A DISSERTATION REPORT

ON
STUDY OF GAP ANALYSIS OF HEALTH CARE SERVICES
OFFERED BY LEADING PRIVATE HOSPITALS IN
DEHRADUN
Submitted in partial fulfilment of the requirement of the degree of
Master of Business Administration
FROM






UTTARAKHAND TECHNICAL UNIVERSITY
SUBMITTED TO SUBMITTED BY
MR. Bipin Chandra Kandpal Saurabh Kumar Tiwari
(Senior lecturer ) UIM, Dehradun MBA 4
th
Semester


BATCH 2012-2014
UTTARANCHAL INSTITUTE OF MANAGEMENT (UIM)

DECLARATION

I SAURABH KUMAR TIWARI from UTTRANCHAL INSTITUTE OF
MANAGEMENT here by declare that this project work entitled To study and make protocol
for Synergy hospital ongoing policies and practices in an accordance to NABH accreditation and
to conduct a employee satisfaction survey
is carried out for 42 days.
To the best of my knowledge & belief, it is an original piece of work and is the sheer
outcome of my own efforts under the vigilant guidance of my guides and has not either in full or
in part been submitted to any other institution for the award of any other course.




Date- Saurabh Kumar Tiwari


Signature:














PREFACE

No professional curriculum is considered complete without work experience. Each individual who under
takes management education has to pass this phase before he/ she considers him/ her self fully qualified
managers.
Knowledge has two aspects- theoretical and practical and no theoretical concept is complete without
having knowledge of its practical application.
As we all know that practical training plays an important role in building the future of an individual.
This summer training programme proves really beneficial to the future managers as they are confronted
with the problems of actual work environment during their training period.














ACKNOWLEDGEMENT



An exchange of ideas generates a new object to work in a better way. Apart from the ability,
labour and time devotion; guidance and co-operation are two pillars for the success of a project.
Whenever a person is helped or co-operated by others, his heart is bound to pay gratitude to
them.

A satiation and pleasure that accompany the successful completion of task would be incomplete
without the mention of the people who have made it possible and whose consent guidance and
encouragement served as a guiding light for the completion of the study.

I would like to express my gratitude to my project guide Mr. BIPIN CHANDRA KANDPAL
for their constant encouragement and guidance without the task would not have been completed.

I consider it privilege to express through my report a few words of gratitude to Mr. BIPIN
CHANDRA KANDPAL my faculty guide who guided and inspired me in completing this
study. I would like to express my deep sense of gratitude to all the staff members for their
support and helping me during my project study.











TABLE OF CONTENTS
Page No.
Introduction
Executive summary
Literature Review
Research objectives
Research Methodology
Data Analysis & Interpretation
Findings
Suggestions
Limitations of Study
Conclusion
References

INTRODUCTION

HEALTHCARE INDUSTRY OVERVIEW
Health Care Industry In India
The rate of growth of the health care industry in India is moving ahead neck to
neck with the pharmaceutical industry and the software industry of the country.
Much has been said and done in the health care sector for bringing about
improvement. Till date, approximately 12% of the scope offered by the health care
industry in India has been tapped. The health care industry in India is reckoned to
be the engine of the economy in the years to come. Health care industry in India is
worth $17 billion and is anticipated to grow by 13% every year. The health care
sector encompasses health care instruments, health care in the retail market,
hospitals enrolled to the hospital networks etc.
Health care industry in India and the GDP or gross domestic product:
Expenses incurred by the Indian Government on health care is the highest amongst
developing countries. India's expenses on health care sector comprises 5.25% of
the GDP. Chances are that the health care market could experience a hike and
attain a figure ranging between $53 to $73 billion five years from now. This in turn
will reflect an increase in the gross domestic product to 6.2% GDP. The health care
industry in India earns revenues accounting for 5.2% of gross domestic product.

The healthcare industry is one of the largest industry of modern India. The Indian
healthcare industry, unlike other industries, stands untouched by recession. There
had been a steady growth in this sector, revenues from the healthcare sector
accounts for 5.2% of the GDP, making it the third largest growing sector in India,
and further the healthcare sector is projected to grow to nearly 1,80,000 crores by
year 2012 and a compounded annual growth rate (CAGR) of 15-17 percent for at
least the next 7-10 years.

Indian Healthcare Sector structure / Market size

The sector comprises hospital and allied sectors that include:
(a) Medical care providers that includes physicians, specialist clinics, nursing
homes and hospitals
(b) Diagnostic service centres and pathology laboratories
(c) Medical equipment manufacturers
(d) Contract research organizations and pharmaceutical manufacturers
(e) Third party support service providers
In India, 80% of all the healthcare expenditure is borne by the patients.
Expenditure borne by the state is 12%. The expenditure covered by
insurance claims is 3%. As a result the price sensitivity is quite high. The
high level healthcare facilities are out of reach for the patients.
Among the top five therapeutic segments, gastro-intestinal and cardiac are
experiencing both high volume and value growth. Opthologicals,
cardiovascular, anti-diabetic and neurological drugs continue to top the
growth list. The anti-infective, neurology, cardiovascular and anti-diabetic
segments have witnessed a high number of new product launches in recent
years.



Current Healthcare Landscape
Amount spent on healthcare - 103,000 crores / annum
86,000 crores is the Healthcare delivery market
17,000 crores is the Retail pharma market

Key findings of current private spending
Private spending on healthcare delivery 69,000 crores
61 % of this is spent on OPD services, 44,000 crores Indicates low levels of
affordability and a disease pattern dominated by infections
39 % on IPD services = 25,000 crores
85 % of IPD spend is in 5 areas : cardio, cancer, accidents, infections and
maternity

Roads Ahead 2012
Private spending on healthcare delivery 156,000 crores because of an
increase in population will lead to increase treatments
Change in socio-economic mix will lead to 8 % increase in treatment rate
and 30 % increase in avg. price paid
Change in prices 26 % increase in price per treatment
Change in mix of diseases 50 % increase in prevalence of lifestyle diseases
will lead to 12% increase in treatment rate & 7 % in price and this would
lead to a change in GDP from 5.2%to 6.2%
Richest 15% will account for 50% of all private healthcare spending & 60%
of inpatient spend
Private spending would increase by another 39,000 crores if the insurance is
likely to impact on middle-income households approx. 350 million in 2012,
leading to achieving GDP spending to 7.5% and private spending on
healthcare delivery to 195,000 cr.

