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Instructions: Answer all questions. Each question carries 20 Marks Total marks 100

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Feasibility study is one of the important concept is planning process of hospital project. It is
done after finalizing the hospital project concept in terms of size and facilities. In this process the
financial viability of project in analyzed. It is useful in planning the means of financing project based
on profitability and capability of servicing debt proportion. It is of the utmost importance to identify
cost of project in realistic manner. Cost of project should be broken under each and every heads
including income generation departments as well as expenditure.

Following are some of the important income generating departments in hospital set up.
1.? Income from OPD and IPD consultations.
2.? Room rents- general wards, rooms, ICU, NICU etc.
3.? Diagnostic facilities like laboratory, radiology, EEG, EMG Cath lab, Audiology etc.
4.? Income from major and minor surgical operations.
5.? Pharmacy.
6.? Emergency services.
7.? Health check up schemes.
8.? Deliveries.
9.? Dialysis.
10.? Blood banks.
11.? Specialty services if available.
For calculating income, there are some important standard assumptions like number of
OPD/IPD days in a year, bed days available with capacity. Average length of stay, number of
admissions, number of operations, number of OPD room, etc.

Following are some of the items of expenditures in hospital setup.

1.? Salaries and wages: cost to company basis.
2.? Departmental expenses in terms of consumables - percentage expense to departmental income.
3.? Profession fees payable to doctors for rendering clinical services.
4.? Electricity, water, generator, medical gases.
5.? Food expenses for patients and staff.
6.? Laundry and Linen expenses.
7.? Housekeeping expenses.
8.? Stationery expenses.
9.? Telecommunications.
10.? Vehicle expenses.
11.? Marketing expenses.
12.? Repairs and maintenance.
13.? Insurance, Legal and audit charges.
14.? Depreciation.
15.? Interest cost for loans.
16.? Taxes.
17.? Miscellaneous expenses.

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1.? First criteria for site selection must be convenience of the patients to reach the hospital.
2.? Site should be large enough for future expansions and developments of hospital.
 3.? Another essential criterion will be that there should be close collaboration with town planning
authorities. Approximate total volume of building and site area must be related by preliminary
calculations. µPlot ratio¶ must be measured to consider degree of crowding.
4.? Site must provide room for substantial Future growth.
5.? The site should be at least double the area required for hospital as it is originally planned.
6.? Sites must be surveyed by architect and engineers.
7.? Supply of water, electricity should be easily available for site.
8.? Site must have main sewerage which is capable of carrying of hospital wastages. Otherwise
suitability of soil for installation of an effective sewerage plant may be investigated.
9.? Site should be free from air pollution from adjoining industries and other sources and free from
insect vectors of disease.
10.? Site should be away from noisy surroundings.
11.? Bearing quality of soil must be investigated considering risk of earth movements. Geological faults
or undergoing mine workings.
12.? Circulation is one of the very much important aspects in hospital planning.

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Intensive Care Units are the specialty nursing units specially designed for very critical patients.
These units are designed, equipped and staffed with especially skilled personnel for very critical
patients or patients who require specialized equipments. It is the central unit of any hospital specially
500 bedded teaching hospitals.

For planning and designing of intensive care Unit, first of all, the most important thing is to
decide the location. Ideally location of ICU should be centralized place and be close and readily
available to any other departments. It is important that other departments should be very easily
accessible with ICU, as the patients admitted in ICU may develop any complications at any time. This
requires instant treatment from other departments of hospital.

Also it has another advantage that, with the help of easy accessibility to other departments and
centralized location, the cost of duplication of costly equipments can be reduced and also manpower
required in handling patients or equipments is lessened. Thereby reducing cost burden to the hospital.

There is also one designing thought for the ICU that location of patient should be different for
different types of patients. So that the patient is moved from ICU to immediate care step down unit and
then to general ward.

It is clear that whatever may be the location of ICU, it must exclude through traffic.

Most of the admissions to ICU come directly through emergency department or from the
operation theaters following major surgery. Hence, ICU must be close to emergency, OT, laboratories
and radiology department. Also it should be close to general nursing units as patient may require
transfer to ICU any time. ICU should be away from heavy traffic and noise. Also, accessibility and
direct visual contact between patient and nurse must also be taken into consideration. The patient
should be close enough for careful watch of respirators, skin color changes, etc.

The number of beds in ICU in 500 bedded hospitals may be up to 12 maximum, as these
patients can be effectively monitored by the staff. Also ICU patient rooms should be planned to
facilitate operations in event of crises. Also, these beds should be located away from the wall to give
staff 3600 access to patient.

Some things must be taken into consideration while designing ICU like, it should not be totally
compact room. Some sort of window arrangement must be present there. Harsh lighting must be
avoided. Also, ICU should be noise free and crowd free.
 Designing should accommodate the machinery, while simultaneously keeping it out of the way
with particular attention to head wall. Attractive casework should be used to hide hookups in head wall.

The beds should be situated to allow ready observation of patient¶s whole body particularly
head. All these depend upon the layout of room which is function of overall unit design and needs to
balance demands of technology, accessibility and privacy.

Similar to these there are separate planning and designing guidelines for specialized ICU units
like Cardiac ICU, Pulmonary ICU, Critical care unit for elderly, Neurological ICU, Burns ICU,
Pediatric ICU and Neonatal ICU.

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Radiology is a very important department in modern hospitals, since it can provide diagnosis
with accuracy in certain cases without taking specimens.
In multispecialty hospital the Radiology department should be located near emergency
department, casting department, women¶s diagnostic centers & nuclear cardiology. The separate
waiting area & changing rooms should be provided to patients according to gender. The radiologist
should be available / approachable to check & report the images acquired or procedure findings of
patient.
Super specialty hospitals radiology department should have.
1.? Radiography room
2.? General fluoroscopy room
3.? Chest room
4.? Mammography room
5.? Ultrasound room
6.? CT Scanning room
7.? MRI Scanning room
8.? Nuclear medicine room
9.? PET Scanning room
10.? Supporting spaces

›adiation Hazards
The potential risks of radiation comprises of stochastic (of which probability increases with
dose) and deterministic (of which severity increases with dose). Cancer induction and genetic
effects are stochastic effects and cataracts, blood dyscrasias and impaired fertility are examples
of deterministic effects.

