CHAPTER - I

INTRODUCTION

1.1 Introduction

In modern healthcare systems, the quality of medical services is often assessed based
not only on clinical outcomes but also on the overall experience and satisfaction of
patients. One of the key elements that affect this experience is facility management.
Facility management (FM) in healthcare facilities encompasses a wide array of
support services that provide a safe, clean, functional, and comfortable environment
for patients, staff, and visitors. These services cover areas such as sanitation,
maintenance, security, waste management, accessibility, and physical infrastructure
management. Though not necessarily clinical in scope, these services play a critical
role in affecting the quality of care and patients' attitudes towards healthcare delivery.

With the increasing focus on patient-centered care, healthcare administrators and

providers alike are recognizing the significance of comprehending patient satisfaction
from diverse angles—ranging from non-clinical domains such as facility
management. An efficiently managed healthcare environment can have a positive
impact on patient outcomes by decreasing stress, promoting safety, improving access,
and maintaining operational effectiveness. Poor facility conditions, in turn, contribute
to dissatisfaction, increased complaints, and even compromised health outcomes.

The inpatients and outpatients are considered important stakeholder groups whose
opinions are critical to assessing and enhancing facility management services.
Inpatients, who undergo long-term treatment and recuperation, engage heavily with
many aspects of the facility. They will likely be impacted by factors like cleanliness
of rooms, levels of noise, lighting levels, bathroom facilities, temperature
management, and timeliness of maintenance services. Their longer duration of
exposure to the facility setting implies that their satisfaction is defined by ongoing and
direct exposure to the infrastructure and support systems.

In contrast, outpatients, who attend health facilities for consultation, diagnostics, or

minor treatments, generally experience shorter and more focused interactions. Their
satisfaction is usually defined by ease of movement, waiting room comfort, tidiness,

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availability of parking space, and front desk efficiency. Even though their stay at the
facility is short compared to inpatients, their convenience and efficiency expectations
are typically higher due to time limitations and the nature of fast-paced outpatient
care.

In light of these varying usage patterns and expectations, there is a need to analyze
levels of satisfaction independently for inpatients and outpatients when evaluating
facility management services. A comparative study can yield richer information on
how various user groups perceive the healthcare environment, and enable service
areas that need to be addressed specifically.

The impetus for this research stems from the increasing acknowledgment of patient
feedback as a central force for quality improvement in the healthcare industry. While
numerous studies examine clinical results or physician-patient communication, fewer
inquiries investigate the domain of non-clinical support services—specifically from
the vantage point of varied patient populations. Knowing inpatients' and outpatients'
satisfaction levels with facility management can assist hospital managers in decision
making about resource utilization, improvement in services, and policy-making.

This research will attempt to measure patient satisfaction using structured

questionnaires and qualitative responses, screening areas including cleanliness,
accessibility, safety, signage, responsiveness of the staff, and maintenance. The study
will also attempt to determine whether demographic factors (age, sex, nature of care
experienced, length of stay, etc.) affect views of the facility services.

Through the attainment of these goals, the research hopes to contribute to the wider
discussion on quality enhancement in healthcare settings. The results can inform
healthcare facility managers on how to design interventions that not only optimize
operational efficiency but also enhance patient well-being and satisfaction.

In conclusion, facility management plays a vital, albeit often overlooked, role in

shaping patient experiences in healthcare institutions. By systematically evaluating
user satisfaction among inpatients and outpatients, this study seeks to highlight the
critical intersection between non-clinical services and patient-centered care, thereby
supporting the continuous evolution of healthcare quality standards.

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1.2 Hospital Profile

Christian Medical College Vellore, widely known as CMC, Vellore, is a private,

Christian community-run medical school, hospital and research institute. This
Institute includes a network of primary, secondary and tertiary care hospitals in and
around Vellore, Tamil Nadu, India. The Christian Medical College is a registered
voluntary, non-profit organization. The hospital is owned and administered by its
Administrative Council of Christian Church leaders from across India.

Founded in 1900 by an American missionary, Dr. Ida S. Scudder, CMC Vellore has
brought many significant achievements to India, including starting the first College of
Nursing in 1946, performing the first reconstructive surgery for leprosy in the world
(1948), performing the first successful open heart surgery in India (1961), performing
the first kidney transplant in India (1971), performing first bone marrow
transplantation (1986) in India and performing the first successful ABO incompatible
kidney transplant in India (2009).

The Christian Medical College (CMC) in Vellore has come a long way from its
humble start as a one-room clinic, growing into one of India’s most prestigious
private hospitals and medical schools. Today, CMC cares for over two million
patients and trains one thousand doctors, nurses and other medical professionals each
year. It is consistently ranked among the top hospitals in India.

Campuses – one, the main campus at the heart of Vellore City, and the other at
Bagayam, which is about 7 km from the main campus. The hospital has been visited
at various times by many prominent leaders including Sir Alexander Fleming, Dr.
Jonas Salk, the American Evangelist Billy Graham, Mahatma Gandhi, Indian
Presidents Radhakrishna, Rajendra Prasad, Abdul Kalam, Prime Minister Indira
Gandhi, and the Countess Edwina Ashley Mountbatten of Burma.

