CHAPTER I

INTRODUCTION

1.1 INTRODUCTION

Stress problems are very common with many people reporting experiencing
extreme levels of negative stress. When stress is considered as something that occurs
repeatedly across the full lifespan, the true incidence of stress problems is much higher.
Being "stressed out" is thus a universal human phenomenon that affects almost everyone.

Generally, most people use the word stress to refer to negative experiences that
leave us feeling overwhelmed. Thinking about stress exclusively as something negative
gives us a false impression of its true nature, however. Stress is a reaction to a changing,
demanding environment. Properly considered, stress is really more about our capacity to
handle change than it is about whether that change makes us feel good or bad. Change
happens all the time, and stress is in large part what we feel when we are reacting to it.
We can define stress by saying that it involves the "set of emotional, physical, and
cognitive (i.e., thought) reactions to a change." Thinking about stress as a reaction to
change suggests that it is not necessarily bad, and sometimes, could even be a good thing.
Some life changes such as getting a new job, moving in with a new romantic partner, or
studying to master a new skill are generally considered positive and life-enhancing
events, even though they can also be quite stressful. Other life changes such as losing a
job or an important relationship are more negative, and also stressful.

Our experience of stress varies in intensity between high and low. How intensely
stressed we feel in response to a particular event has to do with how much we need to
accomplish in order to meet the demands of that situation. When we don't have to do
much in order to keep up with demands, we don't experience much stress. Conversely,
when we have to do a lot, we tend to feel much more stressed out.

Generally speaking, people do not like experiencing the extremes of stress. This is
true for each end of the spectrum of stress intensity, both high and low. Few people enjoy
the feeling of being overwhelmingly stressed in the face of great change. However, most

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people do not like a total absence of stress either, at least after a while. There is a word
for such a condition (i.e., a lack of stress and challenge) which conveys this negative
meaning: boredom. What most people tend to seek is the middle ground; a balance
between a lack of stress and too much stress. They want a little challenge and excitement
in life, but not so much that they feel overwhelmed by it. A variety of events and
environmental demands cause us to experience stress, including: routine hassles (such as
getting the family out the door in the morning, or dealing with a difficult co-worker),
one-time events that alter our lives (such as moving, marriage, childbirth, or changing
jobs), and ongoing long-term demands (such as dealing with a chronic disease, or caring
for a child or sick family member). Though different people may experience the same
type of events, each of them will experience that event in a unique way. That is, some
people are more vulnerable to becoming stressed out than others are in any given
situation. An event like getting stuck in traffic might cause one person to become very
stressed out while it might not affect another person much at all. Even "good" stressors
such as getting married can impact individuals differently. Some people become highly
anxious while others remain calm and composed.

1.1.1 DEFINITIONS
 According to Selye, an important aspect of stress is that a wide variety of
dissimilar situations are capable of producing the stress response such as
fatigue, effort, pain, fear, and even success. This has led to several definitions of
stress, each of which highlights different aspects of stress.
 Richard Dienstbier (1989) questions the emphasis the GAS places on the role of
chronic stress and proposes another model of stress, Physiological Toughening,
which focuses on the duration of stressful events. He points out that stressors
vary in their durations. Acute stressors are the briefest and often involve a
tangible threat that is readily identified as a stressor. Chronic stressors are those
of a longer duration and are not readily identified as stressors because they are
often ambiguous and intangible. Because chronic stressors have become such a
part of modern life, they may be taken for granted and can therefore pose a
serious health risk if they are not recognized and properly managed.

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  Mandler defines stress as an emergency signaling interruption. The basic
premise is that autonomic activity results whenever some organized action or
thought process is interrupted. The term interruption is used in the sense that
any event, whether external or internal to the individual, prevents completion of
some action, thought sequences, or plan and is considered to be interrupted.
Interruption can occur in the perceptual, cognitive, behavioral, or problem-
solving domains. The consequences of the interruption will always be
autonomic activity and will be interpreted emotionally in any number of ways,
ranging from the most joyful to the most noxious.
 According to Frankenhaeuser, physiological reactions to stressors depend on
two factors: effort and distress. She found that there are three categories of
physiological responses to stress. Effort with distress leads to increases of both
catecholamine and cortisol secretion and result from daily hassles. These
stressors are experienced as negative emotions. This category corresponds to
Dienstbier's characterization of the negative emotions present in an event
appraised as a harm/loss or as a threat. Effort without distress leads to an
increase of catecholamine and suppression of cortisol secretion. These stressors
are experienced as positive emotions.

1.1.2 TYPES OF STRESS

i) Acute Stress
Acute stress is the most common form of stress. It comes from demands
and pressures of the recent past and anticipated demands and pressures of the
near future. Acute stress is thrilling and exciting in small doses, but too much is
exhausting. A fast run down a challenging ski slope, for example, is exhilarating
early in the day. That same ski run late in the day is taxing and wearing. Skiing
beyond your limits can lead to falls and broken bones. By the same token,
overdoing on short-term stress can lead to psychological distress, tension
headaches, upset stomach and other symptoms.
Fortunately, acute stress symptoms are recognized by most people. It’s a
laundry list of what has gone awry in their lives: the auto accident that crumpled

