A critical analysis of improvements in the parameters of quality of patient care

services after the implementation of NABH standards in a multispecialty

hospital versus other hospitals in Marathwada region

Dr. Ajay V. Rote: CEO and Dialectologist: United CIIGMA Hospital

Aurangabad.

1) Significance of the problem:

Hospital industry is now going through a turbulent phase. Various pressures and stiff
competition has made it mandatory to improve the quality of patient care in the
hospitals of all magnitudes.

There are multiple barriers to provide good quality patient care services.

1.2. Statement of problem

"The three biggest challenges India faces in the healthcare sector are: the paucity of
hospital beds for people (1 bed for 1050 people, as against 1 bed for 250 people in the
US); the lack of skilled health human resources; and the rise in both infectious and
non-communicable diseases,"

One of the ways to improve quality of patient care is to implement various standards
like ISO 9000, ISO 14000, NABH standards and JCI standards.

Out of them NABH standards are gaining importance since they are govt. agency of
accreditation (Quality Council of India).

NABH standards are detailed, stringent and validated. Hospitals who have already

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been accredited by NABH have a record of good quality patient care.

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1.3. Explanation of the concept

Good quality patient care includes medical services, nursing services, patient safety,
allied services etc. All these aspects are addressed by the NABH standards
.One more important area is the documentation which is a statutory
requirement.

About NABH accreditation:

Hospital Accreditation Hospital Accreditation is a public recognition by a National

Healthcare Accreditation Body, of the achievement of accreditation standards by a
Healthcare Organization, demonstrated through an independent external peer
assessment of that organization’s level of performance in relation to the standards.
In India, Heath System currently operates within an environment of rapid social,
economical and technical changes. Such changes raise the concern for the quality of
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health car e. Hospital is an integral part of health care system. Accreditation would
be the single most important approach for improving the quality of hospitals.
Accreditation is an incentive to improve capacity of national hospitals to provide
quality of care. National accreditation system for hospitals ensure that hospitals/
Health Care Organization (HCO), whether public or private, national or expatriate,
play there expected roles in national health system. Confidence in accreditation is
obtained by a transparent system of control over the accredited hospital and an
assurance given by the accreditation body that the accredited hospital constantly
fulfills the accreditation criteria.

Benefits of Accreditation
Benefits for Patients

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Patients are the biggest beneficiary among all the stakeholders. Accreditation results
in high quality of care and patient safety. The patients are serviced by credential
medical staff. Right s of patients are respected and protected. Patients’ satisfaction is
regularly evaluated.

Benefits for HCO

Accreditation to a HCO stimulates continuous improvement. It enables hospital in

demonstrating commitment to quality care. It raises community confidence in the
services provided by the hospital. It also provides opportunity to healthcare unit to
benchmark with the best.

Benefits for Hospital Staff

The staff in an accredited HCO is satisfied lot as it provides for continuous learning,
good working environment, leadership and above all ownership of clinical
processes. It improves overall professional development of Clinicians and Para
Medical Staff and provides leadership for quality improvement with medicine and
nursing.

Benefits to paying and regulatory bodies

Finally, accreditation provides an objective system of empanelment by insurance and

other third parties. Accreditation provides access to reliable and certified information
on facilities, infrastructure and level of care.

About NABH

National Accreditation Board for Hospital s and Healthcare Providers (NABH) is a

constituent board of Quality Council of India (QCI), set up to establish and operate
accreditation programme for health care organizations. NABH has been established
with the objective of enhancing health system & promoting continuous quality

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improvement and patient safety. The board while being supported by all
stakeholders, including industry, consumers, government, has full functional
autonomy in its operation. NABH provides accreditation to hospitals in a non-
discriminatory manner regardless of their ownership, legal status, size and degree of
independence. ISQua is an international body which gr ants approval to
Accreditation Bodies in the area of healthcare as mark of equivalence

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of accreditation program of member countries. NABH is a member of ISQua
Accreditation Council.

NABH is an Institutional Member as we ll as a member of the Accreditation Council

of the International Society for Quality in HealthCare (ISQua). NABH is the founder
member of proposed Asian Society for Quality in Healthcare (ASQua) being
registered in Malaysia. NABH is a member of International Steering Committee of
WHO Collaborating Centre for Patient Safety as a nominee of ISQua Accreditation
Council.

NABH Standards for Hospitals

NABH Standards for hospitals, 3rd Edition, November 2011 has been released. This
standard has been accredited by International Society for Quality in Healthcare
(ISQua). The approval of ISQua authenticates that NABH standards are in
consonance with the global benchmarks set by ISQua. The hospitals accredited by
NABH will have international recognition. This will provide boost to medical
tourism.

The standards provide framework for quality assurance and quality improvement for
hospitals. The standards focus on patient safety and quality of care. The standards
call for continuous monitoring of sentinel events and comprehensive corrective
action plan leading to building of quality culture at all levels and across all the
functions.

The 10 chapters in the standard reflect two major aspects of healthcare delivery
I.e. patient centered functions (chapter 1-5) and healthcare organization centered
functions (chapter 6-10).
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Outline of NABH Standards:

1. Access, Assessment and Continuity of Care (AAC).

2. Care of Patients (COP).

Patient

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Centered Standards

3. Management of Medication (MOM).

4. Patient Rights and Education (PRE).

5. Hospital Infection Control (HIC).

Organization Centered Standards

6. Continuous Quality Improvement (CQI).

7. Responsibility of Management (ROM)

8. Facility Management and Safety (FMS).

9. Human Resource Management (HRM).

10. Information Management System (IMS).

SERVQUAL technique:

Service providers want to know what customers (internal or external) care

about. Service quality is a good guess. Price, and to a minor degree product

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quality, also count.

But for service providers, customers care most about service quality. Check the
research. Statistically valid research. Of course, providers can always ask
customers. But lacking the money, time and skills, why not look to the leading
research for that understanding?

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Even though service quality research has progressed since 1990 when first
published, this book is still the fountainhead. I referred to it in Gap 5 & Roswell,
and I’m using it here again.

The 5 Dimensions Defined

After extensive research, Zeithaml, Parasuraman and Berry found five

dimensions customers use when evaluating service quality. They named their
survey instrument SERVQUAL.

In other words, if providers get these dimensions right, customers will hand
over the keys to their loyalty. Because they’ll have received service excellence.
According to what’s important to them.

The five SERVQUAL dimensions are:

 TANGIBLES-Appearance of physical facilities, equipment, personnel,

and communication materials
 RELIABILITY-Ability to perform the promised service
dependably and accurately
 RESPONSIVENESS-Willingness to help customers and provide prompt service
 ASSURANCE-Knowledge and courtesy of employees and their
ability to convey trust and confidence
 EMPATHY-Caring, individualized attention the firm provides its customers

Not All Dimensions Are Equal

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All dimensions are important to customers, but some more than others.