Healthcare Fact File
Parameters Current By 2012
No. Of Beds 1.2 beds per 1000 9,14,543 In addition
No. Of Doctors 50,00,000 doctors 6,25,130 In addition
No. Of Nurses 0.8 per 1000 8,36,000 In addition
Infant Mortality Rate 34:1000 10:1000
Maternal Mortality Rate 4:1000 1 :1000
% of population Insured 12.00% 50.00%
Total Private Spending 69,000 Crores 156,000 Crores
OPD Spending 44,000 Crores 82,000 Crores
Hospitals 30,000 hospitals approx 17300 In addition
Primary Health Centres /
Community Health
Centres
1,50,000 approx 1,64,000 In addition
Retails chemist outlets 3,50,000 24,000 In addition
Medical Colleges 229 179 New
Estd Current mrkt size 103,000 Crores 1,80,000 Crores
Average life Expectancy 63.3 years 74 years

Investments plan in Healthcare

The sector has been attracting huge investments from domestic players as well as
financial investors and private equity (PE) firms. Funds such as ICICI Ventures,
IFC, Ashmore and Apax Partners invested about US$ 450 million in the first six
months of 2008-09 compared with US$ 125 million in the same period a year ago,
according to an analysis carried out by Feedback Ventures. Feedback Ventures
expects PE funds to invest at least US$ 1 billion in the healthcare sector in the next
five years.
According to a Venture Intelligence study, 12 per cent of the US$ 77 million
venture capital investments in the July-September 2009 quarter were in the
healthcare sector. As part of its Healthymagination initiative, GE will
spend US$ 3 billion over the next six years on research and development,
provide US $2 billion of financing over the next six years to drive healthcare
information technology and health in rural and under served areas, and
invest US$ 1 billion in partnerships, content and services.
The government, along with participation from the private sector, is
planning to invest US$ 1 billion to US $2 billion in an effort to make India
one of the top five global pharmaceutical innovation hubs by 2020.
The Ajay Piramal Group-owned private equity (PE) firm, India Venture
Advisers, will launch its second US$ 150 million healthcare fund next year.
Leading international clinic chain Asklepios International is gearing up for a
foray into the Indian healthcare market. As part of the 2.3 billion euro
groups strategy to enter the sub-continent, Asklepios is mulling the launch
of a US$ 100 to US$ 200 million fund.
Gulf-based healthcare group Dr. Moopen is investing over US$ 200 million
for setting up hospitals and eye-care centers across India.
Healthcare major, Fortis Hospitals plans to invest US$ 55 million, to expand
its facilities pan-India.

Employment Opportunities

India faces a huge need gap in terms of availability of number of hospital beds per
1000 population. With a world average of 3.96 hospital beds per 1000 population
India stands just a little over 1.2 hospital beds per 1000 population. Moreover,
India faces a shortage of doctors, nurses and paramedics that are needed to propel
the growing healthcare industry. India is now looking at establishing academic
medical centers (AMCs) for the delivery of higher quality care with leading
examples of The Manipal Group & All India Institute of Medical Sciences
(AIIMS) already in place.

A recent survey conducted by HarNeedi.com, gives an out look on the roles that
are in great demand, Specialist doctors such as, Cardiologists, Cardiothoracic
surgeons, Interventional Cardiologists, Orthopedics, Emergency Medicine
Specialists, Oncologists, Radiologists, Ophthalmologists, Neurologists, Neuro-
surgeons, Gynaecologists, Urologists, Duty doctors etc are in great demand.

Some of the other profiles that are in great demand are that of experienced nurses
and technicians who can handle various specialties such as ICUs, Cath labs,
Operation Theaters, Emergency Departments etc. Technicians, like Radiographers,
CT Technician, Radiotherapy technicians, emergency medical technicians etc. are
also in great demand.

Considering all the above facts and the massive growth in the healthcare industry,
huge investments would offer several opportunities for Indian companies to create
'win-win' situations and there would be emerging opportunities for professionals as
well in the near future.













SYNERGY HOSPITAL


Type

TRUST


Location DEHRADUN









SYNERGY HOSPITAL Institue of Medical & Science is an amalgamation of
expertise, resources, opportunities and medical engineering excellence. With
leadership position in line with healthcare services, the hospital believes in its
crucial role of a responsible corporate citizen and sincerely practice empowerment
of the underprivileged and sustainance of the human life. Guided by the six E's -
Enrichment of mind, Enrichment of body, Education, Empathy, Empowerment of
citizens and Environmental sustainance, each and every hospital contributes
towards the betterment of the community at large.
DEPARTMENTS:

ORTHOPAEDIC DEPTT.
MEDICINE DEPTT.

Industry Healthcare Industry
Employees 1045+
Website http://www.Synergyhealthcare.org/
PAEDIATRIC DEPTT.
OPHTHALMOLOGY DEPTT.
ONCOLOGY DEPTT.
PLASTIC AND BURN SURGERY DEPTT.
GENERAL SURGERY DEPTT.
GYNAECOLOGY DEPTT.
UROLOGY DEPTT.
ENT DEPTT.
RADIOLOGY DEPTT.
PATHOLOGY DEPTT.
PRE-MATURE BABY UNIT (P.B.U)
INTENSIVE CARE UNIT(I.C.U)


SYNERGY HOSPITALS is a multi-super specialty hospital that redefines
the standards of excellence in healthcare services and brings together the
best of infrastructure, technology & medical intelligence
Our quality standard along with technology and medical intelligence
enables us to provide healthcare services.

