Marketing Hospital IIPM

A STUDY ON HOSPITAL MARKETING

100

MEDICAL SERVICES

The medical staff doctors- are the backbone of hospital organization. Doctors may be classified under these categories: highly professional specialized doctors, honorary specialized doctors and general doctors (with some / no experience and no specialization in any branch of medical sciences). Highly professional, well-trained and experienced doctors are the real assets of hospital organization. The general doctors help them in their work. Where professional specialized doctors are not sufficiently available or are not provided to the hospital organization by the authority, honorary specialized doctors are generally invited to serve in hospitals.

The hospital hierarchy in which doctors have to work is very sensitive and so constant tension exists. Doctors job is hard and full of stress and strain and patients struggling between life and death. Techniques and procedures, may be potentially hazardous in absence of due care danger of errors, etc. Constitution and atmosphere is quite different from other organizations, which create unique problems involving sometimes a question of life and death. These all require due care and vigilance by the hospital management.

Moreover, harmonious relations between specialized doctors, other doctors and nursing staff are so essential for good professional care of the sick that it requires something more than mere managerial skills or mere specialists skill in every doctor of hospital organization, rather it require the mix of two.

General duties include, diagnosis of illness of state of illness, instruction to patients, instruction to nurses or the matron about the patients needs buying of medicines and other facilities, consulting the medical record of patients, consulting the other doctors or doctor regarding the patients and all the activities which are deemed to be an element of medical care. Over and above these doctors face many behavioral problems, as they have to deal with human beings- other doctors and nurse, patients, their relatives, Class III and IV employees and head of the institution too. They can solve such problems successfully only, if they have some knowledge of behavioral science. So, it is very much essential to make hospital management as a part of medical curriculum.

The medical students in their final year as well as during internship should be exposed to a variety of administrative (and behavioral) problems.

The Head of the institution is also a doctor having specialization in one of the medical areas. But a man may be a first class surgeon or physician, but that does not necessarily make him a first- class administrator. His duties as a doctor itself are very hard and tiring both, physically and mentally.

Apart from this, the head of the institution has to look after so many other things such, supervision and control over personnel, purchasing, store-keeping, kitchen, laundry, toilet, maintenance of equipments and instruments, etc. How he can find enough time for attending medical side of hospital after doing so many jobs on administrative side?

That is why, Hospital boards now have a cadre of hospital administrators who combine some knowledge of medical system with sound management principles, but our institution continue to have administrators whose sole qualification is that they are doctors.MARKETING A HOSPITAL & FACILITIES

India today boasts of hospitals and establishments that are comparable to the worlds best medical facilities. Todays patients are very demanding and expect the best quality of facilities and medical care. The hospitals need to conform to NABH ( National Accreditation Board for Hospitals) and JCI (Joint Commission International) guidelines.

In keeping with this philosophy only International best practices are observed by Hospitals. We need to keep in mind that the Hospital is our showpiece and our show-room. When a patient visits the Hospital he utilizes the facilities. But his relatives and friends who accompany him are also potential patients and the ambience and services that they avail of or observe may influence their decision should they ever require medical attention.

Since all facilities are world-class we must make the medical fraternity and public at large aware of the existence of these facilities. This marketing has to be done in India and abroad, where the medical facilities are not so advanced.

Medical tourism is a reality and efforts have to be made to promote the hospital in countries like Africa, Afghanistan, Pakistan, Bangladesh, Nepal etc where such facilities are not easily available. In advanced countries like the UK and USA the facilities are expensive with long waiting lists and advanced medical facilities in India make it an attractive medical tourism destination.

Most modern hospitals today have full-fledged marketing departments to promote the Hospital locally, nationally and internationally. They also liaise with various agencies to facilitate the patients travel and medical reimbursement.

ORGANOGRAM

A modern hospital exists as a physicians workshop. A number of facilities are required to enable him to diagnose treat patients. The setup of dietary department in a hospital is one of the important facilities provided for adequate of medical care of patients.

Apart from the professional services in different fields, the hospital management has also to provide proper food and housekeeping. Food service is one of the most important activities in any hospital. As a therapeutic measure it contributes directly through scientifically prepared nutritious diets, aimed at specific disease conditions. Moreover, in hospitals persons have to stay for variable period. Some have to stay for a longer period. So it has to provide room services to all, as often patients cannot leave the bed. Further, as they are sick, their needs are of different kinds. Thus, the hotel components of hospital are a challenging task and have an impact on the image of the institution. Sometimes a hospital is compared to a five star hotel. But in such hotels, you may have comforts, good food, recreation, perhaps, physical and mental satisfaction but you do not have to satisfy a group of people- the friends and relatives of the customer who comes in and stay in the hotel. While in a hospital sometimes your major task is not only to satisfy the customer but you have to satisfy his friends and relatives and therefore hospital organization is unique in this sense. Here we listen often to the remarks of a technical person\one who has to know a lot of procedures- some of these being life saving ones. Thus, she has to perform dual task of attending to the patients physical and psychological needs as well as carrying out required tasks and procedures in grave emergency.

Lapses here cause a great danger to patients life. In some hospitals in western countries, selected nurses are given the designations of nurse technician, to help the doctors in the areas like anesthesiology, intensive care unit, kidney unit, radiology unit, post operative care unit, operation theatre, etc. it suggests that the services of nurses in such areas should be specialized, rather than generalized in the interest of the patient and efficient performance of the organization. That would also reduce the load on the over burdened specialized doctors.

The responsibilities of nurses are quite heavy. Their job is tiring and full of stress and strain. Infect, a doctor spends a relatively short time with patients and depends upon the nurses to carry out all of his orders carefully. Functions of nurse include three major areas:

Bed side nursing: receiving patients, investigating patients, sending them to respective clinics, round with the medical officer, assisting the doctor L.P, Tapping etc.

Other than bed-side nurses: it includes IP registration, instruction to servants and other personnel, ward cleanliness, supervision, ward sterilization arranging routine drug mixtures, checking medical dates, etc.

PHARMACY SERVICES

It is the area of increasing importance. This department is often combined with central sterilization and stores. The staff has to be well trained and has to be looked after properly at all levels by the pharmacist. The role of hospital pharmacy in ensuring proper care in preparation, labeling, storage and distribution of drugs and sterilized material is of prime significance. Avoidance of any kind of error is most important here. A hospital in modern era cannot do without a good and qualified pharmacist, who has to supervise, guide and control the performance of his subordinates. Qualify control is an important need in this area and hospital management should encourage and provide all the facilities to the pharmacist in organizing it.

The volume of services is appreciable. In the average hospital, the pharmacy deals with thousands of prescriptions and dispenses a large number of ward orders and requisition in a single year purchase of drugs and the value of the annual inventory run into many thousands of rupees. Therefore, hospitals, which do not employ a pharmacist with proper qualifications, train9ing, experience and talent, are seriously lowering the efficiency of their services and operations.

A well-organized pharmacy will function effectively in its own right and also contribute to the whole integrated hospital organization. Employment of a full- time pharmacist, even in a hospital of moderate size, far from being exorbitant expense, will more than oak for itself through collateral savings.

Therefore, it is necessary to have properly organized pharmacy department under the direction and control of professionally competent and legally qualified pharmacist. For proper services and sufficiency he requires good organization and the full cooperation of the administrator, departmental heads and the medical staff.

PATHOLOGY AND CLINICAL LABORATORY SERVICES

The practice of medicine today requires more and more laboratory services and public demands more precise diagnosis. So, the importance of laboratory services cannot be over- estimated in the process of thorough diagnosis.

Major functions of laboratory services are:

1. To provide the information to assist the physicians in their diagnosis, treatment and prevention of disease,

2. Assist any training program and

3. To conduct research.

The laboratory services are also usefully for having essential information in surgical treatment, for e.g. in pre-operative test, and post-operative tests.

Pathology and laboratory services should be under the direction and control of qualified and experienced physicians. He should be the regular member of active medical staff. Laboratory employees sometimes feel themselves far away from the rest of hospital employees. Every effort must be made to make feel that they are the integral part of the whole organization. Moreover, laboratory should be staffed with qualified and trained technicians. Improperly trained individuals tend to lower the confidence of the medical staff and could lead to results, disastrous to the patient health and care. It is advisable for the medical staff to determine and establish standing orders for all the routine tests to be performed on all patients.

