Social Responsibility Journal

Social responsibility of hospitals: an Indian context

R. Rohini, B. Mahadevappa,
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R. Rohini, B. Mahadevappa, (2010) "Social responsibility of hospitals: an Indian context", Social Responsibility Journal, Vol. 6 Issue: 2,
pp.268-285, https://doi.org/10.1108/17471111011051766
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 Social responsibility of hospitals: an Indian
context
R. Rohini and B. Mahadevappa
R. Rohini is Associate
Professor for MBA
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(Healthcare Management)
at the Institute of Clinical
Research, Karnataka, India.
B. Mahadevappa is a
Reader in the Department
of Studies in Commerce,
University of Mysore,
Mysore, India.
PAGE 268 j SOCIAL RESPONSIBILITY JOURNAL
Abstract
Purpose – The purpose of this paper is to explore the perceived responsibilities of five not-for-profit
hospitals in Bangalore, India, towards society.
Design/methodology/approach – The method used is qualitative design with some quantitative
elements. Data were collected through a survey of 79 physicians and 104 managers and other
stakeholders of the hospitals.
Findings – The analysis reveals the existence of highly significant differences in the perception about
workplace responsibilities between the doctors and other stakeholders. It also highlights the importance
of top management involvement with various stakeholders in effectively carrying out the overall social
responsibilities of the hospitals. It was found that the hospitals must take into account the social, cultural
and financial characteristics of the patients while fulfilling societal obligations. Training needs,
environmental impact audit and encouragement for employees to join local voluntary organizations are
the immediate needs for improving the CSR activities of the hospitals.
Research limitations/implications – The study had a small sample and referred only to the
perceptions of physicians/management personnel. Further studies should be done with larger samples,
comparing different cohorts of stakeholders and, more importantly, patients/their carers.
Practical implications – The study draws attention to issues that emerge from the social
responsibilities of healthcare organizations. Its findings provide new insights into the meaning of
social responsibility in the healthcare sector in an Indian context from a stakeholder perspective.
Originality/value – The paper is based on an original study that addresses the current gap in the
understanding of issues related to social responsibility by the various stakeholders of hospitals. It is
particularly valuable for both the internal and external stakeholders of the healthcare organizations.
Keywords Hospitals, Stakeholders, Corporate image, Social responsibility, Responsibilities
Paper type Research paper
1. Introduction
The advent of globalization has brought a growing range of social obligations for the
business organizations. Throughout the world, corporate social responsibility stems from a
commitment to the society in which a business operates. CSR has enormous potential for
strengthening society.
According to the ‘‘shareholder model’’ or ‘‘profit-centered model’’ of corporate governance,
businesses are ultimately if not uniquely accountable to their owners (Berle and Means,
1968). The proponents of a ‘‘stakeholder model’’ or ‘‘social responsibility model’’, however,
explain that businesses are accountable to everyone (whether individuals or groups of
individuals or society as a whole) who has a stake in their activity (Halal, 2000). In the era of
privatization, liberalization and globalization, it is imperative to examine the various
expectations of stakeholders, as they play a critical role at economic, social, cultural and
political levels (Stevens, 1991).
j VOL. 6 NO. 2 2010, pp. 268-285, Q Emerald Group Publishing Limited, ISSN 1747-1117 DOI 10.1108/17471111011051766
 A wide range of influences, decisions and policies affect hospitals. When examining the
hospital – stakeholder relationships since the 1950s, one can conclude that ‘‘the number
and diversity of stakeholder groups and their power vis-à-vis the health care organizations
have increased, but the level of their support has decreased’’ (Fottler et al., 1989). This
suggests that stakeholder management is becoming of even more critical importance for
hospital managers, and that they need to assess stakeholders’ power and to identify the
sources of that power and the core underlying values. Hence, the development of various
proactive tool kits or models aimed at helping managers map the key stakeholders, link them
to critical issues, and clearly delineate managerial responsibilities for stakeholder
management (Fottler et al., 1989). Also there is the emphasis of the skills a good manager
ought to master if he or she wants to lead a successful negotiation with potentially
threatening stakeholders (Blair et al., 1989).
This paper presents the results of a study designed to measure the hospitals’ various
stakeholders’ knowledge and awareness about social responsibility issues as measured in
terms of workplace responsibilities, environmental responsibilities and socio-economic
responsibilities.
The present study covers a sample of five not-for-profit hospitals (two charity hospitals, two
trust hospitals and one NGO run hospital) based in Bangalore city, Karnataka, India. At the
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time of data collection (2007), three of the sample hospitals have already been involved in an
accreditation process (National Accreditation Board for Hospitals (NABH) and Healthcare
Organisations) for a few months, which is a compulsory assessment on quality and safety of
a medical establishment, and a new basis for a social dialogue needed to be implemented.
In the present study, the term ‘‘stakeholder’’ refers to various employees of the hospitals at
different levels and outsiders or customers as stakeholders are not being investigated.