CMC offers a range of different medical specialties, with advanced diagnostic and
therapeutic services, alongside primary and secondary level care for local
communities. CMC has nearly 2,000 doctors and 3,000 nurses on staff, many of
whom also have teaching and research responsibilities.

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CMC departments are divided into specific areas of expertise, and CMC is known for
its esteemed Neurosciences, Gastroenterology, and Hematology departments. Almost
every clinical specialty is catered to, and many departments are subdivided into units
of particular expertise in specific areas, as in the division of Surgery which is broken
down into eight units specializing in Head and Neck Surgery, Endocrine Surgery,
Vascular Surgery, Colorectal surgery, etc. There are a total of 143 specialized
departments/units. CMC is home to 106 wards, including 11 intensive care units and
six high dependency units. More than 75 percent of its hospital beds are in general
wards and are subsidized to reduce the financial burden on patients. CMC has nearly
40 major operation theaters and 14 facilities for minor procedures. An average of 185
operations is carried out each day.

Diagnostic services are provided in house by the Radiology Department, Nuclear

Medicine and the Laboratories. Radiology reporting is through a filmless digital
system (PACS), enabling doctors to view X-rays and scans on any computer on the
network. All laboratory test results are also available through the hospital intranet, as
part of the “clinical workstation” hospital information system. CMC aims to bring
high quality health care to those who need it the most – wherever they live. The
central strategy in this vision is to develop, through education and training,
compassionate, professionally excellent, ethically sound, servant-leaders in health
care.

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Vision

The Christian Medical College, Vellore seeks to be a witness to the healing ministry
of Christ, through excellence in education, service and research.

Mission

The primary concern of the Christian Medical College, Vellore is to develop through
education and training, compassionate, professionally excellent, ethically sound
individuals who will go out as servant-leaders of health teams and healing
communities. Their service may be in promotive, preventive, curative, rehabilitative
or palliative aspects of healthcare, in education or in research. In the delivery of
healthcare, CMC provides a culture of caring while pursuing its commitment of
professional excellence. CMC is committed to innovation and the adoption of new,
appropriate, cost-effective, caring technology. In the area of research, CMC strives to
understand God’s purposes and designs, fostering a spirit of enquiry, commitment to
truth and high ethical standards. Research may be aimed at gaining knowledge of the
fundamental basis of health and disease, at improving interventions or in optimising
the use of resources.

CMC reaffirms its commitment to the promotion of health and wholeness in

individuals and communities and its special concern for the disabled, disadvantaged,
marginalised and vulnerable. CMC looks for support and participation in its
programmes in education, service, outreach and research, from friends and like-
minded agencies in India and abroad, in a true spirit of partnership.

In its role as a living witness in the healing ministry of Christ, CMC seeks to work in
partnership both with the Church in India and the universal Church, and their
institutions. The medical school is ranked among the top medical colleges in India and
offers an extensive range of undergraduate, postgraduate, and higher specialty courses
in medicine, nursing, allied health sciences and related fields. The college is now
offering 175 different post graduate courses in the medical, nursing and allied health
disciplines, including PhD courses. A total of over 2,600 students are enrolled every
year.

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The CMC & hospital community is made up of an interesting and diverse group of
people – students and faculty come from all over India and a number of other
countries, such as Sri Lanka, Malaysia, Hong Kong and Singapore. Externs, short-
term students and volunteers come from Australia, Britain, USA, Germany, Sweden,
New Zealand and other countries. Working and learning together has been found to be
mutually beneficial. CMC uses a hands-on approach in learning, and allows students
to experience how medicine is put into practice in the hospital and community.

CMC Vellore leads research related to the causes and treatment of diseases, and
combines studies with clinical experience, laboratory work, and teaching. Many
departments are recognized as centers of research excellence, and CMC is one of the
leading contributors of medical research institutions in India. CMC hosts many
conferences and workshops and runs regular courses in research methodology,
epidemiology, biostatistics and several other topics. Several CMC departments are
recognized by the ICMR (Indian Council for Medical Research) as centres of
excellence for research.

The Objective

The object of the Christian Medical College Vellore Association is the establishment,
maintenance and development of Christian Medical Colleges and hospitals in India,
where women and men from the Christian community primarily and also others shall
receive an education of the highest grade in the art and science of healing.

Department Profile - Hospital Facility Management [HFM]

Facilities management services play a critical role within the healthcare environment,
directly impacting the patient experience and enabling the efficient provision of
clinical care. The primary focus of any Hospital Facility Management department is
to ensure an exceptional environment of care along with the safety and security of
both patients and staff. Hospital Facility Management department is the maintenance
and oversight of a hospital facilities' development, maintenance and operations. This
includes any building that provides healthcare services, such as clinics, long-term
facilities, surgical centres and hospitals, and covers every aspect of facility upkeep.

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The Hospital Facility management department – often abbreviated as HFM – is
responsible for supervising the maintenance, overall operations of healthcare
facilities. This ranges from overseeing large projects and maintaining compliance
down to everyday cleaning, maintenance, waste disposal and pest management and
upkeep.

The following are essential functions and responsibilities of hospital facilities

management:

 Managing Day-to-Day Operations.

