CHAPTER - III

HOSPITAL AND HEALTH SERVICES IN INDIA AND

PROFILE OF SELECT SAMPLE CORPORATE HOSPITALS

This chapter describes Theoretical concepts about History of Indian Hospitals,

Hospitals Services and Patient's relationship with Hospital industry. This chapter
presents two parts. Part –I deals with Hospital and health services in India and Part- II
presents brief profile of select sample corporate hospitals.

INTRODUCTION:
As the specialized hospitals are growing in number, each is trying to create a
distinct positioning for itself. There are hospitals specializing in cardiac surgery, cancer
care, spinal injury, eye hospitals, abortion clinics, maternity homes etc. Each one is
trying to create a unique identity and wants to cater to specific segment of the market.
The process, by which they identify, what type of health care service should be
offering, is nothing but applying some concepts of marketing related to segmentation,
targeting and positioning. Thus the marketing concepts can be applied to health care
sector. In this unit an attempt has been made to explain the application of marketing in
hospital services, taking the example of Indian Railway hospitals.

"A customer is the most important visitor on our premises. He is not an

interruption in our work. He is the purpose of it. He is not the outsider on our business.
He is a part of it. We are not doing him a favour by serving him. He is doing us a favour
by giving us an opportunity to do so." Mahatma Gandhi. The importance and
applicability of the above dictums are totally relevant to the commercial sector.
Sometimes the government sector, however, due to a myopic view, is unable to directly
apply it in its services. If they replace the word "customer" by "citizen public" then,
perhaps, they will be able to do justice to the public they serve. The above views of
Gandhiji are true for all sectors, including hospitals. With regard to hospitals, we may
change the word "customer" with "patient". Since the doctors very existence is related
to the patient, hospitals become an integral part of medical care.

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PART-II : HOSPITAL AND HEALTH SERVICES IN INDIA
HOSPITAL SYSTEM AND FUNCTION
When a patient enters a hospital, many groups are involved inside and outside
the hospital. Inside, the patient is concerned with admission, doctors, nurses, dietetics,
the business office, and housekeepers, to name only a few. Externally, the patient is
involved with relatives, friends and (sometimes) a third party- the payer, and is
influenced by government regulations, accreditation and community, to name a few.
The key input of the hospital is the patient- the other important inputs are the skill and
knowledge of the doctors, nurses, support staff, the level of sophistication of the
equipment utilized, etc. Six such stages are given below:
1. Admission
2. Diagnosis
3. Treatment
4. Inspection
5. Control
6. Discharge
These stages do not exist separately, but are interlinked. The three major components of
the internal hospital system are:
1. The medical staff who diagnose, admit and treat patients, and perform quality
control procedure through their para-medical staff organisation.
2. Programs for the detection of illness and direct care and cure of patients such as
nursing, x-ray and laboratory.
3. Support and administrative services such as record keeping, finance and
administration.
The traditional hierarchical organization chart explains the official hierarchy only
and not necessarily the true position. This kind of chart is actually inappropriate for
understanding relationships and influences in the hospital. The professional competence
of the doctor often changes his real position in the hierarchy. The lines of
communication in hospitals are, therefore, quite complex in nature. The functions of
hospitals appear to be obvious, but in reality these are quite complex- they keep
changing with time. Sometimes, they are also in conflict with each other. Some of the
main functions of hospitals are:
1. Patient Care Function: It is important to remember that, besides treatment, the
attitudes and behavioral pattern of health professionals are known to have an important

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influence on patient care as they are directly related to quality of care. The different
systems affecting the patients and their effects are discussed below:
a) Environmental System: Schulz and Johnson quote a number of studies to say that
the physical environment of the hospital also affects patient's response to treatment
a large number of sanatoriums are located in hill stations.
b) Social System: The effect of attitudes of staff towards patients due to a change in
their statue (from independent individuals in normal life to being passive-clothed
hospital dependent patients) is obvious.
c) Cultural Relationships: The lower income group persons have a problem in
communicating with higher socio-economic status physicians which is
obvious. The barrier exists not only because of different languages spoken by
them, but also because of class difference. Some of the doctors make a
conscious effort to overcome this.
d) Seasonality: Seasons have a direct influence on diseases and illness especially in
the context of our country, where the variations are too wide.
e) Providing a Workshop for Physicians: It has to be understood that the physician is
not so much a part of the hospital, as the hospital is part of the physicians practice.
f) Working as Community Health Centre: Hospitals have increasingly taken up a
proactive role to improve the health of the population they serve. Rather sticking to
the reactive role of crisis care.
g) Serving the institution itself by achieving perpetuation, growth and prestige for
institution, its staff and community

HISTORY, GROWTH AND CLASSIFICATION OF HOSPITALS IN INDIA

Since Independence, India has achieved remarkable progress in social, political
and economic fields. After the liberalization, this progress has been given further fillip,
and has been recognized by the advanced countries. In the area of medical science too,
commendable progress has been made during this period. Unfortunately, however,
hospital administration has lagged far behind. Even the most sophisticated and the so
called modem hospitals in India continue to be governed by the stereotyped system of
hospital administration, viz. appointing the senior-most doctor as the Medical
Superintendent. He is entrusted with the responsibility of the entire administration of
the hospital, irrespective of whether or not he has undergone any formal (or even
informal) training in hospital administration.

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 Times have changed and specialization has become the order of the day. It is
therefore, imperative to have separate specialists for general administrative and human
resource functions in hospitals. Secondly, with the tremendous expansion in health
services, it has become essential to have specialists or experts not only in these two
fields, but also in other fields of hospital administration, so that maximum efficiency
can be achieved at the minimum cost. Thirdly, the rapidly rising number of patients and
the inadequate expansion of hospitals and medical service have thrown the hospital
administration machinery completely out of gear. Hence, the need for better planning,
organizing, staffing, coordinating and controlling hospitals can hardly be over
emphasized. Hospital administration can no longer be left to continue in the hands of a
person who is "Jack-of-all trades" and "master-of-none".

In the past, hospitals could perhaps, afford the luxury of being un business-like
and of adopting hit and mis-methods of management as a number of philanthropists
made huge donations to meet the ever-rising deficit in hospital budgets. Similarly in the
field of human resource management, as long as the salary budget comprised only a
small portion of the total budget, hospital administration could afford to neglect the
introduction of scientific and progressive principles of human resource management.
But they can no longer afford to do so as salary and wages represent 65 per cent or
more of the total hospital budget.

As per the report of the Steering Committee on Health for the Tenth Five Year
Plan, in India, there were 15,188 hospitals of modem system of medicine having
6,65,639 beds. There are about 2,991 hospitals of the Indian System of Medicine and
Homoeopathy having 6 0,251 beds, and 25,911 dispensaries of Modern System of
Medicine having 24,803 beds and 23,028 dispensaries of the Indian System of Medicine
and Homoeopathy having 23,028 beds. When we divide these hospitals and
dispensaries under the Indian System of Medicine and Homoeopathy, we find that there
were 14,416 Ayurveda dispensaries and 2,258 Ayurveda hospitals having 40,313 beds,
970 Unani dispensaries and 297 Homoeopathy hospitals having 12,836 beds. Similarly,
when we divide these hospitals and dispensaries under Modem System of Medicine,
there were 25,911 dispensaries having 24,803 beds and 14,926 hospitals having
6,63,163 beds. Hospitals are the focal points of education for the health professionals

49
and clinical research necessary for advancement of medicine. Thus the hospital is one
of the most complex of all administrative organizations. Therefore, it requires a
thorough knowledge not only to the hospital set-up but also of its meaning, history,
classification, peculiar conditions prevailing in hospital administration, etc. before one
can undertake its human resource management to study.
NATURE AND SCOPE OF A HOSPITAL
Human beings make a society. Healthy human beings make a healthy society.
However every society has its share of unhealthy human beings. Illness, disease and
invalidity can be a curse for society; but their victims certainly are not. They are as
much apart of society as the healthiest of individuals. In the past, an individual affected
by a wound or disease was condemned to suffer and fend for himself. In those primitive
days, the healthy never assisted or looked after the affected. The practice was to
consider such an affected person a spent-force and no longer useful to society. Thus
complete isolation from society was the tragic lot of one who fell ill. No attempt was
made to ascertain the causes and suggest cures for ailments. The belief then was that
illness was caused either by evil spirits or was a punishment for one's misdeeds. Later,
the 'tribe' assumed the responsibility of looking after the sick that were considered
victims of a magic spell, by appeasing or scaring away the evil spirits with a counter-
curse.
As civilization advanced from the individual to the family, from family to the
tribe and finally to the organized community, society acknowledged a common
responsibility towards the sick. It was only when civilization progressed, then man
sought to provide for the welfare of his fellow-beings (other than his own kith and kin).
Illness creates dependency. The sick need medical treatment, nursing care and shelter.
With the advent of the modern society, the institution developed to cater to the needs of
the sick was the hospitals.

HISTORY OF INDIAN HOSPITALS

The history of Indian medicine and surgery dates back to the Earliest of ages.
But hospitals as institutions to which a sick person could be brought treatment were of a
much later origin in other countries. In India, hospitals have existed from ancient times.
Even in the 6th century B.C., during the time of Buddha, there were a number of
hospitals to look after the crippled and the poor. More such hospitals were started by
Buddha's devotees later on in different parts of India as well as outside the country.

50
The outstanding hospitals in India at that time were famous physicians. Medicine (273-
232 B.C), Charka and Sushrutha of ancient India were famous physicians. Medicine
based on the Indian system was taught in the universities of Taxilla and Nalanda, which
probably contributed to the advances hi Arabic medicine. The Upakalpa-niyam
Adhyayam of Charake Suthrasmanam gives specification for hospital buildings, labour
rooms and children's wards. The qualifications for hospital attendants and nurses as
well as specifications for hospital equipment, utensils, instruments, and diets have also
been given. There is evidence to show that there were many hospitals in South India in
the olden days, as observed in the Chola and Malakapuram edicts.

According to historians, the study of the History of the Medicine of Ancient

India was greatly handicapped for want of inscriptions, manuscripts or other records as
are available for other ancient systems of medicine. The seals and tablets discovered at
Harappa and Mohenjodaro are yet to be deciphered. But we do find from the books
written by Arabian and European travelers that the study of medicine in India was in its
bloom. Every major city had a medical school. The decline of Indian medicine started
with the invasion of foreigners in the 10th century A.D which was a period of unrest.
The zeal of the native vaidyas for the investigation of the Indian flora slackened for
want of encouragement. The maintenance of hospitals in India declined during this
period.

The use of the allopathic system of medicine commenced in the 16th century
with the arrival of European missionaries in South India. It was during the British rule
that there was once again progress in the building of hospitals. The first hospital in
India was probably built in Goa, as mentioned in Flyer's ravels. The first hospital in
Madras was opened in 1664; but apparently it was not actually taken up till 1676; the
earliest hospital in Calcutta was built in 1707-1708, and in Delhi, in 1874. The
Portuguese organized hospitals of the European type at Calicut (Kerala), Goa and
Santhome (Madras) through missionary organizations. They set up treatment centres
and trained local men and women as dressers, nurses, etc. hi the early stages, missions
were financed by foreign sources but later on when the people realized their value, local
support and subsidies were available. During the 17th and 18th centuries, there was a
slow but steady progress in the growth of the modern system of medical practice in
India and the indigenous system was pushed to the background. In the 19th century,

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modem medicine took firm root. Medical care based on this system spread all over
India, mainly through the efforts of the missionaries. Organized medical training was
started in the 19th century. The first medical school (The Native Medical School) was
started in Calcutta, followed by one in Madras. In the beginning, both the modem
system and the Ayurvedic system were taught. A Hospital Assistants course of two
years duration was started by the army. The medical school in Calcutta was converted
into a college in 1835, later on, when the Universities were started; some of the medical
schools were taken over and converted into medical colleges.

CLASSIFICATION OF HOSPITALS
Hospitals have been classified into many ways. The most commonly accepted
criteria for the classification of the modern hospitals are; (a) ownership / control basis,
(b) length of stay of patients and (c) clinical basis.

CLASSIFICATION ACCORDING TO OWNERSHIP/CONTROL

On the basis of ownership or control, hospitals can be divided into four
categories, namely, public hospitals, voluntary hospitals, private nursing homes and
corporate hospitals.
Public hospitals
Public hospitals are those run by the Central Government, state governments or
local bodies on non-commercial lines. These hospitals can be general hospitals or
specialized hospitals or both. General hospitals are those which provide treatment for
common diseases, whereas specialized hospitals provide treatment for specific diseases
like infectious diseases, cancer, eye diseases, psychiatric ailments, etc. General
hospitals can diagnose patients suffering from infectious diseases, but refer them to
infectious diseases hospitals for hospitalization, as general hospitals are not licensed to
treat infectious diseases patients.
Voluntary hospitals
Voluntary hospitals are those which are established and incorporated under the
Societies Registration Act, 1860 or Public Trust Act, 1882 or any other appropriate Act
of the Central or state government. They are run with public or private funds on a
noncommercial basis. No part of the profit of the voluntary hospital goes to the benefit
of any member, trustee or to any other individual. Similarly, no member, trustee or any
other individual is entitled to a share in the distribution of any of the corporate assets on

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dissolution of the registered society. A board of trustees, usually comprising prominent
members of the community and retired high officials of the government, manages such
hospitals. The board appoints an administrator and a medical director to run such
voluntary hospitals. These hospitals spend more on patient care than what they receive
from the patients. There is, of late, a trend among voluntary hospitals to charge
reasonably high fees from rich patients and very little from poor patients. Whatever
they earn from the rich patients of the private wards, spend on the patients of general
wards. However, the main sources of their revenue are public and private donations,
and grants-in-aid from the Central Government, the state government, and from
philanthropic organizations, both national and international .Thus, voluntary hospitals
run on a 'no profit, no loss' basis.