Safety measures to be practiced in this department

Principles to consider
Ô? àustification of a practice.
Ô? Protection should be optimized (ORP).
Ô? Dose limitation.
Ô? àustification of procedure versus net benefit.
Ô? As low as reasonably achievable (ALARA) dose.
Ô? It is recommended that the radiologists who work in CT fluoroscopy (CTF) should
employ lead glasses, thyroid shields, lead aprons, lead gloves, and portable body radiation
barriers. They should wear both internal and external radiation badges to monitor their
exposure to scattered radiation during the procedures.

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 Central Sterile Supply Department (CSSD) is one of the major departments in any hospital. It
is the department where medical/surgical supplies and equipments - both sterile and non-sterile are
cleaned, prepared, processed, stored and issued for the patient care. Every hospital consumes large
quantity of new material which needs sterilization before use. Also, it processes large quantity of other
materials that has to be cleaned and sterilized for its use. The purpose of CSSD is to concentrate the
skill and the responsibility for supply of sterile materials and to reduce risk of infection.

CSSD is divided into three zones.

1.? Decontamination zone.
2.? Assembly/sterilization zone.
3.? Storage and distribution zone.

The work flow is centered on processing of soiled instruments through four zones. Distinct
separation is maintained between sterile and soiled areas. The technical staff works on either area only.

In decontamination zone reusable equipments, solid instruments and supplies from various
sections of hospital for initial or gross cleaning are collected. They are cleaned and decontaminated
manually or mechanically or by chemical methods. Exchange cart is cleaned in pass ± through cart
washer and readied in assembly zone to carry items back to departments. Items or equipment used here
are biohazardous waste management system, washer/decontaminators, ultrasonic washers, health care
decontamination systems, cart washers etc.

After decontamination, items are typically assembled into sets or trays. Each set/tray is
wrapped or packed in non woven textile pouch or rigid package/container system for terminal or final
sterilization. Sets are prepared for reuse, storage or further processing. Equipment used in this zone are
high pressure sterile processing systems, low pressure sterile processing systems, to gas sterilizers, gas
generator, chemical sterilization system etc.

After sterilization process, instruments are stored in sterile storage or sent to appropriate
departments. Apart from these, this zone also do other functions like case cart preparation and
delivery, telephone or requisition order filling and delivery of patient care equipments.

Following are some of the preventive measures to be carried out which ensure sterility of
instruments / other items:
1.? Distinct separation of sterile and soiled areas.
2.? Technical staff must work on either side and should not cross from one side to other side.
3.? Instruments, operating packs, trays etc. must be sterilized by autoclaving.
4.? Gas sterilization requires safety precaution like aeration prior to use and special exhaust
ventilation.
5.? Cleaned instruments should be wrapped in special linens.
6.? Clean and dirty materials require separate delivery points.
7.? Rubber gloves should have separate glove room for treatment.



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Instructions: Answer all questions. Each question carries 20 Marks Total marks 100

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Public relations are one of the most important aspects related to hospital and health care
management. In short it consists of the application of necessity, to utilize methods and channels of
communications, which people understand easily. By concept public relation consist of acts, attitude,
behavioral techniques and thinking of every employee, staff members including from lowermost
member to top level governing board. Obviously, these are the people responsible to make the image
and opinion of the hospital or organization at the community level. Only good public relation can
produce good community support with adequate and sympathetic services. On the part of hospital and
its staff. Thus public relations plays vital role to connect the hospital to the community. Obviously, the
factors playing major role in this context are the quality of the services provided by the hospital, like
attitude of doctors, nursing staff, food services, sanitary services, general attitude of all employees etc.
Public relations represent the hospital to public in correct perspective, because like all the institutions or
offices or companies, there are some potential detractors of the hospital, may be doctors, nurses,
housekeeping staff, sometime patients and relatives also. It depends on public relation system of the
hospital to overcome these frustrating situations and to maintain good image of the hospital.
There are several methods useful to improve the public relations. First of all it requires
dedication of each and every individual working there, from lowermost position up to topmost position.
With regard to hospital, sympathetic patient care is must. It must be taken into mind that every action
by any employee at any position in the hospital is regarded as that done by topmost level personnel of
the hospital. Public relation maintenance is part of administrative office. To maintain public relations
should be the duty of each and every member of the hospital may be individually or in groups. Public
relations should develop and promote understanding and appreciation of hospital by the people it
serves. Every program under the public relation should understand and cover total community. Thus
public relations develop the understanding and appreciation of hospital by the community. It interprets
to the public, patients, relatives, staff and employees, objectives and ideas of service to which hospital
is dedicated.
To promote good public relation, all PR authority should be given to the head of public
relations, through the administrator by the top level authority. It should be their duty to seek out,
organize and develop constructive publicity ventures in connection with hospital procedures. All the
material verbal or written related to hospital should be released and distributed to public regularly and
promptly. One person should be given the responsibility for carrying out the public relations program.
Along with this there should be an active public relations committee. This committee should formulate
code of ethics and co-ordination with local press for the release of information regarding patients and
hospital activities.
Obviously, some specific staff of the hospital can be considered as very important in
maintenance of good image of hospital as they come directly in contact with patients and their relatives,
like reception counter personnel, admitting office clerk, cashier, the telephone operator and the
emergency staff. The public relations committee should teach all of them all the useful techniques for
dealing with patients and their relatives, in an order to make good impression of the hospital. Also, this
committee should maintain friendly relations with other hospitals also.
Apart from these general things the public relation department should make certain rules and
regulations adhering to various laws. Only that information which is required by law can be given
without patient¶s consent. For all the other things like pictures, information should be released only
after taking valid consent and with valid consent of attending doctors according to the law. Also, there
should be specific laws for the statements, questions about hospital, and activities referred to public
relations department.
Also, there should be fixed code of ethics for release of information to press for publication, in
accordance with patient and doctors. Also, each employee of hospital must take every opportunity to
promote good public relations with every patient. All the important information regarding hospital
timings, routine OPD timings, emergency timings, facilities available, admission information, dietary
 services, visiting hours for the relatives with messages to them, financial arrangements, discounts, rate
schedule, stay, phone facilities and any other facilities, should be clearly known to all people via
booklets of hospital. It gives clear cut idea to patients and relatives. This is the most important aspect
of public relations maintenance.
Also to improve good public health, the help of volunteers can be taken. They help to raise the
status of hospital and work as link between hospitals and community.

