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Carried out at “Rabindranath Tagore International Institute of Cardiac sciences”

Submitted by……….

Payal Das

Bachelor of Hospital Management

Registration No-151541310016

Roll No-15403315016

Dinabandhu Andrews Institute of Technology and Management

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Company Certificate

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Acknowledgement

The training at RTIICS Kolkata offered both learning experience as well as a glimpse into the

daily management functions of a renowned hospital during the training of this project. I was

fortune enough to interact with people, who in their own capabilities have encourage guided me.

I express my heartiest gratitude and offer my sincere thanks to Mrs. Anupriya Roy to giving me

this opportunity to prosecute the training in the hospital & a special thanks to Mrs. Rita Das&

Mrs. Jaya Sinha for her continuous guidance

I wish to thank our honourable principal Mrs.Sanjukta Nandi, our h.o.d Mr Surajit Das

and my internal guide Mrs. Paramita Ghosh for their support and invaluable guidance.

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Declaration

I am Payal Das student of Bachelor of Hospital Management, roll no-15403315016, of

Dinabandhu Andrews Institute of Technology and Management and have completed a hr audit

project from Rabindranath Tagore International Institute of Cardiac sciences at Kolkata from

3rdJanuary to 3rd April for the fulfilment of my project.

The various information of the submitted project is collected by me and my friends who have

completed their summer training at RTIICS.I further declare that I have not yet submitted this

project to any other organization before submitted in the institute.

……………………………

Signature

Payal Das

Dinabandhu Andrews Institute of Technology and Management

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Executive Summary

The job of medical care today is no more a one man show. Modern hospital organization involves

heterogeneous group of specialized personnel. It is team Work and successful operation of any

hospital organization depends on the services of a large number of personnel specialized in

different areas of medical science and management.

Thus this calls for an effective and perfect management of hospitals. There is no room for

a single mistake in case of hospitals as it can cause of death of the patient and challenge for

existence of the.

This research helped me to learn more about customers of service industry and know their

expectations. Customers should be the first priority for any service industry .Customers are very

difficult to understand as they are .So proper understanding the need of a customer is very crucial.

The quality of service it provides. Customers prefer to get superior services from providers that

should exceed their expectation level. Service providers need to maintain standards and also

promise to serve their customers the best they can.

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Content

Introduction

Hospital profile

Review of litreture

Objectives

Broad overview

Methodology

Suggestion

Conclusion

Biblography

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Introduction

It has become essential for hospital managers to understand and measure consumer

perspectives and service quality gaps, so that any perceived gap in delivery of service is

identified and suitably addressed. A study was conducted at a peripheral service hospital to

ascertain any service gap between consumer expectations and perceptions in respect of the

hospital outpatient department (OPD) services.

Healthcare managers are under increasing pressure to demonstrate that their services are

customer-focused and directed towards providing best possible medical care to the clientele of the

hospital. Taking into consideration the resource constraints under which service hospitals must

function, it has become essential for hospital managers to understand and measure consumer

perspectives, so that any perceived gap in delivery of service is identified and suitably addressed.

Healthcare quality has two distinct facets, namely technical quality and functional quality. Technical

quality refers to the accuracy of medical diagnosis and procedures, and is generally comprehensible

to the professional community but not to the patients. Patients essentially perceive functional

quality as the manner in which the services are being delivered.

Service quality largely determines consumer satisfaction. A popular definition of service quality is

conformance to consumer expectations. The important role played by expectations in consumer's

evaluation of services has been widely acknowledged in the service quality literature. Researchers

have generally agreed that expectations serve as reference points in consumer's assessment of

service performance.

The study was conducted at a peripheral service hospital for a period of three months to ascertain

any perceived service gap between consumer expectations and perceptions about quality of the

outpatient department (OPD) services being offered by that hospital.

