VI

ANNEXURES

ANNEXURE 1: SAMPLE PROCESS CHART

Process Flow

Present Method PROCESS CHART

Proposed Method
SUBJECT CHARTED: DATE
CHARTED BY
CHART No.
DEPARTMENT SHEET No.
Distance Time in CHART SYMBOL Process description
in feet min.

Total
ANNEXURE-2: TIME STUDY OF DEPARTMENTS

Date Time study of patients at department of……………………

Patient Referring Arrival Wait time/ Service Departure Others

No. OPD Time Delay Time Time
ANNEXURE-3: QUESTIONNAIRE FOR PATIENT PERCEPTION TEST

Department: Questionnaire no.

1. While coming here what time did you anticipate it will take for treatment and what was the
actual time taken?
Anticipated time Actual time
Less than 30 minutes Less than 30 minutes
30 minutes -1 hour 30 minutes -1 hour
1-1.5 hour 1-1.5 hour
1.5-2 hour 1.5-2 hour
2-2.5 hour 2-2.5 hour
2.5-3 hour 2.5-3 hour
3-3.5 hour 3-3.5 hour
3.5-4 hour 3.5-4 hour
4-4.5 hour* 4-4.5 hour
* The regular OPD time is 9-1.30 i.e. 4.5 hours per day

2. What do you feel about the time taken at various departments/counters?

a. It could have been done in lesser time.
b. there was delay but this much time taken is acceptable
c. cannot say anything
d. there is no delay, this much time is needed for treatment
e. the services were delivered promptly and earlier than expected

3. Services of this hospital are

a. very late b. late c. normal d. prompt e. very prompt

4. Rate the fairness of the sequence (queue) in which patients are treated
a. extremely fair b. fair c. normal d. unfair e. extremely
unfair

5. Were you informed about the cause of waiting? Yes / No

6. Were you informed about the duration of waiting? Yes / No

7. How do you locate a department if you do not know the route?
a. try to find out on my own
b. by reading the signage
c. ask someone else

8. What is your reaction about delays?

a. irritates extremely b. somewhat irritates c. undecided/ never thought
d. okay for me (acceptable as part of life) e. never mind delays

9. Where do you think maximum delays take place?

a. In queue at registration counter
b. Searching for departments
c. In queue in a department
d. Waiting for the doctor/ nurse if they are absent
e. Medicine purchase
f. Going from one department to another department
g. For pathological tests
h. In radio-diagnosis
i. The doctor is busy in something else and takes longer time see the patients
j. Nurse is busy in something else and does not pay attention
k. Personal reasons like resting, waiting for other friends/ relatives etc.

10. Provided this much time taken this time next when you need to see a hospital/doctor, you
a. never come here again b. Prefer to go somewhere else c. cannot
say
d. still consider coming here e. definitely come here only
11. How did you find the waiting atmosphere?
a. boring b. normal c. not boring
ANNEXURE-4: QUESTIONNAIRE FOR DOCTORS

ALL THE QUESTIONS ARE WITH REGARD TO OPDs only. Department …………

(1.) How do you perceive the workload of service providers for the under mentioned departments?
1. Very high 2.high 3.normal 4.low 5.very low

department doctors Support staffs department doctors Support staffs

gynaecology Pharmacy
Paediatric Skin
Sonography Diabetes
Radiology Cardiology
Surgical Medicine
Anaesthetics TB
Orthopaedic Dental
CT Scan ENT
Registration Eye
Pathology

(2.) How do you rate the services of this hospital? (Please tick.)
Very good good normal bad very bad

(3.) Please rate the charges for the services here vis-à-vis another private hospital.
Very low low at par high very high

(4.) How do the patients perceive the services in this hospital?