Led & Managed by Highly Qualified Doctors.
Patient Care--At SYNERGY Hospitals we are committed to provide
personalized medical services to patients with care and compassion.
State of the Art Infrastructure --At SYNERGY Hospitals we have 5
operating theaters, 100 beds and over 10 critical care beds catering to 14
different specialties. We aim to establish a healthcare powerhouse with a
vision to offer the best in clinical care, education and research.
Our Technology--At SYNERGY Hospitals we have the most advanced
technology and state-of-the-art treatment facilities with the motto to deliver
quality healthcare services at an affordable cost.

Strategic Location :
SYNERGY Hospitals is located across a sprawling in JALANDHAR gada
road, parallel to GT road.
The Rich Come Here For The Best Care In Town. The Poor Come Here For
The Kindest Care, For No One Here Is Turned Away For Lack Of Funds.
Special Corporate Services
We offer personalized services to corporate patients that include
Appointment Scheduling, Special Treatment Packages, Discount Faculties
on OPD & IPD, Ambulance facility, Health Awareness
Lectures/Workshops, Health Check Camps that are specially designed to
suit employee needs. They aspire to be a leading player of repute by
delighting their customers in India and across the world with premium home
furnishing solutions at reasonable prices.
SERVICE AT A GLANCE:-

SUPER SPECIALTIES
Anaesthesiology & Critical
Care Medicine
Trauma & Spine Surgery
Internal & Respiratory Medicine Neuro Surgery
Gastro Enterology Paediatric Surgery
Nephrology Urology
Neurology Medical & Surgical Oncology
In-Vitro Fertilization (IVF) Plastic Surgery, Aesthetic & Reconstructive Surgery
Minimally Invasive (Laproscpic)
Surgery
Dermatology
GENERAL SPECIALTIES
Medicine Ophthalmology
Surgery ENT
Paediatrics Chest & Allergy
Obstetrics & Gynecology Diagnostic Radiology & Imaging
Orthopedics & Joint Replacement
SUPPORT SERVICES
Physiotherapy & Rehabilitation Dietician
Health Check up Schemes (Preventive Check up)
24 HOUR SERVICES
Accident & Emergency X-Ray
Pharmacy Ambulance Facility
Pathology & Lab Services
Excellence in Health Care Since 1994








SWOT Analysis
Strengths
Multi & Super-specialty treatment
Clinicians of International repute
Ethical Practice
Centralized location
Affordable Rates Healthcare facilities
Areas for improvement
Pharmacy (for cashless patients)
Ambience (for icu patients)
Medical records (room required)
Discharge time
Staff Turnover
OPD Services
Monetary & non monetary Incentives methods to regulate staff
Opportunities
Liaisons with corporate sector
Enhanced Trauma & Emergency centre
Ivf patients
Women & child floor
Enhance doctor panel
Set up of committees to know the working & to upgrade it.
Capture rural areas
Benefits of Non profit organizations.
Threats
Lack of proper management.
Surrounded by other hospitals. Like pims
Retention of technicians, Nurses & staff.
Credit payments & debts

MISSION
A Dream of Making Quality Healthcare Accessible At Affordable Rates to the
Masses
To make the dream a reality we commit ourselves to:
Developing a healthcare powerhouse for complex medical & surgical problems to be
replicated in rural & urban areas.

Vision
Changing over to (IT) Technology Upgardations like New Website development ,
Telemedicine setup, etc.
Establishing patient friendly atmosphere by minimizing the complaints & getting a
patient co-ordinator to guide them.
Streamlining of Capital Equipments Procurement (Budget Involvement is a Must)
NABH Accreditation is a Must
Streamlining Hospital area practice shar (Doctor Revenue Sharing Models) , Senior
Highest & then accordingly.











IN ORDER TO BRIDGE THE GAP BETWEEN SYNERGY HOSPITAL POLICIES AND
PRACTICES WITH THE NABH STANDARDS I HAVE MADE DETAILED PROTOCOLS FOR
MY 3 CHAPTER IN SOFT COPY AND GIVEN MY SUGGESTION FOR THE HOSPITAL.
The main point of concern for the healthcare organisation was to trace out the gap
between their standards and NABH standards so that they could improve on such
parameter and implement the same and compete with other healthcare
organisations which are:

COMPETITORS:

CITY MAX HOSPITALS
MAHANT INDRESH HOSPITAL
DOON HOSPITAL
OTHER HOSPITALS

During the study there were four research objective which were more of standards
of NABH which hospitals must practice if they have to make themselves eligible
for the accreditation process and to show the evidences of the policies and
procedures to prove the same when the NABH inspection team comes to analyse
their prevailing healthcare services, so the research objective was to analyse the
policies and procedures of the chapters listed below and provide feedback and
suggestion accordingly so that they could improve on such parameters for which
protocol had to be prepared which were

MANAGEMENT OF MEDICATION
CONTONOUS QUALITY IMPROVEMENT
FACILITY MANAGEMENT AND SYSTEM
HOSPITAL INFECTION CONTROL
THEORY OF GAP
CUSTOMER SERVICE
Customer Service is the service provided in support of a companys core products. Customer
Service most often includes answering questions, taking orders, dealing with billing issues,
handling complaints, and perhaps scheduling maintenance or repairs. Customer Service can
occur on site , or it can occur over the phone or via the internet. Many companies operate
customer service call centers, often staffed around the clock. Typically there is no charge for
customer service. Quality customer service is essential to building customer relationships. It
should not, however, be confused with the services provided for sale by a company. Services
tend to be more intangible than manufactured products. There is a growing market for
services and increasing dominance of services in economies worldwide.
There are generally two types of customer expectations. The highest can be termed as desired
service: the level of service the customer hopes to receive. The threshold level of acceptable
service which the patient will accept is adequate service.
Yet there is hard evidence that consumers perceive lower quality of service overall and are
less satisfied.
Possible reasons might be:
With more companies offering tiered service based on the calculated profitability of
different market segments, many patient are in fact getting less service than they have
in past.
Increasing use by companies of self-service and technology-based service is perceived
as less service because no human interaction or human personalization is provided.
Technology-based services (Automated Voice Systems, Internet-Based Services, and
Technology Kiosks) are hard to implement, and there are many failures and poorly
designed systems in place.
Customer expectations are higher because of the excellent service they receive from
some companies. Thus they expect the same from all and are frequently disappointed.