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Purchasing is the function of buying machinery, tools, general supplies, raw materials etc.
required by an organization. Effective purchasing and store control can reduce one of the most
common financial drains on hospital as well as contribute to patient care and employee utilization by
assuring economical but quality products and services.
In 300 bedded hospitals there must be the separate purchase and store control section.
Following are some of the operative procedure for effective organization of this hospital.
1.? First of all, there should be fixed written policies stating the following duties and
responsibilities for the purchase section:
a.? Obtain the right quantity and quality so as to avoid hampering the productivity.
b.? See that purchases are made at most competitive prices.
c.? See that funds are utilized on purchases with utmost discretion.
d.? Cost reduction through competitive buying and negotiations.
e.? Standardization of purchases.
f.? Authorization of purchase requisition and proper sanctions.
g.? Instant dealing with supplies about shortages, rejections, as reported by stores.
h.? Instant information to store about any changes in delivery time, quantities, delays etc.
i.? Proper and planned methods of payments of suppliers in co-ordination with account
section.
j.? Disposal of surplus stock and scraps.
2.? Policies must cover unification or centralization of purchasing authority of purchasing agents,
selection of venders, quantity and quality of items and cost factors such as utility consumption and
maintenance.
For 300 bedded hospitals there should be separate purchase set up. Purchase section should be
divided into groups, each group being under charge of an assistant purchase officer, who will have
certain number of senior and junior assistants under him. The stenographers and typists will work
as group in a pool or under each group, according to convenience. It is usual to have sections to
carry out various research activities for each group like value analysis, standardization, and price
reduction. Centralization of purchases must be done to facilitate the work, though purchasing may
be completely or partly de-centralized also. The purchasing agent or agents must be authorized
according to fixed policy. Local supplies must be given preference over distant vendors, to reduce
accounting activities, buying on bids, using technical and advisory services provided by suppliers.
Policies must be made fix about purchasing quantities and should be strictly followed. Purchasing
principles must be followed like, right quality, market survey, quantity time price, source and
delivery at right place. Price determination should be done with following points like studying
previous purchases, catalogues, price lists, telephone enquiry, tender etc. Samples must be studied
before giving final orders. Supplies should be selected accordingly. Grouping of items must be
done for price determination. Value analysis must be done before finalizing the purchase.
Purchase budget must be made before the start of financial year with corrections made time to time
wise.
Now the rest works on stores section. It should do the functions of receiving, storing and
issuing materials. Strict orderliness and methods should be employed to ensure accuracy,
preservation and safety at all stages of material movement and custody.
All the incoming materials should be received and quantities must be checked according to
orders. Entry must be done in daily goods receipt register. All the materials must be examined for
faults or deficiency. Materials must be stored against deterioration and theft etc.
While issuing, materials must be issued against authorized requisitions only. Accurate records
must be maintained. For proper organization of stores control, this must work in co-ordination
 with accounts section and other respective departments. Periodic verification of stocks must be
done. Centralization of store should be done. All the employees must be educated as to proper use
of supplies to avoid waste or misuse.

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Housekeeping service department is one major department in any medium or large sized
hospital, since it is the department which comes in direct contact with pubic, visitors and also
employees of the hospital. It is also necessary department in order of maintenance and to build good
image of any hospital.
Importance of the house keeping department can be easily known on the basis of duties they
carry out in the hospital.
Primary activities carried out by this department are routine cleaning, dusting, mopping,
waxing, removal of trash, windows and wall washing and other routine duties involved in cleaning
process. These also carry out bed making, preparation of vacated rooms for new patients.
Apart from these they also carry out the functions of general sanitation in hospital including
vermin and rodent control. All the hospital staff always at any time requires help from this department,
specially nursing staff and administrators. This is the staff which can bring the complaints regarding
repair or replacement by telling damages to walls or floors, paintings, plaster cracking etc. Thus they
play vital role in standard maintenance of the hospital.
Housekeeping department works in accordance with policies and objectives of the hospital by
developing their own policy. It is their duty to assist in maintenance of health care quality and patient
care. They are involved in taking precautions in controlling cross infection by the way of high quality
sanitation. It is their duty to maintain quality of hospital. This department is directly responsible to
develop the policies for proper cleaning procedure with proper cleaning agents and equipments. Also,
they are involved in development of newer and improved techniques of cleaning. They have to do
experiments with new techniques and equipments for this purpose.
Apart from all these important duties, they also have to work in maintenance of maintaining of
medical records. For this purpose, they have to co-ordinate with record keeping department. Also, they
have to make daily duty roasters, attendance registers and stock registers etc.
From all these duties and responsibilities one can easily understand the importance of this
department in any hospital. This department must work in co-ordination with other departments of
hospital to maintain good un-interrupted quality services for high quality assurance, the house keeping
department should maintain written schedules with procedures for different policies involved in proper
care of floors, walls, windows, furniture and hospital equipments.
Linens and laundry services are two of major portions of housekeeping services in any
hospital. They are directly involved in making the hospital image with their works as they come in
direct contact with patients and their relatives.

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Maternity services should be provided by almost all multispecialty hospitals now a day. In
regards to management of these services in a 500 bedded hospital we need to consider,
1.? Number of maternity beds: According to studies conducted 12% of the total bed capacity
of hospital should be the number of maternity beds, thus 60 beds in a 500 bedded hospital.
Also the maternity beds can be used for clean gynecological cases, thereby maintaining
the average occupancy rates for these beds. Limiting these beds for maternity services
exclusively will definitely be counterproductive for hospitals.
2.? Staffing Pattern:
a.? A Chief, qualified in obstetrics & gynecology should be appointed to direct the
professional work of the department.
b.? Attending staff can be Physicians & other professionals, as per the need of the
patient but Regulations regarding consultation & operative limitations should be
established & enforced.
c.? Residents & Interns if available should undergo training programs & regular staff
meetings, with attending staff & chief. All maternal & infant deaths should be
reviewed. While monthly statistics should be collected, analyzed & presented.
 d.? Nursing staff should include a graduate registered nurse, who has experience in
obstetrics nursing as supervisor of nursing services for each division of
department. E.g. delivery suites, patient rooms & nursery.
e.? Nurse¶s aides can be used but these should not administer medicines or give
treatments.
f.? Housekeeping & certain simple personal care procedures should be done by
maids & attendants.
3.? Maternity unit procedures: General procedure policies should be formulated by chief of
staff or by a committee of staff obstetricians. The written departmental regulations should
be available for all the staff & nurses. Attending obstetrician or House officer, supervisor
to nursing staff are responsible for maintaining the procedure regulations.
4.? Delivery unit procedures:
a.? Admission of maternity patients should be quick, also assistance for care of other
children at home should be provided through Social Welfare Department.
Complete admission history with prenatal records (if available) & physical
examination, with essential investigations should be carried out for each
admission.
b.? Anesthesia: Only local anesthesia should be administered by obstetrician & rest
anesthetic procedures required should be handled by qualified registered
anesthetist. Each delivery room should have oxygen & suction machine ready.
c.? Consultation: should be sought for all major obstetric complications.
d.? Shock Therapy: Measures for treatment of shock should be available at all times
in all hospitals treating maternity patients, which includes Blood transfusion
facilities, Donor list, nearby blood bank or Red Cross units.
5.? Recovery rooms: should be available to observe post partum patients for at least a period
of 6 hours.
6.? Isolation facilities for infectious maternity patients should be provided.
7.? Minimum visitors should be allowed for first 5 days, post partum.
8.? Patient should be discharged after full recovery.
These are the main points to be considered during setting up of maternity services for 500
bedded hospitals.

