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Journal of the Academy of Hospital Administration

Resource Generation by the Application of Energy Conservation Opportunities in a Tertiary Care Hospital

Author(s): V.P. Bhaskaran, P. Satyashankar, M.A. Suvarna, G. Somu

Vol. 17, No. 2 (2005-01 - 2005-12)

Key Words: Energy Conservation, Energy Audit, Building Management Systems

Key Messages:

  • Electricity in health care systems must be accounted and audited in terms of consumption, costing savings and optimisation
  • Energy cost savings directly contribute to profits


Electrical energy being an expensive commodity, its consumption and cost in a system must be properly accounted. It is invisible, hence often wasted without being noticed. It is proven that reduction in energy consumption by 10-20% is a realizable goal. Energy cost savings directly contributes to profits, which can be very significant. Energy audit (EA) involves analysis of energy usage and comparison of the same with an estimate of the minimum energy required.

Kasturba Hospital, Manipal, a 1475 bedded multi-specialty tertiary care hospital identified the need to implement energy audit to bring about savings on electricity consumption, which accounted for about 6.59% of total annual expenditure.

Analysis of energy usage revealed that Central A/C services and indoor lighting accounted for 60 % and 20% of total electricity consumption, respectively. Energy conservation opportunities (ECO’s) were identified, evaluated and implemented in the above areas from July 2003. ECO implementation involved an investment of Rs1.47 crores. Electricity consumption data collected for eleven months showed 16.72% reduction as compared to previous year. While energy consumption in Central A/C unit was reduced by 35.4%, consumption in indoor lighting was reduced by 18.25%. Approximate savings in money is estimated at Rs58 lakhs per year and the pay back period estimated at 2.5 years. Spin-off benefits accrued from this intervention include additional tonnage of cooling by Central A/C and increased life of A/C and indoor lighting appliances. The paper also suggests that for the sustainable development of healthcare industry, providers must optimize their operations; reducing avoidable costs, and should not overburden patients/Insurance companies.


The electrical energy situation in the national level is not encouraging. As compared to many developed as well as developing countries, the energy required per unit of GDP in India is very high. Electrical energy is invisible, hence it is often wasted without being noticed, except at the month end when the bill is received. Electricity is an expensive commodity and its consumption and cost in a system must be properly accounted. There is a more immediate need to conserve energy in order to contain escalating costs and maintain financial viability.(1,2)

It is proved that a reduction in energy consumption by as much as 10-20 % is a realizable goal. Energy cost savings directly contributes to profits, which can be very significant.(3) Top management’s perspective towards energy conservation is the most important factor. The objectives and perspectives of energy conservation of a firm originate from corporate vision. Major constituents of the operational plan for energy conservation are: (3)

  • Energy audit
  • Technology interventions
  • Training and Awareness.

Energy Audit:

The word “audit” can be defined as a “methodological examination and review” or “an examination with an intent to verify”.(1) Energy audit (EA) involves analysis of energy usage and comparison of the same with an estimate of the minimum energy required.(4) Basically energy auditing is classified into two categories:

Preliminary audit (PEA) – This audit is performed in a limited time span. It is focused on major energy supplies and demands accounting for at least 70 % of the total energy requirement.(1) It places emphasis on identification of obvious sources of energy wastage.(5) The audit involves the historical review of energy related records to establish baseline against which progress can be measured. Electricity billings for at least one year prior to audit are used.

Detailed audit (DEA) – This audit goes beyond quantitative estimates to costs and savings, which are normally huge. It involves technology up-gradation (changeover from old technology to new ones) requiring large investments. It deals with the enumeration of Energy Conservation Opportunities (ECO’s) – to identify ways of decreasing the loss and to evaluate the energy savings and profitability potential in implementing changes.(1)

The ECO’s may be classified according to: minimum implementation time / minimum cost / highest energy saving possibilities / quality of energy saved.(5) During the study of ECO some of the components or the equipment may be replaced by more efficient ones. Evaluation of ECO’s deals with the estimation of energy saving potential of each. Then the cost and benefit analysis for each has to be carried out separately. The benefits have to be compared and the adoption of ECO’s has to be made on a priority basis. Once the energy audit is complete, the entire analysis has to be presented in the form of Energy Audit Report, which should comprise additional costs and pay back period.(1) Generally, DEA is carried out by an external agency, like energy management consultants, so that they can pinpoint the areas of concern with an unbiased approach professionally.(4)