Service providers need to know which are which to avoid majoring in minors. At
the same time they can’t focus on only one dimension and let the others suffer.

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SERVQUAL research showed dimensions’ importance to each other by
asking customers to assign 100 points across all five dimensions.

Here’s their importance to customers.

The 5 Service Dimensions Customers Care About

What’s this mean for service providers?

#1 Just Do It

RELIABILITY: Do what you say you’re going to do when you said you were
going to do it.
Customers want to count on their providers. They value that reliability.
Don’t providers yearn to find out what customers value? This is it.It’s three
times more important to be reliable than have shiny new equipment or
flashy uniforms.

Doesn’t mean you can have ragged uniforms and only be reliable. Service
providers have to do both. But providers first and best efforts are better spent
making service reliable.

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Whether it’s periodics on schedule, on-site response within Service
Level Agreements (SLAs), or Work Orders completed on time.

#2 Do It Now

RESPONSIVENESS: Respond quickly, promptly, rapidly, immediately, instantly.

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Waiting a day to return a call or email doesn’t make it. Even if customers are
chronically slow in getting back to providers, responsiveness is more than 1/5th of
their service quality assessment.

Service providers benefit by establishing internal SLAs for things like returning
phone calls, emails and responding on-site. Whether it’s 30 minutes, 4 hours, or 24
hours, it’s important customers feel providers are responsive to their requests. Not
just emergencies, but everyday responses too.

REPORTING RESPONSIVENESS
Call centers typically track caller wait times. Service providers can track response
times. And their attainment of SLAs or other Key Performance Indicators (KPIs) of
responsiveness. This is great performance data to present to customers in
Departmental Performance Reviews.

#3 Know What Your Doing

ASSURANCE: Service providers are expected to be the experts of the service

they’re delivering. It’s a given.
SERVQUAL research showed it’s important to communicate that expertise to
customers. If a service provider is highly skilled, but customers don’t see that,
their confidence in that provider will be lower. And their assessment of that
provider’s service quality will be lower.

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RAISE CUSTOMER AWARENESS OF YOUR COMPETENCIES
Service providers must communicate their expertise and competencies – before they
do the work. This can be done in many ways that are repeatedly seen by customers,
such as:

 Display industry certifications on patches, badges or buttons worn

by employees

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 Include certification logos on emails, letters & reports
 Put certifications into posters, newsletters & handouts
By communicating competencies, providers can help manage customer
expectations. And influence their service quality assessment in advance.

#4 Care about Customers as much as the Service

EMPATHY: Services can be performed completely to specifications. Yet

customers may not feel provider employees care about them during delivery. And
this hurts customers’ assessments of providers’ service quality.
For example, a day porter efficiently cleans up a spill in a lobby. However,
during the clean up doesn’t smile, make eye contact, or ask the customer if
there is anything else they could do for them. In this hypothetical the provider’s
service was performed fully. But the customer didn’t feel the provider employee
cared. And it’s not necessarily the employees fault. They may not know how
they’re being judged. They may be overwhelmed, inadequately trained, or
disinterested.

SERVICE DELIVERY MATTERS

Providers’ service delivery can be as important as how it was done. Provider
employees should be trained how to interact with customers and their end- users.
Even a brief session during initial orientation helps. Anything to help them
understand their impact on customers’ assessment of service quality.

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#5 Look Sharp

TANGIBLES: Even though this is the least important dimension, appearance

matters. Just not as much as the other dimensions.

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Service providers will still want to make certain their employees appearance,
uniforms, equipment, and work areas on-site (closets, service offices, etc.) look
good. The danger is for providers to make everything look sharp, and then fall short
on RELIABILITY or RESPONSIVENESS.

1.4. Scope and Limitations

The purpose of this study is to critically analyze the impact of implementation of

NABH standards on the actual quality of patient care.

This shall be considered from two perspectives

1) From patients and their relatives point of view

2) From management point of view (from staff point of view)

This research is based on improvement of patient quality services in a multispecialty

hospital after it has decided to implement NABH standard.

1.5. Objectives of the study

1) To study improvement in patient care quality parameters

2) To study cost-effectiveness of the project

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 3) To study long term sustainability of the process.
4) To study the need of awareness about quality standards
5) To critically analyze the comparative efficacy of implementation of
standards
6) To study the barriers of implementation of standards and measures to
improve them.

1.6. Hypothesis or assumptions

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1) Implementation of NABH standards is a hospital setting brings about
significant improvement in the quality of patient care and leads to improved
patient satisfaction and delight.

2) Patients and relatives of patients are aware of the standardization process in

the hospitals and choose hospitals based on those inputs.

3) Implementation of the NABH standards brings about improvements in the

motivational levels of the staff members.

1.7. Research Methods

1) Questionnaires shall be utilized for assessing the level of patient and staff
satisfaction before and after the implementation of NABH standards in United
CIIGMA hospital and 4 other hospitals in Aurangabad region .Since there will
be constraints of time and efforts, total 4 hospitals from Aurangabad are
selected as representative of hospitals all over Marathwada region.

2) The list of hospitals

1) CIIGMA Hospital
2) Kodlikeri Hospital
3) United CIIGMA Hospital
4) Amrut Hospital
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 3) The questionnaire used shall be the TREAT questionnaire for studying
patient satisfaction
4) Separate questionnaire shall be used for assessing the staff satisfaction.

1.7.1 Samples

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 20 patients from all the 4 hospitals and 10 staff members (each) from all the
hospitals shall be included.

HEALTHCARE INDUSTRY 2020:

The COVID-19 era: A new learning curve for global healthcare

If the healthcare industry were a patient, 2020 has been a dramatic rush of ICU visits
and checkups so far, all because of a pandemic that has shaken the entire world.

The Novel Coronavirus that caused the COVID-19 disease unleashed a catastrophe of
unprecedented proportions. Healthcare has borne the impact of COVID-19 more than
most other industries.

Three key phases of the healthcare industry

 The past

The healthcare domain was ill-prepared to tackle a public health emergency at

this scale. The existing state of affairs meant that many industry practices were
not robust enough in terms of policies, infrastructure, risk management, sourcing,
procurement, or supply chain management.

The lack of acknowledgment of how global health risks can affect business made the

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industry further vulnerable. China, the epicentre1 of the global healthcare supply chain,
medical equipment and drug manufacturing, was also the infectious virus’s place of
origin. This made for a bad combination and led to the disruption of a crucial supply
chain equilibrium.

 The present

Healthcare segments across nations are struggling to cope with the massive
imbalance in supply and demand, among other SCM challenges. Global medical
supply chains are in a weak state, given manufacturing plant shutdowns that have
led to a shortage of drugs, testing kits, and other essential items. Pharmaceutical
companies are trying to make peace with this new reality and are looking for
solutions that mitigate and eventually prevent recurrences of the COVID-19
outbreak. Governments, hospitals, investors, pharma companies, and related
businesses are all working toward fast-tracking clinical trials.

