Description
The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion.
Hospitals & HealthCare
INDEX
TOPICS
1. Introduction To Hospitals 2. Health Care Sector - Analysis 3. Medical & Health Care Service 4. Pest Analysis ? Political ? Economical ? Social ? Technological ? Global 5. Accreditation of Hospitals 6. Models of Accreditation 7. SWOT Analysis ? Strength ? Weakness 18. 19. 21. 22. 25. 26. 29. 7. 8. 9. 10. 12. 14. 16.
Pg. Nos.
3. 5. 6.
? Opportunities ? Upcoming Trends ? Threats 8. Types Of Hospitals 9. Segmentation
Marketing Mix
10.
Product 31.
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? Product Mix ? Flower of Service TOPICS Pg. Nos.
33. 35.
? Quality Dimensions 11. 12. 13. 14. 15. 16.
Place 44. Price 46. Promotion 55. People 67. Physical Evidence 70. Process 72.
41.
? Blue Printing ? Service Encounter ? Fish Bone ? Service Recovery 17.
Future Prediction & Analysis 85.
74. 78. 80. 83.
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18.
Wellness Industry 89.
INTRODUCTION TO HOSPITALS
Until the early 1980s, Government-run hospitals and those operated by charitable organizations were the main providers of subsidized healthcare. However, the last two decades have seen the mushrooming of corporate and privately run hospitals. The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion. Previously hospitals were set up as charitable institutions to take care of the sick and the poor. Today it’s a place of diagnosis and treatment of human ills, for the training research, promoting health care activities and to some extent a center helping biosocial research. World Health Organization (WHO) states that hospitals are socio-medical organization whose functions are:
•
Curative,
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• • •
Preventive, Patient services and Training of health workers in biosocial research.
India’s healthcare sector has made impressive strides in recent years. With time the classes and quality of hospitals have changed a lot today. Most hospitals today are trying to provide all ultra facilities and are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare. higher patient turnover ratio. A hospital offers considerable advantages to both patient and society. A number of health problems require intensive medical treatment and personal care, which normally can’t be available in a patient’s home or in the clinic of the doctor. This is possible only in a hospital where a large number of professionally and technically skilled people apply their knowledge and skill with the help of world-class expertise, advanced sophisticated equipment and appliances. The excellence of hospital services depends on how well the human and material resources are utilized to promote patient care. The hospital is not an entity in itself. Today, the hospital is a place for the diagnosis and treatment of human ills and restoration of health and well being of temporarily deprived patients. The first and the foremost function of a hospital is to give proper care to the sick and injured without having social, economic and racial discrimination. However, the hospitals must perform many more things in addition to the patient care. The education and training of doctors and nurses, support to medical research and assistance to all activities carried out by public health and voluntary agencies to prevent diseases and further to promote health attitude are some of the important services of modern hospitals. The essential function of the hospital in the Indian context is to cater to very large masses of people by providing comfortable conditions for various users. Earlier hospitals were thinking inline of Nowadays they are going for a prolonging the duration of patient’s stay.
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This necessitates creation of a system which encompasses patients, doctors and nurses in a synergetic totality. The applications of marketing strategies insist on the development of product or services of the hospitals against the background of changing environmental conditions. Hospital planning in the Indian condition reflects requirements and comforts of Indian masses. The marketing management of hospitals diverts one’s attention on the planning and development of the product in the Indian environment.
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THE HEALTHCARE SECTOR: AN ANALYSIS
Healthcare is one of the most essential services in any growing society. Propelled by an affluent and health conscious growing middle-class, the healthcare industry in India grew by more than 13 per cent per annum in the last decade. India’s healthcare industry is estimated at Rs 1,500 billion or US$ 34 billion. This works out to US$ 34 per capita which is 6 per cent of GDP. Healthcare statistics state that India has: ? 5,03,900 doctors ? 7,37,000 nurses ? 162 medical colleges ? 143 pharmacy colleges ? 3,50,000 chemists ? 15,097 hospitals accounting for 8,70,161 hospital beds There is an extensive three-tiered government healthcare infrastructure comprising of: ? 23,000 Primary Health Centres(PHC) ? 1,37,000 sub-centres (serving the semi-urban and rural areas) ? 3000 Community Health Centres(CHC)
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MEDICAL & HEALTHCARE SERVICE
There are four types of health-care facilities: primary health centers and rural hospitals, government hospitals, private hospitals, and teaching institutions. The central and the state governments are major players in this sector, running hospitals, nursing homes, medical/nursing/paramedical colleges and medical insurance. A large majority of the population, particularly in rural and semi urban areas, receives free or highly subsidized treatment in such hospitals and health care centres. Private sector investment in the sector was opened up in 1983, to bridge the huge gap between demand and government-owned healthcare services. Since then, the private sector has grown significantly and presently accounts for Rs 690 billion, nearly 80% of healthcare expenditure. There are almost 9500 private hospitals and nursing homes in India, majority of them located in major cities, some of them equipped for providing the most modern state-ofthe-art technology and equipment. However, more than 30% of the national bed strength is concentrated in 150-odd corporate hospitals. Important names in the private sector are Escorts, Apollo Hospitals, Max Health Centre, Fortis, and Wockhardt; several foreign healthcare chains have technical/financial tieups with Indian private healthcare chains. The health care services (excluding pharmaceuticals) market is estimated to be growing at the rate of around 16 percent annually. There are certain industries that directly affect and are directly affected the status of healthcare in the region. They may include:
1. Technology and Equipment 2. Drugs and Pharmaceuticals 3. Diagnostic laboratories
Medical Insurance
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PEST ANALYSIS
POLITICAL FACTORS
? The Government of India places top priority to healthcare in the
national agenda. It is very serious about encouraging indigenous R&D and creation of human capital. The imminent changes in Indian laws and procedures relating to recognition of intellectual property and foreign investments will allow global pharmaceutical and biotechnology companies to set up partnerships with Indian counterparts.
? With the second largest population in the world and a high
incidence of disease, healthcare is being accorded priority by the Government of India and individual state governments.
? A study of Government Public Health expenditure (Government,
both Central & State - spending on healthcare is 1.7% of GDP) reveals that only 16% is allocated to primary care and 84% is allocated to secondary & tertiary care.
? Last year, the finance minister announced a list of incentives for
private hospitals to create and upgrade infrastructure, as well as reduce their operational costs:
1. Tax sops to financial institutions lending to private groups
setting up hospitals with 100 or more beds.
2. Increase in the rate of depreciation from 25 percent to 40
percent for life-saving medical equipment.
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ECONOMIC FACTORS
? The FDI policy of India is not up to mark. The 100% FDI route is not
opened in India. If the foreign hospital wants to open its hospital in India, then the only way it can do so is via joint venture. Because of this not many foreign players are interested to invest in India.
? The Indian healthcare market is expected to grow by around 13 per cent
per annum for the next six years.
? It is projected as the next boom in the country after the IT euphoria.
? The amount of hospitals in India is very less when compared to the other developed countries. Even the urban areas do not have enough medical facilities. It is better not to talk about our rural consumers, where one village at an average has one doctor only and the doctor is not very well qualified.
? The country lags behind international standards on basic healthcare
infrastructure and facilities. India has 94 beds per 100,000 population as compared to the WHO norm of 333 beds per 100,000.
? India's healthcare industry is estimated at Rs 1000 billion (£ 14 billion). Of this, pharmaceutical accounts for Rs 200 billion (£2.8 billion). As per some estimates, Rs 185 billion (£2.6 billion) is spent on healthcare annually. Public and private health expenditure is 13% and 87% respectively. Health insurance is extremely marginal as indicated by "Out of Pocket" expenditure percentage of 84.6%.
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SOCIAL FACTORS
? Certain percentages of beds have to be kept for poor people. E.g. in Bombay 20% of beds has to be kept reserved for poor people whether it’s a private or public hospital. ? Look after the needs of local poor people. ? Open counseling and relief centres. ? Teach hygiene, sanitation among the poor masses. ? Safe disposal of hospitals wastes like used injection needles, waste blood etc. and taking due care of environment. ? Spreading awareness about various diseases through campaigns and free medical check ups. ? In brief the social aspect of hospitals industry is to see that latest treatment and medicines are available to people at large at concessional rates or free of cost and that its activities are not only restricted to rich people.
? The people in India do not avail of the hospital facilities very soon. This
is because of the high cost related to it. However this may all change because of the increasing deployment of third party payment either in the form of Medical and Allied Insurance, or in the form of reimbursements from the State. The people are now taking more to the hospital facilities. This in turn will increase the employment opportunities to many people. A study by NOSU hospital consultants revealed that the hospital industry shall employ a large proportion of the skilled work force. In fact the
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Healthcare Industry is poised to become the biggest Employer in all Countries.
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TECHNOLOGICAL FACTORS
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The hospital is on the threshold of a major Growth Spiral which shall assimilate all new technologies to provide cost effective Healthcare. It shall also be the biggest consumer of all new technologies. Innovations such as computer based hospital information systems, medical records; decision support systems, health information networks, telemedicine, real time image transfers and newer ways of distributing health information to consumers are beginning to affect the cost, quality, and accessibility of health care. The technologies today can support vast databases, network
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communications, quick distribution and reliable image transfers. The easy availability of Healthcare related information is changing the traditional relationship between the Doctor and the patient. Employment of Microprocessor Technology to develop implantable devices, which can be monitored with the remote sensors. Healthcare providers in supporting various physiological defects shall use these devices. A greater degree of employment of CPU driven Technology, supported with artificial intelligence, in treating or managing various physiological defect. A greater degree of employment of Robotics Technology in Operating Rooms to provide precise and less traumatic as well as less destructive Surgery (Robotics Micro-surgery).
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A greater degree of employment of Robotics Technology in Laboratory along with traditional technologies to provide automated and precise diagnostic studies. A greater degree of employment of LASER Technology, in and outside of, Operating Rooms to provide precise and less traumatic as well as less destructive Surgery. Development and deployment of instrumentation in Medical & Surgical Practice which shall be based on capturing data on real time basis and providing necessary electro-physiological interventions or Bio-chemical interventions. This shall affect both - normal physiology and pathological physiology. Development and deployment of cultured tissues for control of vital Biological processes. Employment of Information Technology tools for networking of Examination Rooms, Treatment Rooms, Operating Rooms and Diagnostic Reporting Rooms. Employment of Information Technology tools along with Microprocessor Technologies development and of modules remote of (Artificial) Intelligence for for remote of maintenance of Equipment and other instruments thereby enabling controlled instrumentation control Physiological & Pathological Processes. Deployment of Information Technology tools for generation of specific disease related Databases, classified by a number of variables.
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GLOBAL FACTORS
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The healthcare sector is among the most rapidly growing services in the world economy, estimated at $4 trillion yearly in the OECD countries alone. The sector has seen new and rapidly evolving forms of cross-border transactions, spurred by factors as wide-ranging as technology, demographics, costs, skills, growing private sector participation, natural endowments, culture and geography. Globalisation of healthcare is also evident from the growing foreign equity participation in this sector and establishment of joint ventures, alliances and management tie-ups among care establishments, resulting in the transfer of technology, skills and practices. Finally, there is the global movement of doctors, nurses and technicians, and the resulting networks of healthcare professionals that are sources of investment and know how. Investment flows into developing countries and the setting up of stateof-the-art healthcare establishments there will attract overseas patients for quality care at low cost. Which may, in turn, be supported by telehealth services and cross-border movement of health personnel. India also has potential to export telehealth services within the region and is emerging as a base for outsourcing of clinical trials, ethical and regulatory issues aside.
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?
India’s importance as a global supplier of medical personnel to developing and developed countries is long standing. India is also emerging as a source of foreign direct investment (FDI) in health services, as shown by the regional expansion plans of major players, such as the Apollo group. However, India has barely tapped its true potential in the global healthcare market. Only 5% of all patients treated at reputed hospitals like Escorts are foreign, compared to 25% at equivalent Thai hospitals. Inadequacies in supporting infrastructure, equipment, supplies and domestic regulation, lack of recognition of Indian medical qualifications and disparity in standards of training and quality remain major constraints. Globalisation of our healthcare system can yield many benefits, including improved quality and standards and more money for investment in the sector. Cross-border exchange of practices, knowhow, and technologies, resulting from the flow of capital, consumers, health personnel and information, can help in raising standards and the quality of domestic healthcare. Concerns have been voiced about the possible two-tiering and cream-skimming effects of medical tourism and FDI on the domestic healthcare system. And possible adverse effects on costs, resource allocation and equity within the system. One has to assess their true cause.
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This growth of Healthcare Industry shall be supported by Political Will and Social Understanding at all levels of any Society. It must, therefore, meet the new challenges, by providing cost effective Healthcare in a manner that improves the Quality of Humane Life.
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ACCREDITATION OF HOSPITALS
AN OVERVIEW
? Health services in many developed countries have come under severe scrutiny services. ? Accreditation of hospitals is a voluntary process by which an authorized agency or organization evaluates and recognizes health services according to a set of standards describing the structures and processes that contribute to desirable patient outcomes. ? Accreditation can be understood as an indicator of professional achievement and quality of care. Accreditation is opposed to licensing or regulation of healthcare facilities, which is usually mandatory and stateimposed. ? Accreditation is not new to the health system. The first initiative towards accreditation was taken in the United States of America as early as 1910. Over a period of time after several experiments, the Joint Commission on Accreditation of Healthcare Organisation (JCAHO), a national accreditation programme, established itself as an esteemed accreditation body by 1987. JCAHO has high standards of quality assurance and rigorous process of evaluation, which makes it a muchesteemed agency for accreditation. Health services certified by JCAHO are given ‘deemed status’. in recent years. Positioned against the backdrop of globalization, there is an intense move towards accreditation of health
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THE ONSET OF ACCREDITATION IN INDIA
? In India, accreditation of the health services has never been a serious issue though some feeble attempts have been made to evolve a voluntary accreditation system in the late eighties and early nineties interestingly coinciding with the LPG (Liberalisation, Privatisation, and Globalisation) reforms. ? The attempts made by the Indian Hospital Association (IHA) at both Mumbai and Delhi is worth mentioning. Their efforts were not well received as the initiative did not involve the various stakeholders and had moved with predetermined standards of evaluation, membership fees and assessment mechanisms. ? In India, the initial premises of introducing accreditation were based on the overall objective to ensure the quality of care. The Bureau of Indian Standards (BIS) had laid down standards for hospitals having 30, 100 and 250 beds. The National Institute of Health and Family Welfare (NIFHFW) had such rules laid for more than 50-bed hospitals and only for equipment. Most of the standards laid down by both BIS and NIFHFW were criticized for having an urban bias. ? There have been attempts in some states to institutionalize uniform standards for hospitals. In Maharashtra, the government hospitals follow the Hospital Administration Manual. The Andhra Pradesh Vaidya Vidhana Parisad has laid down standards for secondary-level hospitals in the government sector, which comes under it. ? Apart from this some efforts have been made by consumer bodies, groups of health professionals, hospital organisations and non-governmental accreditation. organisations to evolve standards for
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MODELS OF ACCREDITATION
Accreditation across the globe followed three models.
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The first model of assessment gives priority to standards related to available facility norms, equipment requirements, human resources and space specifications. Here, the criterion of accreditation is based on the availability of basic health facilities. The second gives importance to quality assurance and sets standards for those institutions striving to arrive or improve quality of care, hence accreditation is based on satisfying some basic indicators of quality and involves ranking based on levels of quality. The third model is based on the ground that health systems should be accessible and acceptable to health-seekers. It gives importance to the health-seeker with an emphasis on evaluating health systems from indicators such as user-friendliness, providing information to users about the services available, setting up procedures for redressing grievances, etc. In the third model, the criterion of assessment is explicitly geared towards people-centric indicators and brings accountability of the health system to the health-seekers to the table. With each model, the criteria of accreditation changes.
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At the threshold of globalization and increasingly opening-up of the Indian health sector, attempts are being made at various quarters to draft systems of accreditation. There are certain points, which cannot be missed. What does accreditation mean for India? The answer to this question would help us to know which model can be adopted for accreditation of hospitals in India. If it follows the ranking-model based on quality of services provided, accreditation will have very little to contribute to the improvement of the overall health system in India.
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In contrast, the facility-survey model can be partially pertinent in putting in place the basic facilities required for providing care. The most relevant model of accreditation for the Indian health system is the people-centric model, which would ensure the presence of Acceptability, Accessibility, and Accountability. The accreditation process should begin with minimum or moderate level standards and, over a period of time expand to higher, “ideal” level standards and should be achievable by local public health agencies regardless of size provided that they conduct the essential services of public health. State and local accreditation programs should coordinate with and conform in essential ways to a national accreditation program to eliminate possible duplication and conflict. To succeed in bringing about a perceptible change in the delivery services of the health system and to go beyond mere an on-site survey and awarding certificates, any accreditation programme should address all the dimensions of healthcare.
RATINGS
? India's independent credit rating agency CRISIL has assigned a
grade A rating to super specialty hospitals like Escorts and multi specialty hospitals like Apollo. ? NHS of the UK has indicated that India is a favoured destination for surgeries. ? The British Standards Institute has now accredited the Delhi-based Escorts Hospital. ? Apollo Group - India's largest private hospital chain and Escorts Hospital are now seeking certification from the US-based Joint Commission on Accreditation of Healthcare Organizations. ?
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SWOT ANALYSIS
STRENGTHS
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India’s healthcare sector has made impressive strides in recent years. It has transformed to a US$ 17 billion industry and is surging ahead with an annual growth rate of 13% a year. In the last five years, the number of patients visiting India for medical treatment has risen from 10,000 to about 100,000. With an annual growth rate of 30 percent, India is already inching closer to Singapore, an established Medicare hub that attracts 150,000 medical tourists a year. Hospitals in India boast of conducting the latest surgeries at a very low cost. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy. Indian specialists have performed over 500,000 major surgeries and over a million other surgical procedures including cardio-thoracic, neurological and cancer surgeries, with success rates at par with international standards. The quality of healthcare has improved considerably with the availability of world class high-tech medical equipment and information technology.
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WEAKNESSES
? India has poor social sector indices, given the high population of the
poor, acute lack of medical facilities in the lesser-developed parts of the country, and a lack of public funds to provide adequate medical care and attention to the entire population.
? India’s health expenditure is 5.6 per cent of GDP, whereas most
established market economies spend 7-10 per cent of GDP on health. USA spends over 14 per cent.
? Low doctor-patient ratio: US has 2,340 doctors as compared to India’s
143 doctors for very 10,000 people.
? Life Expectancy in India is amongst the lowest at 55.5 years
compared to US at 75.5 years and 66.5 years for Thailand. On an average, 80 out of every 1,000 children die. This figure is just 9 in the US and 30 for every 1,000 in Thailand.
? High deposit fees and high costs of medical services limits itself to high
income level group or is out of reach for common man.
? The “I don’t care” attitude by the government hospital. For e.g. Cooper
Hospital.
? Medicine and drugs fraud by the menials. Even organ selling by
doctors to make more money.
? Complex and long admission procedure for admission, which can
sometimes be fatal.
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? The common men and poor men are completely at the mercy of the
overcrowded government hospitals and dispensaries.
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OPPORTUNITIES
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At the current pace of growth, healthcare tourism alone can rake in over $2 billion as additional revenue by 2012. From less than 10,000 patients visiting India for medical treatment five years ago, the medical tourism market in India is worth US$ 333 million, with about 100,000 foreign patients coming in every year. Voluntary health insurance market is estimated at Rs 4 billion ($86.3 million) currently but is growing fast. Industry estimates put the figure at Rs 130 billion ($2.8 billion) by 2005. Joint ventures for offering medical insurance and other insurance services is one of the Investment & Business Opportunities. Trade in medical equipment and products, including warehousing, selling and servicing the latest medical electronics equipment, diagnostic kits, reagents and consumables. Telemedicine systems, for treating patients in remote areas through a satellite connection. Corporate health care clinics for providing high quality basic services in consultation, diagnostics, minor surgeries etc. Business Process Outsourcing of medical transcriptions and other hospital management administration tasks. R&D base for new molecule development, clinical trials, etc., utilizing the high quality scientific manpower and low costs.
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UPCOMING TRENDS
MEDICAL TOURISM
It is the next big success story out of India. From less than 10,000 patients visiting India for medical treatment five years ago, the medical tourism market in India is worth US$ 333 million, with about 100,000 foreign patients coming in every year. Procedure costs Procedure Surgery Bone Marrow Transplant Liver Transplant Open Heart Surgery (CABG) Neuro surgery Orthopaedic Surgery Cosmetic Surgery Hip Replacement Hysterectomy Gall Bladder Removal Knee Surgery 6,900 2,012 1,755 7,000 16,000 Thailand 62,500 75,000 14,250 Cost (US$) US ($) 400,000 500,000 50,000 29,000 20,000 20,000 India ($) 30,000 40,000 5,000 - 7,000 8000 6,000 2,000 4,500 511 555 4,500
*All figures in US$. The Indian costs are based on the average rates offered by top Indian hospitals like Escorts Heart Institute, Apollo and Batra Hospital. The Thailand rates are based on rates provided by Burnrungard Hospital, Bangkok, which is Thailand’s largest private hospital. Source: IBEF Syndication Studies
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PREVENTIVE HEALTHCARE
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Growing health consciousness among middle and high-income families in India is heralding a new business opportunity - preventive healthcare. The addressable population for preventive healthcare check-ups in India is about 160 million. At current estimates, not more than a million people may have been covered. For hospitals, the preventive healthcare business is attractive. It allows them to build long-term relationships, as patients who come for health check-ups generally come back to the same hospital if they require any treatment.