Very good good normal bad very bad

(5.) How do you rate the promptness with which services are delivered to patients?
Very good good normal bad very bad

(6.) Following are some of the reasons why the patient has to spend unduly high amount of total time in
receiving services, how well do you agree with these reasons? (Choose one out of following five)
1. Strongly agree 2. Agree 3. Undecided 4. Disagree 5. Strongly disagree
Reason Response Response
High time in searching for dept. Less number of nurses
Absence of staffs at various counters Under equipped pathology
Slow service at pharmacy counter Under staffed radiology
Less number of doctors Under equipped radiology
Slow service by nurse Slow service at Radiology
Slow service at pathology Understaffed pharmacy counter
Understaffed pathology Slow service by doctor
Relatively high time taken by Some time is lost by doctors while teaching &
residents/interns demonstrating before a patient
(7.) Please give your suggestion to reduce total time spent by a patient in receiving services here? ………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
……………………………………………………………………………………………………….
ANNEXURE-5: QUESTIONNAIRE FOR STUDENTS/INTERNS/RESIDENTS

ALL THE QUESTIONS ARE WITH REGARD TO OPDs only. Batch …………

(2.) What is the workload of doctors with regard to teaching and training?
Very high high normal low very low

(2.) What is the workload of doctors with regard to treating patients?

Very high high normal low very low

(3.) How do you rate the services of this hospital on a 10 point scale?
Very good good normal bad very bad

(4.) Please rate the charges for the services here vis-à-vis another private hospital.
Very low low at par high very high

(5.) How do the patients perceive the services in this hospital?

Very good good normal bad very bad

(6.) How do you rate the promptness with which services are delivered to patients?
Very good good normal bad very bad

(7.) Kindly give your opinion regarding the total workload of doctors? It’s ………….
Very high high normal low very low

(8.) What is your opinion with regard to workload of the support staffs? It’s………….
Very high high normal low very low

(9.) Following are some of the probable reasons of delay, how well do you agree with these reasons?
(Choose one out of following five)
1. Strongly agree 2. Agree 3. Can’t say 4. Disagree 5. Strongly disagree

Reason Respon Respon

se se
High time in searching for dept. Less number of nurses
Absence of staffs at various counters Under equipped pathology
Slow service at pharmacy counter Under staffed radiology
Less number of doctors Under equipped radiology
Slow service by nurse Slow service at Radiology
Slow service at pathology Understaffed pharmacy counter
Understaffed pathology Slow service by doctor
Relatively high time taken by Some time is lost by doctors while teaching &
residents/interns demonstrating before a patient

(10.) Please give your suggestion to reduce total time spent by a patient in receiving services here?
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………

ANNEXURE-6: THE SERVQUAL INSTRUMENT

PROCEDURE FOR UNWEIGHTED SERVQUAL SCORE

Step1. Using the SERVQUAL instrument, first the score for each of the 22 expectation questions was
obtained. Next, score was obtained for each of the perception questions. The Gap Score each of the
statements was calculated. (Gap Score = Perception – Expectation).
Step2. An average Gap Score was obtained for each dimension by assessing the Gap Scores for each of
the statements that constitute the dimension and dividing the sum by the number of statements making up
the dimension.
Step3. In the TABLE 1 the average dimensions SERVQUAL scores (for all five dimensions) was
transferred from the SERVQUAL instrument. The scores were summed up and divided by five to obtain
the unweighted measure of service quality.

STEPS TO OBTAIN THE WEIGHTED SERVQUAL SCORE

Step1. The importance weights for each of the five dimensions constituting the SERVQUAL scale was
calculated.
Step2. In Table 2 the average SERVQUAL score for each dimension (from Table 1) and the importance
weight for each dimension were written. Then the average score for each dimension with its importance
weight was multiplied.
Step3. The weighted SERVQUAL scores for each dimension were added to obtain the overall weighted
SERVQUAL score.

THE SERVQUAL INSTRUMENT

EXPECTATIONS PERCEPTIONS
This survey deals with your opinions of Hospitals. The following statements relate to your feelings about the
Please show the extent to which you think hospitals Shree Krishna Hospital. Please show the extent to which
should posses the following features. What we are Shree Krishna Hospital you believe has the feature
interested in here is a number that best shows your described in the statement. Here, we are interested in a
expectations about institutions offering health services number that shows your perceptions about Shree Krishna
Hospital
Strongly Strongly Strongly Strongly
Disagree Agree Disagree Agree
1 2 3 4 5 6 7 1 2 3 4 5 6 7