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Hospital Profile

RTIICS Kolkata is a 550 bed full – fledged multispecialty hospital spread over 4 acres on

Eastern Metropolitan Bypass at Mukundapur RTIICS , a unit of Narayana Health has 14 fully

equipped operation theatres and 3 state – of –the – art Catheterization Laboratories with 24

hours facility.

In the last 14 years RTIICS has performed over 24500 life saving adult and paediatric cardiac

operations , 93000 cardiac cath lab procedures , 1500 kidney transplants, 258000 dialysis and

over 35600 multispeciality surgeries, including joint replacements, minimally invasive surgeries

, neuro surgeries and other general surgeries. Over 80000 senior citizen club members and over

20000 patients received financial assistance through Guest Support Cell .A dedicated team of

renowed surgeons, specialist doctors, nurses, technicians , and paramedical staff with the most

modern equipment and laboratory has made RTIICS one of the leading hospitals of the Narayana

Health Group.

RTIICS comprises of 34 major clinical departments that caters to the people of West Bengal and

neighboring districts in Eastern India as well as the North Eastern statesa, The hospital also has

many international patients coming in from Bangladesh , Nepal , Bhutan , Africa and Myanmar

for various treatments and returning home with successful remedies.

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Vision mission & Values of the hospital

Vision-We desire to emerge as a health care destination and training hub for everyone all over

the world and reach to the masses in the remotest comer of the country and out side

Mission- We dream to make sophisticated health care facilities available to the masses

Irrespective of status, class, creed or community with the sole aim of care, compassion and

service to the sick and unhealthy.

Values- Values are represented by the acronym “I care” where

I stands for Innovation and efficiency

C stands for compassionate care

A stands for Accountability

R stands for Respect for all

E stands for Excellence

Facilities

550 beds

150 state-of-art critical care unit

3 state-of-art of GE & Siemens Cardiac Catheterization laboratories

14 fully equipped OT

Fastest response emergency

24x7 blood bank

Tele-Medicine

OPD Free ambulance pickup

Largest dialysis unit in India

Integrated ophthalmology and dental services

Luxurious, deluxe and suit ward

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PAN INDIA NH FACILITIES

NH RTIICS INFRA HIGHLIGHTS

1. 14 fully equipped Operation Theaters.

2. 4 Cath labs.

3. 24 hours emergency unit with 29 fully equipped beds

4. Central Sterile Services Department (CSSD)

5. NABL Accredited Laboratory& NABH AccreditedBlood Bank

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Review of litreture

Acharyulu, Ramaiah (2011) discussed that Indian healthcare provider needs to be benchmarked to

international quality and efficiency standards to provide the quality service to the patients to meet

the expectation. Outpatient department is the Patients’ first point of contact in the Hospital. It is

the shop window of hospital. The service quality provided by this department would makes or mars

the hospital image. A quality OPD service can reduce the load and also improve the perception of

the patients and his/her attendants about the hospital. In the today’s’ healthcare competitive

environment it is very important to provide the quality OPD services to the patients.

Assefa & Mosse, (2011) discussed about Client satisfaction that is the level of satisfaction that

clients experience having used a service. It therefore reflects the gap between the expected service

and the experience of the service, from theclient’spoint of view. Measuring client or patient

satisfaction has become an integral part of hospital/clinic management strategies across the globe.

Moreover, the quality assurance and accreditation process in most countries requires that the

satisfaction of clients be measured on a regular basis. Asking patients what they think about the

care and treatment they have received is an important step towards improving the quality of care,

and ensure local health services are meeting patients’ needs. It is an established fact that

satisfaction influences whether a person seeks medical advice, complies with treatment and

maintains a continuing relationship with practitioners. The leading theorist in the area of quality

assurance has emphasized that Client satisfaction is of fundamental importance as a measure of

the quality of care because it gives information on the provider’s success at meeting those client

values and expectations, which are matters on which the client is the ultimate authority.

