COMPREHENSIVE STUDY OF OUT PATIENT DEPARMENT SERVICES IN MADANAPALLE AREA

Transcription

1 Original Research Article Hospital Management International Journal of Pharma and Bio Sciences ISSN COMPREHENSIVE STUDY OF OUT PATIENT DEPARMENT SERVICES IN MADANAPALLE AREA SRUJAN JOEL PAUL* Department of Hospital management, Annamalai University, Chidambaram. ABSTRACT Various dimensions of patient satisfaction have been identified, from medical care to interpersonal communication. Well-recognized criteria include responsiveness, communication, attitude, clinical skill, comforting skill, amenities, food services, etc. Patient satisfaction with the healthcare services largely determines their compliance with the treatment and thus contributes to the positive influence on health. This study was therefore undertaken with the aim to find out the level of patient satisfaction related to different parameters. It de-notes the extent to which general health care needs of the patient are met to their requirements. The most important reason to conduct patient satisfaction surveys is that they provide the ability to identify and resolve potential problems before they become serious. This study was designed to assess the patient satisfaction regarding the services provided in out-patient department. The respondents were satisfied with the availability of services, waiting time, professional care provided by consultant in OPD, behavior of consultant, nurse s and paramedical staff s. They were unsatisfied with toilet and drinking water facility present in OPD, approach to pharmacist, understanding illness after consultation with doctor and difficulty in telling private thing with doctor. So it is recommended that as OPD services are an important part of health care services in hospital, they need to be improve with special emphasis on improving facilities. KEYWORDS: Patient Satisfaction; Health Care Services; Outpatient Department; Professional Care. SRUJAN JOEL PAUL* Department of Hospital management, Annamalai University, Chidambaram. Received on : Revised and Accepted on : DOI: B- 818

2 INTRODUCTION Patient satisfaction is multifaceted and a very challenging outcome to define. Patient expectations of care and attitudes greatly contribute to satisfaction; other psychosocial factors, including pain and depression, are also known to contribute to patient satisfaction scores. Historically, physicians, especially surgeons, have focused on surgical technique and objective outcomes as measures of patient satisfaction, while patients place great value on the surgeon patient interaction. Patient satisfaction has been an important issue for health care managers. Many previous studies have developed and applied patient satisfaction as a quality improvement tool for health care providers. Following increased levels of competition and the emphasis on consumerism, patient satisfaction has become an important measurement for monitoring health care performance of health plans. This measurement has developed along with a new feature: the patient's perspective of quality of care 1.Outpatient Department in any hospital is considered to be shop window of the hospital. There are various problems faced by the patients in outpatient department like overcrowding, delay in consultation, lack of proper guidance etc that leads to patient dissatisfaction. Now days, the patients are looking for hassle free and quick services in this fast growing world. This is only possible with optimum utility of the resources through multitasking in a single window system in the OPD for better services 2, Patient satisfaction is as important as other clinical health measures and is a primary means of measuring the effectiveness of health care delivery.3 Patient satisfaction denotes the extent to which general health care needs of the clients are met to their requirements. Patients carry certain expectations before their visit and the resultant satisfaction or dissatisfaction is the outcome of their actual experience. 4,5,6,7 The purpose of health care services is to improve the health status of the population. There is now broad agreement that health services should be comprehensive, accessible and acceptable, provide scope for community participation and available at a cost the community and country can afford.8 The data gathered by measuring patient satisfaction reflects care delivered by staff and physicians and can serve as a tool in decision-making. Patient satisfaction surveys can be tools for learning. They can also serve as a means of holding physicians accountable. Patient satisfaction data can also be used to document health care quality to accrediting organizations and consumer groups and can provide leverage in negotiating contracts. Probably the most important reason to conduct patient satisfaction surveys is that they provide the ability to identify and resolve potential problems before they become serious. They can also be used to assess and measure specific initiatives or changes in service delivery. Most importantly, they can increase patient loyalty by demonstrating you care about their perceptions and are looking for ways to improve. 3 he present study made an attempt to focus on various aspects of health care provided by Tertiary Care centre in relation with patient s satisfaction 3,Originated in mid 17th century by Sir George Clark In hotel Dieu in Paris: 6 Physicians were detailed for regular session on Wednesday or Saturday advising poor individually, in turn which introduced the idea of OP clinic. Modern OPD services emerged in 1850 in USA from frame work of dispensaries. General Practitioner ~ Physician ~ Specialist opinion ~ Institutional Care V/s Domiciliary Care Section of the hospital with allotted physical facilities Regularly scheduled hours and personnel in adequate numbers, assigned for established hours, To provide care for patients who are not registered as in- patients while receiving Health services Preventive Health activities Well baby clinics ANC, marriage counselling, planned parenthood etc School health clinic. Control of communicable diseases early diagnosis & detection of chronic diseases like Cancer, TB, RHD etc. Health education & nutritional advice Rehabilitation & prevention of disabilities & handicaps 4, Types Any person given general or emergency diagnostic, therapeutic or preventive health care and who at that time is not registered as an in-patient in the hospital Two types of OP services v Centralized Outpatient Services All services are provided in a compact area which includes all diagnostic and therapeutic facilities being provided in the same place vs Decentralized Outpatient Services: Services are provided in the respective departments General out patient All the patients other than emergencies who report directly to the OPD Emergency out patient A person given emergency medical care for condition which is real or perceived emergency. Referred out patient A person referred to an OPD by his attending medical/dental practitioner for specific diagnostic / treatment procedure Staffing depends upon objectives of department and volume of work load. Ancillary staff in OPD e.g. X-Ray, EEG & ECG technicians. Clerical staff to carry out registration patient billing, cashiering etc. In teaching hospital interns and residents assisting physicians. Receptionist & other volunteer staff 5. Principles of Planning Layout Principles Patient flow should move in one direction to avoid undue back traffic. Sharing with the IPD, All Diagnostic facilities, such as X-Ray & pathology laboratory. Should be amenable for expansion without serious dislocation of work. Layout Double loaded single corridor with rooms on each side of the corridor Double corridor for entry from the opposite sides of the room. Triple corridor which provides two rooms of examination treatment rooms on each side of a staff corridor Double corridor for entry from the opposite sides of the room. Triple corridor which provides two rooms of examination treatment rooms on each side of a staff corridor Size Of OPD Type & number of specialist clinics, Timings of OPD, Number B- 819