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 the car fender, the loss of an important contract, a deadline they’re rushing to
meet, their child’s occasional problems at school, and so on.
ii) Episodic Acute Stress
There are those, however, who suffer acute stress frequently, whose
lives are so disordered that they are studies in chaos and crisis. They’re always
in a rush, but always late. If something can go wrong, it does. They take on too
much, have too many irons in the fire, and can’t organize the slew of self-
inflicted demands and pressures clamoring for their attention. They seem
perpetually in the clutches of acute stress.
It is common for people with acute stress reactions to be over aroused,
short-tempered, irritable, anxious, and tense. Often, they describe themselves as
having “a lot of nervous energy.” Always in a hurry, they tend to be abrupt, and
sometimes their irritability comes across as hostility. Interpersonal relationships
deteriorate rapidly when others respond with real hostility. The work becomes a
very stressful place for them.
The cardiac prone, “Type A” personality described by cardiologists,
Meter Friedman and Ray Rosenman, is similar to an extreme case of episodic
acute stress. Type A’s have an “excessive competitive drive, aggressiveness,
impatience, and a harrying sense of time urgency.” In addition there is a “free-
floating, but well-rationalized form of hostility, and almost always a deep-
seated insecurity.” Such personality characteristics would seem to create
frequent episodes of acute stress for the Type A individual. Friedman and
Rosenman found Type A’s to be much more likely to develop coronary heat
disease than Type B’s, who show an opposite pattern of behavior.
Another form of episodic acute stress comes from ceaseless worry.
“Worry warts” see disaster around every corner and pessimistically forecast
catastrophe in every situation. The world is a dangerous, unrewarding, punitive
place where something awful is always about to happen. These “awfulizers”
also tend to be over aroused and tense, but are more anxious and depressed than
angry and hostile.

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 The symptoms of episodic acute stress are the symptoms of extended
over arousal: persistent tension headaches, migraines, hypertension, chest pain,
and heart disease. Treating episodic acute stress requires intervention on a
number of levels, generally requiring professional help, which may take many
months.
iii) Chronic Stress
While acute stress can be thrilling and exciting, chronic stress is not.
This is the grinding stress that wears people away day after day, year after year.
Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-
term attrition. It’s the stress of poverty, of dysfunctional families, of being
trapped in an unhappy marriage or in a despised job or career. It’s the stress that
the never-ending “troubles” have brought to the people of Northern Ireland, the
tensions of the Middle East have brought to the Arab and Jew, and the endless
ethnic rivalries that have been brought to the people of Eastern Europe and the
former Soviet Union.
Chronic stress comes when a person never sees a way out of a miserable
situation. It’s the stress of unrelenting demands and pressures for seemingly
interminable periods of time. With no hope, the individual gives up searching
for solutions.
Some chronic stresses stem from traumatic, early childhood experiences
that become internalized and remain forever painful and present. Some
experiences profoundly affect personality. A view of the world, or a belief
system, is created that causes unending stress for the individual (e.g., the world
is a threatening place, people will find out you are a pretender, you must be
perfect at all times). When personality or deep-seated convictions and beliefs
must be reformulated, recovery requires active self-examination, often with
professional help.
The worst aspect of chronic stress is that people get used to it. They
forget it’s there. People are immediately aware of acute stress because it is new;
they ignore chronic stress because it is old, familiar, and sometimes, almost
comfortable.

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 Chronic stress kills through suicide, violence, heart attack, stroke, and,
perhaps, even cancer. People wear down to a final, fatal breakdown. Because
physical and mental resources are depleted through long-term attrition, the
symptoms of chronic stress are difficult to treat and may require extended
medical as well as behavioral treatment and stress management.

1.1.3 CAUSES OF ORGANIZATIONAL STRESS

i) Organizational Change
Change is difficult for an institution and for its employees. There is
uncertainty about the future, about what the organization will “look like,” and
how the employees feel they will fit into the new structure. While some
individuals embrace change, most simply accept it—and with widely varying
degrees of willingness. There are those, however, who refuse to change. The
subsequent rejection of cooperative progress puts increased stress on
supervisors, colleagues, and the institution as a whole. Employees frequently
become fearful during times of organizational change because of the instability
change causes. They question their abilities to perform in an unknown future.
There is a tendency to leave what Stephen Covey calls their “circle of
influence” and spend significant time in their “circle of concern,” worrying over
possibilities outside their span of control. Ironically, by clinging to the security
blanket of what is known to them, employees can increase their stress levels
exponentially. The large-scale result is infectious damage to the organization.
ii) Leadership
The quality of leadership is a critical factor relative to the stress of the
organization. Are organizational leaders viewed as competent, ethical, strategic,
approachable, and fair? Do they have reasonable expectations? Do they clearly
communicate their vision and directions? If not, the organization will
experience stress. True leadership does not come from the position held but
rather from creating a vision, setting an example, and inviting participation. An
intelligent leader reads and understands books, but a great leader reads and
understands people.