McCaig, Hooker, Sekscenski & Woodwelln (1998) reported that the structure and process of

health care delivery in hospital outpatient departments, especially in teaching hospitals, are

undergoing rapid change in ways that are likely to increase the use of physician assistants and

nurse practitioners in these settings. For example, in an attempt to generate future savings from

the deployment of a more balanced physician supply, the Council on Graduate Medical Education

has recommended a reduction in the number of specialist positions in hospital-based graduate

medical education programs. Mean while, other changes in graduate medical education are shifting

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greater proportions of primary care medical residents from hospitals to community settings,' which

will contribute to increased demand for PAs and NPs in hospital OPDs. Patients seen in OPD visits

have been shown to differ from those seen in physicians' offices in demographic characteristics:'

for example, OPDs provide a disproportionate amount of care to people of colour and to Medicaid

recipients.' The present study was designed to determine whether PA-NP hospital OPD visits differ

from hospital OPD visits to all types of medical practitioners in terms of factors such as patient

characteristics, tests and procedures performed or ordered, and medications prescribed.

Faulkner, Saltrese-Taylor, O'Brien, Williams, Collins & Frankel, (1995) they also stated that

Outpatient department perceived that there was a large proportion of re-attending patients who

could appropriately have been seen by the GP, but in many cases they were equivocal in judging

the appropriate site of care and acting upon these judgments. There will doubtless always be come

discrepancy between the aggregate of clinicians' opinions and their clinical actions. The method of

review demonstrated in this study can help prioritise conditions which may be candidates for

development of alternative care arrangements across the primary/ secondary care interface.

Jha (2011) observed that in country like India where we find majority of our population insensitive

to the health problem, it is imperative that both the public and private hospitals play a meaningful

role by sensitising the masses. Quality an important consideration in the healthcare services and

therefore we make a strong advocacy in favour of conceptualisation of Total Quality Management.

Poverty and insensitivity are the two important barriers depriving the Indian masses of getting the

quality healthcare services. The mounting demographic pressure makes it essential that the

Hospital Services Consultancy Corporation assigns due weight age to the qualitative-cum-

quantitative transformation so that a large number of our population get the quality healthcare

services.

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Objectives

To assess the existing service delivery standards of a multi- specialty hospital.

To identify the baseline level of health care delivery of all departments

To indicate the gaps in terms of structure , process and outcome

To suggest alterations in structural designs, process of the facilities to meet the requirement.

To give corrective and preventive action of the gaps identified

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Broad overview

The quality of service—both technical and functional—is a key ingredient in the success of

service organizations. Technical quality in health care is defined primarily on the basis of the

technical accuracy of the diagnosis and procedures. Several techniques for measuring technical

quality have been proposed and are currently in use in healthcare organizations. Information

relating to this is not generally available to the public, and remains within the purview of

health-care professionals and administrators. Functional quality, in contrast, relates to the

manner of delivery of health-care services. A general hospital is typically the major health care

facility in its region, with a large number of beds for intensive care and long-term care, facilities

for surgery and childbirth, bio assay laboratories, and so forth. Hospital services are different

and distinct from boarding and grooming services-yet both are easily accessible to pet owners

and team members. Patients just come for diagnosis and/or therapy and then leave

(outpatients), but some others stay the nights (inpatients). Putting the patient first is a

challenge that requires not just a huge change in the mindset of all the stakeholders in health

care provision, but also the means by which to measure the levels of satisfaction of patients,

and to discover what matters to them before, during and after their visit to any hospital.

Patient quality initiatives, with their softer, experiential focus than clinical audit, with its precise

and scientific methods of measurement, demand different measurement techniques. According

to Pricewaterhouse Coopers, in the service sector, the health care industry, one of India’s

largest sectors in terms of revenue and employment, is growing rapidly. In India, the service

quality of health care is miserable and in general, the health outcome is far from satisfactory.

Therefore, government of India has adopted a policy of health care reform having two basic

objectives to achieve health securities for all and to provide quality health facilities for all within

every district in India. In the care sector, customer satisfaction is also an important issue as in

other service sectors. A health care organization can achieve patient satisfaction by providing

quality services; keeping in view patients' expectation and continuous improvement in the

health care service.