 Establishing safety policies and maintenance programs
 Identifying needs for repairs or renovations
 Ensuring legislative and facility compliance
 Performing regular life safety and fire safety assessments
 Ensuring that all buildings meet safety standards
 Overseeing utilities management and electrical engineering
 Inspecting patient rooms, waiting rooms, operating rooms, etc. for cleanliness
and orderliness
 Inspecting buildings to identify existing or emerging structural issues
 Managing workplace safety and cleanliness awareness initiatives.

Compliance

 Maintaining building compliance is critical to the success of any healthcare

organization and is one of the paramount responsibilities of any facilities
manager. Ensuring a High-Quality Environment of Care
 In line with the mission of any healthcare facility is ensuring a safe and
reliable Environment of Care for patients. This includes any healthcare site
where patients are treated, for both inpatient and outpatient settings. The
primary goal of the Environment of Care is to provide a safe and efficient
environment for patients and staff members.
 Healthcare facility management continues to be a cornerstone for providing
the best patient care possible. Whether it’s by maintaining day-to-day
operations or leading safety initiates, healthcare facility management can help
move healthcare organizations into the future.

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 In June 2022 the Facility Management of Ranipet campus started with the
great support form General Superintendent Office under the guidance of
Assoc, General Suptd, and Dy. Gen. Suptd, with the minimum facility. The
transits of OPD, Wards, Labs, Departments and other facility happened
slowly, the external, Internal housekeeping & Pest Control, General &
BioWaste management activities begin gradually with a smaller group of on
sourced labour effective strategies & monitoring. By the Grace of God almost
the departments like OPD’s, General & Private wards, Day care wards,
oncology, chemo wards & BMTU have been completely moved to this new
campus. The average of OPD foot fall and admission raises above 50% to
60%. The Facility Management (External, Internal, Pest Control, General &
Bio- Waste, Management) started its systematic function effectively under the
guidance and the leadership of our Assoc. General Suptd., and Dy. General
Suptd.,. with the great support of the General Superintendent Office, Ranipet
campus, the Facility Management has developed its Procedure Manual
containing the details of staff strength, shifts timings, cleaning protocols,
training records, etc., as a form of records for the future.

Facility
Management

PEST control,
External Cleaning Internal Cleaning General & Bio-waste
Management

Source: Support Services Manual (Ranipet Campus)

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1.3 Problem Definition

Facility management services are essential for ensuring patient comfort and
maintaining the quality of care in hospitals. However, their effectiveness is often not
evaluated from the patient’s perspective. Inadequate facility management, such as
poor cleanliness, insufficient housekeeping efficiency, ineffective odour control,
infrastructure and maintenance issues, and difficulties in accessibility, can negatively
impact patients’ perceptions of care quality, leading to decreased satisfaction. This
study aims to address this gap by assessing the effectiveness of facility management
services through the satisfaction levels of both inpatients and outpatients.

1.4 Objectives of the study

1. To identify the key factors influencing inpatient (IP) and outpatient (OP)
patient satisfaction with the facility management services provided.
2. To measure the satisfaction levels of inpatient and outpatient users with the
services provided.
3. To suggest recommendations for improving patient satisfaction.

1.5 Scope of the study

The scope of the study is to evaluate the satisfaction levels of inpatients and
outpatients regarding facility management services at Christian Medical College,
Vellore – Ranipet Campus. It covers non-clinical services such as housekeeping,
sanitation, maintenance, security, waste management, and support staff behavior. The
research aims to identify strengths and areas for improvement in service quality from
the patient's perspective. Data will be collected through surveys and interviews from a
diverse group of patients. The study is limited to the Ranipet campus and does not
assess medical or clinical care. It seeks to provide actionable insights to enhance
patient experience and operational efficiency. Only services directly affecting patient
comfort, safety, and convenience are included.

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1.6 Limitations of the study

1. Geographic Limitation – The study was confined to the Ranipet campus of

Christian Medical College and does not encompass data from other campuses.
2. Participant Scope – Feedback was collected only from inpatients and
outpatients, excluding insights from hospital staff or visitors, which may
provide a more holistic view of facility management services.
3. Service Scope Limitation – The study focused solely on facility management
services, excluding other non-clinical support services that may also influence
patient satisfaction.
4. Subjectivity of Responses – Patient feedback is inherently subjective and
may be influenced by personal perceptions, individual expectations, and
temporary emotional states during their hospital visit or stay.
5. Timeframe Constraint – The one-month duration of the study may not
capture seasonal trends or exceptional events that could affect patient
satisfaction levels over a longer period.

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 CHAPTER - II

REVIEW OF LITERATURE

Ann Sloan Devlin et al. (2003) examines three areas of primary research: how
patients become involved in their care (for example, the impact of patient control), the
impact of the physical environment (such as noise, light, and art), and creating
specialized facilities for particular patient groups (such as Alzheimer's disease
patients). The article also addresses the challenges of doing rigorous research in
health care environments and contrasts the knowledge that can be obtained from two
different disciplines: architecture and behavioral science. It also explores the
influenced infrastructure, such as cleanliness, up-to-date facilities, as well as
equipment availability, are equally strongly associated with levels of satisfaction.
Generally, researchers concur that strengthening these two dimensions—service
delivery and hospital infrastructure results in greater patient satisfaction. Others even
opine that infrastructure could be a more overpowering influence, particularly in
environments where physical conditions significantly determine the quality-of-care
perception. These observations reinforce the significance of an integrated approach to
hospital management balancing both service excellence and building strengthening.