3 of daily OPD patients, Number of attendants accompanying the patient, Availability of space, Plans for future expansion, Some Recommendations A/c to BIS(Bureau of Indian Standards): For Entrance Zone -2 sq.meter/bed. Ambulatory Zone - 10sq.meter/bed. Diagnostic Zone- 6sq.meter/bed. Total hospital area- 60sq.meter/ bed. Physical Facilities Physical facilities categorized into 4 groups: Public Areas(Entrance zone) Clinical Areas(Ambulatory zone and Diagnostic zone) Administrative Areas Circulation Areas 6, Equipment Equipment related to specialty examination should be available in concerned room. Each consultation cum examination room should have- Work table, physician s desk, wall mounted cabinets, X-ray view box, revolving stool, wash basins, instrument trolley, chairs beside examination couch. All OPD should have equipment for resuscitation of patients collapsing suddenly 7, Work flow The no. of patients visiting OPD depend on many Factors Location of hospital Community needs Programme & resources Season of the year Transport & Communication Out Patient visits New outpatient visit Repeat outpatient visit Ratio between New: Repeat=Varies between 1:1 TO 1:2 Daily OPD Attendance : Usually 4 per In-patient bedor 10 per daily admission. Thumb Rule : 4 patients for every bed each day about 40% new & 60% old Problems in OPD : Patients overcrowding, Long waiting time, Probable reasons : wrong planning of departments, Restricted registration time. Absence of appointment system, Shortage of staff 8 Organization and Managerial Considerations Policy The policy should be able to achieve continuity of high quality patient care with modern techniques & methods. Procedures Managerial Considerations Public Relations OPD timing Management structure Waiting time (Queuing theory, Patient Scheduling)Flow of patient should be smooth, easy & quick Provision of no of sufficient staffs Monitoring and Evaluation Volume: Clinic/department wise statistics of new and repeat visits on monthly and yearl basis. Percentage change in new and repeat visit. Fluctuation in visit by day of week(month)- average, high and low. Utilization and vital statistics: Average number of visit per person/year, vital statistics of population(age & sex). Visit Levels: (New & old visits) Costs and revenues: Cost of each service should match with revenue Gender wise calculation of patient Calculation of PEDIATRIC & GERIATRIC visits Hospital utilization statistics. B- 820