Expected Perceived GAP

(E) (P) (E-P)
Tangibles Tangibles
E1. Excellent Hospitals will have modern P1. SK Hospital has modern looking
looking equipment. equipment.
E2. The physical facilities at excellent P2. The physical facilities at SK Hospital are
Hospitals will be visually appealing. visually appealing.
E3. Employees at excellent Hospitals will P3. Employees at SK Hospital are neat
be neat appearing. appearing.
E4. Materials associated with the service P4. Materials associated with the service are
will be visually appealing at an excellent visually appealing at an SK Hospital.
Hospital.
Average Tangibles SERVQUAL score
Reliability Reliability
E5. When excellent Hospitals promise to do P5. When SK Hospital promises to do
something by a certain time, they do. something by a certain time, they do.
E6. When a patient has a problem, excellent P6. When a patient has a problem, SK
Hospitals will show a sincere interest in Hospital shows a sincere interest in solving it.
solving it.
E7. Excellent Hospitals will perform the P7. SK Hospital performs the service right the
service right the first time. first time.
E8. Excellent Hospitals will provide the P8 SK Hospital provides the service at the
service at the time they promise to do so. time they promise to do so.
E9. Excellent Hospitals will insist on error P9. SK Hospital insists on error free records.
free records.
Average Responsiveness SERVQUAL score
Responsiveness Responsiveness
E10. Employees of excellent Hospitals will P10. Employees of SK Hospital tell patients
tell patients exactly when services will be exactly when services will be performed.
performed.
E11. Employees of excellent Hospitals will P11. Employees of SK Hospital give prompt
give prompt service to patients. service to patients.
E12. Employees of excellent Hospitals will P12. Employees of SK Hospital are always
always be willing to help patients. willing to help patients.
E13. Employees of excellent Hospitals will P13. Employees of SK Hospital are never be
never be too busy to respond to patients’ too busy to respond to patients’ requests.
requests.
Average Responsiveness SERVQUAL
Assurance Assurance
E14. The behavior of employees in P14. The behavior of employees in SK
excellent Hospitals will instill confidence in Hospital instills confidence in patients.
patients.
E15. Patients coming to excellent Hospitals P15. Patients coming SK Hospital feel safe in
will feel safe in treatments. treatments.
E16. Employees of excellent Hospitals will P16. Employees of SK Hospital are
be consistently courteous with patients. consistently courteous with patients.
E17. Employees of excellent Hospitals will P17. Employees of SK Hospital have the
have the knowledge to answer patients’ knowledge to answer patients’ questions.
questions.
Average Assurance SERVQUAL score
Empathy Empathy
E18. Excellent Hospitals will give patients P18. SK Hospital gives patients individual
individual attention. attention.
E19. Excellent Hospitals will have P19. SK Hospital has operating hours
operating hours convenient to all their convenient to all their patients.
patients.
E20. Excellent Hospitals will have P20. SK Hospital has employees who give
employees who give patients personal patients personal attention.
attention.
E21. Excellent Hospitals will have their P21. SK Hospital has their patient’s best
patient’s best interests at heart. interests at heart.
E22. The employees of excellent Hospitals P22. The employees of SK Hospital
will understand the specific needs of their understand the specific needs of their patients.
patients.
Average Empathy SERVQUAL scores

TABLE 1: CALCULATIONS TO OBTAIN UNWEIGHTED SERVQUAL SCORE

Average Tangible SERVQUAL score
Average Reliability SERVQUAL score
Average Responsiveness SERVQUAL score
Average Assurance SERVQUAL score
Average Empathy SERVQUAL score
TOTAL
AVERAGE (= Total / 5) UNWEIGHTED SERVQUAL SCORE

SERVQUAL IMPORTANCE WEIGHTS

Listed below are five features pertaining to hospitals and the services they offer. We would like to know
how much each of these features is important to the customer. Please allocate 100 points among the five
features according to how important it is to you. Make sure the points add up to 100.
The appearance of physical facilities, equipment, personnel, and communication materials.
______________ Points
The Hospital’s ability to perform the promised service dependably and accurately.
______________ Points
The Hospital’s willingness to help customers and provide prompt service.
______________ Points
The knowledge and courtesy of the staff and their ability to convey trust and confidence.
______________ Points
The caring, individual attention the Hospital provides to the patients
______________ Points
TABLE 2: SERVQUAL WEIGHTED SCORES
SERVQUAL Dimension Score X Importance Weight = Weighted
from Table 1 from Table 2 Score
Average Tangible
Average Reliability
Average Responsiveness
Average Assurance
Average Empathy
TOTAL
AVERAGE (= Total / 5) WEIGHTED SERVQUAL SCORE
ANNEXURE-7: CAUSE AND EFFECT DIAGRAM

