JAHA Vol 29 No. 2 [ Jan to Dec. 2017 issue]

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Background: Marketing literature is replete with studies on the impact of pharmaceutical promotions on doctors. Pharmaceutical companies devise their  detailing strategies based on physicians’ behavior s. This study was an attempt to find out how doctors gauge the influence of pharmaceutical marketing on their prescription behavior.
Objectives: To quantitatively investigate the perception of doctors about the role of pharmaceutical companies in influencing their prescription behavior in different clinical settings and to evaluate how they interpret the effect of peer opinion, scientific knowledge and use of generics on their prescription behavior based on their level of specialization, years of clinical experience and their professional setting.
Methodology: A multi-centric, cross-sectional, questionnaire based study, using a 10-item questionnaire composed of four dimensions was used. Results were analyzed using ANOVA and post hoc tests wherever required.
Results: Doctors in the public health sector admitted to a significantly greater influence of pharmaceutical marketing as compared to private sector doctors. Both, knowledge seeking behavior and peer influence were higher in the private sector hospital. Doctors with experience ≤ 10 years and >30 years sought knowledge about drugs more actively than their peers. Doctors with less than 10 years of experience were more susceptible to pharmaceutical marketing as well as peer influence. There was no statistically significant difference between doctors when their levels of specialization were considered.
Conclusions: There is a moderately low influence of pharmaceutical companies on the prescription behavior of doctors; but this needs to be validated in future studies by the direct corroboration of perceived prescription behavior with actual practice.
Keywords: Prescribing behavior, generic drug prescription, pharmaceutical marketing, detailing.
A Longitudinal Study of Morbidity among Nursing Assistants in a Tertiary Care Hospital in Bangalore, Karnataka, India
Background: The personnel of the health service are its most valuable asset, so it is only sensible to make sure that everything possible is done to ensure that they receive the highest quality of health care. Nursing Assistants are a significant group of healthcare personnel in all levels of health care services in the health sector. 
Objectives: Were to estimate the prevalence of existing morbidities and to estimate the incidence of reported morbidities over a one year period among nursing assistants at a tertiary care hospital.
Methodology: A longitudinal descriptive study was undertaken in a private tertiary care hospital in Bangalore for a period of one year (November 2012 – October 2013). After receiving institutional ethics committee clearance, nursing assistants who had work experience of one year in the current work place were enrolled in the study (n= 254). The health status of the workers was assessed periodically to pick up the incidences of various morbidities.
Results: Of the 254 nursing assistants included in the study134 (53%) were in the age group of 21- 30 years with the mean age of 29.4 years (± 8.33 years). Incidence rate of acute morbidity was 36.9 episodes per 100 person months. About 50% of the illnesses were infectious, nearly 30% were musculoskeletal disorders and 3.2% were allergic reactions.
Conclusion: Infectious diseases like URTI and musculoskeletal pain were found to be common acute morbidities. There is a need to adopt more effective measures of health promotion and to encourage adoption of safety measures in this group of health care workers.
Key words: Health care workers, nursing assistants, occupational health morbidities, longitudinal study.
Purpose: Quality focus, customer satisfaction, employee satisfaction and empowerment with committed leaderships all coexist, however what maybe important is; understanding how they relate and its appropriateness in the system. The purpose of this study was to assess success of Lean Six Sigma (Further referred as LSS) deployment in hospitals where there are union / unwarranted lobby issues and uncooperative employees. The study aimed to explore application of LSS methodologies integrated with a transactional change strategy to address the prominent problem with a goal to ensure patient satisfaction, good brand image and improve compliance requirements.
Methodology: A real situation of non-cooperation from ward-boys in a multi-specialty hospital; was addressed with a LSS initiative in the hospital. The study explored the application of the LSS methodology as an enabler to statistically verify the causes and solutions further to plan an implementation strategy of the solution that was integrated with the transactional change design in the system. 
Findings: “Kanban” designed was an innovative application in the service system to control human resource administration process as till date we have seen “Kanban” effectively utilized in manufacturing set-ups and supply chain processes.
The paper first discusses the case and the LSS deployment initiative and then further provides an insight to the significant outcome results of the solution suggested; on:
1. The design of the innovative Kanban.
2. The transactional change management strategy.
The Originality value: The case study demonstrated a statistically significant improved state post LSS initiative, particularly the innovative “Kanban” that was designed and utilized in the system to successfully deploy LSS and transactional change strategy in the hospital system to address a constant problem of non-cooperation from their ward-boys.
Keywords: Lean Six Sigma in Healthcare, Transactional change management in hospitals, Kanban in service, Innovative design, housekeeping administration in hospital
Introduction: Healthcare audit is a retrospective evaluation of work done by healthcare professionals which is documented in the healthcare records of patients. It helps to understand lacunae in healthcare practice. Many a times, one observes errors and gaps in documentation. Such evaluation helps to plan solutions to these issues, to provide best possible quality care to our patients.
Aim of the study was to assess compliance levels of in-patient healthcare records with healthcare audit in a selected teaching hospital in Pune city, India.
Methodology: Explorative and retrospective quantitative survey was carried out on 150 inpatient medical records which were randomly selected. Three point likert scales was used i.e.  0= non compliance, 1= partial compliance, and 2= full compliance.