Department Brief

Laboratory Services at ISIC, Vasant Kunj, New Delhi, is a surrogate component to Clinical practice. The objective is to provide all the necessary laboratory investigations required for patient care. The Laboratory services comprises of department of Biochemistry, Clinical Pathology, Immunology, Microbiology, Hematology, Serology, Endocrinology, Nutrition, Metabolism, Infections diseases, Histopathology, Cytopathology and Immuno-histochemistry.

All these disciplines provide qualitative and quantitative analysis of biological fluids such as blood, serum or plasma, tissue, urine, stool, CSF etc. for specific constituents to support Clinicians in the practice of medicine. The greatest emphasis has been given to ensure accuracy, precision reproducibility and prompt reporting with minimal bench waiting time.

The laboratories are equipped with state of art equipment. To operate these sophisticated gadgets the laboratories have a dedicated, motivated, knowledgeably and qualified doctors and Technical staff. This core team of personnel is constantly involved in updating the laboratory techniques and maintaining international quality control and quality analysis standards. Blood is collected through a close blood collection system called Vacutainers these tubes have a vacuum within them and are filled with a pre requisite amount of preservative.

This system avoids contaminations, minimizes contact, the vacuum allows the punctured site of the blood vessel wall to collapse immediately on with drawing the needle and there by avoiding extra vacation of blood in to the surrounding tissue. The laboratory service at ISIC provides round the clock services 365 days in a year to the people including Sundays and holidays along with clinical consultations.

Biochemistry LabThe Biochemistry Department of ISIC is a third generation laboratory, backed by highly qualified and motivated team of Doctors and Technical staff. It is well equipped with latest state of art technology, to perform not only the routine biochemical test of patients care but also a wide variety of specialized investigations such as Tumor markers, Therapeutic Drug Monitoring including Cyclosporine, Immunoglobulin, Immunofixation, Osmolatliy, Iron deficiency panel, Stone analysis, Diabetic profile and many more. To name a few sophisticated equipments, we have Dade Behring-Dimension AR a fully automatic random access auto analyzer capable of doing Sepectro-photometric and Immunoturbidmetric analyzer of various analytes, this system minimizes the human error to the least Mini vidas. Special emphasis is being given on daily quality checks i.e. internal quality control as well as External Quality Control standards, by participating in Quality Control standards. The Quality control standards are maintained as per WHO recommendations. The reagents kits used for various analysis are FDA approved.

Clinical Pathology Lab

The laboratory is equipped with completely automated instruments, cell counters for carrying out routine hematological investigation such as hemoglobin, total and differential leukocyte counts, platelet count, red cell indices etc. accurately.

The laboratory carried out complete work up Acute and Chronic Leukemia including Cytochemisty and highly specialized Immunophenotyping with wide range of immunomarker. This enables complete labeling of leukemia and thus helps in deciding the treatment and predicting the prognosis.

The Hematology department to ensure adequate collection samples carries out bone marrow aspirates and biopsy procedures.

The laboratory maintains a high degree of internal and external quality control.

Microbiology lab

The department of Microbiology at ISIC, aim to providing accurate and reproductive results on clinical material within the shortest possible time. This has been achieving by round the clock laboratory services online reporting.

Conventional culture for aerobic and anaerobic bacteria, fungi and amoeba from clinical specimen other than blood is carried out on most appropriate media in controlled environment. Identification & sensitivity for bacteria can be reported within 4 6 hours on automated system, thus reducing the time of availability of report by almost a day.

Conventional culture of Mycobacteria is done.

Detection of specific antibodies against different infection organism, bacteria fungi, parasites and virus and autoimmune diseases are carried out both by conventional & ELISA system. More than 60 different types ELISA are performed in our department. Almost all conventional serological tests are available.

Quality control (Q.C) and Quality assurance (Q.A) are strictly implemented and usually authenticated by reproducing results from other laboratories in India & abroad.

Histopathology & Cytopathology lab

This Histopathology laboratory provides opinions on all kinds of cases from Gynae, Urology, Gastro-intestinal, Cardiovascular, Orthopedic and Respiratory Medicine and highly specialized areas are such as Neuropathology, Oncology and Transplant (liver & renal) pathology. The department also supports the newly started breast-screening program in the hospital. Outside cases in form of specimens for review slides are also reported.

Immunohistochemistry is being done, particularly for diagnostic applications in the field of Oncology. Prognostic indications like ER and PR receptor studies are also being carried out in breast cancer cases.

The Cytopathology section is equipped with a 3rd generation application cytocentrifuge and an autostainer. Both Exfolicative and Inerventional Cytology (Fine Needle aspiration Cytology) are practiced; Liaison with the Radiology dept. for imaging guidance (under Ultrasound and Computed Tomography) renders virtually all body sites accessible to the fine Needle (for FNAC), thus allowing reliable tissue diagnoses at low cost and minimal discomfort to the patients.

Squash preparation and imprint cytology are also done to assist Histopathology correlation.

RADIOLOGY SERVICES

The practice of modern medicine and surgery has increased the use of all kinds of specialized services. Among them radiology services have assumed and important role as diagnostic and therapeutic arm of the hospital. The medical staff can utilize their abilities, skill and talent only if radiology services are available.

Functions of the radiology department are to assist in diagnosis through the use of Radiography, CT scan, MRI and Ultra Sound constitutes a major part of the workload in the average hospital. The department should be under the control and direction of qualified and competent radiologist. He should also have had specific training and experience in his specialty. Here also qualified radiology technologist should be available in sufficient number.

OUT- PATIENT SERVICES

Out patient services one of the important functions which most hospitals under in their areas encompassing attention to those patients who may nit require use of a bed. Generally hospital beds are not available in sufficient numbers, nor are they indicated for all those who need diagnostic service. Beds are costly to build and maintain and it is often economic waste to utilize in patient cure when outpatient services would serve the purpose.

The emergency clinic is a major unit of the out patient department. Here the attention to patient needs must be available round the clock, everyday of the year. In the average hospital one of the every five emergency out- patients are admitted as an inpatient.

The director or head of the outpatient department should have full status as a departmental head and participate in policy and program discussions and decisions for the entire hospital organization in that capacity. He should be directly responsible to the administrator.

One of the most annoying experiences to the outpatient is the interminable waiting for and between appointments. Two things must be given due consideration for improvement. First, written policies, procedures and standing orders for all the outpatient functions and responsibilities need to be developed covering organization personnel, operating patterns, relationships with other departments, with physicians, etc.

Second, expeditious handling of a workable appointment system of record completion and transfer need to be developed which contributes to the efficiency and to the satisfaction of staff and patient

ENGINEERING SERVICES

A hospital is described some administrators as ship at high seas. Almost all kinds of emergencies that arise in a ship are required to be attended to in a hospital. Sudden failure in some of the installations in operation theatre, ICU etc., can seriously jeopardize the life of patients. Here some hospital administrators have advised experienced marine engineers in hospitals. These engineers possess the know-how to deal with sudden situations that arise and have to be dealt with without outside help.

The responsibility of engineering service should be assigned to a qualified and competent, well-experienced engineer. He has to be familiar with maintenance in diverse areas like water supply and drainage, boilers, laundry, air conditioning and refrigerators, electric supply, electronic equipments, etc. He also needs a small well-trained group of workmen under him. Hospital engineer is also to organize some alternative arrangement to ensure that casual absence of some individual staff member does not create problems for routine as well as emergency duties.

If the chief engineer has come to the hospital directly from industry, he may need help in his adjustment to the problems and situations, peculiar to the hospitals. He will be confronted with the necessity for 24-hours operations and the problem of operating in spite of emergencies. The personnel manager of the hospital can be of help in assisting with the appropriate development of training programs designed to adjust the employee whose background is outside the hospital field to the general institutional viewpoint.

The traditional rationale for engineering department has been maintenance by crisis. Like management by crisis this may be an exciting procedure, so may it be dangerous. But whereas, the manager who manages by crisis may lose nothing more than his job, maintenance by crisis may cost lives. It is very practice. What is required is preventive maintenance. It involves the calculation of the expected period during which each and every piece of equipment will function satisfactorily ensuring that before trouble occurs, the equipment will receives service attention or be replace without the intervention of anyone but the engineers staff. This demands much time and can be done effectively only by competent by technical staff. It also requires more clerical assistance.

FIRE-FIGHTING, SECURITY AND SAFETY

Hospital can be victims of fires, thefts and accidents. While the first can be dreadful situation for the sick and their relatives, the second one and third one would result indiscipline, dissatisfaction and poor and bad image of the hospital.

