A PROJECT REPORT ON

“ TIME MOTION STUDY as per NABH guidelines “ of

DIALYSIS DEPARTMENT

CONDUCTED AT

FORTIS HOSPITAL ANANDAPUR

SUBMITTED BY – PUJA MONDAL

BHM 6TH SEMESTER

ROLL- 13

REG NO – 151541310021

DINABANDHU ANDREW’S INSTITUTE OF TECHNOLOGY AND

MANAGEMENT
ACKNOWLEDGMENT

Every successful work is backed by sincerity and hard work. During this
two month tenure of my work, I was able to gain a lot of knowledge
both application and theory wise. My training period would not have
been possible without the wonderful support and guide of respected
trainers and official staffs.
I am very grateful to those people who have helped me in every ways of
training report.

I would like to express my warm and heart full gratitude towards Dr.
ARAFAT FAISAL ( MEDICAL SUPERINTENDENT),Dr. SHIVA
PRASAD RAO BOBBA ( ASSISTANT MEDICAL
SUPERINTENDED), Dr. RASHTRI GHOSH ( CLINICAL
INSTRUCTOR ), MR. PRASANT KUMAR PADHI (Human Resource)
for selecting and accepting me as a management trainee in FORTIS
HOSPITAL (ANANDAPUR) . I am also thankful to MRS. SUJATA
SINGH ( NURSING EDUCATOR)for inducting me and for providing
their valuable guidance throughout the training period. I would also like
to thank the entire MEDICAL TEAM team for sharing their knowledge
and cooperating with me and for motivating me throughout.

I would like to thanks DR. SANJUKTA NANDY (principal,

DAITM) SURAJIT DAS (HOD) and MRS MOUMITA ROY(Project
guide) for the continues guidance and for giving me the opportunity to
complete my internship from FORTIS HOSPITAL ANANDAPUR
hospital.
DECLARATION
I do hereby declare that this project work entitled “TIME MOTION
STUDY as per NABH guidelines” OF DIALYSIS DEPARTMENT at “
FORTIS HOSPITAL ANANDAPUR” for 3months (9TH JAN to 1st
APRIL), submitted by me in practical fulfillment for the requirement of
Bachelor Degree in Hospital Management (BHM) from Dinabandhu
Andrew’s Institute Of Technology & Management with the
collaboration of Maulana Abdul Kalam University Of Technology
(MAKAUT) is the result of my original and independent research work
carried out under the supervision and guidance from DAITM college.
I further declare this project work or any part of these has not been
submitted by me anywhere for the award of any degree or other similar
title before.

1. NAME- PUJA MONDAL

2. ROLL NO.-154033150021
3. REG NO.-1541310005
4. DURATION OF TRAINING- 3 Month
5. (Signature of the Student) -
6. For office use only-
7.The project has been approve/ not -
EXECUTIVE SUMMARY

As a part of a special internship program, I was allowed to get hands on

experience of working with trained professionals of the hospital industry
and learning about the nuances of handling and managing operations in
the DIALYSIS DEPARTMENT.

Throughout my training period in FORTIS HOSPITAL I have learnt

floor auditing. I have checked every patient’s file, whether all the
documents were properly arranged according to the NABH guidelines or
not. I also learnt “nursing educational” part, whether they gave the exam
or not, whether they attain respective classes or not.I have done time
motion study in the dialysis department, the average time of stay of the
patient, how much time the technician took for priming, how much time
the nurses took for dressing.

Lastly, to summarize, my overall experience has been a very fruitful

one. It was a good learning experience for me and gave me the first
exposure to gain knowledge about the working of the hospital industry.
TABLE OF CONTENTS

SERIAL TOPIC
NUMBER
1 Introduction
2 Company Profile
3 Review of Literature
4 Training Objective
5 About the Department
6 Research Methodology
7 Discussion & Findings
8 Conclusion
INTRODUCTION
One of the largest integrated healthcare delivery networks in Asia
Pacific.

Fortis Healthcare Limited is a leading, pan Asia-Pacific integrated

healthcare delivery provider. The healthcare verticals of the company
span diagnostics, primary care, day care specialty & hospital, with an
asset base in 3 countries, many of which represent the fastest-growing
healthcare delivery markets in the world.