2. Objectives of the study

The objectives of the present study are to examine how:
B the social responsibility concept is understood by the various stakeholders, that is
employees in different levels of the hospitals;
B the hospitals are fulfilling their social obligations in terms of workplace responsibilities;
B the hospitals are fulfilling their social obligations in terms of environmental responsibilities;
and
B the hospitals are fulfilling their social obligations in terms of socio economic
responsibilities of that power and the core underlying values.

2.1 Hypotheses
H1. There exist significant differences in the knowledge and awareness about CSR
between the doctors and other staff of the hospitals.
H2. There exist significant differences in the perception about workplace
responsibilities between the doctors and other staff of the hospitals.
H3. There exist significant differences in the perception about environmental
responsibilities between the doctors and other staff of the hospitals.
H4. There exist significant differences in the perception about socio-economic
responsibilities between the doctors and other staff of the hospitals.
H5. There exists positive correlation among the independent variables (as measured
by workplace responsibilities, environmental responsibilities and socio economic
responsibilities) and dependent variables (as measured by healthcare education
and prevention of risks; information on the hospital/facilities; to develop partnership
between the hospital and community; and enhancing hospital network).

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 269
 2.2 Literature review
One area of business performance of particular interest to both scholars and practitioners is
corporate social responsibility. The notion that organizations should be attentive to the needs
of constituents other than shareholders has been investigated and vigorously debated for
over two decades. This has provoked an especially rich and diverse literature investigating
the relationship between business and society.
Various studies on the health care sector since the 1990s have clearly been designed adopting
a stakeholder theory perspective (Fottler et al., 1989; Kumar and Subramanian, 1998; Fottler
and Blair, 2002). They all acknowledge that health care organizations evolve in a ‘‘hyper
turbulent’’ environment characterized by fast paced change, the result of which has been to
turn health care into an economic good like any other sector. This means that managers are
confronted with increasing demands from active stakeholders (Fottler et al., 1989; Stevens,
1991; Kumar and Subramanian, 1998; Rotarius and Liberman, 2000). Today, health care
organizations are required to ‘‘provide high clinical quality, high levels of functional quality (i.e.
patient satisfaction), and cost effective patient care’’ with the scarce resources they are
allocated (Fottler and Blair, 2002). Therefore, with a view to reducing uncertainty, (a direct
consequence of the fast changing health care environment), organizations tend to seek new
partnerships with stakeholders and managers feel the need to develop adequate techniques
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to collaborate with those individuals, groups or organizations who have a vested interest in the
organizational decisions and actions (Rotarius and Liberman, 2000).
Stakeholder model is considered by some as particularly relevant for the not-for-profit and
public sectors (Vinten, 2000). These studies have mostly examined the process of
stakeholder management at a practical level, highlighting the need to assess the increasingly
powerful expectations of stakeholders. Stakeholders can have a significant influence on the
global effectiveness of the organization (Fottler, 1987, quoted in Fottler et al., 1989). In their
1989 study, Fottler et al. (1989) identify three broad categories of stakeholders. Internal
stakeholders are ‘‘those who operate entirely within the bounds of the organization and
typically include management, professional, and non-professional staff’’ interface
stakeholders are ‘‘those who function both internally and externally to the organization’’ and
include amongst others the medical staff, the stockholders, taxpayers or other contributors;
finally, external stakeholders are split into three sub categories, which are those who provide
inputs into the organization (e.g. suppliers, patients or funds providers), those who compete
with it (e.g. other hospitals or related health organizations), and those who have ‘‘a special
interest in how the organization functions’’ (e.g. government regulatory agencies,
professional associations, labor unions, the media or the local community). Each
stakeholder group described has a characteristic relationship with the organization.
Indeed, ‘‘whereas the internal and interface stakeholders are at least partly supportive of the
hospital, many of the external stakeholders are neutral, non-supportive, or hostile’’, especially
those who have a special interest in the organization’s management (Fottler et al., 1989).
Weiner and Alexander (1993) assess the theoretical integrity and practical utility of the
corporate-philanthropic governance typology frequently invoked in debates about the
appropriate form of governance for non-profit hospitals operating in increasingly
competitive health care environments. Their findings suggest that the
corporate-philanthropic governance distinction must be seen as an ideal rather than an
actual depiction of hospital governance forms. Implications for health care governance are
discussed. Morlock and Alexander (1986) utilizes data from a national survey of 159
multi-hospital systems in order to describe the types of governance structures currently
being utilized, and to compare the policy making process for various types of decisions in
systems with different approaches to governance. Survey results indicate that multi-hospital
systems most often use one of three governance models.
Results from a study by Alexander and Lee (2006) indicate that hospitals governed by
boards using a corporate governance model, versus hospitals governed by
philanthropic-style boards, were likely to be more efficient and have more admissions and
a larger share of the local market. Occupancy and cash flow were generally unrelated to