Organizations have cut costs to the extent that they are too lean and are too
understaffed to provide quality service.
The intensely competitive job market results in less skilled people working in frontline
service jobs; talented workers soon get promoted or leave for better opportunities.
Many companies give lip service to customer focus and service quality; but they fail to
provide the training, compensation, and support needed to actually deliver quality
service.
Delivering consistent, high-quality service is not easy, yet many companies promise it.

The gaps model positions the key concepts, strategies, and decisions in services marketing
in a manner that begins with the customer and builds the organizations tasks around what is
needed to close the gap between customer expectations and perceptions.
The central focus of the gaps model is the customer gap, the difference between customer
expectations and perceptions. Firms need to close this gap- between what patient expect and
receive in order to satisfy their patient and build long term relationships with them. To close
this all important customer gap, the model suggests that four gaps- the provider gaps- need to
be closed.
The following four provider gaps, shown below are the underlying causes behind the
customer gap:
Gap 1: Not knowing what patient expect.
Gap 2: Not selecting the right service designs and standards.
Gap 3: Not delivering to service standards.
Gap 4: Not matching performance to promises.







The five gaps that organizations should measure, manage and minimize:
Gap 1 is the distance between what patient expect and what managers think they expect -
Clearly survey research is a key way to narrow this gap.
Gap 2 is between management perception and the actual specification of the customer
experience - Managers need to make sure the Hospital is defining the level of service they
believe is needed.
Gap 3 is from the experience specification to the delivery of the experience - Managers need to
audit the customer experience that their organization/Hospital currently delivers in order to make
sure it lives up to the spec.
Gap 4 is the gap between the delivery of the customer experience and what is communicated to
patient - All too often organizations exaggerate what will be provided to patient, or discuss the
best case rather than the likely case, raising customer expectations and harming customer
perceptions.
Gap 5 is the gap between a customer's perception of the experience and the customer's
expectation of the service - Patient' expectations have been shaped by word of mouth, their
personal needs and their own past experiences. Routine transactional surveys after delivering the
customer experience are important for an organization to measure customer perceptions of
service.












Gap 5
Gap 1

Gap 4
Gap 3


Gap 2



The main benefit to the measuring tool is the ability of researchers to examine numerous service
industries such as healthcare, banking, financial services, and education (Nyeck, Morales,
Ladhari, & Pons, 2002). The fact that critics does not render the measuring tool moot. Rather,
the criticism received concerning measuring tool may have more to do with how researchers use
Knowledge Experience Word of mouth
Expected service
Perceived service
Delivered service
quality
Promotion
Service quality
parameters
Management perception
about customer
expectation
the tool. Nyeck, Morales, Ladhari, and Pons (2002) reviewed 40 articles that made use of the
measuring tool and discovered that few researchers concern themselves with the validation of
the measuring tool. This study analyses a dynamic model of service performance and service
quality in private hospitals in Turkey. After reviewing the relevant literature on service quality,
we will use a dynamic model and then will analyze data generated from an empirical study.














EXECUTIVE SUMMARY

As a part of my need in my MBA program, I have prepared my dissertation report through the
primary data collected from SYNERGY hospital and NABH hospitals, DEHRADUN.
At the beginning of my dissertation report I was provided with 10 chapter on NABH
accreditation out of which I was allotted with the three chapters named as (1)Management of
medication deals with hospital pharmacy,(2)Continuous quality improvement,(3)Facility
management and safety .
Simultaneously I have done my employee satisfaction survey along with the chapters mentioned
above in which I have dedicated my two months of summer internship programme.
We actively took part in medical camp and administrative work like making of ppt.
In NAB accreditation chapters we were allotted two week time for each chapter for which we
have deeply studied NABH policies and practices illustrating what all standards are to be
maintained in hospital for getting the NABH standard .I have made protocols for each chapter
through research which include analysing each and every practices of hospital for ex.
Maintenance of attendance register, patient form, case file, working of pharmacy, electricity
supply etc., inclusive of deep study for different department .
After matching NABH standards with ongoing policies and practices of hospital I have made
protocol for each chapter. It was the research project within an hospital to get
NABHaccreditation in which employee satisfaction survey was also amongs the most important
part.So I have conducted survey and got my quessnaire filled by eighty employees and I have
made my analyses according to SPSS and excel.





REVIEW OF LITERATURE

Many studies have been conducted on the Gap Analysis . An attempt has been made
to present in brief, a review of literature on Gap Analysis in general as well as on the Gap
Analysis from hospital services.

Priscilla et al (1983) proposed a cognitive model to assess the
dynamic aspect of consumer satisfaction/ dissatisfaction in consecutive purchase
behavior. They found that satisfaction have a significant role in mediating
intentions and actual behavior for five product classes that were analyzed in the context
of a three- stage longitudinal field study. They found that repurchases of a given brand is
affected by lagged intention whereas switching behavior is more sensitive to
dissatisfaction with brand consumption.

David and Wilton(1988) have extended consumer satisfaction
literature by theoretically and empirically examining the effect of perceived
performance using a model first proposed by Churchill and Surprenant,
investigating how attractive conceptualizations of comparison standards and
disconfirmation capture the satisfaction formation process and exploring possible
multiple comparison processes in satisfaction formation. They suggest that
perceived performance exerts direct significant influence on satisfaction in
addition to those influences from expected performance and subjective
disconfirmation.