Fire-fighting staff must be well trained in preventive measure3 along with their routine task. The whole staff must be thoroughly familiar with the fire- alarm system in the hospital. There should be its regular drill. The whole must be put under the control of specially qualified fire officers.

Security men/women also must be well trained and experienced and they should be polite to all. Smiling security men who are always alert and efficient would be an asset for any organization.

It is therefore advised to have a separate section for this peculiar function of hospitals, as the training, duties and requirements of the staff in emergencies are quite different from other personnel. They are like the armed forces having special and important role to play.

Hospital Laundry Services

The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. It goes without saying that "supportive" services are indispensable for a hospital to perform in the true perspective and deliver good patient care; besides going a long way in developing good public relation of the hospital. A sick person coming to the alien environment of the hospital gets tremendously influenced and soothed by the aesthetics or cleanliness of the surroundings and the linen. On the contrary, dirty linen tends to result in psychological dissatisfaction like a chain reaction, which creates a negative image of the entire hospital (1). Studies have proved beyond doubt, that hospital acquired infections show an increase whenever laundry and linen services are inadequate

Conventional Technology

Conventionally, the following equipment are used in most of the mechanical laundries and the linen is sequenced through washing machines, (cylinder, vacuum-cup or agitator types) hydro-extractors, (motor driven, top loading type) drying tumblers (motor driven, heat injected, front loading type) calendaring machines (single or multiple roller with variable speed control) flat bed steam press, (pneumatic push button types). Most of the hospital mechanized laundries in our country are presently using various combinations of these machines of varying capacity depending upon the quantity and type of linen used in the hospitals

Rehabilitation department

The Holistic Treatment

Besides conventional methods of treating illness, ISIC also provides alternative and holistic methods of rehabilitating its patients. Our task is to strengthen every patients body, mind and spirit. Rehabilitation at ISIC is aided by technology and speeded by counseling. It offers:

Physiotherapy

Hydrotherapy

Occupational Therapy

Orthotic workshop

Peer counseling

Physiotherapy-The Magic Mantra

Physiotherapy is proving to be the mantra for many illnesses. It helps frozen shoulders, paralysis, and neurological strokes, post fracture complications, arthritis, problems in bladder control and above all spondylitis and backaches. It aims at reducing the patients dependence on drugs and increasing his mobility and strength, thereby making him self-sufficient.

Unlike other therapies, in Physiotherapy the result is fast and effective. The response of the people at Indian Spinal Injuries Centre (ISIC) has to be gauged by the mithai boxes the physiotherapists get. Many patients who have been living like vegetables have recuperated and gone back to state, which is close to normal.- The Pioneer.

Physio and Occupational Therapy along with Family Therapy work wonders for the entire rehabilitation process, which also includes Physical, Psychosocial, Occupational and Vocational Rehabilitation for the patient.

Hydrotherapy

Hydrotherapy is a method of using the physical aspects of water for medical and relaxation treatments. ISIC boasts of the largest and the best Hydrotherapy department is approximately 350sqm in size and its objectives are to relieve pain, mobilize joints, promote relaxation, strengthen muscles and enhance co- ordinate and balance.

ORTHOTICS DEPARTMENT

The dept of Orthotic is a Centre for excellence in the delivery of Orthotic appliances for peoples with disability especially for spinal cord injured patient. Wide ranges of comprehensive Orthotic services are available for individual with spinal cord injuries, traumatic brain injuries and neuromuscular, musculoskeletal and chronic condition. The goal of department is to provide the individuals independence, maximize their abilities and assist in their return to community life as quickly as possible.

Hospital Information System and the Internet

Hospital Information System (HIS)Abstract

Hospital Information System (HIS) is expected to provide the staffs with various, worldwide information for decision making and better communication environment. The Internet can satisfy such needs. When HIS aims the direction toward an integrated environment with the Internet, several key issues should be discussed. The first important issue is that the Internet environment should be available everywhere in a hospital. The second is communication environment between hospitals. The third is sharing medical knowledge among hospitals and clinics. The forth is how to create a useful high-quality database available through the Internet. And the last is the security issue.

Hospital Information System (HIS) has evolved as integration system oforder entry systems, an administrative system, and departmental subsystems within a hospital. It has become more and more necessary for every health care staff in a hospital to use a computer terminal at almost every days works.

Under this circumstances, HIS is expected to provide the staffs with various, world-wide information for decision making and better communication environment which can be used just on the computer terminals for every days works.

Furthermore, tale-communication between a central hospital and a satellite clinic/hospital has become more and more necessary especially when a physician consult with domain experts in other hospitals concerning his/her patients' care.

We think that only the Internet can satisfy such needs as above. This paper describes how the Internet can contribute its useful functions to HISs, and introduces the network environment of HIS at University of Tokyo Hospital and some experimental projects using the Internet.

OTHER SERVICES

Financial management is also equally important in hospital. We as medical men are very poor in matters concerning the finance. So we should take the advantage of the experts of finance in making our budget, in cost accounting the cost analysis of the various activities of the hospitals to find out how the maximum could be achieved at minimum cost. This would result in economy and also improve the efficiency of the working of the hospitals.

There has also to be proper planning and organizing, staffing, direction and control of hospitals services.

Moreover, in hospital, lots of data regenerated relating to the patients and the services provided by the various departments. These data when properly tabulated and analyzed provide very useful material for the planning, management and research purposes. The hospital management, therefore, should make full use of the hospital statistic for improving its services, by getting the data analyzed regularly in a variety of ways and in particular, by getting certain indices of performance calculated for the various services. It provides a means of effective budgetary and cost control. It is a mean to assess the adequacy of staff and equipment, etc. It also helps in future planning and in improving the quality of service. It also has a favorable impact on the way in which hospital services are being managed and in their improvement to.

Scopes for Expansion

At present, the Hospital has a state-of-the art Intensive Care Unit apart from the present 90 beds and is in the process of being expanded to 250 beds. It also has three operation theatres with the latest medical equipment that allows surgeons to perform even the most complicated surgeries with ease, ambulance services and a 24 hours emergency centre.

Indian Spinal Injuries Centre has 15 acres of land. The entire covered area of the building as per plans would be around 20,000sq meters. One of the unique features of the building is to provide a totally barrier free environment.

The aim of the centre is to provide world-class facilities for medical management, comprehensive rehabilitation (including physical, psychosocial, sexual and vocational rehabilitation), research and training in the field of spinal injuries. The philosophy is to provide equal services to the economically deprived sections of the society by offering a high percentage of free and subsidized services. Since providing spinal cord injury management is most expensive as compared to any other service, and since most of these injuries take place in the economically deprived sections of the society, it became increasingly apparent that generating the recurring expenditure required for quality services at the Centre would pose a major challenge.

The Hospital has planned a Blood Bank with Immunohematology backup and component laboratory. Assisted fertilization clinic is also part of the future plan

GOALS FOR THE MILLENNIUM

To upgrade Health & Rehabilitation Services to International standards.

To expand the centre to 250 beds, of which 100 beds are devoted exclusively for management of Spinal Injuries.

Networking of the centre with the San Rafaela Bio-Medical Scientific Park, the largest Centre for biomedical research in Italy.

To establish a specialty centre which introduce new techniques in Neurosurgery, Plastic surgery, and Urology & Neurology.

Hi-tech set up for the purpose of training, catalyzing and conducting the development of basic and applied biomedical research.

Establishment of regional centers in India to serve as referral centers.

To establish a vocation training centre, a gait clinic and a halfway home.

Profit to be ploughed back for further expansion of the centre for treatment of the economically deprived and indignant patients.

Hospital Profile

Indian Spinal Injuries Centre is a registered Voluntary organization situated at Vasant Kunj, New Delhi, just 15 minutes drive from the international airport. It believes in ensuring the Joy of Living to the spinal injured persons and their family. Individual and specially designed treatment, rehabilitation and counseling programs ensure that Pursuit of Excellence with different physical parameters is assured.

Distinctive standards

Now conveniently available in India

Climbing a mountain is a test of endurance, matching human performance against the ravages of nature. The highest standards of comprehensive care available at ISIC strive towards assisting the spinal injured persons in negotiating the summits of their own minds. Our team of maintains exceptional standards professional care providers.