Currently, the company operates its healthcare delivery network in India,

Mauritius & Sri Lanka, with over 10,000 potential beds, 240 diagnostic
and 17,000 employees, 65 healthcare delivery facilities, 33 operating
facilities, 120 satellites & heart Command Centre. They have 4 JCL
certified hospital in the country.

Fortis Healthcare is driven by the vision of becoming a global leader in

the integrated healthcare delivery space and larger purpose of saving and
enriching lives through clinical excellence.
FORTIS HOSPITAL, ANANDAPUR

Commissioned on 9th January, 2011 Fortis Hospital, Kolkata is a 400

bedded super specialty hospital located in EM Bypass Road. It is a part
of India’s leading healthcare providers- Fortis Healthcare Ltd. Focusing
on the tertiary care of super specialty like cardiology and cardiac
surgery, bone & joint care, brain & spine care, digestive care, urology &
nephrology, Emergency care and Critical care. Our amenities include
24-hours accident and emergency services including trauma treatment,
ambulance services, blood bank, cath lab, preventive health checkup,
diagnostic lab. We have 14 NABH certified hospitals in the country.
Fortis Anandapur is NABH accredited.
“VISION”
SAVING AND ENRICHING LIVES.

“MISSION”
GLOBALLY RESPECTED HEALTHCARE
ORGANIZATION RECOGNIZED FOR CLINICAL
EXCELLENCE AND DISTINCTIVE PATIENT CARE.
FORTIS LOGO :

The Fortis symbol comprises of two human hands that encloses human
forms. The integration of hands and the human figure represents Fortis’s
responsive approach to healthcare. It is the assurance of patient centric
care. In fact, this symbol engages a constant reminder of their mission
while for audiences outside the organization and for both external and
internal stakeholders.

The Fortis logotype consists of specially hand drawn lettering form to

give weight to signify solidity and scale. The capital “F” clearly cues
leadership. The green colour represents health and well-being while the
red beings dynamism and energy. Vibrant, memorable and
contemporary corporate signature is a fitting face for an organization
that seeks to excel, lead and serve.
FORTIS INITIATIVES:
Sparkle is an initiative to improve & meet international standards of
cleanliness at Fortis. To keep our hospital clean we follow the 5S
concept:
5-“S” include:-
Sparkle-sort
Straighten
Shine
Systematize
Sustain

FORTIS VALUES :
Patient Centricity –
• Commit to ‘best outcomes and experience’ for our patients.
• Treat patients and their care givers with compassion, care and
understanding.
• Our patients’ needs will come first.
Integrity :
• Be principled, organization’s need.
• Model and live our ‘values’.
• Demonstrate moral courage to speak up and do the right things.
Teamwork:
• Proactively support each other and operate as one team.
• Respect and value people at all levels with different opinions,
experiences and backgrounds.
• Put organization’s need before self-interest.
Ownership:
• Be responsible and take pride in our actions.
• Take initiative and go beyond the call of duty.
• Deliver commitment and agreement made.
Innovation:
• Continuously improve and innovate to exceed expectation
• Adopt a ‘can-do’ attitude.
• Challenge ourselves to do things differently.
FLOOR DETECTION:

LEVEL-B-2 - Car Parking

LEVEL-B-1 - Mortuary, Engineering Room, staff Changing Room
LEVEL-1 – Main reception, Admission & Discharge, Billing, Gastro
OPD & Endoscopy, Ortho-Neuro OPD, Emergency, Nest OPD &
radiology, OP pharmacy.

LEVEL-2 – Physiotherapy, Urology OPD, SRL lab, blood bank, HDU

unit & Dialysis.

LEVEL-3 – Multi Ward, Administration office, Main store, IP

pharmacy
LEVEL-4 – Cardiac OPD, CCSD, CCU, &Cath lab
LEVEL-5 – SICU, Operation Theatre
LEVEL-6 – Cafeteria, AHU, Kitchen, Dietetic Room, IT server Room.
LEVEL-7 – Wards
LEVEL-8 – Wards

Level-9 –Wards
FORTIS CULTURE- INDICATORS-
DIFFERENTIATING FACTORS:

