Hospital Industry

CHAPTER

TITLE Acknowledgement

PAGE NO. 3 4 5 6

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Introduction Motivation Research

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objective Research problem Variables Scope and Limitations 2) 3) 4) 5) Literature Review Methodology Findings and results Recommendations & Conclusions Bibliography Annexure 6

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8 18 24 25

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Acknowledgement
I wish to thank my guide Prof Gowri Joshi for her continuous support. Without her, this project would not have been possible. I would also like to thank all my professors who have helped me during this project. I also wish to thank to all the people in the project with whom I have interacted and who have provided me with valuable insights. 2

A special thanks to all the respondents I met during the survey for the project.

Introduction
A hospital as a health care organization has been defined in varied terms as an institution involved in preventive, curative, palliative or rehabilitative services. However, the definition given by WHO is quite exhaustive and exclusive, in which it is defined as, an integral part of the medical and social organization which is to provide for the population complete health care, both curative and preventive, and whose out-patient services reach out into the family in its home environment. The hospital is also a centre for the training of health workers and for bio-social research .

Hospitals, these, days also provide bio-social research, teaching and training facilities for all the members of the hospital, and a health team which includes not only doctors and nurses, but also Paraprofessionals, paramedical, pharmacists, etc. operationally, a hospital could be viewed as consisting of service facilities for out-patient, in-patient, general wards, emergency, special wards, intensive care units, operation theatre, delivery suite, and support services, such as pharmacy, radiology and imaging, blood bank, laboratory, etc. Most of the hospitals are professionally managed, with the objective of providing prompt, adequate, continuous and satisfactory services to the patient because their prime consideration is providing quality health care.

Motivation
A hospital is an institution for health care providing patient treatment by specialized staff and equipment. A hospital today is a center for professional health care provided by physicians and nurses. A hospital is a place which is quintessential for mankind. Everyone needs a hospital, and is dependent on the doctor whenever they are fall sick. Hence, I was willing to know about the human resource management techniques adopted in hospitals so that they could achieve maximum level of patient satisfaction, by providing good services. People working in this industry have to perform their work in a very professional manner as there is no space for errors because it can cost a person his or her life. And hence to provide good services, these
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people should be properly trained and proper incentives should be given to them so that they enjoy their job. I selected this project because I was willing to know the level of patient satisfaction in private hospitals like Lilavati. I was once admitted in Lilavati and hence was aware of its services and was willing to know the level of patient satisfaction.

Research objectives
1. Understand the process of development of human resources which is mainly done by training, performance appraisal and career development 2. Find out the level of patient satisfaction

Research problem
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There are certain industries which are quintessential for mankind to survive. The hospital industry can be counted one amongst them. This industry has certain responsibilities towards society which cannot be avoided at any cost. Hence, it is absolutely necessary for it to operate in a very professional manner as there is no scope for errors as it can cost a person his/her life. This project will try to cover what is required for this industry to function in an efficient and effective manner. Effectiveness of a hospital is to a large extent dependent on quality of service delivered and the work effort expanded by its employees. Therefore, the HRM function is critical and cardinal for the efficient and effective operation of a hospital as an organization. A hospital is largely dependent on the employees. A hospital has to take care of its employees in order to attain maximum level of patient satisfaction.

Variables
Independent variable-Hr policies and practices in hospital industry Dependent variable- Level of Patient Satisfaction

Scope
The hospital industry is quintessential for mankind. Everyone needs medical care. This project shows the HR policies and practices that are adopted in various hospitals and its impact on the performance of the hospital s employees. Hr policies adopted by any hospital have a direct effect on the level of patient satisfaction. It will help establish a correlation between the two variables that will in turn help the industry judge the positive effects of good HR practices and adopt best practices within the industry to increase customer satisfaction and thus increase recall rate and profits for the organization. It will serve as a vital tool to gauge the relevance of good HR practices and the cost involved in adopting them. 6

Limitations
The limitations that I faced while undertaking this project were y I faced immense trouble in convincing the high authorities of the hospital to let me undertake this research project in their premises. y y y There was a lack of support from the top management of the hospital. I also faced high level of resistance by the employees to disclose their internal policies. The patients and their family and friends were hesitant in talking freely to a complete stranger since this industry involves a high level of trust in a doctor-patient relationship. y Also the sample size covered by me is too small to generalize the findings for the entire population. y Demographic and income variations are other hurdles that I faced while working on this project.