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Medical records are the documents which contain statements by the trained observers of
conditions found and results of treatment. They may include out-patients records; operative procedures
detail records, admitted patients records, thesis papers, research papers, hospital policies etc. In short,
they include all the documents related to hospital works. They provide material for analysis of the
immediate results of hospital work and result of quality and quantity of work done.
Importance of Medical Records;
Medical records are important not only for the hospital but they are also useful for patients,
families, community and general public also. Clinically they are of vital importance for immediate
diagnosis and treatment and for future welfare of the patients. With regard to hospital, they are useful
for evaluation of its services and improvement of its efficiency through lowered mortality and
morbidity and better patient care. Moral of the employees can be raised with their evidences. Medical
records are also useful for education, training, researches and post-graduate studies for the physicians
and other related persons. Researchers get very much benefit for their researches with the help of
scientifically recorded observations as in medical records. Also epidemiologist can get valuable help for
their studies with medical records. Medical records are used to identify patients with history of illness,
physical findings and treatment given to them. This can be useful for the patients as evidence in medico
legal cases and in insurance and other claim cases.
With regards to hospital, medical records are useful to furnish all information on all aspects of
patient case, clinical and managerial quality and quantity. It can serve as means for analyzing and
appraising quality as well as quantity of medical services provided by institution. This can be useful to
work out economical aspects of medical care. Also they can be useful to evaluate the patient care and
proficiency of staff of the hospital. Medical records serves as effective management tools for planning
 future programs and facilities for the budgetary allocation, determining distribution of medical and
rationalization of staff with demands. Thus, medical records serve as an important tool for the
administrators.
Medical records provide the base for medical audit. They provide detailed clinical information
on past cases, which can be useful for future diagnosis and therapy.
Also, medical records play vital role in medico ± legal cases, as any medical record can work
as evidence legally for insurance and other claims statements. They can be used to make certain vital
certificates like ± sickness certificates, fitness certificates. Medical records can become important
medico ± legal documents in regard with malpractice suits, wills compensation settlements, injury
suits, criminal cases, authorization of operations etc.
On the basis of the importance, one can easily recognize the importance of Medical Records
Department in hospital.
Every hospital must establish the well organized medical record department (MRD), with
competent, qualified and trained staff, in co-ordination with the chief administrator. A medical record
officer must be appointed as chief of this department who should be given responsibilities of overall
control on MRD. He should supervise; organize all types of registration counts. He should be
responsible for completion, compilation and disposal of records, presentation of records, availability of
records, medico legal cases handling, issuing medical certificates, preparation of monthly or annual
reports and other duties regarding MRD. He should be assisted by medical record technician. Record
committee must be organized to work in co-ordination with chief administrator of hospital. Necessary
furniture, racks, shelves, must be provided with the help of structural personal or engineer. All the
rules of medical record keeping regarding to law must be followed by department like using of records
for personal or legal purpose. All the record should be preserved as per institutional policies.
Some of the operative procedures in effective functioning of MRD are:
1.? Written policies, procedures and rules for compilation of records, release and use of records as
per needed by law should be formulated.
2.? Medical records should be accurate and complete, sufficient to justify diagnoses and establish
basis upon which treatment was given must be written for all patients.
3.? Specific members/committee must be given for compilation and maintenance of medical
records as per policies of hospital.
4.? Proper indexes should be maintained for easy accessibility of records.
5.? Proper classification of records, nomenclatures claiming categories should be done for quick
accessibility.
6.? Communicable diseases, poisoning outbreaks or unusual risen instances should be reported to
concerned specified authority as per law guidelines.
7.? Proper recording methods and procedures should be maintained for proper administrative
practices.
8.? Periodic reviews and presentation should be done for modifications and suggestions from other
staff.
Medical record department should be located at convenient site with adequate space, equipment and
supplies with satisfactory safe storage facilities.
  , - c* )c
Instructions: Answer all questions. Each question carries 20 Marks Total marks 100

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To prosper & grow in this twenty first century the managers & organization functions should
change according to the new changes in political, social, economical & technological scenarios. The
situation dictates two rules: 1. Everything happens faster, 2. Anything that can be done, will be done, if
not by you, then by someone else, somewhere.
Thus organizations who have not prepared themselves are disappearing through mergers,
acquisitions, or bankruptcy. Those that have changed their management methods are benefiting with
increased profits, delighted employees & customers.

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Organizational behavior is a field of study that investigates the impact of those individuals,
groups and structures has on behavior within organization for the purpose of applying such knowledge
towards improving an organization¶s effectiveness. It studies the three determinants of behavior in
organization i.e., individuals, groups and structures. Thus, organizational behavior is concerned with
study of what people are in an organization and how the behavior affects performance of an
organization.
Application of OB concepts to bring about proper management and organizations in health
care institutions:
Health care institutions are unique in several ways. It is only place where we come across
wide skill differential among the people working there. On the one end there are highly skilled doctors
and paramedical staff and on the other hand there are very large numbers of peoples who are easily
substitutable. Management along with these two totally different groups is very difficult task.
Second dimension of health care institution is of their criticality. Their ability to make on
impact on well being of community is undisputable.
Third dimension is community¶s dependence on health care institutions.
Fourth aspect which is the most important among all these is the need of the better
management of these institutions, so that they can be run profitability and add value to the society.
All these problems can be solved with the help of organizational behavior concepts. It offers
both challenges and opportunities. It recognizes differences and helps to serve value of workforce
diversity and practices that may need to be changed when managing in different countries. It can help
improve quality and employees productivity by showing managers how to empower their people as well
as how to design and implement changes to programs. It offers special insight to improve a manager's
people skills. It helps managers to cope in world of temporariness and learn ways to stimulate
innovation and offers guidelines for relevance in management and OB to health care institution.
Thus, in regard with health care institutions, OB can help to develop methodically trained
professionals who will be able to infuse meaning and purpose for institution. For this it helps to develop
trained managers who will be in-charge of these institutions, and thus helps in creating ethically healthy
work climate.

