International Journal of Research Foundation of Hospital and Healthcare Administration

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2018 | July-December | Volume 6 | Issue 2

EDITORIAL

Shakti Kumar Gupta, Maj Gen Sunil Kant

APPLIED PHARMACOECONOMICS IN PUBLIC HEALTH

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jrfhha-6-2-iv  |  Open Access |  How to cite  | 

Guest Editorial 1

Brig Dr Arvind Lal

INDIA IS LEAPFROGGING TO A NEW ERA IN HEALTHCARE DELIVERY

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jrfhha-6-2-vi  |  Open Access |  How to cite  | 

Guest Editorial 2

M. Afzalur Rahim

SOCIAL INTELLIGENCE FOR HEALTHCARE PROFESSIONALS

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:1] [Pages No:0 - 0]

Keywords: Healthcare, Leadership, Performance, Social intelligence

PDF  |  DOI: 10.5005/jrfhha-6-2-ix  |  Open Access |  How to cite  | 

ORIGINAL RESEARCH

N Sathish Raju, Jayati Bahuguna, Jagiri N Rao

Patient Satisfaction Survey among Inpatients in a Multispeciality Teaching Hospital, South India: A Feedback Analysis

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:8] [Pages No:43 - 50]

Keywords: Patient satisfaction, Teaching hospital, Wards

PDF  |  DOI: 10.5005/jp-journals-10035-1090  |  Open Access |  How to cite  | 

Abstract

Introduction: Patient satisfaction is a subjective phenomenon and many factors contribute directly or indirectly. In today\'s competitive healthcare market, patients expect more than just satisfaction. So, patient satisfaction has become a high priority to hospitals and health plans across the country and is the strongest determinant of the hospital. A patient\'s satisfaction may not be totally influenced by the quality of physician available, but it reflects how medical care has been delivered. Although, their main expectation is getting cured and going back to their work, but there are other factors, which affect their satisfaction. It is an important and commonly used indicator for measuring the quality of healthcare. Aim and objectives: (a) To study the level of satisfaction of inpatients in general wards at a multispecialty teaching hospital, (b) To study the different factors affecting patient satisfaction, (c) To find the causes for dissatisfaction, if any and suggest remedial measures for improvement of services leading to better patient satisfaction. Methodology: It is a hospital-based cross-sectional descriptive study. The research was carried out among the patients who were previously admitted in general wards of multispecialty teaching Hospital, Mysuru. Data were collected from already available inpatient feedback forms. Data thus obtained was entered in MS Excel 2013 spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) software package version 22. About 4800 inpatient feedback forms were analyzed for the study. Observations and results: A total of 82% of patients were satisfied with the services at the admission counter, and 84% of patients were satisfied with the discharge process; 95% of patients were satisfied with the doctor\'s care and attentiveness and only 1% said it to be poor; 92% of patients were satisfied with the nursing services; 79% of patients were satisfied with the quality of food served in the hospital; 79% of patients were satisfied with the cleanliness maintained; 92% of the patients are satisfied with the overall services offered. Conclusion: It was found in the present study that most of the patients are satisfied with most of the services provided in this multispecialty teaching hospital and the doctor\'s care and nursing service has the highest satisfaction level, which is very satisfactory and encouraging. Major satisfiers were quality and behavior of doctors, explanation about disease and treatment by the doctors, courtesy of staff at the admission counter, behavior of nurses, timely discharge process. Dissatisfiers were lifted operators guidance, the behavior of the security guards, quality of food and dietary services. Explanation about hospital charges and costs in the billing counter, cleanliness maintained. To conclude, the majority of our patients are satisfied after availing health services. A small fraction of patients seems dissatisfied with our healthcare delivery. We have identified a few deficient areas in terms of service delivery and the same will be bridged as early as possible in order to achieve universal patient satisfaction at our hospital.

