Case Study

Aim, Introduction, Methodology, Observation, Discussion, Recommendation, and Conclusion

Aim

To determine that employees of Civil Hospital, Amritsar are satisfied with their job, and to identify that

patients are satisfied with the medicines provided in the hospital.

Introduction

A hospital requires both patients and good employees to work efficiently. Patients are the customers of the

hospital and employees are its essential assets. Therefore, it is important to know that whether patients and

doctors both are satisfied or not. A research was required in the Civil Hospital of Amritsar to know that

whether the patients are satisfied with the free medicines provided by the Government pharmacy or not. The

Central Medical Store Organization prepares an Essential Drug List (Drug Formulary) which is developed by

a state level multidisciplinary committee keeping in view the WHO guidelines. Punjab Government provides

159 medicines and 27 consumables free to the patients visiting the Civil Hospitals of Punjab. The medical

store is responsible for purchase of all pharmaceutical and surgical products required in the hospital for the

treatment of patient. All products are purchased based on the reorder level calculated for each product.

Pharmacy purchases are done through (i) Central Medical Store Directorate (CMSD)- It is the primary

organization responsible for centralized purchasing of all pharmaceutical requirements for all the hospitals,

PHCs, CHCs, and Dispensaries etc under the purview of Health and Family Welfare Department, Punjab

Government (ii) Self- Purchase- Selection of vendors is strictly limited to those having a rate contract

agreement with the Hospital or PHSC and the rates of the product have to be approved by the Hospital or

PHSC. Purchase orders are issued directly to the authorized vendors by the pharmacy department of the

hospital depending upon the reorder level for the desired product. All payments in this regard will be paid by

the hospital from its approved budget (iii) Emergency Purchase- Few pharmaceutical items are purchased by

the hospital directly from the authorized vendors. Emergency purchase is made from identified medical store

selected on the basis of the following guideline: (a) It should be located in close proximity of the hospital. (b)

It should provide service on a 24 hour basis. (c) It should be ready to offer the product at a cost lower than the

maximum retail price (MRP). (d) It should have a good track record in terms of quality of products and honest

practices.

A flex board on the entrance of the hospital is placed in which names of all free medicines and consumables is

mentioned so that people visiting the hospital can know that these items are free in the pharmacy.

A research on Staff Job Satisfaction was also required because their dissatisfaction from the job can affect

their work performance which can ultimately hamper the functioning of the Hospital. The hospital employees

are classified into two broad categories (i) Permanent Staff – The permanent staff of the hospital are grouped

into three broad categories as per the educational qualifications, experience, seniority level and nature of work

of the individual staff. The three categories are- (a) Clinical Staff – These are the qualified and trained medical

practioners specialized in different branches of medicine. (b) Paramedical Staff – It consists of qualified and

registered Nursing Staff, Pharmacist, and Technicians. (c) Clerical Staff. (ii) Outsourced Staff: - The hospital

outsourced staff can be further classified as: (a) Contractual staff from outsourced agency (b) Daily Wages

worker engaged for short term basis. In this study both permanent and contractual employees participated.

Methodology

STUDY DESIGN

It is a cross sectional descriptive study. The study was conducted in the Civil Hospital of Amritsar, Punjab.

Only primary data was used in this study.

TIME

It was conducted from 9 April, 2013 to 7 June, 2013.

STUDY POPULATION

Employees and Patients of the Civil Hospital were the study population for this study. There are total 165

employees in the hospital allocated for morning, evening and night duties. The record for the number of

people taking medicines from the government dispensary is not maintained.

SAMPLE SIZE

In Staff Job Satisfaction Survey 45 questionnaires were circulated in the Hospital but only 33 responded.

Therefore, respond rate was 73 % only. Doctors, Para-medicals, Technicians, Staff for Registration,

Administration, Ancillary Services, and other jobs were involved and sample size of 33 had to be taken under

consideration. Only the Staff which works in the morning session was taken. For Patient Medicine

Satisfaction Survey sample size of 60 patients was taken for the observation. Only those patients who

approached the government dispensary for medicines were taken for the study.

VARIABLES

The descriptive variables for the Staff Job Satisfaction Survey were-

Evaluations are fair and objective

Consideration to their ideas and opinion is given

There is strong spirit of teamwork among employees

Employees receive praise and recognition

Grievance redressal system is fair

Compensation and other benefits are adequate

Salary is fair for the responsibilities assigned

Work Load is reasonable

Your supervisor/manager is a good leader

Duty schedules are fair

Equal opportunities are provided for training and development

The descriptive variables for Patient Medicine Satisfaction Survey were-

Do they know about the Flex board which has list of 159 medicines and 27 consumables

Do they know that these medicines and consumables are provided free to all patients visiting OPD

and Emergency

Did any doctor/pharmacist informed them about the list

Are they able to read the prescription written by the Doctor

Are they getting all the medicines from the hospital

From where they get the medicines which are not available in the hospital

Medicines provided in the hospital are of good quality or not

Do they face any problem while getting these medicines from the hospital

TOOLS & TECHINIQUES

To conduct these surveys pre-structured questionnaires were provided by the PHSC. Questions in Staff Job

Satisfaction Survey were bilingual i.e. they were both in Punjabi and English Language whereas; Patient

Medicine Satisfaction Survey was in English only.