Historical backgroundThe saga of the centre begins in September 1965 in the war-torn area between India and Pakistan. The two countries had gone to war for the second time in seventeen years, after being one nation just twenty years earlier. A young army officer Major H.P.S. Ahluwalia who had reached the summit of Mt. Everest on 29th May 1965 with the Indian Everest Expedition was wounded in the war with Pakistan in September 1965. It was a gunshot wound which left the young officer paralyzed, what followed is the triumph of determination a conquest of the physical problems. I realized that life was all about climbing the Everest within, says Ahluwalia.

Hardly and facilities existed in India at that time. Major Ahluwalia was thus sent for rehabilitation to Stoke Mandeville Hospital in UK, the worlds then premier Spinal Injury Centre. Ahluwalia made up his up mind to make his contribution to the spinal injured, as no such centre existed in India. Thus started the Indian Spinal Injuries Centre, a tiny seed in the mind of one, who after rehabilitation was now moving from peak to peak; in an effort to conquer new ones

Thus a trust was formed in 1984 with Mr. H.C. Sarin (former Ambassador and senior bureaucrat) as the chairman and registered under the laws of the country. Prime land was purchased in Vasant kunj adjacent to an 8th century historic monument. The then prime Minister, Shri Rajiv Gandhi, laid the foundation stone of the centre on 30th March 1989. The civil works were inaugurated in March 1990

In recognition of his unique contribution to society, the Government of India awarded Major Ahluwalia the country's highest honours - the Padma Bhushan, the Padma Shri and the Arjuna Award. The President of India has also conferred the National Award for Best Work in the Field of Disability on him, for his humanitarian efforts and tireless service for the welfare of persons with disabilities

Internationally acclaimedSurgeons, doctors and therapistsISIC boasts of exceptionally qualified and reputed surgeons and doctors, most of whom have received higher training abroad; as have many of our therapists and nurses. We offer services in all spine related areas: spinal surgery; orthopedics; urology; neurology; plastic surgery and physiatry.

We have Inpatient, Outpatient and Day care facilities. Our standards in the operation Theatre meet all existing international norms and are as good as those western countries, while being significantly less expensive. The Intensive and Acute Care Wards are equipped with the latest hi-tech beds and life-support equipment.

Reaching into Lives: Patient Care

The activities of Daily Living Centre with Physio and Occupational Therapy along with Family Therapy Comforts the patients and their families. The Prosthetic and Orthotics Workshop designs braces and their assistive devices so that patients can return faster to mainstream activities. Special emphasis is laid on communicating the true situation honestly. This benefits the cure and rehabilitation process. Our medical team and therapists observe the utmost ethical standards. Psychological, social work and psychiatric teams assist in enabling the family and patients to regain their pride and self esteem.

Our barrier free built environment assures ease of moving around to all whether a wheelchair user or someone recovering from an injury or accident. A modern kitchen and friendly snack bar adds to the comfort. The patients are housed in air-conditioned beds, whether in wards or single rooms, overlooking greenery, in harmony with nature, as incorporated in our institute design.

VARIOUS ACADEMIC COURCES OFFERED BY ISIC

1. DNB (Diplomat of National Board)

DNB (Fellowship in spine):

DNB (Orthopaedics)

2. MPT (Masters of Physiotherapy)

Course offered:

MPT (Neurology)

MPT (Musculoskeletal)

FacilitiesAll specialties related to spinal cord injuries like:

Spine Surgery

Neurology

Neuro Surgery

Orthopaedic Surgery

Plastic Surgery

Urology, Sexuality

Clinical Psychology & Peer Counseling

Dental Services & Faciomaxillary SurgeryIncluding Hi-tech diagnostic facilities

MRI and CT scan

X-Ray, Ultra-sound, Urodynamics

Active outpatient department with free OPD and special discounts for senior citizens, persons with severe disabilities, ex-servicemen and indigent population

Orthotic and ADL Devices workshop

Continuing Medical Education and Training

Community based Rehabilitation

MISSION OF ISIC

To provide Comprehensive management of spinal ailments & injuries

To provide world class, High tech, cost effective & compassionate services

Making ISIC an apex referral center for the whole country

The Standard of Care not to be based on Caste, Creed, Religion or Socioeconomic Status of the Patient

TO ACHIEVE OUR MISSION, ISIC PROVIDES Facilities for Evacuation from site of accident & Initial Intensive Management.

Comprehensive diagnostic facilities

Surgical Management

Physical, Psychosocial & vocational rehabilitation

Pre- discharge home visits & follow

ISIC PROMOTES & SUPPORTS

Community awareness programs.

The dictum prevention is better than cure Which is most aptly suited for spinal injuries.

Sensitizing the lawmakers for suitable legislation in the field of disability & rehabilitation.

Adoption of highest standards of medical ethics in the field of research related to spine & rehabilitation.

VISION ISIC should become a Center of excellence & an apex referral center in South- East Asia.

To provide highest level of care available with a humane touch, to all needy without any discrimination.

ISIC would aspire wish to collaborate with other leading institutes worldwide in the field of spinal injuries bringing in the latest treatment available to the patients in this continent.

ISIC would have an exchange program with their centers of excellence.

Medical Research in Spinal Injuries & Rehabilitation within the realms of Medical Ethics.

Work in the field of Stem Cell Research and bring its benefits to the common man.

To strive to bring awareness in the field of disability. It would lobby with the policy makers for suitable legislation for prevention of disability and enforcement of Equal opportunity Bill.

Strong emphasis on Manpower Development thought Education programs. It would focus on developing graduate & postgraduate courses in disability management and Rehabilitation.

Post Graduate Courses in other Medical Specialties like Orthopaedics, Spine Surgery, Rheumatology etc. Also aspire to develop graduate and post graduate courses in other field like nursing.

Bring to all of us a sense of achievement, satisfaction & economic stability.

MARKETING RESEARCH

Marketing Manager often commissions formal marketing studies of specific problems and opportunities. They may request a market survey, a product preference test, a sales forecast by region, or an advertising evaluation. We define marketing research. Marketing research is the systematic design, collection, analysis and reporting of data and finding the relevant to a specific marketing situation facing the company.

Effective marketing research involves the five steps are as follows: -

Define the problem and research objectives.

Develop the research plan.

Design a marketing research strategy.

Collect the information.

Information analysis.

Interpretation of the Information

Define The Problem And The Research Objective The first step in marketing research is identifying and understanding the marketing problem. What is the problem? What types of information are required to solve it? What segment of the related information is already a available marketing research also make use of available literature for an in depth background study of problem. A marketing problem must also define the research objective clear.

Develop The Research Plan:

When marketing problem is defined is clearly identified and formulated, a market researcher should develop a plan to collect the reverent information. While developing the research plan, he should also be familiar with the existing research finding. He can also take the help of library sources as well as experienced consultants, personnel with practical knowledge, etc.

Design A Marketing Research Strategy:

A Marketing Researcher should design the research strategy in the line birth of the requirements of the problem. He should make certain hypothesis, the testing of which would be considered helpful in solving the problem.

Collect The Information

A marketing researcher has to make a plan for collecting secondary data primary data or both, as the case may be. Primary data gives the first hand information for specific purposes, where as the secondary data consists the information that already exists.

The marketing researcher select on of the above mentioned method or both. His decision depends on the nature of study, the objective of the study, financial resources available, availability of time and the degree of accuracy desired.

Analysis Of The InformationThe next step in the market research is to extract finding from the collected data the researcher tabulates the data and develops frequency distribution, Averages and measures of dispersion are computed for the major variables. The resources will also apply some advanced techniques and design models in the hope of discovering additional findings.

Present The Findings:

Keeping the objectives of the study in mind, the researcher should prepare the study report; the findings should be written in a concise. Simple and objective oriented languages. Graphs and example in the main report should be only if they are essential for conveying the essential facts or are otherwise necessary to support the statement.

ROLE OF Third Party Administrators

The clinicians would rather be rewarded for being part of an organized, accountable faculty, by the patient. Further the clinician will retain the supreme authority of the patients treatment

Third party administrators (TPAs) are not technically managed care organizations but play an important role in health insurance markets. Neither insurance companies nor care providers, they are intermediaries who bring all components of healthcare such as physicians, hospitals, clinics, long-term facilities, and pharmacies together.

