RESEARCH REPORT

ON
“A STUDY OF HRD CLIMATE IN THE HOSPITALS AND
ITS IMPACT ON PATIENT SATISFACTION”

SUBMITTED IN PARTIAL FULFILLMENT FOR THE

AWARD OF DEGREE OF
MASTER OF BUSINESS ADMINISTRATION
(BATCH-2016-2018)

AFFILIATED TO:
DR. APJ ABDUL KALAM TECHNICAL UNIVERSITY,
LUCKNOW

Institute of Technology and Science

Mohan Nagar Ghaziabad

Submited by - Submited to:-

Mitesh Kumar Chauhan Dr. DK Pandey
Roll No.- 1603870075

1
 PREFACE

In this project the study and analysis about HRD climate in hospital and
impact on patient satisfaction.

In the research report the main function and role of the HRD (Human
Resource Development) in the hospital environment. The project consist of different
types of services provided by the HRD department in the hospital.

How the patient satisfied with the HRD department. In this project we analyse
about the different hospital in the country like public and private sectors hospitals.

In this modern age and globalize world the no. of hi tech and multi city
hospital increasing day by day and their service so, what the HRD department play a
very vital role in the health care sector.

In the hospital the increasing patient day by day which type and what type of
services avail by the hospital HRD environment.

Govt and ministry of health and welfare society improve the services and
provide proper facility in the hospital . it improved the HRD department in the
hospital and promotes to the hospital services and environment. And the care of
patient and provide full satisfaction level of the patient in the hospital.

In this sector both public and private sector in the hospital work together for
improvement of patient satisfaction level.

HRD department play a vital role in the hospital and it try to improve the
productivity of the hospital.

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 CONTENTS

Chapter -1

1: Introduction

2: Objective

3: Scope of the study

4: Use and importance of study

Chapter -2

: Research Methodology
_ Research Methodology

Chapter – 3

: Analysis of Data collection

: finding

Chapter – 4

: Conclusion

: Limitation

: Suggestions

: Bibliography

3
 INTRODUCTION

ABOUT HEALTH CARE INDUSTRY

NATURE OF THE INDUSTRY

Combining medical technology and the human touch, the health care industry
administers care around the clock, responding to the needs of millions of people—
from newborns to the critically ill.

Industry organization. About 580,000 establishments make up the health care

industry; they vary greatly in terms of size, staffing patterns, and organizational
structures. Nearly 77 percent of health care establishments are offices of physicians,
dentists, or other health practitioners. Although hospitals constitute only 1 percent of
all health care establishments, they employ 35 percent of all workers.

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Table 1. Percent distribution of employment and establishments in health
services by detailed industry sector, 2006
Industry segment Employment Establishments

100.0 100.0
Total

42.2 87.1
Ambulatory health care services

17.1 36.7
Offices of physicians

6.9 3.3
Home health care services

6.3 20.7
Offices of dentists

4.6 19.3
Offices of other health practitioners

3.9 3.4
Outpatient care centers

1.7 1.4
Other ambulatory health care services

1.6 2.3
Medical and diagnostic laboratories

34.8 1.3
Hospitals

32.8 1.0
General medical and surgical hospitals

1.3 0.2
Other hospitals

Psychiatric and substance abuse 0.8 0.1

hospitals

23.0 11.5
Nursing and residential care facilities

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Table 1. Percent distribution of employment and establishments in health
services by detailed industry sector, 2006
Industry segment Employment Establishments

12.6 2.8
Nursing care facilities

Community care facilities for the 5.0 3.4

elderly

4.0 4.1
Residential mental health facilities

1.3 1.1
Other residential care facilities

The health care industry includes establishments ranging from small-town private
practices of physicians who employ only one medical assistant to busy inner-city
hospitals that provide thousands of diverse jobs. In 2006, almost half of non-hospital
health care establishments employed fewer than five workers (chart 1). By contrast, 7
out of 10 hospital employees were in establishments with more than 1,000 workers.

Hospitals. Hospitals provide complete medical care, ranging from diagnostic

services, to surgery, to continuous nursing care. Some hospitals specialize in treatment
of the mentally ill, cancer patients, or children. Hospital-based care may be on an
inpatient (overnight) or outpatient basis. The mix of workers needed varies,
depending on the size, geographic location, goals, philosophy, funding, organization,
and management style of the institution. As hospitals work to improve efficiency, care
continues to shift from an inpatient to outpatient basis whenever possible. Many
hospitals have expanded into long-term and home health care services, providing a
wide range of care for the communities they serve.

Nursing and residential care facilities. Nursing care facilities provide inpatient
nursing, rehabilitation, and health-related personal care to those who need continuous
nursing care, but do not require hospital services. Nursing aides provide the vast
majority of direct care. Other facilities, such as convalescent homes, help patients
who need less assistance. Residential care facilities provide around-the-clock social
and personal care to children, the elderly, and others who have limited ability to care

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for themselves. Workers care for residents of assisted-living facilities, alcohol and
drug rehabilitation centers, group homes, and halfway houses. Nursing and medical
care, however, are not the main functions of establishments providing residential care,
as they are in nursing care facilities.

Offices of physicians. About 37 percent of all health care establishments fall into this
industry segment. Physicians and surgeons practice privately or in groups of
practitioners who have the same or different specialties. Many physicians and
surgeons prefer to join group practices because they afford backup coverage, reduce
overhead expenses, and facilitate consultation with peers. Physicians and surgeons are
increasingly working as salaried employees of group medical practices, clinics, or
integrated health systems.

Offices of dentists. About 1 out of every 5 health care establishments is a dentist’s

office. Most employ only a few workers, who provide preventative, cosmetic, or
emergency care. Some offices specialize in a single field of dentistry such as
orthodontics or periodontitis.

Home health care services. Skilled nursing or medical care is sometimes provided in
the home, under a physician’s supervision. Home health care services are provided
mainly to the elderly. The development of in-home medical technologies, substantial
cost savings, and patients’ preference for care in the home have helped change this
once-small segment of the industry into one of the fastest growing parts of the
economy.

Offices of other health practitioners. This segment of the industry includes the
offices of chiropractors, optometrists, podiatrists, occupational and physical
therapists, psychologists, Outpatient care centers audiologists, speech-language
pathologists, dietitians, and other health practitioners. Demand for the services of this
segment is related to the ability of patients to pay, either directly or through health
insurance. Hospitals and nursing facilities may contract out for these services. This
segment also includes the offices of practitioners of alternative medicine, such as
acupuncturists, homeopaths, hypnotherapists, and naturopaths.

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. The diverse establishments in this group include kidney dialysis centers, outpatient
mental health and substance abuse centers, health maintenance organization medical
centers, and freestanding ambulatory surgical and emergency centers.

Other ambulatory health care services. This relatively small industry segment
includes ambulance and helicopter transport services, blood and organ banks, and
other ambulatory health care services, such as pacemaker monitoring services and
smoking cessation programs.

Medical and diagnostic laboratories. Medical and diagnostic laboratories provide

analytic or diagnostic services to the medical profession or directly to patients
following a physician’s prescription. Workers may analyze blood, take x rays and
computerized tomography scans, or perform other clinical tests. Medical and
diagnostic laboratories provide the fewest number of jobs in the health care industry.

Recent developments. In the rapidly changing health care industry, technological

advances have made many new procedures and methods of diagnosis and treatment
possible. Clinical developments, such as infection control, less invasive surgical
techniques, advances in reproductive technology, and gene therapy for cancer
treatment, continue to increase the longevity and improve the quality of life of many
Americans. Advances in medical technology also have improved the survival rates of
trauma victims and the severely ill, who need extensive care from therapists and
social workers as well as other support personnel.

In addition, advances in information technology continue to improve patient care and

worker efficiency with devices such as hand-held computers that record notes on each
patient. Information on vital signs and orders for tests are transferred electronically to
a main database; this process eliminates the need for paper and reduces recordkeeping
errors.

Cost containment also is shaping the health care industry, as shown by the growing
emphasis on providing services on an outpatient, ambulatory basis; limiting
unnecessary or low-priority services; and stressing preventive care, which reduces the
potential cost of undiagnosed, untreated medical conditions. Enrollment in managed
care programs—predominantly preferred provider organizations, health maintenance

8
organizations, and hybrid plans such as point-of-service programs—continues to
grow. These prepaid plans provide comprehensive coverage to members and control
health insurance costs by emphasizing preventive care. Cost effectiveness also is
improved with the increased use of integrated delivery systems, which combine two
or more segments of the industry to increase efficiency through the streamlining of
functions, primarily financial and managerial. These changes will continue to reshape
not only the nature of the health care workforce, but also the manner in which health
care is provided.

WORKING CONDITIONS

Hours. Average weekly hours of nonsupervisory workers in private health care varied
among the different segments of the industry. Workers in offices of dentists averaged
only 27.1 hours per week in 2006, while those in psychiatric and substance abuse
hospitals averaged 35.7 hours, compared with 33.9 hours for all private industry.

Many workers in the health care industry are on part-time schedules. Part-time
workers made up about 19 percent of the health care workforce as a whole in 2006,
but accounted for 38 percent of workers in offices of dentists and 31 percent of those
in offices of other health practitioners. Many health care establishments operate
around the clock and need staff at all hours. Shift work is common in some
occupations, such as registered nurses. Numerous health care workers hold more than
one job.

Work environment. In 2006, the incidence of occupational injury and illness in

hospitals was 8.1 cases per 100 full-time workers, compared with an average of 4.4
for private industry overall. Nursing care facilities had a higher rate of 9.8. Health
care workers involved in direct patient care must take precautions to prevent back
strain from lifting patients and equipment; to minimize exposure to radiation and
caustic chemicals; and to guard against infectious diseases, such as AIDS,
tuberculosis, and hepatitis. Home care personnel who make house calls are exposed to
the possibility of being injured in highway accidents, all types of overexertion when
assisting patients, and falls inside and outside homes.

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EMPLOYMENT

As the largest industry in 2006, health care provided 14 million jobs—13.6 million
jobs for wage and salary workers and about 438,000 jobs for self-employed and
unpaid family workers. Of the 13.6 million wage and salary jobs, 40 percent were in
hospitals; another 21 percent were in nursing and residential care facilities; and 16
percent were in offices of physicians. The majority of jobs for self-employed and
unpaid family workers in health care were in offices of physicians, dentists, and other
health practitioners—about 295,000 out of the 438,000 total self-employed.

Health care jobs are found throughout the country, but they are concentrated in the
largest States—in particular, California, New York, Florida, Texas, and Pennsylvania.

Workers in health care tend to be older than workers in other industries. Health care
workers also are more likely to remain employed in the same occupation, in part
because of the high level of education and training required for many health
occupations.