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 Leader is the person who carries out the function of leadership. Leadership is defined in terms
of both prices and property. Thus, it is the use of non±coercive influence to direct and co-ordinate the
activities of group members, to meet the goal.
The main function of leader is to transform potential into the reality. For this purpose he must
have a set of special characteristics. He has to be innovative. He focuses on the people and inspires their
trust. He has long range perspectives. He can carry out the investigation about the problems and the
reason behind that. He keeps his eyes on horizon rather than on bottom line. Thus, in short leaders
diagnose the situation he is trying to influence. Then he alters behavior and other resources required for
that purpose and then communicate with others in a way that people can easily understand and accept.
There are various types of leadership i.e., Autocratic, Democratic and Laissez Faire style
leadership.
For the units like health care centre, I would prefer democratic type of leadership, because, in
Autocratic style, the whole power and decision making is centralized by leader himself. It creates sense
of frustration and low morale in employees. While in Laissez Faire style of leadership, decision making
is done by subordinates and this can create mismanagement in decision making.
On contrary to this, the democratic style of leadership has many advantages. Here leader takes
decision in consultation with the subordinates. They have to take full participation in decision making
process. It enables subordinates to satisfy his social and ego needs and make faith and confidence, both
in manager and subordinates. It also helps to develop potential abilities of subordinates. Despite of
these, there are some drawbacks of this type, like it is time consuming and may be dominated by few
dominating individuals. But it is useful when the organization makes its objectives transparent to
employees and leader prefer participative decision making. It is the most suitable style.

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Motivation is a process that starts with physiological or psychological deficiency or need that
activates behavior or drive that is aimed at goal or incentives. In general language it is one¶s willingness
to exert efforts towards the accomplishment of his/her goal.
Health care institutions exist in hyper turbulent environment with rapid extent and pace of
technological and process changes. There is intense competition to improve productivity, cost
efficiencies, quality and clinical and patient perceived out comes. Hence, this field requires special
understanding of motivation techniques. A motivated work force is high performing, self driven,
delivers high quality service in productive and efficient manner and is creative and innovative.
In an intension of motivating office staff in health care institution, I would be applying theory
of µPORTER AND LAWLER¶S EXPECTANCY THEORY.¶
This theory suggests that efforts or motivation does not lead directly to performance. It should
be imitated by the abilities and traits and by role perceptions. Ultimately, performance leads to
satisfaction.
The main elements in this theory are:
1.? EFFORTS: It refers to the amount of energy employee exerts on given task. It is determined by
two factors,
a.? Value of Rewards
b.? Perceived effort-rewarded probability.
2.? PERFORMANCE: Efforts leads to performance. Amount of performance are determined on
amount of labor and the ability and role perception of employee. It has direct relationship among
them.
3.? SATISFACTION: Performance leads to satisfaction. The level of satisfaction depends upon the
amount of rewards achieved. If the amount of actual reward meet or exceed perceived reward, the
employee will feel satisfied and vice or versa.
4.? REWARDS: This theory has attempted to measure variables such as the values of possible
rewards, the perception of effort ± reward probabilities and role perceptions in deriving satisfaction.
They recommend that the manager should carefully reassess their reward system and structure.
The effort - performance - rewards - satisfaction should be made integrated to entire system of
management.
' ?
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HRD is the process by which the employees of an organization are helped in continuous and
planned way to acquire sharper capabilities required to perform their functions associated with
present or expected future roles and to develop their capabilities and potential for development of
organization. All this help to develop healthy and useful environment in the organization. There are
various indicators of HRD climate like:
1.? Performance Appraisal: Here, for each type of job the performance targets are set and actual
performance is measured and compared against targets and analyzed.
2.? Potential Appraisal: This will help management to identify suitable candidate and can train him
properly to get maximum benefit from him.
3.? Career Planning: Here individual¶s needs are integrated with organizational needs. It is a sequence
of positions that can be held by an individual during his working life.
4.? Training and Employee Development: Both training and employee development should be viewed
as continuous learning experience to perform current job and to assume future responsibilities.
5.? Organization Development: No organization can be static. It is must do upgrade employee¶s skill
and abilities along with changes in environment. Organizational development provides systematic
planned way for this.
6.? Rewards: Besides pay, feeling of achievement, pride, appreciation of work done, promotions the
benefits offered are the systemic efforts by organization to encourage employees to acquire skills
and capabilities to make them eligible for suitable rewards.
7.? Employees Welfare & Quality of Work Life: These are efforts to make life worth living for
workmen. It includes various services, facilities, benefits offered to employees to improve the
quality of their life as well as quality of work life.
HRD Sector in healthcare sector should also result in social welfare too. Apart from the social
services to ensure physical health, they must ensure their psychological development, to appreciate
this relationship with society. For this, following steps can be taken.
1.? Standards of healthcare provided to society through health programs should be in congruence with
society¶s health requirements and health resources.
2.? Surveys should be done. Directories of technologies should be complied and these should be made
available to public through various ways.
3.? Programs for self awareness and personal growth should be evolved to enable people to see
through their defenses and free their real creative self.









 l).  c c 
Instructions: Answer all questions. Each question carries 20 Marks Total marks 100