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iii) Changes in Roles and Tasks
Many organizations are finding it necessary to examine the ways in
which business is conducted. Whether seen as positive or negative, many
colleges and universities are reexamining processes and services, as well as
staffing, and are taking on more “businesslike” approaches to how work is
accomplished. This may mean streamlining or greater use of technology
(including less in-person contact and more online interactions).
It generally requires that employees learn new skills and commit to
continuous learning. While exciting for some, and taken in stride by many, it is
resented or rejected by a percentage of employee populations. As roles and tasks
change, there is the potential for stress-producing ambiguity, placing increased
emphasis on the importance of adequate and timely communication. Clarity of
job descriptions, reporting relationships, and performance standards are critical
in combating the potential stress caused by changes in role and/or tasks.
iv) Balance in Work and Life
Another significant contributing factor to organizational stress is the
“24/7” expectation in an increasing number of jobs. Many employees express
concerns that they do not have a “life outside of work” anymore. Office-related
e-mails infringe on employees’ evenings and weekends. With the abundance of
laptop computers, the expectation seems to be growing that we can work
wherever we go. Employees risk becoming resentful and are vulnerable to
burnout. Some cease to have the energy and the enthusiasm they had in the past.
As they lose their spark and creativity, the organization loses a major resource.
The modern world, which is said to be a world of achievements, is also a
world of stress. One finds stress everywhere, whether it be within the family,
business organization/enterprise or any other social or economic organization.
The extent of stress is, however a matter of degree. Some organizations are
more harmonious whereas others have greater friction and tension. Stress in
organizations has been defined in terms of misfit between a person's skills and
abilities and demands of his/her job and as a misfit in terms of a person's needs
not being fulfilled by his job environment.

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1.2 NEED OF THE STUDY

This study would help to know the stress among employees in the company. The
influence of stress among employees' job, work environment, employees' turnover etc...,
can also be known through this study. This study would provide more information related
to Stress among employee. So the study on Stress among employees gives value addition
to the growth of organization.

1.3 OBJECTIVES OF THE STUDY

 To study the causes of stress among employees.

 To analyze the level of stress on employees.
 To study the effects of stress on the health of employees.
 To study the effect of stress on productivity of an organization.
 To study the coping up techniques as how they overcome stress.
 To give constructive suggestion to the management as how to minimize stress.

1.4 STATEMENT OF THE PROBLEM

Whatever be the nature of the job, stress is inevitable in today’s fast paced world;
some level of stress is acceptable rather necessary to bring out the best in a worker, but
when the stress level exceeds the limits then problems set in. While stress is common for
all types of jobs, it is important to see that stress levels are extremely high in some
categories of jobs.

1.5 LIMITATIONS OF THE STUDY

 The employees and workers were interviewed during the course of their
working time, so they were in a hurry to respond to the questions, which may
have affected the quality of the data.
 Time constraint was another limiting factor. The time available for study was
very much limited.

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 The study covers only few aspects of stress since it is a wide topic to conduct a
complete study within the limited parameters. In spite of all the above
limitations, every attempts and have been made to present this report in the best
possible manner.

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 CHAPTER II
REVIEW OF LITERATURE

2.1 INTRODUCTION

A review on the previous studies on stress among the employees is necessary to

know the areas already covered. This will help to find our new areas uncovered and to
study them in depth. After understanding the concept of stress, we need to study the
previous studies in order to have a larger view of various effects of stress on employees.
This will surely lay down the scope of the topic for further research. The earlier studies
made on stress among the employees are briefly reviewed here.

2.1.1 Weiss .M (1983)

The Author investigated the sources of Job stress that is linked to Job
dissatisfaction, Job related tension and anxiety and reduced productivity and
effectiveness. He tried to reduce sources of stress so that he can prevent the deleterious
health consequences. Through his study he determined the potential of social support that
alleviate the deleterious consequences of stress.

2.1.2 Singh A. P & Singh .S (2009)

His study emphasizes on the phenomenon of Job Satisfaction in the organizations.

According to him, Job Satisfaction is directly related to Stress and Work culture that an
Organization provides. He identified three sectors in which stress originate and classified
stress into two main types i.e. eustress and Distress. Further, he pointed the importance of
positive stress and positive events for better performance and satisfaction of employees.

2.1.3 Gladies J. J. & Kennedy .V (2011)

The author revealed a significant correlation between Organizational Climate and

Job Stress among the women working in IT companies of India. According to him,
learning how to manage stress is a very crucial issue that should be developed in IT
companies so that they can reduce or eliminate the causes of stress and poor working
environment.
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2.1.4 Charu. M (2013)

He in his study stated that higher stress is directly proportional to quality of work
life for IT professionals. He outlined few factors namely fair pay structure, steady role
demands, supervisory support, congenial job environment, capability fit of the job, role
autonomy and stress that directly affect the quality of work life. The main reason of stress
amongst the associates of IT industry is the rapid change in technology.

2.1.5 Khalid. A (2012)

There is a direct relationship between stress and job performance in any

organization. To improve the performance of an individual in an organization an
employee should receive good support from their leaders. Hence, a supportive leader can
improve the performance of an employee even at unfavourable situations.

2.1.6 Kavitha (2012)

The article focuses on the organizational role stress for the employees in the IT
sector. It also highlights that women face more stress than men in the organization to be
more specific married women faces more stress than the unmarried women.

2.1.7 Urska Treven, Sonja Treven & Simona Sarotar Zizek (2011)

Organizations, where the workers are said to be stressed are more likely to be
unsuccessful in the competitive market. Various approaches of managing stress, good
work organization and good management are the effective ways of preventing stress. He
categorized stress broadly into three main types; they are a) Transient Stress b) Post
Traumatic Stress Disorders (PTSD) c) Chronic Stress.

2.1.8 Richardson (2008)

A classification of stress interventions has been done, those are primary,

secondary and tertiary. He suggested all the employees to adopt relaxation training
intervention for stress management which is the easiest and least expensive approach to
implement.

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2.1.9 Satija. S & Khan .W (2013)

According to him Occupational Stress is as same as Job Stress that need to be

controlled at the workplace otherwise it will affect negatively employee’s work attitudes
and behaviour. He conducted a study to investigate the relationship between Emotional
Intelligence and Occupational Stress. The findings of his study revealed that Emotional
Intelligence as a significant predictor of Occupational Stress.