OCCUPATIONS IN THE INDUSTRY

Health care firms employ large numbers of workers in professional and service
occupations. Together, these two occupational groups account for 3 out of 4 jobs in
the industry. The ext largest share of jobs, 18 percent, is in office and administrative
support. Management, business, and financial operations occupations account for only
4 percent of employment. Other occupations in health care made up only 2 percent of
the total.

Professional occupations, such as physicians and surgeons, dentists, registered

nurses, social workers, and physical therapists, usually require at least a bachelor’s
degree in a specialized field or higher education in a specific health field, although
registered nurses also enter through associate degree or diploma programs.
Professional workers often have high levels of responsibility and complex duties. In
addition to providing services, these workers may supervise other workers or conduct
research.

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Other health professionals and technicians work in many fast growing occupations,
such as medical records and health information technicians and dental hygienists.
These workers may operate technical equipment and assist health diagnosing and
treating practitioners. Graduates of 1- or 2-year training programs often fill such
positions; the jobs usually require specific formal training beyond high school, but
less than 4 years of college.

Service occupations attract many workers with little or no specialized education or

training. For instance, some of these workers are nursing aides, home health aides,
building cleaning workers, dental assistants, medical assistants, and personal and
home care aides. Nursing or home health aides provide health-related services for ill,
injured, disabled, elderly, or infirm individuals either in institutions or in their homes.
By providing routine personal care services, personal and home care aides help
elderly, disabled, and ill persons live in their own homes instead of in an institution.
Although some of these workers are employed by public or private agencies, many
are self-employed. With experience and, in some cases, further education and training,
service workers may advance to higher level positions or transfer to new occupations.

Most workers in health care jobs provide clinical services, but many also are
employed in occupations with other functions. Numerous workers in management and
administrative support jobs keep organizations running smoothly. Although many
medical and health services managers have a background in a clinical specialty or
training in health care administration, some enter these jobs with a general business
education.

Each segment of the health care industry provides a different mix of wage and salary
health-related jobs.

Hospitals. Hospitals employ workers with all levels of education and training,
thereby providing a wider variety of services than is offered by other segments of the
health care industry. About 3 in 10 hospital workers is a registered nurse. Hospitals
also employ many physicians and surgeons, therapists, and social workers. About 1 in
5 hospital jobs are in a service occupation, such as nursing, psychiatric, and home
health aides, or building cleaning workers. Hospitals also employ large numbers of
office and administrative support workers.

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Nursing and residential care facilities. About 2 out of 3 nursing and residential care
facility jobs are in service occupations, primarily nursing, psychiatric, and home
health aides. Professional and administrative support occupations make up a much
smaller percentage of employment in this segment, compared to other parts of the
health care industry. Federal law requires nursing facilities to have licensed personnel
on hand 24 hours a day and to maintain an appropriate level of care.

Offices of physicians. Many of the jobs in offices of physicians are in professional

and related occupations, primarily physicians, surgeons, and registered nurses. About
two-fifths of all jobs, however, are in office and administrative support occupations,
such as receptionists and information clerks.

Offices of dentists. Roughly one-third of all jobs in this segment are in service
occupations, mostly dental assistants. The typical staffing pattern in dentists’ offices
consists of one dentist with a support staff of dental hygienists and dental assistants.
Larger practices are more likely to employ office managers and administrative support
workers.

Home health care services. About 3 in 5 jobs in this segment are in service
occupations, mostly home health aides and personal and home care aides. Nursing and
therapist jobs also account for substantial shares of employment in this segment.

Offices of other health practitioners. About 2 in 5 jobs in this industry segment are
professional and related occupations, including physical therapists, occupational
therapists, dispensing opticians, and chiropractors. Healthcare practitioners and
technical occupations and office and administrative support occupations also
accounted for a significant portion of all jobs—34 percent and 32 percent,
respectively.

Outpatient care centers. This segment of the health care industry employs a high
percentage of professional and related workers, including counselors, social workers,
and registered nurses.

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Other ambulatory health care services. Because this industry segment includes
ambulance services, it employs about 2 out of every 5 emergency medical technicians
and paramedics and ambulance drivers and attendants.

Medical and diagnostic laboratories. Professional and related workers, primarily clinical laboratory
and radiologic technologists and technicians, make up 44 percent of all jobs in this industry segment.
Service workers employed in this segment include medical assistants, medical equipment preparers,

and medical transcriptionists.

Table 2. Employment of wage and salary workers in health care by occupation,

2006 and projected change, 2006-2016.
(Employment in thousands)
Employment, 2006 Percent
change,
Occupation Number Percent 2006-16
All occupations 13,621 100.0 21.7

Management, business, and financial

579 4.2 18.2
occupations
Top executives 98 0.7 11.6
Medical and health services managers 185 1.4 18.6

Professional and related occupations 5,955 43.7 21.3

Counselors 169 1.2 29.3
Social workers 189 1.4 23.3
Social and human service assistants 97 0.7 28.9
Dentists 96 0.7 7.5
Pharmacists 64 0.5 22.2
Physicians and surgeons 468 3.4 17.1
Physician assistants 58 0.4 29.6
Registered nurses 2,072 15.2 25.2
Occupational therapists 66 0.5 28.4
Physical therapists 141 1.0 30.4
Respiratory therapists 91 0.7 23.4
Clinical laboratory technologists and
266 2.0 14.3
technicians

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Table 2. Employment of wage and salary workers in health care by occupation,
2006 and projected change, 2006-2016.
(Employment in thousands)
Employment, 2006 Percent
Occupation Number Percent change,
Dental hygienists 163 1.2 30.4
Cardiovascular technologists and technicians 43 0.3 25.5
Diagnostic medical sonographers 44 0.3 19.2
Radiologic technologists and technicians 184 1.3 15.4
Emergency medical technicians and
130 1.0 22.3
paramedics
Pharmacy technicians 60 0.4 31.6
Psychiatric technicians 48 0.4 -5.2
Surgical technologists 82 0.6 24.6
Licensed practical and licensed vocational
605 4.4 13.4
nurses
Medical records and health information
142 1.0 18.6
technicians

Service occupations 4,334 31.8 27.1

Home health aides 582 4.3 46.9
Nursing aides, orderlies, and attendants 1,240 9.1 18.3
Physical therapist assistants and aides 100 0.7 29.7
Dental assistants 267 2.0 30.3
Medical assistants 390 2.9 36.1
Medical transcriptionists 76 0.6 10.5
Cooks, institution and cafeteria 115 0.8 17.2
Food preparation workers 107 0.8 15.4
Food servers, nonrestaurant 84 0.6 20.0
Building cleaning workers 362 2.7 17.5
Personal and home care aides 307 2.3 53.0
Recreation workers 54 0.4 15.9

Office and administrative support occupations 2,446 18.0 14.4

Billing and posting clerks and machine
192 1.4 10.2
operators

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Table 2. Employment of wage and salary workers in health care by occupation,
2006 and projected change, 2006-2016.
(Employment in thousands)
Employment, 2006 Percent
Occupation Number Percent change,
Bookkeeping, accounting, and auditing
120 0.9 20.9
clerks
Interviewers, except eligibility and loan 106 0.8 13.8
Receptionists and information clerks 363 2.7 22.7
Executive secretaries and administrative
130 1.0 20.6
assistants
Medical secretaries 380 2.8 17.2
Secretaries, except legal, medical, and
190 1.4 6.3
executive
Office clerks, general 335 2.5 21.5

TRAINING AND ADVANCEMENT

Most workers have jobs that require less than 4 years of college education, but health
diagnosing and treating practitioners are among the most educated workers.

A variety of programs after high school provide specialized training for jobs in health
care. Students preparing for health careers can enter programs leading to a certificate
or a degree at the associate, baccalaureate, or graduate level. Two-year programs
resulting in certificates or associate degrees are the minimum standard credential for

15
occupations such as dental hygienist or radiologic technologist. Most therapists and
social workers have at least a bachelor’s degree. Health diagnosing and treating
practitioners—such as physicians and surgeons, optometrists, and podiatrists—are
among the most educated workers, with many years of education and training beyond
college.

The health care industry also provides many job opportunities for people without
specialized training beyond high school. In fact, more than half of workers in nursing
and residential care facilities have a high school diploma or less, as do a fifth of
workers in hospitals.

Some health care establishments provide on-the-job or classroom training, as well as

continuing education. For example, in all certified nursing facilities, nursing aides
must complete a State-approved training and competency evaluation program and
participate in at least 12 hours of in-service education annually. Hospitals are more
likely than other facilities to have the resources and incentive to provide training
programs and advancement opportunities to their employees. In other segments of
health care, the variety of positions and advancement opportunities are more limited.
Larger establishments usually offer a broader range of opportunities.

Some hospitals provide training or tuition assistance in return for a promise to work at
their facility for a particular length of time after graduation. Many nursing facilities
have similar programs. Some hospitals have cross-training programs that train their
workers—through formal college programs, continuing education, or in-house
training—to perform functions outside their specialties.

Persons considering careers in health care should have a strong desire to help others,
genuine concern for the welfare of patients and clients, and an ability to deal with
people of diverse backgrounds in stressful situations.

Health specialists with clinical expertise can advance to department head positions or
even higher level management jobs. Medical and health services managers can
advance to more responsible positions, all the way up to chief executive officer.

OUTLOOK

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Health care will generate 3 million new wage and salary jobs between 2006 and 2016,
more than any other industry. Seven of the twenty fastest growing occupations are
health care related. Job opportunities should be good in all employment settings.

Employment change. Wage and salary employment in the health care industry is
projected to increase 22 percent through 2016, compared with 11 percent for all
industries combined (table 3). Employment growth is expected to account for about 3
million new wage and salary jobs—20 percent of all wage and salary jobs added to
the economy over the 2006-16 period. Projected rates of employment growth for the
various segments of the industry range from 13 percent in hospitals, the largest and
slowest growing industry segment, to 55 percent in the much smaller home health
care services.