JAM JA JEE

16TH TEETH
SMILE

BILI-BELIEVE IT
OR LEAVE IT

TIMJ2-THIS IS
MY JOB TOO

PATIENT
FIRST
EMPATHY
SERVICES AVAILABLE AT FORTIS :
• Accident and Emergency
• Anesthesiology
• Blood Bank
• Brain & Spine Surgery
• Cardiology
• Cardiovascular & Thoracic Surgery
• Cath lab
• Critical Care
• Dental
• Dermatology
• Diabetology& Endocrinology
• Endoscopy
• ENT
• Gastroenterology
• General Medicine
• Maxillofacial Surgery
• Medical Oncology
• Nephrology
• Neurology
• Obstetrics & Gynecology
• Ophthalmology
• Orthopaedics& Rheumatology
• Pathology
• Paediatrics
• Physiotherapy & Rehabilitation
• Plastic Surgery
• Psychology & psychiatry
• Pulmonology
• Radiology & imaging
• Urology

SERVICES NOT AVAILABLE AT FORTIS :

• Patients burns more than 10%
• Patients suffering from Psychiatric Disorder
• Radiation Oncology
• Nuclear Medicine
REVIEW OF LITERATURE
J Biomed Inform. 2014 Jun: Time motion studies were first
described in the early 20th century in industrial engineering, referring to
a quantitative data collection method where an external observer
captured detailed data on the duration and movements required to
accomplish a specific task, coupled with an analysis focused on
improving efficiency. Since then, they have been broadly adopted by
biomedical researchers and have become a focus of attention due to the
current interest in clinical workflow related factors. However, attempts
to aggregate results from these studies have been difficult, resulting from
a significant variability in the implementation and reporting of methods.
While efforts have been made to standardize the reporting of such data
and findings, a lack of common understanding on what "time motion
studies" are remains, which not only hinders reviews, but could also
partially explain the methodological variability in the domain literature
(duration of the observations, number of tasks, multitasking, training
rigor and reliability assessments) caused by an attempt to cluster
dissimilar sub-techniques. We provide a detailed description of the
distinct methods used in articles referenced or classified as "time motion
studies", and conclude that currently it is used not only to define the
original technique, but also to describe a broad spectrum of studies
whose only common factor is the capture and/or analysis of the duration
of one or more events.

J Am Med Inform Assoc. 2011 Sep-Oct : Time and motion

studies (F02.784.412.846.707), workflow (L01.906.893), health
information technology (L01.700), medical informatics applications
(L01.700.508), collaborative technologies, personal health records and
self-care systems, developing/using clinical decision support (other than
diagnostic) and guideline systems, systems supporting patient-provider
interaction, human-computer interaction and human-centered
computing, improving healthcare workflow and process efficiency,
system implementation and management issues, social/organizational
study, qualitative/ethnographic field study, cognitive study (including
experiments emphasizing verbal protocol analysis and usability),
methods for integration of information from disparate sources,
information storage and retrieval (text and images), data exchange,
communication, integration across care settings (inter- and intra-
enterprise), visualization of data and knowledge, developing/using
computerized provider order entry

MarceloLopetegui: Time motion studies were first described in the

early 20th century in industrial engineering, referring to a quantitative
data collection method where an external observer captured detailed data
on the duration and movements required to accomplish a specific task,
coupled with an analysis focused on improving efficiency. Since then,
they have been broadly adopted by biomedical researchers and have
become a focus of attention due to the current interest in clinical
workflow related factors.
TRAINING OBJECTIVE
• To understand the proper overall procedure and principle of
functioning of the Dialysis department
• To have a clear concept of how the Dialysis department work in
the hospital and knowing their respective functions.
• To understand the application of managerial tools techniques
involved in the organization.
• To put the theoretical knowledge into practical experiences.
• To observe the flow of work with proper coordination and
synchronization as it happens
• To have a clear concept of NABH guidelines
• To identify the proper time motion study of the various department
• To calculate the average length of stay
• To done the floor auditing
• Ro identify if there any drawbacks or problems occurring in the
Dialysis department
• To be able to provide proper suggestions for the betterment or
improvement of the respective problems.
ABOUT THE DEPARTMENT
DIALYSIS DEPARTMENT
In medicine, dialysis is the process of removing excess water, solutes,
and toxins from the blood in those whose native kidneys have lost the
ability to perform these functions in a natural way. This is referred to as
renal replacement therapy.

Dialysis may be used in those with rapidly developing loss of kidney

function, called acutekidney injury (previously called acute renal
failure); or slowly worsening kidney function, called Stage 5 chronic
kidney disease (previously called chronic kidney failure and end-stage
renal disease and end-stage kidney disease).