Literature review
Human resource plays a very significant role in effective performance of a hospital which depends to a great extent on the quality of its staff. The better the quality, the higher the level of performance. Hospital is a place where, on one hand, we have highly skilled personnel such as doctors and on the other; we have unskilled workers such as sweepers.

Management has been using the traditional tools which are basically coercive in nature (such as, punishment, suspension, degradation and discharge) to control the employees but it is to be realized that these coercive measures are never productive. To control the staff effectively, modern management tools are to be adopted and coercive measures are to be replaced by persuasive ones. Let me illustrate it by an example. Suppose, a sweeper in a hospital is not in the habit of cleaning the lavatory on daily basis. He does it when told/reminded to do so. If you remind him every day, he will clean it every day. If you do not tell, he does not do. How are you going to tackle this problem? Those who believe in old management theory will follow the course of action as follow herewith: a) call the sweeper, b) describe him the problem, c) warn him of punishment if he does not perform/improve, and d) take action which may include removal from the job, if he does not show improvement. On the other hand, the management which practices the principle of persuasion will tackle the problem in a different way. They will talk to the sweeper, let him feel how important his job is and hence how important he is for the hospital. Such an approach will have a lasting impact on his mind. If necessary, short class room lectures may be held where the matters such as nosocomial infections etc. may be discussed. Having done so, a close watch may be kept on him. If necessary, one person may be deployed who will be after him to make sure that he cleans the toilet every day. In all likelihood, he will improve and cleaning toilets on everyday basis will become his habit. So, the focus should be on converting the duties of staff into their habits. Once the habits are formed, there is no need for reminders/ supervision and the staff will become a very valuable asset for the hospital. Management also faces problems in dealing with doctors. There will be a different set of problems while handling them. Doctors, to some extent, may like to be controlled by a senior doctor manager but not by a non-doctor manager. There are many reasons for the same and they need to be analyzed before any line of action is chalked out. 1) Doctors perhaps have education/knowledge superiority when compared with management professionals. They do not consider the management professionals at par with them and therefore, there is a problem of adjustment. 2) From the beginning, the subject healthcare has been under the control of state/central government. Public hospitals have doctors designated as medical superintendent who take care of the day to day administration of the hospitals. So, doctors have been

playing dual role. Now, it has been felt that healthcare institutions are not delivering results largely due to inefficient management. Therefore there is a trend to bring management professionals for hospital administration/management jobs. Doctors may not have much say in routine administrative matters and therefore, they are resisting the changes although they, too, are very much convinced that they are not best suited for management jobs and it will be in overall interest if they concentrate on clinical jobs only. Not being in the management job may lessen their authority/power on hospital staff and they find it difficult to accept these changes. 3) Doctors are not taught management in medical colleges. For them, hospital means doctor and doctor means hospital. So, they are not educationally equipped to appreciate the roles of management professionals in hospital administration. 4) Doctors were respected in the society. Now, monetary and other related factors have eroded this position. There is customer-supplier relationship between the patient and the doctor. Service of a doctor has become a commodity which is being sold off. Therefore, a need is being felt to hand over the management jobs to management experts only. Doctors, now, have started realizing it. So, doctors and management both need to change their attitude towards each other. Also, the management professionals need to introduce the essence of participative management while dealing with doctors. Doctors simply must not be ignored on the ground that it is none of their business. CME programme of doctors, too, need to be modified. Apart from the clinical subjects, CME should cover the various areas of hospital management. They should also cover the subjects such as development of personality traits and similar other topics so that it can prepare the doctors to adapt themselves easily to the need of hours. Also, there is need to develop positive attitude towards all the jobs of the hospital. A doctor may have to be in operation theatre, say for six hours and it may at appear tough but there is no shortcut to it. Similarly, a hospital administrator sits in the office and manages the affairs from there. There must not be seen any luxury in it. It is the demand of management profession. He cannot move now and then. He has to sit in the office and keep watch on various activities going on in the hospital. Since, he is virtually responsible for everything in the hospital; he cannot assign all the tasks to himself. He has to delegate and keep the control in his hands and play the role of a co-coordinator. Now, no comparison should be made between two jobs. The underlining spirit should be - all jobs are important. Therefore, handling the staff is a real challenging job. 9

Sacking/suspension/discharge is a easy way out to get rid of the staff we do not like but retaining them in job is a real difficult job and only an able hospital administrator can do it.