Table 3. Employment in health care by industry segment, 2006 and projected

change, 2006-16
(Employment in thousands)
2006 2006-16
Industry segment Employment Percent change

Health services, total 13,621 21.7

Hospitals, public and private 5,438 13.0

Nursing and residential care facilities 2,901 23.7
Offices of physicians 2,154 24.8
Home health care services 867 55.4
Offices of dentists 784 22.4
Offices of other health practitioners 571 28.3

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Table 3. Employment in health care by industry segment, 2006 and projected
change, 2006-16
(Employment in thousands)
2006 2006-16
Industry segment Employment Percent change
Outpatient care centers 489 24.3
Other ambulatory health care services 216 32.3
Medical and diagnostic laboratories 202 16.8

Employment in health care will continue to grow for several reasons. The number of
people in older age groups, with much greater than average health care needs, will
grow faster than the total population between 2006 and 2016; as a result, the demand
for health care will increase. Employment in home health care and nursing and
residential care should increase rapidly as life expectancies rise, and as aging children
are less able to care for their parents and rely more on long-term care facilities.
Advances in medical technology will continue to improve the survival rate of severely
ill and injured patients, who will then need extensive therapy and care. New
technologies will make it possible to identify and treat conditions that were previously
not treatable. Medical group practices and integrated health systems will become
larger and more complex, increasing the need for office and administrative support
workers. Industry growth also will occur as a result of the shift from inpatient to less
expensive outpatient and home health care because of improvements in diagnostic
tests and surgical procedures, along with patients’ desires to be treated at home.

Many of the occupations projected to grow the fastest in the economy are
concentrated in the health care industry. For example, over the 2006-16 period, total
employment of home health aides—including the self-employed—is projected to
increase by 49 percent, medical assistants by 35 percent, physical therapist assistants
by 32 percent, and physician assistants by 27 percent.

Rapid growth is expected for workers in occupations concentrated outside the

inpatient hospital sector, such as pharmacy technicians and personal and home care
aides. Because of cost pressures, many health care facilities will adjust their staffing

18
patterns to reduce labor costs. Where patient care demands and regulations allow,
health care facilities will substitute lower paid providers and will cross-train their
workforces. Many facilities have cut the number of middle managers, while
simultaneously creating new managerial positions as the facilities diversify.
Traditional inpatient hospital positions are no longer the only option for many future
health care workers; persons seeking a career in the field must be willing to work in
various employment settings. Hospitals will be the slowest growing segment within
the health care industry because of efforts to control hospital costs and the increasing
use of outpatient clinics and other alternative care sites.

Demand for dental care will rise due to population growth, greater retention of natural
teeth by middle-aged and older persons, greater awareness of the importance of dental
care, and an increased ability to pay for services. Dentists will use support personnel
such as dental hygienists and assistants to help meet their increased workloads.

In some management, business, and financial operations occupations, rapid growth

will be tempered by restructuring to reduce administrative costs and streamline
operations. Office automation and other technological changes will slow employment
growth in office and administrative support occupations; but because the employment
base is large, replacement needs will continue to create substantial numbers of job
openings. Slower growing service occupations also will provide job openings due to
replacement needs.

Job prospects. Job opportunities should be good in all employment settings because
of high job turnover, particularly from the large number of expected retirements and
tougher immigration rules that are slowing the numbers of foreign health care workers
entering the United States.

Occupations with the most replacement openings are usually large, with high turnover
stemming from low pay and status, poor benefits, low training requirements, and a
high proportion of young and part-time workers. Nursing aides, orderlies and
attendants, and home health aides are among the occupations adding the most new
jobs between 2006 and 2016, about 647,000 combined. By contrast, occupations with
relatively few replacement openings—such as physicians and surgeons—are

19
characterized by high pay and status, lengthy training requirements, and a high
proportion of full-time workers.

Another occupation that is expected to have many openings is registered nurses. The
median age of registered nurses is increasing, and not enough younger workers are
replacing them. As a result, employers in some parts of the country are reporting
difficulties in attracting and retaining nurses. Imbalances between the supply of and
the demand for qualified workers should spur efforts to attract and retain qualified
registered nurses. For example, employers may restructure workloads and job
responsibilities, improve compensation and working conditions, and subsidize training or continuing
education.

Health care workers at all levels of education and training will continue to be in
demand. In many cases, it may be easier for jobseekers with health-specific training to
obtain jobs and advance in their careers. Specialized clinical training is a requirement
for many jobs in health care and is an asset even for many administrative jobs that do
not specifically require it.

Office automation and other technological changes will slow employment growth in
office and administrative support occupations; but because the employment base is
large, replacement needs will continue to create substantial numbers of job openings.
Slower growing service occupations also will provide job openings due to
replacement needs.

EARNINGS

Industry earnings. Average earnings of nonsupervisory workers in most health care

segments are higher than the average for all private industry, with hospital workers
earning considerably more than the average and those employed in nursing and
residential care facilities and home health care services earning less (table 4). Average
earnings often are higher in hospitals because the percentage of jobs requiring higher
levels of education and training is greater than in other segments. Those segments of
the industry with lower earnings employ large numbers of part-time service workers.

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Table 4. Average earnings and hours of nonsupervisory workers in health
services by industry segment, 2006
Earnings Weekly
Industry segment Weekly Hourly hours

Total, private industry $568 $16.76 33.9

Health services 623 18.73 33.3

Hospitals, public and private 794 22.19 35.8
Medical and diagnostic laboratories 715 19.48 36.7
Offices of physicians 669 19.98 33.5
Outpatient care centers 658 19.33 34.1
Offices of dentists 557 20.51 27.1
Other ambulatory health care services 555 15.58 35.7
Offices of other health practitioners 498 17.27 28.8
Home health care services 429 14.78 29.0
Nursing and residential care facilities 415 12.84 32.3

As in most industries, professionals and managers working in health care typically

earn more than other workers in the industry. Earnings in individual health care
occupations vary as widely as the duties, level of education and training, and amount
of responsibility required by the occupation (table 5). Some establishments offer
tuition reimbursement, paid training, child day care services, and flexible work hours.
Health care establishments that must be staffed around the clock to care for patients
and handle emergencies often pay premiums for overtime and weekend work,
holidays, late shifts, and time spent on call. Bonuses and profit-sharing payments also
may add to earnings.

Table 5. Median hourly earnings of the largest occupations in health care, May
2006
Ambulatory Nursing and
health care residential care All
Occupation services Hospitals services industries
Registered nurses $26.25 $28.12 $25.03 $27.54

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Table 5. Median hourly earnings of the largest occupations in health care, May
2006
Ambulatory Nursing and
health care residential care All
Occupation services Hospitals services industries
Licensed practical
and licensed 16.78 16.89 18.35 17.57
vocational nurses
Dental assistants 14.50 14.76 - 14.53
Medical secretaries 13.62 13.30 12.66 13.51
Medical assistants 12.58 13.14 11.60 12.64
Receptionists and
11.55 11.74 10.07 11.01
information clerks
Office clerks, general 11.47 12.55 11.12 11.40
Nursing aides,
orderlies, and 10.76 11.06 10.30 10.67
attendants
Home health aides 9.15 10.64 9.23 9.34
Personal and home
7.23 9.17 9.36 8.54
care aides

Earnings vary not only by type of establishment and occupation, but also by size;
salaries tend to be higher in larger hospitals and group practices. Geographic location
also can affect earnings.

← Benefits and union membership. Health care workers generally receive

standard benefits, such as health insurance, paid vacation
←
← SOURCES OF ADDITIONAL INFORMATION
← Audiologists
← Cardiovascular technologists and technicians
← Chiropractors
← Clinical laboratory technologists and technicians
← Dental assistants
← Dental hygienists
← Dentists

22
← Diagnostic medical sonographers
← Dietitians and nutritionists
← Emergency medical technicians and paramedics
← Licensed practical and licensed vocational nurses
← Medical and health services managers
← Medical assistants
← Medical, dental, and ophthalmic laboratory technicians
← Medical records and health information technicians
← Medical secretaries
← Medical transcriptionists
← Nuclear medicine technologists
← Nursing, psychiatric, and home health aides
← Occupational therapist assistants and aides
← Occupational therapists
← Opticians, dispensing
← Optometrists
← Personal and home care aides
← Pharmacists
← Pharmacy aides
← Pharmacy technicians
← Physical therapist assistants and aides
← Physical therapists
← Physician assistants
← Physicians and surgeons
← Podiatrists
← Psychologists
← Radiologic technologists and technicians
← Receptionists and information clerks
← Recreational therapists
← Registered nurses
← Respiratory therapists
← Social and human service assistants
← Social workers
← Speech-language pathologists

23
← Surgical technologists
← Veterinarians

Health care in India

Health care facilities and personnel increased substantially between the early 1950s
and early 1980s, but because of fast population growth, the number of licensed
medical practitioners per 10,000 individuals had fallen by the late 1980s to three per
10,000 from the 1981 level of four per 10,000. In 1991 there were approximately ten
hospital beds per 10,000 individuals.

Primary health centers are the cornerstone of the rural health care system. By 1991,
India had about 22,400 primary health centers, 11,200 hospitals, and 27,400
dispensaries. These facilities are part of a tiered health care system that funnels more
difficult cases into urban hospitals while attempting to provide routine medical care to
the vast majority in the countryside. Primary health centers and subcenters rely on
trained paramedics to meet most of their needs.

The main problems affecting the success of primary health centers are the
predominance of clinical and curative concerns over the intended emphasis on
preventive work and the reluctance of staff to work in rural areas. In addition, the
integration of health services with family planning programs often causes the local
population to perceive the primary health centers as hostile to their traditional
preference for large families. Therefore, primary health centers often play an
adversarial role in local efforts to implement national health policies.

According to data provided in 1989 by the Ministry of Health and Family Welfare, the
total number of civilian hospitals for all states and union territories combined was
10,157. In 1991 there was a total of 811,000 hospital and health care facilities beds.
The geographical distribution of hospitals varied according to local socioeconomic
conditions. In India's most populous state, Uttar Pradesh, with a 1991 population of
more than 139 million, there were 735 hospitals as of 1990. In Kerala, with a 1991
population of 29 million occupying an area only one-seventh the size of Uttar
Pradesh, there were 2,053 hospitals. In light of the central government's goal of health
care for all by 2000, the uneven distribution of hospitals needs to be reexamined.

24
Private studies of India's total number of hospitals in the early 1990s were more
conservative than official Indian data, estimating that in 1992 there were 7,300
hospitals. Of this total, nearly 4,000 were owned and managed by central, state, or
local governments.

Another 2,000, owned and managed by charitable trusts, received partial support from
the government, and the remaining 1,300 hospitals, many of which were relatively
small facilities, were owned and managed by the private sector. The use of state-of-
the-art medical equipment, often imported from Western countries, was primarily
limited to urban centers in the early 1990s. A network of regional cancer diagnostic
and treatment facilities was being established in the early 1990s in major hospitals
that were part of government medical colleges. By 1992 twenty-two such centers
were in operation. Most of the 1,300 private hospitals lacked sophisticated medical
facilities, although in 1992 approximately 12 percent possessed state-of-the-art
equipment for diagnosis and treatment of all major diseases, including cancer. The
fast pace of development of the private medical sector and the burgeoning middle
class in the 1990s have led to the emergence of the new concept in India of
establishing hospitals and health care facilities on a for-profit basis.