M Gadallah et al. (2003) emphasizes that patient satisfaction with primary healthcare
services depends on various factors, such as accessibility, staff performance, and
facility conditions. Egyptian studies indicate a high level of satisfaction with doctor
and nurse performance and waiting areas but problems with drug availability,
laboratory services, and consultation privacy. Demographic determinants like age,
gender, and education tend to have very limited influences on overall satisfaction.
These results imply that increasing resource availability and privacy would be
beneficial to patient experience. Generally, the literature highlights the role of service
quality and facility environment in determining patient satisfaction.

Igal M Shohet et al. (2004) indicates that healthcare facilities management (FM) has
emerged as an important research focus in the wake of increased demands placed on
healthcare services. Maintenance, performance, risk, supply services management,
and development form the central domains of healthcare FM. These are

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interdependent areas that guarantee effective facility operation. Integration via
information and communications technology (ICT) is identified as an important driver
supporting decision-making and enhancing the quality of healthcare FM outcomes. In
summary, the study calls for a comprehensive, technology-based strategy to
efficiently manage healthcare facilities.

Chun-Yen Tsai et al. (2007) emphasizes the role of the physical environment in
Outpatient waiting area influencing patient satisfaction. Important environmental
influences are visual and auditory conditions, body-contact comfort, and hygiene.
Research indicates that patients tend to express moderate to high satisfaction but point
out areas for improvement. Patient attributes like age, sex, visit frequency, and visit
timing have a great impact on their perceptions. An understanding of these socio-
demographic factors is important to the design of waiting spaces that address various
patient requirements. Responsive design of the physical environment to suit various
patient profiles can be beneficial in comfort and satisfaction levels. This collection of
literature supports the importance of patient-centered design in healthcare facility
planning.

Jo Richmond et al. (2007) conducted a housekeeper induction competency

programme reflecting creative leadership from the clinical standards facilitator within
an NHS Trust. The programme offers housekeepers proper training, guidance, and a
chance to exchange best practice. Multidisciplinary coverage at Trust-wide level,
involving dietitians, catering, and facilities managers, has assisted in achieving
improvements in addressing patients' nutritional requirements and enhancing the ward
environment. The programme is aligned with NHS Estates guidance and the Essence
of Care nutrition standards, providing a rigorous framework for quality improvement.
Working together, this has helped to improve both patient care and the ward
environment.

Sonia Maria Alves de Paiva et al. (2007) emphasizes patient satisfaction as a key
indicator for the assessment of service effectiveness. Research stresses the importance
of compliance with national health principles, e.g., those of the SUS, to enhance the
delivery of care. Qualitative approaches such as participant observation and focus
groups have been shown to yield profound insights into patient experiences.
Nonetheless, most studies point to a disconnect between patient satisfaction and the

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true organizational emphasis on quality improvement in health care facilities. As
much as patients may give positive feedback, systematic problems in work
organization may impede the uniform achievement of high-quality care. This
highlights the importance of aligning the operating structures of healthcare facilities
with quality objectives in a bid to improve patient outcomes.

Champika Liyanage et al. (2008) emphasizes the need for successful performance
management in hospital facility management, particularly within domestic services
vital for infection control. A systematic framework through balanced performance
indicators can facilitate benchmarking and quality improvement of services.
Implementation relies on overcoming challenges affecting staff and processes. The
strategy facilitates improved control over healthcare-associated infections and overall
facility operation. The research emphasizes the necessity for easy-to-understand,
manageable systems that support healthcare objectives and enhance staff performance
and patient care.

Daryl May et al. (2008) provides sparse empirical evidence of a direct association
between facilities management (FM) and healthcare health outcomes. In spite of this,
numerous NHS facilities managers perceive that FM's value could be quantified in
terms of patient care. Nevertheless, few healthcare trusts have tried to do this. Current
research mainly centers around perceptions rather than direct evidence of FM's
influence on health outcomes. Secondary analysis of data has failed to display
definitive correlations, pointing to a gap in evidence. This underlines the necessity for
research to emerge on how to quantify FM's impact on healthcare quality and patient
outcomes.

Roberto Cigolini et al. (2008) provides main areas in facilities management and
maintenance, highlighting ongoing trends aimed at enhancing efficiency and
effectiveness. It identifies strategic directions and steps towards enhancing these
developments. Literature included in recent special issues makes a contribution by
providing innovations and insights enriching the general framework. This research
highlights the dynamic nature of facilities management and the need to embrace new
strategies to enhance service delivery and operational performance.

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Karin Diez et al. (2009) emphasizes the role of hospital facility management (FM) in
enhancing operational effectiveness and cost distribution. One study from German
hospitals created an activity-based cost model for FM services, which identified that
existing DRG-based structures have simplified infrastructure expenses. The model
delivers a more precise, patient-focused approach to distributing FM costs, especially
for operation units. It assists in simulating the implications of changes in the delivery
of healthcare on infrastructure use. Evidence indicates that strategic FM planning can
assist in improved use of resources and decision-making. The research highlights
extending this method to other parts of the hospital to integrate cost management
planning.