Lack of Operations
information

Inconvenient Bottlenecks
Timings Search layout
departments

Elaborate
Procedures at Frequent examination
OPDs/counters Comes back to OPD movement
to ask dosage
MAKES THE
PATIENT
WAIT

Takes time Not present

to reach at desk
Busy in some
other task

Lengthy Lack of
conversation competency/slow
Personal reasons
with doctor service
wait for friends/ Teaching/
toilet demonstrating

Patients Service
related providers
ANNEXURE 8: OPD Statistics for the Financial Year 2002-03
OB & Ortho Skin TB
Months ENT Opth. Medicine G . Paed. Psych. Surgery & VD Chest Dental
3 3 3 6 3 1 5 4
April 939 6 798 1 2933 113 899 5 1547 0 957 7 501 9 1343 2 1054 1 167 6 963 37
3 2 3 5 2 1 4 4
May 932 5 765 9 2406 93 859 3 1524 9 757 9 433 7 1231 7 1108 3 151 6 750 29
3 3 10 3 5 2 1 5 4
June 881 4 771 0 2611 0 831 2 1514 8 661 5 477 8 1326 1 1076 1 144 6 624 24
4 3 12 4 7 4 2 6 5
July 1141 4 977 8 3325 8 1034 0 1861 2 1057 1 533 1 1596 1 1333 1 190 7 852 33
4 3 3 5 4 1 5 4
Aug 1090 2 877 4 2869 110 824 2 1405 4 1065 1 434 7 1359 2 1105 3 147 6 784 30
4 3 13 3 5 4 2 5 4
Sep 1138 4 889 4 3385 0 935 6 1480 7 1028 0 540 1 1427 5 1211 7 154 6 760 29
4 3 12 3 5 3 1 4 4
Oct 1040 1 830 2 3326 8 875 4 1352 2 783 0 387 5 1282 9 1277 9 152 6 650 25
3 2 10 3 4 2 4 3
Nov 824 2 630 4 2627 1 782 0 1073 1 729 8 232 9 1171 5 949 7 124 5 492 19
3 2 3 4 3 4 4
Dec 1021 9 759 9 2894 111 949 7 1187 6 803 1 225 7 1259 8 1033 0 160 6 587 23
3 3 10 3 5 2 1 4 3
Jan 995 8 810 1 2755 6 898 5 1319 1 664 6 471 8 1276 8 969 7 210 8 619 24
3 3 3 5 2 4 4
Feb 895 4 919 5 2958 114 783 0 1321 1 719 8 242 9 1287 9 1058 1 226 9 664 26
3 3 3 5 3 4 4 1
March 973 7 901 5 3053 117 965 7 1296 0 828 2 215 8 1226 7 1087 2 306 2 605 23
1063 1005 1326
11869 9926 35142 4 16879 1 4690 15783 0 2131 8350