 The future

As healthcare spend for COVID-19 increases exponentially, companies that

conduct research, produce test kits, develop potential vaccines, and manufacture
or supply medical equipment are likely to benefit the most. The reason is clear -
governments across the world will invest in not only damage control, but also in
the prevention of any potential resurgence of the pandemic. This also means that
companies other than those manufacturing PPE (Personal Protective Equipment)
or infrastructure support that is not directly connected to COVID-19 would face
disruptions in business.
Innovative thinking and preventive measures will become the norm in healthcare.
Here’s a look at the implications of COVID-19 in the healthcare industry.

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Implications of COVID-19 in the healthcare industry-

- Short-term implications
The next three to six months will be extremely crucial for the effective management of
the pandemic across geographies. The pressure on hospital infrastructure is going to be
huge, in spite of entering what is the fourth month since the virus first made the
headlines.
Non-urgent surgeries will decline, and along with it, the demand for related treatment
and equipment will drop. Businesses can expect challenges like payment delays due to
the lack of liquidity and inconsistencies in the demand-supply ratio.

- Medium-term implications
Increased investments in primary care and intensive care are perhaps the only silver
lining in these dark times. For public payers and healthcare

providers, the financing pressure is going to be more than ever before. Private payers
in certain locations might be looking at solvency problems and related issues.
However, things will get back on track in terms of the return of on-ground sales reps
and teams to hospitals as the outbreak flattens out in the next six to twelve months.

- Long-term implications
Governments and organizations need to reprioritize long-term healthcare plans at a
macro level. The post-COVID-19 era will see healthcare adopt relatively new concepts
like telehealth, remote care, and other types of digital healthcare solutions.
It’s likely that we will see a seismic wave of groundbreaking digital solutions for
enhanced patient care in the near future. The focus for healthcare businesses, a year
after COVID-19, will also need to be on reassessing pricing models and looking for
alternative options (value-based pricing, for instance).
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How has this impacted healthcare companies in India?

While public policy measures have been implemented to contain the spread of COVID-
19, the measures have resulted in significant operational disruption for many
companies including those in the Indian healthcare industry. Staff quarantine, supply-
chain failures, and sudden reductions in customer demand have generated serious
complications for companies across a wider range of sectors than initially anticipated. For
most, the revenue lost in this period represents a permanent loss and has put sudden,
unanticipated pressure on working capital lines and liquidity.

Despite the current crisis being a healthcare issue, the private healthcare system in the
country continues to reel under the negative impact of COVID-19. There has been a
significant drop in both in-patient and out-patient footfall for private hospital chains—be
it a single speciality, multi-speciality, tertiary-care hospitals or even diagnostics
businesses, during this lockdown.

This sudden decline in business has had an immediate effect on hospitals’ ability to sustain
fixed costs. The inability of new centres/hospitals to start generating cash, debt repayment
obligations, decreased levels of medical tourism, and increased scheme revenues (which
represents credit revenue) are some of the many factors impacting cash flow.

How are healthcare companies facing these challenges?

In an effort to sustain these challenges, hospitals have begun implementing measures to

reduce or defer costs, with a view to reserve cash in hand. In the context of consumables,
supplier consolidation for better rates and renegotiation of credit periods for pharmacy

26 | P a g e
and consumables are some measures instituted by hospitals to conserve their cash flow.
On the personnel cost front, changes are being made to doctor-engagement models
by moving doctors to fully variable models based on the revenue they generate. In the
case of other staff/employees, increments and variable pay have been calibrated while
evaluating shared services, in an attempt to further reduce overall employee costs. With
respect to other fixed costs, initiatives such as the renegotiation of rent rates, vendor
consolidation (for outsourced services such as housekeeping and security services), and
deferral or staggered payment of annual maintenance costs have been administered. Most
discretionary spends such as advertisement and sales promotions have
largely been ceased.

In such circumstances, there is also an increased focus on monitoring daily, weekly, and
monthly cash flows relative to the budgets. Any deviations from the budget are carefully
monitored to assess the impact on the cash flow. Revenue and other KPIs are also being
monitored with a sharp focus. Hospitals may also have to get used to “the new normal”
with increased hygiene measures and staff safety, resulting in costlier procedures.

Keeping healthcare productive and healthy with CIIGMA GROUP

We understand the vulnerabilities in medical supply chains and believe that flexible
digital technologies and medical services will result in good acheivements.

Our end-to-end healthcare services and integrated medical solutions have a track record
of an annual processing number of health plan memberships. Our teams continue to
ensure dedicated support for healthcare companies during these difficult times.

Service Quality in the Health Sector

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Health services are unique in identifying new challenges. Academics, practitioners, policy
makers, and decision makers are still in the process of identifying valid tools to assess
service quality.

The health care facility can be divided into 2 quality dimensions: technical quality and
functional quality. Technical quality in health care is mainly related to technical
correctness and medical analyses and techniques, whereas functional quality refers to how
the health care service is provided to patients. Furthermore, technical quality is about what
the customers get, whereas functional quality is about how they get it. Ware and Snyder
state that although technical quality has high significance among patients, most patients
do not have the information to assess efficiently the quality of the investigative and
relaxing involvement procedure or material needed. Maximum patients cannot
discriminate among the caring presentation and the curing presentation of doctors.

Through a system approach, quality standards are formulated according to needs, but most
of them focus on the technical delivery of services and ignore the customer’s point of
view. This technical perspective focuses on the accuracy of diagnosis, success of
procedures, and satisfaction of professional requirements at the facility. As customers,
patients describe the quality of services delivered in a limited way because they have
insufficient knowledge about technical aspects of the service. Nonetheless, based on
customers’ perceptions, expectations, and observations, both technical and nontechnical
aspects of services can be evaluated. Patients’ feelings are crucial to improving
services. Patients’ arguments are important, in line with the “marketing concept,” which
focuses on ensuring customer satisfaction and considering that patients are neither right
nor wrong but satisfied.

Service quality and patient satisfaction have a significant impact in health care. Patients’
perceptions of hospital facilities affect the image and cost-effectiveness of the

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hospital. Perceived service quality also determines patients’ loyalty and word-of-mouth
behavior.

Due to increased patient expectations, health care service workers have been encouraged
to recognize the factors that are essential to expanding health care services, which can
lead to patient satisfaction and allow health care services to decrease the time and money
they spend

NABH ACCREDATION AND QUALITY STANDARDS

NABH Accredited Hospital.

NABH is an institutional member of the International Society for Quality in Health Care
(ISQUA). ISQUA is an international body which grants approval to Accreditation Bodies
in the area of healthcare as mark of equivalence of accreditation program of member
countries. .