By the late 1980s, there were approximately 128 medical colleges--roughly three
times more than in 1950. These medical colleges in 1987 accepted a combined annual
class of 14,166 students. Data for 1987 show that there were 320,000 registered
medical practitioners and 219,300 registered nurses. Various studies have shown that
in both urban and rural areas people preferred to pay and seek the more sophisticated
services provided by private physicians rather than use free treatment at public health
centers.

Health care in India

Indigenous or traditional medical practitioners continue to practice throughout the

country. The two main forms of traditional medicine practiced are the ayurvedic
(meaning science of life) system, which deals with causes, symptoms, diagnoses, and
treatment based on all aspects of well-being (mental, physical, and spiritual), and the
unani (so-called Galenic medicine) herbal medical practice. A vaidya is a practitioner
of the ayurvedic tradition, and a hakim (Arabic for a Muslim physician) is a

25
practitioner of the unani tradition. These professions are frequently hereditary. A
variety of institutions offer training in indigenous medical practice. Only in the late
1970s did official health policy refer to any form of integration between Western-
oriented medical personnel and indigenous medical practitioners. In the early 1990s,
there were ninety-eight ayurvedic colleges and seventeen unani colleges operating in
both the governmental and nongovernmental sectors. Health care in India - Data
1995. Courtesy Library of Congress.

It is
not uncommon to see medical colleges and hospitals belonging to various medical
systems such as modern, ayurveda and homeopathy in one Indian city. India provides
an excellent example of medical pluralism. People follow home remedies, spiritual
remedies and treatment from various medical systems simultaneously or one after
another. Metropolitan urban areas provide medical facilities which are available in
developing countries such as cardiac surgery, treatment of all kids of cancers, or in
brief, for the diseases which are associated with affluence. The major diseases
identified in South – East Asia Region under WHO are malaria, filarial and other
mosquito – borne diseases, diarrhea diseases, leprosy, tuberculosis, sexually
transmitted diseases, poliomyelitis and other children diseases, tetanus,
nasopharyngeal and cervical cancers, visual impairment and blindness, etc.

The organized sectors in urban areas such as employees of government and public
undertakings bargain for medical benefits like Employees State Insurance Scheme and
Government Health Schemes. In same cases, medical expenses are reimbursable if
treated at recognized hospitals. At the same time, there is a lot of overlap and even the
private medical practitioners seem to thrive well simultaneously. However, the

26
unorganized sector such as domestic workers, self-employed, porters, cart-pullers,
load-carriers and urban poor mostly living in slums do not get these benefits. They are
also deprived of piped water and modern sanitation, or in any case, the facilities are
woefully inadequate.

Urban poor whose hallmark in expenditure is cheapness get adulterated food and
drugs. On an average, milk milk-products, edible oils, wheat flour, spices and even tea
leaves are adulterated to the tune of 50 per cent.

Mental health has yet to receive due attention in India. While westernized urban elite
require the services of psychiatrists in increasing number, for others family continues
to provide psychic treatment. If crime rate, suicide, divorce, riots and indiscipline are
considered as parameters of mental health, urban area need urgent attention.

It is often said that a large proportion of population suffers from protein calorie
malnutrition. However, the range of nutrition in which people can function efficiently
without getting nutritional deficiencies is wide and what are commonly given as
recommended quantities for intake of nutrients are much higher than what are
required.

Urban poor are unfortunately use bottle feeding and baby feeds under the influence of
commercial advertising on radio, television, and through other popular media like
films.

The revolution in drugs coincided with freedom from colonial rule. The drug industry
has developed out of proportion in comparison with basic amenities like potable water
and sanitation.

Pharmaceutical industry measures developed out of proportion of country in terms of

intakes of per capita consumption of drugs. In India, drugs are only consumed among
20 per cent urban people. The per capita consumption is perhaps the lowest in the
world. However, this code does not represent the correct picture in view of the fact
that about 75 per cent population in rural areas and urban poor has yet to have access
to drugs. Major share of these drugs are taken away by vitamins, tonics, and

27
antibiotics. It is estimated that out of the total production 25 per cent was taken away
by vitamins and tonics, and 20 per cent by antibiotics.

Primary health care is available to the whole population, with at least the following:

- Safe water in the home or within 15 minutes walking distance, and adequate sanitary
facilities, in the home or immediate vicinity;

- Immunization against diphtheria, tetanus, whooping cough, measles, poliomyelitis,

and tuberculosis;

- Local health care, including availability of at least 20 essential drugs, within an

hour’s walk or travel; and

- Trained personnel for attending pregnancy and child-birth, and caring for children
up to at least one year of age.

Treating India's ailing healthcare

system by championing
patient education
Most of us would agree that though Indian
doctors are amongst the best in the world,
the Indian healthcare system is sick. Private healthcare can be world-class; but this is
expensive and unaffordable for the vast majority. While the government does provide free
healthcare, a lot of it is of very poor quality. Both doctors and patients are unhappy, as
evidenced by the increasing violence against doctors and patients.

28
One reason for this sad state of affairs is that the entire medical system is built around
the doctor. This is crazy! Healthcare is a service industry, and should be designed
around the patient. The best way of doing this would be empowering patients with
information, so they know how to get the best medical care, in partnership with their
doctor.
Unfortunately, patient education seems to be no one's baby, as a result of which it is a
relatively neglected area. This is a shame, because the potential cost-benefit ratio is
huge! For the investment of a small amount of money, it's possible to improve the
healthcare millions of patients receive. Patients represent healthcare's largest resource
- and they have been untapped so far. If we can make intelligent use of patients, and
help them to make use of their intelligence, everyone will benefit!
An investment in patient education is one of the most cost-effective ways of
improving healthcare in India. Well-informed patients will take much better care of
themselves, and information therapy will help to make medical care much more
patient-centric.

This can be a major opportunity for pharmacists. So far, chemists in India have been
treated as "baniyas", who only sell medicines. This is partly because most of them
have only focused on making money, by selling products. They do not provide any
value addition. However, the traditional small chemist shop is now under threat, as the
large retail healthcare chains enter India. Just like the small "mom and pop" grocery
stores are closing down because Indians prefer to shop in large malls, the large
pharmacy chains will wipe out the small chemist, because of their financial muscle
and ability to provide better service. The only way the small chemist can counter this
threat is by providing better service to his patients. Patients are thirsty for information,
but their doctors are often too busy to talk to them. If pharmacists (who are also
professionals and expert in their field) can take the time and trouble to educate their
patients, their customers will remain faithful to them!

India Offers Both Best, Worst of Health Care

Most of India's billion-plus people struggle with a public health care system that is
overburdened in cities and virtually nonexistent in villages. On the other hand, private
health care is booming, and the country's state-of-the art hospitals and highly skilled

29
doctors even attract patients from countries where health care costs are much higher.
The challenge before India is to make such top quality care accessible for the majority
of its people.

When Pardip Singh's elder brother fell ill with a severe nerve ailment in a remote
village in the eastern state of Bihar, he brought him all the way to New Delhi's All
India Institute of Medical Sciences - the country's premier government-run hospital.

Singh had little choice. There were no health centers or doctors near his village who
could even diagnose his brother's condition. At the New Delhi hospital, some of the
country's best doctors attend to his brother. Twenty-eight-year-old Singh's worries
should have ended - but they have just begun.

Singh says he has given up his job as a security guard to stand in long lines with his
brother at the hospital. The treatment is free, but to pay for the tests, he has borrowed
350 dollars at a crippling interest of nearly 50 percent a year.

Like Singh, thousands of people flock everyday to big public hospitals in Delhi and
other cities for treatment.

But in these overcrowded hospitals, they must first battle serpentine lines to see
specialists, wait months to undergo tests and surgeries, and spend more than they can
afford for board and lodging. Many sick people never gather the resources needed to
make the journey and tens of thousands of others borrow money or sell assets to cover
expenses.

The head of All India Institute's cardiology department, Srinath Reddy, says one of the primary
problems confronting the country is that two-thirds of its billion plus people live in villages - but
most hospitals are in big cities.

"We have maldistribution," Reddy explained. " The rural areas and some of the underdeveloped
states do not have adequate medical facilities. It is not so much acute lack of vaccines or hospital
beds. But most of the beds are in urban areas whereas most of the people are in rural areas, so that
is where the problem is."

30
It is not just advanced care that poses a problem. Even good basic care is inaccessible to the vast
majority of people. Thousands of primary medical centers exist, but they are perpetually short of
personnel and medicines.

The government, led by the Congress Party, has promised to increase health care services for the
rural areas and the poor by appointing community health workers, and implementing a national
insurance program - but little has been done so far to meet those goals.

The lack of an effective public health system has led to a booming private system,
which takes care of three-quarters of the country's needs.

But the system is unregulated, and poor people are often forced to turn to medical
practitioners who are little more than quacks.

Dr. Reddy at the All India Institute is a member of a new private initiative called the
Public Health Foundation, which wants to train thousands of public health
professionals to meet the country's vast needs.

"There are no standard guidelines (for) treatment which are universally disseminated
and adopted for practice by primary care physicians, there are no quality checks," he
said. " And therefore both malpractice which is intentional as well as inadequate
medical treatment, these are problems that plague the private sector health care
delivery."

The scene is radically different for those who can pay for top-of-the-line private
services.

India's million plus doctors include specialists on par with the best in the world.

These doctors staff state-of-the-art facilities that not only cater to middle class Indians
but also attract patients from other countries.

That has encouraged a budding medical tourism industry - drawing foreign patients to
India for world class treatment at relatively low cost.

New Delhi's Apollo Hospital is at the forefront of this emerging business. Last year it
treated 12,000 patients from across the globe - neighboring Bangladesh and Pakistan,
to Africa and even developed countries such as the United States, Canada and Britain.

31
Some people come for knee replacements and heart surgeries for which they may
have to wait for months in their home countries, others seek cosmetic procedures that
are five to 10 times cheaper in India than in developed countries.

Apollo Hospital's marketing head, Anil Maini, says such hospitals are "centers of
excellence". He says once the hospital door is shut, overseas patients never glimpse
the urban slums, overcrowding and other problems in India that might erode their
confidence in seeking treatment in a developing country.

"Within the four walls of the hospital, we pick him up from the airport and bring him
in, he is totally cocooned in the hospital and not exposed to any Third World bane as
we say," Maini said.

Fernanda Wagland from Britain was traveling in India with her husband when he was
hit by a stomach infection.

She brought him to Apollo Hospital and describes the experience as "pleasant." She
may even consider seeking treatment here in the future.

"In England, we would be in the kind of multiple (bed) ward, a bit more hectic, so we
are getting more exclusive treatment here. If you really wanted something special
done with more care and one-to-one treatment, perhaps one could consider coming
here," she said.

