SIP-Feedback system College

A STUDY ON THE PATIENT

FEEDBACK SYSTEM AT

KASTURBA

HOSPITAL, MANIPAL

Presented by:

Shreekanth Dangi

(091203002)

MIM, Manipal

Introduction

“A hospital is an integral part of a social and medical

organization, the function of which is to provide for the

population complete health care, both curative and preventive

and whose out-patient services reach out to the families and

its home environment; the hospital is also a centre for the

training of health care workers and biosocial research”

Marketing techniques can be applied to a broad set of problem faced by

hospitals.

Where should the hospital locate a new branch or ambulatory care unit?

How can the hospital estimate whether a new proposed service will draw enough

patients?

How can the hospital attract more consumers to preventive care services, such as

annual medical check-ups and cancer screening tests?

How can a hospital successfully compete in the recruitment of highly trained

specialists who are in short supply?

What marketing programme can attract nurses, build community goodwill, and

attract more contribution?

Marketing orientation of hospital services will result in:

1. Improved satisfaction of clients

2. Improved attraction of resources and

3. Improved efficiency in activities.

Introduction…

Satisfaction is the consumer’s fulfilment response. It is

judgment that a product or service feature, or the product or

service itself, provides a pleasurable level of consumption

related fulfilment.

Achieving hospital patient satisfaction and the quality patient

experience:

Pride fully advance your healthcare mission

Attract and retain talented staff

Win patient loyalty

Secure the position of provider of choice in your

competitive healthcare marketplace.

Patient satisfaction

Principle of achieving patient satisfaction

The quality patient experience doesn’t happen by accident.

Anxiety is the rust of life, destroying its brightness and weakening its

power.

Some emotions don't make a lot of noise.

Patients and families want care and service to feel personal.

Ineffective accountability is evidence that we are not serious. The allies

of accountability:

Feisty determination

Clear expectations

Clear agreements

Sound measurement and feedback

Courageous conversations

Consequences

The more strongly your hospital’s culture supports the quality patient

experience, the more sustainable are impressive levels of patient

satisfaction.

Patient satisfaction…

Design of the project

Design of the project

Objective

To identify the level of patient satisfaction and determine the

factors effecting patient satisfaction through patient feedback

system.

Scope of study

The scope of the study is limited to Kasturba Hospital located

at Manipal targeting the in-patient and out-patients visiting

the hospital.

Finally the study is aimed to help Kasturba Hospital to

analyse the effectiveness of the present feedback system and

to improve the efficacy and effectiveness of the feedback

system and to reduce the gap by initiating measures to

resolve the problems exist if any.

Type of research: Descriptive research

Data collection method: The data collected was both primary and secondary

in nature.

Primary data

The primary data was collected through means of as Structured Questionnaire,

targeted towards both In-patients and Out-patients.

No of items in questions:

Questions related to demography

Questions related to satisfaction level toward different parameter of hospital

Questions related to opinions and suggestions

Secondary data

Secondary data means that data which is already available.

Secondary data is important to understand the different parameters which exist

in the hospital and the history of the hospital.

Design of the project…

Sampling plan

Sample population: The target population under this study are the

patients and patient relatives visiting Kasturba hospital, Manipal.

Sample target: In-patient and out-patient corresponding to almost

all departments of the hospital have been taken into consideration.

Sampling method:

Non-probability conveniences sampling for the patients.

Complex random sampling design is cluster sampling.

In out-patient from various departments two patients are selected.

In in-patient three from each department are selected as sample.

Selection of the respondents is based on the easy availability of the

respondents, willingness to fill the questionnaire and return the filled

questionnaire promptly.


Sample size

In-patient: 198 (66*3)

Out-patient: 144 (72*2)

Limitation of the study

1. Some patients were not helpful in responding to the questionnaire

due to stress of the hospital environment and aliment.

2. There wide difference among the respondents on the basis of

demography, education and intellectual abilities. So, there is non-

uniformity in the understanding of questionnaire.


Hospital profile

Kasturba hospital was

established in 1961

under the acumen and

leadership of late

Padamshree Dr. T.M.A.

Pai, an internationally

renowned doctor,

educationist, banker,

industrialist and

philanthropist.

Hospital profile

Premier healthcare institution providing quality tertiary

care.

Patients both domestic and international.