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PAGE 270 SOCIAL RESPONSIBILITY JOURNAL VOL. 6 NO. 2 2010
 hospitals’ governing board configuration. However, effects of governance configuration
were more pronounced in freestanding and public NFP hospitals compared with
system-affiliated and private NFP hospitals, respectively. The results of a survey by
Ibrahim et al. (2000) of 184 directors from 15 hospitals are analyzed to determine their
corporate social responsiveness orientation. They indicate that a board member whose
occupational background is not in health care exhibit greater concern for economic
performance and the legal component of corporate responsibility than their counterparts
whose occupational background is in health care. No significant differences between the
two groups were observed with respect to the ethical and discretionary dimensions of
corporate social responsibility.
A paper by Merali (2005) explores the extent to which the managers in the role as change
agents believe that they hold core values that are in line with the altruistic service ethos of the
NHS and as a result the extent to which they believe they are seen to be performing and
behaving in a socially responsible manner. Furthermore this study also provides an insight
into understanding the managers’ perceptions of their public image and assesses the extent
to which this has an impact on the managers’ psyche, performance and commitment to the
NHS ethos.
A research by Abreu et al. (2005) shows implications at the operational level, the efficiency
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and the effectiveness of the health care strategy with differences between hospitals. This
research confirms that as a global strategy for the health care system, corporate social
responsibility is urgently needed. As a finite resource, the health should demand a
permanent attention from society, as well as the Government in accomplishment prevention
and monitoring systems, with a view to the defense of a sustainable health care system. A
research study by Kakabadse and Rozuel (2006) to examine how corporate social
responsibility (CSR) is contextually understood, in comparison with the definitions proposed
in the academic literature. The study findings provide the basis for the development of a
model of CSR for the hospital. The findings highlight the importance of senior managers’
involvement in stakeholder dialogue, as well as the effect of external influences, on the
overall social performance of the hospital.
The various stakeholders in a hospital setup are both internal as well as external
stakeholders such as consumers, suppliers, creditors, competitors, and community. The
present study does not cover the perceptions of patients/care takers and other external
stakeholders on social responsibility. The study focuses exclusively on the knowledge,
awareness and perceptions of hospitals’ employees at various hierarchical levels on the role
of social responsibility of hospitals.

3. Methodology
The study is empirical in nature, based on the primary data gathered through actual field
survey.

3.1 Sample
The present study was designed with the co-operation of five Bangalore based not-for-profit
hospitals (two charity hospitals, two trust hospitals and one NGO run hospital). The
management teams were up-to-date with the current literature and emphasized the
pragmatic aspects of the research. Their active involvement helped in the assessment of
reliability and ensured that the research instrument would be of practical significance. The
sample hospitals consisted of: (A) a multi specialty, ISO-9000 certified, charity hospital; (B) a
multi-specialty, trust hospital; (C) a medical college attached, ISO-9000 non-certified
hospital; (D) a NGO run hospital; (E) a multi specialty, ISO-9000 non-certified, private
hospital. In these five hospitals, a sample of 79 doctors and 104 other stakeholders were
randomly selected to understand the extent of knowledge and awareness about social
responsibility as measured in terms of workplace, environmental and socio-economic
responsibilities. The details of hospitals and the demographics of respondents are
presented in Tables I and II respectively.

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 271
 The sample of doctors consists of physicians and surgeons. The top-level management
comprises of hospital CEOs, directors, administrators, departmental heads, and nursing
superintendents. In the mid level management there are matrons, managers from accounts,
finance, public relations officer, and senior nurses. The bottom level consists of junior
nurses, clerical cadre personnel, technical persons, and other hospital aides.

3.2 The research instrument

A structured questionnaire (Appendix) was designed and distributed among different
stakeholders of the respective hospitals. Respondents were asked to mark their knowledge
and awareness about the social responsibility of hospitals on a continuous five-point Likert
scale as strongly agree, agree, unsure, disagree, and strongly disagree (part A – nine
questions). In part B, the questions were focused on the issue of social responsibility as a
measure of workplace responsibilities (13 questions), environmental responsibilities (ten
questions), and socio-economic responsibilities (eight questions). Finally the impact of CSR
on the hospitals was also addressed (four questions).

3.3 Data collection and analysis

The primary data on 183 various stakeholders were collected in five hospitals using the
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research instrument. Out of the 150 distributed questionnaires among doctors, 79

responses were received (52.6 percent). The response rate for other stakeholders sample
was 70 percent.