Human resources in hospitals: The changing face

Human Resources functions as a management tool is fast changing. The psyche people at work have also undergone a sea change. Hospitals unlike other industry are a different entity when compared to other industries. The role of this department and its head has a role cutout and exclusive. Unlike any other industry, the advent of technology, modernization, computerization, newer diagnostic and intervention

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techniques, has not reduced the need of human labor in hospitals, which is now an industry. On the contrary, there is a quantum growth in the need to appoint specialized manpower at various levels of patient care, which has emanated from the thought process of those professionals and promoters, who are enlightened with the need to induce QC in patient care. Hospitals shall always remain human intensive.

The role of the HR manager in a hospital is multifaceted and complicated too. Manpower planning and recruitment involves a lot of thought process. Training and development has to be a qualitative and quantitative activity, especially for those who are employed as junior doctors, nurses, front office, ward staff, housekeeping/ward attendants, F & B etc. Since these are the people who come in contact with the patient or his attendant, "FIRST". It is they who create the first impression and therefore, make or mar the reputation of the hospital. "The first four minutes and the last two minutes". In a scenario, where human labor is intensive, the need for an efficient human resources department [hrd] is a prerequisite.

It is debatable as to what qualitative experience should the front office, ward staff, possess. While some hospitals tend to appoint staff with experience in a hospital, this is debatable, especially when we are dealing with established Psyche and mindsets. Large multinationals prefer to select freshers or candidates from a different Industry, since they are sans mindsets and are easily moldable, by rigorous training.

The advent of corporate hospitals has changed the mindset of healthcare conscious people. Medical tourism, debates it further. A school of thought feels it prudent, to appoint people from the hotel industry, who are expected to possess faces and etiquettes in hospitality.

The nurses are the frontiers in a hospital, who need constant up gradation, training and development. They have to be constantly reminded of bedside manners. It is also perfunctory that their numbers are adequate. It differs from hospital to hospital. A broader perspective study revealed that on an average, about 20% of patient in a hospital are completely dependent, 40% are partially dependant and 40% are fully ambulant. It is observed that an average nurse works for 265 to 290 days a year. Therefore, as a thumbrule, 30% of the total nurses required should be added to the figure, due to leave necessities, which are religious, and for ceremonies like marriage. At least 15% should be male nurses. While doing 11

this exercise, it should be kept in mind that on an average, 60-65% beds are occupied at any given point of time. A section of the nurses should periodically be withdrawn from their posts and subjected to class room training, purely to upgrade them. It is a pre-requisite, that all nurses have the basic knowledge of working on a computer, since modern HIS software calls for online entries at all levels and departments.

Hospitals work 24 X 7 and are never closed. It is therefore perfunctory that requisite personnel are available round the clock. Festivals in our country are dime a dozen, beside offs, EL, CL, SL et al. It may not be prudent to suggest that the employee recruitment mix ratio should be based on religions and could be a better way of handling absenteeism, ensuring that, whatever be the festival or holiday, 66.5 % of the staff is available, at a given shift, enough for such exigencies.

To be successful, employees with leadership can be categorized into:

- Technical Those who belong to this category are highly specialized people, who deal with procedures, are analytical, conceptual, touch me not s, could be the doctors and nurses.

- Human Those who belong to this category are those who implement to achieve the goals of the organization, through the help of their subordinates and are deft in handling men and material. They are expected to have a high level of motivation and inevitably with an infectious attitude. They are available always, on a whistle, since for them, functionally, customer satisfaction is paramount.

- Conceptual Those who belong to this category are those who understand the nitty-gritty s of the PCDS [Patient Care Delivery System] have the ability to co-ordinate and can induce changes, with the first hand knowledge, as to how such changes can affect the chain and command. They are expected to visualize the larger picture of things to come. In fact their ability to take a decision and their personality as a whole essays the fabric of the organization. These handfuls few are the top level decision makers of the organization.

Human Resources, therefore needs to recruit an admix of the above, to be successful in their respective objectives. Be that as it may, the base line elucidates that whoever and wherever, the ability and skill to 12

deal with Human beings with their respective idiosyncrasies, is the key.

The power vested by default in the department of Human Resources is considerable. But it has to be understood that powers should be utilized to solve issues rather than use it for fascist attitudes. He should understand that the psyche in changed management issues is to delegate powers, trust and encouraging efficiency in subordinates, that makes the organization more efficient and successful. A tight fist has faded knuckles.

Human beings are the most important resources in health care. Machines and gadgets which are integral parts of health care require the human touch, expertise, and commitment for their full utility and application in delivery of health care. Therefore planning of human resources is the key to any health care provision. The objective of human resource (HR) policy is to a) attract, recruit, retain and develop competent personnel and b) create a continuously learning health care organization.