S. J. Dancer (2009) suggests that over the past decade, rising hospital-acquired
infections have drawn attention due to public concerns linking "superbugs" to unclean
hospital environments. The effectiveness of environmental cleaning in controlling
pathogens like MRSA, VRE, norovirus, Clostridium difficile, and Acinetobacter
remains uncertain, mainly due to limited evidence-based guidelines. Studies suggest
that proper cleaning, with or without disinfectants, can help lower infection rates.
However, cleaning is often part of broader outbreak responses, making it difficult to
assess its individual impact. High contamination on hand-touch surfaces highlights
the importance of targeted cleaning alongside hand hygiene. Research supports
developing hygiene standards to strengthen cleaning practices. This could serve as a
cost-effective strategy in infection prevention and control.

Marc N. Elliott et al. (2010) emphasizes that Hospitals have made significant gains
in patient satisfaction, particularly in domains such as staff responsiveness and
discharge information, based on national survey results from 2008 through 2009. The
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
survey emphasizes these positive developments, though communication with
physicians has not had an identical gain. Most of these gains have been consistent
across different hospitals. The results show that interventions to improve inpatient
care work but also highlight areas of further focus to achieve complete patient
satisfaction improvement. Overall, the results represent a step-by-step but significant
improvement in hospital care quality as perceived by the patient.

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Panchapakesan Padma et al. (2010) underscores how hospital service quality (SQ)
must be understood on both the patients' and attendants' sides. It underlines how
interpersonal quality of care tends to mean more to patients than technical quality
because patients can be challenged to gauge clinical competence. It also underscores
the necessity for healthcare professionals to respond to both groups' expectations in
order to enhance overall service quality. Further, it mentions variations in service
delivery between public and private hospitals and implies that benchmarking can
improve performance. In general, the review advocates for a multi-dimensional
measure of healthcare service quality.

Patricia A. Tillmann et al. (2010) identifies a trend within the UK healthcare

industry to widen services by bringing products and services together, just like
strategies in manufacturing. The idea is to lengthen the life cycle of healthcare
infrastructure while increasing value creation. The research underscores the necessity
of value-driven systems, stakeholder interaction, and enabling policies to create
sustainable healthcare infrastructures. Challenges continue to exist, however, in how
to understand and implement these integrated solutions. Generally speaking, the
research suggests the need for integrating theoretical understanding with practical
approaches to ensure enhanced healthcare service delivery and facility management.

Koichiro Otani et al. (2011) insists on patient satisfaction, being a quintessential

performance indicator for health care management. Various studies have analyzed
generic factors such as nursing and doctor-patient interactions, deeming them to be
crucial in patient satisfaction. Present research, though, tends to fall short of
comprehensively revealing particular habits in these categories. This hinders the
formulation of focused interventions. Research indicates that patients appreciate
courteous and respectful care from doctors more than anything else. Communication
skills and empathy have a lot of influence on patient attitudes. Notwithstanding this,
most healthcare organizations continue to concentrate on technical aspects of care
quality while paying less attention to interpersonal dimensions. To successfully
improve satisfaction, literature suggests training initiatives focused on respect,
empathy, and communication.

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Atefeh Mohammadpour et al. (2012) points out sparse existing literature on
integrating real-time facilities information with healthcare delivery processes. It puts
emphasis on the fact that the majority of facility information is not integrated with
patient care, and thus opportunities for timely intervention and safety improvement
are lost. There is a review of existing studies and standards to identify how improved
coordination between facility management and clinical operations can optimize
decision-making, minimize disruptions, and enhance patient outcomes. The review
emphasizes the importance of more targeted research into the application of real-time
data for facilitating effective and safe healthcare settings.

Vanessa Whatley et al. (2012) emphasizes that public impressions about hospital
cleanliness are influenced by sensory impressions and extrinsic factors like media and
social media. Chief among these factors are surface cleanliness, odour absence,
opportunities for patient hygiene, and staff attire. Infection symptom awareness is low
among the general public. Research indicates that enhancing cleanliness perceptions
calls for multi-dimensional communication practices and coordination between
infection control groups, communication departments, and frontline personnel. In
general, effective communication and transparent cleanliness actions are necessary to
promote increased public confidence in hospital hygiene.

Muslim Amin et al. (2013) emphasizes the strong relationship between hospital
service quality, patient satisfaction, and behavioral intentions. One of the studies
identified five dimensions namely admission, medical service, overall service,
discharge, and social responsibility that have a significant impact on perceived service
quality and subsequently patient satisfaction. Better service quality stimulates good
patient behaviors like loyalty and repeat visits. The findings are, however, based only
on the patients' opinions and not on the healthcare providers as well. These findings
are consistent with earlier studies highlighting the physical environment, signage,
cleanliness, and Total Quality Management (TQM) as key areas to improve patient
experiences and outcomes.

Pitt et al. (2014) conducted a study in two B-class private hospitals in eastern
Bangkok examined the relationship between physical infrastructure, service quality,
and patient satisfaction. Surveying 400 inpatients and outpatients over a single day,
the research utilized statistical analysis to identify key factors influencing patient

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satisfaction. Findings revealed a strong correlation between the quality of core
medical services, non-core facilities, and overall patient satisfaction. Both physical
infrastructure and service delivery were found to significantly impact patient
perceptions and experiences. Improving these aspects can lead to reduced
dissatisfaction and enhance the overall patient experience. The study underscores the
importance of addressing both clinical and non-clinical factors to improve healthcare
service quality in private hospital settings.