Private nursing homes

Private nursing homes are generally owned by an individual doctor or a group of
doctors. They admit patients suffering from infirmity, advanced age, illness, injury,
chronic disability, etc., or those who are convalescing, but they do not admit patients
suffering from communicable diseases, alcoholism, drug-addiction or mental illness.
There is, however, no uniform definition for nursing homes. The phrase may refer to
out-of-home care facilities that offer a range of services similar to many found in a
hospital. These nursing homes are run on a commercial basis. Naturally, the ordinary
citizen cannot usually afford to get medical treatment there. However, these nursing
homes are becoming more and more popular due to the shortage of government and
voluntary hospitals. Secondly, wealth patients do not want to get treatment at public
hospitals due to long queues of patients and the shortage of medical as well as nursing
staff leading to lack of medical and nursing care.

Corporate hospitals
The latest concept is of corporate hospitals which are public limited
companies formed under the Companies Act. They are normally run on commercial
lines. They can be either general or specialized or both.

CLASSIFICATION ACCORDING TO LENGTH OF STAY OF PATIENTS

A patient stays for a short-term in a hospital for treatment of diseases such as
appendicitis, gastroenteritis, etc. A patient can stay for a long-term in a hospital for

53
treatment of diseases such as tuberculosis, cancer, schizophrenia, etc. Therefore, a
hospital can fall either under the category of long-term or short-term according to the
diseases and treatment provided.

CLASSIFICATION ACCORDING TO CLINICAL BASIS

A clinical classification of hospital is another basis for classification of
hospitals. Some hospitals are licensed as general hospitals while others as specialized
hospital. In a general hospital, patients are treated for all kinds of diseases such as
typhoid, fever etc., and in a specialized hospital, patients are treated only for those
diseases for which that hospital has been set up, such as heart diseases, tuberculosis,
cancer, maternity, ophthalmic diseases, etc.

CLASSIFICATION ACCORDING TO DIRECTORY OF HOSPITALS

The Directory of Hospitals in India-1988 lists the various types of hospitals and the
types of management.
TYPES OF HOSPITAL
1) General hospital. All establishments permanently staffed by at least two or more
medical officers, which can offer in-patient accommodation and provide active
medical and nursing care for more than one category of medical discipline (e.g.
general medicine, general surgery, obstetrics)
2) Rural hospital. Hospitals located in rural areas (classified by the Registrar
General of India) permanently staffed by at least one or more physicians, which
offer in-patient accommodation and provide medical and nursing care for more
than one category of medical discipline (e.g. general medicine, general surgery
and obstetrics.)
3) Specialized hospital. Hospitals providing medical and nursing care primarily for
only one discipline or specific diseases (e.g. tuberculosis, ENT, eyes, leprosy,
orthopedic, pediatrics, gynecological, cardiac, mental, cancer, infectious disease,
and venereal diseases) The specialized departments, administratively attached
to a general hospital and sometimes located in an annex or separate ward, can be
excluded and their beds should not be considered in this category of specialized
hospitals.
4) Teaching hospital. Hospital to which a college is attached for medical/dental
education.

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5) Tertiary hospital. States and Central Government set up tertiary hospitals in their
capitals where referred patients are treated such as AIIMS, New Delhi, P.G.I.
Chandigarh, Sanjay Gandhi, P.G.I. Lucknow, etc.

TYPES OF MANAGEMENT
1) Central Government/Government of India. All hospitals administered by the
Government of India, viz, hospitals run by the railways, military/ defense, mining/
ESI/ Post & Telegraphs, or public sector undertakings of the Central
Government.
2) State government. All hospitals administrated by the state /UT government
authorities and public sector undertaking operated by states /UTs, including the
police, jail, canal departments and others.
3) Local bodies. All the hospitals administrated by local bodies, viz the municipal
corporation, municipality, Zilla Parished , and Panchayat.
4) Private. All private hospitals owned by an individual or by a private
organization.
5) Autonomous body. All hospitals established under a special Act of
Parliament / State legislation and funded by the Central / State government / U.T.
e.g. AIIMS (New Delhi) PGI, Chandigarh.
6) Voluntary organization. All hospitals operated by a voluntary body /a trust /
charitable society registered or recognized by the appropriate authority under
Central/State government laws. This includes hospitals run by missionary bodies
and co-operatives.
7) Corporate body. A hospital runs by a public limited company. Its shares can be
purchased by the public and dividend distributed among its shareholders.

HOSPITAL ADMINISTRATION
Administration, on a planned and scientific basis, is necessary for the smooth
running of every institution. A hospital is no exception to this fundamental rule.
Administration plays a vital role in the functioning of a hospital, perhaps more than it
does in any other institution. In order to perform its functions efficiently, hospitals
today must be organized and administrated in a scientific manner. This demands that
every staff member should be adequately trained'. There is now a greater need for
efficient administration in hospitals because the number of people who use hospital

55
service has increased manifold, whereas the financial and other resources available to
hospitals in India have not kept pace with the growth in the number of users. The
optimum use of resources is only possible with an efficient and professionally
competent administration. Many hospitals have of late been calling in social scientists
for practical advice to answer such questions as; how can we obtain more co-operations
from the public? Why do so many patients leave against medical advice? Why is there
such a high staff turnover? Why is there persistent grumbling among the house staff and
how justified is it? Why do patients seem to be so unhappy on one floor and so satisfied
on another?

Thus greater attention will be needed towards hospital administration in the

present days and especially in the future which is full of challenges because of the
increasing competition from internal as well as external sources. Due to the growing
awareness about health amongst the masses, hospitals all over the world are therefore
under tremendous pressure to improve their services and administration for their
survival and growth. This is possible only when the top management of any hospital
will give due consideration in selecting a well qualified and trained hospital
administrator who in turn will give due importance not only in improving medical
facilities but also the efficiency of its personnel, because sophisticated equipments in
medical laboratory, X-ray department, operation theatre, accounts department,
admission office , etc., cannot improve the entire working of the hospital until and
unless its operators and employees are well trained and adequately motivated. In the
light of this, the top management should now recognize the necessity of employing a
trained and dynamic hospital administrator and consider him as an investment to meet
the objectives rather than an overhead cost. Therefore in the years to come, hospital
administration will assume even higher importance.

HOSPITAL ETHICS
"The code of ethics of hospital goes hand with the code of ethics of physicians.
Both of them are required to follow their ethics to render care to the sick and injured.
As far as the hospital code of ethics is concerned, it was developed nearly half century
ago, but the code of ethics of physicians has been in existence since the days of
Hippocrates who lived about B.O 460-377. Today, the code of medical ethics has
become the fundamental law of the hospital and is applicable to all its personnel,

56
including the trustees". The trustees are required to employ a qualified administrator to
keep accurate records, to provide facilities consistent with community needs, to
determine fair policies, to set professional standards and to provide protection to the
patients during their stay in their hospital. There should be neither solicitation for
patients nor undesired publicity of any kind whatsoever. Similarly, personnel of the
various professions and avocations are required to maintain the dignity and honor of
their profession of discharging their responsibilities to ensure that all patients receive
the best care without any unnecessary delay; secrecy about their diseases is maintained
and they are not harassed in any way-neither by soliciting favors nor by accepting
monetary rewards.

No one including the treating physician and the nurse has the right to expose the
patient unnecessarily. Violation of this rule means the loss of confidence of a patient in
the hospital staff. Therefore, each and every hospital personnel including the physician,
nurse, laboratory and X-ray technicians, physiotherapists, and others should avoid all
those acts which would lead to the loss of trust of the patients because whatever a
patient tells, he does so in good faith and expects that all the information will be kept
secret and used only for treatment purpose. Therefore, it is for practical reasons that
sincerity, reliability, sobriety and calm/balanced temperament are required of those who
are caring for the sick and injured, otherwise, the hospital may lose its respect not only
in the eyes of the patient but also of the community because each patient belongs to one
community or the other.

ROLE OF HOSPITAL ADMINISTRATORS IN LEGAL MATTERS

Though all hospital administrators are not qualified legal persons, yet they are
supposed to possess sufficient knowledge of the Indian Laws to be able to take
decisions on legal matters. All hospitals cannot afford to engage full time law officers
or retain part time legal advisors. It is the hospital administrator who keeps the reign of
legal kingdom in his hand in small and medium size hospitals and decides all matters
rightly or wrongly on the basis of his knowledge and common sense. The hospitals are
not longer immune to legal suits due to re induction of the Industrial Disputes Act, 1947
and application of the Consumer Protection Act, 1986. These acts have made
employees as well as patients more conscious about their rights and privileges, and they

57
expect better working conditions and services from the hospital administrator. Thus the
hospital administrator has crucial role to play in legal matters these days.

CEO'S VISION TO IMPROVE HOSPITAL SERVICES

What does a hospital employee want from his job? Money, security and career
development can be high on the list for most of them, but Mike Rudd, Logistics
Director at Bulmers, says that what really motivates employees is sharing the CEO's
vision. Though it sounds odd, with the new world of independent and short stay of
personnel, it is true. The CEO should communicate his vision about the hospitals as
well as involve the employees at every step. They should be invited to give their views
and discuss how they would work towards the vision. It would be easy to say that such
an activity is nothing more than a paper exercise, but it can be very productive and
useful because each individual's job contributes towards achieving the vision. The
process should entail remaining firmly focused on the CEO's vision in conversations
and meetings. Thus, one can defuse difficult situations very quickly by understanding
where the personnel are, why they are there, and where they need to go next so that
everyone in the hospital begins to work in a better way and the vision of the CEO
becomes the vision of each and every employee of the hospital.

COUNSELLING AS A TOOL IN HOSPITAL ADMINISTRATION

No institution can be more sensitive than a hospital because it deals with life and
death of its patients. Slightly indifferent attitudes on the part of employees in a factory
can reduce production, which can well be made up once they reach an amicable
settlement with the management. But this is not so in a hospital. If a patient dies due to
indifference or work-to-rule attitudes on the part of hospital employees, there can be no
making up thereafter. Therefore, no hospital administrator can afford to cause
resentment amongst his employees; he will have to create a team of dedicated
employees who should serve the patients with smiling faces directly or indirectly such
employees of nursing service department or central supply room. To create a team of
dedicated employees, a hospital administrator needs to establish a relationship with
them based upon trust and confidence. While talking to them, he should not only
empathize and be on the same level with them but sometimes should even communicate
something on a very personal level to understand their problems. Like a counselor, he

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not only needs to deal with their grievances from their stand point but also should listen
to them with genuine and sincere concern.

Therefore, a hospital administrator needs to possess the following attitudes:

a. Respect
b. Genuineness
c. Empathy
d. Self-disclosure
e. Concreteness
f. Understanding
g. Forgiving
h. Jovial Personality
i. Listening
j. Humor
Today hospitals are better known for their specialty and super specialty services.
New concepts have also been introduced in the management of hospitals, like day-care
services and transfer of specialized diagnostic and therapeutic services from in-patient
to outpatient areas. There is immense scope for using innovative managerial skill;
(a) In running the specialty and super-specialty services;
(b) To create an environment for professional excellence for high -quality care; and
(c) To provide services more economically.

These functional changes have necessitated a specific managerial approach.

Modern equipment and facilities call for a specific hospital design and plan. Framing of
norms and standards of programming, designing, equipping and staffing such special-
care services are the need of the day. Special facilities require professional and
managerial skills to optimize the use of available resources. Hospital administrators
have realized not the need for scientific hospital administration in the miming of their
hospitals.

IMPORTANCE OF HUMAN RELATIONS IN HOSPITALS

In his book, 'Hospital Organization and Management', Mac Eacheren comments
that hospitals were slow to follow the lead of industries which has realized the necessity

59
for good human relations and had set up human resource departments to perform human
resource functions. Human resource management has been a victim of administration.
In conducting a survey of hospital board meetings, it was found that 40% of the time at
these meetings was spent by the governing board members talking about money, 20%
about building improvement and equipment, 15% about medical staff problems, 10%
about patient services, 10% about public relations and 5% about miscellaneous subjects
including human resource. In modern health-care institutions, the personnel functions
should be given due importance and the human resource manager should be considered
an integral part of the administrative team so that he may arrange organizational
conditions in such a way that people can achieve their goals. This is one of the most
important and complex responsibilities of the human resource manager. This will go a
long way in establishing cordial human relations which will reflect in patient care.

The primary aim of hospitals is to provide patient care of the highest quality. An
often-overlooked truth is that efficient patient-care develops not from modern medical
equipment and drags alone but from the work force, a group of well-rewarded and
motivated medical, paramedical, skilled and unskilled personnel. The assembly of these
personnel, who are committed to institutional goals and their fulfillment, is not just a
matter of chance. It is the result of sound professional administration and cordial human
relations. The role of human relations in health organizations is concerned with the
integration of people into a work situation. It is also concerned with motivating
personnel to work together cooperatively and productively. In understanding the
behavior of human beings, some knowledge of basic needs and human behavior is
necessary. It should therefore be the first duty of health-care administrators and human
resource managers to see that most of the basic needs of their personnel are met so that
their behaviour is of cooperation and not of aggression at their work-place. In hospitals,
the lower ranks of employees are usually not taken into confidence by the hospital
authorities at any stage. They are absolutely ignored. The present day's employees
expect to be treated with dignity. Therefore, all the concerned hospital executives must
stop working from above or pushing from behind. They should, instead, start leading
from the front and must work together with all categories of employees and gain their
genuine and whole-hearted contribution to achieve the hospital goals by providing them
opportunities for participation even at the planning stage.

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MOTIVATION
Motivation plays a crucial role in maintaining cordial human relations,
particularly in service-oriented organizations like hospitals. Attractive architecture,
modern equipment and costly medicines alone are not enough to run a hospital
efficiently and effectively; what is essential to a greater degree, is a well motivated,
dedicated and disciplined work force. Therefore, it should be the earnest Endeavour of
every human resource manager to keep his employees highly motivated so that they
may give better service to patients and do not invite undesired litigation of medical
negligence under the Consumer Protection Act, 1986.