Saha (1988) made an attempt to investigate the interrelationships between
job-satisfaction, life satisfaction, life satisfaction-over-time and health. The
relationship among these four variables and biographical variables were also
examined. The study was conducted over the nurses in Nigeria. The data was
collected from the full time employees only because statements about job
satisfaction and other variables are different when supplied by retirees, part-time
nurses.
Bolton and Drew (1991) proposed a model of how patient with prior
experiences and expectations assessed service levels, overall service quality and
service value. They applied the model to residential patient of local telephone
services. Their study explored how patient integrate their perceptions of a
service to form an overall evaluation of that service. They developed a multistage
model of determinants of perceived service quality and service value. The model
described how patient expectations, perceptions of current performance and
disconfirmation experiences affected their satisfaction or dissatisfaction with a
service, which in turn affected their assessment of service quality and value.
Boulding et al (1993) stated that the service quality relates to the retention
of patient at aggregate level. The author has offered a conceptual model of the
impact of service quality on particular behavior that signal whether patient
remain with of defect from a company. The results of the study show strong
evidence of their being influenced by service quality. The findings also reveal
difference in the nature of the service quality.
Aurora and Malhotra (1997) had done a comparative analysis of the
satisfaction level of customer of public and private sector banks, in order to help the
bank management to formulate marketing strategies to lure patient towards them and
hence increase customer base.
Grewal et al had expanded and integrated prior price perceived value
models within the context of price comparison advertising. More specifically, the
conceptual model explicates the effects of advertised selling and reference prices
on buyers internet reference prices, perceptions of quality, acquisition value,
transaction value, and purchase and search intentions. Two experimental studies
test the conceptual model. The results across these two studies, both individually
and combined, support the hypothesis that buyers internal reference prices are
influenced by both advertised selling and reference price as well as buyers
perception of product quality. The authors also find that effect of advertised selling
price on buyers acquisition value was mediated by their perceptions of transaction
value. In addition, effects of perceived transaction value on buyers, behavioral
intentions were mediated by their acquisition value perceptions.
Voss (1998) had examined the rule of price, performance and expectations
to determine satisfaction in service exchange. When price and performance are
consistent, expectations have an assimilation effect on performance . and the

satisfaction judgments; when price and performance are inconsistent, expectations
have no effect on performance and satisfaction judgments. To examine these issues
authors develop a contingency model that they estimate using data from a
multimedia experimental design. The results generally support contingency
framework and provide empirical support for normative guidelines that call for
creating realistic performance expectations and offering money-back service
guarantees.



Garbarino and Johnson (1999) analyze that the relationships of satisfaction, trust
and commitment to component satisfaction attitudes and future intentions for the
patient of a New York off-Broadway repertory theater company. For the relational
patient ( individual ticket buyers and occasional subscribers), overall satisfaction is the
primary mediating construct between the component attitudes and future intentions
and for the high relational patient (consistent subscribers), trust and commitment,
rather than satisfaction, are the mediators between component attitudes and future
intentions.
Sharma and Chahal (1999) had done a study of patient satisfaction in
outdoor services of private health care facilities. They had done a survey to
understand the extent of patient satisfaction with diagnostic services. They have
constructed a special instrument for measuring patient satisfaction. The instrument
captures the behaviour of doctors and medical assistants, quality of administration,
and atmospherics. The role of graphic characters like gender, occupation,




33

education, and income is also considered. Based on their findings, they also
suggested strategic actions for meeting the needs of the patients of private health care
sector more effectively. In their study provided suggestions like becoming more friendly
and understanding to the problems of patients, maintaining cleanliness in the units,
both internally and externally, providing regular report regarding the patients progress
without waiting for them to demand, conducting surveys to know about the attitude of the
patients with regard to the employees and adopting patient-oriented policies and
procedures.

Simester et al (2000) have studied that multinational firm uses
sophisticated, state-of-the-art methods to design and implement Gap Analysis
improvement programs in the United States and Spain. Their experiments reveals
a complex and surprising picture that highlights implementation issues, a
construct of residual satisfaction not captured by customer needs and the managerial
need for combining nonequivalent controls and nonequivalent dependent variables.
Ofir and Simonson (2001) in their study found that customer evaluations of
quality and satisfaction are critical inputs in development of marketing strategies.
Given the increasingly common practice of asking such evaluations, buyers of
products and services often know in advance that they subsequently will be asked
to provide their evaluations. In a series of field and laboratory studies, the authors
demonstrate that expecting to evaluate leads to less favorable quality.



34


OBJECTIVE

To scrutinize impact of demographic factors of patient in the selected service like
hospital.
To determine service gap between the perception and expectation level of patient in
selected service sectors.
To determine the conceptual linkages among constructs of satisfaction, service quality
and behavioural intention of the patient.
To identify the mediating variable of service quality dimension leads to overall
satisfaction of patient in Hospital.




























35


RESEARCH METHODOLOGY


The present study is based on explorative and descriptive research design
with the objective of measuring the satisfaction level of patients of five major
private hospitals in Dehradun. The study uses both primary and secondary
information. As it is clear from the objectives of the study, the study was divided
into three parts i.e. patients expectations, perceptions from the hospital services
and then measuring their satisfaction level from the hospital services. For both the
first and second objective of study i.e. the patient expectations and their
perceptions of hospital services, primary data was collected through a structured
questionnaire. Then to meet the third objective of the study proper statistical tools
were used on the information collected for the first two objectives of the study.