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HEALTHCARE BPO
? Healthcare BPO could potentially be a US$ 4.5 billion opportunity for
India by 2008, offering employment to about 200,000 people. It includes offshoring of processes such as medical billing, disease
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coding, forms processing and claims adjudication. As healthcare BPO players mature, other businesses like claims
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repricing, medical diagnosis and actuarial work are expected to gain momentum.
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TELEMEDICINE
Telemedicine is a method by which patients can be examined, monitored and treated, while the patient and doctor are geographically distant. Potentially, the next big success story in the healthcare sector, several examples already offer an insight into this emergent opportunity that is changing the lives of over 600 million people in rural India. Gujarat: The Online Telemedicine Research Institute (OTRI) provided telemedicine links for teleconsultation, thereby establishing 750 sessions in a period of 30 days in Bhuj after the earthquake in January 2001.
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Karnataka: Asia Heart Foundation, Bangalore has successfully been practising Telecardiology between Bangalore and cities in eastern India. Paramedics are guided to save patients suffering from Acute Myocardial Infarction by performing life-saving procedures as per doctors’ directions over video conferencing.
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Tamil Nadu: Apollo Hospital, Chennai is providing expert opinion from its tertiary level hospitals in bigger cities to those in farflung towns of India. Over a period of 27 months, over 4,000 patients benefited from teleconsultations and over 75 per cent of those teleconsulted were treated in their respective cities.
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Haryana: Jiva International, a healthcare venture on the outskirts of Delhi, is implementing a novel plan that takes medical care right inside rural India by using a GPRS enabled Java application available with Nokia’s 6800 model. The “Teledoc” project won the World Summit Award for eHealth, at
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the World Summit on Information Society (WSIS) held in Geneva, Switzerland.
THREATS
? The government is reducing the grants given to hospitals, thus making it
impossible to cater to the poor people.
? The unions of the menials and even doctors: they can go on a strike,
disrupting the functioning of the entire health care unit.
? Competition from other international hospital chains, which are more,
advanced in technology and better financial support.
? The public spending on health in India is a mere 0.9% of GDP and the
private spending on health is 4.2%. India ranks 171st out of 175 countries in terms of public spending on health.
? Government pays more attention on age-old programmes like
tuberculosis, leprosy etc. and less attention on killer diseases – cardio vascular, diabetes, obesity and hypertension.
? Unplanned urbanization and neglect of the public health system as
whole has led to the resurgence of water-borne diseases like hepatitis and cholera every year. More virulent forms of tuberculosis are being seen in those infected with HIV, which appears to have spread widely in India.
? The number of people in India infected with the HIV/AIDS virus has risen
sharply. According to India's National AIDS Control Organisation (NACO), more than 4.5 million Indians are infected. HIV/AIDS in India is not only
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confined to high-risk groups and in cities, but is gradually spreading into rural areas and the general population.
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TYPES OF HOSPITALS
CLASSIFICATION ON THE BASIS OF OBJECTIVES
Hospital
Teaching cum Research
General Hospital
Special Hospital
Teaching-cum-Research Hospitals: These hospitals are teaching based. They are found engaged in advancing knowledge, promoting the research activities and training the medics. As for example, All-India Medical Institute, New Delhi, Post-Graduate Medical Education and Research Institute, Chandigarh, etc. General Hospitals : The general hospitals also offer teaching and research facilities but these objectives are secondary. The main objective in the general hospitals is to provide medical care. As for example, different medical colleges and district and sub divisional hospitals like DY Patil Medical College. Special Hospitals : The main objective of special hospital is to provide specialized medical services. These hospitals concentrate on a particular organ of the body or a particular disease. For eg. The Asian Heart Hospital, Mumbai.
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CLASSIFICATION ON THE BASIS OF OWNERSHIP
Hospital
Government Hospitals: Government Voluntary These hospitals are fully owned managed and controlled Private by the SemiHospital Agencies Government Charitable government. They are mainly involved in healing the needy and providing Hospital Hospital healthcare to everyone at very affordable rates. Semi-Government Hospitals: These hospitals are partly owned by government. Time to time government assistance is provided to these hospitals may in the form of finance. Voluntary Agencies: There are some hospitals which are run and are in control of voluntary organizations they can be of any form i.e. may be general hospitals or special hospitals or even teaching institutes. Private Charitable: These private charitable hospitals are owned and controlled by the charitable organizations, which are private. For e.g. Ramakrishna Mission Hospital, Mumbai.
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CLASSIFICATION ON THE BASIS OF MEDICINE
ALLOPATHY HOSPITALS AYURVEDIC
HOMEOPATHY OTHERS
UNANI
CLASSIFICATION ON THE BASIS OF SIZE
Hospital
Teaching Hospital
District Hospital
Tehsil/Taluka/ Subdivisional Hospital
Primary Health Centers
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Hospitals can also be classified on the basis of their size. There are variations in the size of the hospitals. As such, the teaching hospitals generally have 500 beds, which can be increased according to the number of students. The district hospitals generally have 200 beds, which can be raised to 300 depending on population. The teshil / taluk / sub-divisional hospitals generally have 50 beds that can be raised to 100 depending on population. The primary health centers generally have 6 beds that can be raised to 10 beds.
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SEGMENTATION
EXTERNAL SEGMENTATION
1. Income wise: ? ? ? ? No income Low income Middle income High income 2. Gender wise: ? Maternity hospitals for females. 3. Family life cycle: ? Childcare hospitals.
1. Institute of Child Health and Hospital for Children 2. Center For Genetic Health Care
The center is actively involved in Genetic Health Care of Unborns, Children and Adults for the last 15 years. Facilities available at the centre are unique and under one roof. 4. Specialized hospitals: ? Heart,
1. Asian Heart Institute & Research Centre
Speciality Heart Hospital at Bandra Kurla Complex, Mumbai ? Eye, ? Dental etc. 5. On basis of disease:
? Tuberculosis, Tuberculosis Research Centre ? Cancer, Jeevan Jyot Cancer Hospital
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INTERNAL SEGMENTATION
1. Type of care: ? ? ? Intensive care unit Normal ward General ward for check up 2. Facilities/comfort wise: ? Ac room ? Non-AC room ? Deluxe room
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PRODUCT
Kotler says a product is anything that can be offered to a market to satisfy a want or a need. Products that are marketed include physical goods, services, experiences, events, persons, places, properties, organisations, information and ideas. In the case of hospitals, different types of hospitals offer different services to their users. Some of the hospitals give priority to medical education, training and research while some others concentrate on medical treatment. The product of a hospital can be any of the following: PRODUCT
MEDICAL SERVICES
MEDICAL TRAINING
MEDICAL EDUCATION
MEDICAL RESEARCH
PRODUCT LINE WIDTH, DEPTH & LENGTH Medical services Cardiac Dental Dermatology Neuroscience Medical training Surgery Operation Medical education Dentistry Ophthalmology Neurology Medical research Heart diseases Cancer Aids
The following is the product width, depth & length of Lilavati Hospital:
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LILAVATI
MEDICAL SERVICES
SURGICAL
DIAGNOSTIC
ALLIED
DENTAL
CARDIOLOGY
ANDROLOGY
NUCLEAR MEDICINE
PHYSIOTHERAPY
CLINICAL CARE
OPTHALMOLOGY
PATHOLOGY
DERMATOLOGY
ORTHOPAEDICS
RADIOLOGY & IMAGING
RESPIRATORY
GENERAL SURGERY
ONCOLOGY
ENT
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PRODUCT MIX
Level 1: Core / generic product:
This is the basic service product. In hospitals, health or well-being by way of the treatment provided by the doctor to deal with the ailment of the patients is the core product or service. Level 2: Expected products:
This is the basic product and minimum purchase conditions that must be met. In hospitals, in addition to the core product, all other supplementary services like a bed, waiting area, availability of medicines and drugs, meals, hygiene etc.
Cooper Hospital
? Waiting Area, Beds
Lilavati Hospital
? Waiting Area, ? Beds, ? Availability of medicines (24 hours), ? Availability of Blood Banks, etc.
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Level 3:
Augmented Product:
Along with the basic and expected offering, the service provider needs to differentiate its services from its competitors.
Lilavati Hospital
? Great Infrastructure, ? Cardiac Ambulances, ? Centrally AC, ? Cafeteria
Product Augmentation is not observed much in case of BMC hospitals because these hospitals are established to provide free (or at nominal rate) services to the customers. They don’t find the need to differentiate. They are established as they form a part of the basic infrastructure of the city.
Level 4:
Potential product:
The potential product contains potentially feasible features and benefits that play a significant role in holding and attracting the customer. These features and benefits are useful or likely to be useful to the buyers.
AHIRC
Beds are provided for ICU attendants free of charge along with other communication facilities like internet
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FLOWER OF SERVICE
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INFORMATION + In a hospital, providing information refers to making the patients or the general public aware of the services and facilities offered by the hospital. + The customer needs to have some basic information about the service provider so that he/she can make a choice between the different service providers. In the hospitals the basic information that a customer would require is as follows: + + + + The different types of services that the hospital offers. General, specialized The technologies that are being used. About the in-house doctors and their qualification About the visiting doctors i.e. their qualification, number of times they visit in a day and at what time, etc. The tools which hospitals use to provide information are television, internet, radio, etc. Dr. Batra’s Health Care Clinic – radio advertisements Lilavati Hospital has used internet as one of its tool to provide information. The webpage appears as: Eg:
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CONSULTANCY: The customer after getting the information may need some help or further information. The service provider has to find out the customers requirements and develop solution. The customer may require help regarding the following:
•
The specialist doctors and their success rate for the kind of treatment the customer is looking for. The tie ups with the blood banks in case of emergency. The prices of the different wards in the hospital
• •
In any hospital, treatment is provided only after a preliminary check-up and\or various test consultation. Now-a-days, consultation is also done via internet, .i.e. online consultation or telephone. This petal is of utmost importance. The hospitals can differentiate their service by way of their consultancies. Now-a-days the patient, who is going to undergo an operation, is explained in detail what he is suffering from & how the surgery is going to be, the post operation effects & so on. At Lilavati Hospital, Asian Heart Institute & Research Centre & many other hospitals, the surgery or the operation is displayed Live on the monitor which can be viewed by the patient’s relatives.
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ORDER TAKING This refers to the promptness of the service provider in taking the order of the customers. Promptness should be in the following areas: + + + Formalities: The paper work & the legal formalities prior to the admission must be minimum. Accommodation: the patient should be given the accommodation as soon as he\she completes the formalities. Responsiveness: the patient must be attended as soon as he is accommodated. At AHIRC, a patient is required to come in with two relatives. This is because, when the patient enters the hospital, he is either sent to the bed allotted to him (through prior booking) or to the pathology department if certain tests need to be carried out. One relative accompanies the patient, while the other relative remains at the admission counter to complete the admission formalities. This way, the patient is not kept waiting while the admission is carried out.
SAFE KEEPING: [SAFETY AND HYGIENE] When a patient has to undergo a surgery or an operation, he always has a fear that whether he\she is in safe hands. Therefore the doctors, nurses, ward boys and all the other employees, who come in direct contact of the patient, must possess an ability to build trust, win his confidence & make him feel that he is in safe hands. Eg: Most of the hospitals display the success rate of their doctors.
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HOSPITALITY This is becoming increasingly important in the healthcare sector, particularly in hospitals as the expectations of people towards medical care are ever increasing. No longer are they limited to only the clinical outcomes but also involve the delivery process, margin of safety and behavior of personnel. The AHIRC provides a host of conveniences to patients and their relatives. Service to patients: + + A choice of packages from twin sharing, single room and deluxe suites are available to patients. A lot of care has been taken to ensure that the patient does not feel walled in. For example, all rooms have natural and indirect lighting with huge windows and in some cases, terrace gardens. A number of facilities are provided to the patient such as a television, in-house meals etc. So as to make the room aesthetically pleasing and improve patient mentality (they are usually depressed), all medical sockets, instruments or attachments are hidden from view, behind a panel beside the bed. Service to relatives: The AHIRC is the only hospital in Mumbai that has a separate family waiting area for relatives of patients in ICU. Each cubicle in the waiting area has provisions for sleeping such as a bed, pillows, blankets etc. The reason for such an arrangement is that , in the ICU cases, one person should be present in the hospital 24 hours so that he is available to sign the consent form. Patient number is allotted to the relatives bed and in the case of an emergency, the relative is immediately called by the secretary in charge. Relatives also enjoy facilities like internet connection, a multi-cuisine cafeteria, prayer rooms, library, public call booths, coffee machines, a gift shop etc. There is even a travel agency located on the ground floor that caters to the traveling and sight seeing needs of the visitors (particularly in the case of patients from abroad).
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EXCEPTION Exceptional service is not what you are expected to give, it’s a kind of service which you provide to your customers to win customer satisfaction so that he would be loyal to you & spread good word. This petal is deformed in case of many BMC hospitals. Private hospitals make use of this petal at its best to differentiate their service. BILLING Hospitals should ensure that billing and payment procedures are quick so as to enable the patient to return home soon after discharge.At AHIRC, two types of bills are generated i.e. Interim bills and Final bill. The interim bills are generated to give on a bi-weekly basis. They give the patient an idea about the charge payable for the specified period. It helps is avoiding any confusion at the time of generating the final bill. The final bill is generated at the time of discharge. This considers all the interim bills and the advance deposit paid. PAYMENT: The norms for payment of the bill must be simple. 1. The payment counter should be easily accessible. The customer must be able to easily locate it. 2. The mode of the payment should be easy and quick. The customer should be able to easily settle the bill and leave. If the payment is made by the credit cards, even this must be quick and should be on the different counter.
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SERVICE QUALITY DIMENSION
RELIABILITY The ability of the service provider to meet the promises made by them accurately. The customer must develop a feeling that they can depend on that particular service provider for their problem. 1. The staff of the hospital has to be very accurate while performing their job. Only than the customers would rely on them. For e.g. during surgery the amount of anesthesia to be given to the particular patient has to be accurate. 2. The service provided should be such that the customers develop a feeling of loyalty so that the hospitals get the repeat customers as well as new customers. e.g. if Mr. X goes to Lilavati hospital for the bypass surgery and the surgery is conducted successfully and he recovers soon, he would not only become loyal to the hospital but also he will
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narrate the whole incident to many others thereby giving Lilavati more customers. ASSURANCE The service provider and the employees must be capable of winning the trust and confidence of the customers. 1. The customers can be assured by informing them that the doctors, nurses, ward boys and the other related staff is competent enough in providing them their expected level of service. 2. The frontline staffs have to be very polite and friendly to the patient and the relatives. 3. The patient must develop the feel that he is safe in that particular hospital. For e.g. when a patient is brought to the hospital in emergency he and the relatives must be attended with courtesy and also the doctors and the nurses must politely tell them, that “nothing will happen to the patient, we will try our level best” and not react with abrupt and angry statements. His words should sound empathetic and at the same time consoling. TANGIBLES This includes the ambience, the technologies used, the facilities used to communicate things etc. 1. The ambience of the hospitals must be gentle and clean. The technologies used in the hospitals have to be latest or updated regularly. Because now a days people do not buy the product but benefits. 2. The environment of the hospital has to be peaceful. The corridors outside the rooms should not be crowded. Even in the visiting hours too many people should not be allowed at a time.
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3. The seating arrangements for the patient who have just come for some tests and the person accompanying him have to be comfortable. 4. The signboards must be the perfect indicators so that there is no difficulty for the customer to locate the place, he wants to go to. For eg., in Asian Heart Hospital, the technologies used are latest, the visitors are given two passes so only two people can go and see the patient in the visiting hours. EMPATHY The attitude of the service provider should be caring and if possible individual attention to each customer should be given 1. The attitude of the doctors and nurses should be concerned. They should be approachable as and when required. 2. The doctors and nurses must have the ability to understand the problem of the patient and give the solution accordingly. 3. The doctors must communicate well to the patient and the relatives about the disease the patient is suffering from. 4. The nurse and the ward boy should be assigned to look after the patient. RESPONSIVENESS The service delivery should be prompt and up to the mark. 1. The patient should be attended as soon as he comes to the hospital and registers himself. In case of emergency he should be attended immediately. 2. The nurse should be able to locate the doctor soon if he is needed. For e.g. a patient suddenly starts sinking or breathing at a faster rate the nurse should be able to call the doctor immediately. For this, a good intercom facility is required.
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PLACE
STATISTICS REVEALS THAT: PROBLEMS-OF-ACCESS:
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Fifty-four per cent delivered their babies without the support of trained personnel. Fifty-eight per cent of children have not completed their immunisation schedule and 14 per cent have not received a single vaccine. Only one in two women seeks treatment for illness, usually because the nearest health service is too far away, or it's too expensive. These examples are only meant to illustrate the fact that people's access to health care is limited by their ability to pay, as well the availability of services.
•
•
•
DISTRIBUTION The most commonly recognized medical facility is probably the hospital. In the past decade, however, the shift has been away from providing all care in the most expensive medical environment. As a result, a number of other less expensive options have developed. There are ambulatory surgery centers, rehabilitation centers, nursing homes and other residential care facilities, specialty service centers and home care programs, just to name a few. 1. Medical camps
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They are the most common form of distributing the medical services. These camps are generally held when there is a calamity. As we recently saw, these camps being held at various parts of Mumbai, in the aftermath of the floods of 26th July. Such camps are organized on an even larger scale when the calamity is of a very high magnitude. Eg. The camps that were set up in Gujarat ( areas of Bhuj & Anjar) were huge enough to have several Operation Theatres in them & they accommodate upto 100 patients at one point of time. They are equipped with quite a lot of equipments like X ray machine, the ECG etc. they are manned by nurses, general practitioners, specialists, & other medical professionals. 2. Air Ambulances Rooftop heli-pad is available for the emergency airlifting of patients to and from the hospital for specialized trauma treatment. These air ambulances have a crew of up to 5 people, which includes one specialized doctor, a Para-medical staff, 3 member rescue team. Family members of the patient are generally not allowed to accompany him. Though not very common in India, it’s a regular feature in the hospitals of developed countries. Even in India, these emergency services are developed. Eg. The Madke Hospital in Mumbai. 3. Ambulances As we all know, they are the most common mode of transport used in moving in the patients from the place of illness to the hospitals. 4. Mobile Vans Mobile Hospital and Research Centre, was flagged off on October 19, 2002 by His Excellency Dr.APJ Abdul Kalam, President of India. It has been found to be extremely popular & a practical health care model for Uttaranchal. The aim has been to bring advancements in modern medical sciences at the doorstep of the common man, who otherwise would have been neglected of its
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benefits. The project has been conceived, keeping in mind the specific needs of remote hilly terrain of Uttaranchal where negligible modern health care is available to needy and poor people who are staying in far-flung areas of Uttaranchal
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PRICE
The pricing management of a social institution becomes complicated as the policy makers are expected to take social factors into considerations. The lower sections of society look forth to free and cost-free services, as they are not economically backed to support their family’s healthcare expenses. Naturally this jeopardizes the task of top management. It is close to impossible for even the government, specially in an over populated country like ours, to make available world-class services to all without charging any fee. But then, it is also not rational that we expect free services, though we have the capacity to pay, which is another problem with the middle-income class of the country. The pricing strategy helps us to projecting our image. Not only this, if the strategies are welfare oriented, the task of satisfying the users is also simplified. But the satisfaction depends upon sophistication. And sophistication can’t be possible unless we change our pricing strategies. Even the affluent sections of society expect low cost services from social institutions in general and hospitals in particular the task of innovating services in line with latest developments in the field of physical sciences is difficult. Healthcare services involve the use of expensive and complex machinery, which involve huge investments. Apart from that, the cost of maintaining them and cost of running the hospital is in no terms cheap. Doctors’ salaries along with the salaries of the nurses and helpers constitute a great part of the cost too. In a developing country like ours, where the level of income of the general masses is found low, it is significant that pricing decisions are liberal to the economically weaker sections of the society.
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There are a number of questions that service marketers need to ask themselves as they prepare to create and implement a well – thought – out pricing strategy.
HOW MUCH TO CHARGE? PRICING IN GOVT. HOSPITALS
In the Indian setting where a number of persons are below the poverty line it is challenging task to formulate a pricing strategy, which is successful in serving the social interests and generating profits. It is due to this that most government hospitals are in deplorable condition. The ultimate sufferers are the society and specially the poorer sections. Since the affluent sections have an option to avail the expensive medical services made available by private hospitals. The societal marketing principles make an advocacy in favors of The fee strategy for or quantitative protecting the public interests but it is not meant that the hospitals have a uniform pricing/free structure for all the users. engineer a sound foundation for hospitals should be in proportion to the incomes of users, which would qualitative improvements. DISCRIMINATORY PRICING: For social institutions like govt. hospitals a discriminatory fee structure is preferred since it provides even the weaker sections of society, an opportunity to avail the quality medical services. This enables hospitals to innovate services to keep pace with the latest developments in medical sciences.
1. Free service: Generally speaking, all categories of hospitals should
adopt cost-free services to the weaker sections of the society having no source of income for paying even the nominal charges. In this
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context, the government hospitals should be given special grants to avoid an imbalance in their financial management.
2. Subsidised services: The users belonging to the low-income group
should be made available subsidized services. That is, the public or hospitals make nominal charges for the services made available to them. It is more or less clear that subsidized services are a bit lower than the cost involved on treatment. Both the central and state governments would give the subsidies.