MOTIVATED WORKFORCE-THE ONLY SURVIVAL GAME

There are five key ingredients which the hospital administrators need to
inculcate in their employees. They are:
1. High value system- It consists of personality and character ethics.
2. Time management- The art of prioritization of work according to time schedule.
3. Emotional bank balance- Investment in personal relationships.
4. Interdependence- Working in team with spirit.
5. Role of meditation- To develop positive attitude toward life and work.

Thus, hospital administrators not only motivate their employees but can provide
better service to patients.

IMPORTANCE OF TEAMWORK IN HOSPITALS

'United we stand, divided we fall'. All over the world, the most successful
managements always develop a team for efficient organization of their work. The large
companies in Germany have always team management. One member customarily
presides over the team, but all are equal. Similarly, those marvels of efficient
management organization-the 'Big Five' of British banking have always been managed
not by one, but by two chief executive teams; the chairman and the deputy chairman
concerned with basic objective and the joint general managers concerned with policies,
practices and personnel. Teamwork is co-ordinate action by a co-operative group
whose members contribute responsibly and enthusiastically towards task achievement.
It works best in a supportive environment. The essentials of teamwork are: (a) a small

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group; (b) a leader; (c) a common goal; (d) regular interaction; (e) each member
contribution responsibly; (f) coordination; and (g) team spirit.

During and after the Second World War, there was an acute shortage nurses.
Therefore, nursing administrators introduced the functional method of nursing.
Professional nurses were assigned strictly professional duties such as giving medicines,
taking blood pressure checkup, writing notes, going rounds with physicians and
surgeons, etc., and nurse-aides and orderlies were assigned tasks such as making beds,
escorting patients to the X-ray department, carrying stool and urine specimens to the
laboratory, handing over the patient chart for billing, etc. In a hospital set-up, there is no
other job that needs to be organized as carefully and as systematically as that of the
Chief Executives of a hospital. The priorities of the assignments of the Chief Executives
should be arranged systematically. Even then, the job of the Chief Executives of the
hospital cannot properly be organized as the job of one man. It must be the job of a
team of several persons working together. Teamwork is essential at all levels of
management in a hospital.

HISTORY OF INDIAN GOVERNMENT HOSPITALS

The development of hospitals from a place of shelter for the homeless and ill, to
the hub of modem medical knowledge, technology, professionals is a recent
phenomenon. The transition to this present form took place during the late nineteenth
and early twentieth century, when hospitals adopted the biomedical model to cure
diseases in the society. The biomedical model of health is a result of conversions of
certain ideas regarding living beings, related discoveries and inventions in medical
sciences, which are popularly depicted in terms of a series of spectacular breakthroughs.
Here, health is seen from the perspective of medical knowledge. The bio-medical model
espouses an understanding of people's health that is based predominantly on the
scientific theory of diseases causation and hence also recommends effective cure
exclusively in bio-medical terms. It focuses on three areas -firstly; health is
conceptualized merely as absence of biomedical abnormality. Secondly, human body is
viewed as a machine, which has to be restored to health, through treatments designed to
arrest or reverse the disease process. Thirdly, health of society is seen as largely
dependent on the state of medical knowledge and the availability of medical resources.
It relies on the hospital as an organization for the delivery of health care to people and

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society at large; thus, hospitals become the centre of science and technology and for
curing disease. Doctors have assumed importance as providers of curative care; besides
this, they are also the ones who exert strongest control over medical technology, which
is ever improving and becoming more and more accurate.

Certain social conditions are essential for the existence of hospital. One such
condition is the requirement of people to get cured, and hence hospitals become
imperative in our society. Although in its current form, the hospital is a cure-oriented,
complex organization, the notion of treating patients and alleviating their suffering
which formed the foundation of the earliest hospitals, still remains the same. It would
be worthwhile to examine some definitions of a hospital, in order to understand it
better. A hospital is an image of physical buildings in which services are provided by a
skilled staff. Traditionally, hospitals have provided a focus for the delivery of
interventions requiring special personnel skills and equipments, monitoring of patients
for therapeutic reasons. Most part of health care, however, actually takes place outside
the hospitals, in clinics, medical offices, pharmacies, schools and homes. Hospitals, by
providing a technical focal point for the referred delivery of skills care, can enhance the
effectiveness of non hospital health care. The hospital, the major social institution for
the delivery of health care in the modem world, offers considerable advantage to both
patients and society. From the stand point of the individuals, the sick or injured person
has access to centralized medical knowledge and technology that will render treatment
which is thorough and efficient'. Although, hospitals are meant to provide care and
services, they are largely restricted to curative care. In fact, only serious illnesses are
given priority for hospitalization.

According to WHO 'the hospitals is an integral part of a social and medical

organization, the function of which is to provide for the population, complete health
care, both curative and preventive, and whose outpatient services reach out to the
family in its home environment; the hospital is also a centre for the training of health
workers and for bio social research' and 'an institution that provides inpatient
accommodation for medical and nursing care. In fact, the hospital is one of the
important institutions in maintaining and restoring the public health care systems i.e.,
the health of the people. It is responsible for correct diagnosis and appropriate
treatment. In general the major functions of the hospitals are 1) care of the sick and

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injured, 2) education of physicians, nurses, paramedical and other personnel, 3) public
health disease prevention and health promotion and 4) research. The primary function
of the hospital, the one that has been constant throughout the entire process of its
evolution, is care for the sick and injured. While other important functions have
developed, they are all subordinate and are recognized as a part or responsibility of a
hospital because they contribute indirectly to the care of the sick.

EVOLUTION OF HOSPITALS: A HISTORICAL OVERVIEW

The hospital as a social institution is of recent origin and is rooted in the modern
medical model. But the history of medicine and surgery dates back to an earlier age,
even when hospital as an institution were the sick can be taken for treatment was
absent. The existence of hospitals in today's times is a cumulative effect of human fear
of death and disease, and humanitarian values, coupled with civic consciousness and
religious zeal, which motivates people to establish and run hospitals for the benefits of
the population. If society has changed over period, human qualities such as caring,
curing love and compassion have remained much the same even today, for it was these
some fundamental reasons and emotions that led ancient people to build hospitals for
the sick and injured people in those societies.

Early Civilizations
The two major, ancient civilizations in India and Egypt respectively have proto-
types of modern day hospitals. One finds stories available in ancient literature about
physicians and their medical practices, which were made available to village people by
Buddha and his son Upatiso. It is believed that Upatiso built shelters for pregnant
women and diseased people. These examples were quoted very often to inspire the
followers of Buddha to furnish such shelter houses in each and every corner. However,
records pertaining to health practice are scarce. The historical significance of these
institutions is that it reveals the importance attached to the services rendered to people
suffering from various diseases. This reminds us of the nature of modern hospital,
which also considers these principles as the fundamentals. The hospital would provide
eatables and other medicines to the needy. These ethical and moral practices relate to
health care ethical principles of the earlier society. It is extremely difficult to know how
early humans reacted to diseases and how they were treated. Fossil remains such as
teeth and bones extracted from mummies, throw some light on diseases like arthritis,

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parasitic diseases, tumors etc. Early humans used religious rituals, prayers, magic
spells, exorcism, etc., to understand the reasons behind pathological problems.

Egyptian, Greek and Roman Hospitals

In early Egyptian, Greek and Roman civilizations the temples of God functioned
as hospitals. Egyptian physicians used drugs like peppermint, castor oil, opium etc., to
treat patients. Greeks used salt, honey and water from the sacred spring. Some of these
civilizations had planned cities with the objective of restricting the spread of contagious
diseases like malaria. During the Christian era hospitals of the Christian people replaced
the old temples. Church buildings and other building were also used for treatment
purpose. Medical practice in pre-industrial Europe was more of an empirical art aimed
at comforting and consoling the ill persons rather than curing them. Early medical
practitioners were apothecaries, barbers, surgeons and lay practitioners whose remedies
comprised of various flora and fauna. But the healing was limited to certain known
diseases and the rest remained as incurable diseases.

GROWTH OF TECHNOLOGY AND RISE OF HOSPITALS

The image that one gets of a twentieth century hospitals is one of a centre of
sophisticated medical technology. The first half of the nineteenth century is known
mostly for the growing importance of physicians and medical researches based largely
on clinical observations. Hospitals had existed for centuries but increased rapidly in
number during the 1800s in response to the massive migration into the newly
developing cities of the west. Communicable diseases were taking a heavy toll of
people's lives; many among the urban migrants contracted typhoid and TB. Admission
in the hospital was only resort that was available. These patients provided
unprecedented opportunity for clinicians and the researchers to observe the sick and to
search for the patterns in their symptomology, disease progression, and response to
medication.

In the beginning of the era of various diagnostic and therapeutic aids, a notable
development in the hospitals was Winthoven's invention of the electrocardiograph in
1903. This was followed by the first basal metabolism apparatus and then the
Wassermami test in 1906, and test for pancreatic function and urinary sugar in 1908.
Concurrent with this progress in the field of internal medicine was the introduction of

65
radium for treatment of malignant growth, increasing use of clinical laboratories for
microscopic examinations of the pathological tissue and developments in antibiotics.
The result of these varied new diagnostic and therapeutic aids was the conquest of
diseases formerly regarded as incurable, which in turn resulted in a notable increase in
public confidence and in hospital occupancy. A social service department also became
part of the hospital as a natural corollary to the outpatient clinic.

Technological advancements such as artificial heart valves and artificial blood

vessels, and other innovations have further revolutionized the health profession and the
institution of the hospital. Through such evolutionary processes the hospital has now
become the central institution that provides medical care. Because of the complex,
specialized and expensive technology and equally complex procedures that could be
only based in hospitals and the technological orientation of medical educational, both
patients and doctors have been pushed even closer to this centre of medical technology
and technological methods of cure". The steady expansion of scientific and
technological innovations has not only necessitated specialization among all health
professionals (physicians, nurses, and technicians) but has also required the housing of
advanced technology within the four walls of the modem hospital. Increasingly, the
hospital became a more curative oriented and individual patient-centric institution,
where all the medical knowledge and technology are focused on the individual patient
for providing better curative treatment. Hospitals and the personnel within these
organizations now started, evaluating their work in terms of the quality of service
provided to the patient, effective care and patient's satisfaction.

GROWTH OF HOSPITAL AND HEALTH/ MEDICAL SERVICES IN THE

COLONIAL PERIOD
The East India Company has instituted the Indian Medical Service (IMS) in
1764 and a medical officer was required to be attached to eveiy company, ship and to
the permanent trading outposts (factories) with their small standing garrisons. The
army, the main instrument of East India Company's political consolidation, was
primarily composed of Indian soldiers, the European component being outnumbered by
roughly eight to one (Imperial Gazetteer of India, Vol. IV, 1909, cited to Kakade,
1998). Mortality and sickness in the European army were mainly due to four major
diseases; fevers, dysentery, and diarrhea, liver diseases and epidemic cholera, which

66
assumed a virulent form when the troops were on inarch. And the troops were
constantly on the march due to the unsettle condition of the country.

The frequent outbreaks of fevers and cholera in various stations, districts and
cantonments affected seriously the British troops. This led Sir James Martin, who was a
member in the Council of India to propose a scheme, in which every medical officer
was required to send reports on the medical as well as health conditions of the people.
A better understanding of the various regions occupied by the army, their climate and
environment and disease pattern, would provide a basis for a more scientific selection
of sites for camps and cantonments, while regular reports on the sanitary condition of
barracks, hospitals and transportation would help in the formulation of guidelines for
sanitary improvements in the camps under Indian conditions. The events of 1857
highlighted the importance of British soldiers' health and efficiency. The health of the
soldiers, which became the primary concern of colonial health policy, remained an
abiding concern with the expansion of the British Empire; the army in India increased
in importance as the largest single force in the empire, and as a key instrument in the
security of Britain's Eastern possessions. "The main enemy of the British soldier in
India was not the Indian enemy but disease. The mid-19th century marked a watershed
in colonial health policy. The application of medical ideas for the control of disease
currently prevailing in the metropolis was for a long time directed exclusively to the
European civil servants and army establishments in India.

The health service system at the time of independence projected the political
economic and social values of the colonial rulers. Medical services were needed to
support the British army and the British civilian - personnel living in India. Later on,
medical services were made available to the native gentry who constituted a tiny
fraction of the total population. Among the rest, which was more than 90 percent of the
population, only very few could get some form of medical care from the extremely
limited number of hospitals and dispensaries run by government agencies, missionaries,
philanthropic institutions and private practitioners. Similarly, public health services
were provided only when there were massive outbreaks of epidemic diseases such as
plague, cholera and small pox. Personnel of the Indian Medical Science (IMS) and of
the British Indian Army played a key role in framing this colonial pattern of health
services of India. The IMS embodied all the shortcomings of the colonial medical

67
services. Firstly, its backbone was the Army Medical Corps which, in any case, did not
attract the cream of the profession. The armies, being a colonial one, it probably
inducted even more mediocre personnel than were recruited for the home army.
Secondly, and more important, this set of second rank professionals effectively held
complete sway over the Indian medical and health services. Within their ambit of
influence were the native professionals too, many of whom they patronized and
groomed on their own selves, to carry forward the tradition of the colonial medical
services.

