Indoor patients’ satisfactory influential factors’ on healthcare services of small & medium size leading multispecialty hospitals in trichy.

Indoor patients’ satisfactory influential factors’ on healthcare services of small & medium size leading multispecialty hospitals in trichy.

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  INDOOR PATIENTS’ SATISFACTORYINFLUENTIAL FACTORS’ ON HEALTHCARE SERVICES OF SMALL & MEDIUM SIZE LEADING MULTISPECIALTY HOSPITALS IN TIRUCHIRAPPALLI. Dr. D. HEENA COWSAR ASSISTANT PROFESSOR OF COMMERCE BON SECOURS COLLEGE FOR WOMEN, THANJAVUR [email protected] ABSTRACT Patient Satisfaction is a measure of the extent to which a patient is content with the healthcare which they received from their healthcare provider. In evaluations of healthcare services, patient satisfaction is a performance indicator measured in a self-report study and a specific type of customer satisfaction metric. Four hospitals with less number of bed services situated in the traffic area were selected to analyse their satisfaction on various healthcare services offered. In-patients, who have utilized and stayed for minimum 10 days have been selected to measure satisfaction of the multi-specialty hospital services. The select hospitals are multi-specialty in nature and provide all types of services to the patients. This study discussed, the factors influencing the indoor patients to select the suitable hospitals (based on the size of hospitals) for their needed services. Key words: Indoor patient, Patient satisfaction, Healthcare services, small size multispecialty hospital, Medium size multispecialty hospital, Emergency facilities, Life-saving drugs, staff availability etc., INTRODUCTION Majority of the study has proved that patient select hospital and service provider, based on the satisfaction of the attempts of services recollected in the past. Hospitals in the study area are classified in to small, medium and large size based on the Bed ratio and its branches. Health care system is now a challenge for every government, state, political parties and insurance agencies due to high competition in this field. The health care system that was dominated by non-profit/public hospitals is now provided increasingly by private sector. This competition results in satisfying patient through improvement in rendering service, building trust and getting positive reputation. This research is based on healthcare as a major area within the service sector. The service environment in a hospital is complex, with multiple interactions occurring internally; health is a significant field of study from both technical and organizational perspectives providing specific prior research that may be used as a basis for services, and extension into services satisfaction. CONCEPTUAL REVIEWS  Indoor patient: Patients are only admitted to a hospital when they are extremely ill or have severe physical trauma through Inpatient care. A special care of patients whose condition requires admission to a hospital and stay for than a week is referred as indoor patient.  Patient satisfaction: Among healthcare consumers—i.e., patients—satisfaction is best understood as a multi-attribute model with different aspects of care determining overall satisfaction. Importantly, lower performance on an attribute creates much more dissatisfaction than the satisfaction generated by higher performance on an attribute; in other words, negative performance is more consequential than positive performance. Thus, ensuring overall patient satisfaction, it is more important reduce negative performance on the patient-care dimension with the worst perceived performance than to maximize positive performance on another dimension.  Healthcare services: Doctor is one, who decide about the patients’ admission, diagnosis, treatment, and discharge. Hence, proper choice and retention of doctors are extremely important.