I. TARGET HUMAN RESOURCES IN HEALTH CARE The patient unquestionably is the focus of all health care personnel. While doctors, nurses, hospital attendants, technologists, clinical assistants and pharmacists are directly involved in providing OPD and ward care, administration, public relation, security, catering, laundry, electronics, civil, electrical and air 13

conditioning maintenance are involved in supporting the former for providing safe health care. Planning needs to be done for all these personnel and not only for the direct care givers.

II. IMPROVEMENT OF HUMAN RESOURCES This is done through three ways such as a) Work system, b) employee education, training and development, and c) employee well being and satisfaction. a) Work system: The aim of work system improvement is to get co-operation and collaboration among all employees. Health care employees look for good systems in place so that their endeavors would yield favorable results without any wasteful activities. They would like to participate and feel important in laying down these systems. A system that is thrust on them often breeds cynicism as they do not own it. In order to own the system they have to actively participate in designing it. While doing so a cross functional team across various sections brings about greater effectively and cohesion than an intra departmental team. Some of the examples of such teams are given under the following headings: (i) Design/organize formal/informal, temporary or long term units (teams). Infection control team, waste management team and quality improvement (QIP) team are some of the examples that have been doing good quality work in Tata Main Hospital. (ii) Encourage and motivate innovation through quality circle (QC), value engineering (VE) and suggestions. There are over 104 quality circles actively functioning in TMH. These are small circles of five members picked up from supervisors and workers who take small local problems and solve them with organization s support. Employees are encouraged to do cost savings without affecting the quality through intra or inter departmental teams. Suggestions are encouraged from the employees and wherever appropriate those are implemented. (iii) Encourage higher learning, give them higher responsibilities and help them identify their training needs. (iv) Encourage multi skilling and rotate their jobs wherever possible so that there is no boredom with the repetitive type of job. This has been implemented amongst the hospital attendants who rotate in various areas with different job specifications in the hospital. (v) Performance management system:

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Every level of employees must work with a purpose and their work must be Sr. Spl. & HOD, Tata Main Hospital 14 evaluated against their target from time to time so that they achieve their target at the year end. In TMH, this is done by giving targets to all doctors and officers in the form of key result areas (KRAs) which are reviewed twice a year. The annual appraisal identifies the super achievers who are recognized as fast trackers. They move aggressively and groom rapidly. (vi) Compensation, recognition and reward practices This could be non monetary or monetary. Non monetary recognition could be formal by a letter or informal by a pat on the back in front of other employees. Monetary recognitions are through promotions, special increment, joint department council (JDC) award or long service awards after 20 yrs, 25 yrs, 35 yrs and 40 yrs of service. (vii) Communication meetings at all levels Communication upward and down-ward helps inculcate among the employees a sense of oneness in the organization. This is done at a pre-decided interval regularly in TMH. (viii) Recruiting and hiring new employees while recruiting employees, the hospital must first identify the job requirement and while interviewing, an attitudinal and altitudinal survey of the candidate must be done. Transparency must be practiced while explaining to the candidate his/her future growth in the organization. The new employee should be made familiar to the working of the hospital through induction to various areas before he/she is finally posted to his/her place of work.

(b) Employee education, training And development Employees education, training and development should be a continuous process. Their training needs in terms of technical, managerial and behavioral aspects should be identified. Short term goals of training need to be directed towards customer satisfaction and reduction of cycle time and long term goals should be towards better technology. The important thing is to link their training with the patients need in the hospital they are working in. In TMH, the deployment of training has been done through regular continuing medical education (CME) for doctors, nurses and technologists, bed side teaching for doctors & nurses, training through joint departmental councils (JDC) for hospital attendants in subjects such as waste management and oxygen therapy. Communication with patients (or relatives) was identified through periodic surveys as one of the weakest links with our employees at all levels. This was repeatedly addressed through motivation, attitude and time management (MAT) programme which was designed by a group of highly motivated employees drawn from all sections in TMH. Having a 15

training programme in place is not enough. There has to be an evaluation system in place for monitoring the effectiveness of training. The parameters which need to be monitored should be directly related to patient well-being. Some such parameters could be catheter induced infection rates, mortality and morbidity parameters, feedback from patients and relatives, number of admissions for the same ailment and above all retaining the customer.