Marathwada’s First Nationally Accredited Hospital.

Adhering to highest quality standards, maintaining highly efficient healthcare operations
and providing treatment of international standards has resulted in the hospital getting the
highest certification. Patients will be the biggest beneficiaries of this accreditation as they
and their family members will be receiving healthcare of highest standards.
United CIIGMA hospital to not only heal and serve Indian patients but also International
patients in need of selfless and personalized healthcare.
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Hospital Accreditation Programme

Hospital Accreditation: The hospital accreditation program was started in the year 2005.
It is the flagship program for NABH. This program was started with an intent to improve
healthcare quality and patient safety at public and private hospitals, has subsequently
grown to greater heights, with the standards being recognized internationally at par with
other global healthcare accreditation standards and accredited by ISQua (International
Society for Quality Assurance in Healthcare). The accreditation standards for hospitals
focuses on patient safety and quality of the delivery of services by the hospitals in a
changing healthcare environment.

Benefits of Accreditation
a) Patients are the biggest beneficiary as implementation of accreditation standards
ensures Patient safety, commitment to quality care resulting in good clinical outcomes.

b) Improves patient satisfaction and increases community confidence as services are

provided by credentialed medical staff.
c) Accreditation status provides good marketing advantage in the competitive healthcare.
d) The HCO standards has been accredited by ISQua giving the accreditation an
international recognition which will boost medical tourism
e) Accreditation provides an objective system of empanelment by insurance and other
third parties

CIIGMA Quality Policy

 To provide effective healthcare with efficiency and compassion.

 To conduct all our activites in an environment-friendly manner.
 To reduce risks and hazards to the minimun extent possible by establishing a culture
of safety with quality.
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  To strive towards continual improvement in the services offered & in our practices,
by implementing accepted standard techniques and procedures, participating in
research and evaluation that leads to such innovations, sharing out knowledee with
others, and by demonstrating conformance to emerging norms.
CIIGMA Quality Objective

 To provide high quality care according to the health needs of the catchment
population.
 To facilitate patient satisfaction by service and ensuring the dignity & rights of
patients and other stakeholders.
 To provide a safe and conductive work environment for staff.
 To ensure accountable, consultative and transparent management process.
 To provide a safe and conductive work environment for staff.
 To ensure accountable, consultative, and transparent management process.
 To provide basic and continuing education for staff

Quality Assurance And Accreditation of Hospital

Quality assurance is maintained within the hospital with the help of standards which are
prepared according to the Hospital design, culture and other requirements. Standard
Operating Procedures are set up and are strictly followed to achieve the set standards.
Regular audits are conducted in the hospital to monitor quality of functioning of various
departments. Both internal and external audits are conducted within the hospital. Internal
Quality Audit is a powerful tool for any business to measure the effectiveness of the
Quality Management System. It is also a good management tool that can be used to review
processes and identify any weakness, risks and areas of improvement.
United CIIGMA Hospital is committed to provide quality service. To achieve this
objective, it has applied for coveted NABH accreditation from Quality Council of India

31 | P a g e
(QCI). The National Accreditation Board Hospital & Healthcare Providers (NABH) is
accreditation body, which sets and address standards for the healthcare provider’s ‘level
of performance’ in key functional areas such as patient rights, patient treatment, and
infection control! NABH standards lead us to improved patient care, safety and continuous
quality improvement. This also strengthens the confidence of patients, third party and
insurance agencies, providing us a competitive edge.
Facilities Layout

 Basement:

Security, Medical Records, Maintenance, Housekeeping

 Ground Floor:

Casualty, Radiology, Sample Collection, Main Reception, Billing, OPD

(Cardiology, CVTS, Neurology), TMT, 2D Echo, Neuro LAB, Pharmacy
 First Floor:

Endoscopy, Nuclear Medicine, First Floor IPD, OPD (Surgery, Gastroenterology,

Diabetology, ENT, Pulmonology, Orthopedic, Pain Clinic, PFT Room,
Gynecology
 Second Floor:

CCU, Cath Lab, HDV, OT Complex

 Service Floor:

Board Room, Training Hall, Insurance, CSSD, Linen, Server Room, IT, Billing,
MRD, Medical Admin, Nursing, CCTV, HVAC, CEO Cabins, Stores, Purchase,
Maintenance, Housekeeping, HR, Biomedical, Canteen
 Fourth Floor:

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 ICU, IPD, Pharmacy
 Fifth Floor:

Obstetrics, Gynecology & IVF, IPD, NICU, Labour Room, Gynec. OT

 Sixth Floor:

General Ward, Research, Biosafety Cabinet, Super Deluxe room, Dialysis,

Pathology, Urology, Nephrology, Physiotherapy, Dietetics, Dental, Dermatology,
Ophthalmology.

INTRODUCTION

Health workers: A proven return on investment.” #WORKFORCE 2030 and the

sustainable development goals, is World Health Organization’s global strategy for
human they include health service providers, health management and
support workers. The former includes professional and associate professionals as well
as other less qualified health cadres engaged in the delivery of health services,
whether“personal or non-personal, while the latter are people who help the health
system function but do not provide health services directly to the population. Hospitals
and healthcare services are vital components of any well-ordered and humane society,
and are indisputably the recipients of societal resources. According to the World Health
Organization (WHO), Hospitals are health care institutions that have an organized
medical and other professional staff, and inpatient facilities, and deliver services 24
hours per day, 7 days per week. They offer a varying range of acute, convalescent and
terminal care using diagnostic and curative services. That hospitals should be places of
safety, not only for patients but also for the staff and for the general public, is of the
greatest importance. Broadly healthcare delivery is evaluated by three categories of
measurement namely, structure, process and outcome (Donabedian, 1980). The

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 structure of the hospitals is assessed by the human and material resources available in
each hospital. Process denotes the transactions between patients and providers.