4 The statistics pertaining to OPD services as follows Number of new cases. Number of repeat cases. Specialty wise break-up cases. Unit wise break-up of cases. Age & Sex distribution of cases. Diagnostic statistics Daily average outpatient attendance Total no. of OPD attendance during the period No. of OPD working days during the period Average outpatient attendance per patient: (Average duration of the spell of sickness treated in OPD) Total no. of OPD attendance Total no. of new cases 9 Queuing theory definitions The basic phenomenon of queuing arises whenever a shared facility needs to be accessed for service by a large number of jobs or customers. l(wolff) The primary tool for studying these problems [of congestions] is known as queuing theory. l(klein rock) We study the phenomena of standing, waiting, and serving, and we call this study Queuing Theory." "Any system in which arrivals place demands upon a finite capacity resource may be termed a queuing system. l(math world) The study of the waiting times, lengths, and other properties of queues. Characteristics of queuing systems Arrival Process The distribution that determines how the tasks arrives in the system. Service Process The distribution that determines the task processing time Number of Servers Total number of servers available to process the tasks Queuing technique Determination of waiting time, cost of waiting time & its reduction, identification of bottlenecks. This technique is used to analyze alternatives & arrive at solutions to many of all these problems 10. Modules Services Management This module will take care of services provided by the hospital. Rate of services is charged by rules of hospital. It will consider panel, Night Charges, Emergency charges, Age of patient and other parameters while calculating the rate of services for a particular patient Patient Management Every patient treated in hospital will be given unique Patient ID which is useful in tracking visits of patients. All patients data is useful for MRD purposes OPD Management OPD Registration When a patient comes to the reception desk, A new registration number is automatically Allotted to him. His personal details like Name, Age, Sex, Address etc. and the services desired are feeded into the software.opd Billing / Collection Billing of all OPD patients with complete details of Patient Information, Services provided like Consultation, Laboratory, X-ray, Ultrasound, Medicines, Procedures etc. along with Payment details. IPD Management IPD registration When a patient comes to the reception desk for admission, A Separate new registration number is automatically allotted to him. His personal details along with the details of Admission, Room, Consultant, Surgeon, Diet, etc. and the Advance Payment made are fed into the software. The Software will record all this information and print the related documents. IPD Billing On-line billing of all IPD patients with details of Patient Information, Services provided on daily basis like Room rent, Operation, Delivery, Oxygen & Other Gases, Consultation, Nursing Charges, Laboratory tests, X-ray, Ultrasound, Medicines, Procedures etc. IPD Collection of part payment along / Full Payment details/ Refunds/Credit Notes. This information will provide the data for all MIS reports. Discharge Summary After the discharge of patient discharge summary can be automatically generated with just few press of keys. Laboratory data can automatically be imported. Specialty wise standard format can be set. Consultant Management Tracking of consultant share for OPD / Indoor procedures. Option for defining consultant shared based on procedures/department. Classifying visit of patient as new / old for that consultant Store Management 1. Maintain Purchase order with due dates of delivery 2. Maintain MRN and Issue slips 3. Maintaining Stock, Reorder levels and show appropriate warning. 4. Bills can be adjusted against the payments made at other department Laboratory Management As the test is booked at reception request is automatically send to laboratory. Lab can feed the result later and prints attractive reports. Security Management Role base security will be provide to user. Client-server architecture will be followed. Pharmacy Management Complete pharmacy shop can be managed through this module. Additionally it can be linked to main billing. As patient collects medicines from pharmacy shop their charges will automatically transfer to patient billing. Radiology Management As the tests related to radiology is booked at reception request is automatically send to radiology department. Medical Data This module will take care of all medical data of patient. Patient's intake, outtake, Medication, reading etc. TPA (Penals) Pre-admission forms for different TPA can be set. After admission limit of Panel's approval will be taken care of. B- 821