Dubem I. Ikediashi et al. (2015) points towards the increasing trend of outsourcing
hospital ancillary FM services for enhancing efficiency and concentrating on patient
care. Research stresses that the quality of service is a key driver in determining user
satisfaction with outsourced FM services. Typically outsourced services are cleaning,
security, landscaping, and maintenance. Evidence in prior studies suggests that factors
like responsiveness, reliability, and professionalism determine levels of satisfaction.
Structural equation modeling (SEM) is usually applied to confirm causal links
between satisfaction and service quality. In hospitals, security and janitorial services
usually rate high in terms of satisfaction. Technical services such as plant
maintenance are usually behind in performance and user endorsement. Generally, the
literature confirms that adequately managed outsourcing has the potential to increase
service quality and stakeholder satisfaction in healthcare facilities.

Appalayya Meesala et al. (2016) finds that service quality and infrastructure are the
major determinants of patient satisfaction in healthcare. Service quality dimensions
like reliability, responsiveness, assurance, tangibility, and empathy are commonly
researched, and reliability and responsiveness have been shown to be the most
significant with the strongest effects. Infrastructure features like cleanliness, signage,
and accessibility for individuals with disabilities also have a high impact on patients'
experiences. Research based on models such as SERVQUAL, Donabedian's model,
and the Kano model directs attention to matching hospital facilities and services with
patient expectations. Research also verifies that loyalty results from patient
satisfaction, and upgrading infrastructure can improve satisfaction and also
postoperative recovery outcomes. Generally, these findings suggest that hospitals
must undergo continuous improvement in service delivery as well as physical
facilities.

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Borim Ryu MS et al. (2016) suggests that tailored bedside systems, such as the
Smart Bedside Station (SBS), improve patient satisfaction with improved health
information and convenient services in hospital stays. Research indicates that patient
satisfaction is affected by education level and understanding of technology. Data on
usage indicate that patient-tailored menus, hospital guides, and ordering services are
accessed most often. Generally, the incorporation of personalized digital tools within
healthcare environments enhances patient engagement and experience. Additional
research focuses on designing further sophisticated patient-centered communication
systems to enhance hospital-patient interactions.

Lorissa MacAllister et al. (2016) points to increasing significance of patient

satisfaction with healthcare, particularly as it becomes tied to provider reimbursement.
Patient demographics and quality of service are established influencers, but the
inpatient hospital environment also has an important impact. Cleanliness and
quietness are repeatedly identified as accepted principles but too often ignored in
general outcome assessment. The review reveals at least ten spatial environmental
factors with documented effects on health and behavior outcomes. It employs a
patient satisfaction model to systematically examine such influences. Evidence
indicates that hospital environmental design can directly influence patient
experiences. The research demands further studies on these spatial factors to enhance
healthcare outcomes.

Ruwei Hu et al. (2016) emphasizes a Guangdong Province survey of how the quality
of primary care differs by type of facility utilized the Chinese Primary Care
Assessment Tool. Patients' responses from 864 across county and tertiary hospitals,
secondary hospitals, and rural and urban CHCs differed clearly. After controlling for
demographic and health variables, CHCs received substantially higher overall PCAT
scores, especially on first-contact access, continuity of care, breadth of services, and
community orientation, compared with secondary or tertiary hospitals. CHC patients
also rated their care more highly. These results indicate that community health centers
provide better primary-care quality in China and can serve as a good model for
delivering primary care.

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Yann B. Ferrand et al. (2016) focuses on the increasing significance of patient
satisfaction in contemporary healthcare systems, particularly in the transition to
alternative payment models. It underlines that current research has predominantly
been oriented towards satisfaction from the healthcare provider's viewpoint with scant
attention to patients' individual experiences and expectations. The review posits that
satisfaction measures traditionally used may not entirely reflect what is most valued
by patients. It makes a call for more extensive research to better grasp the
determinants behind patient satisfaction and to enhance the measurement of it.

Will T. Shirey et al. (2017) examines the application of Lean Six Sigma (LSS)
methodology in healthcare facilities management (FM), with emphasis on a case
study where LSS was utilized to enhance maintenance and repair services. It points
out a research gap in current studies on LSS in healthcare FM and shows that
applying the DMAIC framework can improve service quality. The research drew on
five months of qualitative and quantitative data gathering and concluded that LSS was
effective in enhancing FM operations. The review indicates wider application of LSS
by healthcare FM may produce considerable service benefits and urges more research
to be conducted in this field.

Kimberly A Fisher et al. (2018) highlights the need to have an environment where
patients are at ease to express concerns while hospitalized. Evidence indicates that
almost half of the patients indicate problems with care, and roughly a third does not
feel at ease to complain. These reasons for discomfort include age, illness, emergency
admission, and language. Hesitant patients also have lower satisfaction with
communication from physicians and nurses and are less likely to recommend the
hospital. Enhancing patient activation, especially for vulnerable patient populations, is
critical to improving service recovery, safety, and the overall patient experience.