ECO’s in Air-Conditioning System

With the advent of technology and development of science, more and more buildings are coming up with an important dimension, which is now no more a luxury but has become a necessity – ‘air-conditioning. The expenses of cooling a building by air-conditioning always exceed that of heating in all climatic conditions. There are various ways in which energy conservation can be achieved in this area.(6,7)

Building design

  • The cooling cost depends on the volume of the building; hence it is essential that the building be designed as compact as possible.
  • Air-conditioning load can be reduced, by properly enveloping the building; by planting trees around and having sunshade devices.
  • To minimize the heat load through glass windows, sun control film can be fitted on to the windows; the use of double-glazed / triple-glazed windows can cut down the heat ingress to the system drastically. Under deck insulation of minimum 50 mm thickness for all exposed roofs will reduce heat gain from roof by 80%.(6)
  • Minimize artificial lighting, as lowered lighting levels decrease both internal building heat load and airconditioning load.(2)
  • Windows and doors should be made airtight, to prevent leakage of cold conditioned air.(6)


In the air-conditioning industry, there are a wide variety of equipment, ranging from window air-conditioners (A/C), split A/Cs, floor mounted package A/Cs, Central A/C system with chilled water plant.

The basic components of a Central A/C system are, cooling towers, chiller units and air handling units (AHUs). Each chiller unit is made up of a condenser, compressor, and evaporator. The cooling towers supply cold water to the condenser via condenser pumps. The condenser uses this cold water to condense the high-pressure gas coming from the compressor. This condensed gas is then circulated to the evaporator. The evaporator (with chiller coils) uses this gas to cool the water for circulation to the AHU’s. The AHU’s use this chilled water to condition the air and blow it into the room. The evaporators are then supplied return water from the AHUs via chilled water pumps.

Compressor - The most energy-consuming component of an air-conditioning system is the compressor. It presents as a worthy target for the application of energy conservation technologies. In a reciprocating type compressor, air is generated by the to and fro motion of the piston in the compression chamber, whereas in a rotary screw type compressor, air is compressed by two rotating, intermeshing rotors. Selection of the right compressor depends on the energy efficiency and load. Screw chillers / compressors are very energy efficient and can bring in power consumption to levels as low as 0.65 kW/TR. Recently, screw compressors with built-in variable frequency drives (VFD); have been introduced in the Indian market. This system facilitates fine-tuning of the compressor capacity precisely to meet the fluctuating compressed air demand, thus handling fluctuating loads.

Condensers – Among the condensers, the water-cooled is the most efficient.


A schematic diagram of the functioning of the plant is shown in Fig 1.

Chilled water pumps – These pumps consume a lot of energy and operate continuously in a chilled water plant. Generally, in a chilled water system, there are two pumping systems: Primary pumps to pump the return chilled water through the chiller / evaporator and secondary pumps to pump the chilled water to the process / AHUs. Chilled water requirements vary from time to time and when the requirement is less, capacity utilization of pumps is less; as a result pumping efficiency is lost. The ideal choice in this case is to install automated VFDs.(6) Variable frequency drives are devices used for varying the speed of a driven equipment (such as pumps, fans, blowers, compressors, etc.) to exactly match the process requirements and achieve energy savings as well.

The benefits of VFDs are multifold viz., energy savings of 20- 70 %, improved control, less wear on equipment, low maintenance cost, ease of operation and hook up with plant automation.(8)

Independent chillers should always be dedicated to a chilled water pump, condenser water pump and cooling tower fan. When the chillers trip, the cooling tower fan and the condenser water pumps too trip, thereby ensuring additional savings in energy.(6)

Variable speed drives for AHU fans – in a study, where a VFD with a temperature control sensor at return air temperature was installed for the AHU fan, average reduction of 25 % was demonstrated in the power consumption of the AHU fan and chilled water compressor. In the study, the VFD automatically reduced the speed of AHU fan depending on the return air temperature (set at 23°C).