SERVICE QUALITY: Traditionally, service quality has been conceptualized as the difference

between customer expectations regarding a service to be received and perceptions of the

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service being received. In some earlier studies, service quality has been referred as the extent

to which a service meets customers needs or expectations. It is also conceptualized as the

consumers overall impression of the relative inferiority or superiority of the services.

SERVICE QUALITY DIMENSIONS:Parasuraman (1988) identified five dimensions of service

quality (reliability, responsiveness, assurance, empathy, and tangibles) that link specific service

characteristics to consumers expectations.

Tangibles-physical facilities, equipment and appearance of personnel

Empathy- caring, individualized attention

Assurance- knowledge and courtesy of employees and their ability to convey trust &confidence

Reliability- ability to perform the promised service dependably and accurately

Responsiveness- willingness to help customers and provide prompt service.

GAP analysis:The "gap" Once the gap is defined, a game plan can be developed that will move the

organization from its current state toward its desired future state.

Gap analysis generally refers to the activity of studying the differences between

standards and the delivery of those standards.Difference between customer expectation and actual

customer experiences in the delivery of medical care. The differences could be used to explain

satisfaction and to document areas in need of improvement.However, in the process of identifying

the gap, a before-and-after analysis must occur.

The main reason gap analysis is important to firms is the fact that gaps between customer

expectations and customer experiences lead to customer dissatisfaction. Consequently, measuring

gaps is the first step in enhancing customer satisfaction. Additionally, competitive advantages can

be achieved by exceeding customer expectations. Gap analysis is the technique utilized to

determine where firms exceed or fall below customer expectations.

GAPS IN SERVICE QUALITY

Gap 1: The difference between management perceptions of what customers expect and what

customers really do expect. Occurs when the company management does not understand what

customers really want.

Gap 2: The difference between management perceptions and service quality specifications.Occurs

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when Management understand what customers want but this does not translate into correct

specifications and orders to the rest of the company.

Gap 3: The difference between Specification of the service and the Service produced. Occurs

when the people who “produce” the service are unable, unwilling or do not know how to reach the

specified standard.

Gap 4: The difference between the Service produced and Communication. Occurs when the

service expectations formed by customers based on corporate communication are not met.

Gap 5: There is no clear consensus on what this gap means. Initially, it meant the difference

between Expectations and Perception of service, which may arise when the customer sees a

characteristic of service quality as something undesirable. But this gap is also now used to identify

overall customer dissatisfaction, which appears as the result of the sum of the other gaps.

expectations are made up of past experience, word-of-mouth and needs/wants of customers

measurement is on the basis of two sets of statements in groups according to the five key service

dimensions.

SERVQUAL MODEL:Measuring service quality is difficult due to its unique characteristics:The

service will be considered excellent, if perceptions exceed expectations; it will be regarded as good

or adequate, if it only equals the expectations; the service will be classed as bad, poor or deficient,

if it does not meet them. Based on this perspective, Parasuraman et al. developed a scale for

measuring service quality, which is mostly popular known as SERVQUAL. This scale operationalizes

service quality by calculating the difference between expectationsand perceptions, evaluating both

in relation to the 22 items that represent five service quality dimensions known as 'tangibles',

'reliabilit', 'responsiveness', 'assurance' and 'empathy'. Intangibility, heterogeneity, inseparability

and perishability. Service quality is linked to the concepts of perceptions and expectations.

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Customers' perceptions of service quality result from a comparison of their before-service

expectations with their actualservice experience.