1. PREAMPLE There is a worldwide effort aimed atincreasing the performances of health

systems in the recent years. The attempts generally address financing, stewardship,
creating resources and providing services, which are the main functions of the health
systems. The power in the centre of the system is the human resources and studies have
revealed that the work carried out to improve the human resources effect the performance
of the health system's main functions in a positive way

(1). Human resources in health care are defined as “the heart of the health systems of the
countries”, “the most effective part of the health care services” and “a critical component
of the health policies”

(2). According to the World Health Office, health care professionals are the people who
protect and improve the health level of the society

(3). Health care professionals are the most important resources in health care and health
care professionals primarily determine the quality of the services provided at health
institutions, the applicability and sustainability of the health policies. Because of the
importance it has in terms of health systems, currently there is more concentration on the
discussions and policy studies regarding health care professionals at international level

(4). In this respect, with the implementation of Health Transformation Program in 2003,
the Ministry of Health declared that it was planning to form a “workforce equipped with
knowledge and skills, and working with high motivation” in the health system and started
a process to take steps towards finding solutions to problems regarding human resources
in health care, which have existed for a long time. Within the frame of this process,
Ministry of Health of the Turkish Republic decided to determine the commitment to their

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institutions, job satisfaction, and motivation levels of health professionals and the
variables affecting these by carrying out a countrywide large scale and detailed survey
called the “Healthcare Employee Satisfaction Survey” in late 2008. Because, when it is
considered either from the individual or social point of view, health care professionals
have undertaken important obligations in increasing the health status of the society and
their fulfilling this obligation in the best way depends on their job satisfactions,
commitments, and motivations

(5). The purpose of the Healthcare Employee Satisfaction Survey is to determine the job
satisfaction, motivation and commitment levels of the health care professionals and their
views on Health Transformation Program, in addition the factors affecting these
mentioned 2 features. The results of the survey fulfilled the defined purposes of the study.
The detailed data obtained provide the needed high quality information for policy making
and provide intermediate input regarding Health Transformation Program and other
applications and policies.

2. DEFINITIONS IN THE SCOPE OF THE SURVEY

Definitions related to the dependent and independent variables within the scope of the
survey take place in this part of the report.

Job Satisfaction: Job satisfaction is the contentment that the employees get from the work
they do and from the physical environment and the “atmosphere” existing in the
environment. Because the job satisfaction is an emotional notion, its perception differs
from person to person

(6). Motivation: The psychological feature which alerts one for acting through an intended
purpose is called as “motivation”

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(7). The motivation notion, which takes place among the job manners of the health care
professionals, means that people act and make effort with their own wills in order to obtain
a certain purpose

(8). Commitment: Commitment can be defined as the strong feeling of an individual as a

part of the organization and defining himself / herself in that way

(9). Health Transformation Program Questions: In relation with the Health

Transformation Program, additional payments based on performance, Family medicine
practice, patient satisfaction issues have been tried to be examined separately. Other
Health Transformation Program Components: Forming qualified health care personnel
subjects such as full time law, patient referral chain system, making the hospitals
autonomous, wise utilization of drugs, income, number and wages of health care
professionals, etc. have been tried to be discussed under this subject. Profession: This
survey attempted to include all the health care personnel serving at the health institutions.

On the other hand, healthcare worker job satisfaction is a very important parameter that
influences productivity as well as quality of work. This complex phenomenon is an
attitude towards one’s job that has an impact not only on motivation, but also on career,
health and relations with co-workers. Healthcare worker job satisfaction has a great impact
on quality, effectiveness, and commitment to work and at the same time on healthcare
costs. Many different studies have shown that there is a great number of factors which can
have an impact on healthcare worker job satisfaction, such as: gender, age, level of
education, work experience, the way in which work is organized, working conditions, and
many others.

This study researches the impact of healthcare worker satisfaction on patient satisfaction.
Furthermore, the aim of the study is to assess which are the parameters with both the
greatest impact on healthcare worker job satisfaction and on patient satisfaction with
services. Defining these relations and factors affecting the quality of work and services
36 | P a g e
will create a basis for the management of important factors which affect both: healthcare
worker satisfaction and patient satisfaction too.

Description of data gathering:

Outcomes are usually evaluated by the standardized mortality ratio which is the ratio of
the observed to expected mortality rate in each hospital. In order to set standards and add
analytical, counseling and self-improvement dimensions to it, accreditation is needed for
any institute. Hospital accreditation has been defined as “A self-assessment and external
peer assessment process used by health care organizations to accurately assess their level
of performance in relation to established standards and to implement ways to continuously
improve”. NABH, an acronym for National Accreditation Board for Hospitals &
Healthcare Providers, is a constituent board of Quality Council of India, set up to establish
and operate accreditation program for healthcare organizations. Its standards have been
accredited by International Society for Quality in healthcare (ISQua), the apex body
accrediting the accreditator, hence making NABH accreditation at par with the worlds
most leading hospital accreditation. The first edition of NABH standards was released in
2006 and after that the standards have been revised every 3 years. Currently the 5th edition
of standards, released in14th April 2020 is in use. There are approximately 196312
hospitals in India, among which only 458 (that is 0.23%) are accredited by NABH. The
NABH Accreditation is manpower extensive and dependent, along with the better patient
care it also has large impact on the human resource working in an accredited organization.
The study was conducted to understand from the perspective of healthcare professional
the effect of NABH accreditation on hospital services, behavior of healthcare
professionals before and after accreditation and level of job satisfaction and patient
satisfaction after accreditation.

A survey was conducted in the hospitals of Marathwada region wherein 4 hospitals which
implant the quality standards given by National Accreditation Board for Hospital and

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Healthcare Providers (NABH). The survey was conducted in Nov-Dec 2020. The main
objective behind conducting this survey was to know the difference in satisfactory ratio
of staff and patients after the implementation of quality standards by NABH than it was
before implementing the same.

The 4 hospitals selected are as follows :-

1. UNITED CIIGMA HOSPITAL

2. CIIGMA HOSPITAL

3. KODLIKERI HOSPITAL

4. AMRUT BAL RUGNALAYA

STAFF SATISFACTION:

Job satisfaction among health-care professionals acquires significance for the purpose of
maximization of human resource potential. This article is aimed at emphasizing
importance of studying various aspects of job satisfaction in health-care organizations.

There has been considerable emphasis on human resource management in recent past. In
an organization, productivity and quality of service depend entirely on the organization's
ability to manage the human resource. Human resource management encompasses
organizational development, human resource development, and industrial relations.
Human resource functions in an organization include everything that has to do with
‘people’, i.e., their recruitment, induction, retention, welfare, appraisal, growth, training,
skill development, attitudinal-orientation, compensation, motivation, industrial relation
and retirement, etc.

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All organizations operate within an internal and an external environment. Technology
provides resources; structure defines the formal relationship of people in organization and
both internal and external environment as well as influences the attitudes of people.

How to get ‘people’ involved and motivated for excellence at work? The key to effective
work performance is in understanding what domains of work are important for job
satisfaction among clinicians.

The job satisfaction of an employee is a topic that has received considerable attention by
researchers and managers alike. The most important information to have regarding an
employee in an organization is a validated measure of his or her level of job satisfaction
(Roznowski and Hulin 1992). Thus, it is fruitful to say that managers, supervisors, human
resource specialists, employees, and citizens in general are concerned with ways of
improving job satisfaction.

The foundation of job satisfaction theory was introduced by Maslow with a five-stage
hierarchy of human needs, now recognized as the deprivation/gratification proposition.
However, much of the job satisfaction research has focused on employees in the private
sector.

The motivation to investigate the degree of job satisfaction arises from the fact that a better
understanding of employee satisfaction is desirable to achieve a higher level of motivation
that is directly associated with patient satisfaction.