3.2 SAMPLE DESIGN AND SELECTION

3.2.1 Population and Sample:
In view of the fact that this was a one person survey to be completed within
limited resources the present study was restricted to only those hospitals which
were located in Dehradun. The population of this study comprised of the indoor
patients only. Five major private hospitals in Dehradun were selected namely:
1. City Max hospital Dehradun
36


2. Doon Hospital Dehradun

3. Synergy Hospital Dehradun

4. Mahant Indresh Hospital Dehradun

5. CMI Hospital Dehradun


3.2.3 Selection of Respondents
From these hospitals primary data was collected from the respondents. The
respondents were either the patients themselves or their relatives. For sample selection,
a multistage sampling procedure was followed. At the first stage, sample units consisted of
total number of general wards and private wards in the hospital. 10% of the general wards
and 10% private, wards were selected randomly. Then from each selected general ward
3 to 5 patients were chosen and from each selected private ward one patient was
chosen. The information was collected through a pre-designed, structured
questionnaire. A sample of 80 respondents selected from these hospitals on the basis
of their convenience for the first objective and the second objective. To suggest solutions
to the problems observed during the survey is done through secondary data.









37


SYNERGY Hospital Employee Satisfaction Survey
1. What is your age?

Under 21 ..............................................................
21 to 34 ................................................................
35 to 44 ................................................................
45 to 54 ................................................................
55 or older ...........................................................

2. What is your sex?

Male .....................................................................
Female .................................................................

3. What is your marital status?

Married ................................................................
Unmarried ............................................................
4. How long have you worked for SYNERGY Hospital?

Less than one year ...............................................
One year to less than two years ...........................
Two years to less than five years .........................
Five years to less than ten years ..........................
Ten years or more ................................................

5. Your role at SYNERGY Hospital
Disagree Agree

Strongly strongly
I am given enough authority to make decisions I need to make ...1.............2 .... .....3 ........... 4 ............. 5
I like the type of work that I do ....................................................1.............2 .... ....3 ............ 4 ............. 5
38

I believe my job is secure .............................................................1.............2 .... ....3 ............ 4 ............. 5
6. Overall, how satisfied are you with SYNERGY Hospital as an employer? (Please circle one
number)
Very Very
Dissatisfied Satisfied
1 2 3 4 5 6 7


7. SYNERGY Hospital training program
Disagree Agree
Strongly Strongly


SYNERGY hospital Provided as much initial training as I needed ......1.........2 ........ 3 .............. 4 ............. 5


8. Pay and Benefits (Please circle one number for each statement)
Disagree agree

Strongly strongly
My salary is fair for my responsibilities .............................................. 1 ......... 2......3 . ........4.......5



9.Your relations with your immediate supervisor
Disagree Agree

Strongly strongly
My supervisor treats me fairly ................................................................... 1 ........ 2.........3 ........ 4 ............. 5


39

10. The patient are totally satisfied with the services given by the staff of Synergy
.
Agree 80
Disagree 20


11. Is the amount of the Hospital is much than that of other Hospitals .
Agree 79
Disagree 21


12.How many of the patients are going for routine check up
Yes 68
No 32
13. Are you satisfied the services of synergy hospital

14. The doctors and Patient communication are good in Synergy .

15 How much patient come hospital regularly.









40

DATA ANALYSIS AND INTERPRETATION




Interpretation :-
From the above graph it could be concluded that more no of employees have good work
experience as 31% of employees have work experience between five to ten years and 14% of
employees are have work experience of more than 10 years.


9%
21%
25%
31%
14%
work experience
less than one year one year to less than two year
two year less thanfive year five year to less than ten year
more than ten years
41




Interpretation :-


In the hospital organization more no of female employees are preferred so in SYNERGY
hospital female employees are 54% which is more than male employees.









male
46%
female
54%
Employees sex
42


I am given enough authority to make decision I need to make




Interpretation :-
Overall more number of employees are satisfied with the authority given to them so in the graph
it is indicated that 17% of them are strongly satisfied to carry out their work ,30%of them agree
to it with 29 % of employees have neutral answer.







disagree
strongly
4%
disagree
20%
average
29%
agree
30%
agree strongly
17%
decision making authority
43

I like the type of work I do



Interpretation :-
Until and unless employees are not satisfied of work they do they are not able to carry out their
work effectively as the graph indicate only 1% of employees are not satisfied of work they do so
it is the good indication for hospital that employees are giving their best.
36% of employees are satisfied along witht18% of people who agree strongly.





disagree
strongly
1%
disagree
29%
average
16%
satisfied
36%
agree strongly
18%
I like the type of work i do
44


I believe my job is secure










Interpretation :-

most of the employees have very less faith on their job security in the hospital as most of the
employees are kept according to their work performance as any mistake can be harmfull to the
patient,so only 6% of people agree strongly on fact that their job is secure.





disagree
strongly
12%
disagree
24%
average
34%
agree
24%
agree strongly
6%
Job security
45


How satisfied are you with SYNERGY hospital as an employer?




Interpretation :-
Employees rate their overall satisfaction level in the SYNERGY b
Among which 45% are satisfied and 18% are not satisfied







very
dissatisfied
6%
dissatisfied
18%
average
22%
satisfied
45%
very satisfied
9%
employee satisfaction
46



SYNERGY hospital provided as much initial training as I need




Interpretation :-

Training is the next step after recruitment and selection. Training is also necessary to keep the employees
update with the changing technology. With each promotion employees are send to the training
programmes. It is not only restricted to promotion but at many stages during job
1)the above figures indicate that SYNERGY hospital have good practices regarding the training
programme as 21% of respondents agree strongly with 26% of people agreeying to the the good training
programme provided to them.
disagree
strongly
10%
disagree
7%
average
36%
satisfied
26%
agree strongly
21%
Training
47


