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A study on patients care quality in public district hospitals in tamilnadu
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International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 43 A STUDY ON PATIENTS CARE QUALITY IN PUBLIC DISTRICT HOSPITALS IN TAMILNADU Dr. C. Jothi Baskara Mohan Associate Professor & Head (I/C), Dr P.Uma Rani Assistant Professor, Department of Business Administration, Thiagarajar College, Madurai. ABSTRACT Health Care delivery systems involve a variety of stakeholders. These include the doctors, nurses, pharmacists and other supportive staff on the one hand and the communities who utilize the services on the other. They organize themselves and interact with each other in highly complex decentralized settings the quality of service—both technical and functional—are a key ingredient in the success of service organizations (Grönroos, 1984). Technical quality in health care is defined primarily on the basis of the technical accuracy of the diagnosis and procedures. Several techniques for measuring technical quality have been proposed and are currently in use in health-care organizations. Information relating to this is not generally available to the public, and remains within the purview of health-care professionals and administrators (Bopp, 1990). Functional quality, in contrast, relates to the manner of delivery of health-care services. This paper examines and measures the quality of services provided by Government hospitals. Empirical research is used to determine patients’ expectations and perceptions of the quality of service, and a comprehensive scale is adapted. Results based on testing the mean differences between expectations and perception indicate that patients’ perceived value of the services exceed expectations for all the variables measured, and the implications are discussed. Key words: Patient Care Quality, Public District Hospitals. INTERNATIONAL JOURNAL OF MANAGEMENT (IJM) ISSN 0976-6502 (Print) ISSN 0976-6510 (Online) Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME: http://www.iaeme.com/IJM.asp Journal Impact Factor (2015): 7.9270 (Calculated by GISI) www.jifactor.com IJM © I A E M E
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International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 44 INTRODUCTION India is one of the fastest emerging economies of the world and the fourth-largest in the world as measured by the purchasing power parity (Sunil, 2007) has not exhibited similar achievements on the health side. India is currently the second fastest growing economy in the world, with a GDP growth rate of 8.1 per cent at the end of the first quarter of 2005-06 (EOI, 2006), but in terms of the health indicators, India performs poorly. The two important weaknesses of the public health system in India is lack of availability of health personnel in the rural areas and inadequate quality of care (Ramesh Bhat, 2000). Often the behaviour of the doctors, nurses and supportive staff is cited as one of the major reasons for the cause of poor perception on the health care services (Bhat and Maheswari, 2005).. But the health conditions in India have improved considerably on account of the sustained efforts towards the promotion of health care. There has been progressive increase in the outlay of health plans since 1950-51 as can be observed from the following table. Outlay of Health Plans (1950-2017) Plans and their periods Total Plan Outlay Public Sector (Rs.Crore) Health Plan Outlay Including Family Welfare (Rs.Crore) First Plan (1951-56) 2356.0 164.0 Second Plan (1956-61) 4800.0 307.0 Third Plan (1961-66) 8098.0 341.8 Three Annual Plans (1966-69) 6756.5 215.3 Fourth Plan (1969-74) 15902.0 749.0 Fifth Plan (1974-79) 30322.0 1179.0 One Annual Plan (1979-80) 12601.0 384.4 Sixth Plan (1980-85) 71000.0 2028.0 Seventh Plan (1985-90) 180000.0 6649.2 Two Annual Plans (1990-92) 137033.5 1934.5 Eighth Plan (1992-97) 412000.0 8400.0 Ninth Plan (1997-2002) 875000.0 20504.7 Tenth Plan (2002-2007) Eleventh plan(2007-2012) Twelfth Plan (2012-2017) 893183.0 892652 .0 994918.0 36378.0 30001.8 39482.3 Source: R.C.Goyal (2012) Hospital Administration and Human Resource Management, Prentice Hall India, The above table shows that the Government has been constantly keeping sufficient funds out of the total plan outlay of the five year plans for the health plans of the country.
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International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 45 The present situation demands high quality medical care and high quality patient care, they can be achieved through the efforts of well motivated, disciplined and well rewarded work force in the hospitals. This paper examines the need for patient care quality in government hospitals. STATEMENT OF THE PROBLEM The government hospitals and the health care centers find it difficult to cope up the increasing pressure. The private hospitals have been proved to be expensive and not serving the interest of masses. Hence the development of the human resources becomes very vital to achieve the task of health for all. In order to suggest programmes to develop and improve the quality of health care personnel, it is needed to measure the different dimensions of the Patient care quality in the government hospitals and hence this study focuses on the different Variables Related to Patient Care Quality of Doctors. OBJECTIVES OF THE STUDY The objectives of the study is confined to i) To reveal the profile of the patients and their perception on patient care quality of the doctors and the hospitals. ii) To analyze & interpret the variables that reflects patient care quality. iii) To suggest suitable measures to improve the patient care quality and achieve excellence in overall health care quality. RESEARCH DESIGN Since the present study focuses on the perception of doctors and patients on the patient care quality of doctors and hospitals, the sample pair has been identified initially (one doctor and one patient) in each hospital. The sample pair represents the doctors working in the government hospitals and the patients who are getting the treatment from those doctors. An initial effort has been made to identify the sample pair as done by the previous researchers (Rohins et al., 2005 Las Chinger et al., 2001). In total 10 pairs have been purposively selected from the government hospitals in each district head quarters. The total sample size came to 580 which consist of 290 doctors and 290 patients. Hence the applied sampling procedure for the present study is ‘purposive sampling’. VARIABLES INVOLVED IN PATIENT CARE QUALITY Even though, the required qualities of doctors are too many, the present study confines to thirty four variables. The patients are asked to rate these variables at five point scale according to their order of perception from very high to very low. The assigned marks on these scales are from 5 to 1 respectively. The mean scores of each variable in patient care quality among the urban and the rural patients have been computed separately in order to exhibit the patients’ perception. The‘t’ test has been used to find out the significant difference among the two group of patients regarding their perception on patients care quality. (Refer Table 1)
4.