Offering the highest quality of health-care services possible to as many people who need
them, within a given environment of social, material, financial, and human resources is
the main goal of health-care systems and of every single health-care organization or unit
within an organization. Achieving this goal requires a committed and high-quality
workforce in health-care organizations. Due to the anticipated significant impact of human
resources management on the quality of services and its increasing coverage in formalized

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quality systems, it is essential that a health-care establishment pays attention to the quality
of human resources in early stages of development of a quality system. Attending to job
satisfaction of staff is then a fundamental component of human resources quality. In
particular, many researchers have demonstrated strong positive correlations between job
satisfaction of medical staff and patient satisfaction with the services in these health-care
settings.

Organizations’ efficiency depends to a large extent on the morale of its employee.

Behavioural and social science research suggests that job satisfaction and job performance
are correlated. Job satisfaction and morale among medical practitioners is a current
concern worldwide.

Poor job satisfaction leads to increased physician turnover, adversely affecting medical
care job satisfaction. Consequently, by creating an environment that promotes job
satisfaction, a health-care manager can develop employees who are motivated, productive,
and fulfilled. This in turn will contribute to higher quality patient care and patient
satisfaction.

JOB SATISFACTION: DEFINITIONS, FACETS, AND IMPORTANCE

Schermerhorn define job satisfaction as the degree to which individuals feel positive or
negative about their jobs. It is an attitude or emotional response to one's tasks as well as
to the physical and social conditions of the workplace. Job satisfaction is motivational and
leads to positive employment relationships and high levels of individual job performance.

According to Locke and Hanne, the definition could be ‘the pleasant emotional state
which flows from someone realizing his or her motives (values) in the work’. ‘Job
satisfaction is simply how people feel about their jobs and different aspects of their jobs.
It is the extent to which people like (satisfaction) or dislike (dissatisfaction) their job. As
it is generally assessed, job satisfaction is an attitudinal variable’.

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Job satisfaction can be considered as a global feeling about the job or as a related
constellation of attitudes about various aspects or facets of the job. The global approach
and the facet approach can be used to get a complete picture of employees’ job
satisfaction. According to Werner, job satisfaction has five facets, which can be put
together to measure a job descriptive index (JDI) as follows:

 The work itself – responsibility, interest, and growth

 Quality of supervision – technical help and social support

 Relationships with co-workers – social harmony and respect

 Promotion opportunities – chances for further advancement

 Pay – adequacy of pay and perceived equity vis-à-vis others

Survey of 10 staff members from each hospital was conducted by providing them a
questionnaire which covered following parameters: -

1. Job Security
2. Performance Appraisal system and outcome
3. Hospital employee policy
4. Fairness of the way treats to the employee
5. Downward and upward communication
6. Current job and designation
7. Involving in planning and execution of work
8. Facilities provided
9. Satisfaction level with salary
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 10. Career Growth
11. Training and development program provided
12. Working environment
13. Leave policy
14. Overall satisfaction level

This was all done to know the overall satisfaction of the staff with respect to the facilities
that were provided after the implementation of quality standards by NABH.

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The data collected is represented as follows:-

Table no. 1:- Staff satisfaction response in count.

VERY PARTIALLY DIS- VERY DIS-

PARAMETERS
SATISFIED SATISFIED SATISFIED SATISFIED SATISFIED
JOB SECURITY 19 21 0 0 0
PERFORMANCE
APPRAISAL SYSTEM AND
OUTCOME 12 24 4 0 0
HOSPITAL EMPLOYEE
POLICY 17 19 2 2 0
FAIRNESS OF THE WAY
TREATS TO THE EMPLOYEE 11 24 4 1 0
DOWNWARD AND
UPWARD
COMMUNICATION 16 21 3 0 0
CURRENT JOB AN
DSIGNATION 16 21 2 1 0
INVOLVING IN PLANNING
AND EXECUTION OF WORK 12 19 8 1 0
FACILITIES PROVIDED 11 16 12 1 0
SATISFACTION LEVEL
WITH SALARY 9 16 10 4 1
CAREER GROWTH 14 16 8 2 0
TRAINING AND
DEVELOPMENT PROGRAM
PROVIDED 11 24 5 0 0
WORKING ENVIRONMENT 21 18 1 0 0
LEAVE POLICY 20 11 6 2 1
OVERALL SATISFACTION
LEVEL 17 22 1 0 0

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 30

25

20

15

10

VERY SATISFIED SATISFIED PARTIALLY SATISFIED DIS-SATISFIED VERY DIS-SATISFIED

The above table and chart represent the count of satisfaction at different levels.

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The percent representation of data is as follows:-

Table no. 2:- Staff satisfaction response in percent.

VERY PARTIALLY DIS- VERY DIS-

PARAMETERS
SATISFIED SATISFIED SATISFIED SATISFIED SATISFIED
JOB SECURITY 48% 53% 0% 0% 0%
PERFORMANCE APPRAISAL
SYSTEM AN OUTCOME 30% 60% 10% 0% 0%
HOSPITAL EMPLOYEE POLICY 43% 48% 5% 5% 0%
FAIRNESS OF THE WAY
TREATS TO THE EMPLOYEE 28% 60% 10% 3% 0%
DOWNWARD AND UPWARD
COMMUNICATION 40% 53% 8% 0% 0%
CURRENT JOB AN
DSIGNATION 40% 53% 5% 3% 0%
INVOLVING IN PLANNING AND
EXECUTION OF WORK 30% 48% 20% 3% 0%
FACILITIES PROVIDED 28% 40% 30% 3% 0%
SATISFACTION LEVEL WITH
SALARY 23% 40% 25% 10% 3%
CAREER GROWTH 35% 40% 20% 5% 0%
TRAINING AND
DEVELOPMENT PROGRAM
PROVIDED 28% 60% 13% 0% 0%
WORKING ENVIRONMENT 53% 45% 3% 0% 0%
LEAVE POLICY 50% 28% 15% 5% 3%
OVERALL SATISFACTION
LEVEL 43% 55% 3% 0% 0%

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70%

60%

50%

40%

30%

20%

10%

0%

VERY SATISFIED SATISFIED PARTIALLY SATISFIED DIS-SATISFIED VERY DIS-SATISFIED

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OVERALL STAFF SATISFACTION

Table no. 3:- Overall staff satisfaction response.

VERY SATISFIED SATISFIED PARTIALLY SATISFIED DIS-SATISFIED VERY DIS-SATISFIED

37% 49% 12% 3% 0%

Overall Staff Satisfaction

60%
49%
50%
Percent response

40% 37%

30%

20%
12%
10%
3%
0%
0%
1
Parameters

VERY SATISFIED SATISFIED PARTIALLY SATISFIED DIS-SATISFIED VERY DIS-SATISFIED

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PATIENT SATISFACTION:-

Patient’s satisfaction is a person’s feeling of pleasure or disappointment resulting from a

service’s perceived performance or outcome in relation to his or her expectations. As this
definition makes it clear, satisfaction is a function of perceived performance and
expectations.