It is long overdue for the clinician to undergo performance scrutiny and objective assessment of ones treatment outcomes. Before a third party evaluates performance and decides the efficiency of a clinician based on cutting costs rather than quality, it would be prudent for the clinician to submit for continuous voluntary evaluation through clinical audits, update ones armory by continuous medical education and compete with each other on the quality criteria, to secure contracts with TPA. This would be possible if the clinicians lay down code of conduct and regulate themselves by an autonomous body of clinicians. This will suitably dissuade the TPA to demand cost-cutting measures causing poor treatment outcomes as a whole. The seal of quality care by the healthcare providers is going to be their bargaining power in long run, be it with the insurance companies or the managed care.

Implications of TPA

The existing ill-structured system is being replaced by a reformed but organized structure called the TPA. An individual doctor through his attachment to a nursing home or a hospital is able to offer his professional services via the provider network extending to almost majority of the nursing homes & hospitals. In an ideal situation the clinician is assured of a steady stream of patients, the nursing home is assured of a steady revenue flow and so the upkeep and facilities of the nursing home & hospital tend to be upgraded. The clinician finds himself in a better equipped set-up, luxurious clinics (which satisfy ones patient also), and there is no constant need to prove ones capabilities by the number of patients one brings to the hospital nor is one obliged to bring sufficient business to the hospital. A favorable work atmosphere creates a healthy and quality practice, which gives better bargaining power to the provider with the TPA. This is the brighter but achievable picture of Third party administration of healthcare. The flip side is the managed care crisis occurring in U.S. The reasons for the crisis though have to be studied in context with the American system of healthcare. It surely cannot be applied to the Indian scenario. We have to wait & watch how many more years it will take for managed care to arrive just as Health Insurance for all (Health for all!) reforms has taken 50 years post-independence!

It is long overdue for the clinician to undergo performance scrutiny and objective assessment of ones treatment outcomes. Before a third party evaluates performance and decides the efficiency of a clinician based on cutting costs rather than quality, it would be prudent for the clinician to submit for continuous voluntary evaluation through clinical audits, update ones armory by continuous medical education and compete with each other on the quality criteria, to secure contracts with TPA. This would be possible if the clinicians lay down code of conduct and regulate themselves by an autonomous body of clinicians. This will suitably dissuade the TPA to demand cost-cutting measures causing poor treatment outcomes as a whole. The seal of quality care by the healthcare providers is going to be their bargaining power in long run, be it with the insurance companies or the managed care.

The clinicians would rather be rewarded for being part of an organized, accountable faculty, by the patient. Further the clinician will retain the supreme authority of the patients treatment.

In the reformed system, the Provider (the treating doctor, hospitals, diagnostic laboratory, radiology and imaging centers etc.), will always be the vital link of the healthcare chain.

It is this fact that the present clinician must utilize optimally. What one can do is accept the change occurring and utilize it to our benefit with collective efforts. The issues of concern, the doubts can be tackled if viewed with a common eye. The arrival of a third party since time immemorial has been constructive. So shall it be in our country with diverse practice of medicine and varying population density and their unique disease patterns.

Functioning of TPA

A Healthcare Provider is one who, by virtue of its credentials provides healthcare services to the consumer/purchaser/customer. It may be a nursing home/ hospital/ Diagnostic center/ primary care, secondary care or tertiary care provider.

Third Party Administrator System has arrived finally to India with a clearly defined identity. It is an entity which liaisons with the Insurance company, the customer (the patient) and the Providers to deliver healthcare. To seek the reasons for the arrival of TPA, one would have to give thought to the Health Insurance status in India, so far.

A patient when comes as an outpatient in a hospital has to pay for the consultation of the Doctor.

Now, if the doctor feels he has to be admitted then he writes on the OPD card the line of treatment and the duration of stay.

The patient is now asked to go to the department, which handles insurance companies etc.

A pre-authorization card is then filled with all the details like name of doctor, diagnosis, line of treatment, expenditure involved, past history, duration of stay etc. (Every TPA has its own format for theses pre- authorization forms, but the information required is the same). This form is then faxed to the TPA.

The TPA then sends in an authorization slip stating the amount till what the patient is covered and the list of items not covered under insurance.

Once the patient is discharged, his signatures are taken on the final bill and all other relevant papers & reports in original are send to the TPA for claim processing. To follow right Billing procedures are very important for speedy recovery of the payments.

Patients are only given the photocopies of the reports and not the originals.

Ethically Right

Marketing of hospital was considered unethical in the eighties. Today some degree of marketing is essential to hospital success, some cases even survival Hospitals provide the most vital services that human beings can need. Empty hospital beds and under utilized equipment and staff are ultimately costly to patients and to the society. Marketing seeks to match what the hospital provides and what the public wants. By helping to adjust the hospitals facilities and services to best meet the communitys true health care needs marketing benefits the patients and the society.

Hospital with responsive effective marketing programs will enjoy public acceptance and support.

MARKETING PLANS

The foundation of the Hospital Marketing Program is the marketing plan. Marketing plan tells us how to get where we want to go. Marketing survey is conducted before the start of the plan to study the existing services available in the region, analysis of diseases prevalent rates and epidemiological studies. New service developments according to market needs and changing customer choices also is studied

POSITIONING

Positioning addresses the question What does this hospital want to be known for? As a health care provider? Every hospital would be prepared to serve the immediate medical needs of every patient who arrives at admission. But no hospital can do all thing for all people.

A small hospital in a rural community must necessarily refer patient in need of a rare or highly sophisticated treatment to specialized center. Today, however a wide choice is available in metropolitan area. Having a mission that differentiate your hospital your hospital from all other and communicating that mission is important.

What does this hospital offer that others dont? What is bigger or better? Does the hospital have more specialists in particular field? Is it providing a particular service to patient at a lower? Does the location of the hospital have special advantage transportation access, a pleasant environment. approximating to some attraction, etc.

The answer will differentiate the hospital from other defining the strengths and the weaknesses of the hospital explicit positioning statement can be written. After adopting the positioning statement, every staff member should be able to answer the question What is the hospital known for?

THE PRESENT SCENARIO IN INDIA

Fairly recently, the concept of Corporate Hospitals has arrived in India. In the early eighties, the Apollo group set up the first hospital in Chennai and followed it in Hyderabad. Escorts group established Escorts heart institute in 1988. Corporate Companies like Wockhardt and Max India started the Hospital industry. Apollo group also built the Indraprastha Apollo Hospital at Sarita Vihar in New Delhi. Many more other companies like Escorts, Fortis Health Care, Reliance and Marico Industries have also aimed at health care sector.

HOSPITALS PREVENTIVE HEALTHCARE MARKET

They say prevention is better than cure. Perhaps, working on this proverb, there is a growing health consciousness among the common man, giving a boost to preventive health check-ups in hospitals.

Now, it is not just the stressed out corporate who go for annual health check-ups, sponsored by their company. Today, most hospitals witness an equal number of walk-in patients who believe more in preventive than curative health care. There has been a marked surge of middle-class patients who would not mind shelling out a few thousands of rupees for annual check-up for their families. Hospitals have been astute enough to have tailor-made packages for all age groups. According to industry analysts, there has been a growth of 25 per cent in the preventive healthcare market in the last five years.

These preventive health packages costs from Rs 500 to Rs 5,000. Majority of the customers prefer the comprehensive health package. The various packages are a permutation and combination of CBC, blood sugar, cholesterol, urine stool, digital chest X-Ray, ECG, general examination, blood group, blood sugar, liver profile, proteins, lipid profile, cholesterol, and renal profile.

The Apollo hospital group, which was the first to introduce the preventive health check-up package in India, today witnesses more than 100 patients in a day. The packages range between Rs.1,900 to 2,500. Says Dr Hari Prasad, vice president, Apollo hospital, Hyderabad,

"The packages are highly subsidized. If a patient undergoes the tests separately, it would cost him thrice the amount."

More than 100 patients walk in to Wockhardt Hospitals every day for 20 test packages, which cost from Rs 500 to Rs 5,000. Says Vishal Bali, vice president, operations, Wockhardt hospitals, "A patient might just come to the hospital for a blood test and can decide to get a complete health check-up done. We have seen patients gifting test packages to their parents. Also, around 10 per cent of the patients who come for the health check-ups require further tests.

Hospitals also conduct talks for a better life-style. Says Brig Joe Curian, CEO, Hinduja hospital, "Our patients are given talks on life-style modifications and dietary habits."

Some hospitals have started marketing their health packages by holding free health check-up camps and educational programs about the importance of preventive health check-ups. Recently, Association of Hospitals, a body of 37 Mumbai-based hospitals declared it would conduct free health check-ups. However, Bali, feels it is not a good proposition, as "It costs us a lot of money to do a comprehensive check-up. Holding free check-ups might lead to a compromise of quality, and that is the last thing that a hospital should do."