Beds: 2050

It has a dedicated team of 323 full-time consultant doctors

of national and international repute, 311 resident doctors

and 2200 paramedical, nursing and other supporting staff

working round the clock for delivering compassionate care.

Hospital is the first Medical College Hospital in Karnataka

to get the prestigious Accreditation from National

Accreditation Board for Hospital & Health Care Providers

(NABH) on 14 September 2009.

ISO 9001:2008 certified

Hospital profile

• Mission Statement: Kasturba Hospital is committed to be the

most preferred and comprehensive hospital through clinical

excellence, patients’ centricity and ethical practices to meet the

health care needs of the community.

• Quality Policy: Kasturba Hospital is committed to meeting patient

needs and increasing patient satisfaction through continual

improvement of its services, quality management system and by

empowerment of staff.

Hospital profile

Findings

Findings

In out-patients and in-patients most of the patients are male and most

of them earn their living as private employee followed by students.

Out-patients In-patients

In both in-patients and out-patients the education level is graduation

for majority the patients.

Findings…


Most of the out-patients come to the hospital for the reason that it is the only good

hospital in the area hand and it is a good old hospital at the same time the reason for

the selection of the hospital for the in-patient are majorly the advance medical

facility at the hospital and good old hospital.


Findings…

Most of the respondents for the out-patients were the patients themselves

whereas in the case of the in-patients the respondents were the friends and

the relatives who came to visit the patient.

Findings…


Out-PatientsFindings related to parameters

What is your educational leve l? * How confident you fee l about Kasturba hospital, Manipal about the treatm ent?

Crosstabulation

2 5 0 0 7

.6 4.9 .8 .6 7.0

0 9 0 0 9

.8 6.3 1.0 .8 9.0

1 29 11 2 43

3.9 30.3 4.8 3.9 43.0

8 57 5 11 81

7.4 57.0 9.1 7.4 81.0

2 0 0 0 2

.2 1.4 .2 .2 2.0

13 100 16 13 142

13.0 100.0 16.0 13.0 142.0

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

primary

secondary

inter(10+2)

graduate

post graduate

What is your

educational

level?

Total

Strongly

conf ident Conf ident

Somew hat

conf ident

Somew hat

lack of

conf ident

How conf ident you feel about Kasturba hospital, Manipal

about the treatment?

Total

Null hypothesis: Patient confidence level on Kasturba hospital is independent

from education level.

Alternative hypothesis: Patient confidence level on Kasturba hospital is

dependent on education level.

Chi-square test

Chi-square test

Chi-square test

Null hypothesis: Recommendation by patient to friends and relative about hospital

is independent of the confidence level of patient.

Alternative hypothesis: Recommendation by patient to friends and relative about

hospital is dependent of the confidence level of patient.

Chi-square test

Findings for out-patients

Excellent Very good Good Fair Poor score

Enquiry 4.9% 29.9% 36.8% 28.5% 0.0% 3.115

Registration 4.2% 24.3% 54.2% 13.2% 4.2% 3.114

Waiting 0.7% 7.6% 16.7% 43.8% 31.3% 2.029

Excellent Very good Good Fair Poor Score

Pharmacy 0.0% 27.1% 50.0% 11.8% 11.1% 2.931

Laboratory 5.6% 24.3% 54.2% 11.8% 4.2% 3.156

Radiology 5.6% 27.1% 41.7% 19.4% 6.3% 3.066

Scheduling 0.0% 13.7% 30.2% 49.6% 6.5% 2.511




Receptionist 0.7% 31.9% 55.6% 11.1% 0.7% 3.208

Nurse 36.8% 43.8% 12.5% 6.9% 0.0% 4.105

Consultant/Doctors 31.9% 29.2% 29.2% 9.0% 0.7% 3.826



Parking 0.7% 23.8% 32.2% 18.2% 25.2% 2.569

Cleanliness 6.3% 39.9% 44.1% 8.4% 1.4% 3.416

Signage 8.5% 31.0% 47.2% 12.0% 1.4% 3.335

Ambience 7.6% 14.6% 31.9% 29.9% 16.0% 2.679

Lift 2.8% 9.1% 18.2% 42.0% 28.0% 2.170

In-PatientsFindings related to parameters

Null hypothesis: Patient confidence level on Kasturba hospital is independent

from education level.

Alternative hypothesis: Patient confidence level on Kasturba hospital is

dependent on education level.