1 If the performance falls short of expectations, the patient is dissatisfied. If the

performance matches the expectations, the patient is satisfied. If the performance exceeds
expectations, the patient is highly satisfied or delighted.

2 It is an important and commonly used indicator to measure the quality of care that can
contribute to a balanced evaluation of the structure, process, and outcome of services.
Patient satisfaction is a subjective phenomenon. It is also a multidimensional aspect as,
many factors contribute directly or indirectly to patient satisfaction, including accessibility
and convenience of services, institutional structure, interpersonal relationships, the
competence of health professionals and a patient’s expectations and preferences. More
importance is now given to satisfaction of patients and their caregivers with hospital care.
Patient Satisfaction is recognized as an important parameter for assessing the quality of
patient care services.

3 It is expected that this simple and cost-effective strategy involving continuous

monitoring of expectations of patients will help to catalyse improvements in the quality
of hospital care. It is important in case of inpatients who are seriously ill and require the
plethora of nursing care and other variety of services, as the landscape of their problems
make them expect highly from the hospitals. Patient satisfaction surveys will not only help
the hospital administrators to revise their patient-care strategies but will also inform about
patients health-related behavior.

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4 Patient satisfaction is one of the buzzwords of the last decade. In the last 10 years,
hospitals have realized that one of the most valuable assets to their business is the loyal
patient. In today’s competitive healthcare market, patients expect more than just
satisfaction. Patients are increasingly more demanding and more difficult to attract. So,
patient satisfaction has become a high priority to hospitals and health plans across the
country, because of its impact on patient loyalty, the hospital’s reputation, perceptions of
quality of care, employee satisfaction and retention and the health of a hospital’s bottom
line. Patient satisfaction is a pre-requisite for achieving the goals of healthcare as it
influences the patient’s decision to follow prescribed treatments and seek professional
healthcare in the future.

5 A patient’s satisfaction may not be totally influenced by the quality of care and the
quality of physician available, but it reflects how medical care has been delivered.
Although, their main expectation is getting cured and going back to their work, but there
are other factors, which affect their satisfaction. To provide the highest level of
satisfaction that is profitable to both the patient and the provider, management must
control both the perception of expectation and the quality of delivery of the healthcare
services. Patients are the foundation of our medical practice, and it is very obvious that
they must be satisfied while in or out of the hospital. So Patient satisfaction has become
one of the strongest determinants of hospital functioning and also it is an internationally
accepted factor which needs to be studied repeatedly for the smooth functioning of the
hospital’s/healthcare systems.

6 In countries like India where healthcare is in a competitive marketplace, success will

only be guaranteed if healthcare organizations have the temperature and pulse and
thermometer of their ultimate customer which is the patient and the patient satisfaction is
the tool much like the thermometer and stethoscope.

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7 Patient satisfaction is one of the important goals of any health system, but it is difficult
to measure the satisfaction and gauze responsiveness of health systems as not only the
clinical but also the nonclinical outcomes of care do influence the customer satisfaction.

8 There are many studies available on the satisfaction of patients with regards to outpatient
services but very few studies were carried out in India for measuring inpatient satisfaction
with hospital services. The purpose of the present study is to carry out an evaluation of
inpatient care of hospital services from feedbacks provided by indoor patients.

Survey of 20 patients from each hospital was conducted by providing them a questionnaire
which covered following parameters:-

1. Registration
2. Facility in rooms
3. Medical facility and treatment
4. Interaction with nursing staff
5. Interaction with chief consultant
6. Cleanliness with resident doctor
7. Behaviour of hospital staff

This was all done to know the overall satisfaction of patients with respect to the facilities
that were provided after the implementation of quality standards by NABH.

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The data collected is represented as follows:-

Table no. 4:- Patient satisfaction response in count.

PARAMETERS EXCELLENT GOOD OK NOT NEEDS IMPROVEMENT

GOOD
REGISTRATION 39 19 16 2 4
FACILITY IN ROOMS 20 46 14 0 0
MEDICAL FACILITY AND 32 40 7 1 0
TREATMENT
INTERACTION WITH NURSING 23 29 27 1 0
STAFF
INTERACTION WITH RESIDENT 31 23 23 2 1
DOCTOR
INTERACTION WITH CHIEF 32 27 7 0 14
CONSULTANT
CLEANLINESS WITH RESIDENT 23 43 11 1 2
DOCTOR
BEHAVIOUR OF HOSPITAL STAFF 25 29 26 0 0

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 50
46
45 43
40
40
35
29 29
30 27
25 23
19
20

15
10
5
0
REGITRATION FACILITY IN MEDICAL INTERACTION INTERACTION INTERACTION CLEANLINESS BEHAVIOUR OF
ROOMS FACILITY AND WITH NURSING WITH WITH CHIEF WITH HOSPITAL
TREATMENT STAFF RESIDENT CONSULTANT RESIDENT STAFF
DOCTOR DOCTOR

EXCELLENT GOOD OK NOT GOOD NEEDS IMPROVEMENT

The above table and chart represents the count of satisfaction at different levels.

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The percent representation of data is as follows:-

Table no. 5:- Patient satisfaction response in percentage.

PARAMETERS EXCELLENT GOOD OK NOT NEEDS

GOOD IMPROVEMENT
REGISTRATION 49% 24% 20% 3% 5%
FACILITY IN ROOMS 25% 58% 18% 0% 0%
MEDICAL FACILITY AND
TREATMENT 40% 50% 9% 1% 0%
INTERACTION WITH NURSING
STAFF 29% 36% 34% 1% 0%
INTERACTION WITH RESIDENT
DOCTOR 39% 29% 29% 3% 1%
INTERACTION WITH CHIEF
CONSULTANT 40% 34% 9% 0% 18%
CLEANLINESS WITH RESIDENT
DOCTOR 29% 54% 14% 1% 3%
BEHAVIOUR OF HOSPITAL
STAFF 31% 36% 33% 0% 0%

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70%

60%

50%

40%

30%

20%

10%

0%
REGISTRATION FACILITY IN MEDICAL INTERACTION INTERACTION INTERACTION CLEANLINESS BEHAVIOUR
ROOMS FACILITY AND WITH WITH WITH CHIEF WITH OF HOSPITAL
TREATMENT NURSING RESIDENT CONSULTANT RESIDENT STAFF
STAFF DOCTOR DOCTOR

EXCELLENT GOOD OK NOT GOOD NEEDS IMPROVEMENT

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OVERALL PATIENT SATISFACTION

Table no. 6:- Overall patient satisfaction response.