The small cities, which on an average do not attract more than 15 to 20 patients per day, are also equally enthused. Around 70 per cent of their patients are through company tie-ups and the rest are walk-in patients. Fortis, for instance, which gets around 15 patients a day, attributes it to the tie-ups that they have with 73 companies. It offers eight packages ranging from Rs 1,000 to Rs 3,000 and four more are in the pipeline. Says Dr Ravindra Karanjekar, medical director, Fortis, Mohali, "It is a big challenge for us to sell the package. We have tied up with different medical associations so that they refer their patients to us." The patient education cell of the hospital educates the relatives of patients to go in for these check-ups. "We do not see many walk-in patients. So we distribute brochures and educate them about our health package." He suggests that a hospital in a small city should approach schools for the tie-ups. Even diagnostic centers have started cashing in on this emerging sector. Says Dr Nilesh Shah, managing director, N M Medical Center, Mumbai, "We score over others as being a diagnostic center, our preventive health check-ups borrow high-tech diagnostic equipment like digital X-Ray, bone densitometry, 3-D and 4-D ultrasonography, facilities which are not available with preventive healthcare centers per se. Every individual who walks into our center is also made to undergo lifestyle and stress management workshops."

Experts say this sector has a tremendous potential to grow, as much as the insurance sector. "The government gives tax benefits to the curative healthcare, but neglects preventive healthcare. With the right kind of incentives from the government, preventive healthcare can make a dent in the curative healthcare sector," says Curian.

JOURNAL OF HOSPITAL MARKETING HAS PUBLISHED THE FOLLOWING ARTICLE ON MARKETING STRATEGIES

"This dynamic journal takes as its mission the dissemination of pertinent and practical material on new and effective ways of marketing hospital services. Written by and for hospital marketing professionals, the Journal of Hospital Marketing & Public Relations shares current and cutting-edge marketing applications and methodologies.

Retitled to better reflect its focus (formerly the Journal of Hospital Marketing), this refereed journal keeps you on the leading edge of the field with theoretical and empirical research papers, case studies, and articles of relevance to both academics and practitioners.

The practical and methodology-oriented articles featured in the journal assist practitioners in enhancing their productivity and effectiveness in such areas as:

Strategic marketing planning

Strategy development.

Fund development

Recruitment

Internal marketing

Joint analysis

Market analysis

Competitive advantage analysis

Marketing research and auditing

Patient liaison activities

Lobbying/regulatory affiliation

Hospital economics

Staff development from a marketing perspective

Contracting

Media selection/placement/relations

Target analysis

Working with marketing consultants

HOSPITAL MARKETING TARGETING WOMEN

Recently, medical researchers and hospitals discovered a fairly important fact: Men and women are differentMen are from Mars and Women are from Venus.

In the past, research on conditions such as heart disease and cancer had been performed on men. That's changing now with the realization that diseases affect men and women differently and that symptoms vary between genders.

As a result of these revelations, hospitals have begun marketing services toward women and establishing separate programs for women. New services at Milwaukee hospitals include centers for women's heart care, cancer research on women, and programs designed to improve women's overall health. To attract women to its programs, Covenant Healthcare System Inc. this year started an extensive marketing campaign at its five Milwaukee-area hospitals to attract women to services offered. Instead of focusing on the reproductive aspects of women's health, Covenant has expanded marketing of services to cover a woman's entire lifespan.

In short, health care executives, after focusing on breast cancer services in recent years, are now pushing for more awareness in other areas of women's health. "There's a much higher level of sophistication in health care decisions and choices, and they are being made by women," said Vicki George, regional vice president for the metro region of Aurora Health Care, Milwaukee. "Hospitals and insurance companies have recognized that and are now navigating marketing efforts toward women."

FINDINGS

To find out the services provide by the hospitals and a comparison between them.

To Study and compare the actual level of services quality in the hospitals surveyed.

To make a comparative analysis of all the services of private Vs Government hospital.

To study the behavior of the doctor towards their patients.

To study the availability of all new technological equipments in the hospital for the convenience of the patients.

Suggestions & REcommendations

for various sections

MRD

Observations

Recommendations

Currently any staff can directly obtain information from the MRD department without the prior permission of AMS or AMD. If any type of query is required to any department staff, like doctors, nurses, ward boys, or receptionist then permission should be taken from the AMS or AMD then obtain the information to the MRD department.

Unavailability of any checklist to check the status of a document. A checklist should be made so that it can be cross checked with the related documents of MRD asst.

Reports of the patients are not being managed properly. The separate racks instead of lying down here and there could maintain reports of the patients.

A senior MRO is itself responsible for carrying, delivering, and sorting of the patients record files.

At least one employee should be added (helper) whose work is, if any demand of record is needed to the doctors chambers or administration then in this case he should deliver or receive the required file instead of assistant medical record officer or many others.

The Sr. medical record officer checks a file casually. He should check each file properly in the sequence given in the record file.

STORE

ObservationsRecommendations

The store keeper maintains the long register it means, in case of emergency if any type of material is require then he allots manually instead of printing or proper filling of registration form. He does not contains the name of the person who issue it or who receiving it, designation, counter signature of the storekeeper, quantities wise, date etc. He should maintain the above discussion matter because it creates problem into the future.

Counter furniture is one-sided open. Counter should be both side open instead of one side. Material cannot be kept in front of the counter. Also in case of fire, all the employees can go out easily and also the items cannot be stolen.

The fire extinguisher is of 5 Kg only, which is not sufficient for the store. The fire extinguishers should be provided of 10 Kg and also check the date of filling or expiry date, which could not be there.

There is no rack to keep record files. Provide the vertical racks for keeping all the files.

No periodical internal audit is carried out Also routine audit e.g., weekly basis or check the stock at least once in a month or prepare the stoke list. Since it helps to measure the fast moving goods or slow moving goods or stationeries goods. That also helps to ordering the appropriate volume of the required materials according to the demand basis.

SAMPLE COLLECTION ROOM

Observation

Recommendation

Chair for the patient is too heavy to be handled by the patient. The chair used in the sampling department should be lighter so that the patient can easily handle it.

Sample collecting staff brings their general shoes inside the sample room; which may carry infections. The staff should be recommended black chapels for sampling room because it can reduce the dirt as well as infection.

There is no privacy for collecting the sample. At least one curtain also used in the sampling room for specialize/privacy maintained while collection of the sample.

The housemen do not wear a glove and mask when collecting the wastes, they dip their hands in poly bags instead of removing of poly bags The houseman should collect the waste into the dustbin using of gloves & mask, also pick up the whole poly bags into the bins instead of dipping the hand into the dustbins

Lab staffs do not wear gloves and mask while collecting the sample to the patient. Lab staff should wear the gloves & mask while collection of the samples or disposal of syringe & tissue etc., to reduce any chance of infection.

Lab staff simply uses toilet soap for washing their hands. Use povidine-iodine or chlorohexadine as antiseptic for hands and forearms wash. For major contacts take extra or denary care to avoid accident wounds from contaminated sharp instruments.

PHARMACY

ObservationRecommendation

Even after meeting with the expiry date many drugs are kept. All the drugs and injection after meeting expiry date should not be kept in the hospital as it affects total cost of the hospital.

There is a goods carrying trolley, which is not being used. Trolley should be removed because it does not have any purpose or it may damage the side sliding glass of the pharmacy.

A bill for the medicine purchased is not given. The pharmacist should register the drug name on time when demanded of the drugs and also raising the bill on time when issuing the drugs for anybody either a patient or ward boy.

Even a ward boy can make a bill. The ward boy cannot be permitted to generate the bill.

Many ward boys get gathered in the pharmacy and start making a noise by gossips. Pharmacist should attend them one by one and can ask them to keep silence or a slip mentioning the same can be pasted on an appropriate visible location, which helps to decrease the noise level and increase a smooth functioning of the pharmacy.

Pharmacists are not as responsible as they should be towards the patients. Pharmacist should improve the communication or behavior to dealing with patient or otherwise.

HEART COMMAND CENTRE


There is a communication gap between the nurses and technicians. Minimize the communication gap between the nurses and technicians.

The Echocardiography machine is in working condition while CD drive and Floppy drive and Video Cassettes are not in working order. CD drive and Floppy drive and also the Video Cassette should be in working order to reduce the burden of the technicians.

