Why are my patients not happy with my hospital?

It is no measure of health to be well adjusted to a profoundly sick society.

Jiddu Krishnamurti

Gubbi, a Taluka headquaters in Tumkur district

Gubbi is a small town in Tumkur district in Southern Karnataka. Gubbi Veeranna, one of the well-known theatre personalities from Karnataka who started the first Kannada theatre hailed from here. Historically, the town was well-known for its local markets for cotton and areca nut. As early as in 1871, Gubbi was a municipality of its own. The Imperial Gazetteer of India in 1871 talks of the monthly ‘jaatres’ or fairs which were well known for the sale of cotton cloth, blankets, rice and other articles from as far as Malnad (the mountainous monsoon-fed wetlands to the west) to the dry areas of Rayalaseema and the low hills of Arcot to the east and South. Today, Gubbi is a taluka headquarters in Tumkur district and is one of the ten talukas in the district.

Gubbi is about 20 km from Tumkur and is situated along the highway to Honnavar from Bangalore, that passes through Tumkur. The taluka hospital of Gubbi is along the highway passing through the town. The Administrative Medical Officer, the doctor in the hospital tasked with managing this hospital is Dr. NL Dani. The hospital was a Community Health Centre earlier with 30 beds being upgraded now to a 100 bedded hospital.

Dani is one of the participants of the capacity-building programme organised by IPH and its partners in Tumkur. Dani is a paediatrician by training with three decades of experience. He is today managing a 100 bedded Taluka hospital. His hospital sees over 200 patients in a day, is severely understaffed and morbidly overloaded. In these days of panchayati raj, he is answerable not only to his superiors in the hallowed chambers of the directorate in Bangalore, but also to the representatives of the people in the narrow chambers of the Gubbi Taluk Panchayat.

Gubbi Taluka Map

The hospital provides out-patient services to nearly 300 people in a day. At a time when there is a beeline towards corporate hospitals and having busy evening practices, it is heartening to see Dani and his colleagues in Gubbi hospital providing services within the constraints they face; and these are many. Dani conducted a study in his hospital to understand patient satisfaction, as it bothered him that most of the people obtaining the services at Gubbi hospital were reporting that they were not happy with the services. Was there truth to this?

Dani approached it very scientifically. He did not take this for granted. Nor did he cursorily conclude on the reasons for patient dissatisfaction. He conducted a study consisting of exit interviews of through a structured questionnaire. Patients were recruited into the study randomly. He considered the following aspects in his questionnaire:

  1. Staff availability of patients
  2. Basic amenities like toilets, drinking water, ambulance services and drug availability
  3. Patient safety in hospital – infection control, physical safety of women and children
  4. Perceptions of cost
  5. Administrative and procedural problems

The questionnaire confirmed his hunch about dissatisfaction. Presenting the results in Tumkur, Dani also shared the possible reasons for this. On an average, each doctor in his hospital sees over 70 patients in a day. Many of these, of course are specialists who are supposed to be giving a lot more time than they can to these patients that are referred from primary health centres. However, these patients needing specialist care are clouded by many others who come here for routine health problems. There is no referral system in place.

Dani in his study prepared hospital performance indicators for all departments – in-patients, specialities, CSSD etc. He identified issues in human resources, infrastructure and a few other issues as key reasons for the patient dissatisfaction. He found that staff motivation was poor. Also, he was working in a severely understaffed hospital. Recruitment to the hospital happen in Bangalore. While it is easy to upgrade the beds from 30 to 100, finding the requisite support staff and motivated doctors to work here is another story. The district is helpless to fulfill existing vacancies. In addition, he found that supervision was poor. The doctors and other senior staff could hardly devote time to supervise and hand-hold their non-clinical team. Where is the time for management of the hospital?

In addition to doctors not being available in good numbers, the amenities provided were also poor. Residential quarters were not available for all the staff. The hospital lacked good water and sanitation facilities. A reception counter itself was not there.

This was of course a small study done in a small taluka hospital, one among over a hundred taluka hospitals in the country. However, the issue Dani identified for his study, ‘patient dissatisfaction’ is a universal phenomenon in public health services in the country today. In India today, irrational health practices and expensive health care is becoming a feature rather than a problem. Government-provided health services is the lifeline for millions of poor, who depend on these, and for whom health expenditure is often catastrophic. The reasons Dani identifies through his study are also quite representative of hundreds of other taluka hospitals.