Stanley Njuangang et al. (2018) conducted a survey on The history of health-care

facility management (HFM) services and their contribution to infection control (IC)
from ancient Roman military hospitals through to today. Infection was originally
believed to be caused by non-clinical factors such as "miasma," but the identification
of bacteria redirected attention to clinical causes, and this resulted in an
underestimation of HFM services. But according to research, non-clinical functions
like cleaning, waste disposal, catering, and maintenance are still critical in infection

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prevention. Research highlights that there should be stronger integration between
clinical and non-clinical functions within hospitals. Reinforced by evidence, reforms,
particularly in systems like the NHS, have tended to fragment HFM services.
Literature confirms that acknowledging the role of HFM staff is important for
successful infection control.

Tanut Waroonkun et al. (2018) aimed to learn how the environmental elements of
Thai community hospitals influence user satisfaction. It was observed that previous
hospital expansions never took into account the needs of users, instead emphasizing
design rather than patient comfort. Researchers grouped the built environment into
four important categories: Ambient Features, Architectural Features, Interior Design
Features, and Outdoor Environment Features. Ambient Features emerged as the most
influential, followed by Architecture, Interior Design, and Outdoor Features, using
interviews and the AHP model. The research underscores the significance of a
patient-focused environment and offers a basis for enhancing hospital design based on
user experience

Oti Amankwah et al. (2019) identifies that quality facilities management (FM) is an
important factor in increasing patient satisfaction and overall healthcare performance.
Research indicates FM service quality acts as a mediator of the association between
patient satisfaction and the most important healthcare variables like service quality,
staff, and availability of resources. Some administrative factors might contribute less.
Studies in developing nations such as Ghana are scarce, and therefore such research is
essential in understanding how FM impacts healthcare outcomes. Generally, good FM
is a key factor in enhancing the healthcare experience

Sweta DCunha et al. (2019) emphasizes increasing significance of the services cape
for constructing patient perception and experience in healthcare settings. It also
defines services-cape as the physical and social environment where healthcare
services are produced, including aspects such as design, ambiance, and patient-
clinician interaction. Existing studies indicate that patient satisfaction, trust, and
perceived quality care are positively influenced by a properly designed service scape.
Key elements like layout, cleanliness, signage, and social interactions that drive
overall patient experience have been recognized by researchers as well. Variation in
perception between patient types (inpatient or outpatient) has been investigated but

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with inconclusive results. The review underscores the importance of reliable measures
to capture servicescape and justifies the applicability of such models to hospital
environments. It lays down a basis for assessing how the environment affects
healthcare results and quality of service.

Daniel Amos et al. (2020) stresses the creation of performance management models
and key performance indicators (KPIs) specific to hospital facilities management
(FM), with a particular emphasis on local services of utmost importance for infection
control. Research stresses the necessity of balanced and overarching measurement
systems consonant with healthcare objectives and enhancing service quality. Expert
validation and statistical testing endorse the applicability of identified KPIs, such as
financial and operational aspects. Challenges in implementation and calling for
additional empirical testing are recognized. Generally, these frameworks and KPIs
provide useful tools for improving FM performance and patient outcomes in the
hospital context.

Eunice Wong et al. (2020) emphasizes that patient feedback-based interventions can
enhance hospital care quality, especially in domains such as communication,
continuity of care, and responsiveness. Multi-component interventions addressed at
individual behaviors and organizational processes are more effective compared to
single-focus interventions. Nevertheless, the overall evidence is weak because of few
well-designed trials and no clear theoretical underpinnings. The majority of the
studies indicated positive outcomes in patient experiences, such as satisfaction with
staff, surroundings, and availability of care. The review calls for stronger studies to
understand better the mechanisms through which these interventions act and to
improve patient-centered care.

Ginthotavidana et al. (2021) seeks to develop a tailored model for assessing

housekeeping (HK) performance in health-care facilities in Sri Lanka. Adopting the
exploratory sequential mixed-methods strategy, the study commenced with semi-
structured interviews and case studies to determine the pertinent key performance
indicators (KPIs) before a questionnaire survey was conducted to confirm the
findings. Via statistical analysis, with the one-sample t-test, 46 KPIs were grouped
and prioritised under balanced scorecard perspectives. The findings reveal that these
KPIs have considerable input to the provision and measurement of quality HK

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services for both actual and perceived cleanliness. The model provides useful
advantages for quality auditing and inspection and can aid HK managers in tracking
performance more effectively. It also has the potential for transferability in other
facilities management services. The paper adds to the scarce research concerning HK-
specific performance measurement in health-care facilities.

Nuratiqah Aisyah Awang et al. (2021) underscores the significance of quality

services in healthcare environments, especially among persons with disabilities
(PWDs). The studies point out that accessible, safe, and well-serviced facilities have
significant impacts on PWDs' perceptions and satisfaction. The most significant
determinants of FM service quality are maintenance while in operation, signage
clarity, responsiveness of personnel, and effective channels of communication for
support. Physical disabilities receive much attention in current research, with little
inquiry into other types of disability. Integration of PWD feedback in FM strategies is
pivotal towards enhancing healthcare access and equity. SERVQUAL has been
modified to use in measuring perceptions of service quality, and facility managers can
use it to prioritize needs and promote inclusive service provision.