Soon after, the East India Company also required hospitals to take care of the
white settlers working in trade or living in the settlements around trading ports and
factories. The company has set-up hospitals in the three centers of British power, trade
and commerce in the seventeenth and the eighteenth centuries Bombay, Madras and
Calcutta. The first British hospital in Madras Presidency was established at Fort St,
George in 1664, which was meant exclusively for the British population. In Madras, the
second hospital was constructed with public subscription, at a cost of 838 pagodas
(about Rs.3000). The company acquired this hospital and built their hospital in 1690. It
was founded at James Street in the fort with a beautiful building costing about 2500
pagodas in the Tuscan style. A century later in 1772, British constructed another big
hospital called Madras General Hospital. The reconstruction of the hospital's entire
building was completed in 1859.

It was for the first time in history that the native Indians could have access to
these western hospital services, with the possible efforts of Assistant Surgeon John
Underwood. The hospital for the care of the native poor was built at Purasawakkam, a
southern suburb of Madras in 1799. The hospital was named as "Native Infirmary" and
brought under the authority of the medical board. In the early part of the 20th century,
the government took over the management of the 'native infirmary' hospital. A new
hospital with 266 beds and an auditorium was constructed. The native infirmary was
later named as Stanley Hospital in 1940. It had a bed strength of 1000 and catered
chiefly to the poor population of Madras and its suburbs.

68
 Pondicherry was the headquarters of the French on the eastern coast of India,
where the French established a hospital in 1701 for French troops and civilians. The
hospital continued serving the people till the twentieth century, when the French left
India; the Indian government took over and upgraded this hospital, changing its name
into Jawaharlal Nehru Institute of Post Graduate Medical Education and Research
(JIPMER). Meanwhile, the British had consolidated their power strongly during 18th
century, especially in the province of Bengal. In 1707-08, the first hospital was started
by the British government at Fort William of Calcutta, under the authority of Governor
General Robert Clive. A second hospital was started in a temporary building inside the
old fort in Calcutta. The old Fort was later converted into a custom-house, making it
imperative to construct a new hospital inside. Subsequently a third hospital was built in
1769, known as the Presidency General Hospital. These hospitals primarily served army
men and sailors and also admitted Europeans of all class and callings.

It was almost 300 years after the consolidation of their rule that the Britishers
built a hospital which was actually meant for the care of the native people. This hospital
was established in Calcutta during 1792 and 1793 and was later called as Medical
College Hospital. It was inaugurated on 1st April 1838, as a small hospital with thirty
beds and an OPD, to provide clinical instruction to students of the new college. By
1853, the hospital has expanded to 500 beds, accommodated within twenty-four wards.
The hospital also contained a ward for women and children, an obstetric ward and an
ophthalmic ward too. It was the first hospital that admitted both European and native
Indian patients.

British control over Calcutta got diverted as Bombay developed on western

coast, making it the stronghold of British rule in the late seventeenth century. In 1676,
British constructed the first hospital in Bombay. By 1784 three more large hospitals
were erected in Bombay one for Europeans within the gates of the Fort, another on the
Esplanade for sepoys and the third for convalescents on the adjacent island. By mid
nineteenth century, the number of hospitals grew in Bombay. The foremost among them
was JJ Hospital at Byculla, established with donation form Jamshedjee Jeejeebhoy and
East India Company in 1843. The hospital was actually opened in 1845 to the people.
To commemorate Sir Robert Grant who concentrated his efforts to uplift the native poor
in his Presidency, a foundation stone was laid on 30th March 1843. The hospital was

69
completed in October 1845. Just five months after the JJ Hospital opened to the poor
patients of Bombay, Grant Medical College was affiliated to it. Thereafter, both Grant
Medical College and JJ Hospital functioned as one of the great institutes, combining the
pursuit of science with service and care of the sick. After the foundation of JJ Hospital,
numerous other hospitals were established by philanthropist in consultation with the
government in Bombay. The foundation stone of the building of St. George's Hospital
was laid on 22nd February 1889 at Old Fort George and the Bai Motilal Obstetric
Hospital was founded on 9th March 1889. Though hospitals services were made
available to the native people, monopoly over dispensing the medical services were
made available to the native people, monopoly over dispensing the medical services
still lay with the British. They had monopoly over recruitment in the government
medical institutions, especially as teaching faculty. The Indian doctors were largely in
private practices, as their entries in the government hospital were restricted. The GS
Medical College and KEM hospital come up in defiance against the British-managed
Grant Medical College and JJ Hospital. The most important condition for the
endowment for KEM was that all members of teaching faculties should be well
qualified Indians not in government service. The college opened in June 1925 and was
affiliated to Bombay University in 1926 for the MBBS degree. In the beginning of the
twentieth century, hospitals were built in large numbers in various places in central
India, like Hyderabad, and in north India as in Delhi, Agra and Indore. By 1912 there
were as many as 2670 medical institutions in India, which treated about 2,78,89,469
people as OPD patients and about 4,53,900 as indoor patients.

ROLE OF PROFESSIONALS IN FUNCTIONING OF HOSPITALS

The major function of the hospitals is that of curing, of healing sick people and
managing diseases and other disorders of the human body. It also has a variety of other
health-related functions like training health practitioners, providing laboratory and other
medical facilities, and executing preventive medical programs to enhance the health of
the community. Within the hospital patient related tasks can be divided into two parts
(I) treating/managing diseases and illnesses, and (2) administrative or managerial jobs
of the hospital. Each of the four major categories of personnel, doctors, nurses, Para -
professional and social workers play a crucial role in the functioning of the hospital.

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Physician
The physician is a key person in the functioning of a hospital whose main
responsibility is to cure the patient by diagnosing the illness of the patient. In order to
carry this job the physician takes assistance from other professionals in the hospital, by
co-coordinating, monitoring and supervising the treatment processes along with the
other support staff. The physician also looks into administrative functioning of the
hospital, where she/he assists in overall management of the hospital. Physicians also
play an important role in formulating policy decisions of the hospital.

Nurses
Next to the doctors, the nurses play a significant role in the hospital. Their job is
to implement/execute the course of action prescribed by the doctor, such as dispensing
the medicine and monitoring the patient's conditions in the present context they to
handle a lot of technologies. They provide bedside care, such as making beds, cleaning
the sick person, etc. Apart from this, they also supervise the work of their sub-ordinates
as well as assist in certain kinds of administrative work. Nurses rank second in the
hierarchy of professionals in the hospitals.

Paramedical Staff
They are the medical experts in various fields of medical technology, which are
used for effective diagnosis and, at times, therapy and management. Their main job is to
assist doctors in accurate diagnosis of disease by conducting various technical tests.

Social Workers
The main responsibility of the social workers in the hospitals is to locate the
patient's disease within the socio-economic and environmental context as against the
clinical approach of the hospital. They help the patient to adjust to the socio-
psychological conditions of the diseases, and also look into the preventive, promotive
and rehabilitative aspects of health care.

Administrators / Management
The administration section forms another important part of a hospital's function.
Other than administrative matters this section looks at the maintenance of the hospital,
provision for the non-medical needs of patient care, management of the financial affairs

71
etc. While the medical staff overseas the therapeutic programmes. The administration
defines the medical staffs official powers, standardizes the hospitals administrative
procedure and establishes a level of quality for the hospital's medical services. They are
responsible for coordinating the work of all hospital personnel.

Sensitivity. CRM in a hospital is a business strategy to manage customers to

optimize long-term value. CRM requires a customer-centric business philosophy and
culture to support effective marketing, sales, and service processes. Building
relationship with customers can be easy but maintaining the built relationship is a must.
CRM is a "chain relation" triggered by new strategic initiatives rather than by that
which one can initiate at work process, or worse yet, at the technology level. In view of
acute competition in the private hospitals, it is definitely one of the competitive
advantages of the hospitals for survival. The effective CRM depends on the level of
customer satisfaction for which a customer is ready to pay a price premium for
customized services.

SERVICE QUALITY AND PATIENT'S SATISFACTION

The service quality has become the success mantra in all sectors ranging from
health care to retailing. The need for understanding the service dimension of each sector
is extremely essential as it forms the basis of evaluation of service itself. If the service
provider is able to comprehend customer's evaluation criteria and designs its service
strategy accordingly and executes it, then the efficiency level is enhanced, resulting in
customer's satisfaction. This is the ultimate objective of all the service providers, as it is
proved by earlier researchers that getting new customers is time consuming and
involves higher costs than retaining the existing customers. This idea is expressed in an
interview with James L. Schoor, the then vice president of marketing at Holiday Inns.
Marketing can be thought of as a bucket and marketing activities like planning and
communication bring business that pour in to the mouth of the bucket. However, there
is one problem, i.e., there is a hole in the bucket. When all the service procedures are in
line, then the hole is insignificant and veiy few customers are lost. When service
standards drop, the customer drop out is more than the capacity to fill it back. This leads
to considerable fall in business revenue. The idea is to fill the hole by increasing
services standards.

72
 This study makes a modest attempt to determine the service quality, which
stands as the basis for evaluating the patient's satisfaction. The service quality is viewed
at two dimensions, namely, external service quality and internal service quality. The
service quality has great impact on patient's satisfaction in hospital industry.
Parasuraman, Zeithaml and Berry (1985) have identified five gaps. They are:

Customer Expectation-Management Perception Gap

Management Perception-Service Quality Specification Gap
Service Quality Specification-Service Delivery Gap
Service Delivery-External Communication Gap
Expected Service-Perceived Service Gap

Quality in service is very essential especially for the growth and development of
service sector business enterprises (Powell, 1995)2. It acts as an antecedent of patient
satisfaction (Ruyter and Bloemer 1995) . hi the past, quality was measured only for the
tangible products as service sector was not contributing much to the economic growth.
Today, services sector has been the major contributor to country's GDP and as a result,
the measurement of service quality has become important. Hospital is essentially a
customer oriented industry and there is close interaction between service provider and
the patient in the traditional hospital scenario. The hospital industry faces lot of
challenges as marketing of services differs from goods marketing in the following
respects: The service is intangible and heterogeneous. Production and consumption
takes place simultaneously and it is perishable. Therefore, marketing of services is an
uphill task the banks and have given rise to the need for new concepts and approaches
for marketing and managing service businesses.

External Service
Quality/Service Quality

External service quality offered to customers is generally referred to as service

quality. Yogeswari Phatak & Abidi (2000) indicated that external service quality which
refers to quality of service delivered to customers has gained importance in the light of
increasing customer which expectations and changing customer preferences. The term
"external service quality" has been defined by many researchers and all focus on

73
meeting customer needs and requirements. For example, service quality is considered as
a measure of how well the service delivered matches customer's expectations or
providing the customer with what he wants it and at acceptable cost within the
operating constraints of business. Delivering quality service to customers is a must for
success and survival in today's competitive scenario. Therefore, service marketers need
to understand the different dimensions of service quality used by customers to evaluate
their service quality.

Measurement of External Service Quality

Different researchers have different dimensions to measure service quality.
Garvnin (1984)6 has identified performance, features, reliability, conformance,
durability, serviceability, aesthetics and prestige as dimensions of service quality.
Driver and Johnston (2001)7 have considered the following attributes as different
dimensions of service Quality: Attentiveness, care, courtesy, flexibility, friendliness,
reliability, competence, integrity, access, availability and functionality.

Measurement of Service Quality using SERVQUAL Model

Most of the researchers have made use of the dimensions identified by
Parasuraman, Zeithaml and Berry (1988) in the SERVQUAL instrument developed by
them. They identified ten dimensions of service quality, namely, access,
communication, competence, courtesy, credibility, reliability, responsiveness, security,
tangibles and understanding the customer. These dimensions were later defined into the
following five generic dimensions into the quality measurement model, SERVQUAL.
The five dimensions are: Reliability refers to 'delivering on promises'; Responsiveness
means, 'being willing to help the customer'; Assurance refers to 'inspiring trust and
confidence in customers by the employees of the service provider'; Empathy means,
'treating customers individually'; and Tangible represent's the physical aspects of
service.

The biggest management challenge in the new millennium of liberalization and

globalization for a business is to serve and maintain good relations with the king the
customer. In the past, producers took their customers for granted, because at that time
customers were neither demanding nor they have many alternative sources of supply or
suppliers. Since the customer was passive customer, the producer dictated terms and

74
had very little customer commitment. But today there is a radical transformation. The
changing business environment is characterized by economic liberalization, increasing
competition, high consumer choice, enlightened and demanding customer, more
emphasis on quality, value of purchase etc.

All these changes have made today's producer, shift from traditional marketing
to modem marketing. Modem marketing calls for more than developing the product,
pricing of the product, promoting the product and making it accessible to target
customers. It demands building of trust, a binding force and a value added relationship
with the customers to win their hearts. The new age marketing aims at whining
customers permanently forever, by respecting the customers, creating products to suit
their needs and developing life time customers through the principle of customer
delight, approval and enthusiasm. Patient's needs are the driver for efficient hospital
services. Personal contact and relationships are very important in healthcare
environment. As there is lot of potential demand for healthcare in the present scenario,
healthcare is considered to be a sunshine industry. Presently, the perception of an
individual on health has transformed from health consciousness to more health
consciousness sensitivity. CRM in a hospital is a business strategy to manage customers
to optimize long-term value. CRM requires a customer-centric business philosophy and
culture to support effective marketing, sales, and service processes. Building
relationship with customers can be easy but maintaining the built relationship is a must.
CRM is a "chain relation" triggered by new strategic initiatives rather than by that
which one can initiate at work process, or worse yet, at the technology level. In view of
acute competition in the private hospitals, it is definitely one of the competitive
advantages of the hospitals for survival. The effective CRM depends on the level of
customer satisfaction for which a customer is ready to pay a price premium for
customized services.

