International Journal of Research Foundation of Hospital and Healthcare Administration

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2017 | July-December | Volume 5 | Issue 2

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Vipin K Koushal, Vineet Goyal

Patient Safety is the Need of the Hour: A Study in Nursing Department of a Tertiary Care Teaching Hospital

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:55 - 59]

   DOI: 10.5005/jp-journals-10035-1076  |  Open Access |  How to cite  | 


Introduction: Patient safety is an important aspect of health care and is an issue of high concern globally. It was aimed to study the patient safety behavior among the nursing personnel of a tertiary care teaching hospital of North India. Materials and methods: A descriptive, cross-sectional study was conducted over a period of 6 months in a tertiary care teaching hospital of North India. Study population included the 200 nursing officers, both clinical and administrative (very few). The data were collected using structured questionnaire using Hospital Patient Safety Survey Questionnaire of Agency for Health Research and Quality, USA. The questions were predominantly close-ended with very few open-ended questions and used five-item Likert scale. It had approximately 45 items on various aspects of patient safety, viz., teamwork across hospital units, patient safety during handoffs and transition of care, staff perception about patient safety, reporting of adverse events, etc. Overall patient safety grade for hospital was taken as outcome variable. The questionnaires were distributed in sealed envelopes in the work areas of the study population and collected after a period of 2 weeks. Results: The questionnaire yielded a response rate of only 66.5%. There was no patient safety committee in the hospital; however, two-thirds (63.9%) of respondents believed that the hospital provides a work environment that promotes patient safety. Almost half (54.83%) of the respondents agreed that their supervisor/managers’ actions/behavior promotes patient safety. Nursing department promotes continuous learning that was agreed by 82.6%. Majority (72.5%) of the nursing staff are afraid to ask questions or speak up if they see something that negatively affects patient care. Only 66% staff agreed that they communicate and discuss errors/adverse events. Most (80.4%) of the staff believe that punitive action would be taken against them if they commit any error. Majority (90%) of the staff believe that they do not have enough staff to handle workload. Two-thirds of the nursing staff think that actions of hospital management promote patient safety. Only 59.2% of staff agreed that there is good cooperation/teamwork across different hospital departments. Almost half of the nursing staff believe that patient safety is compromised during hospital handoffs and transition. Only 26% of the nursing staff rated overall hospital safety as very good and above. Only 9.1% reported any errors/adverse events happening in the unit. By analyzing the data, prevalence of patient safety behavior in the nursing department is found to be 52.6%. Conclusion: Structured system for implementation of patient safety measures is missing and hospital has to work a lot when it comes to delivering the patient care services in a safe environment.



Alexander Thomas, Subramanyam Raghunath, Bhupendra K Rana, Somil Nagpal

An Exploratory Study on the Benefits of Quality Accreditation: Financial Impact and Chief Executive Officer Perspectives

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:8] [Pages No:60 - 67]

   DOI: 10.5005/jp-journals-10035-1077  |  Open Access |  How to cite  | 


Little systematic evidence exists in published literature about the net financial impact of the process of quality accreditation on hospitals that have undergone the process. This exploratory study aims to explore the financial impact of undergoing National Accreditation Board for Hospitals & Health Care Providers (NABH) accreditation in Indian hospitals, based on chief executive officers (CEOs’) perspectives and the financial outcomes perceived by them. The attempt has been to provide a qualitative assessment of the costs and benefits of NABH accreditation on the financial health of the organization. As there were no leading studies to reference that could emulate the data available in the Indian context, the study team developed a set of financial indicators that could be collected from NABH-accredited hospitals. A total of 14 hospitals in Delhi, Ahmedabad, Mumbai, Bengaluru, Mysuru, Surat, and Chennai were included in the study. The CEOs of participating hospitals perceived that the NABH accreditation has been beneficial to their organization and that the overall quality of care for patients within their organizations has improved. In addition, they also confirmed improved awareness of statutory compliances, and of staff responses to emergencies, such as fire and cardiopulmonary resuscitation, and that data and evidence-based decision-making have helped in managing the facility better. The study suggests that the delivery of health care was positively influenced by NABH accreditation. The exploratory study also highlights the factors that may contribute to positive financial outcomes for hospitals. Specifically in terms of financial outcomes, the study has found that the income per used bed shows an increasing trend after the accreditation period. This may suggest medium- to long-term financial benefits to hospitals undergoing NABH accreditation.