5 Reception Management Status of any patient/doctor can be queried from this module e.g. timing of consultant, residential address/patient room search. MRD Management Keeps history of all patient. Data analysis can be further done on any field Keeps truck of the ICD numbers/bed days per consultant and other MRD Records MIS Reports It will provide vital and key reports to management. All the Further we are planning to incorporate graphical analysis of reports. Payroll & HRD Management Complete salary can be computed through this module. This module can be attached through Time machines also. All necessary formats can be generated through this module. Accounts Management Financial accounts All purchase, expenses,payments can be feeded in this module. Receipts can be directly imported from OPD and IPD department. Balance sheet 11, Objectives 1. To study the out-patient s disposition towards the reliability of services offered by public and private hospitals. 2. To study the impact of behaviour and personal attention of doctors and staff on out-patients in public and private hospitals. 3. To study the impact of healthcare services on the revisit and referral intentions of out-patients in public and private hospitals. 4. To identify the average time spent by the patient in the OPD. If the waiting time is high, then identify the factors those are responsible for high waiting time in the OPD. 5. To recommend appropriate suggestions to optimize the waiting time in OPD 12. MATERIALS AND METHODS Source of Data collection To accomplish the objectives of the research work, data was collected from two main sources Primary sources of data Primary data was collected by the means of questionnaires. This data was collected from the general patients Medicine OPD (three units) Secondary sources of data Secondary data was collected from various books, journals and internet. Sampling method Convenience Sampling Sample Size 105(35x3 units) Sample size calculation No of patients Calculation Unit 1 Unit2 Unit3 total live total per day Real total per day Repeat Only repeat Month(April) 8 working days Average per day Number of days per month/total Average sample 10%of total Sample size 10%day sample Inclusion criteria In this study, only the repeat patients were included. The reason for including the repeat patients is that they have encountered the service and other facilities in the medicine OPD before and they would better articulate their perceptions of previous visit and the present one. They will be in the state of saying whether there is any improvement in the OPD services since the management has implemented many changes. Exclusion Criteria In this study, the new registration patients are excluded. The reason for excluding the new registration patients is that they are encountering the OPD services for the first time and they might not know the facilities offered before and they might resist revealing the facts. Process of the Study The whole process of conducting the survey about the how user friendly is the OPD went on like this: 1. After taking permission from relevant authorities, a brief study and observation of the Out-patient department was made.after gathering relevant information about the out-patient department, a pilot study interview was conducted and accordingly a questionnaire was specially made to measure the friendliness of the out-patient department at Madanapalle area hospitals. 2. Then the researcher distributed the questionnaire to the patients in the medicine OPD and also the patients were explained about the purpose of the study. 3. The sample size was considered to be 105 and accordingly data was gathered. 4. Then at last the data so collected was analyzed and conclusions were drawn. And several suitable recommendations have been suggested. Analysis of the Study A pilot study interview was conducted with the randomly selected patients who encountered OPD services. This has been done through informal interview. The result derived in that interview was considered and framed as questionnaire to conduct a survey. This is to find out how user friendly is the out-patient department. The B- 822

6 questions in the questionnaire are divided into five categories. Patient s Perception on OPD Response of the staff Infrastructure & other facilities What OPD should continue doing? What OPD should stop doing? What OPD should start doing? Research Instruments 1. Questionnaire: It was distributed to the medicine OPD patients only. 2. Interview: Interview was conducted among staff and trainees to know what difficulties they face in delivering effective patient care. 3. Observation & comparison: The researcher observed and compared the NABH standards with the current functioning of OPD and also studied the OPD documentation to know the gap between the documentation and real service provided 13. RESULTS AND DISSCUSSION Number of respondents In this study, as stated in the research methodology, the researcher focuses on the repeat patients of the OPD. From this question, it is sure that the survey covers only the repeat patients and not the new registration patients. Table 1 Number of respondents Table 2 Service respondents From the above question, it is clear that 61.9 % patient feels that overall OPD service is better now, 3.8 % patient feels that it worse now and 34.3% feels that it is the same now. Response of the staff From this question, the researcher would like to find out the response of the staff especially whether the staff listens to the patients. It is clear that 42.9 % of patients rates excellent and 46% of patients rate it as good. From this statistics, it is clear that the patients feel comfortable since the staff listens to them. B- 823