International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 46 MANAGERIAL IMPLICATIONS The highly perceived patient care quality among the urban patients is, personal concern were of utmost importance for the hospital, checking the patient before writing prescriptions and communication with other doctors, since their respective mean scores are 3.0239, 3.2144 and 3.0143. Among the rural patients, these variables are doctors’ knowledge, systematic and analytical nature among the doctors and capability of performing test on patients since their respective mean scores are 3.8184, 3.4509 and 3.6457. Regarding the perception on patient care quality the significant differences among the urban and rural patients have been noticed in the case of 14 variables out of 34 variables since their respective‘t’ statistics are significant at five per cent level. MAJOR FINDINGS The important perception of patients on patient care quality of doctors explains all variables in patient care quality to the extent of 85.22 per cent. The important patient care quality of doctors, the variables in each factor, their Eigen value and their reliability co-efficient are explained in the Table 2 The important patient care quality factor is empathy since its Eigen value and the per cent of variation explained by the factor are 3.8184 and 18.42 per cent respectively. It consists of six variables with the reliability co-efficient of 0.8145. It reveals that the variables included in ‘empathy’ factor explain it to the extent of 81.45 per cent. The second and third important patient care quality factors are ‘patients’ needs and ‘relationship’ since their Eigen values are 3.0449 and 2.5496 respectively. The per cent of variation explained by these two factors are 16.29 and 15.11 per cent respectively. The patients’ needs consist of five variables with the reliability co-efficient of 0.7208 whereas the relationship consists of 5 variables with the reliability co-efficient of 0.7644. The next two patient care quality factors are professionalism and carefulness since their Eigen values are 2.0641 and 1.7342 respectively. Both these factors consist of four variables with the reliability coefficient of 0.8339 and 0.6996 respectively. The last factor identified by the factor analysis is ‘responsiveness’ since its respective Eigen value and the per cent of variation explained by it are 1.2369 and 9.45 per cent respectively. It consists of three variables with the reliability coefficient of 0.7401. SUGGESTIONS The commitment, competencies and skill of the doctors in the health system have significant implications for any sector reform process. This study suggests that although Tamilnadu has invested in a large way in its health system development, the sector faces a number of challenges to ensure the professional and the organizational commitment of the doctors. Meeting the health care needs of the population goes beyond the budget allocations. The state has to invest in developing the leadership quality, the supervision skills, and developing autonomy in its public health institutions. Along with making public health institutions responsible to local governance, the department has to also give autonomy to its medical officers in popularization and synchronization of the health programmes. CONCLUSION Because perceived quality is an important measure in influencing consumers’ value perception and, in turn, in affecting consumers’ intention to purchase products or services (Bolton & Drew, 1988; Zeithaml, 1998), the findings of the present study are of importance for hospital administrators with respect to the non-clinical aspects of service quality.