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   Multispecialty hospital:A Multi-specialty Hospital is one that has facilities for all ailments and diseases with an expert team of doctors and specialists. The patients are so immensely taken care of with air-conditioned rooms and canteens inside and personalized care.  Emergency facilities: The counts collected from the ‘Presence of emergency infrastructure facilities’ like power, oxygen etc; ‘Regular visit by the doctor’ to ICU admitted patients, ‘Presence of simple and mini laboratory’ inside the operation theatre, ‘The Medical aid is made available round the clock’ to the emergency patients, ‘Presence of adequate number of beds in ICU’, Health checkup is based on correct order ‘token system’ in OPD were blocked in the head Emergency & other facilities.  Life-saving drugs: The Drugs always kept ready to meet emergency are referred as life-saving drugs.  Staff availability: The medical staff may occupy various positions depending on their qualifications and experience such as Super Specialist, Specialist, Registrars, general duty doctors (Assistant Surgeon), Casualty Medical Officer, Residents and Interns. STATEMENT OF THE PROBLEM Health care plays a dominant role in the service sector. Providing social health protection and equal access to quality health care has positive health effects on individual and public health that leads to economic growth and development. It is a combination of both tangible and intangible service aspect. However, customer service is important for sustaining this sector in the challenging world. Multi-Specialty hospital services are provided by both public and private sector. The present study focus on the private multi- specialty services located in the center of Tiruchirappalli. Against a background of growing consumerism, satisfying the patients has become a key task for all healthcare activities. A hospital has to provide a good patient care and it has to satisfy its patient expectations of services, as patient satisfaction is an ultimate tool to measure the success or failure of all services that the hospital produces. OBJECTIVES OF THE STUDY  To examine the inpatient satisfaction with reference to healthcare services of Small & Medium size hospitals.  To identify the association between demography of inpatients and the healthcare services in various size of hospitals.  To offer suggestions for improving the healthcare services provided by select sample hospitals in the study area. SCOPE OF THE STUDY The present study covers the various services rendered by the small & medium unit multi- specialty hospitals and the inpatient satisfaction on the services of such hospitals. This survey is conducted to collect information on the patient satisfaction that enables the hospitals to understand where they are lacking and to understand how to improve their services. This study covers only the patients satisfaction on healthcare services aspects provided by small & medium size Multispecialty hospitals. RESEARCH DESIGN A. Research Methodology: This is the survey method of research based on Primary data. B. Sources of data: For the purpose of the study, Primary data have been collected using a well- structured Questionnaire and secondary data has been collected from published research articles, books and magazines, Online and Offline Journals.
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  C. Statistical tools:The Descriptive analysis, chi - square test and Neuron Network Model are used to have an insight and understand clearly the research study. D. Sampling method: Since the population is indefinite, the convenience method of sampling is used in order to collect data from the respondents. E. Sample Size: A structured questionnaire is framed and an Interview schedule method is exclusively used for the purpose of data collection from 391respondents. The questionnaire is framed in such a way that could help to find out a solution for the objective of the study. RESULT ANALYSIS The analysis on various services offered by the small & medium size Multispecialty hospitals in the study area. An attempt is also made to elicit the opinions of the Inpatient for knowing their satisfaction with regard to the services offered by the selected hospitals. For this purpose, few Private hospitals, situated in the Middle and traffic place of Tiruchirappalli were selected as mentioned below. Small & Medium Units of Hospital: SMU – I, SMU – II, SMU – III & SMU – IV. Descriptive Statistics on the factors related patient satisfaction towards Small & Medium unit of hospital services Sl. No. Factors Mean Std. Deviation No. of Respondents = 391 I Healthcare Services 1 Health Staff & Machines availability 19.6445 5.00297 2 Emergency & other facilities 22.6931 5.62530 3 Arrangement of facilities 10.9207 3.07369 4 Legitimate presence of conditions 15.8159 3.70957 5 Life saving drugs 7.3146 2.17698 II Supportive Services 6 Maintenance of patients 23.5345 4.80525 7 Adequate ward arrangement 23.9028 5.39570 8 Materials & services 16.0384 3.46426 9 Report services 12.4629 2.68099 10 Supervision of doctors 11.2174 2.95284 11 Service attitude 7.6982 1.95618 III Ancillary Services 12 Housekeeping services 19.5806 3.89649 13 Security services 11.4936 2.89373 14 Hospital environment 7.6854 1.91774 15 Patients feeling 7.6650 1.83353 IV Peripheral Services 16 Power supply 11.3964 2.58673 17 Physical facilities 11.3529 2.77687 Source: Primary Data The above table portrays the Descriptive Statistics on the aspects related to patient satisfaction towards the Small & Medium unit hospital services. Patient satisfaction on hospital services is assessed based four important services like Healthcare services, Supportive services, auxiliary services and peripheral services. The mean and Standard deviation values were used under descriptive statistics to measure the satisfaction level of the patient. Under Health Care Services, the mean value of Emergency & other facilities (22.6931) had scored better than other factors of healthcare services and the score consistency value that deviates from mean is 5.62530.