3. Cost-based Services: This is based on the principle of no-profit, noloss. Or say, the cost based strategy in which prices or fees are equal to the costs involved on treatment. This is basically for the middle income group.
4. Cost plus Subsidy: This strategy allows charging more than the costs
involved on the services, but only from the better-off sections of society. The transfer of these surpluses to the account of subsidy for compensating the losses on account of providing free or subsidized services to the weaker sections and low-income group users is also necessary.
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Government Hospitals FEE/CHARGE
1.
FREE (For No Income group)
2.
SUBSIDISED (For Low Income group)
Discriminatory Pricing
3.
COST + LOSSES FROM 2 (Middle Income group)
4.
COST + SURPLUS TO MAKE UP THE LOSSES OF 1. (High Income group)
On one hand, it is judicious that no discrimination is found in respect of making available the medical aids, but on the other hand, we can’t adopt uniform policy while making available to the users and their attendants other facilities like standard of room, indoor facilities and other non medical amenities. This is justified on the ground that all groups are not paying equal fees for availing their services. Moreover when no income group has been availing the services without paying any fee, their expectations would not be more than the proper medical aids. At Cooper Hospital all the patients are not charged. Only those who can afford to pay would pay others can pay whatever they can or pay nothing at all.
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PRICING IN PRIVATE HOSPITALS
It is difficult to offer free or subsidized services to the masses. On the other hand, the technological sophistication has raised the cost of services as the inputs used in making available the medical services are found costly due to rising inflationary pressure. Thus private hospitals take the following approaches to pricing: 1. Cost Based Pricing: Direct price + overhead costs + profit margin. This approach involves setting prices relative to financial costs. The hospital sets a price sufficient to recover the full costs (variable, semi variable & fixed) of providing the service. These ads a sufficient margin to yield the described level of profit at the predicted sales volume. Hospitals generally incur high fixed costs due to expensive physical facilities. In hospital services, this method is cumbersome because the tracking & identification of costs apart from doctors fee, is difficult. In spite of this, some hospitals in the private sector do follow this method.
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2. Demand/Value Based Pricing: This involves settling a price consistent with the customer’s
perception of service value. That is, prices are based on what customers will pay for the services provided. Hospitals with a reputation for high quality successful treatments etc. can & do charge a premium simply based on the sheer perception of quality health care. Those who can afford are generally willing to spend high amounts on quality care. However there was a case during the out break of leptospirosis , when the was a huge requirement of white blood platelets they were not easily available in the city. As a result its charges rose from Rs.250- 300 to Rs.1000+ deposit of Rs. 600 3. Relationship Pricing: Hospitals may undertake relationship pricing with regard to corporate clients so as to develop & maintain long-term customer relationships. Here the hospital offers company’s o n treatment of its employees over a period of time.
4. Competition based pricing:
Using other price as an anchor for the hospitals price, heterogeneity of service across and within providers makes the approach complicated.
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WHAT SHOULD BE THE BASIS OF PRICING?
Pricing in hospitals may be based on the following:
1. Time based: It is based on the time of use. Fr example: In case of
an admission the duration of the patients stay is un predictable, so rooms may be charged on a daily basis. In AHI, the rate of a suit is Rs.5500 /- per day.
2. Value based: it is based on the value or the importance of the
service. In case of consultation with a doctor or out patients, doctor's fee may reflect till expertise or be tied to the complexity of the diagnosis etc.
3. Flat rate basis: This is charging flat/ standard rates for some
services. Again, there may be flat rates assigned to various treatments for example: charges for an X- Ray, ECG & so on. At Breach Candy Hospital on admission, an initial deposit is collected at the in-patient billing counter. The amount depends on the category of room and the treatment / surgical procedure planned. The in-house doctors are paid salaries by the hospital as per the hospital norms whereas the visiting doctors decide the fees in consultation with the patients and only 10% of this fee is retained by the hospital. All the billing transactions are done through the hospital. Various categories of rooms ranging from a shared room to the deluxe suite are available.
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Room Charges and Deposits at Breach Candy Hospital:GENERAL: Room Category Deluxe New wing Single Rooms (West) Single Rooms (East) Single Rooms (Shared Bath) Double Shared Room Non – A/C Single Room (Shared Bath) MATERNITY: Room Category Deluxe Maternity Single Room (With Attendant Couch) Single Room Single Rooms (Shared Bath) Double Shared Room (Shared Bath) Shared Room (Shared Bath) Labour Room Tariff (Rs.) 4,500 3,500 3,200 2,400 2,200 1,300 1,800 Deposit (Rs.) 20,000 20,000 20,000 20,000 20,000 20,000 Tariff (Rs.) 4,500 4,200 3,000 2,500 1,500 1,300 1,200 Deposit (Rs.) 40,000 40,000 30,000 25,000 20,000 20,000 20,000
INTENSIVE CARE UNITS: Room Category Surgical Medical Neonatal 1 Neonatal 2 High Dependency Unit Day Care Tariff (Rs.) 5,000 5,000 3,500 2,200 3,200 900 Deposit (Rs.) 40,000 40,000 35,000 30,000 30,000 20,000
CHARGES AT COOPER HOSPITAL: Category 1. a) Outside patient- for case paper b) 14 days after for re-checking 2. a) Light checking b) E.C.G 3. a) Ultra sonography b) If they need the imaging film Amount (Rs.) Rs.10 Rs.10 Rs.30 Rs.30 Rs.100 Rs.50
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4.
E.E.G.
-
brain
Checking
for Rs.250 Rs.5000 Rs.500 Rs.200
psychiatric 5. Extra special Surgery 6. Special Surgery 7. Normal Surgery
PROMOTION
Buoyed by corporatisation of healthcare, India’s promotion as a sought after medical tourism destination and threatened by the mushrooming of new hospitals, it is becoming difficult for hospitals these days to depend on mere word of mouth promotion to attract patients.
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The Code of Medical Ethics of Medical Council of India says that a doctor cannot solicit business by advertising, but nowhere does it mention that a hospital cannot advertise. Hospital managements are putting extra effort in carving a brand image of the hospital and improving hospital’s visibility. In other words, many would agree, that hospitals marketing has evolved from being subtle to aggressive. Generally a lot depends on the brand name of the hospitals. Well-established hospitals all ready have a brand name like Breach Candy hospital, Lilavati hospital. These are well-established hospitals known for their excellent service. They are distinguished by their services provided. A few of the used promotion methods by hospitals are as follows:
PERSONAL COMMUNICATION
(a) Personal selling:
This involves an immediate and interactive relationship between two or more persons. Business-to-business marketing:
?
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Hospitals
usually
resort
to
personal
selling
for
business-to-business
marketing. Both in the case of corporate tie-ups and approaching doctors for patient referrals, it is the hospitals marketing executive who personally approaches the corporate or the doctor so as to pitch and finalize the deal. Network of doctors: On the other hand, they also have a network of doctors linked to them. These doctors are ‘consulting doctors’ who don’t have clinics of their own. Thus, they treat all their patients in the hospital premises itself. Other visiting doctors are also linked to the hospital and even they pull their patient-base to the hospital for surgery, treatment and recovery. Many hospitals also provide incentives to the doctors so as to ensure that the hospital is the first preference of the doctors for referral. Apollo Hospital in Chennai interacts with doctors on one on one basis. They regularly conduct seminars and continual education programmes to explain to doctors the advances in the medical sciences and the infrastructure that their hospital has.
?
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(b) Customer service and training:
In hospitals, almost all the services are delivered in the customer’s presence. Front-line personnel are directly involved in the process of offering the services, due to which they must be efficiently informed, trained and supported. For instance, if nurses neglect patients, receptionists misbehave and doctors do not show a human approach, the hospital will fail in delivering good service to the society in spite of the availability of most sophisticated equipments and technologies, efficient doctors and nurses and most comfortable buildings and infrastructure facilities. Thus, hospitals invest a lot in internal marketing by way of training so as to ensure that the employees are at their best of behavior with the patients and well informed about the various activities of the hospital, including free checkup camps and talks. Important ways of internal marketing is analyzing feedback from regular customer satisfaction surveys and improve service delivery so that the way of service delivery itself is the marketing of the service. Example: One way in which AHI ensures good customer service is by holding training programs for nurses every 15 days, enlightening them about how to handle various patients etc. At Fortis Hospital at Noida, there’s also a system of taking feedback from patients and visitor, which enables them to check flow in their service.
(c) Word of mouth:
In Medicare services, word of mouth plays a very important role, as people are more likely to trust a hospital if they have heard about its success in treatments or quality care from a patient. Thus, by ensuring good customer service, hospitals also get a lot of promotion by way of word of mouth.
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CAMPS FOR SOCIAL PURPOSE:
They conduct camps in rural areas to give medical check ups at reasonable prices, they sponsor visits to old age homes etc. Participating in the country’s biggest medical conventions and conducting health camps are also other prominent forms of making their presence felt. For example: Hinduja Hospital had also sent a team of their medics to Bhuj when the catastrophic earthquake hit the place some time ago.
ADVERTISING
They are not used frequently in hospital marketing. Hospitals can focus on the quality of their services, their contribution to the social transformation process, but they cannot advertise for generating profits. Mostly, advertising through mass communication media like TV ( special programmes, interviews of specialists), print media (fitness magazines, news papers) etc. is only used in social marketing where the objective is to pass on a social message like family planning, child immunization, health and family welfare etc.
SALES PROMOTION
In hospitals, sales promotion usually by way of: - Sign up rebates or discounts, especially in the case of corporate clients - Gift premiums, for ex. Doctors are offered various gifts and benefits in return for patient referrals.
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PUBLICITY AND PUBLIC RELATIONS
Hospitals may sometimes issue press releases regarding the success of rare and crucial operations and surgeries. This is because its success rate of crucial operations and surgeries reflects the technological and knowledge- based edge of the hospitals over the competitors. When many successes are discussed in health magazines and newspapers, it becomes a natural advantage for the hospital. To reach the consumers, Apollo Hospitals rely mostly on public relations. Whenever their doctors perform pioneering surgeries or winning awards for their achievements, they talk to the media and when people come to know about their achievements they get confidence to go for the services.
INSTRUCTIONAL MATERIALS
Use of traditional approaches like printed materials, ranging from brochers and instruction manuals to step-by-step instructions are used by hospitals they also follow printing and making readily available various emergency or appointment numbers. AHIC: AHIC has a ‘patient guide’ in every patients room which gives patient valuable information regarding booking, cancellations, various facilities available, what to expect during the stay, discharge procedure, billing and payment procedures etc.. They also have a patient education service, wherein brochers regarding the heart, what the various heart ailments are, what the various heart surgeries or treatments involve, how heart disease can be avoided by way of healthy eating and exercise etc. Almost all the private hospitals have web sites with information for patients, doctors, facilities available, price for the same etc. One of the most effective
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marketing tool of Jaslok Hospital is a web site (www.jaslokhospital.net), which is constantly updated by their technical staff. Brochures and printed material are also available at certain other places. For ex. Printed material at the blood bank helps educate patients or donors on why to donate blood, precautions to be taken before donating blood etc.
CORPORATE TIE-UPS
There are 2 ways of doing this:
?
Direct Tie- Ups: Hospitals may either tie-up directly with corporate and offer health checkups and treatments at discounted rates to the employees of the corporate Sometimes free conferences or camps are also conducted for the employees of corporate by the hospital so as to educate them on prevention of heart diseases etc. Corporate Tie-ups - entitles executives to consultation and admission without payment formalities. The bills are settled directly by the company, simplifying the admission and discharge procedures for selected employees. Regular correspondence is maintained with their corporate clients, they are sent brochures and flyers regularly. For Example, Breach Candy Hospital has tie-ups with 150 corporate companies and consulates, Also tie-ups. The marketing strategy of Jaslok Hospital involves tying up with corporates, some of them being Oil and Natural Gas Commission (ONGC), Mumbai Port Trust (MBT), Bhabha Atomic Research Centre (BARC) and Air India. At AHIC they undertake corporate marketing by approaching various corporate and inviting them to join their panel. Different packages are offered Hinduja hospital has around 170 Corporate
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to these corporate such as discounts of 5-10% depending on the strength of employees, health check ups and programs for employees etc. corporate are also offered credit facilities i.e. the bill of employees is sent to the company after 15 days for settlement.
?
PPO’s (Preferred Provider Organization): They can attract corporate business through PPO’s (Preferred Provider Organization). PPO’s have an understanding with corporate and in case an employee falls sick, the corporate refers the employee to the PPO, which in turn sends them to the hospital for check-ups and treatments. which brings them a lot of business and also, helps in promoting the high – class quality of service they provide.
FREE HEALTH CHECK-UPS
This can be an important marketing tool as a patient attending a free health check up camp or talk at the hospital, goes back with a nice and charitable image of the hospital. Thus, the next time he is sick, he thinks of coming to that hospital. Most hospitals feel that if more than 50% of the patients who attend these free camps turn for further check ups, then organizing the camps are worth the trouble. For example Breach Candy Hospital conducts conducts free pediatric camps and eye camps. They also offer free check ups and free treatment to outpatients from time to time. Other marketing strategies of Jaslok Hospital involves that the hospital conducts free health check-ups like diabetes and cardiac check ups for the general public.
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CONTINUOUS MEDICAL EDUCATION PROGRAMS/ EXHIBITIONS
Under this, hospitals hold seminars and conferences relating to specific diseases or latest technology, where they involve the doctors from all around the country, for detailed discussion. This makes the hospital well known amongst the doctors, who could in future refer complicated cases to the hospital. For example Liver Day was celebrated at Apollo Hospital, which was aimed at educating and creating awareness amongst children and parents, they organized a fashion show and health quiz, which generated a lot of interest Fortis Hospital at Noida was the first hospital to organise an exhibition in the National Capital Region, wherein the general public could visit all departments of the hospital and get answers from experts. Secondly, Fortis launched a dialysis technician programme for women from the weaker section of society in which they were given free training by the hospital and they will be assimilated in the hospital itself.
PRESENCE OF EMINENT PERSONALITIES
? In board of trustees: Many hospitals have eminent personalities from the industry in their Board of trustees so as to create a sense of confidence in the minds of people. ? As Patients: Celebrities, who, when admitted, are spoken about in the newspapers which gains a lot of indirect promotion for the hospital. Breach Candy’s clientele consists of a lot of celebrities treated which includes the Former Prime Minister Mr. Vajpayee, Late Mr. Dhirubhai Ambani, Shammi Kapoor, Shahrukh Khan, etc.
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INTERNATIONAL MARKETING
With medical tourism picking up, hospitals are emphasizing on marketing themselves in the developed special packages for those overseas patients and have tie ups with various hotels. At AHIC International marketing is done by organizing cutting edge medical programs & inviting foreign doctors to participate in them. Besides, many members of the surgical & cardiology team hold positions in international bodies pertaining to cardiac care and are on the editorial boards of international journals. Some of them are also visiting professors to various universities abroad. Also tie-ups with foreign consulates help them make their brand name. For the same reason Jaslok hospital has recently tied-up with FICCI to utilise the potential of this upcoming sector. They are also inviting foreign faculty and holding joint symposiums with the foreign delegates to share their skills, knowledge and experience. The hospital has a tie up with Stanford University Medical Centre, US and they hold video conferencing every month with the doctors of the centre, who interact with the faculty of their hospital.
BRANDING
A small hospital set-up that caters to the needs of the local community may not feel the need to create a brand. For them, local identity through word of mouth is sufficient. However, brand plays a vital role in the growth of ambitious healthcare service providers like corporate hospitals. The healthcare industry is moving towards corporatisation. Unlike other industries, healthcare is highly consumer driven. Since branding goes parallel to any consumer related activities, hospitals are moving towards satisfying consumer needs. Therefore, the need of getting branded is originating from the consumer itself.
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Branding is an empowerment of the Indian healthcare consumer. Experts feel that without a strong branded customer service, a hospital’s marketing budget is wasted. We live in a very different healthcare world today where the consumer is far more knowledgeable about the diseases and their choices of treatment. Institutions which will focus their energies in identifying the needs of their patients and create seamlessness in the experience of their patients will become the trusted brands of the community It is formed by keeping tin mind the following factors: 1. Reputation: Marketing or brand building may not be a conscious attempt. Brand speaks a level of reputation. If one has developed a good reputation, this will lead to creating a brand. When one achieves a superlative reputation, it extends into a great brand. For instance, institutions like CMC Vellore, Lilavati hospital, Nanavati hospital have created a strong brand for themselves through their decades of dedicated service. 2. Exclusivity of the Hospital: A brand should have some exclusivity and must be built around the vision that the hospital stands for. Brands should convey this upfront, otherwise it is futile spending on brand building. Brands communicate in a certain language. A Hospital should ask oneself- Which language does my hospital speak? Hospital should find its key strengths and then build its brand based on these key factors. Factors like service delivery, clinical expertise, and medical technology help to create an image.
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3. Word of mouth: This being a promotional technique adds to build a brand. Unlike consumer brands, healthcare is a very sensitive, personal experience. It depends on a in a hospital. Brands are established in healthcare through and therefore brandbuilding in healthcare is a lengthy process. 4. Patient’s experience: Healthcare brands emerge not through advertising but through the power of patient experience. Hospitals should see things from a patient’s perspective. Each patient has different needs. The hospital should be able to satisfy every patient’s needs. 5. Consistency: Besides, there should be consistency in the process of delivering healthcare in a hospital. A patient’s experience differs from hospital to hospital. If there is consistency in the processes it will relate to the consistency in the image the patient carries in his mind.
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Which hospitals have been the ‘fore-runners’ in this area?
Across geographical regions in India we do find hospitals which are powerful brands in those specific regions. Apollo and Wockhardt Hospitals are the Indian healthcare brands which have a pan India presence.
Brand Building of Wockhardt Hospitals: The Wockhardt Hospitals brand has been established over a time
?
frame of 15 years. Their brand has been built by a synergy of excellent clinical expertise with a professional management team which has constantly strived to give their patients a great healthcare experience. Their entire focus is to excel in their health care delivery process. ? They started with a single speciality cardiology institute in Bangalore which is a front runner in the country, followed by a kidney institute in Calcutta, followed by cluster of specialty hospitals in Bombay which have excelled in the area of cardiology, orthopedics, neurology and ophthalmology. ? They have also established a single speciality heart hospital in Nagpur which has made its mark as a cardiac institute of central India. Today Wockhardt is a super specialty brand. Hinduja Hospital and Research Centre Speaking about brand positioning of Hinduja Hospital and Research Centre, Mumbai, the three elements around which the brand of Hinduja Hospital is positioned is ‘Credibility’, ‘Delivery of Medical service’ and ‘Human Touch’. All their actions, right from patient care to various marketing exercises are aimed at reinforcing these elements.”
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PEOPLE
Service personnel play an important role in an organization, which provides services. In a hospital the behavior and attitude of the personnel providing services is very important as far as the customers overall perception of the service is concerned. It is necessary that the staff in a hospital be trained to provide quality patient care using state of the art technology.
THE SERVICE MARKETING TRIANGLE
HOSPITAL
(ENABLES TP KEEP THE PROMISE) INTERNAL MARKETING INTERACTIVE MARKETING
(MAKES PROMISES) EXTERNAL MARKETING
DOCTOR
PATIENT
The triangle comprises of the company i.e. the hospital, employees i.e. the doctors, nurses and the customer or in this case, the patient
1. The company here is the hospital which promises of a service offering
by way of treatment, which will satisfy the customers i.e. patient’s expectations of getting cured.
2. The patient who seeks to get cured is the customer for the hospital as
he is the one who avails the benefit of the service and pays for it.
3. The employees comprise of all the people who are involved in providing
the service, namely doctors, nurses, technicians, attendants, administrative personnel etc.
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From the triangle we see that three kinds of marketing activities take place in a hospital. 1. External Marketing The hospital undertakes external marketing as to promote the service i.e. treatments and facilities to the patients. This is explained in detail in the promotion mix. 2. Interactive Marketing Secondly interactive marketing takes place between the employees and the patients. Interactive marketing describes the employees’ skill in serving the client/patient. We know the customer of the hospital is the patient who is in some degree of discomfort or suffering when he is admitted/comes in. From the time he enters to the time of discharge, the patient has to continuously interact with the hospital’s employees by way of talking to the nurses, attendants, etc. Thus in his vulnerable state of suffering or sickness the patient expects quality care along with empathy and consideration of his every need by the hospital staff. Thus the selection, motivation, training of the hospital staff makes huge difference in the well-being and recovery of the patient. 3. Internal Marketing Good and effective interactive marketing is made possible only through efficient internal marketing. Hospitals undertake internal marketing to train employees and motivate them to serve customers well. Such training will help improve employee's competence and improve employee responsiveness, problem solving ability as well as their attitude, goodwill towards patients, all of which in turn will result on patient well-being and recovery or customer satisfaction.
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Thus internal marketing ensures that the employees are at their best behavior with the patients and well informed about the various activities of the hospital. An important way of internal marketing is analyzing feedback from regular customers satisfaction surveys and improving service delivery so that the way of service delivery itself becomes the marketing of the service.
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PHYSICAL EVIDENCE
Physical Evidence is the environment in which the service is delivered with physical or tangible commodities and where the service provider and the customer interact. Corporate image plays an important role in terms of physical evidence when it comes to hospitals. This can be developed with corporate relation programs. Modern hospitals need to create a good ambience because when a patient walks into a hospital, he immediately forms an opinion about the hospital. The staff should follow a dress code to show professionalism and
?
maintain discipline. The staff also needs to be trained to be understanding, warm and
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comforting because the clientele that goes to the hospital is usually disturbed or unhappy. It is necessary for a hospital to be well organized and segregated
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into different departments. All the doctors should be provided with a well – equipped cabin. If
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possible, the hospital should be centrally air – conditioned. However, good lighting and ventilation is a must. Special care should be taken to maintain hygiene; cleanliness and
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the whole hospital must be well – lit. This is generally taken care of by the housekeeping department.