Chi-square test

What is your educational leve l? * How confident you fee l about Kasturba hospital, Manipal about the treatm ent?

Crosstabulation

0 4 0 0 4

.3 2.9 .2 .5 4.0

0 17 0 2 19

1.5 14.0 1.2 2.4 19.0

0 12 2 14 28

2.1 20.6 1.7 3.6 28.0

10 94 10 9 123

9.4 90.4 7.5 15.7 123.0

5 17 0 0 22

1.7 16.2 1.3 2.8 22.0

15 144 12 25 196

15.0 144.0 12.0 25.0 196.0

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

Count

Expected Count

primary

secondary

inter(10+2)

graduate

post graduate

What is your

educational

level?

Total

Strongly

conf ident Conf ident

Somew hat

conf ident

Somew hat

lack of

conf ident

How conf ident you feel about Kasturba hospital, Manipal

about the treatment?

Total

Chi-square test

Chi-square test

Null hypothesis: Recommendation by patient to friends and relative about hospital

is independent of the confidence level of patient.

Alternative hypothesis: Recommendation by patient to friends and relative about

hospital is dependent of the confidence level of patient.

Chi-square test

Findings for in-patients

Excellent Very

good

Good Fair Poor Score

Friendliness of reception staff 5.6% 62.1% 28.3% 4.0% 0.0% 3.693

Promptness 16.7% 32.3% 30.3% 19.2% 1.5% 3.435

Information provided by the

reception staff

11.6% 28.3% 57.6% 2.0% 0.5% 3.485



Explanation given about the

treatment

21.2% 41.9% 26.8% 9.8% 0.5% 3.741

Explanation given about the

problem

16.4% 35.9% 32.8% 14.4% 0.5% 3.533

Consultation provided by the

doctors

36.0% 56.9% 6.1% 1.0% 0.0% 4.279

Answers to your enquiries 11.9% 50.3% 29.5% 8.3% 0.0% 3.658


Excellent Very

good

Good Fair Poor Score

Cleanliness of room/toilet 12.2% 36.5% 38.6% 12.7% 0.0% 3.482

Décor and Ambience 2.5% 12.7% 37.1% 40.6% 7.1% 2.629

Supply and cleanliness of

linen

17.9% 54.9% 25.1% 2.1% 0.0% 3.886



TV 0.0% 4.6% 12.8% 29.6% 53.1% 1.691

Telephone 0.5% 7.7% 25.5% 38.3% 28.1% 2.145

Lights 6.1% 30.5% 49.2% 13.7% 0.5% 3.280



Receptionist 9.7% 35.7% 44.4% 10.2% 0.0% 3.449

Doctors 31.8% 55.1% 13.1% 0.0% 0.0% 4.187

Nurses 33.8% 42.4% 19.7% 4.0% 0.0% 4.057

House-keeping 3.1% 26.5% 42.3% 21.9% 6.1% 2.983



Pharmacy 20.8% 54.3% 22.8% 2.0% 0.0% 3.936

Laboratory 23.5% 49.5% 20.4% 6.6% 0.0% 3.899

Radiology 11.7% 49.5% 32.7% 6.1% 0.0% 3.668

Scheduling of tests and

services

9.6% 40.4% 40.9% 8.6% 0.5% 3.500



Food & Beverage 4.1% 19.5% 34.4% 29.2% 12.8% 2.729

Lift services 10.4% 17.6% 35.2% 35.2% 1.6% 3.000

Parking area 12.2% 21.9% 37.8% 28.1% 0.0% 3.182

Security services 12.7% 29.4% 45.7% 9.1% 3.0% 3.394

Facilities for visitors 3.6% 51.5% 30.1% 13.3% 1.5% 3.424

Hospital feedback

1. Hospital feedback system provides single score for all the parameters.

That is not an extensive feedback which can provide detailed

information regarding the good and the poor parameter of the hospital.

2. The sampling method is not scientific and not designed properly to give

samples across all departments of the hospital.

3. Although patients visiting hospital is almost same each month, the

sample size vary in the hospital feedback. The sample size take per

month is irrespective of the patients visiting that month.

4. There is no proper method for the selection of the respondents for the

hospital feedback. Some of the respondents are not willing to give

feedback. In that case they end up fill the questionnaire for the sake of

formality and provide fake response.

Hospital feedback

5. Hospital feedback system has the questions that are open ended. More

of complains, suggestion and comments are asked in the questionnaire

which cannot provide statistical information and they are not even easy

to follow.