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  With regard toSupportive services, the mean value of the adequate wards arrangement is 23.9028 which is higher than the other factors. The score consistency that deviates from mean value is 5.39570. In case of Auxiliary services, Housekeeping services had scored 19.5806 that are more than its other factors and the value of score consistency that deviate a less significant from its mean score is 3.89649. In connection with the peripheral services, the power supply score 11.3964 that are slightly higher than physical facilities. The score competency of power supply is 2.58673 that variation from mean is also lesser. Thus among the seventeen variables taken up to measure the satisfaction level of patient towards the small & medium unit of hospital services, adequate ward arrangements secured maximum mean value of 23.9028 with the mean deviation score consistency of 5.39570. So the adequate ward arrangement play a key role in determining the patient satisfaction. Chi – Square test to test the Association between the overall inpatient satisfaction & the Health care services’. Null Hypothesis: There is no significant association between overall inpatient satisfaction & the health care services of the Small & Medium Scale hospital services. Factors satisfaction Level Overall Satisfaction Respondents (n=391) Value Df p value Low Moderate High Health Staff & Machines availability Low 40 27 37 39.035 4 Significant at 1per cent level Moderate 43 98 52 High 27 60 7 Emergency & other facilities Low 26 23 40 46.980 4 Significant at 1per cent level Moderate 67 96 46 High 17 66 10 Arrangement of facilities Low 35 44 46 19.434 4 Significant at 1per cent level Moderate 61 100 37 High 14 41 13 Legitimate presence of conditions Low 32 32 53 54.074 4 Significant at 1per cent level Moderate 64 97 34 High 14 56 9 Life-saving drugs Low 40 49 44 15.719 4 Significant at 1per cent level Moderate 47 78 24 High 23 58 28 Source: Primary data (Output generated from SPSS 20) The table shows the association between overall inpatient satisfactions on the health care services of the Small & Medium Scale hospitals. It is notable that the all the health care factors like Health Staff & Machines availability (χ2 = 39.035, p=0.000), Emergency & other facilities (χ2 = 46.980, p=0.000), Arrangement of facilities (χ2 = 19.434, p=0.020), legitimate presence of conditions (χ2 = 54.074, p=0.000), Life-saving drugs (χ2 = 15.719, p=0.000) are associated with the overall satisfaction of the respondents at 1% degree of freedom. It is induced from the above table that overall satisfaction of inpatient is associated with the health care services of the small & medium scale hospitals. OVERALL SATISFACTION OF THE CUSTOMERS’ OPINION ON HEALTH CARE SERVICES BY USING THE NEURAL NETWORK (NN) METHOD The Neural Network architecture, used in this study, is a multilayer feed forward network using SPSS 20. The architecture which provides the best fit for the data is the network with three hidden layers and an
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  output layer. Thelearning and momentum parameters are 0.6 and 0.9 respectively and error convergence falls below 0.01 Percent. Tan sigmoid is the activation function chosen for the hidden layers, and the pure linear function is used to get the output layer which is the real time values. The architecture which provides the best fit for the data is the network with seven input layers, twenty covariate variables and one hidden layers and one output layer, as shown in the below figure. Basic Neuron Model for overall satisfaction of the customers’ opinion on health care Services The neural network model stems from the studies on the working of human brain systems, and serves as an associative memory between the input and output patterns. These models contain many densely interconnected elements called Neurons or Nodes. The neuron has a set of “n” inputs “x”j, where the subscript “j” takes a value from 1 to “n” and indicates the source of the input signal. Each input “x”j is weighted before reaching the main body of the processing elements, by the connection strength or weight factor “wj”. (Multiplied by“wj”). In addition, it has a bias term “w”0, a threshold value that has to be reached or exceeded for the neuron to produce a signal, a non-linearity function F that acts on the produced signal (or activation) R, and an output