My salary is fair to my responsibility




INterpreation :-


Salary Remuneration is what an employee receives in exchange for their contribution to the
organization.Generally wage and salary helps an organization obtain, retain and maintain a productive
workforce. From the analysis of the pie chart the following inferences can be drawn:
1)most of the employees are very dissatisfied with the amount of salary given to them only 9% agreeing
to the fact that their salary is fair to their responsibility which is very low in number and can be harmfull
to the organisation because thir may be instances due to less salary they may quit job.
2)Total 47% of the people are some how satisfied with neutral answer

disagree strongly
10%
disagree
37%
average
33%
agree
9%
agree
strongly
11%
salary
48


My supervisor treats me fairly




Interpretaiton :-
The satisfaction of the employees are much concerned with the behaviour and co-ordination with the
immediate supervisor
1)overall response is neutral as in hospital industry employees are not handled by only one supervisor
they are under the authority of doctors,visiting doctors etc so any minor mistake can give them
punishment due to which reason for behaviour of their supervisor.







disagree
strongly
1%
disagree
24%
average
30%
agree
26%
agree strongly
19%
My supervisor treats me fairly
49

Are you satisfied the services of synergy hospital


















yes
no
50


The doctors and Patient communication are good in
Synergy .
















agree
disagree
51



How much patient come hospital regularly.

















0-50
60-100
100-200
52



The patient are totally satisfied with the services given by the staff of Synergy .
Agree 80
Disagree 20











Agree
Disagree
53




Is the amount of the Hospital is much than that of other Hospitals .
Agree 79
Disagree 21











Agree
Disagree
54




How many of the patients are going for routine check up
Yes 68
No 32











yes
NO
55




CROSS TABULATION

1)how long have year worked for SYNERGY hospital? * I believe my job is
secure Cross tabulation

Count

I believe my job is secure Total
disagree
strongly disagree average Agree agree strongly
disagree
strongly
how long have
you worked
for
SYNERGY
hospital?
less than one year
2 5 0 0 0 7
one year to less than
two year
3 4 7 3 0 17
two years to less than
five years
2 7 7 4 0 20
five years to less than
ten years
3 1 11 8 2 25
ten years or more
0 2 2 4 3 11
Total
10 19 27 19 5 80


Interpretation :
There are people who have work experience of more than 5 years in SYNERGY hospital then
also they are not sure about their job security.
2) how long have you worked for SYNERGY hospital? * my salary is fair to
my responsibility Cross tabulation

Count

my salary is fair to my responsibility Total
disagree
strongly disagree average agree agree strongly
disagree
strongly
how long have
you worked
for
SYNERGY
hospital?
less than one year
1 4 2 0 0 7
one year to less than
two year
1 5 7 2 2 17
two years to less than
five years
2 8 6 2 2 20
five years to less than
ten years
2 10 8 1 4 25
ten years or more
2 3 3 2 1 11
Total
8 30 26 7 9 80

56


INTERPRETATION
Employees who have work experience between five years to ten years disagree on their salary ,as
they say that their salary is less in an accordance to the responsibility given to them in the
hospital organisation.
3) how long have you worked for SYNERGY hospital? * I am given enough
authority to make decision I need to make Cross tabulation

Count

I am givin enough authority to make decision i need to make Total
disagree
strongly disagree average agree agree strongly
disagree
strongly
how long have
you worked
for
SYNERGY
hospital?
less than one year
1 1 4 1 0 7
one year to less than
two year
1 8 6 1 1 17
two years to less than
five years
1 5 6 6 2 20
five years to less than
ten years
0 2 4 12 7 25
ten years or more
0 0 3 4 4 11
Total
3 16 23 24 14 80

INTERPRETATION
Employees who have work experience of more than five years agree to the authority given to
them to take decisions for the smooth functioning of hospital the above interpretation indicate
that employees who have more experience are provided with more of authority which is a good
indicator for such patient care centre.

how long have you worked for SYNERGY hospital? * my supervisor treats me fairly Cross
tabulation

Count

my supervisor treats me fairly Total
disagree
strongly disagree average agree agree strongly
disagree
strongly
how long have
you worked
for
SYNERGY
hospital?
less than one year
0 2 3 0 2 7
one year to less than
two year
1 2 4 6 4 17
two years to less tthan
five years
0 7 7 2 4 20
57

five years to less than
ten years
0 5 7 10 3 25
ten years or more
0 3 3 3 2 11
Total
1 19 24 21 15 80

INTERPRETATION:
Employees who have work experience of more than 5 years agree to the fact that their supervisor
do not treat them properly.so it can be concluded that work experience do not matter for
supervisor to talk to their employees as in hospital organisation any one can be punished if any
mistake is committed.

















58



Findings
1. Expectation level is very high and nearly same for almost all the factors i.e.
for behaviour of the doctors, behaviour of medical assistants, quality of
administration and service/facilities provided.
2. Mean score for the expectations from all the four factors is 8.30 which is
very high on the scale 9.
3. Under behaviour of doctors attribute availability and thorough check up has the
highest score 8.98 and empathy and individual consideration have 7.31
and 6.70 respectively.
4. Attribute convenient office hours has lowest expectation score of 6.53 and
behaviour of clerical staff has the highest 8.89 among all the attributes of factor quality
of administration.
5. Bedding arrangements, dust boxes and flies and mosquitoes has score 9 for
expectations for these attributes of factor services provided by the hospitals.
6. Overall mean score for perceptions of patients about the four factor is 7.31 which is
considered good on the scale of 9.

7.Empathy with score 5.85 has the minimum score and thorough check up with score
7.89 has highest score among all the attributes of factor behaviour of doctors.

59




8. Perception about the dress of medical assistant is very good with score 9 and
handling of queries is lowest with score 6.1.

9. Fee has the lowest level of perception and behaviour of security staff has the highest
level of perception.
10. Perception of patients about the attributes of factor services/facilities provided by
the hospitals are almost good.
11. The largest difference between expectations and perceptions is 1.91 for attribute
handling of queries and lowest for individual consideration 0.88 under factor behavior of
doctors.
12. For behaviour of medical assistants the largest difference is for the attribute handling of
queries and lowest for maintenance of record. Also dress has negative difference which
means perceptions are larger than expectations.
13. Attribute convenient office hours of factor quality of administration is negative,
largest difference is for the attribute check up procedure and lowest for behaviour of
security staff.
14. Outer & inner appearance has the lowest difference 0.025 and well equipped
units have the highest 1.24. and attribute staff appearance has the negative difference of
1.11.