2.1.10 Bhatti .N,Shar .H. A, Shaikh .F. M & Nazar .M. S (2010)

He has classified stressors broadly into two main types-a) Extra-Organizational

and b) Intra-Organizational Stressors. According to his study he predicted that the major
causes of stress are firstly workload that causes 25% of stress, secondly timings that
results 16% of stress, thirdly climate that causes 11% of stress.

2.1.11 Kodavatiganti .K & Bulusu. V (2011)

The aim of the article is to have a clear understanding of the phenomenon that
causes stress among the academicians. According to the article women educators face
comparatively higher level of stress than men counterparts. The stress amongst the
academicians are caused because of lengthy working hours, inadequate resources and
long working hours, classrooms that are over filled.

2.1.12 Sharma .S, Sharma .J & Devi .A (2012)

The level of stress within a role varies because of individual differences in mind-
set, age, gender, and their performance in job. However, various factors that influence
stress are age where the younger employees are more stressed as compared to other
employees, level of qualification, pay, and authorities of control, awards, and word of
praise, improved designations and working couples. The study recommended a
reinforcement approach that should be positive in nature so as to reduce the degree of
stress at the workplace.

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2.1.13 Srivastav .A.K (2010)

The articles focus on the nature of role that causes stress. It says role performance
encountered the problems of stress so they should be tried to reduce or eliminated. The
nature of role stress was found to be heterogeneous which cannot be dealt with one
uniform solution or intervention as a whole. Hence, specific problem related solution or
interventions should be adapted for better organizational performance and effectiveness.

2.1.14 A. Y. Tatheer (2013)

Majority of the bankers of Pakistan claim that they are highly stressed because of
their jobs that not only affect their performance in banks but also equally affect their
health and personal life. They also declare that the organizational politics and
bureaucracy are the main reasons of stress in their banks.

2.1.15 Michailidis .M and Georgiou .Y (2005)

The author focus on the degree of occupational stress that is influenced by the
factors like level of education, various patterns of their relaxation and any other habits
like drinking or smoking . The implications say that consuming alcoholic drinks is the
main factor that determines the degree of occupational stress in an individual.

2.1.16 Sinha V. and Subramanian K.S. (2012)

The study highlights that various levels of organization experience different kind
of organizational role stress. It also states that stress is influenced by various factors like
shortage of resources, inadequacy within a person, and overload with a role, stagnation of
a role and isolation and expectation of a role.

2.1.17 Pratibha G. (2010)

The impact of distress level on the quality of life is negative that may result to
serious burnout problems in private banks. The distress level in the banks can only be
reduced by various stress management programmes or interventions that would also
improve the quality of work life.

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2.1.18 P.S. Swaminathan & Rajkumar .S (2013)

He conducted a study that focused on the levels of stress among the age group,
profession, different varieties of jobs, hours of work and the influence of work
environment on the degree of stress faced by employees. Stress in an employee is very
individual in nature. His study indicates about an optimum level in which every
individual can perform with his full capacity. He has identified three conditions
responsible for work stress they are a) Role overload b) Role self-distance c) Role
stagnation.

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 CHAPTER III
INDUSTRY PROFILE

3.1 INTRODUCTION

Indian medical device manufacturing sector is a highly diversified industry that

produces a range of products designed to diagnose and treat patients in healthcare
systems. Medical devices differ from drugs in that they do not achieve their intended use
through chemical reaction and are not metabolized in the body. Medical devices range in
nature and complexity from simple tongue depressors and bandages to complex
programmable pacemakers and sophisticated imaging systems.

Key Products

The key products that comprise the medical devices industry, include, surgical
appliances and supplies, surgical and medical instruments, electro-medical equipment, in-
vitro diagnostic substances, irradiation apparatus, dental and ophthalmic goods.

The challenge of collecting data on Medical Device Industry

Firms in the medical device sector (medical devices as defined by regulations) are
reported under many Indian Industry Classification System codes, and those codes often
include non-device firms.

3.2 Overview and Global Competitiveness

(1) Industry Characteristics

Announcements of progress in medical technology that allow for earlier detection

of diseases and more effective treatment options are now almost daily occurrences.
Particularly notable technological advances in the industry in recent years included new
developments in neurology (e.g. deep-brain-stimulation devices for treating symptoms of
Parkinson's), cardiology (e.g. artificial device designed to replace diseased heart valves)
and Health IT (e.g. "data liquidity" to facilitate information sharing, wireless
telemedicine devices, systems designed to track the cardiac activity of patients with
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implanted medical devices). Scientists have used Nano sensors for the quick detection of
cancers through blood tests, with Nano-material also enabling the release of medicine at
targeted organs.

Minimally invasive surgery has also seen major gains - an exciting example of
this trend is an endoscopic technique that integrates nontechnology and diagnostic
imaging. Capsule endoscopy, which involves swallowing a tiny wireless camera pill that
takes thousands of pictures as it travels through the digestive track, gives physicians more
detailed information about hard to navigate sections of the digestive tract compared with
earlier endoscopic technologies. The ability to navigate and detect conditions in the small
intestine is the most promising aspect of this new technology; providing physicians with
greater ability to diagnose conditions such as intestinal tumours and Chrohn’s disease.