Results

In Staff Job satisfaction survey 27% (9) Doctors, 21% (7) Para-medical, 9% (3)Technicians,

6% (2)Registrations, 12% (4)Nurses, 6% (2)Administration, 6% (2)Ancillary Services and 12%(4) people

from other job gave their feedback. 73% (24) Agree, 12% (4) Neutral and 15% (5) Disagree with the fairness

of the performance evaluation. 49% (16) Agree, 21% (7) Neutral and 30% (10) Disagree from the fact that

any consideration to their idea and opinions is given. 70% (23) Agree, 24% (8) Neutral and 6% (2) Disagree

with the fact that there is a strong team spirit among employees. 43% (14) Agree, 21% (7) Neutral and 36%

(12) Disagree with the fact that the praise and recognition are appropriate. 52% (17) Agree, 33% (11) Neutral

and 15% (5) Disagree with the fairness of Grievance redressal system. 12% (4) Agree, 21% (7) Neutral and

67% (22) Disagree with the adequacy of compensation and other benefits. 49% (16) Agree, 24% (8) Neutral

and 27% (9) Disagree with the fairness of the salary assigned as per responsibilities. 12% (4) Agree, 33% (11)

Neutral and 55% (18) Disagree with the fact that work load is reasonable. 64% (21) Agree, 30% (10) Neutral

and 6% (2) Disagree with the fact that their co-workers are cooperative. 76% (25) Agree, 21% (7) Neutral

and 3% (1) disagree that their supervisor or manager was a good leader. 79% (26) Agree, 9% (3) Neutral and

12% (4) Disagree with the fairness of the duty schedule. 49% (16) Agree, 24% (8) Neutral and 27% (9)

Disagree from the fact that equal opportunities are provided for Training & Development. Overall 52% (17)

people are Very satisfied, 42% (14) Neutral and 6% (2) are dissatisfied with the management of the civil

hospital as an employer.

In Patient Medicine Satisfaction Survey 55% (33) said No and 45% (27) said Yes when it was asked that do

they know the list displayed on the Flex board outside the hospital of 159 medicines and 27 consumables.

72% (43) said Yes and 28% (17) said No when it was asked that these medicines are provided free to the

patients visiting OPD and emergency. 47% (28) said Yes and 53% (32) said No when it was asked that

Doctor/Pharmacist informed them about the list of free medicines available. 33% (20) said Yes and 67% (40)

said No when it was asked that they can read and understand the written prescription. When it was asked who

explained them to take medicine 2% (1) said Pharmacist and 98% (59) said Doctor. 80% (48) said No and

20% (12) said Yes when it was asked that are they getting all these medicines from the hospital. When it was

asked that from where are they getting the medicines which are not provided or available in the hospital, 80%

(48) said they take from Market and 20% (12) said they take from Jan Aushadhi. 92% (55) said Yes and 8%

(5) said No when it was asked that the medicines provided from the hospital are of good quality and effective.

57% (34) said No and 43% (26) said Yes when it was asked that do they face any problem while getting the

medicines from the hospital.

Discussion

The Office Hour for the Civil Hospital of Amritsar is 9 am to 3 pm. Registration timing in summer is 8 am to

11 am and registration timing in winter is 9 am to 12 am. For Staff Job Satisfaction survey it was very difficult

to get the feedback from the doctors because they were all busy in the morning with patients. Senior Medical

Officer of Civil Hospital also requested not to approach doctors in Rush Hours. I started my survey from

nurses and they gave effective detail about good and bad points related to their job. There are 70 sanctioned

posts for nurses but only 38 are filled. Nurses had immense work load. 17 people are required for office work

but only 4 people manage everything. Posts for Sweepers and Sanitation workers were also vacant and those

who were present had not got any training for their work. Dissatisfaction was high in Nurses, sweepers and

sanitation workers. Many employees had neutral response. It was challenging to get the right response because

they had a fear that their responses may get them into any trouble. They need not had to mention their names

in the questionnaire and their privacy was completely hidden but then also many hesitated in their response.

No such survey was done in the hospital before therefore it was a new thing for them. I had to gain their

confidence before managing to get any feedback from them. Some took the questionnaire and promised to fill

it later but either they lost it or never filled it.

To conduct Patient Medicine Satisfaction Survey I waited near the government dispensary to catch those

people who were coming for the medicine or any consumable. I observed that maximum patients of

gynaecology and emergency department visited government dispensary. Among 159 free medicines only 50

were provided to the Civil Hospital of Amritsar. PHSC didn’t send all 159 medicines. Many medicines are not

in stock e.g. Rabies injection, Skin ointments, eye drops, ORS etc got finished two months ago. As limited

stock of medicines is left in the hospital therefore they only give three day medicines to each patient. Many

patients commented that they get some medicines in the hospital and rest they had to purchase from Jan

Aushadhi or Market. Some also told that they didn’t get any medicine at all. Some patients visited the hospital

first time so they were not sure about the quality of medicines but they managed to reply as per the feedback

they received from their friends and family members.

Recommendation and Conclusion

Feedback is very important to evaluate the strength and weaknesses of the work performance. Civil Hospital

of Amritsar should make a proper feedback system so that complains and problems of the employees and

patients both can come in light. This will help in taking the steps of improvement timely. Training of work

should be given to every employee on periodic basis or whenever required. Vacant posts should be filled

immediately so that work can be allocated efficiently. Demand and Supply analysis should be done in the

hospital. This will help in determining the quantity and type of medicines required in the hospital. The

medicines which hospital didn’t get should be provided by the government without any further delay.