***Considering a 26 days month

 ANNEXURE-9: OPD Statistics for the Financial Year 2003-04
OB & Skin & TB
Months ENT Opth. Medicine G Ortho. Paed. Psych. Surgery VD Chest Dental
3 3 3 5 2 4 4 1
April 995 8 875 4 2861 110 883 4 1351 2 742 9 219 8 1097 2 1073 1 313 2 628 24
3 3 3 5 2 4 3
May 926 6 813 1 2916 112 836 2 1335 1 745 9 287 11 1227 7 1024 9 242 9 526 20
3 2 10 3 5 2 4 4
June 847 3 744 9 2783 7 876 4 1291 0 673 6 193 7 1215 7 1114 3 174 7 543 21
4 4 13 4 5 3 1 5 4
July 1085 2 1135 4 3602 8 1100 2 1543 9 938 6 251 0 1400 4 1242 8 180 7 592 23
4 4 13 3 4 3 4 4
Aug 1054 1 1243 8 3467 3 898 5 1246 8 952 7 190 7 1227 7 1277 9 217 8 573 22
5 5 14 4 5 3 5 5 1
Sep 1435 5 1319 1 3839 8 1089 2 1393 4 963 7 234 9 1486 7 1368 3 260 0 671 26
3 3 3 4 3 4 4
Oct 899 5 936 6 2967 114 792 0 1062 1 939 6 174 7 1059 1 1123 3 197 8 398 15
4 4 13 4 5 3 5 4
Nov 1122 3 1234 7 3418 1 1124 3 1382 3 985 8 199 8 1306 0 1150 4 203 8 650 25
4 5 13 4 5 4 5 4
Dec 1251 8 1400 4 3490 4 1242 8 1382 3 1060 1 219 8 1412 4 1056 1 202 8 605 23
4 4 4 4 3 4 3
Jan 1107 3 1203 6 3004 116 1070 1 1218 7 837 2 295 11 1069 1 983 8 170 7 545 21
4 4 4 4 3 4 3
Feb 1040 0 1205 6 2894 111 1037 0 1281 9 940 6 211 8 1165 5 927 6 198 8 666 26
4 4 13 4 6 3 5 4
March 1101 2 1273 9 3409 1 1061 1 1554 0 1015 9 154 6 1368 3 1054 1 231 9 698 27
1286
2 13380 38650 12008 16038 10789 2626 15031 13391 2587 7095

***Considering a 26 days month

ANNEXURE-10: AVERAGE NUMBER OF PATIENTS BEING TREATED BY A
DOCTOR PER DAY IN OPD IN 2002-04

Average number of patients being treated by a Doctor per day in OPD in 2002-04*
OB & Ortho Skin & TB
ENT Opth. Medicine G . Paed. Psych. Surgery VD Chest Dental
Mean1 38 32 113 34 54 32 15 51 43 7 27
Mean2 41 43 124 38 51 35 8 48 43 8 23
grand mean 39.5 37.5 118.5 36 52.5 33.5 11.5 49.5 43 7.5 25
Total Dr. 9 12 13 15 9 9 12 14 6 6 12
TotalDays 6 6 6 6 6 6 6 6 6 6 6
Dr./Day 1.5 2 2.167 2.5 1.5 1.5 2 2.333 1 1 2
Av. Patients /Dr. 26 19 55 14 35 22 6 21 43 8 12.5
**** 21 15 44 11 28 18 5 17 34 6 10

**** Assuming morning OPD to consist of only 80% of total OPD for the patient.
* Treatment by residents not included
ANNEXURE-11: FACTOR ANALYSIS TO SEGREGATE THE REASONS FOR DELAY
AS PERCEIVED BY THE PATIENTS

KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling .680
Adequacy.
Bartlett's Test of Sphericity Approx. Chi-Square 182.376
df 66
Sig. .000

Rotated Component Matrix

Componen
t Extraction Method: Principal
1 2 3 4 Component Analysis.
a. REGNQUEU .470 .535 .302 -.235 Rotation Method: Varimax
b SEARCHDE .661 3.413E-02 .305 -4.028E-02 with Kaiser Normalization. a
c MEDPURC 2.826E-02 .165 5.731E-02 .806 Rotation converged in 6
d DEPTQUE 1.944E-02 .905 7.305E-03 8.195E-03 iterations.
e RADIOLOG .131 -2.101E-02 .104 .797
f DOCBUSY .428 .204 .752 8.060E-02
Total Variance Explained
g PATHOTES .451 -.208 .320 .468
Initial Extraction Rotation
h NURSBUSY -2.999E-02 8.733E-02 .907 .209
Eigen Sums of Sums of
i WAITDOC .224 .650 .159 .203
values Squared Squared
j INTDEPTL .799 9.527E-02 -7.681E-02 .310
Loadings Loadings
k. PERSONAL .772 .304 3.242E-02 .193
Componen Total % ofCumulativ Total % ofCumulativ Total % ofCumulativ
t Variance e % Variance e % Variance e %
1 4.168 34.734 34.734 4.168 34.734 34.734 2.631 21.923 21.923
2 1.717 14.309 49.043 1.717 14.309 49.043 1.904 15.870 37.793
3 1.193 9.941 58.983 1.193 9.941 58.983 1.872 15.602 53.394
4 1.122 9.354 68.337 1.122 9.354 68.337 1.793 14.943 68.337
5 .856 7.130 75.467
6 .729 6.076 81.543
7 .564 4.697 86.240
8 .476 3.970 90.210
9 .394 3.286 93.496
10 .354 2.949 96.444
11 .269 2.241 98.685
12 .158 1.315 100.000
Extraction Method: Principal Component Analysis.
ANNEXURE-12: METHODS-ENGINEERING
APPROACH