ORIGINAL RESEARCH

Aditya Kumar, Saroj Kumar Patnaik, Madhav M Singh, Nishu Singh, Ashuthosh Sharma, Tapas Paul

Financial Prudence of Healthcare Screening Program in Urban Set-up

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:6] [Pages No:51 - 56]

Keywords: Cost-benefit evaluation, Cost-effectiveness, Healthcare, Screening program

PDF  |  DOI: 10.5005/jp-journals-10035-1091  |  Open Access |  How to cite  | 

Abstract

Introduction: Health screening is one of the rapidly growing and accepted practice in healthcare setup across the globe. Public health screening programs are used to control epidemics of infectious disease and to target treatment for numerous chronic diseases. Methods: Duration of the study: The study was carried out from November 2018 to January 2019. Study setting: The study was carried out at Meerut. Study design: Traditional costing was done, and then a comparison was drawn to estimate the realistic costs incurred towards medical camp. Results: The cost of screening during the camp was INR 616 per person. With this cost, a large number of disorders were detected in an early stage which has the potential to develop in full-blown disease which may cause more cost to society at large. Hence this study recommends such screening program for families should be carried out on the frequent interval at least annually. Conclusion: Public health screening programs are used to control disease and to target treatment for acute or chronic diseases. Medical screening programs provide medical as well as socioeconomic benefits. Medical screening is a method for detecting disease or body dysfunction before an individual would normally seek medical care. The fundamental purpose of screening is early diagnosis and treatment of the individual and, thus, it has a clinical focus. Screening tests are generally administered to people who have not yet sought medical care, but at high risk for certain adverse health outcomes. This is a very cost-effective method of preventing the disease at an early stage. The study revealed the screening program is a very effective tool, as shown in this study.

ORIGINAL ARTICLE

Nitin Garg, Gagan Hans, Shakti K Gupta, Arushee Bhatnagar, Vikas H, Veena Pandey

A Study on Prevalence of Domestic Violence among Women in Servant's Quarters of a Tertiary Care Hospital in North India

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:6] [Pages No:57 - 62]

Keywords: Abuse, Addiction, Domestic violence

PDF  |  DOI: 10.5005/jp-journals-10035-1092  |  Open Access |  How to cite  | 

Abstract

Introduction: Domestic violence (DV) is a major human right and public health problem which can have physical as well as mental health-related adverse effects. Aim: To study the magnitude, type, and causes of domestic violence against women in the servant\'s quarters of a tertiary care hospital in North India. Materials and methods: A questionnaire-based study was conducted in servant\'s quarters of AIIMS, New Delhi from March 2018 to September 2018 among women of 18 to 65 years. A questionnaire was specifically designed, validated and subsequently used for collecting data on domestic violence. It covered all the information regarding socio-demographic details of the participants as well as their experience with domestic violence. The data collected was then analyzed using the Statistical Package for Social Sciences (SPSS). Results and discussion: In the study population it was found that 36.4% (75) women suffered from domestic violence, out of which 35.5% (71) were married, 4% (3) unmarried and 1.33% (1) widow with a mean age of 34 years. It was seen more among young age group, less educated females, early years of marriage, more number of family members living as a joint family and among females having spouses with alcohol addiction. The most common type of abuse was emotional (psychological) followed by physical and economical. Majority of them responded that alcohol addiction and financial difficulties were primary reasons for violence happening more than once in a month in (57.3%). The most common consequence suffered by females was psychological followed by 17.3% complaining of severe health effect. 33.4% of respondents took a corrective step of which only 4% showed improvement. Conclusion: Domestic violence was found to be highly prevalent and alcohol emerged out be a major risk factor.

ORIGINAL ARTICLE

Shakti K Gupta, Innayath Kabir, Meeta Tyagi

Improving the Efficiency of Refraction Services at a Tertiary Care Eye Hospital Using an Action Research Methodology

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:5] [Pages No:63 - 67]