Dialysis is used as a temporary measure in either acute kidney injury or

in those awaiting kidney transplant and as a permanent measure in those
for whom a transplant is not indicated or not possible.

DIFFERENT TYPES OF DIALYSIS :

DIALYSIS

HEMODIALYSIS PERITONEAL DIALYSIS

HAEMODIALYSIS:
Haemodialysis, CRRT and SLED are similar procedure and use the
same principle (membrane filtration). At thestart of the session, needles
are inserted into the AV fistula/ graft and taped into place. In some
patients, an existing vascular access port (e.g. Internal
Jugular/Subclavian vein ) may be used to connect the dialysis machine
instead of an AV fistula/graft. Blood is slowly removed and transferred
through a tube to a dialysis machine which is made up of a series of
membranes. These membranes filter waste products from blood, which
are passed into the dialyser fluid. The ‘dirty’ dialysate fluid is pumped
out of the dialyser and the ‘clean’ blood is passed back into the body
through the second needle. The needles are removed at the end of
session. A dialysis session takes around four hours to complete because
blood needs to be removed, filtered and replace slowly, in CAPD, tube is
inserted into the abdominal cavity and the peritoneum is used as the
filtering membrane.

PERITONEAL DIALYSIS:

Peritoneal dialysis (PD) is a treatment that uses the lining of your

abdomen (belly area), called your peritoneum, and a cleaning solution
called dialysate to clean your blood. Dialysate absorbs waste and fluid
from your blood, using your peritoneum as a filter. One benefit of PD is
that it is not done in a dialysis center. You can do your PD treatments
any place that is clean and dry. This can allow you more freedom to
work, travel or do other activities you enjoy without worrying about
scheduling dialysis appointments. The two most common types of PD
are continuous ambulatory PD (CAPD) and continuous cycler-
assisted PD (CCPD).
During peritoneal dialysis, a cleansing fluid (dialysate) is circulated
through a tube (catheter) inside part of your abdominal cavity
(peritoneal cavity). The dialysate absorbs waste products from blood
vessels in your abdominal lining (peritoneum) and then is drawn back
out of your body and discarded.

INTENDED BENEFITS:
Provide an alternative for reduced kidney function.
Removal of waste products from the blood.
Removal of extra fluid from the body.
Improving quality of life.

SYMPTOMS OF DIALYSIS:
Lethargy.
Weakness.
Shortness of breath.
Generalized swelling (edema)
Generalized weakness due to anemia.
Loss of appetite.
Lethargy.
Fatigue.
BENEFITS OF DIALYSIS

Kidney transplantation is the treatment of choice for many people with

end-stage kidney disease. A successful kidney transplant can improve
your quality of life and reduce your risk of dying. Ideally, patients who
are eligible to get a kidney transplant do so before ever starting
on dialysis.

They also help control blood pressure and regulate the levels of
chemicals in the blood, such as sodium, or salt, and potassium.
Without dialysis, salts and other waste products will accumulate in the
blood and poison the body. However, dialysis isn't a cure for kidney
disease or other problems affecting the kidneys.

Pros of hemodialysis

• When AV fistulas are used for vascular access, the risks complications
of hemodialysis are reduced.
• AV fistulas for hemodialysis can last many years, longer than
transplanted kidneys, catheters for peritoneal dialysis and other forms of
vascular access, with usually no need for additional surgical
intervention.
• Hemodialysis at dialysis centers is done 3 times weekly leaving most of
the week dialysis free.
• Trained staff at the centers continuously supervise and monitor patient’s
health and treatments
• Hemodialysis at treatment centers allows for social interactions with
people undergoing the same process
• Hemodialysis sessions can be used for work, reading and relaxation
• Hemodialysis carries a relatively low risk of infection
• Hemodialysis can also be done at home, at your own convenience.
Hemodialysis done at home is generally done daily, with assistance from
a partner.
• Nocturnal hemodialysis done at home is a relatively gentle form of
treatment, leaving the patient feeling stronger
• Nocturnal hemodialysis allows for sense of normality and for regular
work/school schedules
Cons of hemodialysis

• If hemodialysis is done in a clinic you will to travel to the clinic, and

spend 3-4 hours there each session.
• Hemodialysis schedule must be stringently kept.
• Travel is more complex, requiring advance planning and arrangements.
• Diet and fluid restrictions must be adhered to strictly.
• Fistula may seem ungainly and ugly to patient
• If undergoing home hemodialysis, a partner must be home, and must be
involved in the nursing.
• If done at home space, electrical and plumbing needs must be considered
• Possible side effects include low blood pressure, shortness of breath and
nausea.