1
Determine problem or objective

Study conditions
2

3 Plan possible solutions

4 Evaluate possible solutions

5 Recommend actions

6 Follow-up

7 Check results
ANNEXURE-13: SHOW CARDS

SCALE 1 (For Questionnaires)

VERY GOOD

EXTREMELY IMPORTANT
5

GOOD

4 IMPORTANT

AVERAGE
3
CANNOT SAY

BAD
2
UNIMPORTANT

VERY BAD
1 EXTREMELY UNIMPORTANT

SCALE 2 (For SERVQUAL Instrument)

1 2 3 4 5 6 7
STRONGLY STRONGLY
DISAGREE AGREE
ANNEXURE – 14: PRINCIPLES OF MOTION ECONOMY & CLASSIFICATION OF
MOTION

Principles of Motion Economy

Motion economy refers to the manner in which human energy can be conserved while
performing a task. The following questions were asked to the concerned doctor.
• How many times do you turn your body or reach for an instrument?
• Does the assistant/nurse eliminate your stress by transferring the instruments and
materials to you as and when required?
• Does the assistant have primary responsibility for transfer of materials and instruments or
is the assistant often unoccupied while the dentist reaches for an instrument or changes a
bur?
• Are the hand pieces and instruments within a 21-inch radius of the assistant?
• Think about your daily activities and decide how you can modify the routine to reduce
motion. Plan ahead to ensure all materials are prepared in advance in a motion effective
environment.

Classification of motion
Motions can be classified (to understand what is to be done and what IS to be avoided) into five
categories according to the length of the motion as shown below:
• Class I: Movement of the fingers only when picking up something say a cotton roll.
• Class II: Fingers and wrist motion as used when transferring an instrument to the
operator, or manipulating a hand instrument.
• Class III: Fingers, wrist, and elbow as when reaching for a hand-piece.
• Class IV: The entire arm and shoulder as when reaching for supplies away from the work
area, or to adjust the operating light.
• Class V: The entire torso as when turning around to reach for equipment from adjacent
fixed cabinetry.
ANNEXURE - 15
COLOUR SCHEME OF DEPARTMENTS AND SAMPLE SIGNBOARDS
1 REGISTRATION
2 PHARMACY
4 DERMATOLOGY
5 PSYCHIATRY
7 MEDICINE
3
4 SURGERY
1
8 DENTISTRY
2 OB &
4 GYNAECOLOGY
2
6 PAEDIATRICS
3
0 X-RAY
EYE
3
6 ORTHOPAEDICS
2
1 PATHOLOGY
E.N.T.

EYE

E.N.T.
ANNEXURE - 16: TIME TAKEN FOR PATHOLOGICAL TESTS IN SKH VIS-À-VIS
PRIVATE LABS.

Sr. No. TEST TYPE NORMAL TIME TIME TAKEN

Pathology SKH Private clinic
1 Histogram with TC, DC, 10min 30 min. 15min
Hb, MP Test each
2 ESR 45 min 1.2hr 1 hr
3 Blood group 10min 25 min 15 min
4 Stool examination 15min 1 hr 30 min

Microbiology
1 Culture & sensitivity 24-48min 36-48 hrs
2 Widal test 20min 45-60min 30 min
3 Stain sputum 15min 45min 30
4 Pregnancy test 15min 45min 30

Histopathology
1 FNAC Biopsy

Biochemistry
1 Lipid Profile 45min 1.5hr 1 hr
2 Biological fluids 30min 1hr 45 min
3 Urine analysis 15min 30min 30 min
4 Liver function test 30min 45min 45 min
5 Blood glucose 30min 1hr 30 min
6 Post prandial 15min 1.3hr 30 min
7 Random 20min 40min 30 min
8 Blood urea 15min 45min 20 min
9 Uric acid 20min 40min 30 min