(2) Global Medical Device Sector

The global medical device manufacturing industry is made up of more than

27,000 firms worldwide and employs about one million people. The global industry has
traditionally a low level of industry concentration, with no one firm dominating. Small
companies are common and typically specialize in developing niche technology, while
larger players frequently seek to acquire smaller firms to expand their product range or
gain access to a particular technology or market.

In 2011, the key business segments of the global medical device market were
consumables (15%), diagnostic apparatus (e.g., MRI and CT-scan) (27%), patient aids
such as hearing aids and pacemakers (12%), orthopaedic products (11%), dental products
(7%), and other medical equipment (28%).

Medical device companies are expected to realign their business structures and
strategies to compete in the changing global environment (such as growth of emerging
markets, health care reform and cost containment). Anticipated changes include company
restructuring as well as an increased reliance on strategic alliances and outsourcing for
marketing, distribution, research and manufacturing activities.

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(a) Medical Device Sector

Medical device sector is a highly diversified and export-oriented industry that

manufactures equipment and supplies. Purchasers include international hospitals,
physician's offices, laboratories, clinics as well as patients (through direct purchases).The
sector is populated with companies driven by product innovation.

The industry is able to draw on world-class innovative research being conducted

research institutes and hospitals, some of which has been spun-off into Indian medical
device companies.

(b) Global Market for Medical Device Products

(i) Medical Device Market

Company has an estimated 6.4 cores (2012) medical device market accounting for
about 2 percent of the global market. The following were key expenditure areas, as a
percentage of total 2012 medical device sales:

 Diagnostic apparatus (25.8%)

 Consumables (15.3%)
 Patient aids (12.3%)
 Orthopaedic and prosthetic (11.9%)
 Dental products (6.9%)

And, Other (27.8%) (including wheelchairs, ophthalmic instruments, anaesthesia

apparatus, dialysis apparatus, blood pressure monitors, endoscopy apparatus, hospital
furniture, other). Approximately 80 percent of the market is supplied by imported
medical devices.

(ii) International Medical Device Markets

In 2012, the global market for medical devices was valued at 327.7 cores,
excluding in vitro diagnostics. With a market of 188.9 cores or 36.3 percent of the global
market, the United States is the world's largest and most developed market and the

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leading supplier of medical devices with 16 out of the top 25 medical device global
companies.

(iii) Commercialization Initiatives

Sector initiatives to facilitate technology commercialization include efforts by

organizations such as the Health Technology Exchange (HTX), Biomedical
Commercialization, and Le Campus des Technologies de la Sante (CTS). Three Centres
of Excellence for Commercialization and Research (CECR) with focused specialties in
medical device research.

Each CECR is a not for profit corporation created by organizations such as

companies, universities and research institutions to match research expertise with
business needs for the purpose of stimulating commercialization.

The three CECRs are:

1. Centre for Imaging Technology Commercialization.

2. Centre for Probe Development and Commercialization.
3. Centre for Surgical Invention and Innovation.

(iv) Export Development

Export Development an export credit agency which offers a range of trade

finance, credit insurance and other risk management services to exporters.

3.3 Key Non-Regulatory Policy Areas

(a) Reimbursement

Valuation and reimbursement of products by public and private sector financial

entities are crucial to the success of the medical device industry. The Department of
Health and Human Services’ Center for Medical and Medicaid Services (HHS/CMS)
administers both the Medicaid and Medicare program that covers the reimbursement of
medical devices. In addition, the Veterans Administration is the key agency responsible

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for negotiating an agreement with manufacturers/distributors of medical devices (Federal
Supply Schedules) for procurement of medical devices by certain government agencies.

(b) Healthcare Reform

Health care reform will have a wide ranging impact and will impose new
mandates on individuals, employers, medical service providers and health products
manufacturers.

(c) Comparative Effectiveness

As policy-makers contend with rising healthcare costs it is likely that some form
of comparative effectiveness, a system based on the relative benefits a product delivers,
will be implemented or expanded and abroad.

Comparative effectiveness employs research that compares the clinical

effectiveness of different drugs, devices and procedures with an eye toward improving
quality of care. However, issues remain as to who should conduct the research or when
and how cost effectiveness should be factored in.

(d) Industry Consolidation - Mergers and Acquisitions

In the medical device industry small firms faced with devoting significant
resources to innovations often merge with larger 9 firms with the financial resources
necessary to bring products to market. The results was mutually beneficial - larger firms
receive the benefit of the new technology and, therefore, maintain market share; small
firms can afford to continue to produce and get the benefit of the large firms devoting
resources to continued incremental improvements that are crucial in the industry.

(e) Demographics

Marked increases in the average age and populations has already influencing the
direction of the medical device industry through the changing health needs of senior
citizens and shifts in thinking on how and where they will be treated. As pressures mount
to contain costs, expensive and/or extended stays in healthcare facilities will be

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discouraged and healthcare will be increasingly delivered in alternative settings such as
nursing homes, hospices, and, especially, the patient’s own home. Home health-care is
one of the fastest growing segments of the industry, and is branching out into new areas.
What used to be limited to only the lowest technology products is now encompassing a
proliferation of high technology medical devices that are intended to be used by unskilled
health care workers or patients.

(f) Product Convergence

As medical device and biotechnology products converge, medical devices will act
as delivery systems for pharmaceutical treatments and research resulting from genetic
engineering and biotechnology research. Many industry experts view the impending
convergence of medical devices with biotechnology and nanotechnology with cautious
optimism, but also warn that if the regulatory and reimbursement issues are not addressed
problems will ensue as convergence takes place.