Replacement of V-belt drives in motors in fans with flat belt drives – the V- belt drives consume more power, due to the ‘wedge-in’ and ‘pull-out action’ of the belt; whereas the flat belt drive has a higher transmission efficiency. The present trend is to convert the V-belt drives to flat belt drives, resulting in power savings of at least 5%.(6)

Fig.1: Functioning or Air Conditioning Plant

Fig.1: Functioning or Air Conditioning Plant

ECO’s in Indoor Lighting System Lighting in India, accounts for an inordinately large amount of electricity consumed i.e. about 17-20 % of the total electrical energy. Lighting in India, therefore has a tremendous scope for energy conservation, achievable by a slight modification in the design techniques / adoption of efficient equipment and control techniques or a combination of both.(9) Innovation and continuous improvement in the field of lighting, has given rise to tremendous energy saving opportunities in this area.(6) Selection of ‘right’ light sources Incandescent lamps: produce light by virtue of filament heated to incandescence by the flow of electric current through it.

Reflector lamps: they are basically incandescent, provided with a high-quality internal mirror. Gas discharge lamps: light in this is produced by the excitation of gas contained in either a tubular or elliptical outer bulb. Types of gas discharge lamps are: Fluorescent lamps (FTL), Compact fluorescent lamps (CFLs), mercury vapour lamps, sodium vapour lamps, metal halide lamps.(6)

The technical data of various light sources is shown in Table 1 Color rendering index (CRI):It is a measure of the degree to which colors of surfaces illuminated by a given light source confirm to those of the same surfaces under a reference illuminant.(6)

Installation of Color-80 series energy efficient fluorescent lamps in place of “conventional” fluorescent lamps – these lamps offer excellent color rendering properties in addition to the very high luminous efficacy. Energy efficient fluorescent lamps are the ideal choices for application in hospitals.

Installation of high frequency (HF) electronic ballasts in place of conventional ballasts: Ballast is a current limiting device, to counter negative resistance characteristics of any discharge lamps. In case of fluorescent lamps, it aids the initial voltage build-up, required for starting.(6) Conventional electromagnetic ballasts consume about 10-15 W, while the HF electronic ballasts consume only 3-5 W; when used in conjunction with the 40 W or 36 W fluorescent tubes.(10) HF electronic ballasts have the following advantages over the traditional magnetic ballasts:


  • Instantaneous starting
  • Reduced lamp flicker
  • Improved power factor
  • Operates in low voltage load.
  • Less in weight
  • Increases life of lamp.
  • Less heat dissipation, which reduces air-conditioning load.(6)

On switching over to 36W fluorescent tube with electronic ballast, from 40W fluorescent tube with conventional ballast, energy savings of 25 % have been documented.(9)


The central AC plant at Kasturba hospital Manipal is located in the basement and is functional round the clock. The plant provides air-conditioning to all the essential areas in the hospital: Operating rooms, ICUs, Cobalt room, CT/ MRI & Xray room & Cardiac cath lab. There are 36 AHU’s placed at different locations with in the hospital. The capacity of the air-handling units ranges between 3 TR to 20 TR.

Table 1: Technical Data of various Light Sources (6,9)

Incandescent 15-1000 12-18 Excellent Due to poor luminous efficiency, it has restricted use.
Fluorescent 20-80 69-96 Good Popular for indoor lighting
CFL 5-36 55-65 Very good Tremendous potential for energy savings
Mercury vapor 50-2000 58 Fair Street lighting; high bay lighting
High pressure sodium vapor 70-1000 145 Fair High efficacy & suitable when color rendering is not important
Low pressure sodium vapor 35-250 200 Poor High energy saving but poor color rendering
Metal halide 70-2000 90-100 Excellent High luminous efficiency


Stage 1 Energy Audit:

In this stage an engineering study was done:

  • Retrospective data for a period of 1 year (Jan ‘01- Dec ‘01) was collected by the project team regarding the power consumption by various equipment and machinery in the hospital. A period of one year was chosen to know the baseline energy consumption of each equipment, taking into account seasonal fluctuations.
  • The hospital equipment and machinery was classified into three categories:
    • Central A/C plant.
    • Biomedical equipment: viz, X-ray, USG,
    • Lithotripsy, Dialysis and other equipment.

Based on the data analysis, it was found that Central A/C services accounted for 60 % and indoor lighting accounted for 20 % of the total electricity consumption by the hospital; thus these two areas were identified as high power consumption areas. Rest of the equipment and machinery put together consumed the remaining 20 % of electricity.

