEMENT SYSTEM. Uncounted services are found at Speciality Clinic in relation to the Out Patient Department. REGISTRATION: Registration module is the first entry point for a patient to get the treatment in a hospital. It encompasses various activities related to registration, appointment and scheduling, payment collection and verification, recording out patients consultation, treatment details, referral details, reporting, issuing lab requests and storing the patients history. The system generates patients id numbers (PUKA) for the out patients. The (PUKA) is issued for future identification of the patients and recording their essential data. Registration is also essential for the delivery of lab reports. The system also generates referrals for clinical investigations. The investigations which are to be carried for the patients would be accessed on-line by labs. The

system would help to schedule the visit of the patients by fixing the appointments with the doctors as per their availability dates. BILLING: Billing is the system where bills are generated and payments are collected against them. The system has options of both Centralized Billing and Decentralized Billing. In centralized billing, the patient clears all monetary dues to the hospital at one central payment counter. In decentralized billing the bills are generated at one place and payments are collected at the respective service counters of the department where the services are rendered. Main Features of Billing Charge slip generation Collection of payments Refund and adjustments Running bill generation Final bill generation

Invoice generation

VARIOUS DEPARTMENTS OF SPECIALITY CLINIC WITH THERE REEPECTIVE ROOMS DEPARTMENTS ROOM NUMBERS:

Neuro Science E.E.G / E.M.G Room Pathology Urology Physiotherapy Dietician General Medicine General Surgery Clinical Psychologist Gastroenterology Orthopedic Pediatric

26, 27, 28 29 30 31, 32, 33 35 36 37, 38, 39, 40 41 42 43 44, 45 46, 49, 50

Obstetrician & Gynecology 47, 48 Chest & Respiratory Dental ENT Cosmetic Clinic 51 25 D 15, 16, 17, 18 Total 6 Rooms

SURVEY INSTRUMENTS:The methodology of my project was purely based on personal observations, patient survey through structured questionnaires, direct interaction with patient as well as patient party, and a thorough discussion with the executives and various other staffs . My methodology of work includes Patient survey and direct observation - Patient survey is very important as it helps to know how satisfied patients are with the quality of catering and physical amenities provided for inpatients or the accessibility of health care facilities. Questionnaire- The inpatients were subjected to a questionnaire consisting of a number of questionss Sample:- A randomly selected part of the population constitute the sample and the methodology of selecting the sample is called sampling. A characteristic of a sample is called a statistic. My project is based on stratified sampling; I have selected the feedback form and the questionnaire on this basis for analysis. Stratified random sampling:- in most situations, the parent population is not homogeneous. The population is subdivided into several strata or subpopulations which are relatively homogeneous with themselves, but between the strata there are material differences. Random samples following simple random sampling without replacement are drawn from each stratum in proportion to its size. Some prior knowledge is necessary for subdivision into strata, called stratification. In a stratified random sampling, the different sections of the populations are suitably represented through the subsamples, while in random sampling some sections may be over-represented or under-represented or may even be omitted. Hence stratified random sampling results in better estimates than simple random sampling of same size.

DESIGN OF RESEARCH:Population- Total number of patients REGISTERED between 13.06.2011 and 12.08.2011 Sample-100 (number of patients I have taken for data analysis on patient satisfaction)

RESULT
How frequently do you visit to this hospital?
17% 37% Occasionally for some specific illness 46% Frequently for any problem For the first time

FIGURE:1 Figure 1. shows the distribution of samples with regards to the frequency of visits to the hospital. As shown in the PIE CHART among the responding outpatients 17% of the patients came to the hospital for the first time. 46% of the patients came to the hospital for occasionally for some specific illness. 37% of the patients came to the hospital frequently for any problem. The above data reveals that the visit of patient to the hospital is more to a specific illness because of the famous of hospitals specific departments.

Did you take appointment before reaching to the hospital

22%

yes 78% No

FIGURE: 2 Figure 2, shows the nubmer of patients who took appointment efore reaching to the hospital. Figure shows the number of patients who took appoinment and who did not take appointment before reaching to the hospital: 22% of the customers took the appoinment before reaching to the hospital while 78% of the customers did not take appointment before reaching to the hospitals. It indicates that first come first serve is obeying in OPD only a few Consultants have the appointment system. Figure shows the number of patients who took appoinment and who did not take appointment before reaching to the hospital

Reason to choose the hospital

35 30 25 20 15 10 5 0 No. of patient

Near to Reputatio the house n of the hospital

Reffered by the family doctor 9

Availibity of physical facilities 33

Sent by relatives/ friends

Series1 Series2 25 30 13

FIGURE : 3 It is quite clear from the bar diagram that 25% of the customers came to the OPD because of near the house to the hospital. Because of the Reputation of the hospital 30% of the customers visit to the hospital. 9% of the customers were referred by the family doctors to the hospital. 33% of the customers were visited to the hospital because of the availability of physical facilities. 13% of the customers were sent by relatives/friends to the OPD of the hospital. From the above diagram it can be identified that majority of the customers choose the hospital of the availability of the physical facilities