PATIENT'S RELATIONSHIP MANAGEMENT IN HEALTH CARE

INDUSTRY

Patient's relationship management (PRM), which has over riding significance

for any business, is no less significant for hospital services. Hospitals arc the most
important element in any healthcare delivery system. A hospital plays a major role in

75
maintaining and restoring the health of the people. Care of the sick and injured,
preventive health care, health-related research and training of medical and paramedical
staff, are general broad functions of a hospital. It involves both outpatient and inpatient
hospital services and on many occasions, emergency medical services are included. An
important resource in a hospital is the human resource. This should be particularly
emphasized in the context of a hospital since relationship of medical staff plays an
important role in treating patients- the hospital customers. Following the growing trends
towards corporatization and privatization of health services, patients and society at
large, have multiple choices to choose from. The hospitals should maintain a high
degree of transparency and accountability in their services, as only then patients will
develop durable relationship with them. In the health care, PRM practices should
become one of the key strategies for efficient hospital services. PRM practices are
essentially patient-focused strategies that involve effective management of hospital
interface and interaction with patients.

Effective PRM practices in a hospital may mean, providing service related

information to patient very quickly, responding to the patient's appointment and
admission requests, promptly, dealing with patients, and extending the best of care and
courtesies to the patients. One possible way through which a patient can be kept
satisfied and informed is that the infrastructure, personnel in the hospitals with whom
the patient has frequent interface, should be trained well to answer the general queries
of the patients.

Patient's Relationship Management (PRM) is a business approach that integrates

people, processes and technology to maximize the relations of an organization with all
types of customers. The true value of PRM is to transform strategic operational
processes and business functions in order to retain customers and increase customer
loyalty. PRM practices for hospital services, can be described as organized endeavors to
establish and improve relationship between the hospital and the patient and his/her
relatives, with the twin objective of assisting the patient; and the hospital to enjoy a
good reputation in the community. PRM practices also have a major implication for the
vision, mission, values, culture, and processes and services structure of a hospital. PRM
practices not merely relate to just being nice to the patient, these arc concerned with
providing service of the highest degree with uncompromising sincerity. Normally, more

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cordial relationships can exist where patients can have more frequent and personal
contact. PRM strategies can help hospitals, to enhance many of their relationships with
patients and their relatives and stakeholders like hospital administrators, medical and
paramedical staff, and the community at large. The PRM in hospital should be seen as a
strategy to serve, satisfy, retain and attract patients. The PRM could be viewed as the
hospitals' wide growth strategy aimed at knowing and servicing the patients by using
the latest technology to create a personal, caring and service-oriented interface.

Hospitals' customers include not only individuals but also the organizations,
which engage them for a periodic health check up/maintenance of the health of their
employees. It is important that hospitals should pay due attention to the PRM practices
to retain individuals and the organizations that they serve. Delivering value is like
building a block of relationship. Value is not just the price of the service delivered or
discounts offered. In fact, the patient's perceptions of values are based on a number of
factors that include quality-of-service, ease-of-delivery without hassles, speed,
responsiveness, flexibility and service excellence. Hospital administration should
endeavor to improve hospital productivity and reduce cost while improving or
maintaining service quality at the same level. PRM strategies, being one of the key
issues in hospital management, should include solutions with an array of system,
software and professional services that should help hospitals in providing immediate
attention and assistance. The major concern in PRM practices in hospitals is the quality
of outpatient, inpatient and emergency services. The entire hospital staff, should be
proficient in PRM practices, and should be a friend, philosopher and guide to the
patients. It is important to have cordial doctor-patient interface and a durable hospital-
patient relationship. Hospitals deal with human beings under stress and strain, and
hence it is important that there is no gap between supply and demand of facilities either.
Medical and Paramedical staff should not be merely experts in their profession but they
should be available in an optimum number. Certain other very vital hospital resources
like the beds in wards for inpatient services and ambulance fleet for emergency
services, should be provided in adequate strength which along with adequate medical
and paramedical staff size, help in building a deep and abiding hospital-patient
relationship.

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EMERGENCY MEDICAL SERVICES AND CRM

The word emergency is derived from Latin word "urgons" which means urgent.
Medical emergency (casualty) is a situation in which a patient needs urgent and high
quality medical care. Emergency services should be available 365 days a year and 24
hours a day. The foremost requirement of emergency services is that it should be done
without any delay. The CRM practice in emergency service implies that the patients
should be brought to the casualty from the patient's home/site with a minimum possible
response time and should be attended with a minimum possible delay. Patients of
cardiac problems, strokes, and fires in high-rise buildings accidents, building collapse,
natural calamities, or any critical health conditions are dealt with in emergency medical
services. In most hospitals, ambulance service operates under direct charge of the
Emergency Department. The standards of service here should not fall below patient's
expectations. After an ambulance brings a patient to the hospital, the Emergency
Department provides round-the-clock service and the prescribed treatment. When the
patient is brought to the examination room, a doctor on duty on emergency basis should
examine him. Later, the specialist's advice can also be sought depending upon the
nature and severity of the patient's condition. Patients not requiring any admission are
treated here and following recovery discharged immediately. Patients needing further
treatment are sent to the concerned emergency ward, and those needing observation are
sent to the observation ward/ 1CU. Nurse /ambulance personnel assigned to receive
calls in Emergency Department for dispatching ambulances should be experienced
enough as a desirable CRM practice to distinguish between a symptom that can wait for
a doctor's appointment the next day or one for which the ambulance needs to be
promptly dispatched for immediate treatment. Ambulance alarm and communication
system is thus an important CRM feature of ambulance service, which helps to
minimize the delay.

HOSPITAL RELATIONSHIP MANAGEMENT

Management of hospitals thus draws attention on planning, organizing, staffing,

directing, communicating and controlling a social institution professionally which
makes available to the patient's quality Medicare services at an affordable price. It also
gravitate attention on managing the functional areas of hospitals with the motto of

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serving the society, such as management of material, management of human resources,
management of finance and management of marketing.

Hospital management is an aggregation of two words - "Hospital" and

"Management. It is managerial process of practicing the principles of management. It is
a social process because it is also considered that hospital as a social institution. It is
based on the holistic concept of management that necessitates sub serving of social
interests. It is a science and more so a profession because the hospital
managers/administrators need proper education and training for achieving perfection. It
is the management of an organization which is not supposed to make profits. It is based
on professional excellence where an administrator is required to blend optimally the
core and peripheral services.

INTER-DEPARTMENTAL ANDINTRA-DEPARTMENTAL RELATIONSHIP

For the efficient management of an organization, it is pertinent that personnel

working in different capacities in the different departments make possible friendly
relations. Superiors would remain superiors even if they arc not influenced by ego. The
moment we find superiors acting like a superior and behaving like an
officer/administrator, the possibilities of degeneration in the relationship can't be over
ruled. Because we find the services of hospitals based on a team-work, it is essential
that all the personnel irrespective of the rank and position they hold make sincere and
honest efforts to accomplish the organizational goals. The superiors are successful in
developing a sense of affection in the subordinate's success in generating a sense of
respect among the subordinates. It we turn our eyes on the workings of government
hospital in particular; this dimension of relationship presents a very gloomy picture.
The superiors fed themselves superpowers; they hardly assign any weightage to the
instrumentality of low echelon of employees in discharging their responsibilities
efficiently. It is against this background that we find degeneration in the departmental
relationship. Even intra-departmental cooperation is found nonexistent then what to talk
of the inter-departmental relationship. This makes it essential that the hospital managers
assign an overriding priority to this dimension and make best of their efforts to make
the relationship friendly, cohesive, sweet in which albeit the difficult tasks are
performed successfully.

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PATIENTS' EXPECTATIONS FROM HOSPITAL SERVICES

To initiate a comprehensive understanding of building relationships between

suppliers and operations personnel within the hospital services to result in excellent
CRM, the following expectations of the patients have been listed.

PATIENT'S EXPECTATIONS FROM A HOSPITAL

• Proximity, central location

• Clean environment

• Comfortable lobby seating

• Adequate space in patient rooms

• Attached toilets in the patient rooms with a geyser facility

• Pure filter water availability

• Timings to suit their requirements

• Lift services and Laundry services

PATIENTS' EXPECTATIONS FROM HOSPITAL PERSONNEL

Some of the visible hospital personnel include doctors, nurses, attendants, reception
personnel, billing personnel, ambulance personnel, and diagnostic report division
personnel. These are the people with whom the patients have an immediate bearing.

FROM DOCTORS

 To be an expert in the field

 To be gentle, a confidence booster and easily approachable
 To be able to explain the problem in common terminology and put the patient at
ease
 To be tidy and smart
 To be able to justify the need for running the numerous diagnostic tests.

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FROM NURSES

 To be gentle, cheerful, helpful and friendly

 To be tidy and be able to answer simple queries pertaining to the disease
 To understand the need for privacy of the patient

FROM EXECUTIVES

 To be able to guide patients to respective divisions

 To be well groomed and courteous
 To be able to handle rush hour situations
 To be able to give a user friendly bill
 To have technology and procedures which is customer focused?

The expectations of the patients have assumed such a form that the healthcare
industry has to establish a productive contact with the outside suppliers who have been
responsible for the supplies of tangible items.

OUTPATIENT SERVICES AND PRM

Hospital management is incomplete without caring for the outpatient services.

An out-patient service is one of the most important departments, which determine the
hospital image, provide diagnostic, curative, preventive and rehabilitative services. It is
not uncommon those OPDs are overworked and that the patients have to spend
considerable part of their time waiting at different places. If OPD services are managed
effectively, it will result in cost reduction to the hospital, less strain on hospital resource
and at the same time would be more economical and satisfactory to the patient and his
relatives.

It is estimated that one short-term inpatient cost is equal to 20 outpatient

consultations. The first interface of the patient or his/her relatives with the hospital is
the hospital reception / the enquiry counter, which is also, involved with registration
and admission formalities. The relationship founded at this point will go a long way in
building the overall positive image of the hospital. The PRM practice up to this stage
involves the procedures to sec that the patients arc properly received and courteously
guided about the investigations that arc being contemplated.

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INPATIENT SERVICES AND PRM

The inpatient service is an important element in healthcare delivery, which is

provided in hospital wards, which can be of general type like male, female wards or
specialty wards. Specialty wards can include maternity wards, isolation wards, or wards
for patients who need hospitalization in particular specialties such as orthopedics,
pediatrics, psychiatry, etc. Intensive Care Units are essentially the wards for critically ill
patients. During patient hospitalization, medical and nursing staff should extend utmost
personalized care to the patients undergoing treatment. In maintaining PRM practices at
this stage, support services like dietary, linen, housekeeping, pharmaceutical services,
etc, should be kept up to the mark, which can go a long way in enhancing patient
information to patients for their adequate understanding of treatment options, risks
involved in various procedures, duration and the likely expenditure for treatment. All
possible queries, doubts, apprehensions and precautions should be examined, prior to,
during, and after any procedure of surgery which should be explained and clarified in
simple layman's language to the patient. In addition some of these explanations can be
given in the form of leaflets or brochure. Patient's fears should be allayed by the
attending doctors. Nonverbal communications such as facial expressions, eye contact,
pleasing gestures, and a comforting touch helps in building up this relationship which
can help in providing anxiety free stay for the patient in the hospital. Nursing services
are vital aspects of PRM practices, which should be properly maintained. In inpaticnt
service, nurses play a major role in building strong relationships with patients. A cordial
behavior and congenial relation are some of the main aspects PRM practices in nursing
care. The housekeeping staff helps in keeping the hospital clean & tidy. Many of them
come in direct contact with the patients. Their services are important aspects of PRM
practices as their activities contribute directly to the patient's comfort and peace of
mind. During the patients stay in the hospital, his physical comfort contributes greatly
to his progress. Hence, maintenance services assume considerable significance in
hospital PRM practices. The maintenance crew is expected to attend to the complaint as
early as possible, diagnose the fault, and rectify it. Hospital security, apart from security
responsibilities, also has a role affecting welfare and happiness of the patients in many
ways. They should be more flexible than the traditional security system in all
organizations as they often need to allow entry of relatives when they find them in

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overriding distress. Availability of beds is a very important resource for any in paticnt
services on which planning of all other resources depend.

RELATIONSHIP

Sound management of behavior makes the ways for friendly and harmonious
relations, a prerequisite for efficiency-generation. The hospitals where we find a team
work, it is pertinent that the hospital managers make sincere efforts to improve
relationships. Since the hospital personnel bear the responsibility of serving the
patients, it is essential that hospital personnel in general are found liberal to the sweet
relationships with the patients. This draws our attention on the first dimension of
relationships where we go through the problem of improving relationships between
hospital personnel and the patients. The second aspect in the very contest is related to
the relationships among the different categories of hospital personnel. The inter-
departmental and intra-departmental relationship is found important in the very context.
The superiors bear the responsibility of behaving decently with the superiors as well as
with the subordinates. At the same time, it is also important that subordinates have a
sense of respect for the superiors. This is related to the departmental relationships. The
last dimension of relationship is related to the relationships of different categories of
hospital personnel with the management.

HOSPITAL PERSONNEL - PATIENTS RELATIONSHIP

We classify the relationship of hospital personnel with the patients in two parts,
viz., Doctor-patient Relationship and Nurse-patient Relationship.

DOCTOR-PATIENT RELATIONSHIP

The doctors have expertise or specialization in a particular discipline. They have

professional excellence and are also supposed to have ethical and human values. The
patients on the other hand are found in stress with high level of expectations because
they consider doctors thoughtful and warm person and committed to do everything for
the welfare of patients. Such a situation increases the responsibility of doctors. It is
his/her professional excellence, personal-touch-in-service, humanitarian approach,
ethical values that play a big role in the satisfaction of patients. It is also right to
mention that unlike western countries, the patients in India feel that doctors bear the

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responsibility of serving them in all the conditions. We can't deny the fact that such a
perception is on account of the constitutional barrier because in the Indian context, the
medical attention is claimed as a fundamental right Since the concept of
commercialization of Medicare services is yet to be practiced in the Indian hospitals,
the doctors need to discharge their functional responsibilities very carefully. There arc a
number of factors to be taken into consideration while studying the problem of doctor
patient relationship.