Table I Hospital details

Establishment
Hospitals Type (year) Bed size No. of employees No. of medical staff Location

A Charity 1973 165 450 60 Urban

B Trust 2001 350 650 158 Urban
C Trust 1970 750 998 265 Urban
D NGO 1938 75 150 50 Urban
E Charity 1985 600 924 340 Urban

Table II Demographics of respondents by gender, experience and designation

n %

Gender
Male 78 42.6
Female 105 57.4
S 183 100

Experience (y)
,5 62 33.9
6-10 46 25.1
11-15 26 14.2
16-20 13 7.1
21-30 28 15.3
.30 8 6.4
S 183 100

Designation
Doctor 79 43.2
Top level mgmt 35 19.1
Mid-level 24 13.1
Bottom level 45 24.6
S 183 100

Note: n ¼ 183

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 Informal interviews were conducted to obtain additional data from the respondents to
supplement the questionnaire data.
Reliability was tested using the Cronbach alpha coefficient. Averages and standard
deviations were used to measure the scores. Simple one-way ANOVA was used to test
whether any significant difference exists in the perceptions of doctors and other
stakeholders’ perceptions about CSR (H1, H2, H3, and H4). Correlation was done to test
the relationship between the dependant and independent variables (H5). Statistical
software, SPSS (v 11.0) was used to tabulate and analyze the data.

3.4 Reliability and validity

The internal consistency method (Nunnally, 1978) was chosen to assess the reliability of the
research instrument used in this study. The internal consistency of a set of measurement
items refers to the degree to which items in the set are homogeneous. Internal consistency
can be estimated using a reliability coefficient such as Cronbach’s alpha (Cronbach, 1951).
Cronbach’s alpha is computed for a scale based on a given set of items. Using the reliability
program (Hull and Nie, 1981) an internal consistency analysis was performed separately for
the items of each of the three dimensions of the research instrument. Table III presents the
reliability co-efficient associated with the three dimensions of the questionnaire. The
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reliability co-efficient ranged from 0.93 to 0.95 for the dimension scores. Typically, reliability
coefficient of 0.7 or more are considered adequate (Cronbach, 1951; Nunnally, 1978).
Accordingly the scale used here was judged to be reliable.

4. Item to scale correlations

The item to scale correlations is presented in Table IV.
Nunnally (1978) developed a method to evaluate the assignment of items to scales. The
method considers the correlation of each item with each scale. Specifically, the item-score to
scale-score correlations are used to determine if an item belongs to the scale as assigned,
belongs to some other scale, or if it should be eliminated. If an item does not correlate highly
with any of the scales, it is eliminated.
Table IV shows the correlation matrix for four scales (labeled as scale . . .). For example item
A1 has correlations of 0.481, 0.129, 0.332, and 0.175 with the four scales. Since scale 1 is the
average of A1 to A7, high correlation between scale 1 and A1 is expected. In addition, since
item A1 showed relatively smaller correlations with other scales, it was concluded that it has
been assigned appropriately to scale 1. All other items were similarly examined.
As seen in Table IV, all items having high correlations with the scales to which they were
originally assigned relative to all other scales. Accordingly, it was concluded that all items
had been appropriately assigned to scales. Since the detailed item analysis results were
satisfactory, the items reported in Table IV are the final scales of items.

5. Findings and discussion

5.1 Knowledge and awareness about corporate social responsibility
Table V presents the means and standard deviations of the respondents’ knowledge and
awareness about CSR. According to the respondents social responsibility means, hospitals
must take into account the social and financial characteristics of patients (QA1, Mean score

Table III Results of reliability analysis of respondents’ perception about CSR

Dimensions No. of items Cronbach alpha

Workplace responsibilities 13 0.94

Environmental responsibilities 10 0.95
Socio-economic responsibilities 9 0.93

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 273
 Table IV Item to scale correlation
Items Scale A Scale B1.4 Scale B2.5 Scale B3.4

Factor scale A: knowledge and awareness about A1

corporate social responsibility 0.481 0.129 0.332 0.175
A2 0.638 0.243 0.268 0.209
A3 0.518 0.031 20.028 20.123
A4 0.635 0.341 0.176 0.171
A5 0.420 20.064 0.006 20.199
A6 0.570 0.025 20.006 20.036
A7 0.619 0.290 0.126 0.154
A9 0.604 0.113 0.198 0.041
Scale B1.4: workplace responsibilities A 0.263 0.828 0.770 0.538
B 0.261 0.823 0.609 0.650
C 0.240 0.683 0.610 0.525
D 0.234 0.765 0.594 0.461
E 0.252 0.740 0.432 0.523
F 0.282 0.879 0.661 0.605
G 0.255 0.808 0.720 0.674
H 0.230 0.776 0.640 0.589
J 0.226 0.843 0.812 0.725
K 0.169 0.843 0.531 0.584
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L 0.106 0.756 0.677 0.755