Kanika Jain, Sujeet K Sinha, Anant K Verma

Assessment of the Level of Anxiety and Associated Factors among Heart Patients Waiting for Cardiac Procedure at a Tertiary Care Hospital in North India

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:68 - 72]

   DOI: 10.5005/jp-journals-10035-1078  |  Open Access |  How to cite  | 


Introduction: The anxiety experienced among patients may have various causes, including not feeling cared about as an individual, not explained by physician regarding plan of treatment, too much waiting time before the procedure begins, and the physical discomfort like not getting proper bed by the hospital authority. Anxiety can cause behavioral and cognitive changes which can result in increased tension, apprehension, nervousness, and aggression. Some patients may become so nervous and apprehensive that they are unable to understand or follow simple instructions. Some patients may be so aggressive and demanding that they require constant attention of the nursing staff and may end up fighting with the health care provider. Need of this study: With few public-run cardiac centers, it was always a difficult task of managing the huge patient load on limited beds by the management. Nonavailability of beds forced the clinicians to keep the patients waiting for admission on trolley or postpone the surgery. In addition, it was also noticed that the doctors did not adequately counsel the patients regarding their plan and procedure of treatment. As a result, there is always disgruntlement among the patients, resulting in increased anxiety, apprehension, and aggression. Objective: To assess the level of anxiety of patients before the cardiac procedure as per the Hamilton Anxiety Rating Scale (HAM-A) and to analyze whether adequate time is being given by the treating physicians in counseling of the patients about the treatment plan. Materials and methods: This is a cross-sectional study done on patients waiting for cardiac procedure in a cardiac center of a tertiary care hospital. Patients admitted on daycare basis for the procedure were also included. All the patients waiting for the procedure were assessed at the time of admission. Participants were assessed using a performa containing two parts. Part one of the performa was used to capture the demographic profile of the patients and questions related with their disease condition. The second part consisted validated HAM-A. The HAM-A is a widely used scale in both clinical and research settings. The scale consists of 14 items. Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0 to 56, where <17 indicates mild severity, 18 to 24 mild to moderate severity, and 25 to 30 moderate to severe. These patients were then grouped as having mild, moderate, and severe anxiety based on HAM-A score. Results: The study was carried out to find out the severity of anxiety of the patients waiting for the cardiac procedure. Total 110 patients were enrolled in the study. It was found that 63 (70.8%) male and 9 (42.9%) female patients had mild anxiety. In contrast, 4 (19%) male and 5 (5.6%) female participants had severe anxiety. There was statistically significant relationship (p < 0.05) in the anxiety level between male and female patients. Patients who were not adequately counseled by the physician were found to be suffering more moderate (33.3%) and severe (16.7%) anxiety in comparison with other groups. Conclusion: There is no doubt that anxiety is very much relevant before any cardiac procedure. Counseling of the patients before any procedure plays a significant role in reducing the severity of the anxiety level.



Libert A Gomes

Role of Standard Radiation Safety Practices in Public Health: An Experience of a Tertiary Care Teaching Hospital

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:4] [Pages No:73 - 76]

   DOI: 10.5005/jp-journals-10035-1079  |  Open Access |  How to cite  | 


Ionizing radiation is employed for diagnostic and therapeutic purposes round the clock in hospitals. Hence, it is the prime responsibility of the hospital management to ensure the safety of the patients, staff, visitors, public, and the environment. Patient relatives and the public/visitors who are not concerned with medical use of radiation can become vulnerable to stochastic effects of scattered radiation close to therapeutic or diagnostic radiological facilities. This article highlights radiation safety measures that have public health relevance in hospitals having both diagnostic and therapeutic radiological facilities.