Obinna C. Madubuike et al. (2022) emphasizes the urgent necessity of efficient

healthcare facilities management (HFM) to guarantee patient safety and
organizational effectiveness. Conventional HFM practices tend to be reactive, with
limited real-time monitoring and proactive maintenance features. Current research
suggests sophisticated technologies such as digital twins (DT) to overcome these
shortcomings by delivering real-time virtual copies of physical infrastructure,
allowing for ongoing monitoring and more efficient coordination. Research also
highlights the need for embedding sensors, data analytics, and communication
networks in DT platforms to enhance system performance, including monitoring
HVAC and indoor air quality. Generally, the literature posits that embracing new
digital solutions can greatly contribute to HFM, albeit the remaining practical
application challenges.

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Qiufeng Gao et al. (2022) highlights that patient satisfaction is an important indicator
of healthcare quality and is determined by multiple provider-related factors. Research
with standardized patients in rural China shows that satisfaction scores are generally
low, with physician attributes, consultation quality, cost, and convenience being major
determinants. The process of consultation, especially effective communication and
adequate consultation time, is particularly significant in determining satisfaction.
These results highlight the necessity of focused policies aimed at enhancing the
quality of service in primary care facilities. In general, optimizing provider-patient
interaction and service availability are necessary to enhance patient satisfaction in
rural health centers.

Sirou Han et al. (2023) indicates that patient feedback-based interventions can
enhance hospital care quality, particularly in communication, continuity of care, and
responsiveness. Multi-component interventions targeting individual as well as
organizational factors are more successful than single intervention strategies.
Nevertheless, the overall evidence is constrained by the dearth of properly designed
research studies and distinct theoretical models. The majority of research findings are
positive improvements in patient experiences, including satisfaction with staff,
environment, and access to care. The overview points toward an urgent need for
stronger studies to have a better understanding of how the interventions are effective
and to improve patient-centered care interventions in hospitals.

Gita Pandey et al. (2024) emphasizes the extensive impact of physical infrastructure
on patient satisfaction within health facilities. Most important among these are the
presence of up-to-date equipment, hygiene, sanitation, sterilization procedures, and
easy access to facilities, which have a direct impact on patients' judgment of the
quality of care. Evidence indicates that these factors are responsible for developing
patients' confidence following treatment and determining their acceptance of service
charges. Though sterilization is significant in building patient trust, cleanliness and
modishness are more influential in overall satisfaction. This evidence base implies
that spending on sophisticated infrastructure and adhering to stringent hygiene
conditions are key strategies for healthcare providers looking to enhance patient
experiences and outcomes.

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Nusrah Samat et al. (2024) points that patient satisfaction is an essential indicator of
the effectiveness of healthcare services, impacted by several factors such as the
quality of interaction with the healthcare professionals, their perceived competence,
and the ease of administrative processes. Empirical evidence indicates that good
professional relationships and confidence in healthcare providers have a significant
impact on satisfaction. The ease of registration and administration, the availability and
quality of facility amenities, also contribute significantly. Research indicates that
patient satisfaction and overall healthcare outcomes can improve with enhancements
in these domains. Such findings inform healthcare providers and policymakers on
how to prioritize interventions for improving patient experience.

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 CHAPTER - III

RESEARCH METHODOLOGY

Research Approach – Quantitative Study

A quantitative approach focuses on collecting and analyzing numerical data to
identify patterns, relationships, and measurable outcomes. It uses statistical tools to
interpret results, ensuring objectivity and accuracy. This approach is suitable for large
samples like in this study.

Research Design – Descriptive Research Design

Descriptive design is used to present a clear picture of the existing situation without
manipulating variables. It helps in understanding characteristics, frequencies, and
trends in the study population. This design is ideal for summarizing patient
experiences in OP and IP departments.

Study Setting – Christian Medical College, Vellore (Ranipet Campus)

The study was conducted in a real-world hospital environment at CMC Ranipet
Campus. This setting provides access to diverse patients and healthcare processes,
ensuring relevant and practical data collection.

Study Area – Outpatient (OP) and Inpatient (IP) Departments

The research was limited to OP and IP departments to compare patient experiences in
both care settings. These areas cover most patient interactions, making them valuable
for analyzing service quality and satisfaction.

Study Duration – One Month (May 5 – June 4, 2025)

A one-month period was chosen to collect adequate data while ensuring timely
analysis. This duration also helps capture a variety of patient cases and seasonal
variations in hospital visits.

Source of Data – Primary and Secondary

Primary data was collected through a standardized, self-administered questionnaire to
ensure uniform responses and reduce interviewer bias. Secondary data from journals
and articles supported the literature review and provided a theoretical base.

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Study Population
The study included all OP and IP patients who attended the Ranipet Campus and
consented to participate. Inclusion and exclusion criteria ensured the data was
ethically collected and relevant to the study objectives.

Sample Size – 420 Respondents (IP – 212; OP – 208)

A total of 420 participants were selected to ensure reliable statistical analysis.
Splitting between OP and IP provided balanced insights into both patient groups.

Sampling Method – Simple Random Sampling

Simple random sampling gave each eligible patient an equal chance of selection,
reducing selection bias. This method increases the representativeness of the sample.

Data Collection Tool – Structured Questionnaire

A structured questionnaire was used to gather consistent and comparable responses
from participants. It contained predefined questions to measure specific aspects of
patient experience in both OP and IP departments.

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