(C ) Employee well being and satisfaction Employee satisfaction is essential for a motivated work force. It will do what a state of the art technology cannot do in health care. This issue could be addressed under three heads such as i) work environment ii) work climate and iii) employee's satisfaction. (i) Work environment: A healthy work environment needs to be created where employees feel safe to work. Universal precautions need to be enforced; proper disposal of waste should be implemented; periodic health checkup for all the employees need to be done and hepatitis B vaccination should be compulsorily given to all the employees. The organization needs to identify and safeguard against unsafe practices. Serious 15 efforts have been made in the past two years in TMH to achieve the desired goals for all the employees in the aforesaid areas. (ii) Work climate: Every employee needs to be provided with certain awareness programmes and facilities for him or her to feel proud and being looked after by the organization. AIDS awareness programme, cooperative society, injury on duty (IOD) facility, subsidized (no profit - no loss) canteen facility, academic activity and library are some of the measures TMH has provided to improve the work climate. (iii) Employee s satisfaction: This is not an easy area to tackle. There are few hospitals where most of the employees are satisfied. Human mind is not satisfied with what it has achieved and therefore to expect that employees will be satisfied with certain facilities is far from being true; however the organization must collect feedbacks through formal/informal assessment methods and relate these findings to identify improvement priorities. This will at least make the employees feel that management is sincere about its concern for them. DNB course was started in TMH after identifying a long standing need of the graduate doctors in TMH.

III. CONCLUSION

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A satisfied human resource is valuable and has no alternative. Human beings needs Are dynamic and therefore to satisfy those the health care organization has to be dynamically thinking. Only then our most important customer, the patient, can get his just need fulfilled. Employee's growth and development should be the result of both the employer s responsibility and the employee s initiative. Appropriate timely rewards and recognition go a long way in retaining a motivated employee. Inspite of providing all the help and resources if certain human resources can t be molded to fit into the organization s needs, the organization should not hesitate to leave them behind. Tata s H.R philosophy attract good people, retain the better people and advance the best people is a right step in this direction. It may appear a bit harsh but at present it appears to be the only scope for a fast changing health care organization.

Research Methodology

Research Design

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The research design is descriptive in nature. Research is descriptive when there is lots of theory and study been done on the topic. There was theoretical research done on this topic. Descriptive research is mostly used and the basic reason for carrying out descriptive research is to identify the cause of something that is happening. The research type being descriptive, secondary research will form the base of the study. Also I floated a questionnaire amongst people from diverse background to gain an in depth understanding on my topic of study.

Sampling Design
The sampling technique used for the study is convenience sampling which is a non-probability sampling technique. It involves the sample being drawn from that part of the population which is close to hand. That is, a sample population selected because it is readily available and convenient. As time was a major constraint, I selected a sample of 50 people.

Data collection methodology

Both primary and secondary methods were used for data collection. I floated a questionnaire amongst people from diverse background to gain an in depth understanding on my topic of study. 50

respondents were a part of the sample that filled the questionnaire to facilitate my study. Secondary research i.e. various research papers and portals on the internet would act as a base for the theoretical part of the study. Sites like Wikipedia, EBSCO etc. would form the core part of the secondary research.

Primary data analysis

1)Patient satisfaction regarding services
According to the primary data collected from the hospital, 80% of the patients are satisfied of the service provided by the hospital staff. And 20% patients were hesitant about their remarks due to many 18

factors which made them believe that the services provided were not up to the mark. the services provided is very good and the doctors make us feel at home. We feel very comfortable at this hospital was a remark made by a satisfied patient who was admitted in Lilavati hospital.

quality of services
20% Satisfied Not satisfied 80%

2)Patient satisfaction regarding the cost involved

When i conducted the sample survey, 20 out of 50 people said that they had no issues paying a bit extra for the service provided. Only people who belong to a rich family are ready to pay for the treatment. They admitted that even though the costs regarding treatment are on the higher side they are inevitable costs which cannot be ignored. Although people admitted in government hospitals like K.E.M and J.J, felt that the treatment provided is similar in these hospitals but at a lower cost and hence they preferred government hospitals.

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cost involved

40% 60%

satisfied Not satisfied

3)Patient satisfaction regarding technology available

Patients admitted in Lilavati hospital said that as compared to other medical clinics and hospitals, they felt Lilavati had better facilities and better technology for their treatment. A patient who was been treated said that the hospital has the technology to cure the disease at even a very highly critical level and it was a cake walk for the doctors and that he had no issues choosing this hospital over others for his treatment regarding technology. While a few patients who have been treated outside India said the technology could get better. 42 out of 50, felt that the technology available was satisfactory.