The challenge before the country now is to put such high quality services within reach
of the poor. Doctors say there is little time to lose - millions in the country suffer from
infectious diseases such as tuberculosis and other killers such as AIDS, and lifestyle
diseases such as diabetes and heart problems are emerging on a massive scale in
rapidly growing cities.

32
HUMAN RESOURCE DEVELOPMENT

Human Resource Development (HRD) is the integrated use of training, organizational

development, and career development efforts to improve individual, group, and
organizational effectiveness.

HRD helps to:

 Develop the key competencies that enable individuals in organizations to

perform current and future jobs, through planned learning activities
 Groups within organizations initiate and manage change
 Ensure a match between an individual and organizational needs.

Typical HRD practices include:

 Executive and supervisory/management development

 Professional skills training
 Technical/Job instruction and coaching
 Sales and marketing training
 Customer service training
 New employee orientation
 Health and safety training
 Organizational development consultation

HRD HELPS TO IMPROVE THE HOSPITAL ENVIRONMENT:-

 Human Resource Development helps to the health care system in the hospital.
 It care on the patient health and incentive care.

33
 It improves the hospital work systems and procedure.
 HRD focus on the patient satisfaction in the hospital environment.
 HRD in the hospital consists of many functional areas :-

a) Hygienic of the surgical instrument.

b) It conducts many awareness program in the hospital and among the
patient. For example- AIDS program, family planning, TV and polio
awareness scheme.
c) Neating and cleaning of bed furs, use of disposable injections. Proper
training and development to the doctors and nurse.
d) Lab safety and cure from viral deases.

34
Health Human Resources Development (HHRD)

ICN judges that health human resources development (HHRD) - planning, management and
development - requires an interdisciplinary, inter-sectoral and multi-service approach. This
recognises the complementary roles of health service providers, and values the contribution of
the different disciplines. Inputs are required from the key stake holders -- consumers, service
providers, educators, researchers, employers, managers, governments, funders and health
professions’ organisations. Similarly, ICN acknowledges that integrated and comprehensive
health human resources information systems and planning models as well as effective human
resources management practices are desired outcomes of this consulting process

Patient need should determine the categories of health personnel and skill pools required to
provide care. When new categories of health workers are created or role changes are
introduced, the possible consequences on national and local health human resources, career
structures, and patient and community outcomes need to be identified and planned for at the
outset. These would include financing arrangements and organisational impacts. Planning for
this should take account of:

35
  Health care needs and priorities.
 Available competencies within the health care provider pool, including competencies
shared by more that one health care provider group.
 Initial skills set development.
 Skill changes, such as new and advanced roles for nurses.
 Educational implications of making changes to roles and scopes of practice, including
provision for life-long learning programmes.
 Appropriate and accessible supervision and mentoring programmes.

PUBLIC AND PRIVATE HOSPITAL SERVICES

There is no denying that much is wrong with our public hospitals. Recent economic
policies promoting privatisation have brought into sharp focus all public sector units
including public hospitals. Experts and the general public perceive public hospitals as
inefficient, dirty, unhygienic and their staff as rude, negligent and callous.

Public hospitals certainly lack the five star culture of private hospitals but is the
quality of treatment in private hospitals in public hospitals? This issue is important to
remember that then public hospitals is poor, illiterate, not conversant with the general
principles of hygiene.

Do private hospitals offer good medical care?

Good medical care implies appropriate treatment given to the patient in reasonable
time, compassionately and at low cost.

Private hospitals invest heavily in acquiring state- of- art technology and expect
attending physicians and surgeons to recover the cost through their patients.
Expensive investigations are ordered on grounds that do not stand scientific scrutiny.
Surgeons are hauled up if they do not get sufficient numbers of patients into the
expensive categories of beds and generate adequate income to the hospital from
operations. It is no wonder that many aggrieved patients talk of a nexus between

36
doctors, laboratories and the referring physicians in perpetuating unnecessary
investigations and operations.

That money making, and not the general good of the patients, is the main
consideration in private hospitals is amply clear from the fact that so many hospitals
specialising in cardiac diseases have come up in recent years. Angioplasties and
bypass operations are cost- intepsive and make good business sense. When did you
last hear of anyone starting a private hospital for infectious diseases or tuberculosis?

Health rightly remains a concern of the government in most advanced countries of the
world. The temptation of following everything American should be tempered with full
knowledge of the the fact that thirty million people cannot afford medical treatment in
the USA. Concern for them prompted the Clinton proposals for reform - shot down by
powerful forces. There is much that is wrong with high- tech and cost- intensive
private healthcare system and we must be especially careful about introducing such a
system in a country riddled with poverty.

Corporate hospitals in India, started by non- resident Indians from USA, are based on
the principle of profit- making by providing quality (read expensive) care to the few
rich while ignoring the large middle class and the poor who must depend on public
hospitals.

Healthcare and care of the sick cannot bc equated with any other industry or
enterprise. It is degrading to make money on human misery and illness.

It must strike even the least observant that a society which tolerates the lack of basic
sanitation and hygiene but applauds the availability of ill- equipped private medical
colleges, computerised tomography, magnetic resonance and color doppler scanners
even in small towns has its priorities woefully away.

Public hospitals are assets

It is time that thinking people consider public hospitals as assets to society.

Intellectuals and opinion makers must show concern about healthcare policies of the
government and suggest measures to revitalise public systems. Such revitalisation will

37
have to simultaneously focus on developing the strengths and eliminating the many,
acknowledged deficiencies in public hospitals.

Along with education, healthcare needs to remain in the public sector but in a greatly
improved, more efficient and cost effective form. Privatisation of healthcare will harm
the most vulnerable - the poor and the old - who form a large part of our population.

There was a time when public hospitals enjoyed the place of pride. Even today it is
not unusual to see complicated and difficult cases being transferred from private
hospitals to public hospitals. The first open heart operation, the first test-tube baby
and now the first successful heart transplant were milestones passed by the much-
maligned public hospitals. These hospitals have provided exemplary service to society
during such catastrophies as riots, bomb blasts, major accidents and natural disasters
such as earthquakes. Private hospitals have yet to prove their social commitment.

Problems in public hospitals and possible solutions

These institutions have suffered because of lacklustre policies of governments and the
general neglect of people whose opinions matter in the affairs of the State, probably
because they do not visit these hospitals and can well afford the expensive treatment
at private hospitals.

The problems in public healthcare can be traced to,

 unsatisfactory policy on medical education

 neglect of basic healthcare measures such as sanitation, environmental hygiene
and clean drinking water
 failure to streamline and integrate primary, secondary and tertiary healthcare
systems ’
 the gap between healthcare proponents and policy makers
 uneven levels of training of different categories of personnel; (medical
specialists are very well trained; nurses, technicians and other health workers
are neither well trained nor motivated)

38
  bureaucratic hurdles, inadequate funding and the practice of accepting lowest
tenders (with consequent obsolete technology, substandard equipment and
poor maintenance)
 low salaries and perquisites to public hospital employees (especially the
doctors and nurses) with a consequent near- continuous exodus of trained staff
to private hospitals and institutions abroad and frustration in the dedicated
staff who continue to struggle against odds.

It is necessary to urgently restore public hospitals to good health. To do so, we need

an efficient and responsive healthcare system together with a national medical
education policy. A fixed percentage of medical graduates (0- 60%) should be helped
to specialise in general practice. Improved facilities at rural centers are essential if we
are to succeed.

The number and variety of specialists should be determined by the needs of the
country. Prospective analysis and planning, with periodic reviews must ensure that
these needs are met. This is especially important when we consider such disciplines as
cardiovascular surgery and neurosurgery. Training of such specialists must be
conducted at carefully selected centers which reach and maintain international
standards. All selections (to faculty and the student community) must be based on
merit and merit alone. These institutions must be shielded from irritants such as
reservations, nepotism and political pressures. Periodic reviews of these institutions
will weed out those with falling standards.

If the present unplanned glut prevails, we will continue to supply trained doctors and
scientists to other, wealthy nations at considerable loss to ourselves.

Industrial houses and philanthropists must generously support public hospitals and
help them upgrade existing facilities and acquire new technology. They must also
ensure optimal usage of these resources through their presence on the boards of
management of these hospitals. This will be their gift of life to the poor and
deserving.

39
Public sector reform and demand for human resources for
health (HRH)

Abstract

This article considers some of the effects of health sector reform on human resources
for health (HRH) in developing countries and countries in transition by examining the
effect of fiscal reform and the introduction of decentralisation and market mechanisms
to the health sector.

Fiscal reform results in pressure to measure the staff outputs of the health sector.
Financial decentralisation often leads to hospitals becoming "corporatised"
institutions, operating with business principles but remaining in the public sector. The
introduction of market mechanisms often involves the formation of an internal market
within the health sector and market testing of different functions with the private
sector. This has immediate implications for the employment of health workers in the
public sector, because the public sector may reduce its workforce if services are
purchased from other sectors or may introduce more short-term and temporary
employment contracts.

Decentralisation of budgets and administrative functions can affect the health sector,
often in negative ways, by reducing resources available and confusing lines of
accountability for health workers. Governance and regulation of health care, when
delivered by both public and private providers, require new systems of regulation.

The increase in private sector provision has led health workers to move to the private
sector. For those remaining in the public sector, there are often worsening working
conditions, a lack of employment security and dismantling of collective bargaining
agreements.

Human resource development is gradually being recognised as crucial to future

reforms and the formulation of health policy. New information systems at local and
regional level will be needed to collect data on human resources. New employment
arrangements, strengthening organisational culture, training and continuing education
will also be needed.

40
Introduction

This paper considers health sector reform and its impact on human resources for
health (HRH) in developing countries and countries in transition. Health sector reform
has been defined as the "sustained purposeful change to improve the efficiency, equity
and effectiveness of the health sector". Health sector reform involves many
fundamental changes to the way in which public services are financed, organised and
delivered in both developing and developed countries, and often operates as part of a
wider programme of public sector reform. Fiscal reform, the introduction of market
mechanisms and decentralisation are three key elements of health sector reform. This
paper will show the impact of these elements on human resources for health and
attempt to assess the changing demand for health workers. A series of
recommendations will seek to address some of the issues that have emerged for HRH
demand during the process of health sector reform.

Impact of health sector reform on human resources for health (HRH)

Fiscal reform
The introduction of new budget management systems, designed to maintain financial
control throughout government, is one of the most important elements of fiscal
reform. These incorporate new financial planning and control systems that emphasise
what outputs a department or agency will be expected to deliver. Overall, there is a
focus on the performance of public services . Mechanisms for monitoring and
enforcement of targets are designed for all government departments. In the health
sector, over 50% of costs are labour costs, so that demonstrating effectiveness
depends largely on attempting to measure the work of health staff. Measuring outputs
in health care is often difficult because of having to capture both the quality of care
and patient outcomes.