3.4 Industry Trading Environment

(a) Key Export Destinations

The EU’s regulatory system for medical devices is generally considered open and
transparent, is based on international standards, and accounts for about one quarter of the
global medical device market. The EU’s regulatory structure is contained in the Medical
Device Directives (MDD), which recently underwent amendments imposing more
stringent requirements as to what constitutes "clinical evidence" and mandating stronger
enforcement by authorities. These changes will be completed and in place in 2010. In
2009 the EU was considering additional significant revisions to its MDD, but
consultations with industry on what was known as the “recast” led the Commission to
delay implementation and revisit the numerous issues associated with the planned
changes.

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(b) Key Competitors

It is important to note that most of these foreign companies manufacture a

significant amount of medical devices. For example, as a result of recent acquisitions
Philips currently produces more medical devices in India. High-quality but lower
technology medical device firms are being challenged by numerous lower-cost producers
from China, Brazil, Korea, Taiwan and U.S, all of which are building up their domestic
industries and beginning to complete globally.

(c) Export Barriers

 International Regulatory Environments

 International Reimbursement Payment Environments
 Harmonization Efforts
 IPR and Counterfeit Medical Devices

3.5 Infrastructure

The healthcare Infrastructure of India has to keep pace with the economic growth.
Some key examples:

(1)Manufacturing incentives

The medical electronics industry is largely dependent on imports. Nearly three

quarters of India’s demand for medical devices is being met by imports. Most hi–tech
Innovative products and technologies originate from a well developed ecosystem and
innovation cycle, which needs to be developed in India. Incentives must be given to
achieve an indigenous manufacturing ecosystem which over a period of time will reduce
our dependence on imports.

(2)Human Resources in Healthcare

The number of healthcare workers per 10,000 populations in urban areas is 42 and
that in rural areas is roughly 12. Technicians are critical for proper use and operation of
medical electronics equipment’s. There is a huge potential for increase in the numbers of

21
skilled healthcare professionals and meeting this requirement will lead to higher reach of
medical electronics based solutions in India.

(3)Adoption

Major cities drive the demand for medical electronic devices however it is
significantly lower for smaller cities/town/rural areas. As identified in the WHO Priority
Medical Devices Project, lower adoption is a result of 4A's - Affordability, Accessibility,
Appropriateness, and Awareness14. While some improvements have been observed in
these areas, there are still major challenges that need to be overcome.

(4)Affordability

The overall reach of healthcare in India can be increased by offering affordable

healthcare solutions to the end customer, keeping in mind the wide range of income
levels existing in the country. This challenge can be met by a joint effort from all
stakeholders towards innovative development of solutions that fit well into the economic
conditions varying from urban to rural India.

(5)Accessibility

Penetration of public health infrastructure in lower tier cities and rural India can
be increased by looking forward towards development of portable and easy to use,
condition friendly systems for diagnostics and point of care therapy. Distribution of
medical equipment’s and devices in harsh terrains and remote areas becomes challenging
and the time to reach increases.

3.6 Ecosystem Driving Future Growth

(a) Healthcare Provider

 Increasing presence in lower tier cities and rural India.

 Growing demand for medical equipment for higher operational productivity.
 Rising need to serve willing customers with diagnostic services.
 Surging initiatives from government to increase service affordability.

22
(b) Manufacturers

 Lowering price due to increased domestic R&D and manufacturing.

 Growing need for frugal Innovations to enhance product affordability.
 Increasing focus towards customization to match domestic market need.
 Rising focus on appropriate regulatory amendments.

(c) Payers/ Insurance Firms

 Growing attractiveness towards urban as well as rural coverage with tiered

offerings Increasing OPD and diagnostics coverage.
 Rising offering of public insurance scheme increasing affordability for mass
(volume = scale economics).
 Increasing insurance penetration enabling better accessibility.

(d) Patients

 Increasing population and ageing mass.

 Increasing disposable income.
 Changing disease profiles.
 Increasing awareness of healthy lifestyle and preventative healthcare.
 Growing demand for diagnostic service.
 Changing socio economic and cultural profile of population (rising tech savvies
and usage, increased literacy, modernization).

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 CHAPTER IV
COMPANY PROFILE

Elim Meditech Pvt Ltd is India’s leading manufacturer, developer and distributor
of medical electronic equipment with subsidiaries in country. Our major product lines for
export are patient monitors, electroencephalographs, evoked potential and
electromyography systems, electrocardiographs, defibrillators, and haematology
analysers. Elim Meditech equipment is well known for its quality and ease of use.

Elim Meditech actively contributes to the advance of medical technology. Elim

Meditech researchers have published valuable research in some of the world's most
prestigious medical, engineering and scientific journals. Elim Meditech has significantly
contributed to the advancement of modern medical treatment with many innovative
products and technologies. Pulse oximetry, the technology to non-invasive measure
oxygen in the blood. In addition to supplying the world with our own high quality
medical equipment, Elim Meditech imports outstanding overseas products. Our wide
range of imported equipment includes cardiology, urology, respiratory care,
anaesthesiology, emergency care, sports medicine and rehabilitation. Our extensive
domestic sales network consists direct sales staff. Our mission is to improve the quality
of life through advanced medical technology.

4.1 In fulfilling our management philosophy:

Our fundamental goal is to establish trust and grow as a company that is

recognized by its customers, shareholders, business partners and society for its superior
products, services, technologies, financial standing and employees.