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International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 47 Government efforts to decrease its expenditure on health care, and to modernize hospitals through the accreditation exercise, have successfully improved the level of service quality. In general, in comparison with the government health-care providers seem to be doing a better job in achieving customer satisfaction with regard to patient care quality. REFERENCES 1. Abu Naser Ahmed Tshtique, Md. Shapriar Akter and Suntu Kumar Glosh (2006), “Customer Expectations and Perception towards health services through SERVQUAL model–An Evaluation of Medical Diagnosis Service in Bangladesh”, Pakistan Journal for Medical Research 10(1&2), April-October. 2. Ahamed, K.Z., and Raida, A.B., (2003), “The association between training and organizational commitment among the white-collar workers in Malaysia”, International Journal of Training and Development, 7(3). 3. Bhat, R. and Maheswari, S.K., (2005), “Human Resource Issues and its implication for Health Sector Reforms”, Journal of Health Management¸7(1). 4. Englehardt, C.S. and Simmons, P.R., (2002), “Creating and organizational space for learning”, the learning organization, 9(1). 5. Ervin, N.E., Walcoft – Mc Quigg, J., Chen, S.C., and Upshaw, H.S. (1992), “Measuring patients’ Perception of Care Quality”, Journal of Nursing Care Quality, 6(4). 6. Evans, D., Edejer, T., Lawer, J., Frenk, J. and Murray, C. (2001), “Measuring Quality: from System to the Provider”, International Journal for Quality in Health Care, 13 (6). 7. SATHYAJITH S and Dr. R. HARIDAS, “Job Satisfaction among Nurses of Private Hospitals in Kerala” International Journal of Management (IJM), Volume 4, Issue 2, 2013, pp. 176 - 179, ISSN Print: 0976-6502, ISSN Online: 0976-6510. 8. S. Karthikeyan and Dr. A. Savarimuthu, “Hospitals as Learning Organizations: An Explication through A Systems Model” International Journal of Management (IJM), Volume 6, Issue 1, 2015, pp. 573 - 584, ISSN Print: 0976-6502, ISSN Online: 0976-6510. TABLE 1 Perception of the Patients on the Variables Related to Patient Care Quality of Doctors Sl.No. Variables Mean score among patients in t-statistics Urban Rural 1. Doctors did their Test 2.2563 3.1415 –2.5969* 2. Doctors were Courteous 2.0672 2.9342 –2.7334* 3. Doctors was interested me as a Person 2.3472 2.5646 –0.3969 4. Doctors talked me Frankly and Politely 2.6162 2.8583 –0.4424 5. Doctors explain each procedure and test to me 2.0144 2.9193 –2.8163* 6. Doctors worked hard to prevent me from worrying 2.2042 2.9908 –2.2065* 7. Doctors carried out my test completely and carefully 2.4494 2.3441 0.2644 8. Doctors work upto my expectations 2.1403 3.0676 –2.5883* 9. My personal concern were of utmost importance for the hospital 3.0239 2.2616 2.1739*
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International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 48 Sl.No. Variables Mean Score among Patients in t-statistics Urban Rural 22. Doctors’ Personal Care 2.6673 3.2145 –1.2962 23. Doctors were capable of performing test on me 2.9902 3.6457 –1.9969* 24. Doctors are systematic and analytical 2.3414 3.4509 –2.0624* 25. Doctors have sufficient knowledge 2.5103 3.8184 –.31403* 26. I have enough confidence in my doctor 2.4432 3.6062 –2.9192* 27. Doctors respond in follow-up treatment 2.6617 2.9197 –0.4546 28. Doctors took extra effort to enrich their Service 2.2086 2.4145 –0.3969* 29. Doctors response on my Frequent Visit 2.4441 2.6536 –0.4103 30. Doctors discussed the medical issues with me 2.8184 2.9908 –0.2172 31. Doctors are having Caring Attitude 2.2413 3.0565 –2.1096* 32. Doctors explained frankly to me 2.9193 2.0446 2.6867* 33. Doctors are able to recall my History 2.0414 2.3311 –0.7339 34. Doctors spend enough time to examine me 2.4146 2.9197 –1.2445 *Significant at five per cent level. Sl.No. Variables Mean Score among Patients in t-statistics Urban Rural 10. Doctors respond to My Questions 2.3939 2.2616 0.3164 11. Doctors are gentle and Sympathetic 2.2445 2.8986 –1.8183 12. Doctors made me feel Comfortable 2.9908 2.8184 0.2642 13. Doctors check me before writing prescriptions 3.2144 2.7671 1.4547 14. I have complete trust on doctors 2.4503 3.4541 –2.8968* 15. Doctors gave medical advice in an understandable way 2.9519 2.3039 1.6817 16. Doctors Correctly Diagnose the Disease 2.6083 3.1443 –1.3969 17. Doctors spent extra time to remove my fear and concerns 2.1443 2.2654 –0.2446 18. Doctors took care of me immediately 2.6869 2.9903 –0.4591 19. Doctors communicate freely to other doctors 3.0143 2.3069 2.0917* 20. Doctors Respond to my Request 2.4145 2.8914 –1.0229 21. Doctors asked my permission before performing any test. 2.0964 2.2145 –0.5083
7.
International Journal of
Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 - 6510(Online), Volume 6, Issue 2, February (2015), pp. 43-49 © IAEME 49 Important Patient Care Quality of Doctors (PCQD) Sl.No. Important PCQD Number of Variables in Reliability Co- efficient Eigen Value Per cent of Variation explained Cumulative Per cent of Variation explained 1. Empathy 6 0.8145 3.8184 18.42 18.42 2. Patients’ needs 5 0.7208 3.0449 16.29 34.71 3. Relationship 5 0.7644 2.5496 15.11 49.82 4. Professionalism 4 0.8339 2.0641 13.24 63.06 5. Carefulness 4 0.6996 1.7342 12.71 75.77 6. Responsiveness 3 0.7401 1.2396 9.45 85.22 Total 27 KMO measure of sampling adequacy: 0.7949 Bartletts test of sphericity: chi-square value: 99.04* *Significant at zero per cent level.
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