M 0.075 0.788 0.563 0.552
N 0.124 0.609 0.466 0.364
Factor scale B2.5: environmental responsibilities A 0.163 0.586 0.864 0.602
B 0.107 0.580 0.782 0.896
C 0.188 0.763 0.896 0.556
D 0.265 0.642 0.841 0.567
E 0.192 0.667 0.831 0.610
F 0.278 0.549 0.790 0.480
G 0.257 0.716 0.862 0.581
H 0.175 0.750 0.809 0.642
I 0.129 0.675 0.806 0.644
J 0.168 0.615 0.796 0.521
Scale B3.4: socio-economic responsibilities A 20.048 0.449 0.491 0.659
B 20.090 0.475 0.480 0.789
C 0.078 0.571 0.523 0.831
D 0.125 0.718 0.641 0.885
E 0.200 0.534 0.466 0.708
F 0.054 0.664 0.633 0.881
G 0.172 0.694 0.634 0.786
H 0.002 0.596 0.581 0.846
I 0.154 0.699 0.599 0.788

Table V Knowledge and awareness about corporate social responsibility

Questions Mean SD

A1. The hospital must take into account all the characteristics of the
patients (e.g. social, financial etc.) 4.52 0.80
A2. The hospital has economic responsibility as a measure of SR 4.09 0.79
A3. The hospital has legal responsibility as a measure of SR 3.70 0.98
A4. The hospital has discretionary responsibility as a measure of SR 3.67 1.02
A5. The hospital has ethical responsibility as a measure of SR 4.19 0.73
A6. The hospital reports on social services 3.87 0.84
A7. The hospital has undertaken reviews on the SR activities that have
impacted on their reputation 3.85 0.87
A9. For extended care to be effective there must be a relevant and
meaningful dialogue defining medical care and community care 4.38 0.59

Note: n ¼ 183

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 4.52). Care that is in direct relation to the medical dimension is ‘‘medical care’’ and the care
that includes the role the hospitals’ play in the local community is the ‘‘community care’’. The
notion of ‘‘care’’ appeared to be at the core of the hospitals’ mission for every respondent.
During the personal interviews, mainly executives and paramedical staff referred to these
different aspects of care. Technical and social workers in the hospitals expressed a wish to
develop partnership between the hospital and the community. They also expressed the view
that there must be relevant dialogue defining medical and community care (QA9, Mean
score 4.38). The dialogue should aim to adequately meet both the needs of the community
and local healthcare providers. Extended care is thus the outcome of a dialogue
encompassing the perceptions of all the stakeholders of medical care and community care
the hospitals should provide. Discretionary responsibility, however, was not viewed seriously
as a measure of CSR (QA4 mean score 3.67).
According to the respondents social responsibility is voluntary (85 percent), however only 15
percent felt social responsibility as organizational obligation (QA8).
Some of the questions that were asked in the interviews with the hospitals’ CEOs and senior
managers are:
1. ‘‘How important are internal customers to your hospital?’’ – ‘‘Internal customers are an
integral part of the service delivery system that ultimately affects the external customer.’’
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2. ‘‘How your workplace obligations for employees as stakeholders in the hospitals are
affecting their performance?’’ – ‘‘The better you serve internal customers the better
service you get from internal customers.’’
3. ‘‘According to you, who are the hospital’s main ‘Stakeholders’, that is, people to whom it
should be accountable?’’ – ‘‘First patients, and then employees’’.
4. ‘‘Do you have time/resources constraints in implementing CSR?’’ – ‘‘Not at all’’.

5.2 Workplace responsibilities

The stakeholders’ perceptions on their hospitals’ social responsibilities as measured in terms
of workplace responsibilities are presented in Tables VI and VII. The respondents (84
percent) agreed that the hospitals are having arrangements for employee protection such as
health insurance coverage, family pension schemes, and retirement benefits. There was
also consensus regarding the presence of workgroup such as palliative care, pastoral care
and strong community health initiative groups in these hospitals. All the stakeholders
strongly felt that their respective hospitals seek to inspire, support and promote a culture that
is people centric and committed to their employees and community (QB a, Mean 3.79). The
quality of leadership is critical was expressed by all the groups. Even though there is wide
range of training and employee development activities, the stake holders especially from the
lower level category expressed that training on social responsibility is not adequate. The top
and middle management personnel agreed that training on SR activities has been provided

Table VI Perception on workplace responsibilities

Questions Yes (%) No (%) Do not know (%)

B1.1. The hospital has a process to ensure that

adequate steps are taken against all forms of
discrimination both in the workplace and at the
time of recruitment 69 17 14
B 1.2. The hospital has suitable arrangements for
health safety and welfare that provide sufficient
protection for its employees 84 12 4
B1.3. The hospital has a work group which is
formed to improve our hospital’s impact on
society (e.g. social, community health initiatives,
palliative care, pastoral care etc.) 83 10 7

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 275
 Table VII B1.4 – workplace responsibilities
Sl. no. Issues Mean SD

