Analysis of feedback of private wards patients: missing links in patient satisfaction in services at tertiary care public hospital

Background: Feedback of client/customer is the key for improvement in any services. It is a precious input for identifying gaps and developing an effective action plan for quality improvement in any organization. Hence, patient feedback on services provided by the health care organization is important quality tool for improvement of services both in public and private hospitals. With the back ground this study was conceptualized with the aim to analyse feedback of inpatients admitted in private wards of a government tertiary care hospital of India, regarding hospital personnel and for basic amenities provided by the hospital. Methods: This was a record-based study where predesigned feedback forms of one year were analysed. Feedback was categorized under three themes and subthemes which were services provided by the hospital, infrastructure of the hospital and feedback with respect to the care provided by the hospital staff. Results: 80% patients were dissatisfied with the delay in conduct of investigations and receipt of reports and cleanliness in ward, housekeeping services and quality of food. As far as clinical care and soft skills of healthcare providers are concerned, 80% of the patients were satisfied by the care provided by doctors and nurses. Suggestions were analysed and implemented to strengthen the service delivery to initiate quality assurance. Conclusions: Major factors for dissatisfaction among patients are the unscientific processes which can be improved with minimum cost

A Note On Simultaneous Estimation of Order Restricted Location Parameters of a General Bivariate Symmetric Distribution Under a General Loss Function

The problem of simultaneous estimation of order restricted location parameters $\theta_1$ and $\theta_2$ ($-\infty<\theta_1\leq \theta_2<\infty$) of a bivariate location symmetric distribution, under a general loss function, is being considered. In the literature, many authors have studied this problem for specific probability models and specific loss functions. In this paper, we unify these results by considering a general bivariate symmetric model and a quite general loss function. We use the Stein and the Kubokawa (or IERD) techniques to derive improved estimators over any location equivariant estimator under a general loss function. We see that the improved Stein type estimator is robust with respect to the choice of a bivariate symmetric distribution and the loss function, as it only requires the loss function to satisfy some generic conditions. A simulation study is carried out to validate the findings of the paper. A real-life data analysis is also provided

Estimation of Order Restricted Location/Scale Parameters of a General Bivariate Distribution Under General Loss function: Some Unified results

We consider component-wise equivariant estimation of order restricted location/scale parameters of a general bivariate distribution under quite general conditions on underlying distributions and the loss function. This paper unifies various results in the literature dealing with sufficient conditions for finding improvments over arbitrary location/scale equivariant estimators. The usefulness of these results is illustrated through various examples. A simulation study is considered to compare risk performances of various estimators under bivariate normal and independent gamma probability models. A real-life data analysis is also performed to demonstrate applicability of the derived results

A unified study for estimation of order restricted location/scale parameters under the generalized Pitman nearness criterion

We consider component-wise estimation of order restricted location/scale parameters of a general bivariate location/scale distribution under the generalized Pitman nearness criterion (GPN). We develop some general results that, in many situations, are useful in finding improvements over location/scale equivariant estimators. In particular, under certain conditions, these general results provide improvements over the unrestricted Pitman nearest location/scale equivariant estimators and restricted maximum likelihood estimators. The usefulness of the obtained results is illustrated through their applications to specific probability models. A simulation study has been considered to compare how well different estimators perform under the GPN criterion with a specific loss function

Componentwise Equivariant Estimation of Order Restricted Location and Scale Parameters In Bivariate Models: A Unified Study

The problem of estimating location (scale) parameters $\theta_1$ and $\theta_2$ of two distributions when the ordering between them is known apriori (say, $\theta_1\leq \theta_2$) has been extensively studied in the literature. Many of these studies are centered around deriving estimators that dominate the best location (scale) equivariant estimators, for the unrestricted case, by exploiting the prior information that $\theta_1 \leq \theta_2$. Several of these studies consider specific distributions such that the associated random variables are statistically independent. This paper considers a general bivariate model and general loss function and unifies various results proved in the literature. We also consider applications of these results to a bivariate normal and a Cheriyan and Ramabhadran's bivariate gamma model. A simulation study is also considered to compare the risk performances of various estimators under bivariate normal and Cheriyan and Ramabhadran's bivariate gamma models

Mediastinal tuberculosis in adult: case report

Mediastinal lymph node enlargement commonly seen in sarcoidosis, lung cancer, lymphoma and tuberculosis in children’s. Tuberculosis in adult mostly involve parenchyma of lung and very rarely involve mediastinal lymph nodes, here we report a 27-year-old male, non-diabetic, non-hypertensive, non-alcoholic and non-smoker who present with low grade fever and dry cough. Search for the cause of morbidity revealed him to be suffering from mediastinal tuberculosis. He was treated for tuberculosis with ATT

Study of compliance to prescribed lighting standards in hospitals of Delhi NCR, India

Background: An adequate level of lighting is essential for clinical, diagnostic and other processes in hospitals. This study has been conceptualised to assess the existing lighting standards in Indian hospitals. Carefully designed lighting can transform the appearance of a space, making it attractive, welcoming and either restful or stimulating depending on the effect created. It can enhance the architectural appearance of the space and contribute to orientation and way finding.Methods: Select hospitals of Delhi NCR were visited and the existing level of luminance in various areas of the hospital were recorded and analysed against prescribed National and International standards. The existing lighting standards in different areas of the hospital were assessed against the prescribed Indian standards given under National Lighting Code 2010 of India (2) and IS 4347: Code of practice for hospital lighting in India.Results: There has been a gap in the existing and prescribed lighting standards in all the hospitals considered in this study. This study revealed that none of the Hospital was having 100% compliance to the prescribed lighting standards. The best compliance was with hospital ‘A’ (56.5%), which is a private Corporate Hospital and worst with hospital ‘E’ (8.7%), a govt. hospital. The areas where compliance was  highest was OT complex (100%)  and  circulation areas (60% ) while service areas have least compliance rate (20%), with only hospital ‘A’ having 50% compliance and others having 0% compliance. As far as wards are concerned, 80% of the Hospitals adhere to the   prescribed lighting standards for general lighting and lighting at nursing station, but none of the hospitals adhere to the prescribed lighting standards for patient examination, reading lights for patients and night lighting. At the entrance 100% hospitals adhere to the prescribed lighting standards. The major reason cited by the concerned hospital authorities was the unawareness on the prescribed lighting levels and standards.Conclusions: Major conclusions drawn from this study are there are identified gaps in the existing lighting standards in the Hospitals and the recommended lighting levels and standards. Compliance to lighting standards in Indian Hospitals range from 8.7% to 56.7%, with majority of the hospitals in the range of 26% to 35%.There is as urgent need to sensitise the environment regarding recommended lighting standards.

Case study on reimbursement process and settlement of bills of patients treated under package charges in super speciality public hospital

Background: In the Government hospitals, because of constraints of resources, patients are often asked to buy certain items required for their treatment procedure. There is an inadvertent delay in bill reimbursement process due to the cumbersome procedure, which causes dissatisfaction among patients. Thus, it was highly imperative to reduce the reimbursement time and improve the level of patient satisfaction by improving quality of services. The present study depicts modifications initiated to reduce causes of delay and improve patient satisfaction.Methods: Process mapping was done for different procedures which are carried out under package system at Cardio Neuroscience Centre. All the available documents were analysed from Operation theatre, Wards, ICU, Billing section, Account office, OPD area etc. and Interviews were taken from consultants, nursing staff, staff working at Billing section, Account office etc. to identify causes of delay.Results: The study helped in improvement in efficiency by 60% percent and reduces the number of resources by 10 percent.Conclusions: The study helped to increase productivity gains and improve accuracy