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?
Develop way finding systems that allow users, and particularly
outpatients and visitors, to find their way efficiently and with little stress. Convenience store, public call booths, coffee vending machines, rooms, information kiosks, etc.
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library, prayer
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Separate waiting area with counselors for relatives of patients
undergoing surgery or angioplasty. Clinical pathways (more effective if placed on individual patient’s chart)
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PROCESS
Process is a set of activities that take an input, convert it and add value to the input and finally, create an output. A process is divided into the following phases in a hospital:
1. The joining phase – which includes
? The arrival of the patient ? Registration – where a patient has to make an initial deposit at the inpatient billing counter after which a file is opened in the patient’s name to know the patient’s medical history
2. Intensive consumption phase – which includes
? Diagnosis – where the consultant diagnoses the illness by making the patient undergo various tests ? Treatment – where the illness is treated with proper medication or surgery ? Information about further actions – the consultant will instruct the patient regarding the diet to be followed, the medication to be taken etc.
3. Detachment phase – which includes
? Discharge of the patient ? Payment – after the patient is discharged, the bill will bee paid at the billing counter. 4. Feedback At this stage, the patient is requested to fill an evaluation form, which helps the hospital authorities to know the level of satisfaction derived by
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the patient. Patient’s suggestions are always considered for improving the hospital services.
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FLOW
The joining phase Arrival Registration
Intensive consumption phase Diagnosis
Treatment Information about further actions
Detachment phase Discharge Payment
Feedback
BLUE PRINTING
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•
Blue printing is a tool of designing which portrays the picture or a map of a service so that the employees can understand their part better and the changes to make service more efficient or better can be made. The blue print that is prepared looking at the basic working of the hospital is attached. This blueprint is a very simple showing only the basic steps of the service at a hospital. In this blue print the customer comes in initial contact either through phone whereby if he needs to take appointment then he comes into contact with the receptionist or else for general information he contacts the customer care back office. Then the patient or customer needs to register by filling some necessary forms and making some advance payment. The form then goes through various levels as every aspect it has is checked by the back and front office. Then the customer meets the assigned person who checks and examines the patient and then sends him to his room. Here the dress, the cleanliness, assurance of doctor is very important. After the tests such as X-Ray, ECG etc depending is done and laboratory tests are done backstage which are important but not with direct contact with the customer. After this the last and final interaction is with the discharge department or the payment department. Accounts department in the back office prepares the bill and the cashier has to collect the payment from the customer. There are many other stages of which blue print can be prepared but then it will become too complex. Thus given is a simplified format of blueprint.
•
•
•
•
•
•
•
BLUE - PRINT OF HOSPITALS
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C A
U R
S R
T
O I V
M E S
E
R
O F O R F O F N T I CR E E C C E P A T R I EO S U A GN L I S T Y T R
P DA
D IT A I O G NT OR SE I A S T F I N D F I S O C M U E R R H N T M A T H A R T E T G R I O E
B O
A F
C F
K C U S T O M I C ES E R V I C
E E
R
X S
- R O N
A O
Y G
,
B R
L A
O P
O P DA H Y
Y T M E SE T N , e t c .
C D
U E
S P
T A
O R
M T
E S
R
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Hospitals & HealthCare OUT-PATIENT DEPARTMENT
OPD
Registration
Examination
Prescription
Investigatio n
Dressing & Treatment
Admission to patient ward & treatment in-
X-Ray
Laboratory
Tests Report
Discharge
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Hospitals & HealthCare CASUALTY DEPARTMENT
Casualty Dept Reception & Enquiry Registration Examination Observation Admission Discharge Dressing
Normal Health
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SERVICE ENCOUNTERS
A service encounter is the time at which the customer comes in direct contact with the service provider. Hospital services are the one, which involves very high service encounters in which the patient is the direct recipient of a service and the physical presence of the patient is prerequisite for a series of quite tangible operations to be carried out. The patient’s opinion about the service is influenced by his/her opinion of the service production and the consumption process. The service production at hospitals includes the patient, the facilities (X-ray, ECG's testing instruments, etc.) The service consumption process includes the behavior of nurse and doctors, the manner in which the production facilities are used, and the way the physical resources, technology and systems support the consumption of the service. In medical services the joining phase occurs when the patient joins in the service production process in order to consume a core surgical service. The actual service encounters at hospitals can be distinguished into three distinct phases: ? Pre treatment process ? Actual treatment process ? Post treatment process The quality of the final service delivered depends on the following factors : Complimentary services (sanitary facilities, hygiene facilities, some sort of entertainment may be magazines, books etc) ? ? Professional expertise (nurses and doctors) Physical evidence and service-scope (equipments, signs and symbols for direction guide, information) ? ? Pleasantness (catering facilities) Final surgery operation (the surgery team, the technology used etc)
?
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The process of delivering quality service at hospitals starts from the point at which the patient enters the hospital. The elements of parking, registration formalities, telephone services and the receptionist friendliness of delivering the service, location and easy availability of information, the ability of the ward personnel (friendliness, openness, trustworthiness etc) are all very important. Getting the required information of, for and to the patient and his relatives is extremely important at hospitals because of the uncertainty factor prevalent in this kind of service. Doctors and nurses should make the patient comfortable and should be polite with them as the trauma the patient goes through in hospitals is very high. The life of the patient is in the hands of doctors and nurses so any small mistake while delivering the service at hospital or any healthcare center could result in either delay in recovery and pain or the loss of the patient’s life. Thus, no mistake or mishandling of any aspect in its minutest form is not tolerable at hospitals. CAUSES OF SERVICE FAILURES IN HOSPITALS: Failure to diagnose or delay in diagnosis - Wrong diagnosis made Failure to recognise complication of treatment - Failure / delay in admission / referral to hospital ? Operate on the wrong patient / body part - Surgical foreign body left in situation ? ? ? ? ? ? ? Delay in performing an operation - Intra-operative problems Failure to warn (informed consent) - Failure in follow up arrangements Improper delegation to unsupervised Failure to X-ray / interpret correctly - Infusion problems Problems with medical records - Lack of adequate facilities / equipment Equipment malfunction - Self Harm Failure/delayed availability of operating theatre - Failure/ delayed availability of anaesthetist
? ?
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FISH BONE ANALYSIS
C
U
S E T Q O U M I P F E MR R
OE
N
P T R L O I CN
EE
D
U
R
D
E
L
A
Y
O
T
H
M
E
A
R
T
S
E B R A I AC
LK I N O
F F OF
RI C M E
A
T
I
There are five things involved in service failure: 1. Equipment failure 2. Frontline & Back-office failure 3. Information failure 4. Procedure failure 5. Material failure
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Equipment failure This failure may occur due to some problem in the equipment used in diagnosing or during an operation or at any other time during the patients stay at the hospital. An equipment failure in this industry is very dangerous as the life of a person could depend on it. Surgical instruments need to be sterilized before they can be used. Any negligence here can lead to severe problems resulting dreadful diseases and pain. Frontline & Back-office This includes both the frontline officers and the supporting staff. The hospital provides healthcare facilities. Healthcare involves high contact between the customer and the service providers. The doctors should be above par in terms of the qualifications needed to deal with the respective illnesses of patients. The nurses and other frontline staff too have to be well trained to take proper care of the patients. Hospitals are always surrounded by uncertainties, trauma, chaos and the overall environment is always tensed so the patients and their relatives are to be best received by the frontline officers offering them easy and reliable service. They need to maintain a constant smile so that they can bring some relief for the patients. Information ? There should be adequate collection of all possible related information about the patient and his records should be properly maintained so that diagnosis can be done properly. ? Files containing all patient reports and medication should be maintained. ? Before operating or prescribing heavy medication, all the required tests and information that needs to be collected should be done preciously such as allergies and consideration of previous medical history.
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Procedures
? Consistency of results is never guaranteed in this industry. The main
operation or surgery itself may be unsuccessful, as it is not always possible for a doctor to save a patient. It may not even be his fault, but in the end, one cannot assure the safe completion and success of such complicated procedures.
? All activities supporting the procedural system must also be in place and
the doctors and other personnel should be aware of all the related information and related procedures.
? Few procedures such as filling the pre-treatment form or registration
form, etc. should be simple and short so as to avoid delay in medication. Material This includes failure due to wrong usage of drugs.
•
Wrong usage of drugs that implies different drug used for curing disease for which it is not implied.
• • • •
Drug used after the expiry date. Duplicate Drugs Shortage of drugs Ineffective sterilization of clothes and equipment could lead to several diseases.
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SERVICE RECOVERY & COMPLAINT HANDLING
When the company (hospital) fails to meet its promises made to the customer (patient) on the basis they build expectation, it’s to be said that there is service failure. This might result in losing the customers as well as the goodwill earned. Customer is very important in any industry, hence retaining them is the biggest challenge, and however service failure acts as an obstacle to it. In order to overcome such failures we undergo the Service Recovery process. Service recovery is an aspect of the total customer service strategy that is often overlooked by hospitals and health care workers. Service recovery provides the tools employees need to help customers “recover” from negative perceptions, thus becoming satisfied patients The first thing that is expected is to involve senior management in the planning phase. Some necessary arrangements should be made by the hospital so that in case any service failure takes place by the hospital in whole necessary compensation can be made however there is no compensation that can be made for loss of life. At the same time, if the doctors and other staff put in everything to try and save a persons life, but are not able to due to certain circumstances, if the fault is not the hospital’s and if they can even just give the patient a few hours more to live, both the patient and their relatives are sure to show their gratitude towards the doctor and the staff and these relatives would surely come back only to that hospital. The following points should be taken into consideration while handling complaints: ? Acknowledge any inconvenience and apologize. ? Listen, empathize, and ask questions. ? Offer a fair fix to the problem and/or offer some value-added atonement. ? Keep your promises and follow-up.
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The following criteria are used by the customers to judge how a hospital responds to their complaint in case of service failure : ? The treatment the customer receives while lodging the complaint ? The response of the organization with particular emphasis on time ? The outcome of the complain such as apology or compensation Key factors towards effective service recovery programs: 1. Emphasize the importance of listening. ? Hear the patient. ? Empathize with the patient. ? Apologize to the patient. ? Respond to the patient. 2. Empower the employees to take control of service recovery efforts. ? By empowering any employee to take some action to the service failure patients can receive an immediate response to any complaints. Thus the perception of the hospital might add to the customer loyalty towards the hospital. ? Focus on selected departments with high visitor interactions.
3. Solicit immediate feedback
Effective programs typically incorporate some sort of proactive solicitation of patient’s feedback. This may take the form of comment cards in the patients room or hospital lobby, staff rounding around hospital beds, or using interactive television or bedside Internet facilities to solicit patient comments. 4. Track and review all patient complaints. 5. Generate staff support in the service recovery process
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FUTURE PREDICTIONS AND ANALYSIS
THE HEALTH BUSINESS Health is a common concern of almost every individual on this planet. It is also well known to us that we cannot ignore taking care of our health to gain or achieve other goals like financial success. In fact a healthy person is a much more competent person in any sphere of life. Thus, we must have some knowledge about our body, how it works, what does it need etc. As we proudly say that our country is developing fast, we have also been noticing the drawbacks of this development. The levels of stress and Pollution are rising at unbelievably high rates. This is resulting in increasing numbers of heart attacks and cancer and many other such diseases. Headaches and Viral infections are nothing unusual to any body. Researchers all over the world have been recognizing the potential damage of this kind of a life and the damage is bigger than what our minds can yet conceive. All this is excellent for the Health industry. More the number of people falling sick, more the industry grows. Doctors and lawyers are some of the richest people in America. We will not comment on the lawyers but doctors sure seem to have a very prosperous future in India too. But is it going to continue the way it has always been? We know how constant the variable change is. Is the Health Industry going to witness changes too? What possible changes could there be? Science has developed so much that medicines act like magic. Fall sick, go to the doctor, take some pills, and start working again. The major changes that I feel are going to be implemented in the hospitals would be in their services.
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Hospitals are becoming business organizations. They make huge money for the services they render. The rooms and operations in a private hospital cost a lot more compared to Government hospitals. It is like the ratio of rates charged by Government banks to the rates charged by the private banks. Hospitals are also competing and thus they form strategies like: 1. Market Segmentation 2. Distinguishing their product/service 3. Promotional techniques etc
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SOME OF THE SERVICES THAT MAY BE INTRODUCED IN THE NEAR FUTURE CAN INCLUDE: Mobile Hospitals: ? This includes Helicopters being used by the hospitals to airlift the patient to save the time it takes to reach the hospital. ? It is a fact that there are a lot of incidents where the doctors failed because the time taken for the patient to reach the hospital was too long. This will be a great break through and could save a lot of lives. ? The practice is already followed by some of the developed countries. ? The helicopter itself can have some life saving equipment so that the doctors can immediately start their work on the patient. ? However, This service will most probably be accessible by the richer class, as it may be quite expensive. We observe the following strategies here: 1. 2. Market Segmentation: As only the richer class will be able to access it. Distinguished Product/Service: Not all hospitals will introduce it simultaneously. Thus, whoever does it first can get an edge over the market. 3. Promotional Technique: Can be advertised to lure the potential customers.
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Medical Tourism: This Is a concept which has already been introduced by some hospitals. Apolo hospitals was the one to introduce it. It aims at promoting India as a great destination for medical treatment. Medical services in USA and Europe are much more expensive compared to India. Thus if India matches the International Standards in this industry, it would get millions of people to get their treatment done here. The hospitals have collaborated with the tourism industry to make the package even more interesting. Since the foreigners have already come to India to get the treatment, they might as well travel around India a little bit. Services of an expert no matter what your location: With the growth of technology, computers and Internet, the world today has become very small or much better connected. In the near future it may be possible that the patient is in America but he wants to be treated by the doctor he trusts the most but that doctor is in India. Technology makes it possible for the doctor he wants to be able to observe perfectly, the body of the patient through cameras and internet etc. He can then instruct the doctors in America to do exactly what he feels should be done. Thus to a great extent, the patient is actually enjoying the service of the doctor in India while he is in America. These were some of the additional service I visualize that the hospitals will introduce in the coming future. There is one significant movement that has started. The Health industry is observing a path different from the traditional path.
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THE WELLNESS INDUSTRY LET FOOD BE THY MEDICINE’
A famous line that was quoted 100’s of yrs back holds true even today. The scientists are taking this thought very seriously. Nobody generally has a deficiency of vitamins or minerals. If we had we would suffer from specific diseases. Deficiency of vitamins and minerals cause specific diseases. Scurvy is a disease where your tissues break down and you bleed into your tissues. In the old days when they use have long sea voyages they use to not carry fresh fruits and vegetables because they would decay anyhow. A man went out for a voyage and after 2 weeks he had scurvy. His son followed his Dad’s footsteps and did the voyage and even he developed Scurvy. So Scurvy is a genetic disease. We know now that Scurvy is not a genetic disease and is caused by deficiency of vitamin C. We do not suffer from such diseases any more. No one gets Berry Berry, which is a deficiency of Vitamin B3. We are dying of Heart Diseases, Cancer, and Diabetes. These are diseases caused by free radicals and not by Vitamin deficiencies. Free Radicals can only be combated by Anti Oxidants. One of the free radical caused disease is: AGING 1. 2. No one can avoid Effect of Free radicals in our cells and DNA 3. 4. Everyday, these free radicals that we introduce in our body are attacking our DNA and we get older. More the free radicals quicker we get age.
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There was a person who looked like he was in his 60’s. Looked like a healthy 60 years old. He drives his car himself to the mechanic. One day when he took his car, he was looking tired. The mechanic asked him what was wrong. He replied that he is coming straight from Nashik by road. He had just opened a new manufacturing plant there. It is expected to generate profits after 5 years and he is looking forward to it. His actual age was 92. Passion is what drives him. Aging is a free radical disease. Other Free radical diseases are: ? ? ? Heart Diseases Cancer Diabetes 95% of modern day diseases are caused by free radicals FREE RADICALS: They are generated by over use of oxygen Oxygen is very essential. We have to breathe to live. But we do not need to go overboard. The body is taking more and more oxygen because: 1. SYENTHETIC CHEMICALS When we introduce synthetic chemicals, the body takes a lot more Oxygen and energy to get rid of it. The waste product is Oxygen based Free Radicals Oxygen based free radicals are unstable chemicals that lack an electron. It needs an electron from somewhere to stabilize. So it goes around the body
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to get the electron and attacks the blood cells and the DNA and rips the electron out disturbing the natural, normal functioning of the body. 2. STRESS Stress again burns more oxygen. Therefore, Free Radicals are caused by excessive Synthetic Chemical’s and Stress (Modern Society) The city life today is very unhealthy. We don’t breathe fresh air; neither do we eat pure food. The food, the water, everything we consume is generally not as clean as it should be. It’s even got remains of pesticides and insecticides, which are poisonous. Doctors, scientists, and those concerned are realizing the severity of the damage done by modern city life and are trying to device ways of regaining a pure healthy life. A balanced diet is only a term that we are unaware of. There are very few people who know what makes a balanced diet. Books have been written on the advantages it has. There was an observation that an average man spends his entire life trying to save money and looses his health in the process. The rest of his retired life, he spends all that money to regain the lost health. This situation can be changed. A person’s body is compared to a machine. It requires good food in the head and the stomach and needs regular maintenance to function smoothly for a long time. When the food is not sufficient or is not of good quality, and if regular maintenance is not taking place, this machine like body will start malfunctioning and may even die.
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SOME OF THE FEATURES OF THE WELLNESS INDUSTRY ARE: Increasing the awareness in people. This is being done by various ways like: a. b. life. c. d. e. Anti-smoking campaigns and making a lot of places smoke free. Increased stress on quality food. Seminars and T.V shows educating the audience about the harmful effects of an urbanized life style and remedies. Etc. Research and Development of food supplements: f. Nutrition being extracted from plants grown in pollution free fields. These plants are grown without the use of pesticides or chemical fertilizers. Eg. Nutrilite products. g. Production of various health tonics and drinks. Eg. Drinks like Energy and flavored milk are gaining popularity and with increased promotion such category of drinks will replace our purchase of Colas. h. Lot of research is taking place for the development of capsules, which could replace our requirement of food. However, this concept is being designed for the people in the city. It would save the time it takes to have a meal. That is a little contrary to the philosophy of the wellness industry. Though it could ensure people not skipping meals, which often happen. Newspaper articles. Everyday in Bombay Times we see articles about food, exercise, and how to avoid various health problems. Hoardings displaying slogans motivating people to live a healthy
?
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?
The Corporate Co-operation: i. Manufacturers of products like refrigerators, microwave’s etc are trying to engineer their products in such a way that they keep the food fresh. This is one of their main promotional tools these days. They are trying to help restore the nutritional value and freshness of the stored food. However, they are interested in their own profits. Cold storage is not a healthy solution. It is a fact that as soon as a fruit or vegetable is plucked, its nutritional value starts decreasing even if you put it in cold storage. Refrigerators are only worsening the situation as people buy in bulk and store it and do not prepare fresh food every day. j. Changing the company policies and making job’s less stressful. People are becoming more aware of the harmful effects of stress and the companies are considering this problem. k. There are few companies, which have even adopted a model, which could provide financial freedom to those, willing to work for a few years. This is one of the most successful and beautiful concept because research has proved that most of the problems of an urban man are because of money issues. If money is not an issue, the whole perspective towards life will change and one can enjoy a stress free life with a positive outlook. l. Contributing in the funding for more research.
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?
Growing publicity of motivational books, seminars, workshops etc,
which focus at minimizing the negative thoughts from your head by giving you a very positive outlook towards life. This is very important but a lot of people tend to ignore it. Good food in the head can do wonders to your health. Spreading awareness of the benefits of yoga, meditation, gyms,
?
aerobics and various other activities, which could be done for daily maintenance. We are aware of intense research happening on unconventional
?
treatments across the globe. It includes things like music therapy for curing cancer and other big diseases, metaphysics that is researching on the spiritual energy and various such ways of ensuring a healthy life.
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The wellness revolution basically aims at spreading knowledge and suggesting ways to live a healthy life. Its focus is on providing an alternative treatment to various diseases with the help of natural things rather than medicines and injections. Its deeply researching on how to make the defense system of the body stronger to fight the free radicals. The defense system includes: 1. Food 2. Front line defense – Vitamin E, Vitamin C etc. 3. Discovering super anti oxidants which is like a back up system. It still needs the front line defense though. ‘WE CANNOT CHANGE THE CURRENT PROBLEMS WITH THE SAME THINKING WE USED TO CREATE THEM’ --------------------------------------------------These concepts do not go in harmony with the concepts of the illness industry. In the whole 5 years course of MBBS, there is only one chapter on Nutrition. The doctors in the hospitals complain that if people will not fall sick, their business will go down. However, there are some very dedicated doctors in the illness industry also whose efforts are helping to save the lives of many people. Also the wellness industry came out of the illness industry and will take a lot of years still to outgrow the illness industry. We will have to wait and see what predictions come true. --------------------------------------------------
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doc_818726562.doc
The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion.