Results: Audit tool consisted 52 items under six headings such as history and physical examination, nursing assessment, medication administration, daily nursing “Flow sheet”, progress note and consent form. This study shows that in-patient healthcare records were not up-to the standard and has number of lacunae; hence need serious attempts towards improvement. Majority of items show no compliance hence needs extra efforts on education and training of healthcare professionals. Mainly, it shows need for improvement in current practices of documentation.
Healthcare audit, medical audit, compliance, healthcare records
Health & Medical Education Department of Jammu & Kashmir shifted from traditional procedures of demand generation to online demand generation for hospital supplies, after E-Aushadhi (DVDMS) - Drug, Vaccine Distribution and Management System was successfully implemented by Jammu and Kashmir Medical Supplies Corporation Ltd. (JKMSCL). E-Aushadhi software has been  developed and implemented by CDAC, Ministry of IT and Commerce, and it helped in scientific demand generation, procurement and distribution of medicines and other hospital supplies in the health care institutions of J&K state.
Prior to online demand generation through e-Aushadhi, the Department of Health and Medical Education J&K was relying on the information provided by end users, without knowing their budgetary provisions and the nature of the medicines and other hospital supplies, which could be procured on their demand. The entire exercise was very tedious and time consuming, as it required lot of paper work. The officer in charge of the health care institution like Block Medical Officers, Medical Superintendents and the Chief Medical Officers etc. were most of the time adding 10% every year to the previous year’s projected demand of medicines and other hospital supplies and submitting the same to the next higher authorities.
The exercise was not based on the scientific system of inventory management and the first step of material management i.e. realistic demand estimation, which forms basis for all future activities was faulty, which on one hand resulted in shortage of vital and essential items in the hospitals and on the other hand resulted in over stocking of the items, which were not required in a particular institution.
In the first year, another big challenge before JKMSCL was to get the distribution plans of the hospital supplies, which were procured on the demand of Directorate of Health Services Jammu/ Kashmir. It took more than 3 Months to get the distribution plans, so that the hospital supplies could be issued to the institutions for its use.
It was therefore planned to utilise software for online demand generation, so that the supplies after their procurement were provided to intending departments, strictly as per their requisitions.
An extensive exercise of training on demand generation, compilation and finally placement of the purchase orders was carried out by JKMSCL, which resulted in placement of more than 3000 purchase orders amounting to Rs. 87.00 Crore and then the distribution of these supplies as per the demand of the end users.
A work engagement survey was carried out in Indian Hospital context. The survey shows employee engagement level at 49.36 percent. This is in contrast to the global employee engagement level which is only 13 percent. Earlier survey in 2013 by the Gallup Company of USA showed only 9 percent employees in India are engaged. The explanation for this is not straightforward. Certain possibilities have been suggested. 
Keywords: Job engagement, drivers of engagement, UWES, Likert, RESPECT model
Consumer Satisfaction In A Tertiary Health Care Institution – Anempirical Study On Tripura Medical College, Agartala
Health care sector has a vast canvas and it is thefilial duty of the nation to protect and sustain thehealth of its citizens. Therefore it is incumbent uponthe institutions like hospitals and medical collegesto ensure sustainable healthcare solutions to thepatients. Unlike past health care industry hasemerged as one of the key service sector a playerover a decade or two where patients transcendentto consumers and certain expectations have beendeveloped pertaining to services a patient shouldexpect in a medical institution. With patientsclamouring for more like a demanding consumer andhospitals ruffling in the tough and competitive terrainof high service quality assurance, a slight deviationcan impact the satisfaction adversely. From ethicalstandpoint as well, the demand of the patients couldnot be negated. This paper aims to assess thesatisfaction level of patients who have consumedmedical services of the institution by measuringcertain selected performance variables. The authorsdeveloped and deployed a multiple regression modelwhich revealed that though overtly certain level ofsatisfaction exists among the patients still fewdepartments needs immediate improvement.
Keywords:health care, medical college, hospital, patientsatisfaction, service quality, multiple regression
Background: A hospital ward is termed as the unitof a hospital. The wards of the hospital are setaccording to different specialities present in ahospital. A hospital ward is an area or floor of ahospital in which patients with similar needs areplaced together. The function of hospital wards is tokeep similar patients together, either according toage, disease, or condition e.g. emergency wardgroups patients requiring immediate care & a dialysisward groups together patients receiving dialysistreatments. Ward management is required to impartproper decision making and improve the performanceof the staff working within them, for this functioningNursing In-charges are employed. Employing NursingIn-charges improves the quality of care and keepsthe necessary specialists grouped in a specific area,entailing to the fact that care provided is moreimmediate than if specialists were scatteredthroughout the hospital. In view of the day to daymanagement various problems were indicated tohave hindered in the proper functioning of the wards.This study avers to analyse and facilitate the wardmanagement by prioritising and taking definitive stepsto forestall the problems by using Delphi Techniquein Sanjay Gandhi PGMS, Lucknow, India; a tertiarycare hospital. Taking into account all of the above,study was designed and questionnaires generatedas per the selections made by the Nursing In-charges, since they were the deciding factors andalso the deciding experts
Keywords:Problem solving, Ward management, Nursing In-Charges, Delphi Technique
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Declaration Snapshot:
In pursuance with JAHA policy, I hereby certify the following:
1. The above mentioned article has not been published in any other journal as on date.
2. The above mentioned article has not been submitted for review for publication in any other journal.
With Warm Regards,
Yours Sincerely,
Dr. Shyama S Nagarajan
Executive Editor – JAHA