1 (a) Seeks to inspire, support and promote a culture that is

people-centered, committed to quality, accountable and
corporate in culture 3.79 0.96
2 (b) Offers a number of work/life balance schemes (e.g. job
share, family-friendly, flexible working pattern etc.) 3.26 1.03
3 (c) Counseling service provided for staff members 3.25 1.19
4 (d) Wide range of training and management development
opportunities 3.61 1.11
5 (e) A variety of formal and informal mechanisms to
recognize and reward employees (company bonus
schemes, long service awards, pension schemes, winners
etc.) 3.24 1.24
6 (f) Creates an employee morale process improvement team 3.36 1.05
7 (g) Encourages employees to develop real skills and
long-term careers (e.g. via a performance appraisal
process, a training plan) 3.33 1.17
8 (h) Reads employees well without discrimination 3.44 1.05
9 (j) Actively offers a good work/life balance for its employees 3.51 1.02
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10 (k) Hospital consults with employees on important issues 3.30 1.16

11 (l) The management has received training on social
responsibility issues 3.15 1.19
12 (m) The training has been provided in-house 3.08 1.33
13 (n) Training has been provided by an outside specialist
organization 2.87 1.25

internally, intervention by an external specialist organization is very much essential in order

to have serious impact (QB n, mean 2.87).

5.3 Environmental responsibilities

The frequencies and average scores of the responses by the stakeholders hospitals on the
environmental responsibilities are presented in Tables VIII and IX respectively. Even though
78 percent of the respondents know about the existence of environmental policy in their
respective hospitals, only 54 percent (top and some of the middle management) know that
the environmental management system is ISO 14000 compliant. This is because of the lack
of awareness among some of the doctors and the lower level workers about accreditation
processes that is happening in the hospitals. However, most of the respondents strongly
agree on the existence of a waste management department and the implementation of
segregation and recycling schemes in their hospitals (91 percent). All most all the
stakeholders agreed that the hospitals are intensely involved in waste reduction, monitoring
of discharges and emissions, recycle and reuse materials appropriately. But environmental
audit which is very crucial has not been carried out in the NGO run hospital and non-certified

Table VIII Perception on environmental responsibilities

Questions Yes (%) No (%) Do not know (%)

B2.1. There exists an environmental policy in the

hospital 78 7 15
B2.2. The hospital has a waste management
team to address environmental issues 90 5 5
B2.3. The hospital has implemented an
environmental management system compliant
with ISO 14000 54 15 31
B. 2.4. The hospital has implemented
segregation and recycling schemes 91 4 5

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 Table IX B2.5 – environmental responsibilities
Issues Mean SD

(a) Promotion of environmental education 3.66 1.02

(b) Development and promotion of environmentally sound practices 3.62 1.01
(c) Energy conservation 3.44 1.04
(d) Waste reduction 3.72 0.98
(e) Monitoring of discharges and emissions 3.74 0.97
(f) Aims to recycle and reuse materials where appropriate 3.73 1.04
(g) Reduces consumption of non-renewable resources 3.50 1.03
(h) Environmental impact audit carried out 3.43 1.14
(i) The hospital supplies clear and accurate environmental information
on its product services and activities to customers, suppliers, local
community etc. 3.53 1.11
(j) The hospital considers potential environmental impacts when
developing new products and services (e.g. assessing energy usage
recycling or pollution generation) 3.50 0.94

hospitals (Q B2 h, mean 3.43). Many respondents expressed the view that sound
environmental education and awareness programs need to be carried out in hospitals.
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5.4 Socio-economic responsibilities

The frequencies and average scores of the responses by the stakeholders of hospitals on
the environmental responsibilities are presented in Tables X and XI respectively. The sample
hospitals as such not-for-profit organizations, are making prices easier for people who
cannot afford (B3e, mean value 3.9). It was found that the hospitals are having a ‘‘sliding
pricing’’ system wherein economically affordable patients are charged at a moderately

Table X B3. Perception on socio-economic responsibilities

Questions Yes (%) No (%) Do not know (%)

B3.1. The hospital has an excellent record in

involving the community, developing links and
establishing strong partnerships 75 13 12
B3.2. The hospital has a volunteer support policy 67 17 16
B3.3. The hospital has an open dialogue with the
local community on adverse, controversial or
sensitive issues that involve the hospital (e.g.
accumulation of waste outside the premises,
vehicles obstructing roads or footpaths) 61 21 18

Table XI B3.4 Socio-economic responsibilities

Issues Mean SD

(a) Donations to various charities through events 3.60 1.14

(b) Staff are encouraged to become members of various local
voluntary organizations 3.08 1.24
(c) In an extraordinary situation the hospital gives information to
society immediately 3.43 1.19
(d) Offers training opportunities to people from the local community 3.18 1.21
(e) Makes prices easier for people who cannot afford 3.90 1.09
(f) Gives regular financial support to local community activities
projects (e.g. charitable donations or sponsorship) 3.40 1.23
(g) Hospital registers and resolves complaints from both internal and
external customers 3.73 0.98
(h) Contributes positively to the social and cultural life of our city 3.50 1.22