Hospitals & HealthCare
INDEX
TOPICS
1. Introduction To Hospitals 2. Health Care Sector - Analysis 3. Medical & Health Care Service 4. Pest Analysis ? Political ? Economical ? Social ? Technological ? Global 5. Accreditation of Hospitals 6. Models of Accreditation 7. SWOT Analysis ? Strength ? Weakness 18. 19. 21. 22. 25. 26. 29. 7. 8. 9. 10. 12. 14. 16.
Pg. Nos.
3. 5. 6.
? Opportunities ? Upcoming Trends ? Threats 8. Types Of Hospitals 9. Segmentation
Marketing Mix
10.
Product 31.
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? Product Mix ? Flower of Service TOPICS Pg. Nos.
33. 35.
? Quality Dimensions 11. 12. 13. 14. 15. 16.
Place 44. Price 46. Promotion 55. People 67. Physical Evidence 70. Process 72.
41.
? Blue Printing ? Service Encounter ? Fish Bone ? Service Recovery 17.
Future Prediction & Analysis 85.
74. 78. 80. 83.
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18.
Wellness Industry 89.
INTRODUCTION TO HOSPITALS
Until the early 1980s, Government-run hospitals and those operated by charitable organizations were the main providers of subsidized healthcare. However, the last two decades have seen the mushrooming of corporate and privately run hospitals. The corporate hospital sector is most evolved in the south while charitable/trust hospitals proliferate in the west. However, the north and east are also showing a growing trend in private hospital expansion. Previously hospitals were set up as charitable institutions to take care of the sick and the poor. Today it’s a place of diagnosis and treatment of human ills, for the training research, promoting health care activities and to some extent a center helping biosocial research. World Health Organization (WHO) states that hospitals are socio-medical organization whose functions are:
•
Curative,
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• • •
Preventive, Patient services and Training of health workers in biosocial research.
India’s healthcare sector has made impressive strides in recent years. With time the classes and quality of hospitals have changed a lot today. Most hospitals today are trying to provide all ultra facilities and are in the process of making state of the art hospitals. Hospitals provide the infrastructure facility to healthcare. higher patient turnover ratio. A hospital offers considerable advantages to both patient and society. A number of health problems require intensive medical treatment and personal care, which normally can’t be available in a patient’s home or in the clinic of the doctor. This is possible only in a hospital where a large number of professionally and technically skilled people apply their knowledge and skill with the help of world-class expertise, advanced sophisticated equipment and appliances. The excellence of hospital services depends on how well the human and material resources are utilized to promote patient care. The hospital is not an entity in itself. Today, the hospital is a place for the diagnosis and treatment of human ills and restoration of health and well being of temporarily deprived patients. The first and the foremost function of a hospital is to give proper care to the sick and injured without having social, economic and racial discrimination. However, the hospitals must perform many more things in addition to the patient care. The education and training of doctors and nurses, support to medical research and assistance to all activities carried out by public health and voluntary agencies to prevent diseases and further to promote health attitude are some of the important services of modern hospitals. The essential function of the hospital in the Indian context is to cater to very large masses of people by providing comfortable conditions for various users. Earlier hospitals were thinking inline of Nowadays they are going for a prolonging the duration of patient’s stay.
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This necessitates creation of a system which encompasses patients, doctors and nurses in a synergetic totality. The applications of marketing strategies insist on the development of product or services of the hospitals against the background of changing environmental conditions. Hospital planning in the Indian condition reflects requirements and comforts of Indian masses. The marketing management of hospitals diverts one’s attention on the planning and development of the product in the Indian environment.
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THE HEALTHCARE SECTOR: AN ANALYSIS
Healthcare is one of the most essential services in any growing society. Propelled by an affluent and health conscious growing middle-class, the healthcare industry in India grew by more than 13 per cent per annum in the last decade. India’s healthcare industry is estimated at Rs 1,500 billion or US$ 34 billion. This works out to US$ 34 per capita which is 6 per cent of GDP. Healthcare statistics state that India has: ? 5,03,900 doctors ? 7,37,000 nurses ? 162 medical colleges ? 143 pharmacy colleges ? 3,50,000 chemists ? 15,097 hospitals accounting for 8,70,161 hospital beds There is an extensive three-tiered government healthcare infrastructure comprising of: ? 23,000 Primary Health Centres(PHC) ? 1,37,000 sub-centres (serving the semi-urban and rural areas) ? 3000 Community Health Centres(CHC)
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MEDICAL & HEALTHCARE SERVICE
There are four types of health-care facilities: primary health centers and rural hospitals, government hospitals, private hospitals, and teaching institutions. The central and the state governments are major players in this sector, running hospitals, nursing homes, medical/nursing/paramedical colleges and medical insurance. A large majority of the population, particularly in rural and semi urban areas, receives free or highly subsidized treatment in such hospitals and health care centres. Private sector investment in the sector was opened up in 1983, to bridge the huge gap between demand and government-owned healthcare services. Since then, the private sector has grown significantly and presently accounts for Rs 690 billion, nearly 80% of healthcare expenditure. There are almost 9500 private hospitals and nursing homes in India, majority of them located in major cities, some of them equipped for providing the most modern state-ofthe-art technology and equipment. However, more than 30% of the national bed strength is concentrated in 150-odd corporate hospitals. Important names in the private sector are Escorts, Apollo Hospitals, Max Health Centre, Fortis, and Wockhardt; several foreign healthcare chains have technical/financial tieups with Indian private healthcare chains. The health care services (excluding pharmaceuticals) market is estimated to be growing at the rate of around 16 percent annually. There are certain industries that directly affect and are directly affected the status of healthcare in the region. They may include:
1. Technology and Equipment 2. Drugs and Pharmaceuticals 3. Diagnostic laboratories
Medical Insurance
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PEST ANALYSIS
POLITICAL FACTORS
? The Government of India places top priority to healthcare in the
national agenda. It is very serious about encouraging indigenous R&D and creation of human capital. The imminent changes in Indian laws and procedures relating to recognition of intellectual property and foreign investments will allow global pharmaceutical and biotechnology companies to set up partnerships with Indian counterparts.
? With the second largest population in the world and a high
incidence of disease, healthcare is being accorded priority by the Government of India and individual state governments.
? A study of Government Public Health expenditure (Government,
both Central & State - spending on healthcare is 1.7% of GDP) reveals that only 16% is allocated to primary care and 84% is allocated to secondary & tertiary care.
? Last year, the finance minister announced a list of incentives for
private hospitals to create and upgrade infrastructure, as well as reduce their operational costs:
1. Tax sops to financial institutions lending to private groups
setting up hospitals with 100 or more beds.
2. Increase in the rate of depreciation from 25 percent to 40
percent for life-saving medical equipment.
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ECONOMIC FACTORS
? The FDI policy of India is not up to mark. The 100% FDI route is not
opened in India. If the foreign hospital wants to open its hospital in India, then the only way it can do so is via joint venture. Because of this not many foreign players are interested to invest in India.
? The Indian healthcare market is expected to grow by around 13 per cent
per annum for the next six years.
? It is projected as the next boom in the country after the IT euphoria.
? The amount of hospitals in India is very less when compared to the other developed countries. Even the urban areas do not have enough medical facilities. It is better not to talk about our rural consumers, where one village at an average has one doctor only and the doctor is not very well qualified.
? The country lags behind international standards on basic healthcare
infrastructure and facilities. India has 94 beds per 100,000 population as compared to the WHO norm of 333 beds per 100,000.
? India's healthcare industry is estimated at Rs 1000 billion (£ 14 billion). Of this, pharmaceutical accounts for Rs 200 billion (£2.8 billion). As per some estimates, Rs 185 billion (£2.6 billion) is spent on healthcare annually. Public and private health expenditure is 13% and 87% respectively. Health insurance is extremely marginal as indicated by "Out of Pocket" expenditure percentage of 84.6%.
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SOCIAL FACTORS
? Certain percentages of beds have to be kept for poor people. E.g. in Bombay 20% of beds has to be kept reserved for poor people whether it’s a private or public hospital. ? Look after the needs of local poor people. ? Open counseling and relief centres. ? Teach hygiene, sanitation among the poor masses. ? Safe disposal of hospitals wastes like used injection needles, waste blood etc. and taking due care of environment. ? Spreading awareness about various diseases through campaigns and free medical check ups. ? In brief the social aspect of hospitals industry is to see that latest treatment and medicines are available to people at large at concessional rates or free of cost and that its activities are not only restricted to rich people.
? The people in India do not avail of the hospital facilities very soon. This
is because of the high cost related to it. However this may all change because of the increasing deployment of third party payment either in the form of Medical and Allied Insurance, or in the form of reimbursements from the State. The people are now taking more to the hospital facilities. This in turn will increase the employment opportunities to many people. A study by NOSU hospital consultants revealed that the hospital industry shall employ a large proportion of the skilled work force. In fact the
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Healthcare Industry is poised to become the biggest Employer in all Countries.
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TECHNOLOGICAL FACTORS
?
The hospital is on the threshold of a major Growth Spiral which shall assimilate all new technologies to provide cost effective Healthcare. It shall also be the biggest consumer of all new technologies. Innovations such as computer based hospital information systems, medical records; decision support systems, health information networks, telemedicine, real time image transfers and newer ways of distributing health information to consumers are beginning to affect the cost, quality, and accessibility of health care. The technologies today can support vast databases, network
?
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communications, quick distribution and reliable image transfers. The easy availability of Healthcare related information is changing the traditional relationship between the Doctor and the patient. Employment of Microprocessor Technology to develop implantable devices, which can be monitored with the remote sensors. Healthcare providers in supporting various physiological defects shall use these devices. A greater degree of employment of CPU driven Technology, supported with artificial intelligence, in treating or managing various physiological defect. A greater degree of employment of Robotics Technology in Operating Rooms to provide precise and less traumatic as well as less destructive Surgery (Robotics Micro-surgery).
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?
A greater degree of employment of Robotics Technology in Laboratory along with traditional technologies to provide automated and precise diagnostic studies. A greater degree of employment of LASER Technology, in and outside of, Operating Rooms to provide precise and less traumatic as well as less destructive Surgery. Development and deployment of instrumentation in Medical & Surgical Practice which shall be based on capturing data on real time basis and providing necessary electro-physiological interventions or Bio-chemical interventions. This shall affect both - normal physiology and pathological physiology. Development and deployment of cultured tissues for control of vital Biological processes. Employment of Information Technology tools for networking of Examination Rooms, Treatment Rooms, Operating Rooms and Diagnostic Reporting Rooms. Employment of Information Technology tools along with Microprocessor Technologies development and of modules remote of (Artificial) Intelligence for for remote of maintenance of Equipment and other instruments thereby enabling controlled instrumentation control Physiological & Pathological Processes. Deployment of Information Technology tools for generation of specific disease related Databases, classified by a number of variables.
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GLOBAL FACTORS
?
The healthcare sector is among the most rapidly growing services in the world economy, estimated at $4 trillion yearly in the OECD countries alone. The sector has seen new and rapidly evolving forms of cross-border transactions, spurred by factors as wide-ranging as technology, demographics, costs, skills, growing private sector participation, natural endowments, culture and geography. Globalisation of healthcare is also evident from the growing foreign equity participation in this sector and establishment of joint ventures, alliances and management tie-ups among care establishments, resulting in the transfer of technology, skills and practices. Finally, there is the global movement of doctors, nurses and technicians, and the resulting networks of healthcare professionals that are sources of investment and know how. Investment flows into developing countries and the setting up of stateof-the-art healthcare establishments there will attract overseas patients for quality care at low cost. Which may, in turn, be supported by telehealth services and cross-border movement of health personnel. India also has potential to export telehealth services within the region and is emerging as a base for outsourcing of clinical trials, ethical and regulatory issues aside.
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?
India’s importance as a global supplier of medical personnel to developing and developed countries is long standing. India is also emerging as a source of foreign direct investment (FDI) in health services, as shown by the regional expansion plans of major players, such as the Apollo group. However, India has barely tapped its true potential in the global healthcare market. Only 5% of all patients treated at reputed hospitals like Escorts are foreign, compared to 25% at equivalent Thai hospitals. Inadequacies in supporting infrastructure, equipment, supplies and domestic regulation, lack of recognition of Indian medical qualifications and disparity in standards of training and quality remain major constraints. Globalisation of our healthcare system can yield many benefits, including improved quality and standards and more money for investment in the sector. Cross-border exchange of practices, knowhow, and technologies, resulting from the flow of capital, consumers, health personnel and information, can help in raising standards and the quality of domestic healthcare. Concerns have been voiced about the possible two-tiering and cream-skimming effects of medical tourism and FDI on the domestic healthcare system. And possible adverse effects on costs, resource allocation and equity within the system. One has to assess their true cause.
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This growth of Healthcare Industry shall be supported by Political Will and Social Understanding at all levels of any Society. It must, therefore, meet the new challenges, by providing cost effective Healthcare in a manner that improves the Quality of Humane Life.
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ACCREDITATION OF HOSPITALS
AN OVERVIEW
? Health services in many developed countries have come under severe scrutiny services. ? Accreditation of hospitals is a voluntary process by which an authorized agency or organization evaluates and recognizes health services according to a set of standards describing the structures and processes that contribute to desirable patient outcomes. ? Accreditation can be understood as an indicator of professional achievement and quality of care. Accreditation is opposed to licensing or regulation of healthcare facilities, which is usually mandatory and stateimposed. ? Accreditation is not new to the health system. The first initiative towards accreditation was taken in the United States of America as early as 1910. Over a period of time after several experiments, the Joint Commission on Accreditation of Healthcare Organisation (JCAHO), a national accreditation programme, established itself as an esteemed accreditation body by 1987. JCAHO has high standards of quality assurance and rigorous process of evaluation, which makes it a muchesteemed agency for accreditation. Health services certified by JCAHO are given ‘deemed status’. in recent years. Positioned against the backdrop of globalization, there is an intense move towards accreditation of health
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THE ONSET OF ACCREDITATION IN INDIA
? In India, accreditation of the health services has never been a serious issue though some feeble attempts have been made to evolve a voluntary accreditation system in the late eighties and early nineties interestingly coinciding with the LPG (Liberalisation, Privatisation, and Globalisation) reforms. ? The attempts made by the Indian Hospital Association (IHA) at both Mumbai and Delhi is worth mentioning. Their efforts were not well received as the initiative did not involve the various stakeholders and had moved with predetermined standards of evaluation, membership fees and assessment mechanisms. ? In India, the initial premises of introducing accreditation were based on the overall objective to ensure the quality of care. The Bureau of Indian Standards (BIS) had laid down standards for hospitals having 30, 100 and 250 beds. The National Institute of Health and Family Welfare (NIFHFW) had such rules laid for more than 50-bed hospitals and only for equipment. Most of the standards laid down by both BIS and NIFHFW were criticized for having an urban bias. ? There have been attempts in some states to institutionalize uniform standards for hospitals. In Maharashtra, the government hospitals follow the Hospital Administration Manual. The Andhra Pradesh Vaidya Vidhana Parisad has laid down standards for secondary-level hospitals in the government sector, which comes under it. ? Apart from this some efforts have been made by consumer bodies, groups of health professionals, hospital organisations and non-governmental accreditation. organisations to evolve standards for
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MODELS OF ACCREDITATION
Accreditation across the globe followed three models.
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The first model of assessment gives priority to standards related to available facility norms, equipment requirements, human resources and space specifications. Here, the criterion of accreditation is based on the availability of basic health facilities. The second gives importance to quality assurance and sets standards for those institutions striving to arrive or improve quality of care, hence accreditation is based on satisfying some basic indicators of quality and involves ranking based on levels of quality. The third model is based on the ground that health systems should be accessible and acceptable to health-seekers. It gives importance to the health-seeker with an emphasis on evaluating health systems from indicators such as user-friendliness, providing information to users about the services available, setting up procedures for redressing grievances, etc. In the third model, the criterion of assessment is explicitly geared towards people-centric indicators and brings accountability of the health system to the health-seekers to the table. With each model, the criteria of accreditation changes.
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At the threshold of globalization and increasingly opening-up of the Indian health sector, attempts are being made at various quarters to draft systems of accreditation. There are certain points, which cannot be missed. What does accreditation mean for India? The answer to this question would help us to know which model can be adopted for accreditation of hospitals in India. If it follows the ranking-model based on quality of services provided, accreditation will have very little to contribute to the improvement of the overall health system in India.
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In contrast, the facility-survey model can be partially pertinent in putting in place the basic facilities required for providing care. The most relevant model of accreditation for the Indian health system is the people-centric model, which would ensure the presence of Acceptability, Accessibility, and Accountability. The accreditation process should begin with minimum or moderate level standards and, over a period of time expand to higher, “ideal” level standards and should be achievable by local public health agencies regardless of size provided that they conduct the essential services of public health. State and local accreditation programs should coordinate with and conform in essential ways to a national accreditation program to eliminate possible duplication and conflict. To succeed in bringing about a perceptible change in the delivery services of the health system and to go beyond mere an on-site survey and awarding certificates, any accreditation programme should address all the dimensions of healthcare.
RATINGS
? India's independent credit rating agency CRISIL has assigned a
grade A rating to super specialty hospitals like Escorts and multi specialty hospitals like Apollo. ? NHS of the UK has indicated that India is a favoured destination for surgeries. ? The British Standards Institute has now accredited the Delhi-based Escorts Hospital. ? Apollo Group - India's largest private hospital chain and Escorts Hospital are now seeking certification from the US-based Joint Commission on Accreditation of Healthcare Organizations. ?
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SWOT ANALYSIS
STRENGTHS
?
India’s healthcare sector has made impressive strides in recent years. It has transformed to a US$ 17 billion industry and is surging ahead with an annual growth rate of 13% a year. In the last five years, the number of patients visiting India for medical treatment has risen from 10,000 to about 100,000. With an annual growth rate of 30 percent, India is already inching closer to Singapore, an established Medicare hub that attracts 150,000 medical tourists a year. Hospitals in India boast of conducting the latest surgeries at a very low cost. The healthcare industry employs over four million people, which makes it one of the largest service sectors in the economy. Indian specialists have performed over 500,000 major surgeries and over a million other surgical procedures including cardio-thoracic, neurological and cancer surgeries, with success rates at par with international standards. The quality of healthcare has improved considerably with the availability of world class high-tech medical equipment and information technology.
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WEAKNESSES
? India has poor social sector indices, given the high population of the
poor, acute lack of medical facilities in the lesser-developed parts of the country, and a lack of public funds to provide adequate medical care and attention to the entire population.
? India’s health expenditure is 5.6 per cent of GDP, whereas most
established market economies spend 7-10 per cent of GDP on health. USA spends over 14 per cent.
? Low doctor-patient ratio: US has 2,340 doctors as compared to India’s
143 doctors for very 10,000 people.
? Life Expectancy in India is amongst the lowest at 55.5 years
compared to US at 75.5 years and 66.5 years for Thailand. On an average, 80 out of every 1,000 children die. This figure is just 9 in the US and 30 for every 1,000 in Thailand.
? High deposit fees and high costs of medical services limits itself to high
income level group or is out of reach for common man.
? The “I don’t care” attitude by the government hospital. For e.g. Cooper
Hospital.
? Medicine and drugs fraud by the menials. Even organ selling by
doctors to make more money.
? Complex and long admission procedure for admission, which can
sometimes be fatal.
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? The common men and poor men are completely at the mercy of the
overcrowded government hospitals and dispensaries.
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OPPORTUNITIES
?
At the current pace of growth, healthcare tourism alone can rake in over $2 billion as additional revenue by 2012. From less than 10,000 patients visiting India for medical treatment five years ago, the medical tourism market in India is worth US$ 333 million, with about 100,000 foreign patients coming in every year. Voluntary health insurance market is estimated at Rs 4 billion ($86.3 million) currently but is growing fast. Industry estimates put the figure at Rs 130 billion ($2.8 billion) by 2005. Joint ventures for offering medical insurance and other insurance services is one of the Investment & Business Opportunities. Trade in medical equipment and products, including warehousing, selling and servicing the latest medical electronics equipment, diagnostic kits, reagents and consumables. Telemedicine systems, for treating patients in remote areas through a satellite connection. Corporate health care clinics for providing high quality basic services in consultation, diagnostics, minor surgeries etc. Business Process Outsourcing of medical transcriptions and other hospital management administration tasks. R&D base for new molecule development, clinical trials, etc., utilizing the high quality scientific manpower and low costs.
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UPCOMING TRENDS
MEDICAL TOURISM
It is the next big success story out of India. From less than 10,000 patients visiting India for medical treatment five years ago, the medical tourism market in India is worth US$ 333 million, with about 100,000 foreign patients coming in every year. Procedure costs Procedure Surgery Bone Marrow Transplant Liver Transplant Open Heart Surgery (CABG) Neuro surgery Orthopaedic Surgery Cosmetic Surgery Hip Replacement Hysterectomy Gall Bladder Removal Knee Surgery 6,900 2,012 1,755 7,000 16,000 Thailand 62,500 75,000 14,250 Cost (US$) US ($) 400,000 500,000 50,000 29,000 20,000 20,000 India ($) 30,000 40,000 5,000 - 7,000 8000 6,000 2,000 4,500 511 555 4,500
*All figures in US$. The Indian costs are based on the average rates offered by top Indian hospitals like Escorts Heart Institute, Apollo and Batra Hospital. The Thailand rates are based on rates provided by Burnrungard Hospital, Bangkok, which is Thailand’s largest private hospital. Source: IBEF Syndication Studies
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PREVENTIVE HEALTHCARE
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Growing health consciousness among middle and high-income families in India is heralding a new business opportunity - preventive healthcare. The addressable population for preventive healthcare check-ups in India is about 160 million. At current estimates, not more than a million people may have been covered. For hospitals, the preventive healthcare business is attractive. It allows them to build long-term relationships, as patients who come for health check-ups generally come back to the same hospital if they require any treatment.