Hence, it was decided by the project team to focus their Energy Conservation techniques on the Central A/C services and indoor lighting to bring about a substantial cost reduction.

Stage 2 Formulation of the proposal

A financial proposal to undertake the project was made, mentioning:

  • Target areas for implementation of the ECO’s and the basis for selection of these areas.
  • Investment needed for the implementation.
  • Estimate of power savings per year (due to the applied energy conservation measures) was worked out to be about 21% per year.
  • Payback period – the duration of time needed for savings to balance the costs incurred due to the project; was estimated as 3 years without interest and 5 years with interest on the total amount invested. * Percentage of the amount saved per year that will be taken by energy management consultants was estimated at 3.5 % of the savings for a period of 7 years.

It was proposed to carry out the energy conservation measures in the target areas at an overall cost of Rs 1.47 crores.

The break-up of this cost was worked out as below:

  • Central A/C modifications – Rs 1,12,50,000/-
  • Plant automation & control procedures – Rs 11,06,500/-
  • Indoor lighting modifications – Rs 8,88,500/-
  • Window A/C modifications – Rs 10,75,000/-
  • Professional charges – Rs 3,80,000/-

The proposal was submitted to the management and was subsequently accepted.

Stage 3 Implementation phase

This phase lasted for about 3 months (April ‘02 – June ‘02). During this phase, various modifications designed to lower the equipment’s/machinery’s power consumption were made. As proposed, the main areas focused upon were:

  • Central A/C services
  • Indoor lighting all over the hospital
  • Window A/Cs

Modifications in the Central A/C services:

Action areas (areas where the modifications were actually made):

  • Chiller unit
  • Cooling towers
  • AHUs (Air handling units)
  • Pumping system – which pumps chilled water from the cooling towers to the condenser and from the chiller to the AHUs.
  • BMS (Building management system)- Automated control system handling the entire Central A/C services.

Prior to modification in the chiller unit:

The A/C plant had a total of 7 chiller units, which catered to the needs of the air-conditioned areas of the entire hospital.

Their capacities were as below:

  • 75 Ton 2nos Kirloskar Co.
  • 50 Ton 3nos Kirloskar Co.
  • 40 Ton 1nos Voltas Co.
  • 40 Ton 1nos York Co.

These compressors within the machines were based on the principle of “reciprocating compression system” (pistontype). Each had an average power consumption of 1.3 kW/ ton/hour.

Modifications done in the chiller unit:

  • Two 50-ton chillers were replaced with two 150-ton chillers.
  • The new machines worked on the principle of “gas pumping system”(rotary screw compressors).
  • Each new chiller has an average power consumption of 0.6kW/ton/hour.
  • Each chiller is dedicated to a chilled water pump, condenser water pump and cooling tower fan, ensuring additional savings in energy.
  • These new chillers have intelligent microprocessors, which take care of conditions like, power breakdown and pump failure; hence do not require full time operators.
  • The gas used in the compressor has been changed from Freon 22 to Freon 134A. Although this has not led to any power savings, the new gas is known to be more ozone friendly.

Modifications done in the cooling towers:

There were 3 cooling towers (each 150 ton capacity) out of which 2 towers were upgraded.

  • Revolutions per minute (RPM) of the fans were increased.
  • Chamber diameter was increased.
  • Water sprinkling system in the towers was changed from rotating to nozzle type.

All these changes led to increase in capacity of each tower from the previous 150 ton to 200 ton.

Modifications done in the AHU’s:

  • Temperature sensors were installed in the return air duct of the AHU’s.
  • These sensors were connected with the Building Management System i.e. BMS (computerized control).
  • Actuators (connected to the BMS) were installed in the chilled water control valves (which supply chilled water from the chiller to the AHU’s). When return air temperature fell below a certain preset level, the sensors would transmit a signal to the BMS, which in turn would activate the actuators. These actuators would then via a motor close the valve to the required degree.
  • The belt connecting the motor and the blower in the AHU was changed from ‘V’ shaped belt to ‘Flat’ belt. This belt has a lower coefficient of friction, which reduces frictional losses of power. It can also tolerate more amount of torque and has fewer incidences of slippage.
  • The valve in the chilled water line of the AHU was changed from ‘gate valve’ (cylindrical / spindle type) to ‘butterfly valve’ (flap type). The butterfly valve had less water leakage problems caused by improper closure and also fewer problems due to dust accumulation.