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 277
 higher price and poor/needy patients are treated at a concessional rate or free of cost. The
respondents also agreed that in extraordinary situations such as epidemic spread,
crisis/disastrous situations, the hospitals have alert systems to properly inform the
community immediately. However, the internal stakeholders felt that the top management
should encourage them to join local voluntary groups to carry out the community activities by
providing them leave facilities, flexible time allotments for work and arranging for
conferences/seminars on the importance of social responsibilities of hospitals towards
community.
In the present study one way analysis of variance has been used to test the following
hypotheses:
H1. There exist significant differences in the knowledge and awareness about CSR
between the doctors and other staff of the hospitals.
H2. There exist significant differences in the perception about workplace
responsibilities between the doctors and other staff of the hospitals.
H3. There exist significant differences in the perception about environmental
responsibilities between the doctors and other staff of the hospitals.
H4. There exist significant differences in the perception about socio-economic
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responsibilities between the doctors and other staff of the hospitals.

According to the results of ANOVA in Table XII, there exist highly significant differences in the
perception about Workplace responsibilities between the doctors and other staff of the
hospitals. Significant differences are there in the perception about socio-economic
responsibilities between the doctors and other staff of the hospitals. However there are no
statistically significant differences in the knowledge and awareness about CSR and in the
perception about Environmental responsibilities between the doctors and other staff of the
hospitals. This could be due to the fact that in the surveyed hospitals, there is lack of
knowledge about social responsibility among the wardboys, ayahs and some of the office
staff. Environmental safety education/training is not provided, audits on environmental
activities of the hospitals are not carried out in the non-certified hospitals. Doctors being both
the technical as well as functional service providers of the hospitals are aware of the
environmental responsibilities as a measure of social responsibility. The helpers and other
aides of hospitals are aware of the day-to-day activities such as waste disposal, recycling of
wastes, existence of hospital waste management team etc. but beyond this, they are
unaware of how to cooperate with the hospital system to carry out their responsibility towards
environmental protection.
Table XIII presents the means and standard deviations of dependent variables. The
correlation between independent variables (as measured by workplace responsibilities,
environmental responsibilities and socio economic responsibilities) and dependent

Table XII ANOVA results

Sum of squares df Mean square F Sig.

Knowledge and awareness Between groups 0.434 1 0.434 2.692 0.103*

Within groups 29.186 181 0.161
Total 29.620 182
Workplace responsibilities Between groups 10.713 1 10.713 14.858 0.000***
Within groups 130.507 181 0.721
Total 141.221 182
Environmental responsibilities Between groups 0.071 1 0.071 0.097 0.756*
Within groups 132.120 181 0.730
Total 132.190 182
Socio-economic responsibilities Between groups 5.996 1 5.996 7.776 0.006**
Within groups 139.568 181 0.771
Total 145.564 182

Notes: *Insignificant; **Significant; ***Highly significant

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PAGE 278 SOCIAL RESPONSIBILITY JOURNAL VOL. 6 NO. 2 2010
 Table XIII Means and SDs of impact of CSR
Impact of CSR Mean SD

(a) Healthcare education and prevention of risks 3.96 1.02

(b) Information on the hospital/facilities 3.93 0.89
(c) To develop partnership between the hospital and community 3.93 1.01
(d) Enhancing hospital network 3.89 0.96

variables (as measured by healthcare education and prevention of risks; information on the
hospital/ facilities; to develop partnership between the hospital and community; and
enhancing hospital network) is given in Table XIV.
The correlation results conform to the hypothesis H5: there exists positive correlation among
the independent variables (as measured by workplace responsibilities, environmental
responsibilities and socio economic responsibilities) and dependent variables (as
measured by healthcare education and prevention of risks; information on the hospital/
facilities; to develop partnership between the hospital and community; and enhancing
hospital network). The higher the socio-economic responsibilities are carried out by the
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hospitals as a measure of CSR, the greater is the information on the hospitals and their
facilities and partnership between hospitals and community will develop appropriately.
Hospital networks would be enhanced if work place and environmental responsibilities are
adequately and properly carried out.

6. Conclusion
The present study serves as a basis for healthcare managers to understand the key
elements of social responsibility and assess the social performance of their hospitals. The
following key findings emerge from the present study:
1. The hospital must take into account all the characteristics of the patients (e.g. social,
financial etc.)
2. The hospitals seek to inspire, support and promote a culture that is people centered,
committed to quality, accountable and corporate in culture.
3. Monitoring of discharges and emissions- top priority.
4. The hospitals fix prices easier for people who cannot afford – top priority.
5. There exist highly significant differences in the perception about workplace
responsibilities between the doctors and other staff of the hospitals.
6. Correlation is significant between the dependant and independent variables at 0.01 level.