Fiscal reform introduces new ways of allocating resources in line with government
objectives . There may not be a precise match with individual sectoral objectives.
Fiscal reform also tries to encourage improved use of resources, which may inform
the reorganisation and management of central agencies and the downsizing of the civil
service.

41
Health sector employees are often part of the civil service, and so civil service reform
has an impact on the employment and deployment of health workers. Civil service
downsizing results from policies to cut the costs of the public sector and transfer the
delivery of services to the private or non-profit sectors. These changes lead to a
reduction in the size of the public health care workforce. Compensation schemes may
include retraining and lump-sum severances to ease the transition of workers into the
private sector. This may be accompanied by wage policy reform to limit and contain
wage expenditures, again with the potential to affect health workers.

Trying to improve the performance of the health sector, one of the objectives of health
sector reform, has been a slow process because the savings from reducing the size of
the workforce are often not enough to raise salaries for the remaining staff. Several
countries, including Zambia, have set up a separate health service agency, operating
as a semi-autonomous government agency, that employs staff directly. Some writers
argue that agencies need to be well-managed on a limited budget rather than be seen
as an escape from civil service restrictions . In addition, "the importance of political
and institutional context in which reforms have to be implemented has been
undervalued" . Many ministries have a poor record of human resource management
and planning. New information systems can provide a more accurate picture of the
current number, type and distribution of staff, but civil service systems rarely provide
incentives to reduce staff budgets. There may also be attempts to strengthen linkages
between government departments, which are relevant for the health sector.

The decentralisation of budget management is another element of fiscal reform. In the

health sector, this has been reflected in the decentralisation of service provision to
semi-autonomous hospitals, because hospitals often consume the largest part of the
health sector budget. Set up as institutions run on business principles, "corporatised"
hospitals bring the results of fiscal reform to local level. With limited available
resources, there may be pressure to generate income through the introduction of user
fees such as for health services, as well as trying to achieve outputs and outcomes at
the lowest cost. Delegation of financial authority can also provide managers with the
scope to use existing resources differently or consider different ways of delivering
services, such as by using a range of local providers.

42
The motivations for introducing corporatisation may also vary from wanting to
increase efficiency and achieve cost saving and quality improvements to just wanting
to "free up a public function from constraints of ... red tape". Cassels argues that
decentralisation has provided "major contradictions for health care" between
accountability, competing priorities and equity and tensions between small-scale
participation and managerial effectiveness required at a large scale.

In Mexico, new systems of financial management affected public health institutions

by restricting the maintenance and upgrading of equipment and imposing cuts in the
wages of health workers. This has led to the deterioration of working conditions and
the quality of care provided by the public health sector.

Financial management
Part of a programme of fiscal reform involves the development of new systems and
structures of financial management, which have organisational implications . The role
and functions of the finance ministry in central government are strengthened and it
develops a dominant role over other government departments. This affects
government health ministries, because the priorities of the finance ministry are often
different from those of the health ministry and priority setting and resource allocation
issues become sources of conflict. The nature of the relationship between the finance
and health ministries has been exposed in the development of poverty reduction
strategy papers.

In health systems, new forms of financing for the health sector may involve moving
from a tax-based system to an insurance system. This, in turn, introduces new forms
of budgetary management and control between insurance funds and health service
providers as well as new systems of payment collection. Financial management is
often accompanied by new information technology systems, which have the potential
to change the ways in which public services are monitored.

Market mechanisms
The introduction of market mechanisms is often driven by the goal of fiscal stability.
Stronger systems of budget and management control are introduced that focus on
results. They affect sectoral priorities and available human resources. Market
mechanisms may be introduced by making health care institutions operate within an

43
internal health care market and subjecting some health services to wider market
testing.

As part of developing a managed market in the public sector, the health sector is often
reorganised into two separate purchasing and provider functions. The purchasing
entity, typically a national or regional health authority, buys services from provider
units within the government sector and is also encouraged to buy services from a
range of providers in the private and NGO sectors. This has immediate implications
for the employment of health workers in the public sector, because the public sector
may reduce its workforce if services are purchased from other sectors. The private
sector may start to expand. Health workers often move from the public to the private
sector because of better prospects and higher pay. Market testing has often led to
changes in the size of the public sector workforce, increasing short-term and
temporary employment contracts, and changes in wage levels.

User fees
User charges have been introduced as a way of generating income for the health
sector. User fees in many countries have affected access to services and equity. In
Nicaragua, the introduction of user fees and separate services for private, paying
patients started as a national initiative but is now incorporated into local health
systems. User fees have become the main source of decentralised revenue. At hospital
level, 30% goes towards salary supplements . In Honduras, the revenues collected
from user fees have contributed only 2% to the Ministry of Health expenditures but
the administrative costs are 67% of the revenues collected . In most countries,
however, the preparation of staff and supporting systems for implementing user
charges has been minimal. The introduction of user fees places new pressures on
health workers, especially when user fees contribute to the actual wages and salaries
of health workers.

A recent World Bank report (2002) presents informal payments as a hindrance to

health sector reform. Payments made to health workers are considered to draw
resources away from the health care system because they are given to individuals
rather than institutions. Such payments operate as a private, unregulated system and
the practice is often illegal. Poor people often avoid using health care facilities
because of the need to make informal payments. Stronger management capacity is

44
needed to support and coordinate public, private and NGO providers and provide
accountability so that revenue from user fees goes directly for service improvements.
This would also depend on health workers' being paid an adequate salary and the
introduction of transparent systems to support the collection of user fees within the
health care sector.

Performance management
Public sector and health sector reform often introduce new approaches to managing
staff. Perhaps the most important innovation is "thinking differently about staff",
which effectively underpins other changes. The three most innovative dimensions are
"flexible staffing and recruitment practices, recognising achievement and developing
performance contracts".

The element of fiscal reform that emphasises outputs and outcomes of government
services informs the development of performance management. It aims to address
management problems relating to poor employee performance management, wage and
non-wage incentives, job classification systems and ineffective payroll and personnel
systems. Performance management may also be introduced as a way of improving
standards within public services and making services more responsive to citizens.
Wider programmes of training and capacity building for staff can accompany this.
Some developing countries have experimented with performance management
systems, with limited success. Often the new "corporatised" hospitals have only
limited management autonomy, and governments lack the capacity to manage
performance in the health system .

Decentralisation
The delegation and decentralisation of administrative and management processes
often accompany budgetary reforms. In Nicaragua, decentralisation was used to
introduce market reforms. Budget cuts, loss of resources from primary health care,
user fees and privatisation were introduced at the same time. In 1991 Local Integrated
Health Care Systems (SILAIS) were introduced, which are made up of a hospital and
a network of primary care units. Each SILAIS has a separate Board of Directors
consisting of local officials, church officials, health sector representatives, community
members and the SILAIS director. This group monitors services and approves the
local health plan and budget, but accountability remains unclear. The Ministry of

45
Health controls funding through "performance agreements, and controls 80% of the
health budget including staff levels and composition". Only recently have Local
Health Systems been given the power to sack staff.

In Uganda at the time of decentralisation, salaries for staff on the payroll were a
central responsibility, although this has now been decentralised through a special
conditional grant. In the past, professional staff were put on the national payroll and
nursing aides were hired locally for work in rural health centres and health posts and
paid for by the Ministry of Local Government. After the decentralisation reforms,
nursing aides were supposed to be paid by local committees, but in practice this often
did not happen and they were not paid for long periods.

Botswana and Tanzania have had long experience of decentralisation. As a result of

health sector reform, health staff were transferred to local government contracts
although senior staff remained employed by the Ministry of Health. This has led to
confused loyalties and management responsibilities. In some districts the "personality
factor" has meant that individuals working together have managed to overcome some
of these problems, in spite of the systems introduced. Senior staff who have
subsequently been transferred to local government complain that that there is "little
relationship between promotions/disciplinary actions and performance". In both
countries there is some scope for local decision-making in relation to personnel
management, but there is still resistance to distributing staff according to local needs.
More incentives and other measures are considered necessary if regional imbalances
of staff are to be addressed.

Decentralisation may lead to a loss of resources for the health sector. In Uganda, after
decentralisation, once central government stopped a block grant, primary heath care
was not given the allocation at local level that had been expected by the Ministry of
Finance. There were also considerable district variations in the allocation of health
resources. Although some districts did increase their health allocation, in many cases
decentralisation led to fewer resources for health. One of the reasons cited for the
decline in allocation of resources to the health sector was that a large part of the health
budget goes on salaries and wages, which do not show any dramatic change in the
sector. Decentralisation in this context led to problems of financial management and

46
corruption at local level, new problems of governance with a lack of accountability
and concerns over quality of services .

Some changes have run contrary to the main aims of reform, such as increased
centralisation of controls over pay. Much health sector reform was to strengthen and
rationalise budgeting, financial control and staff classification, but in some cases
control over health sector staffing has remained at national level. Even when transfer
of budgets has taken place, there is confusion between local government and health
sector responsibilities.

Changes in provision
The use of the private sector as a health service provider has had implications for the
recruitment and retention of staff in the public sector. Some services have been
privatised and are now run by local, national or international private companies. Other
services have been contracted out to both private and non-profit service providers.
This has resulted in movement of health workers from public to private or non-profit
sectors .

In the public institutions that remain, market conditions have been introduced and
services are contracted out, which has resulted in a widespread decrease in job
security in many countries. Health workers have moved from collective-bargaining
arrangements to individual contracts. Decentralisation and privatisation have
contributed to the breakdown of national collective bargaining. In Eastern and Central
Europe, new organisations and professional associations and reorganised trade unions
have led to a breakdown in labour relations expertise.

Changes of responsibility for managing health services, from national to local level
and from public to private sectors, have led to some confused accountabilities for
health workers. Health workers have moved from being accountable to both a public
service and to their profession, to being accountable to a commercial employer with
performance-related pay and conditions. This often causes tension between
professional standards and pressure from the commercial employer.

The process of health sector reform has had an impact on human resources for health
through new systems of financial and performance management, decentralisation and

47
the introduction of market mechanisms. This has led to changes in the demand for
health workers and in some cases the types of skills and expertise required from
health workers. At the same time, the capacity of the new management systems is
unable to create conditions in which a new health workforce can be developed. This
can be seen particularly clearly in the process of budget decentralisation, which leads
to a focus on local decision-making but where the capacity of local institutions to
recruit, train and manage local health service workers is limited. This has an influence
on the quality of health care delivered.