7 Table 3 Response of the staff Table 4 Response of the staff new service Response of staff From this question, the researcher would like to find out the response of the staff especially whether the staff spends enough time with the patient. 27.6% of patient rates as excellent and 56% of patients rates as good which means the staff are spending enough time with the patients in OPD Table 5 Response of the staff-advice and treatment Response of the staff and nurses From this question, the researcher would like to find out the response of the staff especially whether the staff gives good advice & treatment to the patients. 31% of patient rates as excellent and 48 % of patients rates as good. From this response, it is clear that the staff gives good advice & treatment to the patients 14. B- 824

8 Table 6 Response of the staff nurses and medical assistants Response of the staff-friendly and helpfulness From this question, the researcher would like to find out the response of the staff especially the nurses & medical assistants. Only 21% of patient rates as excellent and 54.4 % of patients rates as good yet 3% of patient rates it as poor 15. Table 7 Response of the staff-friendly and helpfulness Infrastructure From this question, the researcher would like to find out the response of the staff especially whether the staff friendly and helpful to the patients. 32% of patient rates as excellent and 49 % of patients rates as good. From this response, it is clear that the staff are friendly and helpful to the patients. Table 8 Infrastructure Ease of finding From this question, the researcher tries to find out the infrastructure facilities available to the patients are satisfactory. 60.7% of patients rates it as excellent or good but 39.2% of patients rates as fair or poor. From this it is clear that though most of the patients are satisfied with the cleanliness, the management should take further step in improving the same since 39.2% are not satisfied with cleanliness. B- 825

9 Table 9 Ease of finding Time in examination room From this question, the researcher tries whether the patient finds it easy to find his way to the respective department without much confusion. 48.5% of patients rates it as excellent or good but 51.4% of patients rates as fair or poor. From this it is clear that half the sample not satisfied with the OPD infrastructures which provide directions. The management should consider this statistics and provide sufficient directions without confusing the patients. Table 10 Ease of finding Waiting of tests to be performed From this question, the researcher tries to find out what the patient perceives about the time taken in examination room. 69.2% of patients have rated as excellent and good but 31.8% of patients have rated as fair and poor. This shows that most of the patients are satisfied with the time spend on the examination room. Table 11 Waiting of tests to be performed Waiting for results From this question, the researcher tries to find out what the patient perceives about waiting for tests to be performed. 62.7% of patients have rated as excellent and good but 37.3% of patients have rated as fair and poor. This shows that most of the patients are satisfied with the waiting time for tests to be performed yet 37.3% are not that satisfied with waiting time for tests to be performed so this issue should be considered and further actions need to be taken B- 826

10 Table 12 Waiting for results Privacy and dignity maintained From this question, the researcher tries to find out the patients perception while waiting for results. 17.3% of patients have rated as excellent, 39.4% as good, 39.4% as fair and 3.8% as poor. Though patient s perception might vary, the time involved in giving the results varies according to the test. If the waiting time include some other issues other than examining the results have to looked and action has to be taken. Table 13 Privacy and dignity Interpretation From this question, the researcher tries to find out whether the privacy and dignity of the patient is maintained while they encounter service in OPD. 89.5% of the patients have rated as excellent & good. It is clear that the patients are treated with dignity and their privacy is maintained CONCLUSION Most of the respondents were satisfied with the availability of services, waiting time, professional care provided by consultant in OPD, behavior of consultant, nurse s and paramedical staff s. They were unsatisfied with toilet and drinking water facility present in OPD, approach to pharmacist, understanding illness after consultation with doctor and difficulty in telling private thing with doctor. So it is recommended that as OPD services are an important part of health care services in hospital, they need to be improve with special emphasis on improving toilet facility, drinking water facility and approach to the pharmacist. CONFLICT OF INTEREST Conflict of interest declared none. REFERENCES 1. Dr.Satpal Singh, Dr.Vikas Kumar, SATISFACTION LEVEL OF PATIENTS IN OUT- PATIENT DEPARTMENT AT A GENERAL HOSPITAL, HARYANA[internet] 6 ( 1)(cited 2015 January 2 (2015), pp ,Available at: r/satisfaction%20level%20of%20patien TS%20IN%20OUT%20PATIENT%20DEPARTME NT%20AT%20A%20GENERAL%20HOSPITAL% 20HARYANA/SATISFACTION%20LEVEL%20OF %20PATIENTS%20IN%20OUT%20PATIENT%2 0DEPARTMENT%20AT%20A%20GENERAL%20 HOSPITAL%20HARYANA.pdf B- 827