Table XIV Correlation

To develop partnership
Healthcare education Information on the between the hospital and Enhancing hospital
Variables and prevention of risks hospital/facilities community network

B1. Work place

responsibilities 0.512* 0.543* 0.472* 0.693*
B2. Environmental
responsibilities 0.525* 0.553* 0.465* 0.630*
B3. Socio-economic
responsibilities 0.561* 0.622* 0.619* 0.595*

Note: *Significant at 0.01 level

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 279
 7. It is evident by the field study and personal interviews that certain specific social
responsibility activities that are undertaken by the surveyed hospitals are – Rural Health
Initiative to deliver high quality primary healthcare in rural India; Public awareness
programs – Walk Healthy Heart (free health camp); control diabetes; cancer awareness;
promise yourself to stay healthy etc.; ‘‘Hope’’ Blood cancer (children aid); Disaster victim
aid (dedicated physicians/aides); Free of cost screening camps; Adaptation of villages;
Trauma care center-equipped with ambulance and pharmacy; Mobile detection
units-cancer and cardiac screening; Sliding scale of payment; Insurance and Accident
prevention awareness in educational institutions and Private firms; Hospice-complete
free service for terminally ill cancer patients; Cleft lip and palate-free of cost; Free insulin
treatment (FIT); Patient counseling; Planning to start Community Development Institute.
Although complying with legislation covering employment, workplace health and safety
issues can ensure that the hospitals provide for their workers’ basic needs, visible
commitment to the improvement of their job satisfaction, career development and personal
welfare will demonstrate that the hospitals really value them as individuals and value their
contribution to the healthcare business. The hospitals can build internal partnerships with
their employees by ensuring trust between managers and employees, training of all the
internal stakeholders undertaken from both inside personnel and external agencies, thrust
on Environmental impact audit, and encouragement them for joining local voluntary
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organizations. A motivated staff often leads to a stable, contented workforce-and helps to

build a good reputation for the hospitals. Every hospital can help by reducing energy
consumption by minimizing waste and by recycling materials. Good environmental
performance often makes financial sense also in terms of cost reduction which is very much
needed in healthcare sector. Being positively engaged in local community can help the
hospitals to identify new markets, customers or business opportunities, build contacts with
local authorities and opinion-leaders, and facilitate new opportunities with other community
projects. The healthcare business sector should be the perfect example of responsible
business and should lead people and other businesses to invest for society. Healthcare
sector should underscore its role as a good corporate citizen with a number of activities in
the fields of education and research, environment, social needs, sports and culture to be the
leader of sustainable development. The study contributes to CSR research in the healthcare
sector and is of value to academics/hospital managers by adopting the multi-stakeholder
approach to explore contextually determined views of CSR.

6.1 Study’s significance and limitations

The study findings provide new insights into the meaning of the social responsibility in the
healthcare sector in Indian context from a stakeholder perspective. However, the results of
the not-for-profit hospitals do not lend themselves to generalization. A more comprehensive
study involving more number of corporate/government/ISO certified hospitals is required
which would throw light on the CSR perspectives in the Indian context. The absence of the
perceptions of patients and other external stakeholders is considered as a significant
limitation. It would be beneficial to conduct extensive studies in order to refine the study and
create more comprehensive and generalizable model of CSR in healthcare organizations,
not limited to local hospitals in the Indian context. For the analysis of different types of
hospitals, the researchers felt the sample size as small. Further work is in progress by which
appropriate comparison of perceptions of different types of workers in different types of
hospitals could be made. Research is also under progress taking into consideration patients
as key stakeholders.

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 Appendix. Questionnaire

Figure A1 Perception on social responsibility: demographics of respondents

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Figure A1

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 283
 Figure A1
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About the authors

R. Rohini is currently working as Associate Professor at the Institute of Clinical Research
India, Bangalore. She obtained her Master’s in Chemistry from Mysore University and was a
senior research associate in Astra Zeneca Pharma Ltd. After obtaining her MBA in HR she
pursued her doctoral studies at the University of Mysore. She has published several
research papers and presented papers at national and international conferences. Her area
of interest is Human Resource Management and TQM in healthcare services. She is
Associate Member for Academy of Hospital Administration (AHA), India; life member for

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PAGE 284 SOCIAL RESPONSIBILITY JOURNAL VOL. 6 NO. 2 2010
 Indian Society of Hospital Administrators (ISHA) and Member for International Society for
Third Sector Research (ISTR).
B. Mahadevappa is a Reader in the Department of Studies in Commerce, University of
Mysore, Manasagangotri, Mysore, India. His area of research is TQM and Accounting and
Finance for Non-profit Organizations. He was a UGC postdoctoral research fellow at the
University of Mysore. He has published several research papers in national and international
journals and attended an International Conference at Bangkok. He is a life member of Indian
Accounting Association and member of International Society for Third Sector Research
(ISTR). He has 23 years of teaching and research experience.
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To purchase reprints of this article please e-mail: reprints@emeraldinsight.com

Or visit our web site for further details: www.emeraldinsight.com/reprints

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VOL. 6 NO. 2 2010 SOCIAL RESPONSIBILITY JOURNAL PAGE 285
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