Response and courtesy shown y the OPD staffs

40 35 30 25 20 15 10 5 0 Series1

no. of customers

Excellent 22

Good 40

Fair 20

Poor 18

FIGURE: 4 Figure 4 shows feelings of the customers over the response and courtesy shown by the OPD staffs 22% of the customers felt Excellent over the response and courtesy shown by OPD staffs 40% of the customers felt Good over the response and courtesy shown by OPD staffs 20% of the customers felt Fair over the response and courtesy shown by OPD staffs 18% of the customers felt Poor over the response and courtesy shown by OPD staffs It indicates that most of the patient felt Good to the response and courtesy of the OPD staffs.

Are you satisfied with the hospital outpatient physical facilities?

100 80 60 40 20 0

No. of patient

Sitting Drinking Toilet facility Trolley , Arrangemen water stretcher t Yes 88 85 46 90 No 12 15 54 10

FIGURE: 5 Figure 5 shows the satisfying level of physical facilities available in the OPD. Sitting arrangement and Drinking water of the OPD are satisfied by 88% and 85% respectively of the customer and less no patient i.e only 12% and 10% are not satisfying with them. It shows that most of the customers satisfy with sitting arrangement and drinking water facility. More than half (54%) of the customers were not satisfied with toilet facility of the hospital. Trolley and stretcher facilities were almost (90%) satisfied by the customers.

What do you feel about the quality service of opd?

80 70 60 50 40 30 20 10 0 good average bad no. of respondents

Reception 45 43 22

help desk 30 42 28

cleanliness 68 30 2

waiting time 32 50 18

FIGURE: 6 The Figure 6 shows the respondents feelings about the quality services of OPD The bar diagram shows that the OPD Reception is feeling good by the 45% of the customers, 43% of the customers felt average, and 22% felt bad. It indicates that the services of the Reception of the OPD is good but needs to improve in to satisfy all the customers. The above bar diagram shows 30% of customers felt good about the Help Desk of the OPD, 42% of the customers felt average and 28% of the customers felt bad. It reveals the services of the Help desk is average, nearly half of the customers have the desire to improve the help desk of the OPD. 68% of the customers felt good about the cleanliness 30% of the opd, 30% of the customers felt average, only 2% felt bad. It shows cleanliness of the opd is good. The above bar diagram shows 32% of the customers felt good about the waiting time, 50% felt average and 18% felt bad. Half of the customers felt average about the waiting time of registeration as well as consultants.

what do you think about the area of OPD?

Very congested Reasonably spacious Quite spacious

36%

16%

48%

FIGURE: 7 The bar graph clearly indicates that 16% of customers are felt the area of OPD is very congested, 48% of the customers felt Reasonably Spacious, 36% of the customers felt Quite Spacious. It reveals that most of the customer felt the OPD as reasonably spacious.

Ease of access to the medical specialists in the hospital

Excellent Good Poor Bad

16% 20%

12%

52%

FIGURE: 8 Figure 8 shows customers respondants about the ease of access of Medical Specialists in the hospital 12% of the customers felt Excellent about the ease of access of Medical Specialists 52% of the customers felt Good about the ease of access of Medical Specialists 20% of the customers felt Poor about the ease of access of Medical Specialists 16% of the customers felt Bad about the ease of access of Medical Specialists It reveals that most of the customers felt Good about the ease of access of Medical Specialists

Will you refer CMRI to your friends or relatives?

45 40 35 30 25 20 15 10 5 0 Series1 no. of respondents

Yes 42

May be 40

No 10

Never 8

FIGURE: 9 Figure 9 shows customers response about the referring of this hospital to the friends or relatives. 42% of the customers response YES and they were ready to refer the hospital to the friends or relatives. 40% of the customers response May Be, it reveals that they were neither satisfied nor dissatisfied to the OPD service . 10% of the customers response No, it shows the dissatifaction level of the OPD services. 8% of the customers response Never, it shows the highly dissatifaction level of the OPD services.

Problem identification:
1. Lack of effective and efficient manpower. 2. Lack of appointment system. 3. Lack of coordination among the OPD staffs. 4. Lack of trolley and stretcher. 5. Toilet facility inside the hospital premises.