Keywords: Action research, Refraction services, Uncertainty in appointment

PDF  |  DOI: 10.5005/jp-journals-10035-1093  |  Open Access |  How to cite  | 

Abstract

Background: The hospital under study is a 300 bedded tertiary care eye hospital in New Delhi, India. The hospital being the apex tertiary care eye institute of the country faces a constant issue of demand-supply mismatch. Due to the demand-supply, the appointment system for refraction posed problems of uncertainty and non-availability of appointments for the same resulting in delay in diagnosis and hence patient dissatisfaction. Objective: The main aim of the exercise was to ascertain the cause and to find an amicable solution for the uncertainty in the appointment system for refraction. Methodology: Action research methodology was applied to the process in the form of planning, implementation and evaluation in 2 cycles. The existing registration process was analysed in the first phase and the problems identified. In the first cycle, the detailed workflow process analysis and capacity calculation of Refraction services was carried out following which the problems were identified and actions were planned in a collaborative manner. The planned actions were implemented and evaluated. Based on the evaluation of the cycle 1 changes were planned for cycle 2 and implemented. Results: The problems identified in cycle 1 were absence of knowledge about the present capacity, slow registration process, uncertainty of appointment for refraction and lack of display of timings for registration and confirmation of appointments. The calculated capacity for refraction varied between 156 and 120 due to variation in the availability of consultation chambers. The changes planned were sensitisation of staff to the changes, increasing the capping limit of appointments to 160 in the morning and 80 in the afternoon (which included 33% above the capacity to cater to no shows). The results of cycle 1 were evaluated and the problems were identified. The corrective actions were planned for cycle 2 and planned actions were implemented. The capping limit for appointments was increased to 200 in the morning and 100 in the evening Conclusion: The main objective of the study was to address the patient grievance with regard to uncertainty in appointment by the participatory approach of action research methodology. In conclusion, action research is socially oriented and the intended outcome will therefore be evidenced through changes in social situations, systems and conditions.

ORIGINAL ARTICLE

Jordan H Llego, Ryan O Maramba

A Correlational Approach on the Influence of Stress Level on the Job Performance of Employees in a Private Hospital

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:6] [Pages No:68 - 73]

Keywords: Correlational study, Job performance, Private hospital, Stress level, Urdaneta city

PDF  |  DOI: 10.5005/jp-journals-10035-1094  |  Open Access |  How to cite  | 

Abstract

Aim: This study assesses the level of stress and its relationship to the job performance of the employees in a private hospital. Materials and methods: This study used a descriptive-correlational design using a questionnaire. The total enumeration was used in this study to represent the population adequately with 295 respondents. To analyze the data frequency, percentage, mean, and Pearson-r were utilized. Results: Results include: (43.70%) are 25–34 years old; (63.40%) are females; (52.20%) of them is rendering their service less than five years; (31.20%) are earning 9060 to 10059 pesos; (32.20%) are in the nursing department. The stress level of the respondents had a mean score of 2.31. The overall job performance of the employees shows a mean score of 3.43. Also, Pearson-r revealed a score of (r = -0.17, n = 295, p = 0.01). Conclusion: The researchers conclude that: the hospital employees in a secondary hospital in Urdaneta City are young adults, that is female dominated and are relative neophytes who are making a decent amount of money, who are nurses. Hospital employees are experiencing minimal stress. The employees are a high-performing human resource. The stress level of the employees has a minimal damaging connection with their overall job performance. Clinical significance: The results of this study will be a guide for the plans and activities in stress control, and enhancement of employees’ job performance. Moreover, the results of this study will increase the employees’ awareness about the stress they are experiencing, their job performance level, and how stress influences their job performance. The findings of this study will also give patients information about the quality of service the employees provide to them.

RESEARCH ARTICLE

Meeta M Ruparel

Evaluation and Impact Assessment of Application of Lean Six Sigma in Healthcare Service

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:6] [Pages No:74 - 79]

Keywords: Green hospitals, Lean six sigma in healthcare/hospitals, Mistake-proofing in hospitals/healthcare, Patient safety in healthcare, Performance excellence in hospital services, Quality management in hospitals

PDF  |  DOI: 10.5005/jp-journals-10035-1095  |  Open Access |  How to cite  | 

Abstract

Purpose: In the current competitive scenario, the demanding corporate strategies and the ever-rising branding world many a healthcare set-ups strive to implement the best and stand out as a benchmark. There have been many attempts to improve quality in healthcare, but most have been unsustainable. Internationally many healthcare organizations have already benefited from lean six sigma (LSS) strategies. The research aimed to deploy LSS methodologies in hospital systems to evaluate and assess the healthcare service delivery process performance on important performance criteria; namely efficiency, patient safety, care pathway, productivity, standard compliances, patient satisfaction, and employee satisfaction and further evaluate their retrospective cost Impact. Methodology: Observation/case study (CS) techniques were used on site of stratified segment sample identified from exploratory research of only hospitals/units where LSS was allowed to be implemented; to study and analyze LSS deployment project results. A focus group feedback Pre and Post project deployment was also taken from process owners Findings: It was statistically evident that the application of LSS methodologies significantly improves the hospital/healthcare service delivery process performance. It was observed that in an LSS deployed process project, with an improvement even in one measurable indicator that was critical to the quality of the process performance resulted in improvement of a mix of Impact Factors, which in turn resulted in its retrospective cost Impact Originality value: The primary research was structured around the study of efficient utilization of the key resources like care time, physicians’ time, manpower, material, space and equipment and management arrangements with practical project deployments of LSS methodologies. The study further addressed the problem of high incidences of adverse and sentinel events and its reductions with appropriate LSS applications in real situations.