NURSE-PATIENT RELATIONSHIP

Another important fact of hospital personnel-relationship is the nurse-patient

relationship. Of course we find degeneration in the perception of relationship in the
field of medical care services but we can't negate the fact that till now this dimension of
relationship is found well protected. Except a very few, we find all of them working
with a sense of dedication and devotion. They are professionally sound and personally
committed and it is due to the fact that the government hospitals in particular are found
existent despite of a number of odds. If the nurses and sisters start working with a
negative attitude; the government hospitals would of course become non-existent. If
there is something left in the government hospitals, it is due to their commitment to
profession. It is in this context that we can find it an important point for the
development of relationship.

RELATIONSHIP WITH SUPERIORS

The hospital managers bear the responsibility of implementing the policies for
the development and smooth functioning of the hospitals. This increases his/her
functional responsibilities. The top-level management fixes accountability of good-
patient care to the hospital managers. This in a very natural way makes it essential that
on the basis of coordinated efforts he/she is in a position to make available to the top
management the necessary feedback. Since we find the senior doctors as a lever spring
of a hospital, the hospital managers by their action and behaviour need to be careful that
they don't feel themselves neglected. Whatever the strategic decisions are to be taken
up, the hospital managers need to consult them and to assign due weightage, to their
valuable solutions. Whatever the constrains they feel, the hospital managers are pledged
to remove them so that the time honored and quality services are made available to the

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users. Our behavior profile makes the ways or makes it difficult to accomplish or not to
accomplish the organizational goals.

RELATIONSHIP WITH PEERS

The hospital managers in this context are required to improve their relations
with peers or colleagues. It solicits cooperation or needs to extend cooperation. The
relationship with peers assumes a place or outstanding significance. In their day-today
dealings, the exchange of cooperation plays an incremental role which is found
instrumental in increasing the level of efficiency.

PATIENT RELATIONS APPLIED TO SUPPORT SERVICES

Irrespective of the size or category of the hospital, it is a recognized fact that all
support services form an excellent complement to the services of the medical fraternity.
The support services are:

 Nursing
 Security
 Food and Beverage
 Maintenance and Engineering
 Pharmacy
 Biomedical
 Stores
 Transport
 Pest Control
 Medical Records

These support services are responsible for the welfare of the patient, sometimes directly
and many times indirectly. They interact and provide comfort and an anxiety-free stay
for the patient in the hospital.

DEPARTMENTAL RELATIONSHIP AND GOOD-PATIENT CARE

Good patient care is the target of a hospital manager and if we find something
wrong in the relationships, it is to influence the quality of Medicare services. The
services offered by a hospital arc found based on a team work which is related to the

85
different types of services offered by the different departments. The interdepartmental
or infra-departmental relationships make possible coordination and the results are good-
patient care. Contrary to it, if we find conflicts of different types among the different
categories of hospital personnel, even if the hospitals have high potentials of offering
the world class services, a gap between the services assured and services offered can't
be denied. It is against this background that we find it an important area of study
requiring due attention of hospital managers.

PATIENT RELATIONS IN HOSPITALS

Patient relations is a planned effort to establish and improve degrees of mutual

understanding between the hospital and the patient and his relatives, with the primary
objective of assisting the patient and the hospital to deserve, acquire and retain a good
reputation. It is a way of developing reciprocal understanding and goodwill, which is
one of the essential components of the organizational activities and services rendered by
a hospital. Just as cosmetic surgery beautifies the face or other parts of the body, patient
relations enhances the various activities carried out in a health service organization,
such as a hospital, nursing home, or even a single practitioner's clinic.

Awareness regarding a scientific and professional management of patient

relations in hospitals has still not reached the level it should have by now in India. High
quality patient care is the result of not only medical expertise, modern equipment,
nursing care and drugs, but also of the efforts of a well motivated, disciplined and
highly professionalized patient relations department. Patient relations is not 'just being
seen to be nice' to the patient, because a hospital serves people who are sick and their
attendants and whose nature and outlook are different from people going to other
organizations. Hence, it is not enough to be just nice or polite; the person concerned
with patient relations should provide service of the highest degree with
uncompromising sincerity. Hospitals deal with human beings under stress and strain,
and the treatment and comfort provided by even the best of doctors and nurses cannot
be able to completely fill the gap between their suffering and its alleviation. Hence, it is
necessary, particularly now, in view of changing societal demands and attitudes, that
specially trained professionals are available to eliminate the gap. In our country, there
are several agencies providing health services, such as governmental, non-
governmental, missionary, voluntary bodies, philanthropic groups, etc. The Indian

86
government has recognized, as stated in the Constitution, that 'the health for a citizen
is a fundamental right'. It was mainly government agencies which provided health
care to about 70 per cent of the population prior to Independence. The commitment was
limited, due to disproportionate workload, limited manpower and other resources. As
such, the finer aspects of hospital services, such as the doctor-patient relationship and
patient-nursing care services were limited.

It is only during the last two or three decades that a different view of health care
services has come into vogue, and slowly recognition of the finer elements of patient
care - such as medico-social services, patient care relations, patient guidance
counseling, etc., have been introduced into hospital activities. These services, additional
to their apeutics, have been increasingly recognized mainly by private and corporate
hospitals. In the beginning, these special services were considered secondary, or of
minor importance. But, in the last one decade, with the advent of high-tech treatment,
and with the corporate sector entering the health care industry, the importance of patient
relations has been duly recognized, and a certain amount of professionalism has come
in. Now this trend has been accepted with some vigor and vitality, giving more
importance to patient relations in hospitals. However, much still remains to be done,
and there is immense scope for the development of patient relations in hospitals,
particularly in large ones.

Another aspect in support of these arguments is that in our country there is a

growing awareness and demand now among the public that the medical and health
services they receive must be explained to them.

INTER - PERSONAL COMMUNICATION

In a hospital, big or small, even a brilliant doctor cannot possess appropriate

communication skills. There arc very few people belonging to the medical fraternity
who are brilliant doctors and also convincing conversationalists. People belonging to
the older generation say that some very successful doctors of their times were very good
conversationalists. They also say that half the suffering and pain of the patient was
relieved by speaking and listening to such doctors. This is an example of the good
patient relations practiced in those days. It is believed that a doctor should not only be
good in the practice of medicine, but he should also be an excellent human being -

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sympathetic, kind and understanding. It is now relevant and imperative, in every
hospital, to develop and practice good communications, keeping in view the advantages
of developing a good doctor - patient relationship, and also a good hospital - patient
relationship, which ultimately results in a satisfied patient.

PROCESS AND PRACTICE OF PATIENT RELATIONS

The role of interpersonal relations in any field of human activity is of utmost

importance. This is one of the important processes that every civilized human being
passes through, day in and day out. Human values are also enhanced when skills of
interpersonal relations are used in daily life, and in one's dealings with one's family,
profession and everyone else - a simple example, saying 'Good Morning1 with a smile,
to anyone, one meets for the first time in the morning will bring cheer and a lot of good
feeling to both. The day begins bright and warm. Even without our being aware of it,
we perform several interpersonal activities in our daily life. Many of these small or
large gestures bring goodwill and help maintain cordiality. An exchange of pleasantries
always brings rapport with one's fellow human beings.

The major concern in the concept of patient relations in a hospital is patient

care, irrespective of the size or category of a hospital, and is applicable to all levels
within it. Hospital staff faces challenges from different quarters, and also hostility from
ailing patients and their anxiety-stricken attendants. Patients, since they are suffering,
need all the sympathy, empathy and unstained support they can get. Hence, the hospital
personnel should put in all their efforts into relieving the pain and anxiety of the
patients, and help them resolve their problems. As a matter of fact, every employee in a
hospital, right from the ward boy to the top level administrator, should be proficient in
patient relations, and should be a friend, philosopher and guide to the patient, whose
welfare, comfort and satisfaction should be the only concern of all hospital personnel.
The people or groups of people, who interact with the patients, and/or their attendants in
the hospital, are listed below:

PATIENTS / ATTENDANT - INITIAL CONTACT POINTS

 Reception / Enquiry
 Casualty / Emergency
 Out-Patient / Consultation Room of the Doctor

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 Usually the first contact point is of paramount importance from both the patients
and the hospitals point of view. Hence, it is essential that personnel in the enquiry and
reception offices should endeavor to guide and direct patients, to the best of their
ability, with utmost care, patience and empathy. It is better if a doctor with experience
and maturity cares for the patient's well-being and peace of mind, trains and heads the
front office, which typically includes the reception, registration and admissions
formalities. Some basic knowledge of the activities of various departments and
laboratory services would help in providing service acceptable to the patient. The
relationship founded at this point will go a long way in building a positive overall
image of the hospital. The first impression is the best impression.

SERVICES PATIENTS/ATTENDANT—LABORATORY AND DIAGNOSTIC

This step is also equally importance because the patient's future stages of
diagnosis and plan of treatment depends on and begins here. The role of patient
relations at this stage is that the patient should be properly received, courteously treated,
and if needed, he/she should be briefed all about the investigation(s) that are being
contemplated. One simple sentence, "I am sorry, but I have to give you a small prick
and cause pain, but it will not last long, and it is for your good", uttered in a polite and
friendly voice will go a long way in keeping the patient relaxed and ensuring his/her
full cooperation.

PATIENT / ATTENDANT - TREATMENT

 Doctor
 Nursing Staff

Everyone in hospital service should realize that this stage in patient relations is
the most important of all services. Any amount of effort expended at this stage is less,
unless one can 'delight' the patient. Hence, an appropriate and a well-designed training
program for creating good patient relations is necessary for both doctors and nurses.

PATIENT / ATTENDANT — SUPPORT SERVICES

 Housekeeping
 Food and Beverages

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  Pharmacy
 Maintenance
 Billing
 Transport Services

It has now been realized and recognized that the role of support services is not less
important, and is as essential as doctors and nurses. In building proper patient relations,
support services play an equally importance role, and as such, an appropriate and well-
designed training program is essential for them. Their interaction, directly or indirectly,
has a definite bearing on the final outcome of the patient's satisfaction. Hence, as
envisaged earlier, all personnel in these services should be trained meticulously, to
become proficient in patient relations.

PATIENTS/ATTENDANT - AMBULANCE SERVICE AND OTHER SERVICES

Ambulance service plays a vital role in achieving patient satisfaction, and hence,
both the vehicle, as well as the men concerned should be kept in good shape. Personnel
working in ambulance services should also be trained to provide genuine, sincere care
and equip themselves with excellent patient relations skills. Among the several patient
relations activities in a hospital, communication is an important one, and it is also the
focus of many complaints. Because of the low level of literacy among the public, and
the medical sciences being an abstract subject for even educated patients or attendants,
medical terms arc not understood unless they are properly explained.

Doctor-patient relations arc of vital importance in hospital services, for the

patient (and/or attendant) and the doctor to have a human and scientific interaction. No
matter what technical skills and medical knowledge a doctor can possess, he should also
develop and cultivate excellent communication and conversational skills; and gain the
confidence of the patient, by behaving with him pleasantly, beginning with the
exchange of pleasantries. An old saying goes,

"A good doctor can relieve half the suffering with his good and humane approach to a
patient".

Doctors need to learn new skills to help them prepare an agenda (plan); interact
with patients and their attendants. Seeking information is now considered a basic right

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of the patients, their kith and kin. The doctor should learn to deal with this situation as a
part of his inter-personal communication skill. Doctors should give all relevant and
possible information to patients for their adequate understanding of treatment options,
the risks involved in the various procedures, the duration of the treatment, and the
expenditure expected to be incurred in the course of the treatment.

A busy consultant or specialist can appoint a junior doctor to obtain and record
the patient's ailment history, the results of physical examinations, etc., of the patient,
and then examine him or her to decide on the treatment and the care to the provided for
the specific problem. This system is known as a referral from a primary physician. It
gives confidence to the patient that the consultant has accurately diagnosed the exact
nature of the disease, and is planning to implement the correct treatment. At this stage,
all possible queries, doubts, apprehensions and precautions to be followed prior to,
during, and after any procedure or surgery, should be explained and clarified in simple
layman's language to the patient. In addition, some of these explanations can be given in
the form of leaflets or brochures. This exercise, apart from educating the patient, allows
the doctor to gain time and the patient's confidence. It is common knowledge that 25 per
cent of readmission are due to lapses in treatment and insufficient understanding of
doctors' instructions. A patient relations executive in a hospital, and the secretary at the
entrance of the clinic, are helpful and provide support in important spheres, such as
saving time, fee collection, seeking the doctor, etc. An important aspect of patient
relations is developing and expressing social skills which ensure an assertive and
positive relationship between the patient and the physician. The physician's ability to
express clearly his/her empathy for the patient's feelings, rights and suffering is of
paramount importance. Non-verbal communication, such as facial expressions, eye
contact, pleasing gestures, and a comforting touch helps in building up this relationship.

HOSPITAL INFORMATION SYSTEM AND INFORMATION TECHNOLOGY

- AN OVERVIEW

The intent of this chapter is to provide prospective hospital administrators and

information technology (IT) professionals with information regarding the factors
involved in the successful installation of the Hospital Information system (HIS). A
successful HIS does not require a computer, but it requires a committed teamwork
approach from all disciplines in a hospital or a medical institution, such as, the IT

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department, administrators, nurses, paramedics, physicians and surgeons, medical
technologies, accountant, stores purchase- material executives, pharmacists, front office
executives, biomedical executives, security officers, and, of course, the top
management. Information technology tools are used to automate manual processes and
to make life a bit easier for all users of the hospital, including the patients. The adage,
'computer replaces people', is no longer true for any organization, including a
hospital. The use of the computer makes people more efficient, and helps in getting a
distributing a varied output faster, making use of the same human resource.

TELEMEDICINE

Patients will be able to have second and expert opinions from around the world
through image and report transmittal to remote consulting centres. In a similar way,
high-specialty hospitals will provide consultation and advice to hospitals having a
limited infrastructure, or those which are located in rural areas.