Modifications done in the pumping systems:

Previously, there were only a single type of chilled water pumps which brought water from the AHU’s to the chillers for cooling. Now, there are two types of pumping system connecting the chillers and AHU’s:

  • Chilled water primary pump – which run continuously. They supply water from the AHU’s to the chillers.
  • Chilled water secondary pumps – they are higher capacity pumps, also k/a ‘booster pumps’. They are required to pump water to the various AHU’s from the chiller and to maintain the pressure at the tail end (i.e. even to AHU’s on the 3rd floor). These pumps do not work continuously, instead are controlled via ‘Variable Frequency Drive’ (VFD). Depending on the AHU that is working (or chilled water control valve that is open), the VFD in the pump gets activated and controls the RPM of the pump (i.e. the pumping capacity of the pump). As a result, the chiller works only according to the load / the AHU’s working and does not pump chilled water into the system unnecessarily.

The building management system:

This is a system, which integrates the AHU’s all over the hospital, and allows ease of control of these AHU’s from the Central A/C plant itself. The program allows real time control of the AHU’s via two modes:

  • Auto mode: In this mode, the AHU’s are set to function according to a timed program e.g. from 8.00 a.m to 9.00 a.m. Under this program, the AHU will automatically switch off at 9.00 a.m.
  • Manual mode: In this mode, if the A/C plant operator wants to switch off/on any AHU, he can do so, via the computer in the A/C plant, within 30 seconds. This saves time and reduces error as compared to the previous system, in which an operator had to go all the way to the AHU to switch it off/on.

This system also helps the chiller to work efficiently according to the load. When the temperature in the return air duct of the AHU falls to the level set in the BMS, the temperature sensors transmit a signal to the BMS. The BMS then activates the actuators, which in turn close the chilled water control valves in the chilled water line supplying the AHU. This leads to the activation of the VFD in the chilled water secondary pump of the chiller, leading to reduction in the RPM (pumping capacity) of the pump. This allows the chiller to pump chilled water into the system according to the need of the AHU’s working.

Indoor lighting:

Prior to modification:

The tubes in the hospital were fitted with choke (Copper ballast). These tubes operated in a narrow voltage range of 200-220 volts, with flickering in times of voltage fluctuations. The tubes were designed such that the copper ballast consumed 12W/hour and the tube consumed 40W/hour, amounting to a total consumption of 52W/hour of electricity. The intensity of light generated by these tubes was 2450 L (lumen). The life of the tube was approx. 3000 hours.

After modification:

All the tubes in the hospital (about 4200) were replaced with new tubes with CRI 80 and electronic ballast. These tubes operate in a wider voltage range of 180-240 volts, with no flickering in times of voltage fluctuations. The tubes are designed such that the electronic ballast consumes 1W/hour and the tube consumes 21W/hour (even though tubes are 36 W capacity), amounting to a total consumption of 22W/ hour of electricity (i.e. a reduction in power consumption by 50 %). The intensity of light generated by these tubes is also 2450 L (lumen); if the tubes are allowed to work at 36 W then the intensity of light generated would be 3500 L with reduced energy savings. The life of the tube is approx. 3 times the life of the previous ones. In addition, the electronic ballast requires no maintenance.

Modifications in the Window A/C:

Prior to modification

When the desired room temperature was attained, the thermostat in the window A/C got activated and led to system cut-off i.e. compressor stopped working but the fan continued to run.

After modification

An electronic circuit has been incorporated in the Window A/ C unit. This led to auto cut-off of compressor for a period of 3 minutes after every 22 minutes. However the fan continued to run. This was similar to the previous system of cut-off except that in this case the cut-off is timed and not based on room temperature. The thermostat mechanism of the A/C remains unaffected by this modification.

This timed cut-off has 2 main advantages:

  • If the compressor cuts off for 3 minutes every 22 minutes, it leads to a direct reduction of 12 % in the power consumption by the A/C unit.
  • Life of the compressor is also increased. The electronic circuit not only saves power but also protects the Window A/C against low / peak /surge voltage.


Table 2 shows a Comparison of the electricity units consumed by central a/c plant in eleven months before & after intervention

Therefore, comparison of units consumed by Central A/C plant in 11 months before and after modification revealed a savings of 35.4 %.