RESEARCH ARTICLE

Dinesh Bammidi

Cost of Hospitalization for the Patients in Corporate Hospitals in India: A Retrospective Analysis of Five Years of Data from 2012 to 2017

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:2] [Pages No:80 - 81]

Keywords: Healthcare spending, Hospital costs, Trend analysis

PDF  |  DOI: 10.5005/jp-journals-10035-1096  |  Open Access |  How to cite  | 

Abstract

This is a research article for the ‘cost of hospitalization’ for the in-patients in private hospitals in India. I restricted the review to the corporate hospitals and analyzed the cost of hospitalization for the patients throughout five years. The average ‘cost of hospitalization’ for in-patients over the years in these hospitals, shows surprisingly less increase and the inflation-adjusted rise of these costs is marginal. This is counter intuitive, and I am publishing this analysis so that there can be further studies dissecting these costs and if this data reflects the accurate picture. If so, it would be interesting to understand why this is so.

RESEARCH ARTICLE

DK Sharma, Vijaydeep Siddharth, Angel R Singh, Mohammad Kausar, Rahul Ranjan

Hospital Administration Control Room: An Effective Concept for Managing Hospital Operation Issues: A Study in Tertiary Care Public Sector Hospital

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:9] [Pages No:82 - 90]

Keywords: Control room, Decision making, Hospital administration

PDF  |  DOI: 10.5005/jp-journals-10035-1097  |  Open Access |  How to cite  | 

Abstract

Introduction: Hospitals are complex organizations comprising of the myriad of core clinical, diagnostic and support services departments. Conventionally, administrative issues at public sector hospitals are managed by medical superintendent with a mainly clinical background. In the hospital understudy, there is a hospital administration control room managed by resident administrators attended to various routine and challenging issues in hospital operations. A study was contemplated to explore the modality of organizing control room services, the issues encountered and their management for the benefit of hospital administrators faced with similar challenges related to hospital operations Methodology: A descriptive and observational study of various issues was conducted from March to June 2017 in the Hospital Administration Control Room at All India Institute of Medical Sciences, New Delhi. At the control room, all matters reported were recorded in a report book and submitted before the medical superintendent. Review of those daily reports for the year 2016 was conducted. Frequency distribution tables of issues were made. Important issues were described in brief. Results: The infrastructure of a control room had all the communications channels and other wherewithal needed for accurate inputs for implementing quick decisions—management information system, monthly duty roster, a big chart listing the important phone numbers, telephone directory, hotline, news on television. It was manned by a senior resident administrator holding an MD degree in hospital administration and a junior resident administrator pursuing it. For further support, the matters were escalated to medical superintendent, and support from residents and faculty concerning their hospital areas were sought. Training was provided as understudy duty and supervised duty. Centralized repository of important circulars, resident manual, hospital administrators manual were available in the control room. The duty officer was responsible for ensuring statutory and legal compliances like brain death, coordinating organ transplant, examination of an asexual assault victim, bed management, local purchase (LP) in an emergency. The duty officer initiated a well-established VIP emergency plan or the disaster management plan by informing all concerned, personnel management and took necessary actions including escalations to ensure smooth delivery of patient care services. Duty officer got arranged ventilators and provided directions regarding ABG machines. In dispute resolution duty officer played a crucial role. During fire issues, the security cum fire control room was informed, and the quick reaction team (QRT) was activated. At workplace violence, local police were also informed. Conclusion: The study introduces to a time tested the concept of the administrative concept of control in a hospital room and succinctly describes and management of important issues encountered. It adds to domain knowledge where little is available.