MEDICAL RECORDS

For privacy, access to records can be restricted by patient consent, by

fingerprinting, DNA matching, or with the Iris Scan.

SMART CARD

Storage of essential and vital patient data can be stored in a smart card, which is
equipped with an electronic chip. A smart card can be carried by individuals and
provide ready information regarding the patient health history at the time of emergency.

DIGITAL LIBRARY

Storing rare specimens and images electronically, this can be used for
presentation and archiving.

MULTIMEDIA

Patient education programs in Indian Language regarding the effects of HIV,

AIDS, diabetes, cardiothoracic surgery, handling burns patients etc.

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ENTRANCE HALL

It serves as a waiting area for the patients before getting registered, and for the
attendants who wait for the return of the patients. The size of the hall can be determined
on the basis of the number of beds available to back up the OPD. Adequate toilet
facilities should also be provided close to it.

WAITING SPACES

Waiting spaces per clinic and subsidiary waiting spaces are required adjacent to
each consultant's room and treatment rooms of the clinics. Waiting spaces in the
pediatric clinic should provide for recreation and play facilities for children, in addition
to toilet facilities.

MEDICAL RECORDS

It is desirable to maintain the medical records of the out-patient department, in

continuation of registration area.

CLINICS FOR VARIOUS MEDICAL DISCIPLINES

These clinics include general medicine, general surgery, obstetrics, Gynecology

and Pediatrics. The cubicles for consultation and examination in all clinics should
provide for the doctor's table, chair, patient's stool, attendant's seat, wash basin,
examination couch and equipment for examination. The treatment and dressing room
should be spacious enough to accommodate a medicine shelf, sinks, dress tables with
screen in between, and a pedal-operated bin to hold soiled material. The medical clinic
should have facilities for cardio graphic examination.

FAMILY WELFARE CLINIC

The Clinic should provide educative, preventive, diagnostic and curative

facilities for obstetric and gynecological treatment, pediatric and health education. The
importance of health education is being increasingly recognized as an effective tool of
preventive treatment. People visiting hospitals should be informed about environmental
hygiene, clean habits, need for taking preventive measures against epidemics, family

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planning, etc. The treatment room in this clinic should act as the operation room for
IUCD insertion and investigation.

PHARMACY (DISPENSARY)

The dispensary should be located in an area conveniently accessible from all

clinics. Its size should be adequate to accommodate 5 percent of the total clinical visits
to the OPD in one session, at the rate of 0.8 square meter per patient. The dispensary
and compounding room should have multiple dispensing windows, counters and
shelves. The plan according to which the counters and shelves are arranged should
depend on the size of the room. Medicines which require cold storage can be kept in
refrigerators.

CASUALTY / EMERGENCY

Emergency cases should be attended by OPD during OPD hours and in wards
afterwards.

TELEPHONE AND INTERCOM

Wiring in conduits should be provided to give telephone outlet points in rooms,

wards and departments, as desired by the authorities. An intercom system can also be
provided in addition to the telephone. The communication system should be adequately
designed in hospitals, to alert all persons looking after patients, and all employees of the
hospital who are inside the building, in the event of an emergency. The alarm system
should be capable of being operated from intercoms, telephones and the administrative
office.

PATIENT RELATIONS APPLIED TO SUPPORT SERVICES

Irrespective of the size or category of the hospital, it is a recognized fact that all
support services form an excellent complement to the services of the medical fraternity.
The support services are:

• Nursing

• Security

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• Food and Beverage

• Maintenance and Engineering

• Pharmacy

• Biomedical

• Stores

• Transport

• Pest Control

• Medical Records

These support services are responsible for the welfare of the patient, sometimes
directly and many times indirectly. They interact and provide comfort and an anxiety-
free stay for the patient in the hospital.

NURSING SERVICES

The nursing services are of great importance and an absolute necessity in a

hospital. They provide service to the patient and execute the doctor's orders
meticulously. Most patients depend on the nurses to convey their problems to the
doctors treating them. The nurses play a multifaceted role, with a sense of responsibility
and empathy. Nursing is a vital aspect of health care, which should be properly
organized. 'Nursing Care1 and the management of the nursing staff reflect on the image
of the hospital or nursing home. Hence, an effective patient relations training, given to
every nurse, will enhance the quality of every aspect of nursing in hospitals. Proper and
rigorous training in patient relations for nurses should be conducted on a regular basis.
They should be trained in communication skills, the right etiquette and a positive and
caring bedside manner. It is the nursing staffs who make the maximum number of visits
to the patient, and hence, their interaction with the patient should be congenial,
emphatic, firm and cautious. In addition to the execution of doctor's orders every nurse
should posses the qualities of a friend, philosopher and guide. However, no nurse
should get emotionally attached to a patient. The nurse should help the patient recover
as quickly as possible, and with sincerity, help him in his recovery, during his stay in

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the hospital. A well-trained nurse, with specialized patient relations training, will be an
asset to any hospital. Nursing and hospitality, blended with missionary zeal, will bring a
good name to, and increase the prestige of the hospital. As of now, there is hardly any
kind of specialized patient relations training which will make an immense difference in
the nursing services. Hence, it is essential to include patient relations training as a part
of the curriculum for the nurses.

HOUSE- KEEPING

The housekeeping staffs help in keeping the hospital clean and tidy. Many of
them come in direct contact with the patients. Their services are also important, since
their activities contribute directly to the patient's comfort and peace of mind. For
example, a member of the housekeeping department cannot behave politely while
bringing a urinal to a patient, thereby upsetting him or her. If there is some delay in
attending to the patient, the housekeeping staff should politely seek pardon by saying,

"I am sorry, sir. I was late because I was attending to some other work. I assure you
that it will not happen again"

The patient's response will be to overlook and forget the inconvenience. Thus,
pleasantness and goodwill will pervade the atmosphere, and everyone's task will
become much easier. Before providing training in patient relations to the staff, they
should undergo rigorous on-the-job training, get acquainted with details about the
various services to be rendered to patients, and the need for them. Most of the staff,
particularly at the lower level, does not understand the meaning, relevance and content
of patient relations. Hence, training them can be a difficult task unless suitably effective
methods are applied. They should be made to understand that the patient is their
customer, who has come to them in pain and suffering. Hence, they should be accorded
hospitality of a high order. The housekeeping, food and beverage staff, or for that
matter, staff in any department, should not lose their temper under any circumstances,
and should always are polite and accommodating. If there is any problem, they should
seek the support of their immediate superior, who in turn, after due enquiry, should
convince them and help them appreciate the need for being empathetic towards patients
and their attendants.

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SECURITY

The role of the security department has several ramifications and needs
modification in their attitude to work. They should be helped to understand that their
job responsibility is different from that of the staff in an industrial organization, because
a hospital deals with people who are suffering and arc anxious. They are not only the
custodians of security, but arc also responsible for contributing, can be indirectly, to the
welfare and happiness of the patient in many ways. They should learn to use a different
and special approach in the discharge of their duties. If the necessity arises, security
personnel should carry out the duties of the staff of the transport department, and to
every extent possible, help the patient. No service carried out in the interest of the
patient can be of small value and lack dignity. Good behaviour and excellent manners
are some of the main aspects of patient relations. These elements should be
scrupulously practiced and maintained in any hospital. It is imperative to employ a
well-trained professional who can take charge of the department. If a qualified and
trained patient relations executive is available among the doctor administrators, he/she
will be able to view and handle all patient relations matters and their related technical
aspects in the proper perspective. Moreover, when a qualified doctor, trained in patient
relations works in a hospital, many irritating problems can be easily resolved.

FOOD AND BEVERAGE

It is nowadays a common and necessary practice to service food and beverages

to patients as well as their attendants in a hospital. Most hospitals have become aware
that diet contributes to a patient's recovery from disease; in addition, it keeps the patient
happy and satisfied if it is tasty. Hence, an efficient food and beverage service greatly
enhances the overall services a hospital offers. Nutritious and tasty food is essential for
the patient. The importance of hospitality shown to a guest in the Indian tradition is
emphasized even in the scriptures atithi devo bhava.

A hospital should treat the patient as a guest. The role of patient relations, for
hospital staff, in the food and beverage department is of paramount importance. Every
staff in this department should be very polite and should meet the patient as often as
necessary, seek his views about the service and quality of food served, as well as his
comments and suggestions regarding improvement. The food served should conform to

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the doctor's instructions, and should be hot (or cold) delicious, clean, and it should be
served on time. Meals should never be delayed. The attendant, while serving, should
make a few courteous remarks and enquiries. No attendant should serve the food
mechanically. He should smile and serve the food, arrange the table, water, napkin, etc.
If need be, he should wash the patient's hands, lips, etc., with concern and care. Not
good food alone, but also the way it is served to the patient, goes a long way in creating
a positive image. Hence, the role of patient relations is a very relevant one.

MAINTENANCE AND ENGINEERING

This is one area, with which the patient cannot come into direct contact.
However, the efficiency of this department has a definite bearing on the physical
comfort of the patient. These include a 24 hour water and power supply, electrical
appliances (fans, air-conditioning, and laundry), hospital equipment and instruments in
a working condition, and uninterrupted laundry services. The maintenance/ engineering
department has the responsibility of providing these services. During the patient's stay
in the hospital, his physical comfort contributes greatly to his progress. Hence, the
maintenance staff should maintain good patient relations.

HOSPITALS IN ANDHRA PRADESH

The state of Andhra Pradesh becoming a medical hub has many multispecialty
corporate hospitals meeting the health care needs of its growing population. Public
health is an organized effort to improve the health of a population, the life span of its
individuals and the extent to which people are free from illness. Specifically, it can be
seen as a concept concerned with collective efforts by the state and community, aimed
at protecting and promoting health of the population. According to Winslow's classic
definition 'Public Health is the science and art of preventing diseases and prolonging
life and promoting physical health and efficiency through organized community efforts
for the sanitation of the environment, the control of community infections, the
education of the individuals on the principles of personal hygiene, the organization of
the medical and nursing service for the early diagnosis and preventive treatment of the
disease, and the development of social machinery which will ensure to every individual
in the community a standard of living adequate for the maintenance of health".

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 Public health is a broad social enterprise, more akin to a movement that seeks to
extend the benefits of current knowledge in ways that will have the maximum impact
on the health status of a population. It does so by identifying problems that call for
collective action to protect, promote and improve health, primarily through preventive
strategies. It is unique in its interdisciplinary approach and methods and emphasis on
preventive strategies and its linkages with government and political decision making.
Above all, it is also a collective effort to identify and address the unacceptable realities
that result in preventable and avoidable health problems and enhance one's quality of
life, and it is a composite of efforts and activities that are carried out by people
committed to these ends. These factors make public health a system in itself.

Modem hospitals form an integral part of public health and are one of the inputs
necessary to achieve the goals of public health. Hospitals are important for public health
as well as for modern societies because one of the major functions of hospitals is to
provide curative care to people. An expert committee of WHO highlights the necessity
of hospitals in today's society as the hospital is an integral part of a social medical
organization, the function of which is to provide for the population complete health
care, both curative and preventive, and whose out-patient services reach out to the
family and its home environment; the hospital is also a centre for the training of health
workers and for bio-social research. Health of the people is not a domain exclusively of
technical and biological inventions of medical sciences; rather health is shaped by
biological, social, economic and political factors in society. Health and well-being
therefore cannot be a static concept. Health and health systems are a function of the
balance between socio-economic, political and technological forces.

Hospitals represent the organizational form that provides curative, preventive

and rehabilitative services to population. Taking care of one's health is a fundamental
need of all individuals and the modern-day hospital assists in the fulfillment of this
need, by alleviating suffering and pain. The hospital has become the centre of modern
technology, knowledge and therapeutic facilities to treat all kinds of illnesses. It has
become capable of catering to almost all health needs from serious to routine health
problems of the people. Its goal is to cure the health problems of an individual as well
as society at large.

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PART- II : BRIEF PROFILE OF SELECT SAMPLE CORPORATE
HOSPITALS OF THE STUDY

1. KIMS SSH Hospital, Srikakulam

KIMS Srikakulam - Sai Seshadri Hospital is the only 150-bedded Multi Super
Specialty Hospital in Srikakulam. It is located on New Bridge Road, PN Colony
Junction, Srikakulam, KIMS SSH is where personalized medical care meets modern
technology. At KIMS SSH, the cream of specialists come together to fulfill a wide
range of medical requirements and serve a cross section of population in Srikakulam.
KIMS SSH puts strong emphasis on high quality patient care at an affordable cost. The
hospital is equipped with state-of-the-art medical instruments, and other allied facilities
to ensure that the patients and their attendants get the best possible care. Sophisticated
and fully equipped with AMC, ICCU, MICU, RICU, SICU, PICU, NICU. Digital
Cardiac Cath Lab, ESWL ( Kidney Stone Blasting without Operation ) Multislice CT,
Color Doppler, Digital Radiography, Advanced Operation Theaters, Endoscopy,
Colonoscopy, Sigmoidscopy Procedures. Fully equipped Laboratories, 24 Hours
Pharmacy, 24 Custom Built Ambulance Service, IVF & ICSI Centre, Infertility Centre
with IUI facility are the main facilities available in KIMS SSH.