Many times the rush has been occurred on the nursing station but there is no nurse / technician at that time. At least a nurse should be sit permanently during the duty hour so that a patient can be attended.

There is sitting arrangement (sofa) near to the nursing station. Sitting arrangement should be outside so that it can be used in effective way


There is a computer in the MRI console room; which is not being used. Remove the computer to the MRI console room, to save the space and it can be used by any other department.

Staff should be computer literate. Staff should be briefed to register name and ID of the respective patient in the computer.

Only one X-ray machine is available. One more X-ray machine is required, since the current one troubles some times thats why the patients have to wait for long time or hospital loses the revenue.

RADIOLOGY

ICUObservationRecommendation

There is only one doctor in ICU. At least two doctors should be posted in ICU.

Presently there are 9 beds and only 4 ventilators, 4 blood gas analyzer, 4 infusion pumps and 4 ceiling fans. Every single bed has to be providing separate ventilators, blood gas analyzer, infusion pumps and ceiling fans.

A piece of cloth is used on the shelves. Using the piece of cloth on the shelves should be removed because it creates infections.

Oxygen cylinders are kept in Isolation room. Separate rooms for keeping the Oxygen cylinders instead of Isolation rooms.

A nurse treating to a patient using the gloves touches anywhere at the same time. A nurse should be briefed about how to reduce the chance of infection.

There is no foot cover in ICU. A foot cover should be provided in the ICU.

Curtains or moving curtain trolley are washed once in a month. Curtains or moving curtain trolley should be washed twice in a week.

There are fixed type of beds or one sided movable. Every bed in the ICU should be movable to both the side.

There is no any device for remotely monitoring of patients. A CCTV camera should be provided to the nursing counter to keep good monitoring of the patients

CSSD


The packing table in the CSSD department is in bad condition. The packing table in the CSSD department should be repaired/ replaced.

Staff working in CSSD department do not have any protective equipment. All the staff working in the CSSD should be provided personal protective equipment which include heavy duty rubber or plastic gloves, face mask, eye wear, water proof apron etc.

There is no housekeeping device. Two sets of house keeping equipments are provided on decontamination.

There is a bin made up of card board which got damaged at its base. A standard black bin should be providing in the inner sterilization department

Date of packing and date of expiry are not mentioned on the packets Each pack must be labeled as to its contents and its date of packing and expiry date.

LAUNDRY


A/C is out of order. Provide or start the window, air conditioning which is given in the frame provided on the wall of the laundry.

Laundry staff do not use provided gloves and aprons, The laundry staff should use plastic gloves, waterproof aprons etc.

The washbasin, walls, doors, ac windows are not clean.

The washbasin, walls, doors, ac windows should be cleaned on the monthly basis.

ENGINEERING


The hydrotherapy water heating plant runs for 14 hours. The hydrotherapy water heating plant reduces the timing in nights. It should be run 6 hours a day (at night); because it saves the electricity.

AC plants run for 18 to 20 hours. Each AC plant should be run for 6 hours only giving total of 12 hours running and an interval of 2 hours.

Induction choke and yellow bulbs are being used. Use of electronic choke instead of induction choke and fluorescent tubes should be provided since it saves electricity.

There is no trained person for fire extinguishing; and no one knows how to use fire extinguishers in effective manner. At least two people are appointed for fire extinguishing, if it is not possible then taking the help of Delhi Fire Brigade team for briefing about the fire extinguishing; how to prevent it or use the fire extinguisher cylinders.

AC plant is being run with the help of four blowers of which two are fitted in the basement and two are fitted on the terrace. Each blower is of 22KW; it means two blowers consume 44KW per hour, which monthly running cost is approx Rs.110, 000. The two blower of the terrace can be replaced with the natural cooling tower, air exhaust without any drive and also cannot consume electricity which has only one time cost (Rs.550000) and which save approx Rs.1320000 of electricity bill yearly.

KITCHEN


The distance of the Iron Net on the window is 3 inches. The distance of the Iron Net on the window could be at least 1 foot because there is no clear area of the glass of the window and if the window is opened then the lots of mosquitoes and dust get inserted.

Cooks do not wear clothes in recommended way. The dress of the cook should be-clean-with Chinese collar or close collar because if sweating arises then it cannot get mixed with cooking items.-no wrist watch, thread or any type of chain could be wearing doing the cooking.-polished shoes should be worn.

The cooler is situated inside the kitchen. The cooler cannot be located inside the kitchen because it can create an infection since the exhaust fan of the cooler can bring dust particles.

There is only one exhaust fan. At least four exhaust fans should be provided in the kitchen in each corner with minimization of infection.

Dough maker machine and oven need repairs. .The electronic devises should be repaired, so that they can be used appropriately.

Cut salad is washed in the water. According to the Standard Food Cutting guidance cut salad should not be washed in water instead it should be washed before cutting to maintain the texture and hygeine of salad.

All the utensils are washed and clean on the same cloth But it can be drying with the help of drying machine which also reduces the infections.

WARDS


There is only 4 feet gap between two beds. According to Indian Standard Institution in their standard ISI 10905 Part-I recommended on area at least 6feet for every beds.

Visual impact of the general wards is not proper because many times nurses are sitting inside the nursing counter which is big around 4 feet wall so it could be less. A CCTV should be used to monitor the patients and wall height should be reduced by two feet to enhance the visibility.

Here HIV or AIDS patients have separate isolation room, which contains 3 beds. It should be increased. - the linen, pillow cover or any other clothes are to be separately washed in the house keeping room with sodium hypo chloride solution and send then to laundry.

Washbasin is too high to be used by a patient on the wheel chairs. Wash basin used by wheel chairs patients should be 70 cm deep with a narrow basis.

There is no dirt utility room that can store bedpans, urinal, and sputum mugs and for temporary storage of stool and urine specimens is termed the dirty utility room. This room can be a part of sanitary block.

There is no treatment and dressing-room -which major work is to perform a minor surgical procedures, lumbar puncture; some special examinations. Part from other things (the dressing and treatment room can be provided with an instrument sterilizer and sink).

There is no rack Also provide the separate rack for different records e.g. X-ray records, city scan reports, patient laboratory records etc. Instead of dumping in open area which could wear the dirt.

PREVENTON OF INFECTIONS

A written policies and procedures which defines the type of surveillance to be carried out and how data ill be analyzed and used.

Single room with closed room doors. (Ideal Isolation Room).

Use plastic dishes.

Surveillance of nosocomial infection (microbiology infection)

Limit the number of people who enter these areas.

Procedure for hand wash:1. Before examining each patient

2. After examining each patient

3. After handling blood, urine or other specimens.

4. Before going from one patient to another.

Separate bins for separate wastes should be used to the wet rooms.

General waste of plastic waste can be separated and using bins of different colors can separate it.

The bins should be foot operated to reduce the infections.

A bin is locating it the nursing station should be 20 Kg instead of 5 Kg.

According to the provision of law, the waste of puncture proof box should be transferred to the blue bins.

As soon as of these waste bags get filled, then it should be removed from the container, tied tight with a plastic string.

Suggestion to avoid the pitfalls of hospital infection to the staff and patient.

1. Print material: hand bills flipcharts, posters, books, manuals, booklets etc.

2. Audio visual aids including slide shows, overhead projections.3. Situational analysis and problem solving sessions.4. Trainer of Hospital Waste Manager should obtain regular feedback from the personnel involved in the educational programs.MARKETING STRATEGIES OF CORPORATE HOSPITALS

Numerous marketing strategies are being adopted by these corporate Hospitals in order to ensure competitive advantage. Some of them are as follows:

Attractive preventive check up packages comprising of whole body check-ups including Blood profile, Ultrasound and treadmill tests, CT scan, endoscopy etc.

Many hospitals have eminent personalities from the industry in their board of trustees. This leads to increase inflow of patients working in the companies of these trustees.

Hospitals attract the shareholders by offering discounts.

Successes of crucial operations and surgeries are discussed in the health magazines and newspapers, which become a natural advantage for the hospital.

Hospitals holding seminars and conferences relating to specific diseases where doctors throughout the country are invited for detailed discussion. This makes the hospital well known among doctors who may refer complicated cases to these hospitals.