MODEL OF SERVICE QUALITY GAPS

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Implementation of Service Gap Model in RTIICS

Customer service and patient satisfaction matter more than anything. Patients have higher

expectations and less tolerance. To provide the highest level of satisfaction, health care providers

must control patients’ expectations and perception of treatment quality .The gap model of service

serves as a framework for service organizations attempting to improve quality of service. The Gap

model consists of two parts:-

1) The Customer Gap

2)The Provider Gap

Customer Gap:The customer gap is the difference between customer expectations and

perceptions. Customer expectations are standards or reference points that customers bring into

the service experience whereas customer perception are subjective assessments of the actual

service experiences. The Customer Gap In the case of RTIICS Patients are considered as customers and

providing satisfactory services are major concerns. Customer Expectation Perceived Services

Customer Expectations: Some factors influencing Customer Expectations:

1) Word of mouth: Word of mouth is the passing of information from person to person by oral

communication. If patients are satisfied they will spread good comments about the hospital.

Patients depend on the judgments of people close to them such as relatives, colleagues and

friends.

2) Personal needs: Patients will be happy if they get desired level of service from the hospital. But

as there are more than one building patients have to move around the whole hospital for testsas a

result they feel dissatisfied. Some patients complained that they were not given proper attention.

3) Past experience: Patient’s past experience is a crucial part of service industry. Most of the

patients relate present services with the past experiences which is moderate level of satisfaction.

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Provider Gap

Gap 1: Listening gap: The listening gap is the gap between customer expectations of the service

and the company understanding of those expectations. Primary cause of this problem is service

providers do not accurately understand customer expectations.

Gap 2: The service design and standards gap: Customer driven standards are different from

conventional performance standards that a firm establishes. These problems are reflected in gap 2,

the difference between company understanding of customer expectations and development of

customer driven service designs and standards.

Gap 3: The service Performance gap: This is the actual discrepancy between development of

customer driven service standards and actual service performance by the firm’s employees.

Standards must be backed by appropriate resources(People, systems and technology) and also

must be enforced to be effective.

Gap 4: Communication gap: The communication gap illustrates the difference between service

delivery and serve provider’s external communications. The discrepancy between actual and

promised service can widen customer gap

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Methodology

Sample Design: -100 samples of respondents has been taken which include patients coming at

outpatient department irrespective of their age, gender, qualification and income and selected

randomly from cardiac department of RTIICS.

Inclusion Criteria:-

The OPD patients of the Rabindranath Tagore International Institute of Cardiac Sciences.

Willing to provide answers to study interviewers.

Patients who made at least 2 visit( including present visit)

Exclusion Criteria:-

Patients cannot speak or listen.

Patients were in severe pain.

Patients have a mental problem.

Data Collection Method:-After choosing the sample the next step in research program, is Data

collection. The present study is based on two types of data:

Primary data: Primary data are collected by personal interview and 4 parts of questionnaire,

which is to be filled by the patients coming at outpatient department of RTIICS. Most of the

questions are of multiple choices and close ended type based on four or five point scale and

filled by using survey method.

Secondary data:Secondary data is collected from internet, journal and books.

Area of the Study:The present research study is carried out in OPD's, reception area, health check-

up reception area and different areas of the outpatient department.

Study Period:-This three months study is undertaken during the 6th semester of B.H.M.

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Data analysis and interpretation:-This study was conducted to determine the patient

satisfaction with health care services at outpatient department (OPD) of Rabindranath Tagore

International Institute of Cardiac Sciences.100 patients were interviewed at the outpatient

department. Structured questionnaire were facilitated for data collection. The result was

presented in descriptive form.

According to the research there is a huge gap in waiting time in the billing section, blood

pressure monitoring counter and for doctor consultation a little bit gap in physical facilities and

cleanliness due to lack of staff.

0 5 10 15

Physical facilities

Waiting time

Cleanliness & hygiene

Perceptions(P)

Expectations(E)

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Data showing gap in individual attention to patients and readiness for personal attention as

staffs maintain equity in all patients.