4.2 ME (Medicine and Engineering):

ME (Medical Electronics or Medical Engineering) is the union of medicine and

engineering. ME is a common abbreviation in recent years but the founders of Elim
Meditech began working in medical electronics. The neuromuscular tissue of a small bird
was the impetus behind the founding of Elim Meditech. The founder of Elim Meditech,

24
was doing research in electrical Engineering when one day he happened to see an
experiment involving stimulation of the neuromuscular tissue of a small bird.

He was struck by the wonder of biology and remarked. That “to measure part of a
living body requires several hundred times the sensitivity and At least two decimal places
more than the equipment developed by the leading electrical Engineering experts.” He
wondered if it might be possible to apply a higher level of engineering to the subtleties of
biology and study the human body. And furthermore, if this union of medicine and
engineering could be used for saving human life. With this powerful inspiration, he
Studied medicine and founded Elim Meditech. With the unshakable conviction that
“curing disease is something that transcends politics and national borders, and we will
never have any regret putting all our energy into this goal”.

Elim Meditech produced a number of state of the art medical Electronic

instruments. As medicine evolved, Elim Meditech products branched out into many
areas. However, the original vision did not change and it still inspires The Company’s
engineers. Elim Meditech will continue growing as a company that contributes to the
world by striving to use advanced technology based on our experiences to fight disease
and improve healthcare.

4.3 Mid-term Business Plan, Strong Growth 2017 (April 2013 to March 2017):

Elim Meditech mid-term business plan, Strong Growth 2017, is the second stage
and the coming four-year period is crucial for building a more solid foundation in
order to realize its long-term vision. Elim Meditech aims to achieve sustainable growth
under the national future vision to reorganize the medical and nursing care systems by
2025 and achieve strong growth in international markets. The Company will also enhance
its operating base to ensure its growth.

4.3.1 Basic Principles:

Each and every employee will act autonomously and implement the following
principles aimed at realizing the Company’s long-term vision:

25
  User oriented

Take all necessary actions for the customer.

 Relationships

Strengthen relationships with customers and partners both inside and outside
the Company.

 Global:

Enhance global communication skills as well as think and act with a global
perspective.

 Speed:

Strive to do everything with greater speed.

4.3.2 Key Strategies:

1. Pursue the highest level of quality in the world:

Ensure quality in every activity of every division across the entire Elim Meditech
Group, from development to production, logistics, sales and services

2. Strengthen technological development capabilities:

Strengthen R&D organization to address the needs of clinical practice swiftly and
flexibly. Promote industry-government-academia collaboration as well as collaboration
with other companies both inside and outside India.

3. Strengthen business expansion by region:

Reinforce business expansion in Asia and emerging markets including BRICs.

4. Achieve further growth in core businesses:

26
 Achieve further growth in 4 core businesses: Patient Monitors, Diagnostic
Equipment, Treatment Equipment, and Consumables and Services in order to expand
global market share and establish a stable and consistent revenue base.

5. Develop new businesses:

Develop new core businesses by self-development, alliances and M&A. Focus on

solutions to

i. help improve medical safety,

ii. address lifestyle-related diseases, dementia and intractable diseases, and
iii. Respond to an integrated community care system.

6. Consolidate corporate fundamentals:

Foster a more robust business structure that is globalized, efficient and fast-paced
Implement CSR activities Strengthen human resource development initiatives.

Key Facts (March 31, 2019):

 Name: Elim Meditech Pvt Ltd.

 Type of Business: Development, production, and sales of medical electronic
equipment.
 Paid-in Capital: 5 cores (as of March 31, 2019).
 Net Sales: 1.4 cores (year ended March 31, 2019).

Shares of Common Stock:

 Issued and outstanding: 45,765 thousand (as of March 31, 2019).

Stock Listing First Section of Stock Exchange:

 Stock Code : 6849

Workforce:

 Elim Meditech Group: 200 employees (as of March 31, 2019).

27
4.4 VARIOUS DEPARTMENTS

4.4.1 Human Resource Department

The basic function of the human resource department in the modern corporate
world is knowledge management. The HR department strives to maintain cohesiveness
among employees. It also ensures interdepartmental cooperation in achieving targets.

The appraisal system is also taken care by this department. The HR department
delves deep into the employee’s psyche to analyze the positives and negatives of each
employee, so that a proper system of delegation and / or empowerment can be evolved.

4.4.2 Finance Department

The finance department takes care of the regular financial needs of the company it
ensures proper allocation of funds and takes care of the working capital requirements. It
verifies capital raised by different departments and sends them for approval to the higher
authorities.

4.4.3 Stores Department

The function of this department is to provide adequate and proper storage and
preservation of various items to meet the demand of various other departments by proper
issues and maintaining accounts of consumption. It also keeps a track of stock
accumulation and abnormal consumption.

4.4.4 Erection and Fabrication Department

As the name suggests, this department identifies new projects and helps in
erecting them. This department also undertakes major modifications of equipment.

4.4.5 ERP Department

ERP department helps to integrate the entire enterprise starting from the supplier
to the customer, covering financial and human resources. This will enable the enterprise

28
to increase productivity by reducing costs. It also ensures a single solution to the
information needs of the whole organization.

4.4.6 Production Department

As a part of their ongoing commitment to produce hi-tech quality coco peat and
pharmaceuticals that take care of the specific needs of markets around the world,
Ranbaxy Laboratories Limited has increased the investment in the production
department. It is the most important department of the company and has the following
objectives:

 Improving volume of production.