Table 3 shows a Comparison of the electricity units consumed by the hospital in eleven months before & after intervention.

Therefore, after modification there has been an average savings of 16.72 % in electricity consumption.

Table 4 shows highlighting the comparison between total electricity units consumed by other equipment including lighting in eleven months before and after intervention

Therefore, savings of electricity by other equipment including lighting is 2,66,316 units in eleven months.

For practical purposes, these savings may be attributed to indoor lighting modifications as well as to Window A/C modifications (as the power consumption by other equipment has remained constant).

The current unit rate for electricity consumption was worked out as:

Current unit rate = Amount (Rs) spent on electricity during (Jan-May 04) / Units consumed during the same period

= Rs 1,24,08,465 / 21,00,545
= Rs. 5.90 per unit

Table 2: Comparison of the electricity units consumed by central a/c plant in eleven months before & after intervention

No. of units
savings on
2002–2003 2003–2004
July 1,89,120 90,000 52.41
August 1,67,760 96,720 42.34
September 1,40,880 95,040 32.50
October 1,80,360 1,07,760 40.25
November 1,69,560 1,09,080 35.67
December 1,42,800 99,120 30.59
January 1,62,840 90,120 44.60
February 1,69,560 95,760 43.52
March 1,67,400 1,29,720 22.50
April 1,70,400 1,42,560 16.34
May 1,60,320 1,20,360 24.90
TOTAL 18,21,000 11,76,240 35.40

Table 3: Comparison of the electricity units consumed by the hospital in eleven months before & after intervention

Calendar months No. of units consumed Percentage savings
2002 – 2003 2003 – 2004
July 5,15,086 3,90,230 24.23
August 4,90,974 3,92,416 20.07
September 4,89,061 4,33,361 11.40
October 5,19,198 4,16,850 19.70
November 5,00,041 4,03,430 19.32
December 4,65,499 3,99,334 14.21
January 4,99,116 3,81,257 23.61
February 4,61,000 3,68,459 20.07
March 4,97,015 4,52,416 08.97
April 4,97,378 4,56,797 08.15
May 5,12,874 4,41,616 13.89
TOTAL 54,47,242 45,36,166 16.72

Table 4: Table highlighting the comparison between total electricity units consumed by other equipment including lighting in eleven months before and after intervention

(in 11 months)
02-03 03-04 Savings
Total Electricity
units consumed by
Kasturba Hospital (a)
54,47,242 45,36,166 9,11,076
Total Electricity
units consumed
by Central
A/C plant (b)
18,21,000 11,76,240 6,44,760
Total Electricity
units consumed
by other equipment
including lighting
c = a-b
36,26,242 33,59,926 2,66,316

Units of electricity saved in a year was calculated as follows: Units saved in a year = (Units saved in 11 months / 11) × 12 months

= (9,11,076 units / 11) × 12
= 9,93,901 units

Therefore, the amount saved on electricity consumption for 1 year was worked out as:

Amount saved (Rs) = Units saved in a year × Current unit rate

= 9,93,901 × 5.90
= Rs 58,64,016

Implementation of ECO’s, helped in achieving savings of about Rs 58.6 lakhs on electricity consumption.

The payback period (without interest) for recovering the investment made on ECO is estimated as: Payback period (in years)= Investment made on ECO implementation / Savings per year

= 1,47,00,000 / 58,64,016
= 2.5 years

Thus, the hospital intends to make a complete recovery on its investment on ECO within two and a half years.

Limitations: The study involves data collected for a period of 11 months only. This is because the meter measuring electricity consumption of Central A/C plant per se was installed only in July 2002. Hence, Central A/C electricity consumption data for the month of June 2002 could not be computed and compared with data for June 2003. To maintain uniformity the remaining data collection was also restricted to 11 months (July 2002 – May 2003).


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V.P. Bhaskaran1, P. Satyashankar2, M.A. Suvarna3, G. Somu4

1 Professor & Head, Department of Hospital Administration, Kasturba Hospital, Manipal.

2 Assoc. Professor & Asst. Medical Superintendent, Kasturba Hospital, Manipal.

3 Post Graduate Trainee, Department of Hospital Administration, Kasturba Hospital, Manipal.

4 Post Graduate Trainee, Department of Hospital Administration, Kasturba Hospital, Manipal.

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