Data representing gap in polite OPD staff they need more training and adequate support by the

hospital to the OPD as there is a crunch of bed and technician in procedure room so there is a

gap

0

1

2

3

4

5

6

7

8

9

Individualattention to

patients

Readinessfor personal

attention

OPD staffaware of

the need ofthe patient

Expectations(E)

Perceptions(P)

0

1

2

3

4

5

6

7

8

9

Feel safe Polite OPD staff Adequatesupport by the

hosp to the OPD

Expectations(E)

Perceptions(P)

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Data showing a little gap in dependable OPD services because there is a lack in procedure rooms

and sympathetic attendance to patients this gap is found due to OPD crowd.

According to the survey patient felt problem while taking appointment for consultation, face lack

of co-ordination during the whole process.

0

1

2

3

4

5

6

7

8

9

DependableOPD service

Accuraterecord keeping

Sympatheticattendance to

patients

Expectations(E)

Perceptions(P)

6.5 7 7.5 8 8.5 9

Easy Appointment

Prompt response

Staff always willing to help

Perceptions(P)

Expectations(E)

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Recommendations

1. No of housekeeping staff should be increase.

2. Female changing room should be situated near the procedure room.

3. No of billing counter as well as billing staff shuold be recruited.

4. There should be a specific report delivery counter.

5. Toilets should be clean regularly.

6. Parking space should be available for patients also.

7. A door should be fix in front of E.C.G & ECHO area to control the traffic.

8. There should be a few more ophthalmologist and pediatric medicine doctor.

9. Public holidays & doctors on leave should be clearly displayed on the notice board for the

convenience of the patient.

10. No of chairs in reception area should be increase.

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Conclusions

This study aims to diagnose the service quality based on the difference between the patients’

expectation of quality services and their perception of the services received. It is found that

there is a huge gap on reliability, responsiveness and tangibility services. With the increasing

number of new and unknown diseases attacking mankind, the hospital industry faces a colossal

and tough task of ensuring rapid treatment and sound health. The timely and correct

information provided by the hospitals determines the very course of treatment of the diseases.

Hence the hospital industry needs to revamp its prevailing image. Management needs to

inculcate professionalism and implement modern techniques of customer relationship

management.

In the era of globalization, competition has become a key issue in all sorts of industry as well as

service sectors. Literature survey suggests that patient satisfaction and perceived service

quality both should be considered together for the stability of a health care organization in a

competitive environment. Researchers have suggested different models and methods of

measuring patient satisfaction considering service quality as one of the antecedents. Different

literature established that SERVQUAL is a popular model for measuring service quality.

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Bibliography

1. https://www.openmet.com/en/engap-analysis-for-customer-satisfaction.

2. https://www.ncbi.nlm.nih.gov/pubmed/27365810

3. http://shodhganga.inflibnet.ac.in/bitstream/10603/8372/8/08_chapter%20%205.pdf

4. medind.nic.in/maa/t11/i3/maat11i3p221.

5. https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-14-49

6. Volume : 2 | Issue : 3 | March 2013 ISSN - 2250-1991PARIPEX - INDIAN JOURNAL OF RESEARCH

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Annexure

Item Expectations(E) Perceptions(P) Service Gap(P-E)

TANGIBLE

Physical facilities

7.00

6.05

-0.95

Waiting time 6.24 4.60 -1.64

Cleanliness & hygiene 9.75 8.98 -0.77

EMPATHY

Individual attention to patients

8.96

8.00

-0.96

Readiness for personal attention 9.00 8.15 -0.85

OPD staff aware of the need of the patient 7.58 7.25 -0.33

ASSURANCE

Feel safe

6.00

6.00

0

Polite OPD staff 7.00 6.50 -0.5

Adequate support by the hosp to the OPD 8.50 7.98 -0.52

RELIABILITY

Dependable OPD service

7.20

7.00

-0.20

Accurate record keeping 6.65 6.65 0

Sympathetic attendance to patients 8.00 7.80 -0.20

RESPONSIVENESS

Easy Appointment

8.00

7.30

-0.7

Prompt response 8.65 8.50 -0.15

Staff always willing to help 8.00 7.90 -0.1