Implications for HRH demand

Demand for human resources in health systems that have experienced health
sector reform must be considered in terms of the numbers of health workers and
the skills and expertise needed currently and what will be anticipated in the
future. There is a growing awareness that human resource issues need to be
prioritised more effectively within reforms in order to secure an adequate health
care workforce to deliver services now and in the future.

Public sector culture

Although health sector reform has included elements of human resources strategies
such as improved education and training, restructured salary scales and a closer link
between performance and reward, it has also had a fundamental impact on
organisational culture and public sector ethos, which in turn influence demand for
human resources.

A study of four countries in Eastern and Southern Africa concluded that "human
resource development, personnel management and staff motivation are critical
issues". Tanzania, although it has invested in human resources development, found
that low salaries, delayed promotion opportunities and poor working conditions led to
dissatisfaction in the workforce. Staff performance has been found to be
unsatisfactory. Although monetary and non-monetary allowances were supposed to
compensate for low wages, they have led to poor teamwork and lack of continuity in
health service operations. The regional health team was found to spend 40% of its
time out of the region on training and meetings.

48
Burkina Faso introduced health sector reforms in 1991 but they have not been fully
implemented. It has recently introduced civil service reform, which "aims at a more
flexible management and better performances of personnel". In a country where
services are centralised, with an imbalance in personnel and low staff motivation and
poor standards of care, there is resistance to the new reform. There has been a decline
in standards of service between 1986 and 1997. Poor financial and human resources
policies and management are resulting in high cost and poor quality of care. A recent
study concluded: "Human resources should become the central focus for reform".

Matheson (2002) points out that "the least systemically orientated area of recent
public management reforms has been human resource management.... There is a
danger that the constitutional, legal, cultural and leadership factors, which together
create what is important and distinctive about public services, are not reflected on, or
are dismissed as the bureaucratic problem which must be 'reformed' ".

Demand for health workers

Some national health sector reforms reduced the numbers employed in the health
sector, as in Chile and Latvia. Others, as in Mexico and Zambia, led to a rise in
employment . In almost all countries, health worker employment was restructured.
Health sector reform has often aimed to restructure organisations to reduce costs and
the power of the workforce. Pressure of work and hours worked have in many cases
increased since health sector reform. There is also an increased workload due to lack
of staff, pressure for results and staff reductions. This affects the future demand for
health workers.

Health services have usually been seen as "essential services" and so health workers
had the legal status of public servants. They had to account to both employers and
professional bodies subject to strict regulation and registration rules. The effect of
privatisation has been to change the pay and terms of employment and the legal status
of health workers. The public health sector has changed from being a public service to
one with a greater commercial focus. This may have an effect on recruitment. The
Nicaraguan government has continued to cut the number of doctors, changing to an
hourly rate of reimbursement rather than salaries, and ending the commitment of
government to employ graduating medical students. This process is effectively
influencing the demand for doctors in the public sector.

49
The introduction of flexible contracts and fall in full-time permanent contracts has
been a characteristic of most reforms, leading to a reduction in long-term employment
security. Some of these changes in terms and conditions have led to health workers'
taking on second jobs. This may be caused by the increase in part-time employment
and low and erratically paid wages. In Eastern and Central Europe, women have been
most affected by the reduction in jobs in the heath sector. Their prospects for
redeployment are often limited due to a lack of mobility . The growth of part-time
work in the public sector is a sign of the changing demand for health workers.

Low pay levels have led to staff leaving the public sector and moving to the private
sector, NGOs and aid agencies. Low pay also contributes to low administrative
capacity, as well as poor organisational discipline. In an analysis of health worker
motivation, health sector reform was found to influence health worker motivation
through changing organisational structures and community-client roles.
Organisational factors influence worker motivation through management structures
and processes, communication processes, organisational support structures and
processes, and ways of providing feedback about organisational and individual
performance.

These changes in organisational culture have often had a negative impact on workers'
motivation. Important informal factors – for example, staff commitment – have
"become the prime means of direction, motivation, coordination and control". When
staff commitment deteriorates over time, health workers may migrate, not only from
the public sector to the private sector, but internationally. This results in a shortage of
skilled health workers within the public sector, precipitating a growing demand for
skilled health workers.

The aim of introducing market mechanisms to the public sector has been to improve
economic efficiency. New skills are needed to implement commissioning and
contracting of services. For example, contracts can be a powerful form of regulation if
drawn up and monitored effectively, but increased expertise is required to establish
this form of regulation.

Process of reform

50
Understanding the process of reform is important for understanding how changes
have taken place but also what the critical factors are for successful policy
implementation in future. "The process of reform offers numerous opportunities to
alter the political equations that impede change". This is also significant for
understanding the potential role that health workers can play within reforms.

In Latin America, health sector reform has been characterised by various forms of
privatisation, competition among providers, new insurance systems, management
autonomy for hospitals and increased community participation. The goals were
efficiency, accountability and improved quality of services. A recent study looked at
how groups, such as unions, play different roles in relation to reforms with some
opposing and others supporting reform. Some public sector health workers have
played an important role in supporting change . The importance of "principled agents"
in public sector organisations has also been noted. Public servants can be motivated
by managerial and incentive schemes to lead and support change. Linking popular and
unpopular reforms has often led to reformers' changing their attitudes to reform.
Networks of reformers can also play a role in supporting reformers in environments
hostile to change.

Communities also influence health worker motivation through their expectations of

services. As health sector reform also aims to empower service users, this focus will
have a significant impact on the individual health worker in future . The evidence
showing the extent to which users of health services have been empowered by health
sector reform is limited in developing countries.

However, health workers do play an important role in the implementation of health

sector reform policies. The lack of consideration of the value of human resources in
health sector reform programmes has meant that this has often been ignored. Gilson et
al. (2003) recommended that: "Technical analysts might consider working with
middle managers and health workers to ensure adequate consideration is given to
implementation realities in proposal development".

Knowledge gaps
The process of health sector reform is not complete. More research is needed to
monitor changes still taking place as well as the outcomes of the reforms. One of the

51
major changes is the role that health workers play in both the public and private
sectors. How health workers perceive their roles in the different sectors and what the
implications are for motivation, particularly in the public sector, will need further
exploration.

The role of the public sector is changing and this is reflected in public sector
institutions and the public sector ethos. How this changed public sector can
demonstrate a commitment to health workers as well as harnessing their own
commitment, still needs to be explored.

A further area of research needs to improve the understanding of human resources in

health sector appraisal studies "by incorporating functional, institutional and policy
dimensions. Only then will human resources become in practice the most valuable
resource within any national system".

Conclusion

There is a growing awareness that human resources for health (HRH) must be
addressed more effectively within public sector reform. Stein thinks that HRH
strategies need to be a "primary objective for public organisations".

Public sector reforms have sometimes been characterised as containing the paradox of
aiming to reward performance and empower staff whilst at the same time
implementing downsizing and redundancy – the "human costs of reform". Issues
resulting from these changes include loss of institutional memory and the use of
downsizing as a way of making financial savings rather than administrative reform.
Changing rules and processes do not always lead to changes in organisational culture.
"Multi-faced interventions sustained long enough to achieve change" will be needed
to change public sector culture.

To address some of these issues, action at strategic, regional and local levels will be
needed to strengthen skills, expertise and analysis of HRH and to strengthen the
integration of HRH issues into health policy making and with relevant agencies. New
human resources systems are needed at regional and local level.

52
Additional data on existing employment, retention and deployment issues must be
made available to decision makers so as to relate them to health equity issues. An
increased awareness of the importance of improved coordination of facility planning
and human resource planning at national and local level is needed. A better
understanding of the role of organisational culture and public sector ethos in health
worker motivation is needed. This might be achieved by developing case studies of
health workers as "drivers of change" and more process research to look at emerging
practice.

The working conditions of health workers need to be improved. This might be

achieved through developing more flexible employment arrangements that are
employee-focused. The public sector needs to be encouraged to establish a "living
wage" and other forms of worker security so that terms and conditions of public
sector workers are better than those of private sector workers. Health workers need to
have access to continuous professional development that includes skills for
performance management, management of contracts and other new ways of operating
in reformed systems.

The role of central government in setting standards for professional practice and legal
requirements for registration needs to be strengthened so that human resources
policies, registration and regulation are mutually supportive. Registration
requirements that include experience in rural or remote areas would help to address
uneven distribution of health workers.

DIFFERENT TYPES OF SERVICES ABAILABLE IN THE HOSPITALS

SERVICES PROVIDED TO THE PATIENTS IN THE HOSPITALS

Accuracy, precision and timely reporting

Lifeline hospital features the most sophisticated and advanced technologies for the
diagnostic purposes. In the safe hands of the internationally trained doctors, these
latest technologies yield excellent outcomes, which in turn help in the speedy
recovery of the patients. Diagnostic facilities that are offered are:

53
  CT SCAN , M.R.I & X-RAY
 Ultra sound. echo, dopler
 Mammography
 Colonoscopy
 24 hrs PH study
 Endoscopy
 Manometry
 E.R.C.P
 Echo-sonography
 Computerized image capture software
 Genetics & molecular biology lab

Laboratory Services

At Lifeline Multi-Speciality Hospital, computerized Lab services offer a wide range

of investigations for both inpatient and outpatients. Accuracy, precision and timely
reporting are the key factors of the lab service; that has brought in several accolades
from across the globe.

The laboratories function with the latest computerized equipment for the clinical
biochemistry, clinical microbiology and immunology section using Immune chemistry
with Glaxo ELISA reader routine basic screening tests for viral infection of liver like
HbsAg, HCV antibody and to Screen AIDS (HIV I & II) are done by experienced
doctors and senior technicians and same ELISA reader Hormone Assays are carried
routinely to rule out Hypo and Hyper function of Thyroid Gland and LH and FSH and
Cancer Tumour Markers like PSA, CEA & AFP.

There is a full fledged separate Microbiology section where routine Culture and
Sensitivity test for blood, pus, urine and body fluids and serology investigations like
VDRL, ASO, CRP, RF, and TPHA are carried out by qualified Microbiologists and
senior technicians. With flame emission method, body fluid and blood electrolytes are
investigated for routine and emergency cases. The lab services at Lifeline hospital is
authorised to take up all clinical pathology investigation including Haematology.