Saroj Kumar Patnaik, Madhav M Singh, Bhandaru Sridhar

Medical Audit of Documentation of Inpatient Medical Record in a Multispecialty Hospital in India

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:7] [Pages No:77 - 83]

   DOI: 10.5005/jp-journals-10035-1080  |  Open Access |  How to cite  | 


Introduction: A medical record enables healthcare professionals to plan and evaluate a patient’s treatment and ensures continuity of care among multiple providers. A study was conducted to do medical audit of documentation of inpatient medical record in a multispecialty hospital to assess whether the existing documentation procedure is as per laid-down policy. Study design: Retrospective, descriptive study. Study area: A 545 bed multispecialty hospital in medical ward, gynecology and obstetrics ward, surgical ward, ear, nose, and throat (ENT) ward, eye ward, pediatric ward, skin ward, and psychiatry ward. Sample size: Systematic random sample of all inpatient medical records of select ward of last 12 months was done. Sample size was 320 case sheets, 40 from each department. The data collected were primary and the source was the discharge case files of the last 12 months available in the medical record section. The approach used for data collection was quantitative. The techniques applied were survey and observation. A structured checklist (audit tool) with 26 checklist points was developed keeping few of the quality indicators as the benchmark. Findings: Gynecology and pediatric department records were not found appropriate. Psychiatry and dermatology dept record keeping was found appropriate as per laid-down policy. Planned care was not planned as per standard protocol in surgery department. Recommendation: Sensitizing the clinical staff regarding the importance of proper documentation of the forms and hospital-wide standardization of the medical record keeping including admission and discharge summary. Rewarding the best performing department/unit and educating and training the responsible staff to make a complete record of every patient should be emphasized in the hospital. There should be monthly audit of the documentation procedure. Conclusion: Medical records are technically valid health records that must provide an overall correct description of each patient’s details of care or contact with hospital personnel. Medical records form a very important and critical document in hospital. These records are vital for legal purposes and for future planning of the hospital medical care.



Shibu John, Prerna Singh

Female Education and Health: Effects of Social Determinants on Economic Growth and Development

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:5] [Pages No:84 - 88]

   DOI: 10.5005/jp-journals-10035-1081  |  Open Access |  How to cite  | 


This study aims to discuss about girl’s education and health’s direct impact on economic growth. Education leads to higher social standing, independence, and greater autonomy in the decision-making process. Educated women will have greater control over family finances as they are more likely to spend discretionary resources on investments in human capital, such as health, education, and food. Desired millennium development goals cannot be achieved unless women are educated and are strengthened to take decisions about their own health in a suitable and conducive environment. This can only be attained by community-based demand side interventions for better education and maternal health. This study suggests that educated women were more likely to contribute to strengthen the economic growth of the nation than uneducated women. Female education level improves the health status of the family, which ultimately leads the economic growth and achievement of social development goals.



Ankit Singh

Home Health Care: The Missing Link in Health Delivery System for Indian Elderly Population—A Narrative Review

[Year:2017] [Month:July-December] [Volume:5] [Number:2] [Pages:6] [Pages No:89 - 94]

   DOI: 10.5005/jp-journals-10035-1082  |  Open Access |  How to cite  | 


Elderly population in India is at a disadvantageous position in comparison to other countries in matters of dedicated health facilities, health insurance, and geriatric specialist. Health issues of the elderly can be summarized as geriatric syndromes, cognitive decline, immobility, falls, and incontinence. These peculiar health characteristics of old age population can be better dealt with home health care, which is of recent origin in India and is limited to only metro cities in the private sector. Whereas home health care in the USA is present from over a century, in Europe it is present in most of the countries. This study presents the status of existing private home health care industry of India and advocates about the benefits of home health care for the elderly and supports that Indian policymaking bodies should incorporate home health care in its policy for improving access and quality of health care to elderly population.


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