6. There are no dedicated staffs for the survey done for the hospital

feedback system from the customer care and feedback department. As

they are taken by the nursing and attending staffs. They don’t show

much interest in the survey to be done.

7. The hospital feedback system uses local languages like Malayalam,

Kannada along with English. This is easy to understand to the local

patients.

Hospital feedback

8. Hospital feedback system uses an automated computer program to

generate report each month. Which requires translation of complains

and suggestions provided by the respondents from local languages to

English. This increases the chance of error and even makes the process

complicated.

9. The reports generated are sent to the concerned departments for the

proper action to be taken.

Hospital feedback

CSI score of Out-patients

OP

Year Month No of feedback Forms CSI SCORE

2011 Jan 2422 4.22

Feb 2132 4.26

Mar 3067 4.33

April 2510 4.27

May 2392 4.29

June 1886 4.43

July 1834 4.58

August 1934 4.59

Sept 1454 4.59

October 1106 4.52

November 1500 4.41

• Minimum CSI score required as per ISO standard is 3.5 for the out-patients

• Total Out-patient visit in October 2011- 54631

CSI score of In-patients

Year Month No of feedback forms CSI Score

2011 Jan 1244 3.11

Feb 985 2.37

March 1770 3.26

April 1961 3.25

May 1687 3.26

June 1252 3.29

July 1217 3.11

August 1129 3.31

Sept 996 3.31

October 964 3.40

November 773 3.36

Minimum CSI score required as per ISO standard is 2.5 for the in-patients

Total In-patient visit in October 2011- 5779

Suggestions

For the improvement of Hospital feedback

system

1. Multi score feedback system

2. The sample method of the respondent is not scientific. Proper sampling

of respondents should be done keeping in mind the following points as:

a. Sample should cover across all the departments of the hospital.

b. Sample Size should be justifiable with the respect to the total patient

visiting the hospital for a given time period.

c. Respondents should be selected keeping in mind the willingness of

the respondents to participate in the feedback process.

3. Patients from various walks of life visit Kasturba Hospital.

Understanding of the questionnaire is very important. Respondents

should be selected on the basis of their understanding. Or they should

be assisted to understand the questionnaire clearly.

Suggestions

4. Instead of asking open ended question in the questionnaire, more

emphasis should be on the close ended questionnaire.

5. Dedicated staff is needed who can assist the patients in responding to

the questionnaire.

6. The computer application used in not up to date and the functions of the

application is not well known to the staffs working with it. New

application should be placed which is more user friendly and practical.

7. Technology like touchscreen monitors and feedback application can be

used to get patient feedback instantaneously and storing it

electronically. The real time score can be generated which could be

very useful in pin pointing the problem area.

Suggestions…

Following suggestion are based on the finding about the patient satisfaction

regarding the hospital services:

1. Hospital should position itself as advance hospital which has been

serving the society since long time because these factors are drawing

most of the patients to the hospital.

2. Proper counselling and explanation is required to be given to the patients

regarding treatment and problem to improve the confidence level of

patients towards the treatment and services provided by the hospital.

3. Waiting time for the out-patients is high. It should be minimised by

using proper appointment system like appointment over telephone or

automated tokens.

4. Some steps should be taken to improve the transfer. One of the steps

which can be taken to improve the patient file management can be use of

electronic media to store the information.

Suggestions…

5. There is dissatisfaction among the patients regarding the décor and

ambience. So, these need to be improved by use of some wall paintings,

brighter white colour walls and use of tiles in the wards.

6. Lift service is very important for hospital. There is dissatisfaction with

the lift service. So, the lift service has to be improved as many patients

find it difficult to go up to third floor.

Suggestions…

Conclusion

• The hospital feedback system has many weak points which are affecting

the efficiency to determine the satisfaction level of patients toward the

services provided by the hospital.

• There is large difference in the result obtained by the study done here

with comparison to the result obtained by the hospital feedback system.

• Hospital feedback system show high level of satisfaction in case of the

out-patient departments and little low level of satisfaction in case of in-

patient.

• Patient satisfaction and the quality of the service at the hospital can be

obtained by continues improvement at different level of the hospital

function. There is a need for involvement at managerial as well as at

operational level. So, a feedback system is needed that can product

extensive report for every level of hospital.

Conclusion

SIP-Feedback system College

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