60


SUGGESTIONS

Give better work profiles according to the capabilities, background of a person.
There should be Direct supervision of the facilities available in organization.
Promotion and transfer policies should be revised to improve growth path.
SYNERGY should carry out equal pay packages among employees of same grade.
Proper supervision could be given.
Clarify the rules and regulation to employees time to time.
Employee should be rewarded even at non- monetary level.
Feedback of employees could be taken
Result of the survey conducted should be shared with in the organization and should be
communicated to respective authorities so that a complete action plan can be chalked out for
betterment of employees and organization.
Job security assurance could be set up by maintaining performance appraisal system.
Leave system should be made easy without reduction in salary.
Some compensation can be given to employees like free monthly check up.

SUGGESTION FOR SYNERGY HOSPITAL
General cleanliness and maintenance of all the buildings and surrounding structures needs to be
scheduled and carried outfall clinical areas along with supportative services shall be
interconnected through covered corridors. All isolated blocks used by patients need to be
connected with min hospital building through all weather proof covered links.

Dietary and Laundry services if so desired need to be preplanned with requisite
functional elements and flow. Proper covered food trolleys need be procured for
transporting cooked meals to patient dining areas
61


Toilet facility for inpatients, outpatients, staff and visitors / attendents need to be
replanned and provided at appropriate locations and their upkeep and maintenance shall
be accorded priority.


The Surgical suites, Delivery suites needs to be replanned with due consideration of four
well defined zones of varying degree of cleanliness. They are sterile,clean,protective and
disposal zones.

Surgical suites shall be grouped between 2-3 OTs in one location for easy control and
operational efficiency. Some of the OTs may be planned with individual AHU, HEPA
filter and Laminar flow. The requirement of OT planning and internal facility to be
provided in each OT was explained to the surgeon, nursing staff and PIU staff.

.
In the Imaging suites- Radiology department, there is a need to create change rooms for
male and female patients going in for plain X-ray. This will curtail the service time for
X-ray as more than double number of patients can be imaged. It is advisable to locate
the dark room / automatic processor for easy access from all X- rayrooms. The PIU shall
work in consonance with hospital administration and facilities incharge / users.
.
The Flooring, skirting and dado shall be provided as per the facility need. They shall be
easily maintainable. The skirting and dado shall be kept flush with wall surface to avoid
dust collection.
At present the ambulances are parked near the entrance canopy near emergency. All
ambulances need to be provided a covered parking bay with the emergency and
ambulance control room. It shall have communication facility with the emergency and
ambulance control room.

62

Medical store needs to be replanted with adequate space & ample shelving for The
Flooring, skirting and dado shall be provided as per the facility need. They shall be
easily maintainable. The skirting and dado shall be kept flush with wall surface to avoid
dust collection.
.
Medical store needs to be replanned with adequate space & ample shelving for storage
of drugs & care needs to be taken to prevent dampness by proper maintenance. Locked
areas for storage of high risk medicines with proper compliance need to be provided in
Training programme could be implemented for employees during non working
hours so that they may be able to attend sessions without any disruption of their
work .Training session can be carried down in slots .
Bias free environment can be implemented by daily report submission of
employees by PCC which could include certain performance parameter before the
name of employee for ex .no of patient attended, work done ,time devoted for
work etc
Review committee can sit once in a month for proper updating and
documentation of quality assurance programme
Feedback of working staff could be taken for the up gradation of new practices
and employees can be given some incentive for their involvement.
Remuneration can be introduce to increase motivation for work among
employees.
Person responsible for audit should be bais free
Cooperation and involvement of medical staff.
A good medical records could be made imperative to patient illness and all events
connected with it while he or she is in the hospital are lucidly and faithfully
recorded.
.
63

Person responsible for giving training can go through studies in order to sharp his
or her knowkedge .
Requirement can be made available before training programme
It may occur at time when all employees cannot be present because of their
working hour ,so time table can be made when employees in different slots can
undergo their training programme.
One small traing room can be made available with necessary requirement.
Two copies of sensitive case can be made so that during inspection also proper
treatment can take place and information in both the file can be matched and
updated.
Each patient can be given patient satisfaction quessionaire written in easy
language which can help to determine certain factor where improvement can be
done for ex.cleanliness in the rooms.














64





LIMITATIONS OF STUDY

Every project has some limitations. Even the researcher came across some
limitations while working on the project which made the analysis a little
inappropriate at times. Some of the basic limitations faced during the research are
listed below:


Sample chosen may not be representing the characteristics of the entire
population
Secondary data was considered while undertaking studies, so all the
shortcomings of secondary data are inherent
there was a time constraint, due to which a small number of EMPLOYEEs
were surveyed.
The research is based in the hospital only.
At the time of research, few of the patients and the staff did not sincerely
respond to me.






65





CONCLUSION

By interpretation it is clear that employee satisfaction depend on the salary
and other benefits provided by them .

By looking through Pie chart we can conclude that majority of the
employees are not satisfied with salary .
Training programme is effectively carried out.
most of the employees have very less faith on their job security in the hospital as most of
the employees
THERE IS A RELATION BETWEEN SALARY , other benefits and
employee satisfaction but we cant say that ait ration rate is more due to
employee dissatisfaction.
As overall 55 % (more than half) of employees are overall satisfied.
More than half of employees have more than 5 years of work experience
within an hospital




66



REFERENCES:
www.NABH accreditation.com (Home Page, Profile)

www.hospital industry.com ( Home Page, corporate vision)

www.google.com

India Today

The Hindu

The Times Of India











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