O. The non-linearity function used in this network is the sigmoid. The sigmoid is very popular because it is monotonic, is bounded, and has a derivative: f”’(s) = kf (s) [1-f(s)]. The model used in this work is the Feed Forward Multilayer perception, using the Back Propagation Algorithm. Where (4-3-1) 7-Input layers 20-Covariates layers 1-Hidden layers 1-Output layer All inputs are analyzed in the experimental validation part, with appropriate output results by the illustration of graphs so that the influences of the parameters of tensile strength are taken into consideration. The network information is presented in the table. The validation of the estimated NN and Experimental value illustrations is shown in Figure. Model Summary for Neural Network Model for customers’ opinion on health care services Training Sum of Squares Error 122.776 Relative Error .482 Stopping Rule Used 1 consecutive step(s) with no decrease in errora Output Covariate Overall satisfaction of the indoor patients Indoor patients’ opinion on health care services HIDDEN LAYER INPUT Socio-Demographic Profile of the customers
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  Training Time 0:00:00.91 Testing Sumof Squares Error 81.659 Relative Error .586 Dependent Variable: Overall Satisfaction a. Error computations are based on the testing sample. Source: Output generated from SPSS 20 Neural Network Model for overall satisfaction of the customers’ opinion on health care services Input Layer Factors 1 Gender 2 Age 3 Educational Qualification 4 Residential Status 5 Occupation 6 Marital Status 7 Income (monthly) Covariates 1 Availability of Doctors 2 Good professionals & competent doctors 3 Listen the patients queries & answer politely 4 Refers the best quality medicine 5 The Medical aid is made available round the clock 6 Presence of emergency infrastructure facilities like power, oxygen etc; 7 Availability of life saving drugs 8 Adequate & trained Staffing 9 Regular visit by doctor 10 Proper functioning of machines 11 Presence of adequate number of beds 12 Neat and bacteria free theatre with pre- anesthesia room 13 Presence of power, lighting, and essential infrastructure facilities 14 Presence of simple and mini laboratory 15 Health checkup is based on correct order token system. 16 Timely service 17 Patients general body checkup(height, weight, B/P) 18 Availability of number of beds 19 Enough spacious between wards 20 Clean and hygienic toilet room is Number of Unitsa 48 Rescaling Method for Covariates Standardized Hidden Layer(s) Number of Hidden Layers 1 Number of Units in Hidden Layer 1a 6 Activation Function Hyperbolic tangent
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  Output Layer Dependent Variables 1 OverallSatisfaction Number of Units 1 Rescaling Method for Scale Dependents Standardized Activation Function Identity Error Function Sum of Squares a. Excluding the bias unit Source: Output generated form SPSS 20. The factors inducing the indoor patients’ towards the health care services, model parameters are modeled by using the NeuralNetwork Method. The parameters are optimized so as to determine the set of parameters, which will influence the increase in the Overall satisfaction of the customer towards, Neural Networks Architecture and network information. Independent Variable importance for Neural Network Model for the overall satisfaction of the customers’ opinion on health care services Independent Variable Importance Importance Normalized Importance Gender .015 13.1% Age .016 14.1% Educational Qualification .022 19.3% Residential Status .028 24.8% Occupation .021 18.8% Marital Status .010 8.8% Income (monthly) .037 32.3% Availability of Doctors .024 21.2% Good professionals & competent doctors .014 12.7% Listen the patients queries & answer politely .113 100.0% Refers the best quality medicine .034 30.1% The Medical aid is made available round the clock .064 56.1% Presence of emergency infrastructure facilities like power, oxygen etc; .036 31.8% Availability of life saving drugs .031 27.3% Adequate & trained Staffing .027 24.0% Regular visit by doctor .027 24.0% Proper functioning of machines .046 40.7% Presence of adequate number of beds .036 31.8% Neat and bacteria free theatre with pre- anesthesia room .080 70.3% Presence of power,lighting, and essential infrastructure facilities .051 45.3% Presence of simple and mini laboratory .033 28.7% Health checkup is based on correct order token system. .025 21.8% Timely service .021 18.8% Patients general body checkup(height, weight, B/P) .037 32.8% Availability of number of beds .044 38.9% Enough spacious between wards .056 49.2% Clean and hygienic toilet room is .051 45.2% Source: Output generated from SPSS 20