11 2. Dr. S. K. Jawahar MHA, DNB (Health Administration), A STUDY ON OUT PATIENT SATISFACTION AT A SUPER SPECIALTY HOSPITAL IN INDIA, [internet] 2(2), (cited 2007 december 6)pp 89-93, Available at: akspublication.com/paper03_jul-dec2007.htm. 3. Arvind Sharma1, P K Kasar2, Richa Sharma3, PATIENT SATISFACTION ABOUT HOSPITAL SERVICES: A STUDY FROM THE OUTPATIENT DEPARTMENT OF TERTIARY CARE HOSPITAL, JABALPUR, MADHYA PRADESH, INDIA,[internet] (cited 2014 April 12); 5(2): Available at: 4. MINAKSHI GAUTAM, OUT PATIENT DEPARTMENT, [internet] [updated 2012 june 15;cited 2012 nov 5],Available at: makeourway. weebly.com/uploads/1/3/7/2/ /4._out_pat ient_services.pptx 5. Lisa Brandenburg, Patricia Gabow, Glenn Steele, John Toussaint, and Bernard J. Tyson*, Innovation and Best Practices in Health Care Scheduling, February 2015[internet] 9(2),(cited 2009december 26)pp Availabale at: SchedulingBestPractices.pdf 6. Franklin Becker and Kelley S. Parsons, Hospital facilities and the role of evidence-based design, September 2013[internet] 5(4),(cited 2007 december)pp ,availabale at: human.cornell.edu/files/2013/09/hospital-facilities -and-the-role-of-evidence-based-design- 1cjmn37.pdf 7. David Mutia 1, 2* John Kihiu 1 Stephen Maranga 1, Maintenance Management of Medical Equipment in Hospitals,februvary 2012,[internet] 2(4),(cited 2012december)pp ,Availabale at: article/viewfile/1619/ Carol Cain; Saira Haque, Organizational Workflow and Its Impact on Work Quality,april 2008[internet] 2007 Jul-Aug;14(4):415 23, Availabale at books/ NBK2638/ 9. Russell Cropanzano, David E. Bowen, and Stephen W. Gilliland, The Management of Organizational Justice,November 2007,[internet] 2(4),(cited 2012december)pp34-41,Availabale at: adings/cropanzano_etal_2007_organizational_jus tice.pdf. 10. S.Shanmugasundaram and P.Umarani, QUEUING THEORY APPLIED IN OUR DAY TO DAY LIFE,April 2015[internet] 6, Issue 4, April Available at: paper/queuing-theory-applied-in-our- DAY-TO-DAY-LIFE.pdf 11. Byoung K. Choi Donghun Kang, SIMULATION- BASED OPERATION MANAGEMENT OF OUTPATIENT DEPARTMENTS IN UNIVERSITY HOSPITALS,march 2013[internet]Available at: files /201.pdf 12. Varun Virmani, Waiting Time Analysis of Outpatient Department at Gmers Medical College Hospital Valsad, February 2014, [internet] Available at: international-journal-of-scientific-research- (IJSR)/file.php?val=February_2014_ _0c336_90.pdf 13. Dana Lynn Driscoll, Introduction to Primary Research: Observations, Surveys, and Interviews, march 2011, [internet]available a colostate.edu/books/writingspaces2/driscoll-- introduction-to-primary-research.pdf 14. Ann Kutney-Lee, Development of the Hospital Nurse Surveillance Capacity Profile,april 2009, [internet]available at: gov/pmc/articles/pmc / 15. Shibu John,Rasika Sharma,Manoj Kumar Dhingra, Role of Employee Satisfaction in Influencing Patient Satisfaction, December 2013, [internet] Available at: com/ejournals/showtext.aspx? ID=5150&Type=FREE&TYP=TOP&IN=_eJournal s/images/jplogo.gif&iid=396&ispdf=yes. B- 828

12