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Quality is the frequent terminology used in not only health care field but also in other business
fields. It is relative term, one can¶t exactly define quality. It can be defined as the degree of excellence
of a thing. It is directly in relation with customer service, cost & productivity. It builds on existing
strengths & good practices. It includes improvement in customer satisfaction, professional audit, and
improvement in efficiency and reducing cost.
The ³need for quality´ concept elaborate the importance of quality, why it is essential to have
good quality services & what are consequences of poor quality services. Now, in today¶s world,
consumer pressure has raised so much that quality has become differentiating backbone of health
services without which in such tough and growing competition, the survival of the hospital or health
care organization is not very much safe.
Concept µneed for Quality¶ emphasize on the sure benefits of good quality services.
By adopting good quality approach, cost of products can be reduced and productivity can be
raised. By making infrastructure organized and leisure consuming not only the excessive expenditure
reduced but also the customer satisfaction can be increased. Provision of good quality services reduce
customer complaints and automatically work becomes easy, less frustrating and also more satisfying.
For staff Good quality services are useful to manage expectations and can be useful to lessen the
confusion and confrontation. It can also be useful to lesson or avoid negligence claims and obviously
the profit of the hospital or health care organization if reduced.
A good quality service reduces cost, improves profitability and provides more opportunities for
investments and increases sales through competitive advantages. Also good quality services improves
professional co-operation. Better communications between professionals saves not only time but also
money and through the competitive advantage also gained.
As stated above, these are the gains from providing good quality services. Poor quality service
provision has many disadvantages in terms of loss in money, time, reputation, material and personnel.
Money is lost in time spent in needless complaints, legal procedures, insurance matter, rework, wrong
supplies and information, also over procedures and coordination, mistakes, duplication of work, high
turnover & absenteeism of staff due to loss of morale & high degree of dissatisfaction.
Thus providing good quality services is one of the most essential part of not only health
management but any organization. This concept is called as ³NEED FOR QUALITY.´

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As patient, we can expect lots from the hospital to ensure good quality of service.
First most important thing is that the patients think that he is spending his money for this
purpose, that¶s why he must get good appropriate value for his money. In today¶s health care system,
lots of advanced medical technologies are being invented for which very high cost is being taken. So,
beside good quality to cure, we first think of budget we can afford for the treatment.
As a patient while entering the hospital, I would first see the general first view about the
hospital, like construction of building, general appearance of building like color of building, position of
entrance, condition of outside wall from which we can asses maintenance conditions of the hospital.
Then, inside construction of hospital like OPD rooms, inpatient wards, bathrooms and toilets, dressing
rooms, sanitary services, condition of beds, furniture etc. are also very much important as these make
first impression of the hospital and psychological effect over the patient that we have come to right
place for the treatment.
Then the receptions counter, is the first place where first direct contact with hospital personnel
happens. If you are welcomed with smile and sympathetic behavior it creates lot of psychological
effect for the patient. Then the most important factor is the time we require to wait in the waiting room
for the turn. If the hospital staff include sisters or doctors or whosoever involved in this process are
prompt, this factor can be solved with proper and systematic organization of work as patients are
suffering from lot of pain and discomfort, the time he have to wait becomes the important factor for his
satisfaction.
 Then comes direct contact with doctor. If the patient gets the sympathetic treatment and
sympathetic behavior in the view of good smiling welcome, careful history taking, proper conversation,
listening to patient¶s complaints and from these the patient can assess the standards of quality he is
supposing to get from the doctors. Then comes the inpatient wards in case of hospital admissions. As
patient is residing away from his home, he will expect some special treatment from the staff there. First
of all come condition of wards in terms of sanitary conditions, clean and fine bed sheets, drinking water
facilities, call bell system etc.
Here also patient satisfaction will be decided on the type of treatment he is going to get from
the working staff like nurses, doctors, and ward boys. He will surely expect that they should talk in
sympathetic way, their needs be properly fulfilled.
Apart from this, we can expect that we should be treated by specialist and experienced doctors
to assure of quality of service. Also money factor is important. The patient must feel that he should get
proper value for his money.
As a patient I will expect good quality of service in terms of good behavior from doctors and
hospital staff, good quality care, high standard of care and good value of my money that I am spending.
These are the factors to assure good quality of leisure.

$ ?    "  "  #    +   

Hospital is the place where patient come with some sort of pain or problem, may be physical or
psychological. They have lot of expectations from the hospital, doctors, staff and services which are
being given in the hospital.
Good quality care start from the entry of patient in the hospital. Good warm, smiling,
sympathetic welcome will create sense of relaxation and security in patient¶s mind. For this purpose to
carry out, good front office and administrative staff should be appointed. Waiting rooms should be very
well constructed, proper sitting arrangements should be made. There should be availability of good
newspapers and magazines to pass the waiting time, which is the worst time to pass in a hospital. Then
comes the contact with the doctor. Doctor should give heartily and smiling welcome to the patient and
have very sympathetic and friendly talk with patient as this relieves half pain of patient. The entire
checkup should be done in ethical way avoiding unnecessary checkups or expensive laboratory tests.
Laboratory should be easily accessible without wastage of time. Also, they should be economical to
patient as some time patient complains that they spent more money over tests than doctor fees.
In case of emergency all the emergency staff i.e. doctors, nurses, ward boys should be readily
available as patient and their relatives are in immense tension at this time. The entire required
instrument should be readily available to avoid any complications.
Next thing is assuring good quality in cleanliness in wards to OPD to OTs. Strict instructions
must be given to staff related with these.
Lastly comes the economical point of view. Patient thinks that he must get the full benefit of
his every single rupee he is spending. The billing method should be done ethically and should be told to
patient before admission to the hospital to avoid any aftertime complications as seen in many hospitals.
Systems for bill payments should be very clear and with sympathetic conditions also.
Thus, to assure good quality care to patients, doctors, staff should be very friendly,
sympathetic towards patients and their relatives. Hospital should be neat and clean, doctors should be
experts in their field with advanced knowledge. Services should be high quality according to standards
prescribed.