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  Normalized importance foroverall satisfaction of the customers’ opinion on health care services The table and diagram shows the service quality of customers’ opinion on health care services “Listen the patients’ queries & answer politely” is contribute more towards the output of overall satisfaction of the customers. Suggestions  Among the various factors contributing towards health staff availability & machines functioning, the availability of doctors scored 42 per cent.  With regard to the factors contributing towards Emergency & Other Facilities, the availability of adequate beds scored 41 per cent.  In connection to the factors focusing towards Arrangement of facilities, the availability of adequate beds scored 45 per cent.  In relation to the factors contributing towards legitimate presence of condition, the trained staff for ICU services scored highest frequency of 45 per cent.  It is notable that life-saving drugs availability satisfied most of the patients.  From the sample of 391 respondents selected for the study, 21.9% of the respondents were the inpatients of Unit I, 10.2% of them studied were the inpatients of Unit II, 14.4% of them were from Unit III Hospital and respite 5.7% of the respondents were the respondents of Unit IV hospital.  From the sample undertaken, 64.7% were male, 26.3% of the patients’ fall in above 56years of age, 37.3 % of the respondents had education up to Post graduate level, 65.2% were living in urban nativity, 34.8% inpatients occupation were Professionals, 55.6% respondents were married, 40% of the respondents were earning the monthly income of above Rs. 40001, 51.5% of inpatients preferred hospitals for its specialist treatment, 55.1% of the inpatients stayed in sickbay for less than 10 days, more than 50%
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  of the respondentshad not sustained to any insurance coverage, 60% of the respondents visited hospital regularly for their treatment and 52.9% of the respondents knows the hospital through friend circle.  The Neural Networks Architecture and network information model is applied to optimize the parameters that determine the set of factors, which will influence the increase in the Overall satisfaction of the indoor patient. Listen the patients queries & answer politely contribute 100% towards overall satisfaction.  From the normalized importance chart, among the factors contributing the overall satisfaction of the indoor patients on health care services “Listen the patients’ queries & answer politely” contribute more towards the output of overall satisfaction. Conclusion The present research study has made an attempt to measure how far the indoor patients’ satisfactory influential factors’ on healthcare services of small & medium size leading multispecialty hospitals in Tiruchirappalli. Of the various types of services, only Healthcare services are analyzed the Legitimate presence of conditions served as best in satisfying and highly promoting inpatients satisfaction. It is notable that all other factors also contribute positively. Under the application of the Neural Networks Architecture and network information model, Listen the patient’s queries & answer politely by the medical practioner contribute more towards the output of overall satisfaction. Thus the study concludes that high level of professionalism of the staff plays a major role in satisfying the patients. References 1. https://en.wikipedia.org/wiki/Healthcare. 2. Anand,K.K., Hospital Management A New PerspectiveJAew Delhi,Vikas Publishing House Pvt. Ltd., 1996. 3. Balaji, B., Services Marketing and Management, New Delhi, S. Chand andCompany Ltd, 2002. 4. Bapu P. George (2006); “Marketing of Healthcare Services”; Abhijeet Publications, Delhi, First Edition, 2006. 5. Jha, S.M. Hospital Management, Mumbai, Himalaya Publishing House, 2001. 6. Heena cowsar. D (2018), Inpatients satisfaction on the health care services of selected multi- specialty hospitals in Tiruchirappalli. 7. https://www.sciencedirect.com/topics/computer-science/neural-network-model 8. https://otexts.com/fpp2/nnetar.html