 Reducing rejection rate.
 Maintaining rework rate.

4.4.7 Engineering Department

This department undertakes building, construction and maintenance. Maintaining

service facilities such as water, gas, heating, ventilation, air conditioning, painting and
plumbing are some of the other areas dealt by this department. This department also helps
in maintaining electrical equipment such as generators, transformers, telephone system
and electrical installation.

4.4.8 Purchase Department

The purchase department provides material to the factory without which the
wheels of machines cannot move. The various functions performed by this department
include:

 Securing good vendor performance, including prompt deliveries of supplies of

acceptable qualities.

 To develop satisfactory sources of supply and maintaining good relationships with

the suppliers.

29
  To pay reasonably low prices.

4.4.9 Quality Control/Quality Assurance Department

The purpose of QC & QA departments is to ensure that the desired quality

standard is achieved. It also ensures that the processing or fabrication of material
conforms to the specific characteristics selected, to assure that the resulting product will
in fact perform its intended function.

ORGANISATION CHART

Senior VP

VP

Director Director Director Director

Manufacturing Finance QC Special projects

GM GM GM GM GM
Production Finance HR E&F InfoTech

SM
SM SM SM SM SM PP
M
SM SM SM SM MM
M
SM SM
M
M M

30

S
VP Vice President QC Quality Control
GM General Manager HR Human Resource
SM Senior Manager E&F Engineering & Facilities
M Manager PP Production Planning
ERP Enterprise Resource Planning

31
 CHAPTER V
RESEARCH METHODOLOGY

5.1 INTRODUCTION

Research methodology is a way to systematically solve the research problem. It

may be understood as a science of studying how research done scientifically.

It stands for advance planning of the method to be adopted for collecting the
relevant data and technique to be used in the analysis, keeping in view the objectives of
the research and availability of the respondent’s time and money.

5.2 OBJECTIVES OF THE STUDY

1. To study the level of stress among employees.

2. To identify stress coping strategies at organizational level
3. To assess the perception of the personnel towards their Job Stress.
4. To know the consequences of stress among the employees.
5. To identify the different way to manage stress.
6. To suggest ways to manage stress.

5.3 SCOPE OF STUDY

This study of the stress management depends on the Elim Meditech pvt ltd and
then management. Because the stress related to work, family, decision, your future, and
more. Stress is both physical and mental. It is caused by major life events such as illness,
the death of a loved one, a change in responsibilities or expectation at work and increase
job promotion, avoids loss, or changes in the organization. Changing worker
demographics (race/ethnicity, gender, and age) and worker safety and health. Stress
underlies such diverse conditions as psychosomatic, heart diseases and can be a major
contributor to disturbances in one's emotional, social, company and family life. It inhibits
creativity and personal effectiveness and exhibits itself in a general dissatisfaction; there
are great impacts that end up with stress.

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5.4 RESEARCH DESIGN

It is being used for clear and precise investigation and information is gathered
about practical problems on a particular conjectural statements.

5.4.1 SAMPLING SIZE:

Sample of 98 was taken for the study.

5.4.2 SAMPLING TECHNIQUE:

Convenience sampling technique was used in the study to select the sample. Non
Probability samples that are unrestricted are called convenience samples. Normally the
cheapest and easiest technique, Researchers have the freedom of choosing whomever
they find, hence the name convenience.

5.5 METHODS OF DATA

Structured questionnaire was used for data collection. A questionnaire is a

research instrument consisting of a series of questions and other prompts for the purpose
of gathering information from respondents. They are often designed for statistical
analysis of the responses.

 Primary data
 Secondary data

5.5.1 PRIMARY DATA:

Primary data entails the use of immediate data in determining the survival of the
market. The popular ways to collect primary data consist of surveys, interviews and focus
groups, which shows that direct relationship between potential customers and the
companies. The primary data were collected through personal investigation with the help
of questionnaire.

33
5.5.2 SECONDARY DATA:

Secondary data is a means to reprocess and reuse collected information as an

indication for betterments of the service or product. Secondary data was collected and
analysed by the organization to organize the requirements of various research objectives.
The sources of secondary data are,

 Books
 Internet websites
 Journals and company brochures.

5.6 PERIOD OF STUDY

Period of study based on my topic Buying Behavior of Customer as long as for

one month.

5.7 TOOLS USE FOR THE STUDY

For data analysis the tools used in the study are:

 Percentage analysis

5.7.1 Simple percentage analysis

Percentage refers to a special kind of ratio. Percentages are used in making

comparison between two or more series of data. Percentages are used to describe the
relationships. Percentage can also be used to compare the terms the distribution of two or
more series of data.

No of respondents
Percentage analysis = ∗ 100
Total no of respondents

34
5.8 LIMITATIONS OF STUDY:

Certain limitations do creep in a research study due to constraints of the time,

money and human efforts, the present study is also not free from certain limitation, which
were unavoidable.

 The main limitation of the study is the shortage of time due to lack of time we
are unable to prevent into deeper aspects to study.
 The sample size very small and hence the result can have a degree of
variation.
 Also impossible for company to prove information is confidential.
 Due to fast pace of life, some customers were not able to do justification to the
questionnaire.
 Personal biases might have come while answer the questionnaire.

35
 CHAPTER VI
DATA ANALYSIS AND INTERPRETATION

5.1 INTRODUCTION

36