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According to the definition given by British Standard Institute (BSI) quality assurance in
management system designed to give the maximum confidence that gives acceptable level of quality
service is being achieved with minimum of total expenditure.
Actually quality assurance is proactive and not reactive. Its aim is to make sure that nothing is
going wrong rather than finding out that something is going wrong and making corrections to that.
These are the activities undertaken to predict and prevent poor quality. It is being done with the help of
quality systems which work by establishing quality correction and quality management cycles. Certain
quality assurance standards are being set by quality management cycle to ensure that customers receive
 the required products or services to required standards every time. Obviously, the standards when
applied correctly will provide maximum customers satisfaction. Thus, quality assurance is an
integrated, systematic and comprehensive approach to quality in an organization.
On the other hand, accreditation is formal recognition and attestation of standard of quality
achieved by company. It makes it easier to be able to refer to specification developed by experts or
professionals for types of service they wish to contract. Via the process of accreditation the experts
judge the service independently and declare whether or not it meets these specifications. It is just like
licensing or registration. It is recognition by an accrediting agency that an individual or organization
meets certain criteria set by that agency.
In regards with hospital setups, I think quality assurance system would be better as it is
continuously working to improve the quality standard it refers to day to day and immediate actions to
maintain quality which is rather more necessary to sustain in competition rather than working against
specified standards. It is always better to prevent wrong things to happen rather than to take corrective
measures after something wrong has happened.
However accreditation itself has some drawbacks like, it is just like licensing or registration
and it is Voluntary. It can¶t be forced upon customers to refer these standards to decide whether
appropriate quality standards are they meeting. Also it can predict standards of quality for the start line
but can¶t assure about the same in the future. Also it can¶t assure that service is organized to improve
quality continuously. For accreditation to have predictive value, it must ask services to show that they
have effective quality system and this is not achievable without desire and learning capacity which are
subjective phenomenon. Accreditation can¶t achieve that. Hence quality assurance is the better option in
regards with the hospital setup.

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Quality cycles are used to resolve quality issues. There are two types of quality cycles. First is
quality management cycle and another is quality correction cycle. In quality management cycle,
standards of quality i.e. the most important features of quality is defined, then against these standards
the performance which doesn¶t meet these standards, action is taken and then again cycle is executed
with revised standards with improved quality.
Quality management cycle starts with inputs from service strategy. Quality features are
gathered from market analysis and quality specifications in purchased contracts. Then from there it is
defined what are requirements to attract the patients to service and to influence purchasers. It also helps
to improve important features of quality for market performance. Then from this background data the
service package complete flow process diagrams of service delivery process are described. Then those
aspects of service which are critical to each dimension of service quality at particular time are defined.
At the start, few will be picked out so that full cycle can be established. Then comes the most important
aspect of cycle i.e. to set the standard of quality. Any conflicts both standards are identified and
changeable means are picked out. Now the performance against these standards are measured and
documented. Now with the help of records the performance is analyzed and presented. It will help to
show the variations in performance for each item specified and measured. These are made available for
whole staff to understand. Now the action is taken either congratulatory or corrective. Now the next part
is to reassess whether to continue to improve performance on original quality featured or to add new
quality features. Thus with the help of quality management cycle, it can be ensured that quality methods
are used in right way or not or if correction is required.
 2. Formulate
Standards
(for Client D


quality, 

 

Professional
quality & 
 
Management
quality)

Inputs 
 





Requirements  

(Service brief) !


 

& service design "
(From service strategy) 















The Quality Management Cycle

With the help of quality management cycle staff takes part in all phases of cycle. Focus is done
on the process. The most important features get proper attention and also variations are reduced
resulting in improvements of any performance.












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Instructions: Answer all questions. Each question carries 20 Marks Total marks 100

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Sales and marketing are two different concepts. They vary in term of their orientation. Sales is
a concept in which the main focus is over the product. The target is that this product should be sold by
any means to customer and the profit is maximized by any way. For this purpose, aggressive selling and
sales promotion is done emphasizing on price variation to close the sale.
But marketing is the different concept. Here, the main focus is customer rather than product.
Here, those steps are used which make the product will better than the competitor in customers view.
For this, integrated marketing plan is done comprising of price promotion and distribution backed by
opportunity analyses. Here main emphasis is done on the quality of service.
When we go to diagnostic centre for check, we are suffering from some health problem
undoubtedly. So, in our mind there are always some expectation from that diagnostic centre related with
types of treatment, money, behavior from doctor, time required for check up, the bills, behavior from
other nursing staff etc. So, here the satisfaction will get will be sum of all these things rather that just
getting satisfaction from single thing. Satisfaction in this come with personal feeling of pleases of
disappointment resulting from comparing doctors/ diagnostic centre¶s perceived performance in relation
to the expectation from the same. You go to this diagnostic centre/ doctor by forming expectations from
advertisement, information from friends or other hospitals, or by one past experience. Hence, in terms
of satisfaction, I would say that I must be truly satisfied, not like that not justified or just about satisfied.
This will be the customer satisfaction in this case.
In case of this diagnostic centre all the benefits both tangible and intangible that I would expect
from this diagnostic centre will be the value and all the costs, either tangible or intangible, that I would
expect to incur or actually incurs in evaluating, obtaining, using and disposing of this centers facilities
will be the costs. The total benefits I get would be effects of treatment, differences in attitude and good
feeling, psychological benefits from treatment.
This diagnostic centre can communicate and promote itself by various means, the most
important being advertisements in terms of non personal presentations and promotion of ideas, goods,
or services by identified sponsors. These can by various ways like press and news papers, periodical
newspapers, televisions, outdoor Medias, direct mailing, telemarketing, Directories or on internet.
Also, this diagnostic centre can promote itself by organizing personal and formal meetings to
discuss services with other doctors or for group of patients or customers. Also, this can be done by
informing and educating the public above various services and also can be achieved by informing the
consumers how to obtain services easily and conveniently by front office staff.

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Market research is one of the most basic things in any new hospital setup. It is useful for
deciding systematic design, collection, analysis and reporting of data and finding relevant to specific
marketing design situation facing a company.
For marketing research of hospital, various ways are useful to obtain it, like from market
research, departments of other hospitals or from syndicated service research firms, marketing research
firms, engaging students and professors of management and professional colleges and also from many
small organizations operating in local market.
For carrying out market research for the hospital, there are several steps required. First of all,
the problems should be clearly identified avoiding ambiguity and with specificity. Then specific
research objectives and research design is framed. This can be done with help of exploratory research. It
will also help to identify the problems. Also it finds the cause and effect relationship. Descriptive
research also can be done to find out numbers and groups.
 The next thing in marketing research is to identify source data, which may be primary or
secondary, which is already available from the internet, journals, newspapers, magazines, research
papers. Compared to secondary data sources the primary data sources are more reliable and specific.
Then the next important thing is data collection, which can be done by various methods like,
observation, which can be direct observation or video cameras. Also it can be done by surveys or
experimentation or focus group discussions, with the group of people discussions about products,
services, and offers. Now, also data can be collected by questioners either with open ended or close
ended questioners, which can be administered through personal interviews, mail or phones. It can be
also collected by association and projection tests, in which picture is presented and respondent is asked
to build story around it. Now, sampling is done and taking into consideration, selective groups, i.e.,
samples, either probability sample or non-probability sample method is used.
Now the next important in marketing research is analysis of collected data, collected on three
levels i.e., primary, secondary and advanced. Data is complied, checked by groups and then preliminary
and then finally in depth analysis is done. Now, final report is prepared and data is presented.
SWOT Analysis is always done out before launching an action. Both strength and weakness
are assed. Strengths are to be improved and weaknesses are to be overcome, opportunities are to be
judged and caught. Threats are to be faced and conquered.