EXCELLENT GOOD OK NOT GOOD NEEDS IMPROVEMENT

35% 40% 20% 1% 3%

Overall patient satisfaction

45%
40%
40%
35%
35%

30%
Percent response

25%
20%
20%

15%

10%

5% 3%
1%
0%
1
Parameters

EXCELLENT GOOD OK NOT GOOD NEEDS IMPROVEMENT

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TOOLS AND TECHNIQUES

It was a quantitative research in which primary data were collected by using a

questionnaire. It was a causal study, which done in a natural environment, i.e. in a non-
contrived setting. The purpose of this study was to find out satisfaction level about
health sector located in Marathwada region. Variables used in this study were such as
the dependent variable was patient and staff satisfaction in health sector and the
independent variables are reliability, responsiveness, assurance, empathy and
tangibles. It was a field study in which data were gathered by using a questionnaire.
The Population used in this study was the staff and patients in the hospitals selected.
Respondent were those people, who belong to Aurangabad and overall Marathwada
region, convenient sampling was used to collect data. The Sample size used in this
study was 80 for patients and 40 for staff members, data gathered by distributing
questionnaires in different hospitals of Marathwada region that implant the quality
standards given by NABH.

This study tries to focus on various “quality characteristics” these characteristics found
significant in the previous studies. Our selected respondents were those people who
are using the services of the hospitals situated in Aurangabad (Marathwada).

A part of demographics also used in the questionnaire in which questions related to

quality, safety, efficacy, treatment, diagnosis and other healthcare related queries for
the patients were included. On the other hand, in the other questionnaire in which
questions related to salary satisfaction, leave policy and other measures for the staff
members were included. All measures were obtained by using “Self-report”
questionnaire. All the responses were recorded in different levels of satisfaction.
Patient satisfaction is used as the dependent variable and the dimension of service
quality are namely reliability, responsiveness, assurance, empathy and tangibles as the
independent variable.

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 While the NABH accreditation process in hospital has clearly addressed all facets of
patient care, it would be useful to guage patients’ reaction this. The survey was carried
out in the hospitals and results were analysed and corrective actions were carried out.

Some important benefits of such independent, professionally carried out satisfaction

surveys are:

 Improvement in the quality of services based on specific feedback.

 Improvement in clinical performance and profitability.
 Hospitals are seen as patient friendly with improved doctor interaction, staff
courtesy and compassion and an improved image in local community.
 Cleaner, more hygienic surroundings, better ambience
 Better risk management through an ‘early morning system’
 For insurers, employers and government a means to empanel hospitals based on
quality.

RESULTS AND DISCUSSION

STAFF SATISFACTION

Table 1 represents healthcare staff wise response to various parameters given by the
participants involved in the study.
Table 2 represent response rate in percentage for each parameter.
Table 3 represents overall staff satisfaction response.

The majority of participant responded positively i.e. Average 86% believes there is
improvement in hospital processes post NABH accreditation.

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The facilities provided had an improved level than earlier. Average 90% staff is
satisfied with working environment. The quality standards and policies have a very
good impact on staff growth. The work platform is more friendly than earlier. Overall
staff is satisfied with the NABH standards which are imposed on hospital.

PATIENT SATISFACTION

Table 4 represents the patient response to various parameters provided by the staff.

Table 5 represents the patient response in percentage for each parameter.

Table 6 represents the overall patient satisfaction response.

The majority of patients were satisfied with the quality of services provided by the
hospital. Average 75% believes that there is an improvement in the services an
facilities provided. The patients are happy with the safety, efficacy, treatment and
quality provide by the hospital. The interactions with nursing staff, chief consultant
and registration/admission faculty also gives a satisfactory percentage of more than
55%. The NABH is helping the patients with continuous improvement by
implementing the new quality standards.

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CONCLUSION

More than 80% of participants perceives that there is positive effect of NABH
accreditation on the hospital services and the processes have improved in the hospital
post NABH accreditation. 86% participants felt an impact on overall staff satisfaction
among them post NABH accreditation.

Hand in hand with staff satisfaction, patient satisfaction also had a good response i.e.,
75% to hospital services which are continuously improving by the implementation of
quality standards.

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1.8. Bibliography

1. Facilities Planning and Management ; GD Kunders; tata McGraw-

Hill Publishing Company Limited , New Delhi ;2004

2. NABH publication : General Information Brochure ; July 2012

3. Standard Operating Procedures for Hospitals in India ; Arun K.

AgrawalAtlantic Publishers and distributors pvt .Ltd.;2011

4. Law and the practice of Medicine ; SK Joshi, Jaypee Brothhers

5. patient Safety and quality management ; Giridhar ghayni .

6. http://nabh.co/standard.aspx

7. http://www.serviceperformance.com/the-5-service-
dimensions-all- customers-care-about/

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1.

Questionnaires

United CIIGMA Hospital

Plot No. 6, 7, Survey No. 10, Shahnoorwadi, Darga Road, AURANGABAD

431005, Maharashtra, INDIA. Tel: [email protected], Website:
www.unitedciigma.in

Feedback Form

Date:

Patient Name

Registration No. Admission Date: Discharge Date:

Please mention your feedbacks

in brief about the services of our hospital , which will help us to improve them

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 Please check and give equal sign ( /) in particular box given below
Sr. Services Excellent Good Ok Not Good Needs
No. Improvement

१. Registration /Admission
२. Facility in the rooms
३. Medical facility and treatment
४. Interaction with nursing staff
५. Interaction with resident doctor
६. Interaction with chief consultant
७. Cleanliness with resident doctor
८. Behavior the hospital staff

Remark:

Patient Name:

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63 | P a g e
Relatives Name: (Relation with patient ):

Mobile No. Signature :

Questionnaire for staff members

UNITED CIIGMA UCH/HR/29

T
HOSPITAL

HUMAN RESOURCE / PERSONNEL DEPARTMEN

EMPLOYEE SATISFACTION FEEDBACK FORM

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We require your Suggestion and Feedback to know about working environment of
our hospital. Kindly spare some time to tell your experience of satisfaction level. This
form and its contents are kept strictly confidential.

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Kindly tick 5 4 3 2 1

Very Satisfied Satisfied Partially Satisfied Dissatisfied Very

Dissatisfied

5 4 3 2 1

 Job Security

 Performance Appraisal system & outcome

 Hospital Employee Policies

 Fairness of the way treats to the employee

 Downward & Upward communication

 Current Job & designation

 Involvement in Planning & Execution of work

 Facilities Provided

 Satisfaction Level with Salary Payment

66 | P a g e
 Career Growth

 Training & Development Program Provided

 Working Environment

 Leave policy

 Overall Satisfaction Level

COMMENTS / SUGGESTIONS

NAME: EMP.ID:

DESIGNATION

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DEPARTMENT: DATE: SIGNATURE:

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