Hospitals promoting medical colleges. This helps them to generate extra resources in the form of fees using the same infrastructure.MARKETING A HOSPITAL & FACILITIES

India today boasts of hospitals and establishments that are comparable to the worlds best medical facilities. Todays patients are very demanding and expect the best quality of facilities and medical care. The hospitals need to conform to NABH ( National Accreditation Board for Hospitals) and JCI (Joint Commission International) guidelines.

In keeping with this philosophy only International best practices are observed by Hospitals. We need to keep in mind that the Hospital is our showpiece and our show-room. When a patient visits the Hospital he utilizes the facilities. But his relatives and friends who accompany him are also potential patients and the ambience and services that they avail of or observe may influence their decision should they ever require medical attention.

Since all facilities are world-class we must make the medical fraternity and public at large aware of the existence of these facilities. This marketing has to be done in India and abroad, where the medical facilities are not so advanced.

Medical tourism is a reality and efforts have to be made to promote the hospital in countries like Africa, Afghanistan, Pakistan, Bangladesh, Nepal etc where such facilities are not easily available. In advanced countries like the UK and USA the facilities are expensive with long waiting lists and advanced medical facilities in India make it an attractive medical tourism destination.

Most modern hospitals today have full-fledged marketing departments to promote the Hospital locally, nationally and internationally. They also liaise with various agencies to facilitate the patients travel and medical reimbursement.

TPAS The hospitals should display a list of TPAs on the panel so that there is no confusion for the patient. The hospital authorities should not hide any information, which may go against the patient or delay the issue of his or her authorization letter.

The hospitals need to employ an extra staff and should train them to various aspects of TPAs running. The hospitals need to be tolerant when dealing with dissatisfied customers/patients who have been asked to wait, till an authorization is sent by the TPA. Hospitals even can have a booklet, highlighting the terms & conditions of Mediclaim policies, which could be used to educate the patient, before things go out of hand. The hospitals also should not insist on authorization every time & should provide first aid to the patient & even should go ahead in doing a life saving procedure, in an emergency. The hospitals may or may not extend discount, commissions to the TPAs depending upon their policies & procedures but it should definitely not be unethical.

Hospital being satisfied with the concept of TPA would like to further insure their own staff through a TPA, as they feel satisfied with the services provided to them.

TPAs feel that it is a good business & a profitable one. They feel that the hospital authorities should not hide any facts from them & should inform them within 24 hrs of admission. They should admit a patient on its on merit & not fake emergencies and give unnecessary treatment. They try to make the payments to the network hospital but end up nor doing so. They do feel that at times both patients & network hospitals use legal influence to get work out of them, but they seldom do so. They also share our concern that the patients consumers are not aware of the various terms & conditions and it is a collective responsibility of all three to make it more transparent & educative. People have high expectations from TPAs & when an authorization is denied to them they scream & create a scene. They feel that they should be given a discount/commission but seldom insist for it.

The IRDA should play a more active role in regularizing the number of TPAs in the market. There may be more than 23 TPAs on the panel of IRDA but there are actually very few around 7 TPAs, which are functioning smoothly.

I feel it is the collective duty of IRDA, Insurance companies, TPAs, agents and finally hospitals to make the consumer more aware of the various terms & conditions mentioned in the Mediclaim policy. It is also the duty of the consumer/patient to go into the details of the policy which one is about to buy or had already bought. IRDA has to act as a police man in making sure that these TPAs make regular payment to Network hospitals or otherwise they will stop entertaining the TPAs and ultimately it is the consumer who will suffer.

IRDA should also find means to lower the waiting time of patients and make Mediclaim friendlier to the consumer. Though the consumer has welcomed the cashless facility but it is not that simple to access it.

At the end the concerns, which have emerged is that, the level of awareness of terms & condition of Mediclaim needs to be enlarged, and IRDA role should be more proactive to make Mediclaim more consumers friendly

Following are the questions asked to patients: --

Awareness about TPAs.

Concept of TPA.

The best TPA.

Awareness of cashless facility.

Non-Reimbursement of OPD cost.

Awareness that admission for more than 24 hrs is must.

Awareness that authorization from TPA is must except in case of an emergency before start of treatment.

No authorization, patient needs to pay.

Awareness of non-reimbursement of cost of only investigations to be done at the hospital.

Awareness of Pre-existing diseases being not covered.

Reimbursement of cost of treatment taken 30 days before & 60 days after admission.

Awareness of minimum number of beds for reimbursement.

Awareness of non-reimbursement of charges towards Certain Diseases not covered during 1st year of policy.

Awareness of non-reimbursement towards spectacles, hearing aid etc.

Awareness of non-reimbursement of Dental Charges.

Quality of treatment being provided to cashless insurance patient vise-e-vie cash paying patient.

One needs to wait to obtain an authorization form TPA.

Waiting time to obtain an authorization.

The promises about the features of the Mediclaim policy, made by the agent at the time of issuing the policy, stand true.

Re-imbursement from the TPA takes how long.

Quality of services provided by TPAs.

Method of enrollment.

Need for medical insurance.

Following are the questions asked TO Net work Hospitals: -

Behavior of the patient in case of denial of an authorization.Empanelment with Hospitals.

Business volume after TPA Empanelment.

Regularity in Reimbursement.

Reimbursement within the stipulated time.

Work Load since TPAs empanelment.

Legal action against TPAs.

Outstanding from TPAs.

Regular follow up for Payments from TPAs.

Extra staff to deal with TPAs.

Discounts sought by TPAs

Commissions for referring patients.

TPAs force their own tariff.

TPAs Influence in selecting a patient.

Utilization of TPAs services to insure your own staff.

Concept of TPA for the hospital.

Name of TPAs are: -

1. E- Meditek.

2. Genins India Ltd.

3. Medicare.

4. Paramount Health care.

5. Raksha TPA.

6. Universal Medi aid services.

7. Vipul Corporation.

Comparison between government and private hospitals

In private hospitals services are better than government hospitals .government should try to spend more money or budget on medical services in government hospitals.

Improve a quality of services in government hospitals .Many trained doctors working in government hospitals but the administration services and other services services like latest labotaray test facilities and operation facilities are provide in hospitals.

Special treatment and facilities provide to all old age patients.

In government hospitals services are not good but in private hospitals services and facilities are good but many percentage of patient not able to take a treatment in private hospitals so the patients bond to take a admission in govt hospitals but govt provide a more better facilities to and care in all departments of hospitals.

In major government hospitals doctor not properly attend a patient this is a main reason some percentage of patients are approach to private hospitals.

In govt hospitals provide latest techniques in all departments and provide customer care training to all employees of hospitals.

OBJECTIVES OF THE STUDY

To examine the satisfaction level of consumers by the facilities provided in the hospitals.

To examine the Marketing Strategies adopted by private hospitals to promote their services.

To study the awareness of consumers regarding services & new techniques adopted in hospitals.

To examine the new areas of hospitals marketinginternational marketing tie-ups, health tourism etc.

RESEARCH METHODOLOGY

The study is based on primary data obtained through a well designed questionnaire the questionnaire consisted of the 9 type of question 5 each on technical (TQ) and environment (EQ) dimensions and 5 on functional qualities. The customers were required to mark their responses for each statement on the Likert scale (range 1to5) where 1 referred to Mostly Disagree and 5 meant Mostly Agree.

The actual mean score for each hospital against all the 9 services quality dimensions were calculated. The average score for each service quality component (TQ, FQ, EQ) would arrived the score for each sector (public, Private and foreign) was computed for future analysis.

Research Methodology is systematically way to solve the research problems. It is the systematic gathering recording and analysis of data problem. In this way methodology includes the over all research design the sampling procedure and the data collection method and marketing research.

Marketing research includes the systematic gathering recording and analysis of data recording and analysis of data problem, related to the market. It is usually based on statistical probability theory marketing infect it is a part of social research, which has acquired academic status.

Lets work through survey study, which forms an important instrument in the research field. The survey consists of the question to be asking to the retailer and other persons concerns.

It includes various types of research such as market analysis of the sales records of the company consumer research, advertising research chiefly as avoid to the management of advertising works. Advertising research under taken for the study of relating to the preparation of the measurement of advertising effectiveness.

Techniques Used In Study

Research study has been carried out through field research by adopting following techniques:

Library research:-

For collection of data following two methods were adopted:

Primary Data

Personal interviews.

Questionnaire

Observation method.Secondary Data

Pas

Marketing Hospital IIPM

Documents

general doctors

medical staff doctors

experienced doctors

doctors job

honorary specialized

hospital management

hospital marketing

hospital boards