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HEALTHCARE BPO
? Healthcare BPO could potentially be a US$ 4.5 billion opportunity for
India by 2008, offering employment to about 200,000 people. It includes offshoring of processes such as medical billing, disease
?
coding, forms processing and claims adjudication. As healthcare BPO players mature, other businesses like claims
?
repricing, medical diagnosis and actuarial work are expected to gain momentum.
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TELEMEDICINE
Telemedicine is a method by which patients can be examined, monitored and treated, while the patient and doctor are geographically distant. Potentially, the next big success story in the healthcare sector, several examples already offer an insight into this emergent opportunity that is changing the lives of over 600 million people in rural India. Gujarat: The Online Telemedicine Research Institute (OTRI) provided telemedicine links for teleconsultation, thereby establishing 750 sessions in a period of 30 days in Bhuj after the earthquake in January 2001.
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Karnataka: Asia Heart Foundation, Bangalore has successfully been practising Telecardiology between Bangalore and cities in eastern India. Paramedics are guided to save patients suffering from Acute Myocardial Infarction by performing life-saving procedures as per doctors’ directions over video conferencing.
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Tamil Nadu: Apollo Hospital, Chennai is providing expert opinion from its tertiary level hospitals in bigger cities to those in farflung towns of India. Over a period of 27 months, over 4,000 patients benefited from teleconsultations and over 75 per cent of those teleconsulted were treated in their respective cities.
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Haryana: Jiva International, a healthcare venture on the outskirts of Delhi, is implementing a novel plan that takes medical care right inside rural India by using a GPRS enabled Java application available with Nokia’s 6800 model. The “Teledoc” project won the World Summit Award for eHealth, at
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the World Summit on Information Society (WSIS) held in Geneva, Switzerland.
THREATS
? The government is reducing the grants given to hospitals, thus making it
impossible to cater to the poor people.
? The unions of the menials and even doctors: they can go on a strike,
disrupting the functioning of the entire health care unit.
? Competition from other international hospital chains, which are more,
advanced in technology and better financial support.
? The public spending on health in India is a mere 0.9% of GDP and the
private spending on health is 4.2%. India ranks 171st out of 175 countries in terms of public spending on health.
? Government pays more attention on age-old programmes like
tuberculosis, leprosy etc. and less attention on killer diseases – cardio vascular, diabetes, obesity and hypertension.
? Unplanned urbanization and neglect of the public health system as
whole has led to the resurgence of water-borne diseases like hepatitis and cholera every year. More virulent forms of tuberculosis are being seen in those infected with HIV, which appears to have spread widely in India.
? The number of people in India infected with the HIV/AIDS virus has risen
sharply. According to India's National AIDS Control Organisation (NACO), more than 4.5 million Indians are infected. HIV/AIDS in India is not only
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confined to high-risk groups and in cities, but is gradually spreading into rural areas and the general population.
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TYPES OF HOSPITALS
CLASSIFICATION ON THE BASIS OF OBJECTIVES
Hospital
Teaching cum Research
General Hospital
Special Hospital
Teaching-cum-Research Hospitals: These hospitals are teaching based. They are found engaged in advancing knowledge, promoting the research activities and training the medics. As for example, All-India Medical Institute, New Delhi, Post-Graduate Medical Education and Research Institute, Chandigarh, etc. General Hospitals : The general hospitals also offer teaching and research facilities but these objectives are secondary. The main objective in the general hospitals is to provide medical care. As for example, different medical colleges and district and sub divisional hospitals like DY Patil Medical College. Special Hospitals : The main objective of special hospital is to provide specialized medical services. These hospitals concentrate on a particular organ of the body or a particular disease. For eg. The Asian Heart Hospital, Mumbai.
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CLASSIFICATION ON THE BASIS OF OWNERSHIP
Hospital
Government Hospitals: Government Voluntary These hospitals are fully owned managed and controlled Private by the SemiHospital Agencies Government Charitable government. They are mainly involved in healing the needy and providing Hospital Hospital healthcare to everyone at very affordable rates. Semi-Government Hospitals: These hospitals are partly owned by government. Time to time government assistance is provided to these hospitals may in the form of finance. Voluntary Agencies: There are some hospitals which are run and are in control of voluntary organizations they can be of any form i.e. may be general hospitals or special hospitals or even teaching institutes. Private Charitable: These private charitable hospitals are owned and controlled by the charitable organizations, which are private. For e.g. Ramakrishna Mission Hospital, Mumbai.
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CLASSIFICATION ON THE BASIS OF MEDICINE
ALLOPATHY HOSPITALS AYURVEDIC
HOMEOPATHY OTHERS
UNANI
CLASSIFICATION ON THE BASIS OF SIZE
Hospital
Teaching Hospital
District Hospital
Tehsil/Taluka/ Subdivisional Hospital
Primary Health Centers
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Hospitals can also be classified on the basis of their size. There are variations in the size of the hospitals. As such, the teaching hospitals generally have 500 beds, which can be increased according to the number of students. The district hospitals generally have 200 beds, which can be raised to 300 depending on population. The teshil / taluk / sub-divisional hospitals generally have 50 beds that can be raised to 100 depending on population. The primary health centers generally have 6 beds that can be raised to 10 beds.
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SEGMENTATION
EXTERNAL SEGMENTATION
1. Income wise: ? ? ? ? No income Low income Middle income High income 2. Gender wise: ? Maternity hospitals for females. 3. Family life cycle: ? Childcare hospitals.
1. Institute of Child Health and Hospital for Children 2. Center For Genetic Health Care
The center is actively involved in Genetic Health Care of Unborns, Children and Adults for the last 15 years. Facilities available at the centre are unique and under one roof. 4. Specialized hospitals: ? Heart,
1. Asian Heart Institute & Research Centre
Speciality Heart Hospital at Bandra Kurla Complex, Mumbai ? Eye, ? Dental etc. 5. On basis of disease:
? Tuberculosis, Tuberculosis Research Centre ? Cancer, Jeevan Jyot Cancer Hospital
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INTERNAL SEGMENTATION
1. Type of care: ? ? ? Intensive care unit Normal ward General ward for check up 2. Facilities/comfort wise: ? Ac room ? Non-AC room ? Deluxe room
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Hospitals & HealthCare
PRODUCT
Kotler says a product is anything that can be offered to a market to satisfy a want or a need. Products that are marketed include physical goods, services, experiences, events, persons, places, properties, organisations, information and ideas. In the case of hospitals, different types of hospitals offer different services to their users. Some of the hospitals give priority to medical education, training and research while some others concentrate on medical treatment. The product of a hospital can be any of the following: PRODUCT
MEDICAL SERVICES
MEDICAL TRAINING
MEDICAL EDUCATION
MEDICAL RESEARCH
PRODUCT LINE WIDTH, DEPTH & LENGTH Medical services Cardiac Dental Dermatology Neuroscience Medical training Surgery Operation Medical education Dentistry Ophthalmology Neurology Medical research Heart diseases Cancer Aids
The following is the product width, depth & length of Lilavati Hospital:
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LILAVATI
MEDICAL SERVICES
SURGICAL
DIAGNOSTIC
ALLIED
DENTAL
CARDIOLOGY
ANDROLOGY
NUCLEAR MEDICINE
PHYSIOTHERAPY
CLINICAL CARE
OPTHALMOLOGY
PATHOLOGY
DERMATOLOGY
ORTHOPAEDICS
RADIOLOGY & IMAGING
RESPIRATORY
GENERAL SURGERY
ONCOLOGY
ENT
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PRODUCT MIX
Level 1: Core / generic product:
This is the basic service product. In hospitals, health or well-being by way of the treatment provided by the doctor to deal with the ailment of the patients is the core product or service. Level 2: Expected products:
This is the basic product and minimum purchase conditions that must be met. In hospitals, in addition to the core product, all other supplementary services like a bed, waiting area, availability of medicines and drugs, meals, hygiene etc.
Cooper Hospital
? Waiting Area, Beds
Lilavati Hospital
? Waiting Area, ? Beds, ? Availability of medicines (24 hours), ? Availability of Blood Banks, etc.
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Level 3:
Augmented Product:
Along with the basic and expected offering, the service provider needs to differentiate its services from its competitors.
Lilavati Hospital
? Great Infrastructure, ? Cardiac Ambulances, ? Centrally AC, ? Cafeteria
Product Augmentation is not observed much in case of BMC hospitals because these hospitals are established to provide free (or at nominal rate) services to the customers. They don’t find the need to differentiate. They are established as they form a part of the basic infrastructure of the city.
Level 4:
Potential product:
The potential product contains potentially feasible features and benefits that play a significant role in holding and attracting the customer. These features and benefits are useful or likely to be useful to the buyers.
AHIRC
Beds are provided for ICU attendants free of charge along with other communication facilities like internet
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FLOWER OF SERVICE
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INFORMATION + In a hospital, providing information refers to making the patients or the general public aware of the services and facilities offered by the hospital. + The customer needs to have some basic information about the service provider so that he/she can make a choice between the different service providers. In the hospitals the basic information that a customer would require is as follows: + + + + The different types of services that the hospital offers. General, specialized The technologies that are being used. About the in-house doctors and their qualification About the visiting doctors i.e. their qualification, number of times they visit in a day and at what time, etc. The tools which hospitals use to provide information are television, internet, radio, etc. Dr. Batra’s Health Care Clinic – radio advertisements Lilavati Hospital has used internet as one of its tool to provide information. The webpage appears as: Eg:
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CONSULTANCY: The customer after getting the information may need some help or further information. The service provider has to find out the customers requirements and develop solution. The customer may require help regarding the following:
•
The specialist doctors and their success rate for the kind of treatment the customer is looking for. The tie ups with the blood banks in case of emergency. The prices of the different wards in the hospital
• •
In any hospital, treatment is provided only after a preliminary check-up and\or various test consultation. Now-a-days, consultation is also done via internet, .i.e. online consultation or telephone. This petal is of utmost importance. The hospitals can differentiate their service by way of their consultancies. Now-a-days the patient, who is going to undergo an operation, is explained in detail what he is suffering from & how the surgery is going to be, the post operation effects & so on. At Lilavati Hospital, Asian Heart Institute & Research Centre & many other hospitals, the surgery or the operation is displayed Live on the monitor which can be viewed by the patient’s relatives.
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ORDER TAKING This refers to the promptness of the service provider in taking the order of the customers. Promptness should be in the following areas: + + + Formalities: The paper work & the legal formalities prior to the admission must be minimum. Accommodation: the patient should be given the accommodation as soon as he\she completes the formalities. Responsiveness: the patient must be attended as soon as he is accommodated. At AHIRC, a patient is required to come in with two relatives. This is because, when the patient enters the hospital, he is either sent to the bed allotted to him (through prior booking) or to the pathology department if certain tests need to be carried out. One relative accompanies the patient, while the other relative remains at the admission counter to complete the admission formalities. This way, the patient is not kept waiting while the admission is carried out.
SAFE KEEPING: [SAFETY AND HYGIENE] When a patient has to undergo a surgery or an operation, he always has a fear that whether he\she is in safe hands. Therefore the doctors, nurses, ward boys and all the other employees, who come in direct contact of the patient, must possess an ability to build trust, win his confidence & make him feel that he is in safe hands. Eg: Most of the hospitals display the success rate of their doctors.
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HOSPITALITY This is becoming increasingly important in the healthcare sector, particularly in hospitals as the expectations of people towards medical care are ever increasing. No longer are they limited to only the clinical outcomes but also involve the delivery process, margin of safety and behavior of personnel. The AHIRC provides a host of conveniences to patients and their relatives. Service to patients: + + A choice of packages from twin sharing, single room and deluxe suites are available to patients. A lot of care has been taken to ensure that the patient does not feel walled in. For example, all rooms have natural and indirect lighting with huge windows and in some cases, terrace gardens. A number of facilities are provided to the patient such as a television, in-house meals etc. So as to make the room aesthetically pleasing and improve patient mentality (they are usually depressed), all medical sockets, instruments or attachments are hidden from view, behind a panel beside the bed. Service to relatives: The AHIRC is the only hospital in Mumbai that has a separate family waiting area for relatives of patients in ICU. Each cubicle in the waiting area has provisions for sleeping such as a bed, pillows, blankets etc. The reason for such an arrangement is that , in the ICU cases, one person should be present in the hospital 24 hours so that he is available to sign the consent form. Patient number is allotted to the relatives bed and in the case of an emergency, the relative is immediately called by the secretary in charge. Relatives also enjoy facilities like internet connection, a multi-cuisine cafeteria, prayer rooms, library, public call booths, coffee machines, a gift shop etc. There is even a travel agency located on the ground floor that caters to the traveling and sight seeing needs of the visitors (particularly in the case of patients from abroad).
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EXCEPTION Exceptional service is not what you are expected to give, it’s a kind of service which you provide to your customers to win customer satisfaction so that he would be loyal to you & spread good word. This petal is deformed in case of many BMC hospitals. Private hospitals make use of this petal at its best to differentiate their service. BILLING Hospitals should ensure that billing and payment procedures are quick so as to enable the patient to return home soon after discharge.At AHIRC, two types of bills are generated i.e. Interim bills and Final bill. The interim bills are generated to give on a bi-weekly basis. They give the patient an idea about the charge payable for the specified period. It helps is avoiding any confusion at the time of generating the final bill. The final bill is generated at the time of discharge. This considers all the interim bills and the advance deposit paid. PAYMENT: The norms for payment of the bill must be simple. 1. The payment counter should be easily accessible. The customer must be able to easily locate it. 2. The mode of the payment should be easy and quick. The customer should be able to easily settle the bill and leave. If the payment is made by the credit cards, even this must be quick and should be on the different counter.
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SERVICE QUALITY DIMENSION
RELIABILITY The ability of the service provider to meet the promises made by them accurately. The customer must develop a feeling that they can depend on that particular service provider for their problem. 1. The staff of the hospital has to be very accurate while performing their job. Only than the customers would rely on them. For e.g. during surgery the amount of anesthesia to be given to the particular patient has to be accurate. 2. The service provided should be such that the customers develop a feeling of loyalty so that the hospitals get the repeat customers as well as new customers. e.g. if Mr. X goes to Lilavati hospital for the bypass surgery and the surgery is conducted successfully and he recovers soon, he would not only become loyal to the hospital but also he will
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narrate the whole incident to many others thereby giving Lilavati more customers. ASSURANCE The service provider and the employees must be capable of winning the trust and confidence of the customers. 1. The customers can be assured by informing them that the doctors, nurses, ward boys and the other related staff is competent enough in providing them their expected level of service. 2. The frontline staffs have to be very polite and friendly to the patient and the relatives. 3. The patient must develop the feel that he is safe in that particular hospital. For e.g. when a patient is brought to the hospital in emergency he and the relatives must be attended with courtesy and also the doctors and the nurses must politely tell them, that “nothing will happen to the patient, we will try our level best” and not react with abrupt and angry statements. His words should sound empathetic and at the same time consoling. TANGIBLES This includes the ambience, the technologies used, the facilities used to communicate things etc. 1. The ambience of the hospitals must be gentle and clean. The technologies used in the hospitals have to be latest or updated regularly. Because now a days people do not buy the product but benefits. 2. The environment of the hospital has to be peaceful. The corridors outside the rooms should not be crowded. Even in the visiting hours too many people should not be allowed at a time.
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3. The seating arrangements for the patient who have just come for some tests and the person accompanying him have to be comfortable. 4. The signboards must be the perfect indicators so that there is no difficulty for the customer to locate the place, he wants to go to. For eg., in Asian Heart Hospital, the technologies used are latest, the visitors are given two passes so only two people can go and see the patient in the visiting hours. EMPATHY The attitude of the service provider should be caring and if possible individual attention to each customer should be given 1. The attitude of the doctors and nurses should be concerned. They should be approachable as and when required. 2. The doctors and nurses must have the ability to understand the problem of the patient and give the solution accordingly. 3. The doctors must communicate well to the patient and the relatives about the disease the patient is suffering from. 4. The nurse and the ward boy should be assigned to look after the patient. RESPONSIVENESS The service delivery should be prompt and up to the mark. 1. The patient should be attended as soon as he comes to the hospital and registers himself. In case of emergency he should be attended immediately. 2. The nurse should be able to locate the doctor soon if he is needed. For e.g. a patient suddenly starts sinking or breathing at a faster rate the nurse should be able to call the doctor immediately. For this, a good intercom facility is required.
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PLACE
STATISTICS REVEALS THAT: PROBLEMS-OF-ACCESS:
•
Fifty-four per cent delivered their babies without the support of trained personnel. Fifty-eight per cent of children have not completed their immunisation schedule and 14 per cent have not received a single vaccine. Only one in two women seeks treatment for illness, usually because the nearest health service is too far away, or it's too expensive. These examples are only meant to illustrate the fact that people's access to health care is limited by their ability to pay, as well the availability of services.
•
•
•
DISTRIBUTION The most commonly recognized medical facility is probably the hospital. In the past decade, however, the shift has been away from providing all care in the most expensive medical environment. As a result, a number of other less expensive options have developed. There are ambulatory surgery centers, rehabilitation centers, nursing homes and other residential care facilities, specialty service centers and home care programs, just to name a few. 1. Medical camps
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They are the most common form of distributing the medical services. These camps are generally held when there is a calamity. As we recently saw, these camps being held at various parts of Mumbai, in the aftermath of the floods of 26th July. Such camps are organized on an even larger scale when the calamity is of a very high magnitude. Eg. The camps that were set up in Gujarat ( areas of Bhuj & Anjar) were huge enough to have several Operation Theatres in them & they accommodate upto 100 patients at one point of time. They are equipped with quite a lot of equipments like X ray machine, the ECG etc. they are manned by nurses, general practitioners, specialists, & other medical professionals. 2. Air Ambulances Rooftop heli-pad is available for the emergency airlifting of patients to and from the hospital for specialized trauma treatment. These air ambulances have a crew of up to 5 people, which includes one specialized doctor, a Para-medical staff, 3 member rescue team. Family members of the patient are generally not allowed to accompany him. Though not very common in India, it’s a regular feature in the hospitals of developed countries. Even in India, these emergency services are developed. Eg. The Madke Hospital in Mumbai. 3. Ambulances As we all know, they are the most common mode of transport used in moving in the patients from the place of illness to the hospitals. 4. Mobile Vans Mobile Hospital and Research Centre, was flagged off on October 19, 2002 by His Excellency Dr.APJ Abdul Kalam, President of India. It has been found to be extremely popular & a practical health care model for Uttaranchal. The aim has been to bring advancements in modern medical sciences at the doorstep of the common man, who otherwise would have been neglected of its
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benefits. The project has been conceived, keeping in mind the specific needs of remote hilly terrain of Uttaranchal where negligible modern health care is available to needy and poor people who are staying in far-flung areas of Uttaranchal
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PRICE
The pricing management of a social institution becomes complicated as the policy makers are expected to take social factors into considerations. The lower sections of society look forth to free and cost-free services, as they are not economically backed to support their family’s healthcare expenses. Naturally this jeopardizes the task of top management. It is close to impossible for even the government, specially in an over populated country like ours, to make available world-class services to all without charging any fee. But then, it is also not rational that we expect free services, though we have the capacity to pay, which is another problem with the middle-income class of the country. The pricing strategy helps us to projecting our image. Not only this, if the strategies are welfare oriented, the task of satisfying the users is also simplified. But the satisfaction depends upon sophistication. And sophistication can’t be possible unless we change our pricing strategies. Even the affluent sections of society expect low cost services from social institutions in general and hospitals in particular the task of innovating services in line with latest developments in the field of physical sciences is difficult. Healthcare services involve the use of expensive and complex machinery, which involve huge investments. Apart from that, the cost of maintaining them and cost of running the hospital is in no terms cheap. Doctors’ salaries along with the salaries of the nurses and helpers constitute a great part of the cost too. In a developing country like ours, where the level of income of the general masses is found low, it is significant that pricing decisions are liberal to the economically weaker sections of the society.
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There are a number of questions that service marketers need to ask themselves as they prepare to create and implement a well – thought – out pricing strategy.
HOW MUCH TO CHARGE? PRICING IN GOVT. HOSPITALS
In the Indian setting where a number of persons are below the poverty line it is challenging task to formulate a pricing strategy, which is successful in serving the social interests and generating profits. It is due to this that most government hospitals are in deplorable condition. The ultimate sufferers are the society and specially the poorer sections. Since the affluent sections have an option to avail the expensive medical services made available by private hospitals. The societal marketing principles make an advocacy in favors of The fee strategy for or quantitative protecting the public interests but it is not meant that the hospitals have a uniform pricing/free structure for all the users. engineer a sound foundation for hospitals should be in proportion to the incomes of users, which would qualitative improvements. DISCRIMINATORY PRICING: For social institutions like govt. hospitals a discriminatory fee structure is preferred since it provides even the weaker sections of society, an opportunity to avail the quality medical services. This enables hospitals to innovate services to keep pace with the latest developments in medical sciences.
1. Free service: Generally speaking, all categories of hospitals should
adopt cost-free services to the weaker sections of the society having no source of income for paying even the nominal charges. In this
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context, the government hospitals should be given special grants to avoid an imbalance in their financial management.
2. Subsidised services: The users belonging to the low-income group
should be made available subsidized services. That is, the public or hospitals make nominal charges for the services made available to them. It is more or less clear that subsidized services are a bit lower than the cost involved on treatment. Both the central and state governments would give the subsidies.