DIALYSIS MACHINE
The dialysis machine mixes and monitors the dialysate. Dialysate is the
fluid that helps remove the unwanted waste products from your blood. It
also helps get your electrolytes and minerals to their proper levels in
your body. The machine also monitors the flow of your blood while it is
outside of your body. You may hear an alarm go off from time to time.
This is how the machine lets us know that something needs to be
checked.
TIME AND MOTION STUDY
As per NABH guidelines

TIME STUDY is defined as a work measurement technique for

recording the times and rates of working for the elements of a specified
job carried out under specified conditions and for analyzing the data to
determine the time necessary for carrying out the job at a defined level
of performance.

MOTION STUDY implies dividing the work into fundamental

elements or basic operations of a job or a process with the object of
eliminating unnecessary or defective elements in a job. After
investigating all movements in a job, process or operation it finds out the
most scientific and systematic method of performing the operation or
completing the job.

OBJECTIVES
1. They eliminate unnecessary motions, fatigue, and seek to improve
human efforts in doing a job.
2. They bring about improvement in method, procedure, techniques
and processes relating to a job.
3. They make effective utilization of materials, machines, human
resources.
4. They also improve layout and design of plant and equipment and
working environment.
BENEFITS

1. Optimum utilization of materials, plant, labour and financial

resources are possible.
2. Labour requirements can be properly assessed.
3. Job can be standardized.
4. Improvement in work methods by making comparison between
time taken to complete a job and time taken to complete the same
type of job under different methods.
5. Effective cost control and proper planning can be made with the
help of time and motion study.

HEALTH CARE TIME AND MOTION STUDIES measure

time and motion of health care workers to research and track efficiency
and quality. In the case of nurses, numerous programs have been
initiated to increase the percent of a shift nurses spend providing direct
care to patients. Prior to interventions nurses were found to spend ~20%
of their time doing direct care. After focused intervention, some
hospitals doubled that number, with some even exceeding 70% of shift
time with patients, resulting in reduced errors, codes, and falls.
A time and motion study is used to determine the amount of
time required for a specific activity, work function, or mechanical
process. Few such studies have been reported in the in-patient
department & outpatient department of the hospital.
The present trend toward increased efficiency in all kinds of skilled
work has brought about a widespread interest in motion and time study.
The term “time study” and “motion study” have been given many
interpretations since their origin. Time study, originated by Taylor was
mainly used for rate setting; and motion study, developed by the
Gilbreths, was largely employed for improving methods, one group saw
time study only as a means of determining the size of the task that
should constitute a day's work, using the stop watch as the timing
device. Another group saw motion study only as an expensive and an
elaborate technique for determining a good method of doing work.
Today the discussion of the comparative value of using either the one or
the other of the two techniques has largely passed; industry has found
that motion study and time study are insepara
inseparable,
ble, as their combined use
in many sectors now demonstrates. Taking cognizance of present trends
and recognizing the fact that motion study always precedes the setting of
a time standard. Time-motion study may be used for two purposes: (1)
To assist in finding the most efficient method of doing work; and (2) to
assist in training individuals to understand the meaning of time-motion
importance, and when the training is carried out with sufficient
thoroughness, to enable them to become proficient in applying time-
motion principles.
Today, the Indian hospital systems has in a state of transition and
outpatient services in tertiary hospitals face daunting challenges, such as
evolving technologies and reimbursement policies, demographic trends,
competing fiscal demands, and a worsening skilled workforce shortage.
This point in time also affords a unique opportunity as the India is in the
midst of one of the largest health services and renovation booms in
history. A reconsideration of skilled health work force and work
processes holds the potential to affect the efficiency and effectiveness of
healthcare delivery for the foreseeable future. Bold changes in the
outpatient work environment are imperative to ensure the sustainability
and affordability of the outpatient as part of the Indian healthcare
delivery system.
There is requirement to note the record of accountability staff
and time spent debriefing and to make sure that an explanation
of the debriefing is noted in the additional information of the
data collection form.
A time and motion study is a scientific method for recording
time spent on a variety of tasks. The methods used in the study
have been done in a narrow range of specialized work settings,
such as the initial registration and nutritional assessment of the
children. The results have to be very accurate since the mothers
in the study record the amount of time spent on specific tasks.
The sum for each specific case type, that is, old/new registration
was averaged to yield the average time spent, but this value used
in the calculations did not determine the need for an additional
time.