RECOMMENDATIONS: Taking into consideration the problem faced by the customers, some actions are suggested for enhancing the patient satisfaction and improving the service quality of the OPD. These are discussed below: 1. Efficiency of the staffs: Most of the customers said that the information given by Help Desk and Enquiry Desk are not adequate and the behavior of the Receptionist is not good. The customers wants the staffs to be impartial, friendly, sympathetic and courteous under all cicumstances. To make this happen staffs should be given training in dealing with the customers. Taking into consideration the low satisfaction of customers with regards to the information given by the Help Desk and Enquiry Desk staffs, it is suggestd that some type of orientation course on facilities and services available in the hospital be given to them. This will help the mentioned staffs can render the information adequately to the needy customers. 2. Long Waiting Time: Most of the patients were suffering from the long queue in the registration counter as well as long waiting time to meet with the Doctors . In order to reduce this problem appoinment system should be adopted instead of existing first come first serve method for all the consultants. 3. Instruction Boards and Sign Boards: A large of number of customers found difficult to locate some facilities. This requires some instruction boards and sign board in the hospital which will help to directs the customers to their destination. 4. Doctors list: Most of the customers have the high demand of doctors list in the Help desk as well as Registration counter, so it is highly required to supply the doctors list from these two with the addition of Enquiry Desk.

5. Toilet facility: As the OPD toilet is outside the hospital premises, most of the visitors facing a lots uncomfortable, so it is suggested to keep the toilet facility inside the hospital premises for the OPD Visitors.

6. OPD Staffs: Comparing with the visitors and OPD staffs ratio , there is lack of manpower. In order have a smooth workflow in the OPD more staffs should be posted to the OPD of the hospital.

CONCLUSION:
Hospital is a service industry. The service of the customer ( patient) in a hospital is to be individualized( customerisation) to satisfy the individual patients unlike the case of industries. Everyone of us has visited a hospital as a patient or patients relatives or friends. Hospital represent a sizeable investment of resource. There is increasing concern to improve the quality of administration in the hospital to meet the rising expectation of people. There are new needs and new demands. Apart from the quality of staffs, equipment, the main feeling and image carried by the patients about the hospital mainly depends on human aspects the concern sympathy and the understanding shown by the hospital staffs. Many small factors add upto a feeling a high satisfaction. Since the outpatients are considered as the best marketing agent for the hospital, the hospital administration should try tomake them satisfied from the every aspects of the hospital resources. Therefore apart from the clinical studies it is aso very essentials to explore whether the physical facilities, hospital staffs services and courtesy have any influence on their satisfaction level. From the study it can be concluded that in the OPD, physical facilities, OPD staffs service and courtesy have assumed more for importance today as they contriute a crucial role to increase the satisfaction level of the customers in Outpatient Department The study also identified some of the factors which are responsible for the dissatisfaction of the patients, so effort must be made to reduce the level of dissatifaction that patient may have with the services of OPD and thereby to improve the functioning, public image and overall service of the hospital.

ANNEXURES
VISITORS SATISFACTION

I,Ebrahim Khan, a student of BHM(Bachelor in Hospital Management of NSHM COLLEGE OF MANAGEMENT AND TECHNOLOGY, KOLKATA, would like to know how you feel about the services of CMRI provided so that I can make sure; CMRI is meeting your needs. Your responses are directly responsible for improving these services. Kindly give your frank opinion; all responses will be kept confidential and anonymous.
VISITORS NAME: AGE: GENDER: MALE/FEMALE ADDRESS:

TICK THE MOST APPROPIATE ONE

1. How frequently do you visit this hospital-? For the first time Occasionally for some specific illness Frequently for any problem ( ( ( ) ) )

2. Did you take appointment before reaching to the hospital? a) Yes ( ) b) No ( )

3. Reason to choose the hospital a) Near to house b) Reputation of the hospital ( ( ) )

c) Referred by family doctor d) Availibity of physical facilities e) Sent by relatives/ friends

( ( (

) ) )

4. Response and courtesy shown by outpatient department staffs Excellent ( ) Good ( ) Fair ( ) Poor ( )

5. Are you satisfied with the hospital outpatient physical facilities? a) Sitting arrangement b) Drinking water c) Toilet facility d) Trolley, Stretcher yes ( yes yes yes ( ( ( ) ) ) ) no ( no ( no ( no ( ) ) ) )

6. What do you feel about the following quality of service? Good Reception / Registration ) Help desk ( ) Cleanliness of the opd ) Security services ) ( ( ( ) Average ( ) Bad (

) )

( (

) ) (

Waiting/Queuing system )

7. What do you think about area of outpatient department? Very congested Quite spacious ( ( ) ) Reasonably spacious ( )

8. Ease of access to the medical specialists in the hospital Excellent ( ) Good ( ) Poor ( ) Bad ( )

9. Will you refer CMRI to your friends or relatives? Yes ( ) May be ( ) No ( ) Never ( )

10. Any suggestion for improvement:

Date:

Signature:

Thank you for your kind co-operation, valuable suggestion and options.