2. Tirumala Hospital, Vizianagaram

Tirumala hospital (Tirumala Nursing Home) has become a force to reckon with
in the healthcare facility map of Vizianagaram with 100 beds. Established in 1991 with
an aim of bringing quality treatment to patients in the remote corners of their town and
adjoining villages, Dr Tirumala Prasad a keen visionary and eminent laproscopic
surgeon established the hospital. His wife Dr Krishna Shanti, a highly experienced
gynecologist who served in various major hospitals in various cities decided to bring
her specialization and expertise to her hospital by serving patients along with Dr
Tirumala Prasad. The hospital is equipped with state-of-the-art medical instruments,
and other allied facilities with latest and best equipment which is available across India
in the major hospitals in big cities. This has given an opportunity to provide services
which are of the highest standard and match the service standards of any large hospitals.
With a highly committed team of staff who are ever dedicated to providing the best care
for our patients, Tirumala Hospital is at the forefront of providing quality patient care

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for the residents of Vizianagaram and also its surrounding areas and become a hope of
light for people with various ailments. The hospital is fully equipped to handle over 250
to 300 major and minor operations a month with a very high success rate.

3. Kala Hospitals, Visakhapatnam

Kala Hospital is 110 bedded Multi-Speciality Hospital and is one of the

most equipped and premium Hospital. The Physicians Service is an indispensable
guide to the finest doctors and dentists in Visakhapatnam. The most experienced and
highly respected doctors and staff in the region from New born and Child Care,
Maternal Health Care and Cardiology, to Gastroenterology, Internal Medicine,
Stereotactic Radio-surgery, oncology, Geriatric Care and many other areas of
specialization are in Kala Hospitals. Kala Hospital is engaged in providing the latest
internationally recognized medical care to patients with a variety of ailments and
medical conditions, concentrates on all major specialties with headed by Dr. Ramana
Murthy, the leader with unstinted commitment, the expert team of doctors and support
staff ensure the best care is delivered at all time with utmost dedication. It is their
sacrament to enrich and preserve valuable human lives.

4. Hope International Hospitals, Kakinada

Hope International Hospital opened with 350 beds and its doors with the
objective of strengthening medical care in the communities we serve, and to empower
patients and their families to make informed healthcare choices. The Hospital lays
emphasis on excellence in clinical services, diagnostic facilities and research. With the
vision of strengthening healthcare in the country, it has taken large strides in bridging
critical gaps in the healthcare system. Hope International Hospital is equipped with the
latest technological advancements to provide its patients with cutting edge diagnostic
and surgical solutions. The essences of delivering care are the four pillars of ethics,
excellence, expertise and experience, through which spread Health, Hope, Healing and
Happiness with the highest standard of medical care, which is sacrosanct for patient
safety. Staffed by a large team of full time consultants, support personnel and able
administrators, the hospital delivers comprehensive treatment and a management
regime that ensures the best outcomes for patients and their families. The medical team
embodies a humanized approach and alleviate any sense of stress and fear in patients

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they may experience prior to and after their treatment. The staff offers a warm and
welcoming environment a home away from home.

5. Andhra Hospital, Eluru

As the leading provider of tertiary and specialist healthcare services in Andhra

Hospitals, treat thousands of patients every year. There are four specialist hospitals are
home to number of excellent local and world class clinicians and academic staff
committed to finding the patients the best care and treatments. It is one of the large
multispecialty hospitals in Andhra region and a specialist regional centre for number of
specialties and super specialties including Medical and surgical gastroenterology adult
and Pediatric intensive care, Neurosurgery, Nephrology, Urology, Neurology and
Neonatology, Adult and Pediatric accident and emergency department. It serves a
catchment area of more than 10 million population. Andhra Hospitals was formed in
2004. It has 250 beds at main hospital site in Vijayawada. Other Andhra Hospitals
centres at Bhavanipuram (Vijayawada), Eluru and Machilipatnam which will
accommodate 150,100 and 100 beds respectively. The administration is looked after by
the Chief Executive and Chief Surgical Gastro Entomologist Dr.P.V. Ramana Murthy
who has a rich experience in the field of hospital management.

6. Nagarjuna Hospital, Vijayawada

The city of Vijayawada has a population of 1.5 million. This is the cultural,
educational and financial centre for coastal Andhra Pradesh, the agriculture heart land
of Krishna & Godavari delta. Nagarjuna Hospital, owned by Nagarjuna Hospitals Ltd is
a 140 beds specialty hospital located in spacious premises of 4.5 acres at Kanuru,
Vijayawada of Andhra Pradesh. The hospital has excellent infrastructure incorporating
state of the art medical technology supported by a team of experienced consultants,
medical officers and qualified nurses. This is a tertiary referral centre for medical
gastroenterology, surgical gastroenterology, respiratory medicine, intensive care
medicine, anesthesiology, orthopedics surgery, trauma care, nephrology, neurology,
neuro surgery and plastic surgery. In addition medicine, surgery, pediatrics, obstetrics
and gynecology services are also available.

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 7. Manipal Hospital, Guntur

Manipal Hospital is located at Tadepalli of Guntur district, is one of the

largest hospitals in coastal Andhra Pradesh established in 2006. This tertiary care
hospital has a capacity of 350 beds and high end diagnostic facilities. It currently has
240 beds operational. The hospital is renowned for its comprehensive tertiary care
specialties. Manipal Hospitals is part of the Manipal Education and Medical Group
(MEMG), which pioneers in the field of education and healthcare delivery. The focus at
Manipal Hospitals is to develop an affordable tertiary care multispecialty healthcare
framework through its entire delivery spectrum and further extend it to homecare.
Manipal Hospitals has a special significance in the overall healthcare industry of India
and particularly in South India. A social seed sown more than five decades ago is today
the country’s third largest healthcare group with a network of 15 hospitals providing
comprehensive care that is both curative and preventive in nature for a wide variety of
patients not just from India but also from across the globe. One of the most preferred
and recognised healthcare facilities by pharmaceutical companies for drug trials, the
group’s flagship hospital in Bangalore is NABH accredited and ranked amongst the Top
10 multispecialty hospitals in India. The ethos of Manipal Hospitals is its belief in the
credo of its triad of core values namely "Clinical Excellence, Patient Centricity and
Ethical Practices" which have led to it becoming one of the best and most trusted
healthcare providers in the country today. The Clinical Excellence is rooted in our
excellent team of doctors/medical specialists who are well versed with the latest
advancements in their respective field of medical expertise. This is further
complemented by our teams of highly trained nurses and paramedical people along with
state-of-the-art infrastructure and facilities, the finest minds in the country and a
genuine desire for providing the best healthcare drives us to deliver path-breaking care
for our patients on a day-to-day basis, from the smallest to the most complex medical
problems, five tertiary care, nine secondary care across five states, today Manipal
Hospitals successfully operates and manages 4,900 beds and caters to around 2 million
customers from Indian and overseas every year.

8. KIMS Super Specialty Hospital, Ongole

KIMS Ongole is the newest hospital that has been added to the long list of
KIMS Group of Hospital Chain. With this new hospital, those in the Prakasam district

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can now avail services on par with larger cities like Vijayawada and Hyderabad. KIMS
Ongole is a 350-bedded facility, managed by some of the best medical professionals
comprising leading doctors, skilled specialists, paramedical and nursing staff. In
keeping with KIMS tradition, this hospital continues to keep its focus on personalized
services, modern medical facilities, while ensuring that the services are within the reach
of the common man. With leading services in cardiac, paediatric, orthopaedic and other
departments, KIMS Ongole serves as a beacon of hope to patients in the area. Visit
KIMS Ongole for all health needs and be assured of the great KIMS care. Spread over
an area of 2 lakh sq. ft., KIMS Ongole is a new state-of- the art hospital. At KIMS
Ongole, patients are offered superior facilities comparable to international standards.

9. Bollineni Super Specialty Hospital, Nellore

Established with a vision to provide quality healthcare services for all types of
patients, Bollineni Hospitals was established in Nellore in the year 2001with 200 beds
with an impressive list of specialists who serve us in varied capacities and state of the
art equipment, are able to deliver patient services which are second to none in the
healthcare segment in the city of Nellore. The unflinching attitude of placing the
patients well being on the forefront has given an enviable reputation of being the
hospital of choice for many patients in and around Nellore. We are well connected by
all means of transport and offer round the clock specialty services to patients from all
walks of life and economic backgrounds. A Bollineni hospital is founded by an eminent
specialist Dr B. Bhaskar Rao who has wide ranging experience in the medical
profession. He has specialized in cardiothoracic surgery and consults at various major
hospitals in Andhra Pradesh.

10. Sagar Hospitals, Tirupathi

The Sagar Group is a forerunner in path-breaking ventures that have been

touching the chords of the populace in the city of Bangalore. Sagar Hospital, Tirupathi
established with 150 beds. The Group was founded more than five decades back by
Barrister Shri R. Dayananda Sagar and Dr. Chandramma Sagar, and has pioneered
state-of-art Education, automobile services, healthcare sector etc. The group ventured
into healthcare services in 1960 under the qualified leadership of Dr. Chandramma
Sagar. The healthcare and educational activities have attained a global brand status

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bringing pride to Bangalore. The vision of this philanthropic couple is being realized
through the efforts of Dr. D. Hemachandra Sagar, Chairman – Sagar Group and Dr. D.
Premachandra Sagar, Vice-Chairman – Sagar Group, both qualified doctors themselves.
Their dynamic leadership is carrying the legacy of the founders of the group forward
with a mission to add value to life and make healthcare affordable to everyone. The
Sagar Hospitals pioneered the Home Health Care service program, the 1st of its kind in
Karnataka ,made available to the Bangaloreans ,particularly for the Senior Citizens and
the immobile. A dedicated team of 25 people have been deployed constituting skilled
nurses, Physiotherapists , paramedical staff and courier boys for the door-to-door
service to physically examine, collect blood samples and to extend personal assistance
for any additional service. All the reports pertaining to Home Health care would be
delivered at the door step latest by the same evening

11. Sree Mohan Hospitals, Kadapa

Sree Mohan Hospitals is Simhapuri Colony, Cuddapah is a recognized name in

patient care. It was incepted in the year 2015 with 110 beds. They are one of the well-
known Dermatologists in Cuddapah . Backed with a vision to offer the best in patient
care and equipped with technologically advanced healthcare facilities, they are one of
the upcoming names in the healthcare industry. This hospital is easily accessible by
various means of transport. A team of well-trained medical staff, non-medical staff and
experienced clinical technicians work round-the-clock to offer various services . Their
professional services make them a sought after Dermatologists in Kadapa. A team of
doctors on board, including specialists are equipped with the knowledge and expertise
for handling various types of medical cases. This listing is also listed in Dermatologists,
Hospitals, General Physician Doctors.

12. Gowri Gopal Hospitals,Nandyal

Established in 1991, Gowri Gopal Hospital has served with dedication and has
earned the reputation of being the complete family hospital. The hospital has graduated
from a secondary hospital into a state-of-the-art multispeciality hospital. Courteous
service with a ready smile, an easy-to-access location at the heart of the city and a
clean, healthy ambience set the hospital in a class of its own. G G Hospital is a
complete family hospital with the best of modern facilities in over 30 specialties and

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super-specialties with 120 beds. Emergency services are now comparable to some of
the best institutes in India. Hi-tech surgical facilities, 7 well equipped, air- conditioned
operation theatres, state-of- the-art intensive care units and delivery rooms, an exclusive
ophthalmology theatre make it an efficient Medicare centre are the amenities available
in G G Hospital. A knowledgeable, highly experienced team of surgeons, doctors and
consultants, make the hospital the most preferred one in Kurnool, as well as for patients
from other towns in the vicinity. This hospital is Tie-up with 18 companies like FCI,
BSNL, TTK Health Care, Reddy Labs for the treatment of these employees and
recognized to provide medical care to the Police Personnel through "Arogya Bhadratha
Scheme and also recognized by the Andhra Pradesh Government to treat the group
employees against reimbursement facilities with Rajiv Arogya Sree

13. Saveera Super Specialty Hospital, Ananthapuram

Saveera Hospital is the largest super specialty and tertiary care hospital in the
Rayalaseema region, Srinagar colony, Anathapur of Andhra Pradesh with 200 beds.
With the help of cutting-edge medical technology and expert doctors, we work round
the clock to provide world class health care services at affordable prices. The hospital is
equipped with high-end infrastructure and top-notch amenities, we ensure our patients
complete comfort as they recover under our expert care, around 3600 health care
services backed by latest medical innovation, in order to ensure the patients a speedy
recovery and lasting health. Anantapur's first super specialty corporate hospital Largest
hospital in Rayalaseema Ultra-modern and state-of-the-art infrastructural facilities 3600
health care services and all Central/ State government sponsored health schemes and
insurance coverage are major facilities.

CONCLUSION

A patient relation is not an end in itself, but it is also an indispensable aspect of

good management. With increasing professionalism in all the departments of a hospital,
patient relations have become more oriented to management science. The effectiveness
or the utility of a manager depends a lot on his/her personal skills, human, technical and
conceptual, based on scientific foundations. The role of patient relations in building up
an environment of faith, belief, reliability and quality assurance in a hospital cannot be
underestimated. A non-medical person practicing patient relations, and also his/her

106
staff, should be able to avail of the benefit of a carefully designed and 'tailored-to-the-
needs' training, and should be able to use medical terms and phrases. This will help
them gain understanding, confidence and clarity, and enable them to interact effectively
with the patients. Hence, rigorous and high profile training programs need to be
conducted for all staff working at the front office, reception and enquiry counters. A
patient relation is not an end in itself, but it is also an indispensable aspect of good
management. With increasing professionalism in all the departments of a hospital,
patient relations have become more oriented to management science. The effectiveness
or the utility of a manager depends a lot on his/her personal skills, human, technical and
conceptual, based on scientific foundations. The role of patient relations in building up
an environment of faith, belief, reliability and quality assurance in a hospital cannot be
underestimated. A non-medical person practicing patient relations, and also his/her
staff, should be able to avail of the benefit of a carefully designed and 'tailored-to-the-
needs' training, and should be able to use medical terms and phrases. This will help
them gain understanding, confidence and clarity, and enable them to interact effectively
with the patients. Hence, rigorous and high profile training programs need to be
conducted for all staff working at the front office, reception and enquiry counters.

107