To the extent operations are concerned, time and motion study is one of
the better methods for determining the capacity of the hospital and
furthermore the particular time when the effectiveness and productivity
can be improved. This study is a proper answer to determine the “time”
taken to finish a certain task by a particular department.

Time and Motion studies outline the ground work and facilitate to arrive
at a better capacity, robust planning system which will lead the
operations of a hospital to operational excellence.

Basics on How to Do a Time and Motion Study Includes

• Look closely at the present task/current situation
• Identify the opportunities to be more efficient
• Modify the current process that is followed
• Examine if it produces the expected outcomes
• Rinse and repeat

Time and Motion study is an observation method used to decide the

timing and duration of tasks or procedures. It is a work measurement
technique used for recording the times and rates of working for the
components of a specified job carried out under specified conditions and
for analyzing data. The study helps in reducing and controlling costs,
enhancing working conditions and motivating individuals.

At the point when the time taken to finish a task is measured, machine
delays, personal needs, exhaustion, and any other foreign obstruction are
likewise considered. Effectively a job is separated into its parts. The
time taken to finish every part is noted. Furthermore, the parts are
ordered or rearranged, keeping efficiency in mind.

A Time Standard is a vital part of Time and Motion Study. A time

standard considers three factors: qualified laborer, working at a normal
pace and doing a specific task.

A comprehensive time study comprises of:

• Study objective setting.

• Experimental design.
• Time data collection
• Data analysis.

The collection of time data should be done in a few ways, depending

upon study objective and environmental conditions. Time and motion
data can be taken with a typical stopwatch, a handheld PC or a video
recorder. There are various dedicated software packages used to
transform a palmtop or a handheld PC into a time study device. As an
option, time and motion data can be gathered consequently from the
memory of computer control machines (i.e. computerized time studies).
However, Time and Motion study is an essential tool for further
improvement in productivity and operations in any Health care
organization.
RESEARCH METHODOLOGY

PLACE OF STUDY:
FORTIS HOSPITAL, ANANDAPUR
730, Eastern Metropolis Bypass Road, Anandapur, East Kolkata
Township, Kolkata, West Bengal

E-mail :
Phone : 03366284444

DURATION OF STUDY:
9th February to 1st April

SPECIALISED DEPARTMENT:
DIALYSIS DEPARTMENT

SOURCES OF DATA :
i. Primary Observation
ii. Annexure
DATA ANALYSIS

Total number of patients observed in dialysis department

during observation period : 50

(Time taken for pre-procedure in dialysis department )

No.of patient

1 mins
2 mins
3 mins
4 mins
5 mins

Time 1mins 2mins 3mins 4mins 5mins

No. of 23 15 4 7 1
patients
(Time taken by the technicians for priming)

No. of patients
25

20

15
10
No. of patients
5

0
Less than 5 mins More than 5 mins More than 10
mins

Time Less than 5 More than 5 More than 10

mins mins mins
No. of Patients 13 20 3

(Time taken by the technicians for returning)

No. of patients

Less than 5 mins

More than 5 mins

Time Less than 5 mins More than 5 mins

No. of patient 31 19
(Time taken by the nurses for dressing the patient)

No. of patients

Less than 5 mins

More than 5 mins
More than 10 mins

Time Less than 5 mins More than 5 More than 10

mins mins
No. of 24 19 1
patients
CONCLUSION
I have worked on Fortis Hospital, Anandapur, Kolkata as a trainee under
the DIALYSIS Department under the guidance of Mr. Shiva Prasad Rao
Bobba ( Assistant Medical Superintended).
During my project I have learned a lots of things. I collected various
data on the basis of dialysis department. I also came to know about
various factors associated with this, I came to know about various
different rules and regulation as well as some of the procedure of
particular department.
All the management team and the employees also the technicians and
nurses coordinate with me very well and they help me a lot during the
time.

I shall be grateful if this study and findings prove beneficial to the

hospital services anyway.
BIBLIOGRAPHY

Most of the data and information was collected during the period of
training and regular interaction with the patients and other staff of the
department and Others:-
www.google.com
www.fortishealthcare.com