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Generally maternity hospital regularly provide following general facilities like, detection of
pregnancy with the help of pregnancy kits, registration of anti-natal women (ANC), regular ANC
checkups, deliveries. Deliveries may be normal or caesarian section and post natal care. These are the
routine services provided by any maternity hospital to the patients.
Here, in this case product will be offerings by hospital via three basic elements like services
features and quality, services mix and quality and price appropriations. In this case, product means all
the facilities which can be offered to patients to satisfy their needs. Product means the points by which
hospital seek to satisfy patients need. It could be material goods, intangible service, combination of
both, places, experiences and ideas.
In relation with maternity hospital, all the facilities that patient would expect from hospital will
come into product. Starting from the hospital entry, patient would expect location of hospital that is
convenient to reach there, hospital routine timings and emergency timings, hospital waiting room,
comfortable nice, cleanliness, availability of good reading materials, television if possible in waiting
room. These are basic expectation from any patient entering into this hospital. Now, the next thing will
be good behavior from front office and registration staff, smiling welcome, convenience to get all
requested information quickly. Then good behavior from nursing staff, friendly consultation and
communication from doctor, reasonable laboratory activities would be expected by the patients.
Now after the regular ante-natal checkups will be expected from patient with proper
appointments with good counseling and finally at the time of delivery, patient will expect immediate
availability of doctors, nurses, and clean labor room, expert people in this field and after this proper
PNC consultation.
With all these qualities of product, patient¶s main attention will be on reasonable price. Good
accurate billing, including consultation fees, admitting charge, room charges and medicines will be the
core thing in this. Thus, all things would be included in product design in case of maternity hospital.
Product mix in case of maternity hospital will set of all above things the hospital offer to
patients. In this case width of the product mix will be consultation from doctor, diagnosis and delivery
may be normal and caesarian section. Here, the length of product mix will be consultation types like,
routine consultation, emergency consultation, delivery types like normal delivery or caesarian section,
diagnostic methods like pregnancy testing, routine pregnancy testing, like blood testing, urine testing,
etc. Some diagnostic method like routine pregnancy tests, routine blood and urine tests, advanced and
special tests like prenatal HIV test, etc., with economical and premium offering will be the depth of this
product mix.
Segments that will be targeted in case of this maternity hospital can be classified by various
ways like volume segmentation as the patients for maternity hospital will be all the married women.
They can be contacted individually or in groups. They can be contacted area wise in which hospital is
situated. They can be classified according to age, sex, income, occupation, etc. Another way of their
 target segmentation will be their psychology about the services they expect from hospital. The affording
they can spend, etc.

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Pricing is a very much important aspect in relation with the hospital setup. Pricing is in short
what you get either qualitative or quantitative for the price you afford. Setting the right price is crucial
for any services, also for hospital services. It is the most challenging process. If prices are too high,
getting customers become difficult.
There are various factors which affect the pricing like, fixed costs which have to incur
irrespective of volumes, or business like rents/salaries. In hospital settings you have to pay various
prices, irrespective their outputs like salaries of nurses, ward boys, housekeeping department, ward
maintenance, rents of buildings etc. Another aspect is valuable loss like medicines given, bandages, fees
etc. Other aspects which affect pricing are competitions, positioning, promotions, taxes, customer¶s
perceptions about price and quality, damages and elasticity of demands.
All these factors affect in hospital setup because, there are various professional competition in
this field, which affect pricing. Customers differ in perceptions about specific hospitals in terms of
quality and prices of hospitals.
For pricing, one can use cost or demand as base; following are the concept used in pricing.
1.? Discriminatory Pricing: Charging affluent patients more and poorer patients less or different prices
for different times/seasons, more fee for emergencies and less for prior appointments.
2.? Backward Pricing: Pricing according to patients willingness.
3.? Market Penetration Pricing: Starting with initial low prices and then increasing with respect to
services, newer equipments and quality of services.
4.? Discount Pricing: For large quantities giving discounts to the number of patients or offering
seasonal discounts.
5.? Perceived value quality/Price pricing: Premium pricing, high quality and high price, super value
pricing, high quality at low price, good volume strategy, good/medium quality at low price,
economy pricing offering low quality for low price.

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Buying behavior of any customer depends on multiple internal and external factors. Various
types of buying behaviors are:
1.? Complex Buying Behavior: Consumers engage in complex buying behaviors when they are highly
involved in purchase and aware of significant differences between the brands. First, buyers
develop attitude towards that product, then make thoughtful choice about that product. This is
usually done in relation with the product which is expensive, though ought infrequently, risky and
highly self expressive.
2.? Dissonance Reducing Buying Behavior: This type of buying behavior usually come when
customer is highly involved in purchase but reacts little to difference in brands. Buyers will shop
around to learn what is available but will buy fairly quickly responding to good price or to
purchase convenience.
3.? Habitual Buying Behaviors: Here products are bought under condition of low involvement and
absence of significant brand differences. They have little involvement in product category. They
reach for the brand just by their habit. They don¶t search extensively for the product information or
characterization but they make decision by their habits. Here process begins with brand beliefs
formed by passive learning and is followed by purchase behavior which may be followed by
evaluation.
4.? Variety Seeking Buying Behavior: Here, buying situations are characterized by low involvement
by significant brand differences where customers do lot of brand switching. Brand switching
occurs just for the sake of variety rather than dissatisfaction.
There are many of internal and external factors which influence buying behavior like cultural
factors in which comes subculture and social classes. Then comes social factors like reference
groups, family, social roles and status. Then buyer¶s behavior is also influenced by personal
factors like age and stages in life cycle, occupation, economic circumstances, personality and self
support. Other important factors which influence buying behaviors are psychological factors like
motivation, perception, learning beliefs and attitudes.
As healthcare professional one has to think all these factors influencing buying behaviors as
well as all the types of buying behaviors. Because to-days world has become so much professional
and competitive that you want to compete with others you have to think even single factors among
of the above.