Technology available
16% Satisfied Not satisfied 84%

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4)Patient satisfaction regarding the environment and hygiene

Most of the patients were satisfied regarding the environment and hygiene. As seen in the diagram, about 90% were satisfied but people who had earlier taken treatment from outside the country were not satisfied. People who earlier were admitted in government hospitals were not satisfied by the hygiene level maintained and the food provided to them in those hospitals and found Lilavati a better choice. Few patients also complained that the bed sheets were not changed on regular basis in government hospitals. Here 45 out of 50 patients were satisfied.

Hygeine level
10%

Satisfied Not satisfied 90%

5)Patient satisfaction regarding the attitude and behavior of the staff

Most of the patients were satisfied by the attitude and behavior of staff. They were happy with the way they are treated in the hospital and find the staff very friendly. People who earlier were admitted in government hospitals strongly opposed the behavior of the hospital staff in government hospitals. But people who were admitted in hospitals outside India were not satisfied. Only 2 out of 50, were not satisfied.

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Attitude and Behaviour

4%

Satisfied Not Satisfied 96%

6)Patient satisfaction regarding the explanation of procedure of treatment

Most of the patients were satisfied by the explanation of the procedure of treatment. This helped them to understand what exactly was wrong in them and what treatment is provided. But few patients treated outside India felt that the procedure of treatment was explained in a better and more understandable way. Here 36 out of 50 were satisfied.

Explanation of treatment procedure

28%

Satisfied Not satisfied 72%

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7)Patient satisfaction regarding accessibility

Most of the patients who were admitted in Lilavati felt that they did not have easy accessibility and felt that they had to wait for a longer period of time get medical care. 38 out 50 were not satisfied.

24% Satisfied Not satisfied 76%

8)Patient satisfaction regarding treatment available

The reaction of patients admitted were neither on the positive side nor on the negative side which showed that the treatment provided were not up to the mark. People still felt that the treatment available outside India is better. Out of 50, only 27 patients were satisfied.

Treatment available

46% 54%

Satisfied Notsatisfied

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Findings and result

On the basis of the survey and analysis it was found that: y The quality of services provided in Lilavati was much better than the services provided by government hospitals y The cost charged for the treatment was not justifiable as compared to that of the government hospitals but still people were willing to pay higher amount of money for getting better services. y Technology available at the disposal of the patients was much higher than compared to the technology available at government hospitals. y y A high level of hygiene is maintained at the hospital. The attitude and behavior of the hospital staff was friendlier as compared to the government hospitals. y Thus we can overall conclude that the quality of staff employed at private hospitals is much better than those working at government hospitals. y The patients treated at private hospitals are more satisfied than those at other hospitals.

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Conclusion and recommendations

All hospitals are more than just doctors and nurses that we see. The hospitals also function like any other organization involved in the core activities like finance, Hr etc. Since all hospitals fall into the service industry the people employed at the hospitals provide a competitive advantage to the organization. The reason being that it is the employee of the company that provides service to the customer through direct communication and its only in this sector that the production and consumption of the product occurs simultaneously. Hence the importance of a superior quality of staff is vital to dish out quality service to its customers. Thus the Hr policies and practices of an organization are crucial for its success. Good recruitment procedures, healthy performance appraisals, strong training team and a conducive working environment keep the employees happy which in turn motivates them to provide quality service to customers and results high level of consumer satisfaction. I reached to this conclusion during my survey at the hospital where I collected information on the HR practices through informal communication and observation of the environment since I was not allowed by the hospital authorities to conduct formal survey amongst hospital employees. Thus I conclude Happy Employees result in Happy Customers.

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Bibliography
www.yahoo.com www.google.com www.health.net ww.expresshealthcare.mgmt References Managing a modern hospital - A.V.Srinivasan Human Resources Management- S.F.ChandraShekhar

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Annexure
QUESTIONNAIRE

Name: Age: Gender: Hospital:

1.

You have easy access to the medical specialists in the hospital Yes No

2.

Quality of the services provided by the hospital were satisfactory Yes No

3.

The fees charged by the hospital was justifiable Yes No

4.

High level of technology was available Yes No

5.

The doctors explained the procedure of the treatment before starting the treatment Yes No

6.

The treatment provided was satisfactory Yes No

7.

High level of hygiene was maintained Yes No

8.

The attitude and behavior of the hospital staff was friendly Yes No

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