REVIEW ARTICLE

AK Mohiuddin

Pharmacovigilance: Present Scenario and Future Goals

[Year:2018] [Month:July-December] [Volume:6] [Number:2] [Pages:8] [Pages No:91 - 98]

Keywords: Adverse drug reactions, Medicine, Monitoring, Pharmacists, Prevention, Safety

PDF  |  DOI: 10.5005/jp-journals-10035-1098  |  Open Access |  How to cite  | 

Abstract

Pharmacovigilance is the science and activities associated with gathering, recognition, appraisal, checking, and counteractive action of untoward impacts with pharmaceutical items. Pharmacovigilance essentially safety of medicine. Pharmacists have key roles in wellbeing frameworks to keep up the reasonable and safe utilization of medicine for they are medicated specialists who are unequivocally prepared in this field. The perspective of drug store understudies on pharmacovigilance and adverse drug reaction (ADR) revealing has additionally been examined with an intend to center the need to improve content identified with ADR announcing and pharmacovigilance in undergrad drug store educational programs. Globally, despite the fact that the job of pharmacists inside national pharmacovigilance frameworks contrasts, it is exceptionally all around perceived. Reconciliation of ADR announcing ideas in instruction educational modules, preparing of pharmacists and deliberate commitment of pharmacists in ADR revealing is imperative in accomplishing the safety objectives and preservation of general wellbeing. Likewise, these learning holes can be placed through nonstop expert improvement projects and fortifying hypothetical and reasonable information in undergrade drug store educational programs. Without adequately distinguishing and acknowledging preparing requirements of pharmacists and other human services experts, the capability of national pharmacovigilance frameworks is probably not going to enhance which may trade off patient\'s safety. Purpose: Discussion and projection of present situation analysis and future demand for pharmacovigilance. The pharmacists have a vital role to play which is thoroughly discussed. Methodology: Research conducted a year-round comprehensive literature search, which included technical newsletters, newspapers journals, and many other sources. The present study was started at the beginning of 2018. PubMed, ALTAVISTA, Embase, Scopus, Web of Science, and the Cochrane Central Register of was thoroughly searched. The keywords were used to search for different publishers’ journals like Elsevier, Springer, Willey Online Library, Wolters Kluwer extensively were followed. Medicine and technical experts, pharma company delegates, hospital nurses and chemists were given their valuable suggestions. Predictions were based on estimates such as drug end users, providers or prescribers, general knowledge of rational use, consequence and types of different incidences of ADR and non-compliance, their management or overlooking. Studies regarding inclusion and information sources of pharmacovigilance were given priorities. Several factors that influence medication-taking behavior, non-compliance, ADR reporting by pharmacists were communally analyzed and added to the article. Issues regarding economic and cultural barriers were found to be different from subcontinents, countries and even states. Most significant features of pharmacists’ role in the therapeutic intervention were added afterward to maintain a logical sequence. Drug factors, environmental factors and provider-patient interaction followed by pharmacist\'s role in handling patients and to change or correction of medication counseling, dispensing, monitoring was added to reveal their effect on patient compliance which is the eventual goal of meeting therapeutic guidelines. Many studies found regarding pharmacists’ role in therapeutic cost minimization, role in hospital and other healthcare settings, disease prevention, and lifestyle management found to be not within the scope of this article. Findings: Pharmacists are an integral part of the healthcare management system, and the importance of their role play is not after doctors and nurses. Any future role for the pharmacist in counseling, monitoring and vigilance could be addressed as part of a formalized, strategic approach by creating an integrated healthcare team, with attention to further enhancement of pharmacovigilance in any country, community or a healthcare setting. Research limitations: Research has a major limitation with dealing too many information on pharmacovigilance worldwide. An only important aspect of the expanded role of pharmacists, the present situation of vigilance in different countries and a few future prospect, demand and provisions of pharmacists in meeting those emerging demands are discussed. Practical implication: The soul of this article was to detail about the present situation and future demands of pharmacovigilance. Along with students, researchers and professionals of different background and disciplines, e.g., pharmacists, marketers, doctors, nurses, hospital authorities, public representatives, policy makers, and regulatory authorities have to acquire much from this article. Social implication: The article should contribute an integrated guideline for patient compliance, demand pharmacovigilance and last but not the least a silver lining of better healthcare situation in near future.

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