3. Cost-based Services: This is based on the principle of no-profit, noloss. Or say, the cost based strategy in which prices or fees are equal to the costs involved on treatment. This is basically for the middle income group.
4. Cost plus Subsidy: This strategy allows charging more than the costs
involved on the services, but only from the better-off sections of society. The transfer of these surpluses to the account of subsidy for compensating the losses on account of providing free or subsidized services to the weaker sections and low-income group users is also necessary.
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Government Hospitals FEE/CHARGE
1.
FREE (For No Income group)
2.
SUBSIDISED (For Low Income group)
Discriminatory Pricing
3.
COST + LOSSES FROM 2 (Middle Income group)
4.
COST + SURPLUS TO MAKE UP THE LOSSES OF 1. (High Income group)
On one hand, it is judicious that no discrimination is found in respect of making available the medical aids, but on the other hand, we can’t adopt uniform policy while making available to the users and their attendants other facilities like standard of room, indoor facilities and other non medical amenities. This is justified on the ground that all groups are not paying equal fees for availing their services. Moreover when no income group has been availing the services without paying any fee, their expectations would not be more than the proper medical aids. At Cooper Hospital all the patients are not charged. Only those who can afford to pay would pay others can pay whatever they can or pay nothing at all.
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PRICING IN PRIVATE HOSPITALS
It is difficult to offer free or subsidized services to the masses. On the other hand, the technological sophistication has raised the cost of services as the inputs used in making available the medical services are found costly due to rising inflationary pressure. Thus private hospitals take the following approaches to pricing: 1. Cost Based Pricing: Direct price + overhead costs + profit margin. This approach involves setting prices relative to financial costs. The hospital sets a price sufficient to recover the full costs (variable, semi variable & fixed) of providing the service. These ads a sufficient margin to yield the described level of profit at the predicted sales volume. Hospitals generally incur high fixed costs due to expensive physical facilities. In hospital services, this method is cumbersome because the tracking & identification of costs apart from doctors fee, is difficult. In spite of this, some hospitals in the private sector do follow this method.
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2. Demand/Value Based Pricing: This involves settling a price consistent with the customer’s
perception of service value. That is, prices are based on what customers will pay for the services provided. Hospitals with a reputation for high quality successful treatments etc. can & do charge a premium simply based on the sheer perception of quality health care. Those who can afford are generally willing to spend high amounts on quality care. However there was a case during the out break of leptospirosis , when the was a huge requirement of white blood platelets they were not easily available in the city. As a result its charges rose from Rs.250- 300 to Rs.1000+ deposit of Rs. 600 3. Relationship Pricing: Hospitals may undertake relationship pricing with regard to corporate clients so as to develop & maintain long-term customer relationships. Here the hospital offers company’s o n treatment of its employees over a period of time.
4. Competition based pricing:
Using other price as an anchor for the hospitals price, heterogeneity of service across and within providers makes the approach complicated.
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WHAT SHOULD BE THE BASIS OF PRICING?
Pricing in hospitals may be based on the following:
1. Time based: It is based on the time of use. Fr example: In case of
an admission the duration of the patients stay is un predictable, so rooms may be charged on a daily basis. In AHI, the rate of a suit is Rs.5500 /- per day.
2. Value based: it is based on the value or the importance of the
service. In case of consultation with a doctor or out patients, doctor's fee may reflect till expertise or be tied to the complexity of the diagnosis etc.
3. Flat rate basis: This is charging flat/ standard rates for some
services. Again, there may be flat rates assigned to various treatments for example: charges for an X- Ray, ECG & so on. At Breach Candy Hospital on admission, an initial deposit is collected at the in-patient billing counter. The amount depends on the category of room and the treatment / surgical procedure planned. The in-house doctors are paid salaries by the hospital as per the hospital norms whereas the visiting doctors decide the fees in consultation with the patients and only 10% of this fee is retained by the hospital. All the billing transactions are done through the hospital. Various categories of rooms ranging from a shared room to the deluxe suite are available.
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Room Charges and Deposits at Breach Candy Hospital:GENERAL: Room Category Deluxe New wing Single Rooms (West) Single Rooms (East) Single Rooms (Shared Bath) Double Shared Room Non – A/C Single Room (Shared Bath) MATERNITY: Room Category Deluxe Maternity Single Room (With Attendant Couch) Single Room Single Rooms (Shared Bath) Double Shared Room (Shared Bath) Shared Room (Shared Bath) Labour Room Tariff (Rs.) 4,500 3,500 3,200 2,400 2,200 1,300 1,800 Deposit (Rs.) 20,000 20,000 20,000 20,000 20,000 20,000 Tariff (Rs.) 4,500 4,200 3,000 2,500 1,500 1,300 1,200 Deposit (Rs.) 40,000 40,000 30,000 25,000 20,000 20,000 20,000
INTENSIVE CARE UNITS: Room Category Surgical Medical Neonatal 1 Neonatal 2 High Dependency Unit Day Care Tariff (Rs.) 5,000 5,000 3,500 2,200 3,200 900 Deposit (Rs.) 40,000 40,000 35,000 30,000 30,000 20,000
CHARGES AT COOPER HOSPITAL: Category 1. a) Outside patient- for case paper b) 14 days after for re-checking 2. a) Light checking b) E.C.G 3. a) Ultra sonography b) If they need the imaging film Amount (Rs.) Rs.10 Rs.10 Rs.30 Rs.30 Rs.100 Rs.50
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4.
E.E.G.
-
brain
Checking
for Rs.250 Rs.5000 Rs.500 Rs.200
psychiatric 5. Extra special Surgery 6. Special Surgery 7. Normal Surgery
PROMOTION
Buoyed by corporatisation of healthcare, India’s promotion as a sought after medical tourism destination and threatened by the mushrooming of new hospitals, it is becoming difficult for hospitals these days to depend on mere word of mouth promotion to attract patients.
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The Code of Medical Ethics of Medical Council of India says that a doctor cannot solicit business by advertising, but nowhere does it mention that a hospital cannot advertise. Hospital managements are putting extra effort in carving a brand image of the hospital and improving hospital’s visibility. In other words, many would agree, that hospitals marketing has evolved from being subtle to aggressive. Generally a lot depends on the brand name of the hospitals. Well-established hospitals all ready have a brand name like Breach Candy hospital, Lilavati hospital. These are well-established hospitals known for their excellent service. They are distinguished by their services provided. A few of the used promotion methods by hospitals are as follows:
PERSONAL COMMUNICATION
(a) Personal selling:
This involves an immediate and interactive relationship between two or more persons. Business-to-business marketing:
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Hospitals
usually
resort
to
personal
selling
for
business-to-business
marketing. Both in the case of corporate tie-ups and approaching doctors for patient referrals, it is the hospitals marketing executive who personally approaches the corporate or the doctor so as to pitch and finalize the deal. Network of doctors: On the other hand, they also have a network of doctors linked to them. These doctors are ‘consulting doctors’ who don’t have clinics of their own. Thus, they treat all their patients in the hospital premises itself. Other visiting doctors are also linked to the hospital and even they pull their patient-base to the hospital for surgery, treatment and recovery. Many hospitals also provide incentives to the doctors so as to ensure that the hospital is the first preference of the doctors for referral. Apollo Hospital in Chennai interacts with doctors on one on one basis. They regularly conduct seminars and continual education programmes to explain to doctors the advances in the medical sciences and the infrastructure that their hospital has.
?
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(b) Customer service and training:
In hospitals, almost all the services are delivered in the customer’s presence. Front-line personnel are directly involved in the process of offering the services, due to which they must be efficiently informed, trained and supported. For instance, if nurses neglect patients, receptionists misbehave and doctors do not show a human approach, the hospital will fail in delivering good service to the society in spite of the availability of most sophisticated equipments and technologies, efficient doctors and nurses and most comfortable buildings and infrastructure facilities. Thus, hospitals invest a lot in internal marketing by way of training so as to ensure that the employees are at their best of behavior with the patients and well informed about the various activities of the hospital, including free checkup camps and talks. Important ways of internal marketing is analyzing feedback from regular customer satisfaction surveys and improve service delivery so that the way of service delivery itself is the marketing of the service. Example: One way in which AHI ensures good customer service is by holding training programs for nurses every 15 days, enlightening them about how to handle various patients etc. At Fortis Hospital at Noida, there’s also a system of taking feedback from patients and visitor, which enables them to check flow in their service.
(c) Word of mouth:
In Medicare services, word of mouth plays a very important role, as people are more likely to trust a hospital if they have heard about its success in treatments or quality care from a patient. Thus, by ensuring good customer service, hospitals also get a lot of promotion by way of word of mouth.
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CAMPS FOR SOCIAL PURPOSE:
They conduct camps in rural areas to give medical check ups at reasonable prices, they sponsor visits to old age homes etc. Participating in the country’s biggest medical conventions and conducting health camps are also other prominent forms of making their presence felt. For example: Hinduja Hospital had also sent a team of their medics to Bhuj when the catastrophic earthquake hit the place some time ago.
ADVERTISING
They are not used frequently in hospital marketing. Hospitals can focus on the quality of their services, their contribution to the social transformation process, but they cannot advertise for generating profits. Mostly, advertising through mass communication media like TV ( special programmes, interviews of specialists), print media (fitness magazines, news papers) etc. is only used in social marketing where the objective is to pass on a social message like family planning, child immunization, health and family welfare etc.
SALES PROMOTION
In hospitals, sales promotion usually by way of: - Sign up rebates or discounts, especially in the case of corporate clients - Gift premiums, for ex. Doctors are offered various gifts and benefits in return for patient referrals.
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PUBLICITY AND PUBLIC RELATIONS
Hospitals may sometimes issue press releases regarding the success of rare and crucial operations and surgeries. This is because its success rate of crucial operations and surgeries reflects the technological and knowledge- based edge of the hospitals over the competitors. When many successes are discussed in health magazines and newspapers, it becomes a natural advantage for the hospital. To reach the consumers, Apollo Hospitals rely mostly on public relations. Whenever their doctors perform pioneering surgeries or winning awards for their achievements, they talk to the media and when people come to know about their achievements they get confidence to go for the services.
INSTRUCTIONAL MATERIALS
Use of traditional approaches like printed materials, ranging from brochers and instruction manuals to step-by-step instructions are used by hospitals they also follow printing and making readily available various emergency or appointment numbers. AHIC: AHIC has a ‘patient guide’ in every patients room which gives patient valuable information regarding booking, cancellations, various facilities available, what to expect during the stay, discharge procedure, billing and payment procedures etc.. They also have a patient education service, wherein brochers regarding the heart, what the various heart ailments are, what the various heart surgeries or treatments involve, how heart disease can be avoided by way of healthy eating and exercise etc. Almost all the private hospitals have web sites with information for patients, doctors, facilities available, price for the same etc. One of the most effective
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marketing tool of Jaslok Hospital is a web site (www.jaslokhospital.net), which is constantly updated by their technical staff. Brochures and printed material are also available at certain other places. For ex. Printed material at the blood bank helps educate patients or donors on why to donate blood, precautions to be taken before donating blood etc.
CORPORATE TIE-UPS
There are 2 ways of doing this:
?
Direct Tie- Ups: Hospitals may either tie-up directly with corporate and offer health checkups and treatments at discounted rates to the employees of the corporate Sometimes free conferences or camps are also conducted for the employees of corporate by the hospital so as to educate them on prevention of heart diseases etc. Corporate Tie-ups - entitles executives to consultation and admission without payment formalities. The bills are settled directly by the company, simplifying the admission and discharge procedures for selected employees. Regular correspondence is maintained with their corporate clients, they are sent brochures and flyers regularly. For Example, Breach Candy Hospital has tie-ups with 150 corporate companies and consulates, Also tie-ups. The marketing strategy of Jaslok Hospital involves tying up with corporates, some of them being Oil and Natural Gas Commission (ONGC), Mumbai Port Trust (MBT), Bhabha Atomic Research Centre (BARC) and Air India. At AHIC they undertake corporate marketing by approaching various corporate and inviting them to join their panel. Different packages are offered Hinduja hospital has around 170 Corporate
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to these corporate such as discounts of 5-10% depending on the strength of employees, health check ups and programs for employees etc. corporate are also offered credit facilities i.e. the bill of employees is sent to the company after 15 days for settlement.
?
PPO’s (Preferred Provider Organization): They can attract corporate business through PPO’s (Preferred Provider Organization). PPO’s have an understanding with corporate and in case an employee falls sick, the corporate refers the employee to the PPO, which in turn sends them to the hospital for check-ups and treatments. which brings them a lot of business and also, helps in promoting the high – class quality of service they provide.
FREE HEALTH CHECK-UPS
This can be an important marketing tool as a patient attending a free health check up camp or talk at the hospital, goes back with a nice and charitable image of the hospital. Thus, the next time he is sick, he thinks of coming to that hospital. Most hospitals feel that if more than 50% of the patients who attend these free camps turn for further check ups, then organizing the camps are worth the trouble. For example Breach Candy Hospital conducts conducts free pediatric camps and eye camps. They also offer free check ups and free treatment to outpatients from time to time. Other marketing strategies of Jaslok Hospital involves that the hospital conducts free health check-ups like diabetes and cardiac check ups for the general public.
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CONTINUOUS MEDICAL EDUCATION PROGRAMS/ EXHIBITIONS
Under this, hospitals hold seminars and conferences relating to specific diseases or latest technology, where they involve the doctors from all around the country, for detailed discussion. This makes the hospital well known amongst the doctors, who could in future refer complicated cases to the hospital. For example Liver Day was celebrated at Apollo Hospital, which was aimed at educating and creating awareness amongst children and parents, they organized a fashion show and health quiz, which generated a lot of interest Fortis Hospital at Noida was the first hospital to organise an exhibition in the National Capital Region, wherein the general public could visit all departments of the hospital and get answers from experts. Secondly, Fortis launched a dialysis technician programme for women from the weaker section of society in which they were given free training by the hospital and they will be assimilated in the hospital itself.
PRESENCE OF EMINENT PERSONALITIES
? In board of trustees: Many hospitals have eminent personalities from the industry in their Board of trustees so as to create a sense of confidence in the minds of people. ? As Patients: Celebrities, who, when admitted, are spoken about in the newspapers which gains a lot of indirect promotion for the hospital. Breach Candy’s clientele consists of a lot of celebrities treated which includes the Former Prime Minister Mr. Vajpayee, Late Mr. Dhirubhai Ambani, Shammi Kapoor, Shahrukh Khan, etc.
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INTERNATIONAL MARKETING
With medical tourism picking up, hospitals are emphasizing on marketing themselves in the developed special packages for those overseas patients and have tie ups with various hotels. At AHIC International marketing is done by organizing cutting edge medical programs & inviting foreign doctors to participate in them. Besides, many members of the surgical & cardiology team hold positions in international bodies pertaining to cardiac care and are on the editorial boards of international journals. Some of them are also visiting professors to various universities abroad. Also tie-ups with foreign consulates help them make their brand name. For the same reason Jaslok hospital has recently tied-up with FICCI to utilise the potential of this upcoming sector. They are also inviting foreign faculty and holding joint symposiums with the foreign delegates to share their skills, knowledge and experience. The hospital has a tie up with Stanford University Medical Centre, US and they hold video conferencing every month with the doctors of the centre, who interact with the faculty of their hospital.
BRANDING
A small hospital set-up that caters to the needs of the local community may not feel the need to create a brand. For them, local identity through word of mouth is sufficient. However, brand plays a vital role in the growth of ambitious healthcare service providers like corporate hospitals. The healthcare industry is moving towards corporatisation. Unlike other industries, healthcare is highly consumer driven. Since branding goes parallel to any consumer related activities, hospitals are moving towards satisfying consumer needs. Therefore, the need of getting branded is originating from the consumer itself.
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Branding is an empowerment of the Indian healthcare consumer. Experts feel that without a strong branded customer service, a hospital’s marketing budget is wasted. We live in a very different healthcare world today where the consumer is far more knowledgeable about the diseases and their choices of treatment. Institutions which will focus their energies in identifying the needs of their patients and create seamlessness in the experience of their patients will become the trusted brands of the community It is formed by keeping tin mind the following factors: 1. Reputation: Marketing or brand building may not be a conscious attempt. Brand speaks a level of reputation. If one has developed a good reputation, this will lead to creating a brand. When one achieves a superlative reputation, it extends into a great brand. For instance, institutions like CMC Vellore, Lilavati hospital, Nanavati hospital have created a strong brand for themselves through their decades of dedicated service. 2. Exclusivity of the Hospital: A brand should have some exclusivity and must be built around the vision that the hospital stands for. Brands should convey this upfront, otherwise it is futile spending on brand building. Brands communicate in a certain language. A Hospital should ask oneself- Which language does my hospital speak? Hospital should find its key strengths and then build its brand based on these key factors. Factors like service delivery, clinical expertise, and medical technology help to create an image.
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3. Word of mouth: This being a promotional technique adds to build a brand. Unlike consumer brands, healthcare is a very sensitive, personal experience. It depends on a in a hospital. Brands are established in healthcare through and therefore brandbuilding in healthcare is a lengthy process. 4. Patient’s experience: Healthcare brands emerge not through advertising but through the power of patient experience. Hospitals should see things from a patient’s perspective. Each patient has different needs. The hospital should be able to satisfy every patient’s needs. 5. Consistency: Besides, there should be consistency in the process of delivering healthcare in a hospital. A patient’s experience differs from hospital to hospital. If there is consistency in the processes it will relate to the consistency in the image the patient carries in his mind.
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Which hospitals have been the ‘fore-runners’ in this area?
Across geographical regions in India we do find hospitals which are powerful brands in those specific regions. Apollo and Wockhardt Hospitals are the Indian healthcare brands which have a pan India presence.
Brand Building of Wockhardt Hospitals: The Wockhardt Hospitals brand has been established over a time
?
frame of 15 years. Their brand has been built by a synergy of excellent clinical expertise with a professional management team which has constantly strived to give their patients a great healthcare experience. Their entire focus is to excel in their health care delivery process. ? They started with a single speciality cardiology institute in Bangalore which is a front runner in the country, followed by a kidney institute in Calcutta, followed by cluster of specialty hospitals in Bombay which have excelled in the area of cardiology, orthopedics, neurology and ophthalmology. ? They have also established a single speciality heart hospital in Nagpur which has made its mark as a cardiac institute of central India. Today Wockhardt is a super specialty brand. Hinduja Hospital and Research Centre Speaking about brand positioning of Hinduja Hospital and Research Centre, Mumbai, the three elements around which the brand of Hinduja Hospital is positioned is ‘Credibility’, ‘Delivery of Medical service’ and ‘Human Touch’. All their actions, right from patient care to various marketing exercises are aimed at reinforcing these elements.”
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PEOPLE
Service personnel play an important role in an organization, which provides services. In a hospital the behavior and attitude of the personnel providing services is very important as far as the customers overall perception of the service is concerned. It is necessary that the staff in a hospital be trained to provide quality patient care using state of the art technology.
THE SERVICE MARKETING TRIANGLE
HOSPITAL
(ENABLES TP KEEP THE PROMISE) INTERNAL MARKETING INTERACTIVE MARKETING
(MAKES PROMISES) EXTERNAL MARKETING
DOCTOR
PATIENT
The triangle comprises of the company i.e. the hospital, employees i.e. the doctors, nurses and the customer or in this case, the patient
1. The company here is the hospital which promises of a service offering
by way of treatment, which will satisfy the customers i.e. patient’s expectations of getting cured.
2. The patient who seeks to get cured is the customer for the hospital as
he is the one who avails the benefit of the service and pays for it.
3. The employees comprise of all the people who are involved in providing
the service, namely doctors, nurses, technicians, attendants, administrative personnel etc.
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From the triangle we see that three kinds of marketing activities take place in a hospital. 1. External Marketing The hospital undertakes external marketing as to promote the service i.e. treatments and facilities to the patients. This is explained in detail in the promotion mix. 2. Interactive Marketing Secondly interactive marketing takes place between the employees and the patients. Interactive marketing describes the employees’ skill in serving the client/patient. We know the customer of the hospital is the patient who is in some degree of discomfort or suffering when he is admitted/comes in. From the time he enters to the time of discharge, the patient has to continuously interact with the hospital’s employees by way of talking to the nurses, attendants, etc. Thus in his vulnerable state of suffering or sickness the patient expects quality care along with empathy and consideration of his every need by the hospital staff. Thus the selection, motivation, training of the hospital staff makes huge difference in the well-being and recovery of the patient. 3. Internal Marketing Good and effective interactive marketing is made possible only through efficient internal marketing. Hospitals undertake internal marketing to train employees and motivate them to serve customers well. Such training will help improve employee's competence and improve employee responsiveness, problem solving ability as well as their attitude, goodwill towards patients, all of which in turn will result on patient well-being and recovery or customer satisfaction.
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Thus internal marketing ensures that the employees are at their best behavior with the patients and well informed about the various activities of the hospital. An important way of internal marketing is analyzing feedback from regular customers satisfaction surveys and improving service delivery so that the way of service delivery itself becomes the marketing of the service.