Doctors in government services work with many constraints. Staff are demotivated. There is always pressure from elected representatives, sometimes justified, and other times not. Teamwork is lacking and the work environment is not always cheerful or fulfilling. Yet, there are people such as Dani in many of the small hospitals in the country, whose toils go unheard, and whose stories go unsaid. Yet, we often see the glamour and glory that many a corporate hospital catering to a much smaller proportion of people get.

Here is a doctor who in the middle of taluka meetings, trainings, reviews and visits by superiors, also manages a busy clinic as a paediatrician and is expected to manage a 100-bedded hospital for a taluka. In the midst of this, he keeps his spirit alive and did a study to understand and document patient dissatisfaction. We hope that Gubbi finds more specialists and most importantly, committed people like Dani.

Crossposted on IPH India Blog

15 responses to “Why are my patients not happy with my hospital?

  1. This is a real nice post i also bookmarked your site and look for more updates. thanks.

  2. Thanks for telling us the story of Dani, Prashanth. Also it is very inspiring to see such brilliant efforts of Dani to provide quality health care. People like Dani and you are the only hope for the problems being seen in the Indian Health Care. Many such stories may get unnoticed. But I hope the impact will be certainly significant.

  3. Dr. Dani is a gem.

    It is no surprise that a Taluk Hospital has the limitations it does. The critical problem may not be the physical infrastructure. The human infrastructure that manages the hospital may be at the core of the problem.

    Management is undervalued simply because so many people in authority hold the view that they are competent managers and things are just fine. Dr. Dani has done yeoman service by undertaking the study and pointing out the inadequacies.

    Qualified physicians, however well qualified, may not be the best managers.

  4. There is a dearth of doctors who are willing to reside in a rural setting and offer their services for a meagre salary. The only way a start can be made is by making a rural stint compulsory for medical students. It is utterly disappointing when medical students object to rural postings. This is a perfect opportunity for them to learn and serve at the same time. I personally don’t think a doctor understands his/her own value, most of the time. A person studies medicine not to make money, not make it a sort of business, but to be able to help people. This change needs to take place.

    • Well, not working in rural areas is a disorder, not only among doctors. It is there among most professionals. I guess, doctors when they finish their medicine, are like any other person, wanting a fulfilling life. It is perhaps difficult to expect that they will turn to rural areas just to help people. One wishes, they would see good role models during their medicine, either among teachers or among colleagues, that will make them realise the fulfillment that one can obtain through working in rural areas and challenging settings. And unfortunately, this is completely lacking. In fact, what they see is completely antithetical to role models.

  5. Dr Manjunath B D

    Thanks for the article NS,

    The greatest positive factor in the present day health sysem is people like Dr Dani and you.
    Doctors who are interesed in public service are rare, though it is their own responsibility.
    I believe all these problems can be overcome if doctors can understand the responsibility they have towards their own fellow citizens.

  6. Excellent post! Thanks for an inspiring blog. Saw about this post on FB but didn’t read it until Vinay Sreenivasa pinged. Incidentally I am from Gubbi and live here. Reading your post, I realize I have to meet Dr. Dani.

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  8. Thank you for bringing the ‘true picture’ as ascertained by Dr Dani to light. To know one’s faults or shortcomings will give opportunities to improve though the improvements take time and effort and not be as much as we want them to be.

    Please tell Dr Dani that his story inspires others by showing that something constructive can be done in one’s circumstances no matter how hopeless it may seem.

    • Thanks Ashwin for your comments. I am going to share the link to the post with Dr. Dani and I hope he derives encouragement from the kind comments of so many. Seeing people like Dani within the system is also inspiring for some of us who are trying to help improve health services of the Government.

  9. Prashanth,
    A very inspiring article. Great work from all of you! Gives me a lot of happiness to know that I had the chance in life to be your classmate!

    Is there any way, a non-doctor can help a mission? I am surely interested in doing my bit for a cause that you have undertaken. Please let me know, how I can be of help.

    Thanks and good luck!

    Cheers!
    Padma

  10. its very difficult to be sincere in govt set up nowaydays owing to high prevalence of corruption which amounts to sacrifice..

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