54
SPECIALITIES/SERVICES

BARIATRIC SURGERY

CARDIOLOGY

DERMATOLOGY

DIABETOLOGY

EMERGENCY SERVICES
ENT

GASTROENTEROLOGY

GERIATRICS

HEADACHE AND MIGRAINE

INFERTILITY

INTERNAL MEDICINE

NEPHROLOGY & DIALYSIS

NEUROLOGY

OBSTETRICS & GYNEC

ONCOLOGY

OPTHALMOLOGY

ORTHOPAEDICS

55
PAEDIATRICS

PSYCHIATRY

UROLOGY & STONE CLINIC

Services offered at this hospital are:

 Lab
 Radiology
 MRI Scan
 Physiotherapy
 Cardiac Tests

Casualty and Emergency services

24hours casualty services are available for various emergencies. Qualified medical
and nursing staff handle medical and surgical emergencies. All cases are examined by
the duty doctors and emergencies handled by the Cauality Medical officer. Specialist
consultant opinion and guidance are taken for all cases depending upon medical,
surgical, obstetric and paediatric emergencies. The casualty is attached to a dedicated
full equipped operation theatre and a cardio pulmonary resuscitation area.

General Surgery

A well equipped general surgical theatre to deal with all elective and emergency
surgeries. It is well supported by an excellent 5-bedded post operative intensive care
(3 ventilated beds).

 Paediatric Surgery
 Neuro surgery

56
  Laparoscopic surgery
 Orthopaedic surgery
 Plastic surgery

Obstetric & Gynecological services

An excellent ante-natal care is given to expecting mothers and they are trained to have
a peaceful motherhood. Ante-natal check-ups are done along with the lines of
international guidelines to ensure the safe health of the mother and the child. All high
– risk pregnancies are handled with the help of an outstanding team. Pre and post
menopausal problems are handled with ease for middle aged women in this
department. Laparoscopic hysterectomy, diagnostic laparoscopy hysteroscopy,
colposcopy etc are done here.

Department of Paediatrics

24 hr. paediatric services are available for outpatient, inpatient and all sorts of
paediatric emergencies – medical or surgical. The department also supports
immunization for the new borns and has a comprehensive well baby check-up
programmes.

Paediatric ICU:

The 5 bedded paediatric intensive care unit has the updated equipment with 4
ventilated beds including a Hayek negative pressure oscillator which is the first of its
kind in the state of Tamil Nadu. Children are monitored with greatest care and
medication advocated with highest degree of accuracy.

Neonatal ICU:

This unit consists of a 4 bedded neonatal intensive care unit with 4 dedicated neonatal
ventilators with facilities for invasive and non-invasive monitoring of all vital
parameters. The special care baby unit has 8 beds with facilities for oxygen therapy,
phototherapy and care of septic new born babies.

57
DIAGNOSTIC FACILITIES

Following the Lifeline Group’s ethics, the S & V Loga Lifeline hospitals, Karur gives
accurate results for all types of laboratory tests and other radiology diagnosis. The
laboratory services of this hospital is a regional reference laboratory and associated
with Biorad, USA.

The radiology services include:

 500m x-ray machine
 Mammography
 General ultrasound
 Colour Doppler
 Echo cardiography
 Computerised Electro cardiography

Pharmacy Services

A 24 hours well stocked pharmacy, manned by qualified pharmacists is available so

that patients have the immediate comfort of getting quality medicine within the reach
and without the necessity of going out for any life saving drug.

OBJECTIVES

58
The main objectives of Research are: -

 To find out the HRD awareness program in the hospitals.

 The objective finds the health care services in the hospitals.

 To find out the proper health care facilities to the patents in the hospitals.

 To find out the service provided by the hospital and how much the patient
satisfied with the services.

 And analyze about the different hospitals which provide the different services
to the patient.

 Main objective of the research report is to compare between the public and
private hospital services.

SCOPE OF THE STUDY

59
There are many scope of this study in the health care industry. Today, the health care
industry and the hospital sector increasing and developing.

SCOPE IN HEALTH CARE SECTOR :-

The main scope and objective of the research report on the health care industry.
Through this report there are May scope in the health care industry and the hospital
services –

1. The research report improves the hospital services and develops to these
sectors.

2. The main scope of the report to fast improvement of health care service in the
hospital.

3. It’s impact on the patient satisfaction and these services in the hospitals.

4. The Report mostly applied on the public sector health care sector. Which
improve the quality and productivity of the services in the hospital?

5. This project report identifies the HRD system and climate in the hospital.

6. The survey report consists of patient satisfaction by the HRD department in

the hospital, which improve the service level of hospital.

7. This report differentiates both public and private sector health care in different
hospitals.
8. This research report cover of all system related to the hospital like- patient
service provide by the HRD department, doctors and nurse cadre on patient,
patient timing, and proper incentive care and emergency care in the hospital.

9. After analyzing of the primary data we find them that the scope of the study
improve the health care system in Indian health care system.

60
USE AND IMPORTANCE OF THE STUDY

The main use and importance of the study: -

 The study improves the all health care industry and services in the hospital.

 Through this study we can find out the satisfaction level of the patient.

 This report identifies the patient services provided by the HRD climate in the
hospital.

 The main use and importance of the study to identify how patient avail the
services in the hospital.

 The study give compare of services of public and private hospitals.

 The main use and importance that what exactly HRD department proved a
proper facility and care of patient in the hospitals.

61
 RESEARCH METHODOLOGY

The research methodology of my project is descriptive

Research- The research design is characterized by flexibility in order to be sensitive

to the unexpected and to discover insights not previously recognized the purpose of
the research methodology is to discover the answer. And to answers the questions
through the application of scientific procedures. In this research project report we
research about the study of Human Resource Development climate in the Hospitals
and its impact on the patient satisfaction.
In which we use various research method and approach.

Data collection method :-

PRIMARY METHOD :-

Data collected through primary source in the research methodology. i.e. through the
questionnaire from patient in different public and private hospitals in Delhi and NCR.

Data collected through HRD management department in the different hospitals.

Which provide the services to the patient in the hospitals?

For this purpose I am placing to visit a minimum two hospital, one is government
sector and another is private sector.

Name of the Hospitals :-

1. ALL INDIA INSTITUTE OF MEDICAL SCIENCE, AIIMS, NEW DELHI

(GOVERNEMENT)
2. FORTIS HOSPITAL , NOIDA (PRIVATE)

SECONDAYRY METHOD

SOURCES,
i.e. from Journals of different hospitals. Hospital management books etc.

Health Care Magazines, Newspapers, and health care web site from internet, etc.

62
SAMPLING

 Population Definition - Health care Industry.

 Sampling Unit – Hospitals in delhi and Ncr

 Extent – AIIMS AND FORTIS HOSPITALS

 Sampling Time - 10:00 am to 6:00 pm

 Sampling Period - March .

POPULATON

 A population is aggregate of all the elements defined prior to selection of

sample.

SAMPLE SIZE

 Sample size was taken 10 percent of the total population.

 It refers to the number of items to be selected from the population to constitute
a sample. The size of sample should neither be excessively large nor too small.
It should be optimum.

SAMPLING METHOD

 Simple random sampling was chosen as a sampling method.

SAMPLE RANDOM SAMPLING

 Sample selected in such a way that every element of the population has known
and equal probability of inclusion in the sample.

63
 ANALYSIS OF DATA COLLECTION

1. PATIENT ROOM

64
2. TEST AND TREATMENTS

65
3. VISITS AND FAMILY

66
4. PHYSCIANS CONCERNS

67
5. DISCHARGE

68
6. SURGICAL NURSE

69
7. GENERAL NURSING STAFF

70
8. LABORATRY SERVICES

71
9. CLEANESS OF THE DOCTORS

72
10. PROPER PHARMACY AVAILABLE IN THE HOSPITAL

73
11. AVAIBILITY OF SURGICAL SUITS

74
12. RADIOLOGY FACILITIES

75
13. TECHNOLOGY AVAILABLE AT THIS HOSPITAL

76
14. OVER ALL SATISFIED WITH THIS HOSPITAL

77
15. WHAT IF ANY THING CAN WE DO TO IMPROVE THIS HOSPITAL

78
 FINDING

After analyze the data we find that –

 Patient are more satisfied with private hospitals facilities.

 In the private hospitals HRD climate are more concern about their patient
services.

 In private hospitals they have quick services and very fast process in every
step.

 In public sector hospitals AIIMS patients are satisfied with his test and
treatment.

 AIIMS hospital is not concern about every services mostly concern on test
and treatment.

 But we find over all patient satisfaction is high in private sector hospitals like
FORTIS.

79
 CONCLUSTION

 After analyze the all aspect of primary and secondary data we conclude that
patient are satisfied with private hospitals in the Delhi and NCR.

 Patient are more delited by private hospitals HRD climate.

 In private hospitals HRD climate are more aware about patients service and
quality.

 In the private hospitals over all technology is highly improved by HRD

climate in the hospital.

 The comparision of two hospitals AIIMS and FORTIS we conclude that fortis
hospital has provided every aspects of health care services.

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 SUGGESTIONS AND RECOMEDATIONS

After analyzing the primary and secondary data to require some suggestion and
recommendations to improve the quality of health care and hospitals services –

There are some recommendations and suggestions –

 Mostly after analyze the data collection to give the suggestion of public sector
hospitals that HRD department should improve the services quality.

 HRD department should concerns about patient basic need in the hospital.

 Private sector hospital gives the proper facility to poor person in doctors fees.

 Hospitals should improve their HRD climate and department of all services.

 Hospitals should proper care on patient services they have to satisfied their
basic need.

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 LIMITATION

There are some limitation at the time of survey and questionnaire –

 Respondent filled the questionnaire in hurry, which may ease a little

fluctuation in real data.

 The record a data was not available when the respondent filling the
questionnaire.

 HRD department was not concern about all information about the services.

 Some patient was confused and not decided. The time is less and questionare
is to long so we face the problem when asking the quesitonare.

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 ANEXTURE
1. How satisfied are you with the surgical nurse ?

2. Laboratory Services?

3. Patient Rooms?

4. Cleanliness of the Doctors Prepration rooms?

5. Avaibility of Surgical Suits?

6. Cleanliness of the Surgical Suits?

7. Radiology facilities ?

8. Overall how satisfied are you with the Technology?

9. Overall how Satisfied are you with the Services Provided aat this
hospital?

10. What if anything Can We do to improve hospital Services or facilities?

11. Admission:-

 Speed of admission process

 Courtesy of the person who admitted you.

12. Diet and Meals :-

 Quality of the food

 Temperature of the food (cold foods cold hot foods hot)

13. Nurse :-

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  Amount of attention period to your special or personalneeds.

 Promptness in responding to the call button.

14.Visitors and Family

 Helpfulness of the people at the information desk.

 Staff attitude towards your visitors.

15.Discharge:-

 Expert to which felt ready to be discharged.

 Instructions given about how to care for yourself at home.

16.Physician :-

 Physicians concern for your questions and worries.

 How well physician kept you informed.

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WEB SITE OF DIFFERENT HEALTH CARE

 www.surveyconsole.com
 www.pubmedcentral.nih.gov/
 www.who.int/

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