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PHYSICAL EVIDENCE
Physical Evidence is the environment in which the service is delivered with physical or tangible commodities and where the service provider and the customer interact. Corporate image plays an important role in terms of physical evidence when it comes to hospitals. This can be developed with corporate relation programs. Modern hospitals need to create a good ambience because when a patient walks into a hospital, he immediately forms an opinion about the hospital. The staff should follow a dress code to show professionalism and
?
maintain discipline. The staff also needs to be trained to be understanding, warm and
?
comforting because the clientele that goes to the hospital is usually disturbed or unhappy. It is necessary for a hospital to be well organized and segregated
?
into different departments. All the doctors should be provided with a well – equipped cabin. If
?
possible, the hospital should be centrally air – conditioned. However, good lighting and ventilation is a must. Special care should be taken to maintain hygiene; cleanliness and
?
the whole hospital must be well – lit. This is generally taken care of by the housekeeping department.
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?
Develop way finding systems that allow users, and particularly
outpatients and visitors, to find their way efficiently and with little stress. Convenience store, public call booths, coffee vending machines, rooms, information kiosks, etc.
?
library, prayer
?
Separate waiting area with counselors for relatives of patients
undergoing surgery or angioplasty. Clinical pathways (more effective if placed on individual patient’s chart)
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PROCESS
Process is a set of activities that take an input, convert it and add value to the input and finally, create an output. A process is divided into the following phases in a hospital:
1. The joining phase – which includes
? The arrival of the patient ? Registration – where a patient has to make an initial deposit at the inpatient billing counter after which a file is opened in the patient’s name to know the patient’s medical history
2. Intensive consumption phase – which includes
? Diagnosis – where the consultant diagnoses the illness by making the patient undergo various tests ? Treatment – where the illness is treated with proper medication or surgery ? Information about further actions – the consultant will instruct the patient regarding the diet to be followed, the medication to be taken etc.
3. Detachment phase – which includes
? Discharge of the patient ? Payment – after the patient is discharged, the bill will bee paid at the billing counter. 4. Feedback At this stage, the patient is requested to fill an evaluation form, which helps the hospital authorities to know the level of satisfaction derived by
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the patient. Patient’s suggestions are always considered for improving the hospital services.
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FLOW
The joining phase Arrival Registration
Intensive consumption phase Diagnosis
Treatment Information about further actions
Detachment phase Discharge Payment
Feedback
BLUE PRINTING
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•
Blue printing is a tool of designing which portrays the picture or a map of a service so that the employees can understand their part better and the changes to make service more efficient or better can be made. The blue print that is prepared looking at the basic working of the hospital is attached. This blueprint is a very simple showing only the basic steps of the service at a hospital. In this blue print the customer comes in initial contact either through phone whereby if he needs to take appointment then he comes into contact with the receptionist or else for general information he contacts the customer care back office. Then the patient or customer needs to register by filling some necessary forms and making some advance payment. The form then goes through various levels as every aspect it has is checked by the back and front office. Then the customer meets the assigned person who checks and examines the patient and then sends him to his room. Here the dress, the cleanliness, assurance of doctor is very important. After the tests such as X-Ray, ECG etc depending is done and laboratory tests are done backstage which are important but not with direct contact with the customer. After this the last and final interaction is with the discharge department or the payment department. Accounts department in the back office prepares the bill and the cashier has to collect the payment from the customer. There are many other stages of which blue print can be prepared but then it will become too complex. Thus given is a simplified format of blueprint.
•
•
•
•
•
•
•
BLUE - PRINT OF HOSPITALS
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C A
U R
S R
T
O I V
M E S
E
R
O F O R F O F N T I CR E E C C E P A T R I EO S U A GN L I S T Y T R
P DA
D IT A I O G NT OR SE I A S T F I N D F I S O C M U E R R H N T M A T H A R T E T G R I O E
B O
A F
C F
K C U S T O M I C ES E R V I C
E E
R
X S
- R O N
A O
Y G
,
B R
L A
O P
O P DA H Y
Y T M E SE T N , e t c .
C D
U E
S P
T A
O R
M T
E S
R
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Hospitals & HealthCare OUT-PATIENT DEPARTMENT
OPD
Registration
Examination
Prescription
Investigatio n
Dressing & Treatment
Admission to patient ward & treatment in-
X-Ray
Laboratory
Tests Report
Discharge
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Hospitals & HealthCare CASUALTY DEPARTMENT
Casualty Dept Reception & Enquiry Registration Examination Observation Admission Discharge Dressing
Normal Health
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SERVICE ENCOUNTERS
A service encounter is the time at which the customer comes in direct contact with the service provider. Hospital services are the one, which involves very high service encounters in which the patient is the direct recipient of a service and the physical presence of the patient is prerequisite for a series of quite tangible operations to be carried out. The patient’s opinion about the service is influenced by his/her opinion of the service production and the consumption process. The service production at hospitals includes the patient, the facilities (X-ray, ECG's testing instruments, etc.) The service consumption process includes the behavior of nurse and doctors, the manner in which the production facilities are used, and the way the physical resources, technology and systems support the consumption of the service. In medical services the joining phase occurs when the patient joins in the service production process in order to consume a core surgical service. The actual service encounters at hospitals can be distinguished into three distinct phases: ? Pre treatment process ? Actual treatment process ? Post treatment process The quality of the final service delivered depends on the following factors : Complimentary services (sanitary facilities, hygiene facilities, some sort of entertainment may be magazines, books etc) ? ? Professional expertise (nurses and doctors) Physical evidence and service-scope (equipments, signs and symbols for direction guide, information) ? ? Pleasantness (catering facilities) Final surgery operation (the surgery team, the technology used etc)
?
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The process of delivering quality service at hospitals starts from the point at which the patient enters the hospital. The elements of parking, registration formalities, telephone services and the receptionist friendliness of delivering the service, location and easy availability of information, the ability of the ward personnel (friendliness, openness, trustworthiness etc) are all very important. Getting the required information of, for and to the patient and his relatives is extremely important at hospitals because of the uncertainty factor prevalent in this kind of service. Doctors and nurses should make the patient comfortable and should be polite with them as the trauma the patient goes through in hospitals is very high. The life of the patient is in the hands of doctors and nurses so any small mistake while delivering the service at hospital or any healthcare center could result in either delay in recovery and pain or the loss of the patient’s life. Thus, no mistake or mishandling of any aspect in its minutest form is not tolerable at hospitals. CAUSES OF SERVICE FAILURES IN HOSPITALS: Failure to diagnose or delay in diagnosis - Wrong diagnosis made Failure to recognise complication of treatment - Failure / delay in admission / referral to hospital ? Operate on the wrong patient / body part - Surgical foreign body left in situation ? ? ? ? ? ? ? Delay in performing an operation - Intra-operative problems Failure to warn (informed consent) - Failure in follow up arrangements Improper delegation to unsupervised Failure to X-ray / interpret correctly - Infusion problems Problems with medical records - Lack of adequate facilities / equipment Equipment malfunction - Self Harm Failure/delayed availability of operating theatre - Failure/ delayed availability of anaesthetist
? ?
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FISH BONE ANALYSIS
C
U
S E T Q O U M I P F E MR R
OE
N
P T R L O I CN
EE
D
U
R
D
E
L
A
Y
O
T
H
M
E
A
R
T
S
E B R A I AC
LK I N O
F F OF
RI C M E
A
T
I
There are five things involved in service failure: 1. Equipment failure 2. Frontline & Back-office failure 3. Information failure 4. Procedure failure 5. Material failure
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Equipment failure This failure may occur due to some problem in the equipment used in diagnosing or during an operation or at any other time during the patients stay at the hospital. An equipment failure in this industry is very dangerous as the life of a person could depend on it. Surgical instruments need to be sterilized before they can be used. Any negligence here can lead to severe problems resulting dreadful diseases and pain. Frontline & Back-office This includes both the frontline officers and the supporting staff. The hospital provides healthcare facilities. Healthcare involves high contact between the customer and the service providers. The doctors should be above par in terms of the qualifications needed to deal with the respective illnesses of patients. The nurses and other frontline staff too have to be well trained to take proper care of the patients. Hospitals are always surrounded by uncertainties, trauma, chaos and the overall environment is always tensed so the patients and their relatives are to be best received by the frontline officers offering them easy and reliable service. They need to maintain a constant smile so that they can bring some relief for the patients. Information ? There should be adequate collection of all possible related information about the patient and his records should be properly maintained so that diagnosis can be done properly. ? Files containing all patient reports and medication should be maintained. ? Before operating or prescribing heavy medication, all the required tests and information that needs to be collected should be done preciously such as allergies and consideration of previous medical history.
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Procedures
? Consistency of results is never guaranteed in this industry. The main
operation or surgery itself may be unsuccessful, as it is not always possible for a doctor to save a patient. It may not even be his fault, but in the end, one cannot assure the safe completion and success of such complicated procedures.
? All activities supporting the procedural system must also be in place and
the doctors and other personnel should be aware of all the related information and related procedures.
? Few procedures such as filling the pre-treatment form or registration
form, etc. should be simple and short so as to avoid delay in medication. Material This includes failure due to wrong usage of drugs.
•
Wrong usage of drugs that implies different drug used for curing disease for which it is not implied.
• • • •
Drug used after the expiry date. Duplicate Drugs Shortage of drugs Ineffective sterilization of clothes and equipment could lead to several diseases.
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SERVICE RECOVERY & COMPLAINT HANDLING
When the company (hospital) fails to meet its promises made to the customer (patient) on the basis they build expectation, it’s to be said that there is service failure. This might result in losing the customers as well as the goodwill earned. Customer is very important in any industry, hence retaining them is the biggest challenge, and however service failure acts as an obstacle to it. In order to overcome such failures we undergo the Service Recovery process. Service recovery is an aspect of the total customer service strategy that is often overlooked by hospitals and health care workers. Service recovery provides the tools employees need to help customers “recover” from negative perceptions, thus becoming satisfied patients The first thing that is expected is to involve senior management in the planning phase. Some necessary arrangements should be made by the hospital so that in case any service failure takes place by the hospital in whole necessary compensation can be made however there is no compensation that can be made for loss of life. At the same time, if the doctors and other staff put in everything to try and save a persons life, but are not able to due to certain circumstances, if the fault is not the hospital’s and if they can even just give the patient a few hours more to live, both the patient and their relatives are sure to show their gratitude towards the doctor and the staff and these relatives would surely come back only to that hospital. The following points should be taken into consideration while handling complaints: ? Acknowledge any inconvenience and apologize. ? Listen, empathize, and ask questions. ? Offer a fair fix to the problem and/or offer some value-added atonement. ? Keep your promises and follow-up.
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The following criteria are used by the customers to judge how a hospital responds to their complaint in case of service failure : ? The treatment the customer receives while lodging the complaint ? The response of the organization with particular emphasis on time ? The outcome of the complain such as apology or compensation Key factors towards effective service recovery programs: 1. Emphasize the importance of listening. ? Hear the patient. ? Empathize with the patient. ? Apologize to the patient. ? Respond to the patient. 2. Empower the employees to take control of service recovery efforts. ? By empowering any employee to take some action to the service failure patients can receive an immediate response to any complaints. Thus the perception of the hospital might add to the customer loyalty towards the hospital. ? Focus on selected departments with high visitor interactions.
3. Solicit immediate feedback
Effective programs typically incorporate some sort of proactive solicitation of patient’s feedback. This may take the form of comment cards in the patients room or hospital lobby, staff rounding around hospital beds, or using interactive television or bedside Internet facilities to solicit patient comments. 4. Track and review all patient complaints. 5. Generate staff support in the service recovery process
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FUTURE PREDICTIONS AND ANALYSIS
THE HEALTH BUSINESS Health is a common concern of almost every individual on this planet. It is also well known to us that we cannot ignore taking care of our health to gain or achieve other goals like financial success. In fact a healthy person is a much more competent person in any sphere of life. Thus, we must have some knowledge about our body, how it works, what does it need etc. As we proudly say that our country is developing fast, we have also been noticing the drawbacks of this development. The levels of stress and Pollution are rising at unbelievably high rates. This is resulting in increasing numbers of heart attacks and cancer and many other such diseases. Headaches and Viral infections are nothing unusual to any body. Researchers all over the world have been recognizing the potential damage of this kind of a life and the damage is bigger than what our minds can yet conceive. All this is excellent for the Health industry. More the number of people falling sick, more the industry grows. Doctors and lawyers are some of the richest people in America. We will not comment on the lawyers but doctors sure seem to have a very prosperous future in India too. But is it going to continue the way it has always been? We know how constant the variable change is. Is the Health Industry going to witness changes too? What possible changes could there be? Science has developed so much that medicines act like magic. Fall sick, go to the doctor, take some pills, and start working again. The major changes that I feel are going to be implemented in the hospitals would be in their services.
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Hospitals are becoming business organizations. They make huge money for the services they render. The rooms and operations in a private hospital cost a lot more compared to Government hospitals. It is like the ratio of rates charged by Government banks to the rates charged by the private banks. Hospitals are also competing and thus they form strategies like: 1. Market Segmentation 2. Distinguishing their product/service 3. Promotional techniques etc
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SOME OF THE SERVICES THAT MAY BE INTRODUCED IN THE NEAR FUTURE CAN INCLUDE: Mobile Hospitals: ? This includes Helicopters being used by the hospitals to airlift the patient to save the time it takes to reach the hospital. ? It is a fact that there are a lot of incidents where the doctors failed because the time taken for the patient to reach the hospital was too long. This will be a great break through and could save a lot of lives. ? The practice is already followed by some of the developed countries. ? The helicopter itself can have some life saving equipment so that the doctors can immediately start their work on the patient. ? However, This service will most probably be accessible by the richer class, as it may be quite expensive. We observe the following strategies here: 1. 2. Market Segmentation: As only the richer class will be able to access it. Distinguished Product/Service: Not all hospitals will introduce it simultaneously. Thus, whoever does it first can get an edge over the market. 3. Promotional Technique: Can be advertised to lure the potential customers.
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Medical Tourism: This Is a concept which has already been introduced by some hospitals. Apolo hospitals was the one to introduce it. It aims at promoting India as a great destination for medical treatment. Medical services in USA and Europe are much more expensive compared to India. Thus if India matches the International Standards in this industry, it would get millions of people to get their treatment done here. The hospitals have collaborated with the tourism industry to make the package even more interesting. Since the foreigners have already come to India to get the treatment, they might as well travel around India a little bit. Services of an expert no matter what your location: With the growth of technology, computers and Internet, the world today has become very small or much better connected. In the near future it may be possible that the patient is in America but he wants to be treated by the doctor he trusts the most but that doctor is in India. Technology makes it possible for the doctor he wants to be able to observe perfectly, the body of the patient through cameras and internet etc. He can then instruct the doctors in America to do exactly what he feels should be done. Thus to a great extent, the patient is actually enjoying the service of the doctor in India while he is in America. These were some of the additional service I visualize that the hospitals will introduce in the coming future. There is one significant movement that has started. The Health industry is observing a path different from the traditional path.
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THE WELLNESS INDUSTRY LET FOOD BE THY MEDICINE’
A famous line that was quoted 100’s of yrs back holds true even today. The scientists are taking this thought very seriously. Nobody generally has a deficiency of vitamins or minerals. If we had we would suffer from specific diseases. Deficiency of vitamins and minerals cause specific diseases. Scurvy is a disease where your tissues break down and you bleed into your tissues. In the old days when they use have long sea voyages they use to not carry fresh fruits and vegetables because they would decay anyhow. A man went out for a voyage and after 2 weeks he had scurvy. His son followed his Dad’s footsteps and did the voyage and even he developed Scurvy. So Scurvy is a genetic disease. We know now that Scurvy is not a genetic disease and is caused by deficiency of vitamin C. We do not suffer from such diseases any more. No one gets Berry Berry, which is a deficiency of Vitamin B3. We are dying of Heart Diseases, Cancer, and Diabetes. These are diseases caused by free radicals and not by Vitamin deficiencies. Free Radicals can only be combated by Anti Oxidants. One of the free radical caused disease is: AGING 1. 2. No one can avoid Effect of Free radicals in our cells and DNA 3. 4. Everyday, these free radicals that we introduce in our body are attacking our DNA and we get older. More the free radicals quicker we get age.
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There was a person who looked like he was in his 60’s. Looked like a healthy 60 years old. He drives his car himself to the mechanic. One day when he took his car, he was looking tired. The mechanic asked him what was wrong. He replied that he is coming straight from Nashik by road. He had just opened a new manufacturing plant there. It is expected to generate profits after 5 years and he is looking forward to it. His actual age was 92. Passion is what drives him. Aging is a free radical disease. Other Free radical diseases are: ? ? ? Heart Diseases Cancer Diabetes 95% of modern day diseases are caused by free radicals FREE RADICALS: They are generated by over use of oxygen Oxygen is very essential. We have to breathe to live. But we do not need to go overboard. The body is taking more and more oxygen because: 1. SYENTHETIC CHEMICALS When we introduce synthetic chemicals, the body takes a lot more Oxygen and energy to get rid of it. The waste product is Oxygen based Free Radicals Oxygen based free radicals are unstable chemicals that lack an electron. It needs an electron from somewhere to stabilize. So it goes around the body
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to get the electron and attacks the blood cells and the DNA and rips the electron out disturbing the natural, normal functioning of the body. 2. STRESS Stress again burns more oxygen. Therefore, Free Radicals are caused by excessive Synthetic Chemical’s and Stress (Modern Society) The city life today is very unhealthy. We don’t breathe fresh air; neither do we eat pure food. The food, the water, everything we consume is generally not as clean as it should be. It’s even got remains of pesticides and insecticides, which are poisonous. Doctors, scientists, and those concerned are realizing the severity of the damage done by modern city life and are trying to device ways of regaining a pure healthy life. A balanced diet is only a term that we are unaware of. There are very few people who know what makes a balanced diet. Books have been written on the advantages it has. There was an observation that an average man spends his entire life trying to save money and looses his health in the process. The rest of his retired life, he spends all that money to regain the lost health. This situation can be changed. A person’s body is compared to a machine. It requires good food in the head and the stomach and needs regular maintenance to function smoothly for a long time. When the food is not sufficient or is not of good quality, and if regular maintenance is not taking place, this machine like body will start malfunctioning and may even die.
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SOME OF THE FEATURES OF THE WELLNESS INDUSTRY ARE: Increasing the awareness in people. This is being done by various ways like: a. b. life. c. d. e. Anti-smoking campaigns and making a lot of places smoke free. Increased stress on quality food. Seminars and T.V shows educating the audience about the harmful effects of an urbanized life style and remedies. Etc. Research and Development of food supplements: f. Nutrition being extracted from plants grown in pollution free fields. These plants are grown without the use of pesticides or chemical fertilizers. Eg. Nutrilite products. g. Production of various health tonics and drinks. Eg. Drinks like Energy and flavored milk are gaining popularity and with increased promotion such category of drinks will replace our purchase of Colas. h. Lot of research is taking place for the development of capsules, which could replace our requirement of food. However, this concept is being designed for the people in the city. It would save the time it takes to have a meal. That is a little contrary to the philosophy of the wellness industry. Though it could ensure people not skipping meals, which often happen. Newspaper articles. Everyday in Bombay Times we see articles about food, exercise, and how to avoid various health problems. Hoardings displaying slogans motivating people to live a healthy
?
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?
The Corporate Co-operation: i. Manufacturers of products like refrigerators, microwave’s etc are trying to engineer their products in such a way that they keep the food fresh. This is one of their main promotional tools these days. They are trying to help restore the nutritional value and freshness of the stored food. However, they are interested in their own profits. Cold storage is not a healthy solution. It is a fact that as soon as a fruit or vegetable is plucked, its nutritional value starts decreasing even if you put it in cold storage. Refrigerators are only worsening the situation as people buy in bulk and store it and do not prepare fresh food every day. j. Changing the company policies and making job’s less stressful. People are becoming more aware of the harmful effects of stress and the companies are considering this problem. k. There are few companies, which have even adopted a model, which could provide financial freedom to those, willing to work for a few years. This is one of the most successful and beautiful concept because research has proved that most of the problems of an urban man are because of money issues. If money is not an issue, the whole perspective towards life will change and one can enjoy a stress free life with a positive outlook. l. Contributing in the funding for more research.
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Growing publicity of motivational books, seminars, workshops etc,
which focus at minimizing the negative thoughts from your head by giving you a very positive outlook towards life. This is very important but a lot of people tend to ignore it. Good food in the head can do wonders to your health. Spreading awareness of the benefits of yoga, meditation, gyms,
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aerobics and various other activities, which could be done for daily maintenance. We are aware of intense research happening on unconventional
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treatments across the globe. It includes things like music therapy for curing cancer and other big diseases, metaphysics that is researching on the spiritual energy and various such ways of ensuring a healthy life.
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Hospitals & HealthCare
The wellness revolution basically aims at spreading knowledge and suggesting ways to live a healthy life. Its focus is on providing an alternative treatment to various diseases with the help of natural things rather than medicines and injections. Its deeply researching on how to make the defense system of the body stronger to fight the free radicals. The defense system includes: 1. Food 2. Front line defense – Vitamin E, Vitamin C etc. 3. Discovering super anti oxidants which is like a back up system. It still needs the front line defense though. ‘WE CANNOT CHANGE THE CURRENT PROBLEMS WITH THE SAME THINKING WE USED TO CREATE THEM’ --------------------------------------------------These concepts do not go in harmony with the concepts of the illness industry. In the whole 5 years course of MBBS, there is only one chapter on Nutrition. The doctors in the hospitals complain that if people will not fall sick, their business will go down. However, there are some very dedicated doctors in the illness industry also whose efforts are helping to save the lives of many people. Also the wellness industry came out of the illness industry and will take a lot of years still to outgrow the illness industry. We will have to wait and see what predictions come true. --------------------------------------------------
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Hospitals & HealthCare
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